Three takeaways about panic attacks to learn about in therapy

Panic attacks can be hard to control, but you have more power over them than you might think.

We’ve all experienced it at one point or another; that feeling of impending doom or creeping nervousness that suddenly reaches a peak and we feel as if are losing control of our mind and body. Although anxiety and panic symptoms lie on a spectrum, there is no doubt that panic attacks are terrifying and can be a debilitating psychological and physical experience. Although 5% of adults in the United States meet criteria for an ongoing diagnosis of panic disorder*, millions of people experience a single episode. Even one panic attack can leave you feeling fearful of the future and impede your ability to live life spontaneously.

In my work with people who report severe anxiety and panic symptoms, I’ve been able to identify patterns in the way people perceive their experience of a panic attack and how those beliefs greatly impact their daily lives. Essentially, the more someone fears their panic, the more intensely they will feel the symptoms. After sitting with my clients and listening to their panic experiences, I typically provide psychoeducation to normalize their feelings and help their understanding of the science behind a panic attack. The result is that clients can move forward with a more objective view of our brain’s most faulty alarm system. Here are three key phrases I use that tend to be most powerful in helping people manage their panic and anxiety.

“It can’t kill you.”

Unfortunately, there is a lot of crossover between the symptoms of a panic attack and the symptoms of a heart attack, making it difficult to discern between the two. Many people report having gone to the ER out of fear that their panic would kill them or result in a heart attack. Truth be known, a panic attack cannot kill you nor can it transform into a heart attack.

A panic attack is simply our survival mechanism, the fight or flight response, sounding a false alarm. Due to the very impressive evolution of the human brain over the past thousands of years, the emotional side of the brain often perceives things that aren’t actually dangerous as threats. When a threat, real or imagined, has been detected, it only takes a fraction of a second for the body to automatically activate the fight or flight response which is comprised of several physical and psychological symptoms.

Tunnel vision, for example, is activated to help us detect potential threats in the surrounding environment. Our racing heartbeat works to pump blood to major muscles to enhance our ability to flee if necessary. Quicker and shallower breathing allows us to take in more oxygen to prepare the body to fight or flee. The sense of hyperawareness helps us to evaluate threats and make rapid decisions. These symptoms, among others, were originally designed to keep us safe in the face of true danger and are not life-threatening. The panic attack itself may cause excruciating discomfort but it is not actual danger.**
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​“It can’t last forever.”

Clients often tell me that it felt like their panic attack was never going to end; that it would last forever or that it lasted for several hours. Because the sole purpose of the fight or flight response is to keep us alive in an immediate or impending crisis, it will also protect us from overstimulation and turn itself off after 10 to 15 minutes. In other words, a panic attack cannot physiologically last forever. The brain will recognize that it has been panicking for too long and will slowly “turn off” the physical and psychological symptoms.

As your vision returns to normal, any accompanying dizziness will fade and your heartbeat will slow down which will cause your breathing to return to its baseline rate. Blood will flow back into your fingers and toes, and your palms will stop sweating. While it is common to experience residual anxiety that lasts for several hours afterwards, the panic attack itself is over. Our negative outlook of the attack, however, is what prolongs its effects and increases the probability of experiencing another episode.

“You are not your panic.”

A common struggle faced by many of my clients is their instinct to fight panic and anxiety. As it turns out, the harder we try to make the uncomfortable feelings go away by not thinking about them or avoiding triggering situations altogether, the stronger the anxiety gets. When we can safely interact with and embrace strong emotional experiences such as a panic attack, they become weaker and less disruptive.

An intervention that I started out using with children has turned into an effective coping skill for my adult clients as well. The goal of this intervention is to help children manage their panic symptoms by visualizing them as an external experience rather than internal negative emotions. I start out by asking my child clients to draw a picture of their panic, and I often see green monsters or sea creatures – some are warm, fuzzy and comical, others are dark, mean, and scary. They then assign their creature a name and personality, different from their own. We discuss how to visualize the creature whenever they feel panic symptoms coming on. Ideally, with practice, the child can comfortably watch the creature approach them, interact with it, and then observe it as it walks away. Eventually, they become able to watch and feel their anxiety come and go safely from afar. In doing so, they accept their anxiety rather than desperately fight it unsuccessfully.

After repeating the technique of externalizing anxious thoughts and panic symptoms, people learn that they are not their panic. They learn to accept that anxious thoughts and physical symptoms cannot always be controlled or completely extinguished but can instead be observed more safely at a distance. This practice helps panic symptoms become less personal, less imposing, less terrifying, and more manageable.

​What a person believes about their panic attacks is more impactful than one might think. The more we fear and fight panic symptoms, the stronger and more frequent they become. When we can safely interact with one of the human mind’s most powerful psychological experiences and appreciate the way in which our body was designed to keep us safe, panic attacks and anxiety symptoms offer us an opportunity to exercise acceptance and much needed self-compassion.

Originally written for and published by Allison Stein, LCSW on www.ccns.org
*Based on diagnostic interview data from the National Comorbidity Survey Replication and reported by the National Institute of Mental Health.
**Informed by Taking Charge of Anger, Nay; An End To Panic, Zuercher-White; calmclinic.com; Phobias & How To Overcome Them, Gardner & Bell.