Anxiety Shorts: Panic!

If you have ever experienced a panic attack, you will know how scary the symptoms can be. Suddenly, out of nowhere, your heart is beating out of your chest, you can’t catch your breath, you get dizzy, nauseous, sweaty, and you may be scared you’re having a heart attack or dying.

Quite commonly, people having these symptoms go straight to the emergency room. This makes sense, and I know I would too. While finding out that you’re not actually having a heart attack might seem like a huge relief, for many people it’s not. The next question is, “What was that, and what do I do about it?”

When people start having panic attacks they can begin to worry about having more panic attacks, or about the consequences of panic attacks (e.g. dying). They can also start to change what they do because of these fears, such as avoiding going outside. This too makes a lot of sense because who wants to leave the house when they might have another panic attack? Especially when miles away from home or with no way to escape (e.g. on the bus). If these symptoms start happening for more than a month, it can become Panic Disorder, though you’ll need to meet with a professional to make this determination. Because Panic Disorder is so commonly associated with fear of leaving home and being in situations, many people also experience signs of Agoraphobia, which is exactly this fear.

What Is A Panic Attack?

When you have a panic attack your system goes into overdrive. All your muscles are saying, “GO, GO, GO!” Panic attacks peak quickly and can be expected or unexpected. For a Panic Disorder diagnosis, panic attacks are meant to be unexpected and come out of nowhere. Expected panic attacks, that I sometimes call anxiety attacks, happen in response to a known trigger (e.g. having a test, finding out bad news). One belief is that panic attacks happen because your body has a brief fluctuation in a hormone, a heartbeat, a breath, or some other sensation, and it goes into full fight or flight mode.


Some people might panic when in a small enclosed space like this.



What Do I Do About It?

First, it makes sense to check with your doctor and rule out any physical issues. However, assuming that you have met with a professional and determined that you don’t have a medical condition, and that this is all panic attacks or even Panic Disorder, the next step is to understand the symptoms and why they are occurring. The goal of treatment is to learn that these symptoms are not dangerous to you. To understand why your symptoms are occurring, let’s go back to the fight or flight response. Your body is preparing for a threat with everything that it has. Your heart is pumping blood as much as possible to get oxygen to muscles, that’s also why your breathing has increased. You’re shaking because the adrenaline running through your blood is causing involuntary muscle contractions. You’re dizzy because blood is getting diverted to your big muscles. You’re stomach feels nauseous because your body doesn’t want to be digesting food when it’s preparing to run for it. Many of the symptoms are actually no different to if you go on a run, but because they come out of nowhere they can seem very scary. This is why people worry they are having a heart attack or losing control. If you can learn about all of these symptoms then it can become less scary. Remember, the fact that your body is reacting this way actually means that it’s functioning perfectly well! There is nothing wrong with you, you just have to re-learn that these symptoms are safe and they will start to go away. That’s what cognitive-behavioral therapy (CBT) can help with.

Tell Me More

The second step, and the key part of CBT, is to start doing exposures to having these internal sensations. This is called interoceptive exposure. This treatment produces excellent results in a just few weeks for around 70-80% of people, which is a remarkably good stat for psychological treatment. It’s by far the most effective treatment, and it has been shown to be this effective in both research trials and community treatment centers. Amazingly, in research on what therapists do, this is the least used of all treatments for panic disorder. In some studies only around 20% of clinicians use it. This is less than hypnosis, psychodynamic treatment, supportive therapy, art therapy, and relaxation treatment. I find this remarkable.

To restate: The best treatment, interoceptive exposure, is the LEAST used treatment. It’s time to change that!

Use The Best Treatment

To do exposures, I’d highly recommend working with a psychologist who knows how to conduct interoceptive exposure treatment, though there are self-help manuals that use good principles (link to treatments that work). The things you might expect to do in treatment include gradually and purposefully re-creating the symptoms in a controlled setting so that you can learn to be able to cope with them. You would repeat exposures and build upon them over time. Here are examples of things people sometimes try that are listed in treatment manuals:

  • Breath through a straw
  • Run up and down stairs
  • Look in mirror (if you have derealization symptoms)
  • Spin in a chair

What the research shows is that CBT where you do these types of interoceptive exposures, especially in different situations (e.g. in the office, at home, at a park, on the bus) causes your body to stop reacting to them as threats. Once this learning happens, your body stops reacting with the fight or flight system and the panic attacks go away altogether.

I hope you’ve enjoyed this article, let me know if there’s anything I missed that you’re curious about!

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