If there is one main issue that many of my clients deal with outside of our sessions that can completely render them feeling helpless and potentially to unbidden hospital visits, it is panic attacks.
I used to view panic as a category unto itself. As if panic and anxiety itself were two separate things. But my mentor: the “Yoda” of psychotherapy of whom I study under, has told me “panic is just anxiety.”
It’s the exact same physical response in the body-mind. The difference is that panic is anxiety that has gone to a level that it is out of control. It is unregulated, such as how you regulate the flow of water or steam from a pipe.
One symptom of traumatic experience, especially trauma that has repeated throughout childhood and adolescence, are panic episodes that seem to come out of absolute nowhere, with no known triggering events whatsoever.
One theory on this is that there is a global sense of being unsafe and that the other shoe is always about to drop. There are other ideas but it’s beyond the scope of this post.
I want to offer five means of working with panic in your day to day life, if you are suffering from anything like I have described. These may not cure your panic, but if you find at least two that work for you, your panic will be more and more under your control:
1. Breathing:
Breathing is the lowest hanging fruit for changing how one feels and reacts. Meaning, it takes the least effort over any other technique or exercise but beautifully tends to be the most powerful.
There are many methods of breathing. In an episode of panic or near panic, breathing incorrectly can make everything worse or cause a full blown panic. The correct ways of breathing can change everything. So it’s very important to know how to breathe just right when you’re in a place of anxiety.
Here is the general method that I teach my clients to calm themselves, both in session and as a skill to use in everyday life:
- Take a gentle but full breath into your upper belly, where your ribs end
- Breathe in for about 4-5 seconds
- Hold for about one second
- Let the breath out for at least 5 seconds until a pause.
- Allow the out breath to be entirely passive, taking no effort whatsoever
2. Listen to guided meditation
It may be passive but it can be highly beneficial to hear a soothing voice, guiding oneself into a different state.
I’m a fan of something called Open Focus, which is based off of something called Biofeedback. Here’s a 20 minute track on contemplating an Open Focused state of space:
https://www.tarabrach.com/guided-meditation-inner-space-gateway-to-open-awareness/
Youtube has a mix of quality, but there is a gigantic amount of material. Here’s a simple search for guided meditation for panic as an example:
https://www.youtube.com/results?search_query=meditation+for+panic+attacks
3. State the thought that you may be fixated on.
There is emotion, anxiety and reactions that are in direct relation to the outside stressor or even. These are called primary emotions, and then there are emotions and reactions that are in reaction to the primary emotions. These are called secondary emotions.
One feature of secondary emotions is that they tend to (but not always) involved some story or belief that drives them.
For example, in the case of anxiety and panic: imagine a person has a stressful reaction to their partner and automatically feels anxious, maybe frustrated and deflated. This is the primary reaction. Then, let’s imagine that this person has a long history with rejection and takes this stressful event as a rejection just as has occurred many times in the past. This person now thinks this over and over again. Or maybe another channel, as in imagines past and future scenarious of rejection. Suddenly the world becomes overwhelming and they are flooded with anxiety causing a panic attack.
To work with situations such as this, it is helpful to stop the process in its tracks. Ask:
- What is the thoughts or the stories that are driving this reaction?
- What is the primary or main experience or reaction that I’m reacting to?
-State or write down everything you can that is perpetuating and escalating what is happening inside you.
4. Use imagery to separate from the negative feelings that may be at the core of the panic
Different techniques and resources may work very differently for many different people. But I tend to consider this to be the most powerful technique if you can figure out a method that works best for you.
This is also called “clearing a space” which is used in the technique and paradigm of psychotherapy called Focusing.
It involves using inner dialogue and imagination to get a place of inner space from a problem or inner set of feelings.
Take whatever the inner feeling, reaction, or Felt-Sense and ask it to separate from you.
Imagine these things moving to the side of you, maybe in an empty chair where you can visualize it all and get more of a sense of.
Maybe imagine filing it away for later or moving into the next room. Or a safe room or locked chest in your imagination.
It can be helpful to begin by breathing and attempting to relax a little more before you can develop this healthy working distance from whatever is bothering you.
Not everyone can contact and separate from their inner experience using their imagination channel. Some people may be helped by acting it out. Like moving your arms in a pushing or throwing action, or dialoguing with this overwhelmed part in their inner experience.
Here is an introduction to focusing and and clearing a space:
https://www.focusing.org/gendlin/docs/gol_2234.html#hd3
More on this technique and merging with experience in a later post…
5. Listen to healing tones or find a go to app:
Again, there is a high rate of good and bad on youtube, but there is a wealth of material out there using meditative tones that can possibly be an adjunct to difficult and overwhelming states.
Look up healing tones for anxiety or relaxation. The main words for these tones are: binaural beats, monaural beats, and isochronic tones. DO NOT use beta or gamma tones for this, as they are highly stimulating. Also, be careful about using these sounds too much, such as for hours at time, as they can burn out the nervous system with too much use.
Look out for “sound entrainment” companies that make exaggerated and outrageous claims. Also avoid companies that charge hundreds to thousands of dollars for this technology in packages and tiers. This technology has been around a long time and should not cost so much anymore. There is some good science demonstrating that this technology can serve as an adjunct for anxiety and focus, but it’s still needs further study for the long term benefits.
Another idea is to find a go to set of apps. There are many mental health related apps these days. I cannot say I have used these personally, but here is a list of a few that sound helpful for anxiety:
- DBT Diary Card and Skills Coach, Breathe2Relax, Insight Timer, Headspace, iSleepEasy, Deep Sleep With Andrew Johnson
As always, when overwhelmed by any state of emotion or anxiety, reaching out to others, whether it be trusted friends and family, or professionals, such as therapists or crisis services is always the best option.
David Bell, LCSW-C 