June 19, 2024

Navigating Panic: (and the argument for going back in the room…)

Generally speaking, I try to model an attitude of acceptance and willingness toward uncomfortable feelings. Such is the fundamental obligation of any seasoned anxiety therapist (so I am told). That being said, nothing has ever convinced me to amend this position… 

… panic attacks are objectively miserable. 

A few years ago, I was approximately 15 minutes into a seemingly typical session with one of my clients. Then suddenly, with no discernable warning, I started feeling… weird. I paused (awkwardly) in the middle of a sentence to catch my breath. I could feel my heart accelerating as I started to sweat. My limbs felt like Jell-O and everything around me seemed “off”. I quickly realized that my client was now staring back at me with a puzzled look of confusion and concern. ‘Umm, WHAT is happening?’ I wondered. This experience was becoming more bizarre by the second. After several prolonged moments of anxious deliberation, I excused myself from the room to assess the situation. Was I going to pass out? Was this some sort of allergic reaction? Had I been… drugged?! A few minutes passed as I carefully sipped a glass of room temperature tap water in the hall outside my office. Then eventually, it dawned on me, ‘Oh… I’m having a panic attack.’

Many people worry about panic attacks while speaking.

Now, should I have recognized this annoyingly capricious visitor right from the start? Maybe. But honestly, there is something so overwhelming and all-consuming about the experience of panic that it’s difficult reconcile the physiological storm as “just a false alarm”. The brain wants to look for some other explanation… ‘I’m having a heart attack.’ ‘This is stroke.’ ‘I’m going to pass out.’ ‘I’m losing my mind.’ Even when we’re able to recognize panic for what it is, we can get tangled up in thoughts that everyone is judging us or that the sensations of panic are simply intolerable. We might fear getting sick or having no escape. And almost always, the prospect of attempting to function through the panic feels almost unimaginable. 

If you struggle with panic, you’re not crazy and you’re not alone. Additionally, there are several important points that I will encourage you to hold in mind:

1. Panic attacks are uncomfortable miserable, but not dangerous.

Again, let’s be honest… there is nothing pleasant (or even neutral) about a storm of erratic sensations that are completely involuntary and out of context. The internal experience of a panic attack can make you want to jump out of your own skin. But the fact that panic attacks feel bad doesn’t mean that they are bad. Put simply, a panic attack is the body’s normal fight-or-flight response being activated at an inopportune time. The classic analogy is that a panic attack is like a false alarm. There’s no fire, but the sound of that alarm is still painful and piercing.  

NOTE: I would be remiss not to mention that you may never feel 100% certain that your panic attacks aren’t dangerous. You’ll probably need to settle for “confident enough” then practice accepting the remaining feelings of uncertainty (I know… this can feel really hard so be patient with yourself). 

2. Believe it or not, the panic response is designed to be helpful.

Not only are panic attacks not dangerous, they actually stem from a response that is highly adaptive. The fight-or-flight response is a physiological mechanism that evolved to help us navigate threats in our external environment. When we perceive a threat, our sympathetic nervous system kicks in with impressive speed. Our pupils dilate, letting in more light for improved visual acuity. The heart goes to work sending blood to the extremities enabling us to run faster or fight harder. Some even argue that tunnel vision helps us tune out extraneous peripheral information to focus in on the threat. Bottom line: if you were face-to-face with a predator, these “panic” sensations would feel completely natural and would help you survive. 

3. Panic attacks can be triggered by something specific or they can come out of the blue. 

Sometimes panic attacks happen in response to a particular situation such as speaking in public, crossing a bridge, or flying on a plane. They can also happen in the context of distressing intrusive thoughts (e.g. in OCD or PTSD). Other times panic attacks seem to pop up quite randomly. The human body is noisy and ever-changing. Some days your autonomic nervous system might be feeling extra sensitive for one reason or another. It’s okay to reflect a bit on the “why.” Sometimes there are identifiable reasons for this increased vulnerability (e.g. In my case, my husband and I were in the process of closing on a house. I’m sure my body was just feeling extra sensitive due to the stress. 🤷🏻‍♀️). That said, we do need to be careful here. If we become preoccupied with “figuring out” every instance of panic, we might inadvertently give panic too much power/importance. Sometimes this can be the beginning of a vicious cycle.

4. Panic attacks do not always mean panic disorder. 

Panic attacks can occur in the context of any anxiety disorder, OCD, or PTSD. They also happen quite frequently in people with no diagnosis at all. Panic disorder only occurs when 1) panic attacks are popping up out of the blue, 2) we develop an intense fear of/preoccupation with the panic attacks, and 3) we begin to alter our life/behavior around the panic. If you find yourself stuck in this vicious cycle, it can feel truly debilitating, demoralizing, and isolating. However, it’s important to know that panic disorder is highly treatable. Check out this overview by the ADAA for more information: https://adaa.org/understanding-anxiety/panic-disorder 

Panic is uncomfortable but passes over time.

5. All panic attacks are temporary (and the less you fight them, the faster they pass)  

For once, here is some reassurance I’m willing to offer: every. single. panic attack. is temporary. I suppose it’s possible that I’m wrong here, but to my knowledge, no one has ever been stuck in a permanent panic attack. This is because our fight-or-flight response just isn’t designed to work that way. It’s a powerful short-acting mechanism. When we let go and allow panic to run its natural course, it will peak within 5-10 minutes and dissipate in ~ 20 minutes. That said, there are many things that we can do to unintentionally fuel or prolong a panic attack. Most commonly, this involves some form of resistance or avoidance (e.g. safety behaviors that attempt to keep panic at bay). In reality, once a panic attack has started, there is little we can to do to put that cat back in the bag. The more you can let go of these attempts to control or avoid the panic, the sooner you will find yourself on the other side of the storm. 

6. The best way to handle a panic attack is to move through it (not against or away from it)

It can take an incredible amount of courage and self-compassion to navigate your way through a panic attack. Everything in you will want to push it away or make it stop. This is completely human and understandable because (as I’ve said from the beginning) panic attacks are definitely miserable. However, here is a bit of a well-kept secret: you absolutely can function through your panic. It’s not easy, you won’t love it, and me telling you that you can do it will not alleviate your fear. Instead, it will take intentional practice and a leap of faith. This is the only way to cultivate a sense of confidence in your own ability to handle panic. 

And on that note, you may be wondering how my own panic story ended. As an anxiety therapist, there are moments in which I am undeniably prompted (or forced) to practice what I preach. This was one of those moments. After some encouraging words (and perhaps a compassionate kick in the butt) from a few of my colleagues… it was time to go back in the room. It wasn’t comfortable and I watched my mind bounce all over the place, ‘When will it end?’ ‘This feeling is miserable.’ ‘What if this happens in my next session… or the one after that?’ ‘Will I have to quit my job one day if this panic won’t go away?’… 😑. But this was okay because I was expecting my brain to say some wild things. Catastrophic thoughts are just par for the course in the middle of a panic attack. The interesting part was the opportunity for me to model some important skills and a resilient mindset in real-time: “Okay. I’m so sorry for the interruption! It turns out that I’m just having a panic attack. So that’s good news since panic is uncomfortable but not dangerous. I’m ready to keep going if you are…”