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llo everybody,
I hope you are having a day full of value-based action. I have spent some time reading through the "Panic Attacks" forum. Firstly, thank you all for sharing your stories and contributing with useful tips and tricks. In the end, what works, and it works for you, then there isn't "right or wrong" (except for alcohol or drug abuse, or any form of harmful action).
I am a major in psychology and am currently on my way to becoming a licensed therapist. I intend to specialise in the field of anxiety disorders, amongst others. That is why I am creating this threat, in order to share with you my knowledge about panic attacks, as well as my personal experience, since I am was a panic disordered person myself. I would really appreciate it, if you could leave your opinion about the strategy I am going to share and/or contribute yourself in any way.
Most of what I am going to write about is based on the approach from Dr. Harry Barry, which can be found on Youtube or in his book "Flagging anxiety and panic".
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I will be concentrating on two topics - the biology behind panic attacks and the behaviour part
Briefly said, what happens during a panic attack is your brain putting your body in a fight-flight- or freeze modus without any direct, logical danger (like seeing a bear, ready to snack with you). This leads to an amplification of the symptoms of this modus (heart pounding, knot in stomach, sweating or shaking, thoughts racing, feeling of impending doom, feeling of losing control etc), because the person can't apprehend why this is happening, because the perceived danger is mostly an inner thought or sensation on the subconscious level, not clear to see from the person experiencing this.
What happens in the brain and the body:
During a panic attack there are 3 main parts of your brain, which are involved - the Amygdala, the Prefrontal Cortex and the Hypothalamus
The Amygdala: the most ancient, most important and most stupid organ
- activates by perceived danger;
- sends signals to your whole body and especially to your hormone-control box
- prepares you to fight, flight or freeze
- is extremely quick and stubborn. Always on the lookout for danger and always ready to fire.
Think of it like a gunslinger. It is directly connected to your senses and ready to start the chain reaction of activating your body's stress responses. It activates your hormonal system, which itself produces adrenaline - the main cause of the panic attack-related symptoms.
The Prefrontal Cortex: the worrier and the catastrophiser
- it perceives situations and evaluates them as good or bad. Good in the sense of safe and bad in the sense of "potential danger"
- responsible for conditioning
- "communicates" with the Amygdala directly and tells it, if something is potentially dangerous or not
This organ resides in the logical part of your brain and does some high cognitive functions.
The Hypothalamus: the hormone-control box
- regulates the production of hormones
- "communicates" with the adrenal gland and it sends little adrenaline hormones into your blood stream
- fuel for all of the panicky symptoms
Now, enough geeky information. How do these 3 play together to make you experience a panic attack?
You perceive something (anything) which your Prefrontal cortex sees as dangerous. It sends to your Amygdala the sign "DANGER!". The Amygdala fires and puts you in the fight-flight- or freeze modus. It contacts your Hypothalamus, which through the adrenal glands, produces the hormone adrenaline.
Alright, you might say, but why do people get panic attacks, when they are at home or at a safe place, where there are no possible dangers to be perceived?
Well, basically any possible thing can be seen from your brain as a danger. This doesn’t only include typical triggers like a wild animal, a scary social situation, phobias etc. A thought, an emotion or a sensation could also be seen as a danger. And this is where the trick begins. Your brain needs nothing more than a single sensation to believe it could be harmful to you and to engage on the stress response. This is the harsh truth of our nature. Because we survived for so long as species in such dangerous surroundings, our brain has become a highly functioning danger alarm, which fires too often, rather than not often enough. It is the amusing truth, that your very own thoughts or emotions can be evaluated as a threat to you by your own brain. And the trickiest part is that even subconscious processes can lead to a panic attack. This means that something you are not actively aware that you are thinking or feeling can be labelled as dangerous from your brain. A proof of this are the nocturnal panic attacks, where people reported to having woken up from a deep sleep, only to experience a panic attack in the middle of the night. This is the amount of alertness your amygdala has for possible dangers.
Here beings the devil’s circle of amplification. You get these crazy, scary sensations, you don’t know why you are getting them one of a sudden, this scares you even more. You perceive what is happening to you as a threat itself. This leads your brain to believe that what happens is indeed dangerous for you. The stress response of your body gets stronger and longer.
Thanks for the info, smarta**, but what to do about it?
Before we talk about what to do, let me share some facts about panic attacks:
No one ever, in the history of human kind, has died of a panic attack!
Panic attacks could be very uncomfortable, but are not dangerous!
Panic attacks are in no way harmful to you or to you body! What could harm you is the destructive behaviours you initiate, when fighting against an attack (smoking, going outside in the cold, drinking, self harm…)
It is impossible to “lose your mind”, “lose control” or “go insane” from a panic attack. These are normal sensations you experience in this state. Very, very unpleasant, but also very normal.
Now you wonder what to actually do during a panic attack?
Nothing. Remain where you are and for 10 to 15 minutes (a typical duration of a panic attack) and do absolutely nothing. Don’t go anywhere. Don’t try any techniques, don’t call friends, don’t listen to music and please don’t breathe into a paper box. Sounds extremely counterintuitive, right? Let me share why it actually helps:
As you might have found out, panic attacks are a sign your brain sees something as potentially harmful and it gets your body ready to respond. Whether you are actively aware that your brain does this or not, is not important. Sometimes you know what the reason for a panic attack is, sometimes you don’t. The point is- your brain thinks you are in danger. The last thing you want to tell you brain, is that this is true. However, by reacting to your panic attack (trying to stop it, make it go away, make it shorter, make it not appear here or there, control it, make it less uncomfortable) you are telling your brain that indeed something dangerous is happening and you start fighting against it.
Every single possible thing you can do against a panic attack is perceived from your brain as a fight-or-flight response. This then in a way confirms to your brain, that there is a real danger, where in fact, there is none. By doing nothing, you are showing your anxious brain that is mistaken. You show your amygdala that it fired for no reason. By contra intuitively doing nothing, you let your brain realise there is nothing to fight against, or worry about, or run from. The symptoms then subside within 10-15 minutes.
Panic attacks are a normal mistake of your brain, trying to protect you from something, which is not harmful to you. If you start fighting them or in any way trying to control them, you confirm your brains irrational belief that you are endangered and that it has to do something about what you experience. This only makes the attacks stronger, more uncomfortable and can make them last for hours.
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I know this sounds bullocks at first, but for me and many other people I personally know and has read or heard about, it helps. Not only that, but there is a decent scientific research, proving that mindfulness and acceptance are very helpful for any kind of anxiety related phenomena (“Get Out Of Your Mind & Into Your Life, by Steven C. Hayes, “The Reality Slap”, by Dr. Russ Harris, “Flagging Anxiety and Panic”, by Dr. Harry Barry.)
Panic attacks are a big passion of mine as someone, who has experienced the seeming horror they can bring upon you. I can write many more pages about this topic, but more importantly, I want to hear what you people think about it. Do you find something particularly interesting? Do you disagree with any parts? Has this helped you in any way? Please, let me know. Also a good review or a recommendation is always appreciated, it helps me reach out to more people.
Stay healthy and take care!
Best wishes,
Ivo