WEBVTT
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Hi, I'm Dr.
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Mark, and you're very welcome to the latest episode of my podcast.
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I have issues.
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I thought I was going to die.
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I thought I was having a heart attack.
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I thought I was going to collapse.
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I'm terrified of having another one.
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What if I have another one and I'm on the tube or I'm in the car?
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These are all statements I have heard from my patients over the years when they're talking about panic attacks.
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Panic attacks are not your friend.
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They mean business.
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And when you have one, they are seriously distressing and you won't forget them easily.
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They will literally shake your world, leaving you scared, exhausted, and traumatized by the experience.
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The memory of them will stay with you, and you will never want to experience another one when you're having a panic attack.
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Your heart's hammering, you can't breathe.
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Your hands might be tingling, and a voice in your head might be screaming, something is terribly, terribly wrong here.
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And I think I might die from this.
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Sadly, panic attacks are rarely a once-in-a-lifetime experience for some people.
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And they will experience them many times, leaving that poor person terrified about what, about if and when the next one might happen.
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Now you might be listening to this and thinking, well, I've never had one of those.
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You might be completely ignorant to the experience of ever having a panic attack, and good for you, because you don't want one.
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However, if you've ever had one, you know exactly what I mean when I say, in the moment, it feels like the end of the world.
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So in today's episode, I'm going to talk to you about panic attacks.
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Why on earth do they happen when they're so awful?
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What is going on in the brain to create such a dreadful experience?
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If you're a regular listener to the podcast, which I hope you are, you'll know this podcast is all about hope.
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So, like all episodes, I'll be providing hope if you suffer with panic attacks and how you can live your life without them.
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So settle in, whether you're somebody who experiences panic attacks, yourself, or you love somebody who does.
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This episode is for you.
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So, first things first, let's start at the beginning.
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What is a panic attack?
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According to the American Psychological Association, which are the Association America that looks after psychologists, they have a very clear definition of what it is.
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So they describe it as it's a sudden onset of intense apprehension and fearfulness in the absence of actual danger.
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It's accompanied by the presence of such physical symptoms as heart palpitations, difficulty breathing, chest pain or discomfort, choking or smothering sensations, sweating, dizziness.
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The attack occurs in a discrete period of time and often involves fears of going crazy, losing control, or dying.
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Serious business here.
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They are nasty experiences.
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And if you've had one, you will know the awful reality of how this feels.
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Now, the awful cruel irony about panic attacks is nothing is physically wrong, even though your body's having a major reaction.
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Your body has just declared a state of emergency, and it doesn't matter where you are, that can be in the middle of a supermarket while you're sitting at your desk at work or three o'clock in the morning when you're just trying to get to sleep.
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The context is irrelevant.
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They can happen anywhere.
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Now, here's the first thing I really want you to take in because it matters.
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Panic attacks are not dangerous.
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I repeat, panic attacks are not dangerous.
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I know that almost sounds insulting if you're in the middle of one or you suffer with them regularly, but physiologically they cannot harm you.
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Your heart is not going to stop.
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You're not going to suffocate, and you're not going to lose your mind, even though you think you might.
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So what's actually happening is your body's alarm system has fired and it's fired very, very loudly.
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But the alarm itself is the problem, not an actual threat or a response to threats.
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So let's break it down a little bit more.
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There's actually two main types of panic attacks.
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The first are what we call expected panic attacks.
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So why would you expect to have a panic attack when you want to avoid them?
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Well, these are triggered by something specific.
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So for example, if you have a phobia or a stressful situation and an inv an environment or an environment you associate with danger.
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So for example, if somebody has a fear of flying and has a panic attack at the airport, that's an expected panic attack.
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You'd expect the person who has a fear of flying to have a panic attack in the environment of an airport.
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Now, in my clinic, I treat fear of flying.
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So I'll be talking to a patient in my clinic in London, and even though they're in my office, they're not near an airport or an aeroplane, when we're talking about the fear of flying, they can become really anxious in my office, even though we're just talking about the possibility of getting on a plane.
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So can you imagine then what happens when they're actually on their way to the airport or at the airport?
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I've had patients who will make it to the airport, have their flight booked, and will not be able to get out of the car park because their panic is so bad.
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And yes, in those situations, holidays cancelled, the person does not get on the plane.
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So that's an expected panic attack.
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The second type, and this is the one that really tends to shake people, are the unexpected or uncued panic attacks.
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So these are the ones that seem to come out of nowhere.
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For example, when you're driving, when you're watching tell, when you're half asleep, and suddenly, without warning, your body floods with terror.
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Now, these ones are obviously particularly distressing because there's no obvious trigger.
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And that's what makes people feel like they cannot truly be safe anywhere.
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We're gonna come back to why unexpected panic attacks happen a little bit later on.
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So they're the two types.
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Panic attacks are a psychological problem.
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And like all psychological problems, they need a psychological solution.
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That's why we need to have a good look at your brain to explain why they happen in the first place.
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So let's talk about the brain and why on earth it would produce something as awful as a panic attack.
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Again, if you're a regular listener to the podcast, you know I love the science.
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So here comes the science.
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Why does your brain do this?
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Yes, your brain is the most complex and least understood organ in the body.
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However, we're not completely in the dark when it comes to explaining why a panic attack happens.
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To understand panic attacks, you need to meet one of the most important structures in your brain.
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And again, I've spoken about this many times in other episodes, the amygdala.
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So your amygdala is a small album-shaped cluster of neurons or brain cells, and you've got two of them, one on each side of your brain, and their job is threat detection.
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They are brain's smoke alarm.
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When they sense danger, they trigger the fight or flight response faster than your conscious mind can even register what's happening.
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So the response happens in nanoseconds.
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Why that happens so quickly is this system is life-saving.
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You don't want to stop and think carefully if you're caught up in an earthquake or a terrorist attack.
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You want your body to react instantly and your amygdala does that for you.
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It's incredible.
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So when it fires, when it detects threat, it triggers the release of adrenaline and cortisol.
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Now they're your stress hormones.
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So when they get dumped into the bloodstream, they increase your heart rate, they redirect blood to your muscles, they dilate your pupils, and they shut down digestion.
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So they're preparing you to run or fight, act quickly, get out now.
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The problem is, and this is really the heart of it, is that this threat detection system can't tell the difference between a real or imagined threat.
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The brain just registers threats.
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It's not interested if this is all in your imagination or actually happening.
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So as clever as your brain is, can't tell the difference.
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And it really can tell the difference between, say, a shark in the sea that might be stalking you and a stressful email.
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Between physical danger, such as possibly being mugged, or the fear of being judged.
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It can't tell the difference between a genuine threat and a worrying thought.
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It lumps them all together as threat and it activates the threat response system because it's very sensitive.
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Now, here's where panic attacks get really interesting, but sadly really cruel.
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For most people in a genuinely dangerous situation, the fight or flight response kicks in, they deal with the threat, and then the system calms down.
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So your parasympathetic nervous system, or what we call your rest and digest system, that kicks back in, everything's calm, normal service resumes, nothing to see here, let's all move on.
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However, for people who experience panic attacks, something different happens for them.
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The physical sensations of the fight or flight response, the racing heart, the breathlessness, they become threatening in themselves.
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So you start to pay attention and you notice, hmm, my heart's beating a bit faster.
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And then your brain goes, Oh no, something's wrong with my heart.
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And the thought process produces fear.
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More fear produces more adrenaline.
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More adrenaline makes your heartbeat even faster, which means you notice your heart beating even faster now, and you're even more scared.
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You can start to believe you're in real danger of having a panic attack or even dying.
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And I cannot tell you the amount of times I've heard that from my patients.
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Now, this kind of response is what we call the fear-of-fear cycle.
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And it's what turns a stress response into a full-blown panic attack.
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You are in a very real sense frightening yourself into a panic attack.
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Now I know this isn't intentional, but this is the cycle.
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So your amygdala is reacting to your own physiological sensations as if they were a predator.
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Dr.
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David Clark, who is a pioneering cognitive psychologist, he describes this as a catastrophic misinterpretation of bodily sensations.
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Big words there.
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So what your brain does, it takes a normal stress response, a bit of an elevated heartbeat, a bit of breathlessness, and it interprets it as an evidence of a catastrophe.
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And once that interpretation begins, that drives the spiral.
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Now, believe it or not, this is actually good news, even though it doesn't feel like it.
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Because if a panic attack is driven by misinterpretation and the fear cycle, it means we can intervene in that cycle, change the interpretation, break the spiral, and reduce the panic.
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And we'll talk a little bit later on how we're going to do that.
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But first, I want to address one big question.
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Why do some people get panic attacks and others don't?
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Now there's no simple answer to that question, and it's a genuinely complex question.
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But here are some of the things we think might contribute to some people having them more than others.
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Genetics do play a role.
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Panic disorder can run in families, and researchers have identified certain genetic variations that make some people's autonomic nervous system more reactive.
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Temperament and personality matters too.
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Some people are naturally more sensitive to internal bodily sensations, or they might be a bit more anxious in how they think, or a bit more vulnerable, or they're prone to overthinking.
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So these might be more sensitive to having panic attacks.
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No surprises.
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Life experiences are hugely important.
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If you've been through trauma or had chronic stress in your life, or major life changes that have been negative, such as illnesses or grief, these can all sensitize the nervous system.
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Interestingly, certain physical factors can trigger or worsen panic.
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So no surprises, things like caffeine, if you drink too much coffee or cola, if you're sleep deprived, hormonal shifts, thyroid issues, and even hyperventilation can all produce sensations that the anxious brain may misinterpret as we're in trouble here.
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The key insight in all of this is having a panic attack or suffering with them doesn't mean there's something broken or wrong with you.
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What it means is your threat detection system is sensitive, perhaps too sensitive, and it's learned through some combination of biology and experience to fire in situations when there isn't actually a threat.
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Now I want to take a moment to talk about the difference between having a panic attack and having panic disorder, because they're not the same thing, and it's important to know the distinction.
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Having a panic attack, even a really severe one, doesn't automatically mean you're going to have panic disorder.
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Many people have one or two panic attacks in their lifetime, often during periods of high stress, and they never have another one.
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Panic disorder is different.
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That's a diagnosis.
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And that's diagnosed when you have recurrent unexpected panic attacks and you develop persistent worry about having more attacks, and you start to change your behavior or you avoid situations where you think an attack might be triggered.
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The last part, the avoidance, is often what causes the most disruption to the life of the person.
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Now, according to the DSM 5, that's a diagnostic and statistic manual, which is the manual psychologists and psychiatrists use to diagnose conditions.
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This is the criteria for diagnosing panic disorder.
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So a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more out of 13 of the following symptoms are present.
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Now I'm not going to read you through all 13 symptoms, but I'll read you through some of them.
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So in this anxious state, you might experience palpitations, pounding heart, accelerated heartbeat, sweating, trembling or shaking, sensations of shortness of breath or smothering, feelings of choking, chest discomfort or pain, fear of losing control or going crazy, and fear of dying.
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Now you have to have at least one of the attacks followed by one month or more of one or both of the following.
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Persistent concern or worry about additional panic attacks or their consequences like losing control, having a heart attack, or going crazy, andor a significant maladaptive change in behavior related to the attacks, such as avoiding exercise or unfamiliar situations, which are to help you avoid having another panic attack.
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So there's a clear distinction between having a panic attack and having a panic disorder.
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About 2-3% of people will develop panic disorder at some point in their lives.
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And it's more common in women than men, though men often go undiagnosed, because sometimes men don't let people know they're struggling.
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And it can occur at any age, but it's mostly common in early adulthood.
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Panic disorder, again, no surprises, can be accompanied by agrophobia.
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So the fear of being in situations where escape might be difficult or help is unavailable during a panic attack.
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So what that can mean is that you can avoid public transport, crowded spaces, traveling alone, or in severe cases, and I've treated this, that the person doesn't leave their house at all.
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Now avoidance is understandable because if you've had a panic attack in a supermarket, it makes sense that you'd want to avoid supermarkets.
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But avoidance actually maintains and strengthens the anxiety.
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It tells your brain, yes, that place was really dangerous.
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But it shrinks your world as it never gives your nervous system the chance to learn that the situation is actually safe.
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How can it if you keep avoiding it?
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Here's what I really want you to hear about panic attacks.
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Panic disorder is very treatable.
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We're not talking about managing it indefinitely, we're talking about genuine recovery.
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The treatments we have, which I'll talk about in a moment, are effective.
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Most people who engage seriously with treatment experience significant and lasting improvement.
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And I can attest to this because I treated it with many of my patients.
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So if any of this sounds familiar and you're living in fear of having the next panic attack, or if you're avoiding places and situations, if anxiety is shrinking your world, then please, please speak to a doctor or a mental health professional.
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You do not have to go through all of this alone, and you can get better.
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So now we've got the science behind why panic attacks happen, which is great, but how to get better?
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Because that's the most important thing, isn't it?
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And what can you do to manage panic attacks?
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Again, this podcast is all about hope.
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So I'm going to talk you through four steps, which will hopefully start you on the road to manage your panic attacks.
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I know these work because again, I've used them with my patients many, many times.
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Step number one, recognize what's happening.
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When a panic attack begins, the most powerful thing you can do, and I know it sounds very simple, is to name it.
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So say either out loud or in your head, this is a panic attack, I know what it is, it is not dangerous, it will pass.
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This matters because panic attacks have a natural arc.
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They peak within about 10 minutes and then they subside.
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They always end every single one because they have to.
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Your brain cannot physically sustain the level of psych physiological activation indefinitely.
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It literally runs out of the hormones that drive the panic.
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Now I know knowing this doesn't make the panic attack stop immediately, but it changes your relationship to it.
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Instead of fighting it in terror, you can ride it out with the knowledge this is temporary, it will stop, and I will calm down.
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So that's step one.
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Step number two, controlled breathing.
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So during a panic attack, as we've mentioned multiple times already, most people hyperventilate without realizing it.
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They breathe fast and shallow.
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And unfortunately, that actually worsens the physical sensations and symptoms because it lowers your carbon dioxide level in your blood.
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And what that can do is make you feel a bit more dizzy, a bit more tingly, and a bit more breathless, which can reinforce the spiral that something very bad is happening.
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So the technique that works best for slowing down your breathing.
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What we call diaphragmatical breathing, so breathing from below your diaphragm.
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So try this.
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Breathe in through your nose for four counts, hold it for one or two, and then breathe out as slowly as you can through your mouth for six to eight counts.
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The key is making the out breath longer than the in-breath, because this activates the parasympathetic nervous system, which is the brake pedal to the fight or fight accelerator.
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Now you don't need to do this perfectly.
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Just slowing down your breathing, even slightly, begins to interrupt the cycle.
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That's step two.
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Step three, grounding.
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Grounding techniques work by bringing the brain's attention back to the present moment and away from the spiraling thoughts.
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So one of the most effective and widely used techniques is what we call the 54321 technique.
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So look around and identify five things you can see, four things you can touch or feel physically, three things you can hear, two things you can smell, and one thing you can taste.
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Why does this work?
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It focuses the prefrontal cortex, which is this behavior, the thinking and reasoning part of your brain, which then helps the amygdala to calm down.
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So essentially what you're doing, you're redirecting the brain's attention from the internal storm to the external safe reality.
00:23:42.559 --> 00:23:46.160
So ground yourself, refocus the brain.
00:23:46.480 --> 00:23:51.359
The final step, step four, don't fight the panic.
00:23:51.599 --> 00:23:56.880
I know this might sound counterintuitive, but research consistently supports it.
00:23:57.119 --> 00:24:04.240
Trying to stop a panic attack by fighting it, tensing up, or willing it away often makes it worse.
00:24:04.480 --> 00:24:07.759
The struggle can actually amplify the fear.
00:24:08.720 --> 00:24:15.359
Does a technique from acceptance and commitment therapy or act which encourages a different stance?
00:24:15.839 --> 00:24:20.480
So instead of fighting the sensations, observe them with curiosity.
00:24:20.720 --> 00:24:25.680
So notice, hmm, my heart is racing, my hands are tingling.
00:24:26.000 --> 00:24:29.839
This is my nervous system doing what it's designed to do.
00:24:30.160 --> 00:24:36.960
I can observe this without it meaning something terrible is happening to me or I'm in danger.
00:24:37.440 --> 00:24:55.119
So it's not about pretending to be fine or faking it, it's about removing the second layer of fear, which is the fear of the panic itself, which, as we've mentioned earlier, is often what drives the attack to its worst point.
00:24:55.920 --> 00:25:02.079
So there are strategies you can do in the immediate moment where you're having a panic attack.
00:25:02.240 --> 00:25:04.400
Now let's look at longer-term strategies.
00:25:04.559 --> 00:25:10.000
And yes, I'm a psychologist and we are talking about therapy here.
00:25:10.559 --> 00:25:18.480
So cognitive behavioral therapy or CBT, what that targets is catastrophic misinterpretations that we talked about earlier.
00:25:18.720 --> 00:25:38.319
So CBT therapy helps you to identify the specific thoughts, the problematic thoughts that are driving this panic spiral, such as my heart is racing, which means I'm having a heart attack, and helps you to challenge them and to use alternative, more rational thoughts.
00:25:38.559 --> 00:25:42.799
So you're not dismissing your feelings, but you're examining them with the evidence.
00:25:43.039 --> 00:25:47.759
Well, what actually happened the last 50 times my heart raced?
00:25:47.920 --> 00:25:49.759
Did I have a heart attack?
00:25:50.640 --> 00:25:52.079
Was I at risk of death?
00:25:52.160 --> 00:25:54.079
Or did the sensation actually pass?
00:25:54.559 --> 00:25:55.200
Yeah.
00:25:55.839 --> 00:26:04.559
So therapy might involve gradual, kind of supportive, supported exposure to the situations or sensations that you've been avoiding.
00:26:04.720 --> 00:26:10.960
And this is called introspective, especially when it involves bodily sensations.
00:26:11.119 --> 00:26:21.039
So a bit of a weird one, but if you go to see a CBD therapist, they might have you breathe through a coffee stir or a straw to induce mild breathlessness.
00:26:21.119 --> 00:26:28.160
Not because it's pleasant, but they want to teach your brain that the sensation of breathlessness isn't dangerous.
00:26:28.400 --> 00:26:32.319
So over time your brain learns, ah, breathlessness is okay.
00:26:32.480 --> 00:26:35.519
So it helps the alarm to calm down.
00:26:37.680 --> 00:26:47.519
Incredibly, studies have shown that therapy leads to significant improvement in about 80 to 90% of people with panic disorder.
00:26:47.680 --> 00:26:50.720
And we're not talking about short-term gains here.
00:26:51.039 --> 00:26:53.519
These gains tend to be lasting.
00:26:54.960 --> 00:26:56.240
We touched on it earlier.
00:26:56.400 --> 00:26:59.440
Some of the other changes you can make are lifestyle changes.
00:26:59.599 --> 00:27:04.480
And I want to touch on this because it genuinely matters, even though it might sound like common sense.
00:27:04.720 --> 00:27:15.519
So, yes, things like getting enough sleep, getting some exercise, reducing stimulants like caffeine can make a real difference for people prone to panic.
00:27:15.839 --> 00:27:19.599
Sleep deprivation is horrendous for the brain.
00:27:19.839 --> 00:27:23.920
Because what it can do is it can increase amygdala reactivity.
00:27:24.079 --> 00:27:30.559
So, what that means is that your threat detective detection system becomes even more trigger-happy when you're tired.
00:27:30.799 --> 00:27:36.240
Now, regular aerobic exercise has been shown to reduce anxiety levels.
00:27:36.400 --> 00:27:57.839
And interestingly, double whammy here, because exercise raises your heartbeat and it creates a physical sensation of breathlessness too, that those sensations, producing those, can actually help you as a form of natural exposure therapy that your brain goes, actually, elevated heartbeats and breathlessness is okay.
00:27:58.000 --> 00:27:59.359
We're not in danger.
00:27:59.680 --> 00:28:01.279
And let's come back to caffeine.
00:28:01.359 --> 00:28:02.319
I'm not bashing it.
00:28:02.400 --> 00:28:04.720
I love my double espresso in the morning.
00:28:04.880 --> 00:28:15.279
But for some people who are sensitive to it, unfortunately, it can directly trigger panic attack symptoms by mimicking the physical sensations of the stress response.
00:28:15.440 --> 00:28:17.759
So it's worth worth being honest with yourself.
00:28:18.000 --> 00:28:21.599
Am I drinking too much coffee or am I taking in too much caffeine?
00:28:23.039 --> 00:28:24.240
Mindfulness.
00:28:24.480 --> 00:28:36.480
Mindfulness practice, even if it's just 10 minutes a day, can build your capacity with what we talked about earlier to observe your thoughts and sensations without getting swept away by them.
00:28:36.720 --> 00:28:43.920
Mindfulness isn't a quick fix, but over time it helps to rewire the brain's default response to threat.
00:28:44.960 --> 00:28:53.599
Before we finish this episode, I want to say something that I think is often missing from conversations about panic and anxiety.
00:28:54.160 --> 00:28:57.279
Panic attacks are not a personal failing.
00:28:57.440 --> 00:28:58.880
They're not weakness.
00:28:59.119 --> 00:29:01.920
They're not you being overly dramatic.
00:29:02.319 --> 00:29:08.799
The nervous system that produces panic attacks is the same nervous system that keeps you alive.
00:29:09.119 --> 00:29:13.359
It's a system that cares desperately about your survival.
00:29:13.680 --> 00:29:22.240
It's simply through some combination of genes and experiences and learned patterns become overtuned.
00:29:23.039 --> 00:29:27.680
It's sounding alarms when there's no fires to put out.
00:29:28.559 --> 00:29:30.960
But that system can change.
00:29:31.359 --> 00:29:39.039
Your brain has neuroplasticity, which means brain patterns that have been learned can be unlearned and they can change.
00:29:39.599 --> 00:29:42.480
People recover from panic disorder.
00:29:42.799 --> 00:29:51.519
People who once couldn't leave their homes or travel or get to work can live full expansive lives.
00:29:51.759 --> 00:29:58.000
And once again, yes, I've seen this many, many times.
00:29:58.319 --> 00:30:00.240
Not giving you false hope here.
00:30:02.240 --> 00:30:09.599
If you're in the thick of it right now and if panic attacks feel like they're running your life, please hold on to this.
00:30:10.079 --> 00:30:12.799
What you're experiencing is understandable.
00:30:13.200 --> 00:30:14.960
There is a roadmap.
00:30:15.279 --> 00:30:16.880
You can get better.
00:30:17.279 --> 00:30:21.599
And there are people trained to walk that road with you.
00:30:22.160 --> 00:30:26.400
You do not have to figure this out on your own.
00:30:26.640 --> 00:30:28.640
So please don't.
00:30:30.240 --> 00:30:47.119
So to summarize what we covered in today's episode, panic attacks are sudden surges of intense fear driven by the fight or flight response, specifically by the fear of fear cycle, where the sensations of anxiety become threatening in themselves.
00:30:47.440 --> 00:30:54.720
Once again, they're not dangerous, and they always, always, always pass.
00:30:55.599 --> 00:31:07.599
In the moment, specific techniques like naming the experience, slowing down the breathing, grounding techniques can break the cycle.
00:31:08.720 --> 00:31:14.559
The key is reducing the struggle, not adding more fear to the fear.
00:31:15.839 --> 00:31:20.799
In the longer term, therapy is the most effective treatment we have.
00:31:21.039 --> 00:31:31.359
And yes, lifestyle factors like getting enough sleep, exercise, watching your caffeine intake, mindfulness, all matter maybe more than what people think.
00:31:32.400 --> 00:31:40.079
If panic attacks are affecting your quality of life, please speak to your GP or a mental health professional.
00:31:40.400 --> 00:31:43.759
You deserve and need that support.
00:31:45.839 --> 00:31:53.039
If you're in the UK, sources of support, your GP will be your first port of call and they can refer you on to local services.
00:31:53.200 --> 00:32:00.799
Again, in other countries, you can contact your local doctor who can again plug you into local resources.
00:32:01.039 --> 00:32:07.440
Here in the UK, there's organizations like Anxiety UK, that's anxietyuk.org.uk.
00:32:07.680 --> 00:32:10.559
They have a helpline and they have resources for dealing with panic.
00:32:10.799 --> 00:32:17.759
Mind, again, mind.org.uk are wonderful for all the resources that they have about dealing with anxiety and panic.
00:32:17.920 --> 00:32:23.039
If you're really struggling, obviously Samaritans are fantastic, 24 hours.
00:32:23.279 --> 00:32:26.559
Phone number 116123, again, they're available.
00:32:26.640 --> 00:32:31.599
And Sane Line is another one, which is 0300-304-7000.
00:32:32.079 --> 00:32:33.839
Again, they will listen to you.
00:32:33.920 --> 00:32:36.000
You're never on your own.
00:32:38.000 --> 00:32:46.640
If you like this podcast, if you think this is okay, I like the stuff that's in this, then please, please do not keep this to yourself.
00:32:46.880 --> 00:32:49.759
I do this podcast to reach as many people as possible.
00:32:50.000 --> 00:32:52.240
Many people suffer with panic attacks.
00:32:52.319 --> 00:32:55.839
So I want this to reach as many people as need to hear it.
00:32:56.079 --> 00:33:01.200
The best way this podcast can reach people is by you telling people it exists.
00:33:01.440 --> 00:33:04.720
So if you like it, please share it, please share it on your socials.
00:33:04.799 --> 00:33:07.599
Just tell people, hey, I think this is okay.
00:33:08.319 --> 00:33:12.720
If you want to hear me talk about other things, jump over onto other episodes.
00:33:12.960 --> 00:33:17.359
There's 64 now, I think, episodes on all kinds of things.
00:33:17.440 --> 00:33:21.039
So please do go back to other episodes if you feel they will be useful.
00:33:21.279 --> 00:33:25.200
If you'd like to hear me talk about other areas of mental health, jump over onto social media.
00:33:25.279 --> 00:33:31.359
I'm on TikTok, I'm on Instagram, obviously on YouTube as well, and my handle is at Dr.
00:33:31.599 --> 00:33:33.119
MarkRackley.
00:33:34.079 --> 00:33:41.359
As ever, thank you so much for listening, and I look forward to speaking to you on the next episode of I Have Issues.
00:00:05.440 --> 00:00:06.639
Hi, I'm Dr.
00:00:06.719 --> 00:00:10.640
Mark, and you're very welcome to the latest episode of my podcast.
00:00:10.960 --> 00:00:12.640
I have issues.
00:00:12.960 --> 00:00:16.000
I thought I was going to die.
00:00:17.280 --> 00:00:19.440
I thought I was having a heart attack.
00:00:19.679 --> 00:00:21.679
I thought I was going to collapse.
00:00:22.000 --> 00:00:24.960
I'm terrified of having another one.
00:00:25.280 --> 00:00:28.800
What if I have another one and I'm on the tube or I'm in the car?
00:00:29.440 --> 00:00:37.119
These are all statements I have heard from my patients over the years when they're talking about panic attacks.
00:00:37.759 --> 00:00:39.759
Panic attacks are not your friend.
00:00:40.000 --> 00:00:41.840
They mean business.
00:00:42.159 --> 00:00:47.439
And when you have one, they are seriously distressing and you won't forget them easily.
00:00:48.399 --> 00:00:58.960
They will literally shake your world, leaving you scared, exhausted, and traumatized by the experience.
00:00:59.280 --> 00:01:08.000
The memory of them will stay with you, and you will never want to experience another one when you're having a panic attack.
00:01:08.159 --> 00:01:10.640
Your heart's hammering, you can't breathe.
00:01:11.359 --> 00:01:18.079
Your hands might be tingling, and a voice in your head might be screaming, something is terribly, terribly wrong here.
00:01:18.400 --> 00:01:20.480
And I think I might die from this.
00:01:20.719 --> 00:01:26.640
Sadly, panic attacks are rarely a once-in-a-lifetime experience for some people.
00:01:26.959 --> 00:01:36.480
And they will experience them many times, leaving that poor person terrified about what, about if and when the next one might happen.
00:01:36.799 --> 00:01:40.560
Now you might be listening to this and thinking, well, I've never had one of those.
00:01:40.640 --> 00:01:46.480
You might be completely ignorant to the experience of ever having a panic attack, and good for you, because you don't want one.
00:01:47.040 --> 00:01:58.799
However, if you've ever had one, you know exactly what I mean when I say, in the moment, it feels like the end of the world.
00:01:59.280 --> 00:02:04.480
So in today's episode, I'm going to talk to you about panic attacks.
00:02:04.959 --> 00:02:09.439
Why on earth do they happen when they're so awful?
00:02:09.840 --> 00:02:14.800
What is going on in the brain to create such a dreadful experience?
00:02:15.120 --> 00:02:20.879
If you're a regular listener to the podcast, which I hope you are, you'll know this podcast is all about hope.
00:02:21.120 --> 00:02:28.800
So, like all episodes, I'll be providing hope if you suffer with panic attacks and how you can live your life without them.
00:02:29.439 --> 00:02:37.680
So settle in, whether you're somebody who experiences panic attacks, yourself, or you love somebody who does.
00:02:38.080 --> 00:02:39.919
This episode is for you.
00:02:40.719 --> 00:02:44.639
So, first things first, let's start at the beginning.
00:02:44.960 --> 00:02:47.680
What is a panic attack?
00:02:48.080 --> 00:02:58.080
According to the American Psychological Association, which are the Association America that looks after psychologists, they have a very clear definition of what it is.
00:02:58.400 --> 00:03:07.599
So they describe it as it's a sudden onset of intense apprehension and fearfulness in the absence of actual danger.
00:03:07.840 --> 00:03:20.960
It's accompanied by the presence of such physical symptoms as heart palpitations, difficulty breathing, chest pain or discomfort, choking or smothering sensations, sweating, dizziness.
00:03:21.280 --> 00:03:30.960
The attack occurs in a discrete period of time and often involves fears of going crazy, losing control, or dying.
00:03:31.280 --> 00:03:33.199
Serious business here.
00:03:33.599 --> 00:03:36.240
They are nasty experiences.
00:03:36.479 --> 00:03:41.439
And if you've had one, you will know the awful reality of how this feels.
00:03:42.319 --> 00:03:51.840
Now, the awful cruel irony about panic attacks is nothing is physically wrong, even though your body's having a major reaction.
00:03:52.080 --> 00:04:03.919
Your body has just declared a state of emergency, and it doesn't matter where you are, that can be in the middle of a supermarket while you're sitting at your desk at work or three o'clock in the morning when you're just trying to get to sleep.
00:04:04.159 --> 00:04:06.000
The context is irrelevant.
00:04:06.080 --> 00:04:08.240
They can happen anywhere.
00:04:08.560 --> 00:04:14.319
Now, here's the first thing I really want you to take in because it matters.
00:04:14.719 --> 00:04:18.160
Panic attacks are not dangerous.
00:04:18.399 --> 00:04:22.800
I repeat, panic attacks are not dangerous.
00:04:23.120 --> 00:04:34.079
I know that almost sounds insulting if you're in the middle of one or you suffer with them regularly, but physiologically they cannot harm you.
00:04:34.319 --> 00:04:37.040
Your heart is not going to stop.
00:04:37.439 --> 00:04:44.959
You're not going to suffocate, and you're not going to lose your mind, even though you think you might.
00:04:45.360 --> 00:04:52.720
So what's actually happening is your body's alarm system has fired and it's fired very, very loudly.
00:04:52.959 --> 00:05:00.639
But the alarm itself is the problem, not an actual threat or a response to threats.
00:05:01.120 --> 00:05:03.199
So let's break it down a little bit more.
00:05:03.360 --> 00:05:05.920
There's actually two main types of panic attacks.
00:05:06.160 --> 00:05:09.680
The first are what we call expected panic attacks.
00:05:09.839 --> 00:05:14.160
So why would you expect to have a panic attack when you want to avoid them?
00:05:14.399 --> 00:05:17.120
Well, these are triggered by something specific.
00:05:17.279 --> 00:05:26.879
So for example, if you have a phobia or a stressful situation and an inv an environment or an environment you associate with danger.
00:05:27.120 --> 00:05:35.360
So for example, if somebody has a fear of flying and has a panic attack at the airport, that's an expected panic attack.
00:05:35.519 --> 00:05:40.879
You'd expect the person who has a fear of flying to have a panic attack in the environment of an airport.
00:05:41.199 --> 00:05:44.480
Now, in my clinic, I treat fear of flying.
00:05:44.720 --> 00:06:07.120
So I'll be talking to a patient in my clinic in London, and even though they're in my office, they're not near an airport or an aeroplane, when we're talking about the fear of flying, they can become really anxious in my office, even though we're just talking about the possibility of getting on a plane.
00:06:07.920 --> 00:06:14.639
So can you imagine then what happens when they're actually on their way to the airport or at the airport?
00:06:15.279 --> 00:06:25.519
I've had patients who will make it to the airport, have their flight booked, and will not be able to get out of the car park because their panic is so bad.
00:06:25.759 --> 00:06:31.839
And yes, in those situations, holidays cancelled, the person does not get on the plane.
00:06:32.000 --> 00:06:34.399
So that's an expected panic attack.
00:06:34.639 --> 00:06:41.839
The second type, and this is the one that really tends to shake people, are the unexpected or uncued panic attacks.
00:06:42.000 --> 00:06:44.639
So these are the ones that seem to come out of nowhere.
00:06:44.800 --> 00:06:54.000
For example, when you're driving, when you're watching tell, when you're half asleep, and suddenly, without warning, your body floods with terror.
00:06:54.240 --> 00:06:59.920
Now, these ones are obviously particularly distressing because there's no obvious trigger.
00:07:00.079 --> 00:07:04.720
And that's what makes people feel like they cannot truly be safe anywhere.
00:07:04.959 --> 00:07:10.079
We're gonna come back to why unexpected panic attacks happen a little bit later on.
00:07:10.240 --> 00:07:12.160
So they're the two types.
00:07:13.279 --> 00:07:16.399
Panic attacks are a psychological problem.
00:07:16.800 --> 00:07:21.680
And like all psychological problems, they need a psychological solution.
00:07:21.920 --> 00:07:27.920
That's why we need to have a good look at your brain to explain why they happen in the first place.
00:07:28.480 --> 00:07:36.720
So let's talk about the brain and why on earth it would produce something as awful as a panic attack.
00:07:36.959 --> 00:07:41.120
Again, if you're a regular listener to the podcast, you know I love the science.
00:07:41.360 --> 00:07:43.920
So here comes the science.
00:07:44.879 --> 00:07:47.279
Why does your brain do this?
00:07:48.319 --> 00:07:53.839
Yes, your brain is the most complex and least understood organ in the body.
00:07:54.079 --> 00:08:01.120
However, we're not completely in the dark when it comes to explaining why a panic attack happens.
00:08:01.920 --> 00:08:07.839
To understand panic attacks, you need to meet one of the most important structures in your brain.
00:08:08.000 --> 00:08:12.480
And again, I've spoken about this many times in other episodes, the amygdala.
00:08:13.040 --> 00:08:22.720
So your amygdala is a small album-shaped cluster of neurons or brain cells, and you've got two of them, one on each side of your brain, and their job is threat detection.
00:08:22.959 --> 00:08:24.959
They are brain's smoke alarm.
00:08:25.199 --> 00:08:33.200
When they sense danger, they trigger the fight or flight response faster than your conscious mind can even register what's happening.
00:08:33.360 --> 00:08:37.039
So the response happens in nanoseconds.
00:08:37.840 --> 00:08:42.240
Why that happens so quickly is this system is life-saving.
00:08:42.639 --> 00:08:48.399
You don't want to stop and think carefully if you're caught up in an earthquake or a terrorist attack.
00:08:48.639 --> 00:08:53.440
You want your body to react instantly and your amygdala does that for you.
00:08:53.600 --> 00:08:55.039
It's incredible.
00:08:55.360 --> 00:09:02.320
So when it fires, when it detects threat, it triggers the release of adrenaline and cortisol.
00:09:02.480 --> 00:09:04.320
Now they're your stress hormones.
00:09:04.480 --> 00:09:14.720
So when they get dumped into the bloodstream, they increase your heart rate, they redirect blood to your muscles, they dilate your pupils, and they shut down digestion.
00:09:14.879 --> 00:09:20.320
So they're preparing you to run or fight, act quickly, get out now.
00:09:22.559 --> 00:09:34.399
The problem is, and this is really the heart of it, is that this threat detection system can't tell the difference between a real or imagined threat.
00:09:34.799 --> 00:09:36.799
The brain just registers threats.
00:09:36.960 --> 00:09:42.559
It's not interested if this is all in your imagination or actually happening.
00:09:43.039 --> 00:09:46.639
So as clever as your brain is, can't tell the difference.
00:09:46.879 --> 00:09:54.000
And it really can tell the difference between, say, a shark in the sea that might be stalking you and a stressful email.
00:09:54.399 --> 00:10:00.960
Between physical danger, such as possibly being mugged, or the fear of being judged.
00:10:01.279 --> 00:10:05.759
It can't tell the difference between a genuine threat and a worrying thought.
00:10:05.919 --> 00:10:15.279
It lumps them all together as threat and it activates the threat response system because it's very sensitive.
00:10:15.840 --> 00:10:22.000
Now, here's where panic attacks get really interesting, but sadly really cruel.
00:10:23.039 --> 00:10:33.759
For most people in a genuinely dangerous situation, the fight or flight response kicks in, they deal with the threat, and then the system calms down.
00:10:34.320 --> 00:10:47.679
So your parasympathetic nervous system, or what we call your rest and digest system, that kicks back in, everything's calm, normal service resumes, nothing to see here, let's all move on.
00:10:48.320 --> 00:10:54.879
However, for people who experience panic attacks, something different happens for them.
00:10:55.279 --> 00:11:04.720
The physical sensations of the fight or flight response, the racing heart, the breathlessness, they become threatening in themselves.
00:11:05.440 --> 00:11:10.320
So you start to pay attention and you notice, hmm, my heart's beating a bit faster.
00:11:10.399 --> 00:11:13.759
And then your brain goes, Oh no, something's wrong with my heart.
00:11:13.919 --> 00:11:16.799
And the thought process produces fear.
00:11:17.919 --> 00:11:20.799
More fear produces more adrenaline.
00:11:21.039 --> 00:11:31.279
More adrenaline makes your heartbeat even faster, which means you notice your heart beating even faster now, and you're even more scared.
00:11:32.000 --> 00:11:36.639
You can start to believe you're in real danger of having a panic attack or even dying.
00:11:36.799 --> 00:11:41.279
And I cannot tell you the amount of times I've heard that from my patients.
00:11:42.080 --> 00:11:47.200
Now, this kind of response is what we call the fear-of-fear cycle.
00:11:47.440 --> 00:11:53.759
And it's what turns a stress response into a full-blown panic attack.
00:11:54.240 --> 00:11:59.919
You are in a very real sense frightening yourself into a panic attack.
00:12:00.080 --> 00:12:03.679
Now I know this isn't intentional, but this is the cycle.
00:12:03.919 --> 00:12:10.879
So your amygdala is reacting to your own physiological sensations as if they were a predator.
00:12:12.080 --> 00:12:12.559
Dr.
00:12:12.639 --> 00:12:21.120
David Clark, who is a pioneering cognitive psychologist, he describes this as a catastrophic misinterpretation of bodily sensations.
00:12:21.279 --> 00:12:22.480
Big words there.
00:12:22.720 --> 00:12:33.200
So what your brain does, it takes a normal stress response, a bit of an elevated heartbeat, a bit of breathlessness, and it interprets it as an evidence of a catastrophe.
00:12:34.000 --> 00:12:39.440
And once that interpretation begins, that drives the spiral.
00:12:41.039 --> 00:12:45.759
Now, believe it or not, this is actually good news, even though it doesn't feel like it.
00:12:46.080 --> 00:13:01.759
Because if a panic attack is driven by misinterpretation and the fear cycle, it means we can intervene in that cycle, change the interpretation, break the spiral, and reduce the panic.
00:13:02.000 --> 00:13:06.399
And we'll talk a little bit later on how we're going to do that.
00:13:07.120 --> 00:13:11.759
But first, I want to address one big question.
00:13:12.240 --> 00:13:16.240
Why do some people get panic attacks and others don't?
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Now there's no simple answer to that question, and it's a genuinely complex question.
00:13:21.279 --> 00:13:27.440
But here are some of the things we think might contribute to some people having them more than others.
00:13:27.759 --> 00:13:29.840
Genetics do play a role.
00:13:30.080 --> 00:13:40.720
Panic disorder can run in families, and researchers have identified certain genetic variations that make some people's autonomic nervous system more reactive.
00:13:41.039 --> 00:13:43.440
Temperament and personality matters too.
00:13:43.679 --> 00:13:53.679
Some people are naturally more sensitive to internal bodily sensations, or they might be a bit more anxious in how they think, or a bit more vulnerable, or they're prone to overthinking.
00:13:53.919 --> 00:13:57.039
So these might be more sensitive to having panic attacks.
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No surprises.
00:13:59.519 --> 00:14:02.320
Life experiences are hugely important.
00:14:02.720 --> 00:14:14.720
If you've been through trauma or had chronic stress in your life, or major life changes that have been negative, such as illnesses or grief, these can all sensitize the nervous system.
00:14:15.279 --> 00:14:19.679
Interestingly, certain physical factors can trigger or worsen panic.
00:14:19.759 --> 00:14:35.759
So no surprises, things like caffeine, if you drink too much coffee or cola, if you're sleep deprived, hormonal shifts, thyroid issues, and even hyperventilation can all produce sensations that the anxious brain may misinterpret as we're in trouble here.
00:14:36.080 --> 00:14:45.279
The key insight in all of this is having a panic attack or suffering with them doesn't mean there's something broken or wrong with you.
00:14:45.919 --> 00:15:01.679
What it means is your threat detection system is sensitive, perhaps too sensitive, and it's learned through some combination of biology and experience to fire in situations when there isn't actually a threat.
00:15:02.159 --> 00:15:13.840
Now I want to take a moment to talk about the difference between having a panic attack and having panic disorder, because they're not the same thing, and it's important to know the distinction.
00:15:14.240 --> 00:15:21.679
Having a panic attack, even a really severe one, doesn't automatically mean you're going to have panic disorder.
00:15:21.919 --> 00:15:29.120
Many people have one or two panic attacks in their lifetime, often during periods of high stress, and they never have another one.
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Panic disorder is different.
00:15:31.679 --> 00:15:33.279
That's a diagnosis.
00:15:33.759 --> 00:15:50.720
And that's diagnosed when you have recurrent unexpected panic attacks and you develop persistent worry about having more attacks, and you start to change your behavior or you avoid situations where you think an attack might be triggered.
00:15:50.960 --> 00:15:57.039
The last part, the avoidance, is often what causes the most disruption to the life of the person.
00:15:58.399 --> 00:16:07.039
Now, according to the DSM 5, that's a diagnostic and statistic manual, which is the manual psychologists and psychiatrists use to diagnose conditions.
00:16:07.360 --> 00:16:11.200
This is the criteria for diagnosing panic disorder.
00:16:11.759 --> 00:16:26.480
So a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more out of 13 of the following symptoms are present.
00:16:26.639 --> 00:16:32.000
Now I'm not going to read you through all 13 symptoms, but I'll read you through some of them.
00:16:32.240 --> 00:16:52.960
So in this anxious state, you might experience palpitations, pounding heart, accelerated heartbeat, sweating, trembling or shaking, sensations of shortness of breath or smothering, feelings of choking, chest discomfort or pain, fear of losing control or going crazy, and fear of dying.
00:16:53.200 --> 00:17:00.559
Now you have to have at least one of the attacks followed by one month or more of one or both of the following.
00:17:00.960 --> 00:17:25.440
Persistent concern or worry about additional panic attacks or their consequences like losing control, having a heart attack, or going crazy, andor a significant maladaptive change in behavior related to the attacks, such as avoiding exercise or unfamiliar situations, which are to help you avoid having another panic attack.
00:17:26.079 --> 00:17:31.119
So there's a clear distinction between having a panic attack and having a panic disorder.
00:17:31.359 --> 00:17:36.480
About 2-3% of people will develop panic disorder at some point in their lives.
00:17:36.640 --> 00:17:44.559
And it's more common in women than men, though men often go undiagnosed, because sometimes men don't let people know they're struggling.
00:17:44.799 --> 00:17:49.759
And it can occur at any age, but it's mostly common in early adulthood.
00:17:50.079 --> 00:17:54.480
Panic disorder, again, no surprises, can be accompanied by agrophobia.
00:17:54.640 --> 00:18:01.920
So the fear of being in situations where escape might be difficult or help is unavailable during a panic attack.
00:18:02.160 --> 00:18:14.960
So what that can mean is that you can avoid public transport, crowded spaces, traveling alone, or in severe cases, and I've treated this, that the person doesn't leave their house at all.
00:18:16.079 --> 00:18:24.319
Now avoidance is understandable because if you've had a panic attack in a supermarket, it makes sense that you'd want to avoid supermarkets.
00:18:24.640 --> 00:18:28.240
But avoidance actually maintains and strengthens the anxiety.
00:18:28.400 --> 00:18:32.480
It tells your brain, yes, that place was really dangerous.
00:18:32.799 --> 00:18:41.119
But it shrinks your world as it never gives your nervous system the chance to learn that the situation is actually safe.
00:18:41.759 --> 00:18:43.920
How can it if you keep avoiding it?
00:18:45.359 --> 00:18:50.079
Here's what I really want you to hear about panic attacks.
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Panic disorder is very treatable.
00:18:55.039 --> 00:19:01.519
We're not talking about managing it indefinitely, we're talking about genuine recovery.
00:19:02.640 --> 00:19:07.440
The treatments we have, which I'll talk about in a moment, are effective.
00:19:07.839 --> 00:19:13.920
Most people who engage seriously with treatment experience significant and lasting improvement.
00:19:14.079 --> 00:19:18.160
And I can attest to this because I treated it with many of my patients.
00:19:19.279 --> 00:19:36.640
So if any of this sounds familiar and you're living in fear of having the next panic attack, or if you're avoiding places and situations, if anxiety is shrinking your world, then please, please speak to a doctor or a mental health professional.
00:19:36.960 --> 00:19:42.720
You do not have to go through all of this alone, and you can get better.
00:19:43.759 --> 00:19:49.359
So now we've got the science behind why panic attacks happen, which is great, but how to get better?
00:19:49.440 --> 00:19:51.680
Because that's the most important thing, isn't it?
00:19:51.839 --> 00:19:55.440
And what can you do to manage panic attacks?
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Again, this podcast is all about hope.
00:19:58.960 --> 00:20:06.799
So I'm going to talk you through four steps, which will hopefully start you on the road to manage your panic attacks.
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I know these work because again, I've used them with my patients many, many times.
00:20:14.960 --> 00:20:18.400
Step number one, recognize what's happening.
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When a panic attack begins, the most powerful thing you can do, and I know it sounds very simple, is to name it.
00:20:26.319 --> 00:20:36.240
So say either out loud or in your head, this is a panic attack, I know what it is, it is not dangerous, it will pass.
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This matters because panic attacks have a natural arc.
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They peak within about 10 minutes and then they subside.
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They always end every single one because they have to.
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Your brain cannot physically sustain the level of psych physiological activation indefinitely.
00:21:01.039 --> 00:21:04.480
It literally runs out of the hormones that drive the panic.
00:21:04.799 --> 00:21:12.160
Now I know knowing this doesn't make the panic attack stop immediately, but it changes your relationship to it.
00:21:12.400 --> 00:21:22.000
Instead of fighting it in terror, you can ride it out with the knowledge this is temporary, it will stop, and I will calm down.
00:21:22.400 --> 00:21:23.839
So that's step one.
00:21:24.480 --> 00:21:27.920
Step number two, controlled breathing.
00:21:28.319 --> 00:21:35.039
So during a panic attack, as we've mentioned multiple times already, most people hyperventilate without realizing it.
00:21:35.200 --> 00:21:37.440
They breathe fast and shallow.
00:21:37.599 --> 00:21:46.160
And unfortunately, that actually worsens the physical sensations and symptoms because it lowers your carbon dioxide level in your blood.
00:21:46.319 --> 00:21:55.279
And what that can do is make you feel a bit more dizzy, a bit more tingly, and a bit more breathless, which can reinforce the spiral that something very bad is happening.
00:21:56.000 --> 00:21:59.599
So the technique that works best for slowing down your breathing.
00:22:00.160 --> 00:22:04.000
What we call diaphragmatical breathing, so breathing from below your diaphragm.
00:22:04.240 --> 00:22:05.599
So try this.
00:22:06.240 --> 00:22:19.759
Breathe in through your nose for four counts, hold it for one or two, and then breathe out as slowly as you can through your mouth for six to eight counts.
00:22:20.160 --> 00:22:33.279
The key is making the out breath longer than the in-breath, because this activates the parasympathetic nervous system, which is the brake pedal to the fight or fight accelerator.
00:22:34.000 --> 00:22:36.319
Now you don't need to do this perfectly.
00:22:36.559 --> 00:22:43.440
Just slowing down your breathing, even slightly, begins to interrupt the cycle.
00:22:43.759 --> 00:22:44.960
That's step two.
00:22:45.519 --> 00:22:48.000
Step three, grounding.
00:22:48.720 --> 00:22:56.720
Grounding techniques work by bringing the brain's attention back to the present moment and away from the spiraling thoughts.
00:22:56.960 --> 00:23:03.200
So one of the most effective and widely used techniques is what we call the 54321 technique.
00:23:04.079 --> 00:23:20.480
So look around and identify five things you can see, four things you can touch or feel physically, three things you can hear, two things you can smell, and one thing you can taste.
00:23:21.839 --> 00:23:23.039
Why does this work?
00:23:23.759 --> 00:23:33.599
It focuses the prefrontal cortex, which is this behavior, the thinking and reasoning part of your brain, which then helps the amygdala to calm down.
00:23:33.759 --> 00:23:42.160
So essentially what you're doing, you're redirecting the brain's attention from the internal storm to the external safe reality.
00:23:42.559 --> 00:23:46.160
So ground yourself, refocus the brain.
00:23:46.480 --> 00:23:51.359
The final step, step four, don't fight the panic.
00:23:51.599 --> 00:23:56.880
I know this might sound counterintuitive, but research consistently supports it.
00:23:57.119 --> 00:24:04.240
Trying to stop a panic attack by fighting it, tensing up, or willing it away often makes it worse.
00:24:04.480 --> 00:24:07.759
The struggle can actually amplify the fear.
00:24:08.720 --> 00:24:15.359
Does a technique from acceptance and commitment therapy or act which encourages a different stance?
00:24:15.839 --> 00:24:20.480
So instead of fighting the sensations, observe them with curiosity.
00:24:20.720 --> 00:24:25.680
So notice, hmm, my heart is racing, my hands are tingling.
00:24:26.000 --> 00:24:29.839
This is my nervous system doing what it's designed to do.
00:24:30.160 --> 00:24:36.960
I can observe this without it meaning something terrible is happening to me or I'm in danger.
00:24:37.440 --> 00:24:55.119
So it's not about pretending to be fine or faking it, it's about removing the second layer of fear, which is the fear of the panic itself, which, as we've mentioned earlier, is often what drives the attack to its worst point.
00:24:55.920 --> 00:25:02.079
So there are strategies you can do in the immediate moment where you're having a panic attack.
00:25:02.240 --> 00:25:04.400
Now let's look at longer-term strategies.
00:25:04.559 --> 00:25:10.000
And yes, I'm a psychologist and we are talking about therapy here.
00:25:10.559 --> 00:25:18.480
So cognitive behavioral therapy or CBT, what that targets is catastrophic misinterpretations that we talked about earlier.
00:25:18.720 --> 00:25:38.319
So CBT therapy helps you to identify the specific thoughts, the problematic thoughts that are driving this panic spiral, such as my heart is racing, which means I'm having a heart attack, and helps you to challenge them and to use alternative, more rational thoughts.
00:25:38.559 --> 00:25:42.799
So you're not dismissing your feelings, but you're examining them with the evidence.
00:25:43.039 --> 00:25:47.759
Well, what actually happened the last 50 times my heart raced?
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Did I have a heart attack?
00:25:50.640 --> 00:25:52.079
Was I at risk of death?
00:25:52.160 --> 00:25:54.079
Or did the sensation actually pass?
00:25:54.559 --> 00:25:55.200
Yeah.
00:25:55.839 --> 00:26:04.559
So therapy might involve gradual, kind of supportive, supported exposure to the situations or sensations that you've been avoiding.
00:26:04.720 --> 00:26:10.960
And this is called introspective, especially when it involves bodily sensations.
00:26:11.119 --> 00:26:21.039
So a bit of a weird one, but if you go to see a CBD therapist, they might have you breathe through a coffee stir or a straw to induce mild breathlessness.
00:26:21.119 --> 00:26:28.160
Not because it's pleasant, but they want to teach your brain that the sensation of breathlessness isn't dangerous.
00:26:28.400 --> 00:26:32.319
So over time your brain learns, ah, breathlessness is okay.
00:26:32.480 --> 00:26:35.519
So it helps the alarm to calm down.
00:26:37.680 --> 00:26:47.519
Incredibly, studies have shown that therapy leads to significant improvement in about 80 to 90% of people with panic disorder.
00:26:47.680 --> 00:26:50.720
And we're not talking about short-term gains here.
00:26:51.039 --> 00:26:53.519
These gains tend to be lasting.
00:26:54.960 --> 00:26:56.240
We touched on it earlier.
00:26:56.400 --> 00:26:59.440
Some of the other changes you can make are lifestyle changes.
00:26:59.599 --> 00:27:04.480
And I want to touch on this because it genuinely matters, even though it might sound like common sense.
00:27:04.720 --> 00:27:15.519
So, yes, things like getting enough sleep, getting some exercise, reducing stimulants like caffeine can make a real difference for people prone to panic.
00:27:15.839 --> 00:27:19.599
Sleep deprivation is horrendous for the brain.
00:27:19.839 --> 00:27:23.920
Because what it can do is it can increase amygdala reactivity.
00:27:24.079 --> 00:27:30.559
So, what that means is that your threat detective detection system becomes even more trigger-happy when you're tired.
00:27:30.799 --> 00:27:36.240
Now, regular aerobic exercise has been shown to reduce anxiety levels.
00:27:36.400 --> 00:27:57.839
And interestingly, double whammy here, because exercise raises your heartbeat and it creates a physical sensation of breathlessness too, that those sensations, producing those, can actually help you as a form of natural exposure therapy that your brain goes, actually, elevated heartbeats and breathlessness is okay.
00:27:58.000 --> 00:27:59.359
We're not in danger.
00:27:59.680 --> 00:28:01.279
And let's come back to caffeine.
00:28:01.359 --> 00:28:02.319
I'm not bashing it.
00:28:02.400 --> 00:28:04.720
I love my double espresso in the morning.
00:28:04.880 --> 00:28:15.279
But for some people who are sensitive to it, unfortunately, it can directly trigger panic attack symptoms by mimicking the physical sensations of the stress response.
00:28:15.440 --> 00:28:17.759
So it's worth worth being honest with yourself.
00:28:18.000 --> 00:28:21.599
Am I drinking too much coffee or am I taking in too much caffeine?
00:28:23.039 --> 00:28:24.240
Mindfulness.
00:28:24.480 --> 00:28:36.480
Mindfulness practice, even if it's just 10 minutes a day, can build your capacity with what we talked about earlier to observe your thoughts and sensations without getting swept away by them.
00:28:36.720 --> 00:28:43.920
Mindfulness isn't a quick fix, but over time it helps to rewire the brain's default response to threat.
00:28:44.960 --> 00:28:53.599
Before we finish this episode, I want to say something that I think is often missing from conversations about panic and anxiety.
00:28:54.160 --> 00:28:57.279
Panic attacks are not a personal failing.
00:28:57.440 --> 00:28:58.880
They're not weakness.
00:28:59.119 --> 00:29:01.920
They're not you being overly dramatic.
00:29:02.319 --> 00:29:08.799
The nervous system that produces panic attacks is the same nervous system that keeps you alive.
00:29:09.119 --> 00:29:13.359
It's a system that cares desperately about your survival.
00:29:13.680 --> 00:29:22.240
It's simply through some combination of genes and experiences and learned patterns become overtuned.
00:29:23.039 --> 00:29:27.680
It's sounding alarms when there's no fires to put out.
00:29:28.559 --> 00:29:30.960
But that system can change.
00:29:31.359 --> 00:29:39.039
Your brain has neuroplasticity, which means brain patterns that have been learned can be unlearned and they can change.
00:29:39.599 --> 00:29:42.480
People recover from panic disorder.
00:29:42.799 --> 00:29:51.519
People who once couldn't leave their homes or travel or get to work can live full expansive lives.
00:29:51.759 --> 00:29:58.000
And once again, yes, I've seen this many, many times.
00:29:58.319 --> 00:30:00.240
Not giving you false hope here.
00:30:02.240 --> 00:30:09.599
If you're in the thick of it right now and if panic attacks feel like they're running your life, please hold on to this.
00:30:10.079 --> 00:30:12.799
What you're experiencing is understandable.
00:30:13.200 --> 00:30:14.960
There is a roadmap.
00:30:15.279 --> 00:30:16.880
You can get better.
00:30:17.279 --> 00:30:21.599
And there are people trained to walk that road with you.
00:30:22.160 --> 00:30:26.400
You do not have to figure this out on your own.
00:30:26.640 --> 00:30:28.640
So please don't.
00:30:30.240 --> 00:30:47.119
So to summarize what we covered in today's episode, panic attacks are sudden surges of intense fear driven by the fight or flight response, specifically by the fear of fear cycle, where the sensations of anxiety become threatening in themselves.
00:30:47.440 --> 00:30:54.720
Once again, they're not dangerous, and they always, always, always pass.
00:30:55.599 --> 00:31:07.599
In the moment, specific techniques like naming the experience, slowing down the breathing, grounding techniques can break the cycle.
00:31:08.720 --> 00:31:14.559
The key is reducing the struggle, not adding more fear to the fear.
00:31:15.839 --> 00:31:20.799
In the longer term, therapy is the most effective treatment we have.
00:31:21.039 --> 00:31:31.359
And yes, lifestyle factors like getting enough sleep, exercise, watching your caffeine intake, mindfulness, all matter maybe more than what people think.
00:31:32.400 --> 00:31:40.079
If panic attacks are affecting your quality of life, please speak to your GP or a mental health professional.
00:31:40.400 --> 00:31:43.759
You deserve and need that support.
00:31:45.839 --> 00:31:53.039
If you're in the UK, sources of support, your GP will be your first port of call and they can refer you on to local services.
00:31:53.200 --> 00:32:00.799
Again, in other countries, you can contact your local doctor who can again plug you into local resources.
00:32:01.039 --> 00:32:07.440
Here in the UK, there's organizations like Anxiety UK, that's anxietyuk.org.uk.
00:32:07.680 --> 00:32:10.559
They have a helpline and they have resources for dealing with panic.
00:32:10.799 --> 00:32:17.759
Mind, again, mind.org.uk are wonderful for all the resources that they have about dealing with anxiety and panic.
00:32:17.920 --> 00:32:23.039
If you're really struggling, obviously Samaritans are fantastic, 24 hours.
00:32:23.279 --> 00:32:26.559
Phone number 116123, again, they're available.
00:32:26.640 --> 00:32:31.599
And Sane Line is another one, which is 0300-304-7000.
00:32:32.079 --> 00:32:33.839
Again, they will listen to you.
00:32:33.920 --> 00:32:36.000
You're never on your own.
00:32:38.000 --> 00:32:46.640
If you like this podcast, if you think this is okay, I like the stuff that's in this, then please, please do not keep this to yourself.
00:32:46.880 --> 00:32:49.759
I do this podcast to reach as many people as possible.
00:32:50.000 --> 00:32:52.240
Many people suffer with panic attacks.
00:32:52.319 --> 00:32:55.839
So I want this to reach as many people as need to hear it.
00:32:56.079 --> 00:33:01.200
The best way this podcast can reach people is by you telling people it exists.
00:33:01.440 --> 00:33:04.720
So if you like it, please share it, please share it on your socials.
00:33:04.799 --> 00:33:07.599
Just tell people, hey, I think this is okay.
00:33:08.319 --> 00:33:12.720
If you want to hear me talk about other things, jump over onto other episodes.
00:33:12.960 --> 00:33:17.359
There's 64 now, I think, episodes on all kinds of things.
00:33:17.440 --> 00:33:21.039
So please do go back to other episodes if you feel they will be useful.
00:33:21.279 --> 00:33:25.200
If you'd like to hear me talk about other areas of mental health, jump over onto social media.
00:33:25.279 --> 00:33:31.359
I'm on TikTok, I'm on Instagram, obviously on YouTube as well, and my handle is at Dr.
00:33:31.599 --> 00:33:33.119
MarkRackley.
00:33:34.079 --> 00:33:41.359
As ever, thank you so much for listening, and I look forward to speaking to you on the next episode of I Have Issues.
