Panic Attacks

People often use the word panic to mean the same as anxiety. But in my world, the 2 are separated so as to ensure people get the right sort of therapy.

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And hello to you, and welcome to the Richard Nicholls podcast, the personal development podcast series that's here to help inspire, educate, and motivate you to be the best you can be. I'm psychotherapist Richard Nicholls, and today you'll learn all about panic attacks. And if you are ready, we'll start the show. Hello people. How are you all? Good. Bad? Somewhere in the middle. Little bit of both depending on the minute? Yeah, same. I heard somebody recently describe themselves as being a bit bipolar because of that. Which is not what bipolar disorder is, and I often feel a bit protective about language, specifically about how we use clinical language in everyday speech and why it matters a bit more than just being pedantic about words. Because, I am slightly pedantic about words, I'll be upfront about that. But there's a reason for it that's more useful than me just liking to be right. And the reason is this, when we use clinical terms casually to describe just any version of a thing, we end up without a word for the actual clinical thing, which means people who are experiencing the clinical thing struggle to name it, describe it, get help for it, or even recognise that what they're going through is real and has got a name. Now I'm just as guilty as anybody else of using words in the wrong context. I was genuinely talking to a mate last week about the fact I hadn't realised just how close it was to the first of the month and said I had a bit of a panic attack because I didn't know what I was gonna talk about in this episode, which then gave me something to talk about. Because I wasn't having a panic attack about it was I? But panic attack has become a phrase that people use to describe feeling really anxious or really stressed, which I understand. Language drifts and that's generally fine. But panic disorder is something quite specific and quite different from anxiety. And those two things need working with in different ways. So if we're calling both of them panic attacks, It can make it a lot harder to figure out what's actually going on for you and what might actually help. So anxiety first. Anxiety always has a source, even when it feels like it's coming from everywhere at once, even when it's spread itself across your entire life so that it feels that everything is vaguely threatening and nothing feels safe, it still has a root. That root is either cognitive, meaning it comes from the content of your thoughts, the rumination, the catastrophising, the mental rehearsal of everything that could go wrong. Or it's personality based, meaning it comes from the way that you developed. The patterns you learned early on about whether the world was safe and whether you were okay in it. Either way, there's something underpinning it that with the right support you can get to. Panic disorder is different, not in terms of how much it matters or how much it affects your life. 'cause both anxiety and panic can absolutely floor you. But in terms of where it's coming from. Panic attacks aren't primarily psychological. They're neurological. They're what happens when the neurons that are supposed to fire only in response to genuine mortal danger fire anyway, in a context that's completely safe. It's the brain's threat detection system misfiring. And if you've ever been sitting quietly having a perfectly decent time cup of tea in your hand. Maybe listening to how nice the bird song sounds outside, feeling genuinely peaceful. And then completely outta nowhere, your entire nervous system has decided that you're falling out of a plane without a parachute. You'll know exactly what I mean. That's not anxiety. That's something much more visceral, much more physical than that. 'cause the physical experience of a panic attack is unlike almost anything else. The heart rate shoots up fast enough that people genuinely believe they're having a heart attack. The chest gets tight. The hands and face can start to tingle. Vision can narrow or blur, your breathing goes haywire. And then there's the dissociation, which is where it gets genuinely frightening for a lot of people. That sense of suddenly being not quite inside your own body, of looking at your hands and them not feeling like your hands. Of the world feeling slightly unreal and distant. That combination of physical symptoms and that weird untethered feeling is what makes panic disorder so distinctively awful and so different to garden variety anxiety. If you've experienced it, you'll recognise that description immediately, and if you haven't, it's quite hard to explain, but that's why people who've had panic attacks sometimes find it so hard to convince others of how bad it actually was. 'Cause on the outside? Sometimes you can't even tell. And that's 'cause we often forget about one of the other options in the fight or flight response. We talk about fight and flight all the time, but freeze gets left out and freeze is actually incredibly common in panic disorder. Some people experience a panic attack and become completely still, blank faced. They're not pacing about, they're not hyperventilating noticeably anyway. They're just sitting there while their entire inner world is falling apart. Which is isolating in its own way. 'cause the people around you might not have any idea that anything is wrong. Whereas with anxiety there are often more visible signs. The fidgeting, the pacing about the hand wringing, that sort of thing. Panic can be almost invisible from the outside. Something else worth mentioning, 'cause I don't think it gets talked about enough, is nocturnal panic attacks. Some people have their worst ones at night, waking them out of a dead sleep. And that is a particularly specific kind of horrible because there's no context for it at all. You go from asleep to suddenly your body is in full emergency mode with no idea why. No event to point to. Nothing. And of course then you can become afraid to go to sleep, which is a whole extra layer of misery on top of everything else. Now the thing that panic disorder and anxiety do share is that avoidance makes both of them worse. And there's a very specific version of this that really takes hold in panic disorder, which is anticipatory anxiety. The fear of having another panic attack. 'cause once you've had one, especially if it came outta nowhere, part of your brain files that away as evidence that at any moment without warning, your body can turn against you. So you start monitoring yourself. You start watching for the early signs, which means you're slightly on edge all the time, which means your nervous system is slightly activated all the time, which means you're more likely to tip into another one, which makes you more afraid. And round and round it goes, and you end up anxious about the anxiety, which is about as fun as it sounds. The panic disorder creates anxiety, the anxiety feeds the panic disorder and the whole thing becomes a self-sustaining loop that can feel completely impossible to break out of. Understanding that that loop exists is actually really useful in itself. 'Cause it starts to explain why simply avoiding the situations where you've had a panic attack in the past doesn't make the problem go away. Avoidance teaches your brain that those situations are genuinely dangerous, which turns the volume up rather than down. That's not a moral failing, that's just how machinery works. And it happens to basically everyone who has panic disorder, you're not doing anything wrong, you're just doing the very human thing of trying to feel safer. And unfortunately in this context it backfires. When it comes to treating it, the biggest part of the work is making sense of where this has come from, what's underneath it. And ideally that happens with a therapist. If there's also trauma in the picture, and quite often there is, then that needs particular care. 'cause the brain doesn't reliably separate remembering a trauma from re-experiencing it, which is why good trauma therapists move at your pace. We don't push. If you've had therapy that felt like it made things worse, it might be worth considering whether the pace was right for where you were at the time. Anyway, that's a whole other conversation. What I wanna spend a bit of time on is what can actually help in the moment. And I wanna be honest with you about breathing exercises here, because they get promoted as the go-to solution for panic attacks. And I think that can actually backfire sometimes. Now breathing exercises are genuinely useful. Please don't stop doing them. But they are unlikely to stop a panic attack once it's properly underway. And the problem is people are often told that they will. So when they do the deep breathing and the panic attack doesn't immediately end, they feel more helpless, more like nothing is ever gonna work for them. More like they're beyond help, which is the last thing you need in the middle of a panic attack. So yeah, do the breathing, it's a good idea. It's gonna help to oxygenate your blood and send a signal to your nervous system that you're trying to be okay. But don't expect it to be an off switch 'cause it probably isn't one and that's normal. And while we're on coping strategies, there's something I do wanna flag because it catches a lot of people out, which is the difference between strategies that genuinely help and strategies that accidentally make the problem worse over time. And the reason this matters is that some of the things that feel like they're helping in the short term are actually what we'd call escape behaviours. Things that teach your brain that the panic attack was a threat that needed to be escaped from, which reinforces the idea that panic attacks are dangerous, which turns the volume up. It's the same mechanism as avoidance just in a smaller form. So for some people always needing to have a water bottle on them, for example, 'cause it helps them manage in the moment, that can become a safety blanket that actually keeps the anxiety alive. The water bottle stops being a coping tool and starts being a reminder that something might go wrong. And before long, you're sitting in A and E carpark just in case. With your water bottle, not going anywhere without it. And your world has got a little bit smaller. Now, I'm not saying don't have a water bottle or whatever. What I'm saying is it's worth noticing whether your coping strategies are helping you move towards life or helping you stay slightly away from it. For some people, the answer to that is actually to learn to sit with a panic attack and experience it rather than immediately trying to manage it out of existence. And I know that sounds counterintuitive, but for a certain group of people, it can genuinely reduce the fear of them over time. Sitting with it is not for everyone, but it's worth knowing that it's an approach that exists. One of the most useful things you can do in a panic attack though, is ground yourself. And what I mean by that is quite literally remind your body and your brain of where you actually are. You are here in your kitchen or your office or on the bus, whatever, and you are safe. Physically engaging with your environment helps with this because it bypasses the thinking brain, talks directly to the body. So sitting down on the floor, pressing your palms flat against it maybe. Running your hands along a surface and actually paying attention to the texture of it. Rubbing your thighs, stretching out your legs, splashing cold water on your face or your wrists. These things work because sensation pulls you back into your body and back into the present, which is the opposite of what dissociation was doing. And if you need some sort of calming activity, then do it. Doodling is a good one. What I used to do when I was a kid was tap loads of random dots onto a blank page and then join them up and make some weird geometric shapes and then shade them in. These sorts of things really can help. Honestly. There is a reason why colouring books are still popular with adults, and I know they are because if you are a patron of mine on Patreon, then part of your pledge goes to funding care packages for people with panic disorder and anxiety and colouring books are a common request. So, if you are a patron of mine on Patreon, thank you again, by the way. You are genuinely making a significant difference to the world supporting the show. Honestly. You genuinely are. And I often forget to tell everybody that. Anyway. Another childish thing you can do that I know helps for some, is playing with fart putty. You know that silly putty that's squishy. You push your fingers into it and it pushes air in, makes a fart noise. I guess it depends on your sense of humour, but I've known lots of folk who have found the benefit in pulling that out of a drawer when they need a distraction. I guess there's a time and a place for that. Maybe sitting at your work desk in an office is probably not recommended. I mean, I suppose you could take it to the toilet, but I'm not sure it's gonna make you feel better using it there either actually, maybe that's a very unique one. Although, you know, there is plain old silly puty isn't there? That doesn't fart at you. Because the key to these things is engaging your senses and the kinesthetic sense of feeling something is a big one. Works with pets as well. If you're at home stroking an animal, is brilliant for this. Weirdly calming in a very primal way. The mental side of grounding is less about taking yourself off to a peaceful beach. More about neutral imagery because for some people with panic disorder, imagining somewhere calm and safe can actually sometimes trigger more anxiety. 'cause the brain has learned to associate comfort with vulnerability. So for some, instead of a peaceful beach, you might need to try something boring and just mentally walk around the supermarket, picture the layout of a room that you know well. Just think about your commute to work. Something that's neutral with no emotion attached. Something that's just familiar. And the most important thing to remember, especially if you are new to all of this, is that every single panic attack ends. Every one. No one has ever had a panic attack that didn't stop. It might take a while. It might pass like a kidney stone to put it delicately, but it will pass. Your job in the moment isn't to fix it or stop it. It's just to get through it and let your nervous system do what it needs to do and then settle back down, and that knowledge alone that this will end, that can take the edge off the fear enough to make it a bit more bearable each time. Anyway, if you want to go deeper on this sort of stuff, I've got a whole anxiety playlist over on Patreon with some of the best episodes I've made on the subject all collected together, and I'll add this one onto it once it's up. There's some good stuff on there. I'm quite proud of it actually. Right. I'd best be off for now. Have a great month. Take care of yourselves and I'll speak to you again very soon. Bye folks.