Panic Answers

Hi Eli,  Thanks for asking this question! Cognitive behavioral therapy (CBT) can help you feel better about flying and get help with your claustrophobia. As with all therapy, it will take some hard work on your end but it will be worth it in the long run.  As humans, so many of our thoughts and behaviors are based on feelings and our feelings based on thoughts and behaviors. It is likely that your fear of small spaces and of flying is based on thoughts that you are having. CBT will help you to reframe those thoughts into more helpful ones. When you are flying, if you are thinking things like "wow! it's so beautiful to look out the window" or "I am so excited to get where I am going!", you are going to have much more positive feelings than if you are thinking about the small space and other flying related fears. I know, easier said than done! The part to remember is that it can be done.  Most fears can be lessened if we think about them differently. Another helpful thing that CBT can help you with is to look at the facts. For example; how many planes are flying each day? How many of these end up in life threatening situations? Focus on those facts. Of course there is always a chance for negative things to happen in any aspect of life but many of those things are out of our control. We have to focus on those things that we can control. That does seem to be what you are doing by asking this question! You are trying to find a way to take control of your thoughts, which will in turn take control of your feelings and your behaviors. From my perspective, that is what CBT gives us; control of ourselves. It is wonderful to have control of your thoughts, feelings, and behaviors. This can give you better control of your life and can lead to things being in your favor more frequently. A branch of cognitive behavioral therapy, DBT, tells us that the less we allow our emotional minds to take over and gain the ability to rely on logic and emotions together, the more informed and appropriate decisions we will make.  I wish you the best with this!  -Melissa

Thanks for reaching out for advice regarding this matter. Anxiety can be a healthy emotion, it forces us to focus on our problems, and work hard to solve them. But sometimes, anxiety grows out of control, and does just the opposite. It paralyzes our ability to solve problems. When this happens, irrational thoughts often play a role. First of all, it is important to know that anxiety is something that everyone experiences from time to time, but for some people, it can be extensive and excessive. Whenever a person has something that is considered a stressor, whether a real or imagined threat, they sometimes begin to have symptoms of anxiety or panic. I think it is important for you to investigate your feelings around the anxiousness. What is the root of your anxiety, Who benefits from your anxiousness, How does it serve you? It is important to be more mindful of your irrational thoughts. With enough practice, this will become a natural process that can help you manage anxiety. You mentioned that entering a meeting, meeting someone, travel, or anything big triggers your anxiety. Anxiety distorts our thinking by causing us to overestimate the likelihood of something going wrong, and imagine the potential consequences as worse than they really are. Sometimes, just taking a moment to think about these facts can help us recognize our irrational thoughts. For example, what would be the worst, best, and less likely outcomes, and if the worst case scenario happened would it matter in a week, month or a year from now. Please note that negative thinking, avoidance, distorted or biased thinking, and selective memory and attention causes anxiety.  Some of the ways to overcome anxiety is acceptance. For example, using the acceptance-based approach can be very beneficial. (identifying the thought, labeling it, be aware of the moment when the thought comes up, and being aware of the moment when the thought begins to recede from awareness) Another way to overcome anxiety is questioning. Using cognitive restructuring offers a way to critically evaluate potentially distorted thoughts.  Exposure is another way to overcome anxiety. Leaning into anxiety rather than avoiding it but confronting situations help to ease your anxiousness and to show that bad outcomes can still be manageable and even have an upside.  In addition, nutrition is a helpful way to overcome anxiety.  Research shows that anxiety levels can be impacted by the kinds of foods and drinks we consume. For example those who consume more saturated fats and added sugars have high anxiety levels than those with lower consumptions of saturated fats and added sugars. Eating fruits and vegetables and foods high in fiber with limited processed foods improves mood and helps with managing depression and anxiety. However, caffeine can increase your anxiety levels. Moreover, physical exercise if nothing but moving your body for 10 minutes is helpful for anxiety, this helps to improve your mood. Also, mindfulness is very helpful with addressing anxiety, some examples are:  meditation, deep-breathing, and progressive-muscle relaxations. Lastly, connecting with nature can be very important with managning anxiety. Studies show that using any of the five senses to feel closer in nature can boost your mood and put you in a more relaxed state. I hope these resources and coping strategies will be helpful for you. Best wishes to you!!

Thank you for reaching out with a question regarding how you can manage your life with less anxiety.  You say that it is crippling anxiety which is making life so difficult for you at this time.  The good news is that there is specific therapy to support healing from anxiety, called Cognitive Behavior Therapy(CBT). This alongside a counselor who really listens and hears you can promote effective healing. One of the ways that CBT helps is by challenging your thinking around the anxious thoughts. For example; What is the best that can happen? What is the worst that can happen? What is the most likely thing to happen? With a therapist you can explore this 'real time' around your own specific anxiety or worry. We can look at all of the potential outcomes and sometimes even if the 'worst' thing happens it may not be as bad as you think.  We would really explore the options and help you to recognize that with time, and challenge you can start to feel less anxious and more accepting. There are many messages given to us throughout life and some include,'be perfect', 'success is the only option'. These can be debilitating and harmful when given with pressure to get it right every time. These messages are unrealistic to believe in as a life goal.  Yes, you can succeed but in order to succeed you need to learn from your mistakes.  Everybody makes mistakes. I wonder why you are feeling anxious about making a mistake? If this was your best friend what would you say to them? Starting with challenging the smaller anxieties, then building on this will give you the tools to heal. It sounds like you have been feeling anxious for such a long time that your amygdala is in overdrive and triggering your threat response inappropriately. Understanding how the chemistry of the brain and how that influences anxiety responses may be helpful for you alongside some brain retraining with CBT and non judgemental support. It will take time but if you are willing to trust the process and do the work then you can heal.  I am sending you kind thoughts and hope that you are able to connect with a therapist that you can trust and works well with you towards healing. Kindest regards Barbara Lorusso MBACP

There are several ways to deal with anxiety-provoking thoughts. One is to practice Grounding Techniques to distract yourself. Another one is to confront your worries by using Cognitive Behavioral Restructuring Techniques.  The Grounding Techniques can include the 5-4-3-2-1 technique or engaging all of your 5 senses by answering the following questions: What are 5 things you can see? What are 4 things you can feel? What are 3 things you can hear? What are 2 things you can smell? What is 1 thing you can taste? Go slowly through the process of really describing the things you can see in detail, paying attention to what you can smell and hear. Be in the moment. By shifting your attention to the here and now, your anxiety will go down. The second option is to analyze the Negative Automatic Thoughts that you have. Catastrophizing and Emotional Reasoning are symptoms of anxiety. You can lower your anxiety by learning how to restructure your negative irrational thoughts or cognitive distortions. It takes time to learn the techniques which is why being in therapy can be helpful. Another way to deal with anxiety is to do breathing exercises. When we are anxious we don't breathe right. We may start panting. It prevents our bodies from receiving the amount of oxygen necessary for proper functioning. We may start feeling dizzy or experiencing a Panic Attack. It is important to remember to start taking deep breaths or diaphragm breathes. You can count to one, two, three to breathe in, hold, and count one, two, three to breathe out. Repeat it several times. Your anxiety will lower.  You can challenge your irrational thoughts by using questioning techniques. Are my thoughts based on facts or feelings? How would my best friend see the situation? How likely is it that my fear will come true? What is most likely to happen? It would be helpful to analyze in therapy the family of origin dynamics. In many cases, people have both genetic predispositions to anxiety and also learn from their parents if the world is perceived as a safe or a dangerous place. By observing their parents and how they react to different situations, children learn how to respond to them. In severe anxiety cases using medication together with therapy can be the best way to lower the anxiety.

There's no such thing as feeling an emotion for no reason. Our feelings are always valid and, with enough care and concern, explainable. Having a daughter can be a scary thing indeed, leaving the hospital in particular as you mentioned. This anxiety may indicate an insecurity around your preparation to be a mother. Feeling unprepared or ignorant about the journey of motherhood you were embarking on at that time potentially brought up some other issues you have been dealing with. Understanding that anxiety around preparation may indicate insecurity, we must ask a fundamental question: who is supposed to teach us core values around being prepared? Our parents! The difficulties we have as parents raising our children are a reflection of the difficulties our parents had raising us. Thinking about what themes in life your parents still to this day struggle with will assist you in identifying what work you may still have left to do in your own life. The same can be said about getting a job. Were you taught or shown ever how to create a resume, submit one, job etiquette, etc? If so, I wonder what type of grit and commitment landing a job can take or confidence building instruction did you receive. These blindsides won't just be present in how we struggle to find work, or relate to family, it may even be present in how we make friends as well. A feeling of preparedness is essential to healthily executing all things. A lack of preparation can easily stand in the way of productivity. Knowing that you aren't a terrible person, dumb, stupid, blameworthy, etc. at your lack of knowledge is the first step. Forgiving yourself for believing that you should know things when you were never shown in the first place is imperative. Doing so will begin to establish behavior that not even your parents potentially can/could do. This is how you know you are breaking a cycle. Any time you are actualizing your life in a way those before you still struggle to is proof of you developing your own unique expression of how to get things done. 

What Changed? What do you notice is being affected by the pressures at work? Why now, and why are you letting it bother you more now than in the past? The type of work or money you make, has that changed? It isn't always the immediate circumstance that affects us, but what that reminds us of, or what is triggered inside. For example, if you notice that you are feeling pressured to keep this new job because it pays so well, that can add to the pressure of the work and the fear of the manager. Or, let's say you have troubles at home; then yes, there would be more pressure to make a name for yourself at this new, and less established place. Ask yourself, what is work triggering in me that may have already been there? Or what else is going on putting more pressure on work?  Inadequacy, in general, is a topic worth addressing when it comes to workplace anxiety. If we have an inadequacy, then there can be more pressure to perform at our jobs as a way to overcompensate. With our work quality, recognition leads to promotion, which to an inadequate person will validate us and make us finally feel safe. However, the mind tries to tell you; you are OK, but it will not be OK unless you make peace with all parts of yourself.  Now, I am basing this next topic on an assumption of inadequacy; however, in my clinical experience, this is a common theme among people who struggle at work. When the pressure is so significant that we have physical ailments, then we know something deep inside is being triggered; we are being threatened at a vulnerable state. Your job could be what you attach to in providing your identity and your reassurance. So then, the job isn't what matters, but what it does to bolster the self-conscious. Remember, your job hat is just one hat you wear, not your entirety. Being defined by any one thing is setting you up for failure, especially on a bad day at work, or feeling new and inadequate at your qualify of work.  Work on noticing thoughts that get you anxious. Notice that you have thoughts and that these are provoked at times in life or at work. Now, as I stated before, the context makes incidents more significant. So then, it is important to note not just the immediate situation, but what else is going on in life. What else are you experiencing that is causing you to feel such pressure? Then, notice your thoughts and how they are getting your attention. Often I hear people say things like, "I can't leave this job."  This is usually followed by "I need the money" or "this is temporary on the road to something greater." Yet, we are willing to put our body in a health detriment in service to a career? That shows too much identity, attachment, and reliance on a job and money to make our life happy. That thought/belief is cancer, and it is what you can address by distancing from thoughts while in the moment at work.  First step: Notice your thoughts, and what they reveal about you. If you decide to work with a therapist, make sure the topic stays on what you notice, and what you are experiencing, and articulate the abstract in your mind. Do not do or fix anything; notice thoughts and allow them to exist. This will remind you that you have thoughts and that you don't have to act on these thoughts. You have emotions, but you don't need to fix them or get away from them either. Let it all be without fixing or attending to all things.  Anxiety is a part of life; it doesn't go away. Accept it, work with it, and the pressure to rid yourself of it will dissipate.

Our bodies are built with the capacity to function by automatically managing itself.  For example, you breathe faster when your body demands more oxygen in response to physical acceleration (heart beating faster) or chemical changes. You do not have to actively tell your body to do these things, thus they are automatic.  Many of the chemicals in your body are in place to help you be safe (for example, if you were in a dangerous situation, your body would release chemicals that help you to escape from that dangerous situation). Some chemical changes in your body may influence your heart rate.  These chemical changes may be a part of what is occurring as you prepare to rest.  Many times, the concerns that we have as we prepare to rest elevate these chemicals and our alertness is impacted.   Many people who have experienced panic attacks express that they become anxious or worried when they consider the potential of having another panic event. It is normal for these feelings to arrive from time to time.  Thinking about the example above, your body sometimes may 'feel unsafe' and produce chemicals to help you get to safety even when there is nothing actually threatening you. The majority of our human behaviors are developed over time and become habits.  I like to think about it like sports professionals who have worked really hard to perform well.  They developed habits over time and created "muscle memory" to respond to the challenges of the game.  We have to actively (instead of automatically) develop new "muscle memory" create new habits.  What would creating new habits in "muscle memory" have to do with having panic attacks (at night)? The truth is that behavior starts with thinking.  By that I mean that before we behave in any way, we think about it first and that thought leads to a behavior.  For example, I was walking into a building today that was new for me and felt some anxiety about being in a new location. In order to keep myself from feeling out of place, I avoided eye contact with people I was encountering.  I asked myself why I did that after the fact and found that I was likely feeling uncertain about this new setting and keeping my sense of self by not making much eye contact until I felt more comfortable.  What I learned from that is that I thought about feeling uncertain first and then acted accordingly.  I now have to choose to be more aware of my thoughts and actively choose different behaviors. Some things I would recommend in order to prepare yourself for rest is to practice good sleep hygiene by turning off electronics early, reducing the need to respond to emails or texts, reducing food, drink, and caffeine consumption to an earlier time in the day to prevent these from influencing your ability to rest, and practicing Passive Progressive Muscle Relaxation (link to a script on our partner site TherapistAid https://www.therapistaid.com/worksheets/progressive-muscle-relaxation-script).  As you actively do these things, you create "muscle memory" for feeling at ease automatically and experiencing a feeling of being in control and safe.  Remind yourself that you are safe and practice experiencing the things around you that are real to bring yourself to the present. 

Fear and Panic Your fear makes sense because what you are fearing is the loss of something really important to you. Fear itself isn't bad; it's a reminder to appreciate the finiteness of a relationship or being at peace and therefore being present in situations you want to be present at. Fear is a natural part of life and, quite honestly, may be one of the most significant feelings we have because it has kept us alive throughout human existence. It is peace we have had to learn because if we are at peace when things aren't peaceful, we make decisions and put ourselves at risk for harm. Your fears come from somewhere. A caring place, but also a place that says you won't be able to handle it if people aren't there anymore and you are left to cope. Fear says you can't handle it, so we must prepare ourselves and anticipate people's loss. Panic then is right behind the fear because the panic is the fear expanded on. Panic is now reacting to fear, whether or not we know what that fear is. You acknowledge that you fear things, and I acknowledged earlier it's not necessarily the loss of the people, but you fear the pain associated with the loss as though you couldn't handle it. Therefore, panic is a reaction to fear and being in such a helpless state that you don't know what to do.  The subconscious part of our brain, for the sake of this conversation, the amygdala, picks up information from the environment. Our subconscious then determines our fight or flight response and communicates with the limbic system. So, your body, subconsciously, can be in fight or flight mode while your head, your prefrontal cortex, the part of you that is rational and contains your personality, says everything is OK. You have the body noticing something worth getting excited about and your conscious mind not noticing it. These two battling then can cause something like a panic attack. Then we add the fear in our conscious mind that we will experience a panic attack again, and then any warning sign sets us off or worries us that we will be debilitated again.  All of this is to say that what you fear and why you experience panic is because you don't believe you can tolerate the intense emotions associated with something like the loss of a loved one or life in general. Often, when we experience something in life, it's not as intense or "bad" as we thought it might be. Instead, when we are in a moment of loss, though it still hurts, often it doesn't hurt as intensely or in the way we assumed. This is why we have to recognize that we have thoughts, yes, loved ones will die and could die sooner than later. But it is recognizing these thoughts and separating from them that will allow us to find peace.  When you wake up, you have a thought, a judgment, a predictive assessment about the day possibly. You have something going on in your head that I want you to be aware of and start to acknowledge as though you would a person. Your anxiety or fear, or panic can be identified as a suggestion. like a friend with bad advice. Though emotions exist in the abstract, our job is to personify them and talk to them like you would a friend. Anxiety shows up and tells you to be ready for this or that because it's going to be bad. You then can say, "thank you, anxiety for that message, I will consider it." The same goes for anger, sadness, or worry. You can stop from engaging the thoughts as though they are the law of your being and start to sit with them long enough to respect where they are coming from.  The more we learn how to sit with our thoughts and fear, the more we separate from them. Yes, thoughts will always exist. Yes, once you have a panic attack, you are then vulnerable for more. Yes, our memory will be triggered from events in the environment that we don't have control over, yet we can control our reaction to the environment. Sit with what your mind says you fear and realize it is coming from a place that is trying to prepare you for pain. Acknowledge the thoughts, don't remedy or deny, or indulge the belief that your life will be better without the thoughts.  Acknowledge the thoughts. Don't change, judge or alter. Just allow yourself the space to sit with them. A therapist can offer feedback based on what they notice, and you then can hear this feedback and either choose to indulge the fear as though you believe you have to, or you can separate from them, all the while noticing they exist. It's your choice. 

Panic Something caused you to respond this way, most likely triggered by something in your environment. What are you noticing concerning stress? Are there any recent stressors you can think of, loss of job, a relationship ending, death, or disease? What are you noticing about what you have experienced stress and anxiety for? You said you had counseling three years ago; I can assume for the same thing. Either way, what did you learn then about anxiety, stress, and how to cope?  Your thoughts are what tend to lead you into and out of anxiety. Unfortunately, our awareness of what is happening is not always spot on. Our subconscious brain always picks up information from the environment, and it is from there that you might be experiencing triggers to an anxiety attack. Is the weather different, a different living situation, a different smell, a person at work, or anything? Remember when you started the panic attack and what you were scared of? Your body is in overdrive, a fight or flight when you experience panic. Panic is an intense situation where all our mental and physical energy are prepared for battle, running, or freezing so we don't get caught. Your digestion loses functioning when you are in a state of panic. Your mind takes a while to get back centered afterward. You were triggered by something and now acknowledge that you do not have control, which could be very scary to admit.  When it comes to counseling sessions, make sure you talk about what you notice and hear your thoughts and beliefs. The clinician should be good about noticing patterns and identifying underlying beliefs made relevant because of your life choices. You are always working in service to the beliefs you hold about yourself and others, but that is usually in the subconscious and something that would be hard for you to notice. It's why you involve someone else in your life to give you that feedback. Panic is an extreme form of acknowledgment that things are not going well and that you have no control, and now your body fears the inevitable, so it shuts down. The body does not choose to shut down necessarily but is like a computer whose CPU is full; it will just crash.  Coping skills, breathing, staying mindful about where your mind is at and what you are thinking about. Stay aware of early warning signs of an attack so you can avoid or apply coping skills. You can call to attention what lies in the past, being brought forth today. When the subconscious notices something that triggers the panic, your body acts as though it is in a familiar situation where you feel out of control or not having control. You see, if there are any instances of trauma in life, how prevalent panic attacks are because it is tough to pull your body away from something we weren't even aware of. Noticing the early warning signs can help pinpoint what you noticed and then understand that panic or lashing out was to try and keep you safe.  The mind is a funny thing, but it should be respected. You form beliefs and perform actions every day that are subconscious. Stress, anxiety, and panic tell you you are not safe and that you must react. This might not be true, so that belief doesn't work for you anymore. However, you need to practice distress tolerance skills, mindfulness, and body scan exercises and talk about it to understand that what is happening has a purpose; you are just trying to figure out why. To hope that this goes away or doesn't interfere anymore is a waste. Instead, get to know yourself, your mind, what scares you, and what is happening; therefore, you can better handle yourself when feeling a certain way. 

You Sit With It Karen, you learn to sit with what is the most painful because it is a part of you and something that doesn't disappear because we want it to. When we learn to sit with pain and discomfort, we learn a lot about ourselves and what affects us. When we avoid pain and indulge in a remedy or way of thinking, that teaches us that there are alternative ways to help, and this is a cancerous belief because these thoughts, the way you think, they don't go away. So holding out for hope that they will dissolve causes you to experience defeat constantly. The reality of thoughts and emotions triggered by thoughts and then the belief that we can remedy this is that it is inevitable.  Here's a way to dismantle troubling thoughts. Notice them. Look right at the next scary thought you have and ask it something. Treat your thought like you would facing a scary monster who has come to take your life. Stand up, look right at it and ask, "what do you want?" When you face the thoughts that tell you to look away and ask what they want, you are acknowledging their existence and no longer allowing them to pressure you by threatening you. Ask them what do you want. Treat the thoughts and, therefore, your mind that feeds you the thought, as a person. Treat the thought as a friend with bad advice because that is exactly what your most troubling thoughts intend.  Your thoughts are what happened in life through some experience. Something created what could not have been created had you not had the material to create the thought. You can only create new thoughts and ideas with pieces of old ones, such as a purple frog (you may have never seen one but can imagine one). So, these thoughts are troubling and usually tell us stuff about ourselves that we think we need to remedy. We then waste our life trying to do exactly that, remedy our troubling thoughts and ruin our entire life doing it.  No, notice you have thoughts. You are not your thoughts. Notice the thoughts come from somewhere and that they have a purpose. Get accustomed to the thoughts and ask them what they expect you to do. Do self-defeating thoughts tell you not to try, that you will fail? If so, then that is the mind telling you to stay safe and avoid pain. You have to accept these thoughts exist and that they are inevitable to have some peace with them. Once you notice a thought, you can choose to indulge it, or you can choose to not. Either way, once you notice something and practice noticing it, and realize that your mind is trying to convince you to act from that thought, you are back in control and can experience peace without all the hope of the thoughts going away.  A therapist is someone who can walk through this with you, but it is your journey as to how you make sense of thoughts and what you do when they talk to you like they have.  An example below:  https://youtube.com/watch?v=z-wyaP6xXwE&si=EnSIkaIECMiOmarE 

Hello, First, that's painful to be experiencing- both the physical and mental aspects of it and it makes sense that you would be considering therapy now. I'll do my best to setup a guide for you on how to start to work on it and hopefully help you on the path to reducing or eliminating these sadness and anxious symptoms that seem quite powerful. One thing that I like to start with is giving you a tool that helps with reducing the onset of the symptoms through reducing the vulnerability to the physical symptoms. One way to do this is Tip Your Temperature. It's a skill where you can use a bowl of cold water or ice pack and can "dip" your head into the water to kick in your parasympathetic nervous system or the system that calms your body. If you're using an ice pack you would hold it up to your forehead and lean you head forward like you're diving into water or bobbing for an apple in water while holding your breath for up to 30 seconds. The reason why it's important to do something like this is that you're calming your body instantly so your mind can catch up. It would be like we need to treat a cut with a band aid, rather than ignore it and continue to do whatever it is that you were doing. Other ways you can do this is put your head in snow, drink ice water, put a cold ice pack on your neck, put an ice cube up on your neck, etc.- you can be savvy about this part. The next area would be starting to notice when sadness hits for you- it does sound very intense and what we can do is often take the "shock" out of it. If I notice it comes from feeling sadness or when you think about something, do something, then it can be helpful to notice that and that you'll likely experience these intense symptoms. I will say something like, "don't be surprised when an emotion hits, if you notice a pattern or know the feeling here." This can be helpful with noticing what the other experience looks like without the added element of surprise- which often makes things 10x's worse. One more idea I have that is usually very helpful when anxiety and depressed or sad feelings hit quick is to use a technique called square breathing. Square breathing is keeping in mind the look of a box and counting to 4 with each step. The steps are 1) breath in for 4 seconds (with your nose/ this is optional). 2) Hold your breath for 4 seconds. 3) breath out of your mouth for 4 seconds (make a whoosh, if needed) 4. Let your breath sit for 4 seconds. Now repeat this for a few minutes and continue to do as needed. This is often very helpful for panic and anxiety attacks and usually a primary treatment method for those areas as an important skill. I hope these 3 ideas give you a start and I can understand how debilitating things can feel and if you need help, feel free to reach out here or through BetterHelp. I hope you get on the path to the healing you're looking for and I think it's courageous for you to reach out as well. Take Care, Mitchell Daas, MA, LPCC

Helpless but not hopeless I am going to attach a link to the bottom of this response that I will encompass a concept that you might find beneficial. What you are going through is a disconnect. Your body is experiencing something different than reality. Your body is saying something is wrong, but your mind knows it isn't. By your mind, I mean your conscious awareness of what is happening. Your subconscious, your body, is picking up information from your environment and telling you that something is dangerous. What is your environment telling you?  What is outside that you are fearing will happen? Ask your mind this and see what you come up with. Panic at the level you are referring to is often left ominous, and when we try to quantify exactly what is going on, we find that it breaks some of the facades of the fear. Panic is your response to something that you aren't even sure what it is, which is why it makes no sense to our logical mind. Panic attacks are often expressed to be feeling like dying or that you are having a heart attack. Often the way we try to beat this is to breathe and hope it passes.  In the link below, Dr. Stephen Hayes, the psychology professor who started a therapy model called ACT, talks about his own panic attacks. You'll notice towards the end of the TedTalk that he admits that panic still isn't explicitly defined, but he was triggered by a childhood memory and was now in charge of his life and that kid version of himself.  Again, what is going on when the panic attack comes on? Has there been any trauma or chaos in your life that this season, weather, or smell, can send you into this state of chaos itself, a fight or flight response that your conscious mind says doesn't understand. Your conscious mind is saying; we are safe; we are here, while the body says no, we are not. So then the conscious mind, which depends on signals from the subconscious body, tells you it is dangerous out there. You are in charge of how you approach this, but once you look panic in the eye, you realize it isn't real; it's lying to you.  Your panic is lying about the current moment, but it comes from a place that reminds you of something. Again, do the work in asking what is going on and what comes to my mind, and make panic tangible and measurable to disassemble his scary demeanor. Otherwise, you are left with "coping skills, " medications, and long periods of talk therapy sessions. Admit you have panic, do not fear or wish it away, and look at panic as it was meant to be, a warning system that has gone haywire but can be dealt with when you are willing to look at it.  https://youtube.com/watch?v=o79_gmO5ppg&si=EnSIkaIECMiOmarE  

Hello Phoebe! Thank you for you message and your question. Anxiety can be terribly uncomfortable and experiencing a loss on top of the anxiety can make it feel so much worse. No one wants to experience a loss of any kind. Unfortunately most of us cannot avoid it at some point in our lives. Here are things you can do for yourself that can help. 1. Learning how to calm down your nervous system is one thing you can do for yourself. Your nervous system gets activated by cues in the environment and this is what results in those uncomfortable anxious and panicky sensations. Learning some basic mindfulness skills such as deep breathing, nature walking, the 54321 technique, enjoying the aroma of your favorite candle, yoga, meditation, enjoying a warm shower or a bubble bath, listening to music you like, and also playing with your dog or cat if you have one. These are all techniques that help people calm their nervous systems. You could also Google the words "Dialectical Behavior Therapy" or "Mindfulness" and look for some material or even YouTube videos that demonstrate some skills that will help you to calm your nervous system. These skills do not have to take a lot of time and they are not difficult. They just require a little bit of practice so you can apply them when you need them. 2. Self-Compassion. So you have experienced a loss and this is a time to show yourself self compassion and not beat yourself up over what may or may not have happened. This is a good time to perhaps write about your feelings about your break-up. Writing things on paper helps to get those thoughts out of your head which helps to reduce the intensity of the feelings. Try not to judge the fact that you have anxiety and panic -- or for that matter any feelings. Feelings are completely normal. Although they can be uncomfortable, they are perfectly normal. They will pass -- but usually not on our time table! We would like them to go away faster. This is the reason to practice the skills from number 1 -- to help you tolerate those feelings a little better. So writing in a journal or a notebook, or just talking to a friend will help you tolerate those feelings a little better. 3. Another technique is called Radical Acceptance. You could Google that as well. It simply means that you acknowledge the facts of what has happened without judgment. You acknowledge the feelings associated with what has happened without judgment. And then you resist the urge to add what we call a "narrative" which is typically a story about what has happened and generally is based on our perception of what has happened and not necessarily the facts. So the narrative frequently sounds like, "This is awful." "I can't stand this." "This was awful and so unfair." "I don't know what I ever did to deserve this." So essentially it is our spin on what has happened even if there really is no basis in fact for our spin. The narrative tends to make us feel much worse. The idea is to be willing to simply acknowledge that this thing has happened and we are not happy about it. At the same time, we know that we will get through this and we then turn our attention to our values and we align our behavior in the moment to our values. So in spite of how we feel, we are still willing to act according and in line with our values. Not suggesting that this is easy. You can find some videos about radical acceptance on YouTube. While it can be hard to do, it is also a very helpful tool when dealing with something very unpleasant. When we are able and willing to utilize radical acceptance, it is like lifting a weight from our shoulders. 4. Another path that many people do to help themselves get through a difficult time is volunteering. Sometimes the best way to feel better is to help someone else. It could be as simple as walking your neighbor's dog for them, or volunteering at a homeless shelter, or going to the grocery store for someone who is sick. You might not feel like you have the energy to help someone else but a lot of times if you just try to do something small, it will help improve your mood. I hope you are able to apply some of these ideas to help yourself. Maybe just pick one or two of the techniques and practice them.  Thank you for reading my response and I hope things improve for you soon. Judi

Free Your Mind Anxiety is something we all have. Anxiety disorder is when we notice how anxiety interrupts our social, work, or romantic lives. When we notice how anxiety affects us, we can start to do the work where it needs to be done. For example, if I have anxiety that prevents me from going out with friends, I can do the work in what I notice that doesn't allow me to do what I want/need to do.  Your situation seems to be as such because your anxiety has gotten the best of you and boiled over. How do we get our life back from the anxiety monster? We notice the monster and what it tells us about ourselves. Anxiety is the biological response to something your mind notices is worrisome. The subconscious part of your brain (which is most of your brain) is constantly picking up information. The information your brain is picking up is telling your limbic system to overreact. It benefits you not to try to stop anxiety but to learn how to live with it.  So, your subconscious mind overreacts to something, leaving you with the uncomfortable fight or flight response known as anxiety. Now anxiety communicates with your brain to produce thoughts and beliefs to get you to react. Your reaction to what fear tells you is intended to keep you safe, but now it is keeping you from living your life. So then, what do you want to do, and how is anxiety stopping you from doing it? What I mean is explicit, what thought gets the attention that prevents you from doing what you want?  Our beliefs are formed from early childhood. Our beliefs create our thoughts and emotions and then our reactions. It is often our earliest beliefs about ourselves and the world around us that we need to learn about ourselves because they often go unnoticed. To figure these things out about yourself doesn't cost anything, and it's worth your time to ask, "what do I believe here that is contributing to my problems?" Do not overlook beliefs such as the belief that you won't be happy until you rid yourself of anxiety. It is that belief that may prevent you from being happy ever. It is called a happiness trap to believe you will be happy when... So, what can you do? Identify what matters to you, identify what interferes with what matters, and do the work to challenge the thoughts anxiety produces, keeping you from the life you want. Ask yourself "why"  five times for any decision to see why it matters to you. You want to go out with friends- why Being with friends matters to you- why It's good to have relationships- why You don't like being lonely- why You want what's good-why Good people want good things.  In my example, I ultimately discovered that I want to be a good person. I want to be a good person who makes good decisions and benefits people. So then, I can find identity in my choices that I want to make the decision that would define me as "good." Nobody wants to be a "bad" person, unless of course, they see, "bad" as something their social circles promote- which to them, actually makes them "good."  Anxiety ramped up and didn't allow me to do the necessary work to identify what matters. So, it is my responsibility to work on not letting my thoughts consume me because I have things I care about. I still have the thoughts, but I do what I care about. Again, even with anxiety, you can do what you want and still experience anxiety. Do not get trapped into thinking ridding anxiety will make you happy. You can be just as "happy" now with anxiety the way it is.  Let the thoughts produced by anxiety pass. You do not have to change your life according to your thoughts. 

I am so glad you took the risk to reach out and ask for help.   Social anxiety can be so debilitating.  It definitely seems like you are limited by the anxiety you are experiencing.  Have you wondered how your life would be different if you were not so anxious of being around others?   I want you to know you are most certainly not alone.  Anxiety and depression is often considered the 'common cold' of mental health.   There are evidence-based treatments to help you reduce your anxiety and improve your ability to function around others and gain control over how you would like to feel.   Cognitive Behavioral Therapy (CBT) is a treatment that can help alleviate those symptoms. Often we tell ourselves something to produce the anxiety that we feel.  For example, I walk into a crowded store and I feel anxious and want to leave.  There is a thought that I have that informs me of what emotion I will feel.  Maybe that thought is, "If people see me they will make fun of me" or "If people talk to me they will know I'm not smart".   There can be so many 'hidden' thoughts that are distorted and truly effect how we feel.   When you learn to recognize the distorted thinking you will be able to reframe those thoughts into more rational thoughts that can then dictate a more positive emotion.  For example, you walk into a crowded store and you feel anxious, you ask yourself what you are thinking that might be producing that anxiety.  You realize you are telling yourself "If they notice me they will think I'm ugly, stupid, etc.".  That is a distorted thought.  Perhaps a more balanced and rational thought would be "I have walked into stores many times and it has often been a pleasant experience so I'm really thinking that the chances are pretty good this will be too".   That is a rather long but more rational thought that can replace the distorted thought.  The new thought can change how you feel to a more positive feeling.    It would be important to have further discussion to fully assess what treatment options would be better suited to your specific needs.   I hear you when you say you would rather stay home to be away from people.  I wonder if that gets lonely for you sometimes?  You get to define what makes you truly happy.  I want to make sure you feel heard and you gain some skills to reduce that anxiety so that you can live your best life. 

Hi Sluss - Thank you for your question. I'm Dani a licensed therapist working on the BetterHelp platform. I'm sorry to hear that you are experiencing panic attacks, that must be very difficult. It sounds like they happen to you quite often at work, when you are on your own. As a team leader it sounds like you have a lot of stress and pressure in your job, as well as a lack of support from your boss, particularly when you have had to take time off work previously from being over loaded. Panic attacks generally happen when we feel too stressed by something to cope. Our body goes into 'fight or flight' mode. As cave men and women this helped us deal with threats and danger within the environment. If a sabre-tooth tiger was stalking us, we needed to be ready to run away fast. The fight or flight mechanism can still help us stay safe now, it stops us walking out in front of cars, and teaches us to keep ourselves safe in a fight. But it's not so helpful when we are busy at work and our internal response to a threat is not in proportion to what is actually happening to us in the moment. As the stress levels increase in our body, we become flooded with Cortisol, the stress hormone. Our heart rate starts to race and our breathing quickens and we feel breathless, dizzy and like we might be about to die. It really can feel completely terrifying and like it will never end.  I'm not sure if you have seen your doctor to get the panic attacks officially diagnosed, but if you haven't I would recommend you do this. This is to make sure it is a panic attack and not another more serious health issue such as a heart condition, which might mimic the symptoms. There is also research to link panic attacks with causing heart issues, this isn't definitive yet but it definitely points to getting treatment quickly so you don't risk long term health problems. I can see you are doing a lot to help yourself by reaching out here - well done for that. Your doctor may also suggest medication to help with the panic attacks, so it could be good for you to investigate the options. Counseling can definitely help with panic attacks. I would work with you and your story. I would ask you about your experiences and how the panic attacks impact you and together we could work to understand what your particular triggers are.  This can help you to understand why you are having the attacks and can help you learn strategies to prevent them and to safeguard yourself. Work sounds like a big part of the trigger, and I wonder if you have experienced the panic attacks before, or if this is something recent? Triggers can seem obvious or sometimes they can be harder to understand. Perhaps a past trauma is resurfacing, a bit like PTSD, and your mind is struggling with a difficult memory or experience? It might even not be something that you are consciously aware of. If that does fit for your experience, I can help you work with that too.  Once you understand exactly what your particular triggers are, we can look at different techniques to help you control the feeling of panic. There are CBT resources such as managing your thinking to help stop the attacks happening or to reduce the frequency and severity. There are also many grounding and relaxation techniques that can help keep our breathing relaxed. This helps our body produce relaxing hormones, so we keep our nervous system calm. This is a natural antidote to stress and panic. I would teach you some techniques and help you find the ones that are most helpful for you.  I hope my answer is helpful. I do have space in my schedule and would be very happy to meet with you if you would like further support, you are welcome to book a session with me. Thank you for your question and I wish you the best of luck.  Warmest wishes, Dani

Hi Maria, Thank you for your message. It sounds like you are experiencing very difficult symptoms of physical anxiety at the moment. I am sure in particular the feeling of choking must be extremely distressing. And I really appreciate that you are going through a lot at the moment. The first step in seeking help is to acknowledge that we are struggling so you have begun a process by sending this message to the service. In therapy Cognitive behavioral therapy has been proven to be very effective in helping with anxiety and panic attacks. One of the things it asks us to do is focus on is which situations, times or people can cause or exacerbate feelings of panic. I think it might be helpful for you to start using a diary to try and track when these times are happening and what you where experiencing before that might have 'triggered' these feelings and bodily sensations. The next stage in cognitive behavioral therapy would then be the look how we can put the body into a calmer state and feel like we are in control or managing the fees of panic or anxiety before they get to the stage where they overwhelm us. My personal belief is that this is best done with the guidance of a therapist who can apply their techniques and skills to guide you through different exercises to help particularly with panic. Especially with the very difficult physical symptoms you are experiencing I think it you would really benefit from specialized support and a space to talk through what you are going through.  However, if that doesn't feel right for you at this time I would recommend looking at mindfulness techniques and engaging with resources you can find on YouTube which help us to connect with our body in a calm way. Practitioners such as John Kabbat-Zinn focus a lot on how to observe our thoughts in a peaceful and mindful way which means that we are less likely to become overwhelmed by them and it gives us an opportunity to see what is causing the physical aspects of your anxiety. As I said when we experience such intense symptoms it can be very hard to think about what is happening to cause this. So this exploration is best achieved when we can be in a calmer place within our body and mind. You may also find mediation practice helpful to allow you to create a place in your day which centers you mind. It also encourages deep breathing which is always helpful with anxiety. Again meditation resources can be found on YouTube or within many specialized books and resources.  I hope this reply has been helpful to you and again I would encourage you to seek out more support this is a very difficult place to be but you have taken a really important step in seeking help and I hope you will be able to continue.  Best Wishes and Take Care Lucy  

Hello, thanks for reaching out. As you may be aware, anxiety comes in many forms from social anxiety to separation anxiety to everyday general anxiety to more. Fortunately the form your anxiety takes matters less than your triggers for your anxiety, which from what you're saying, large crowds could certainly be a trigger as could public speaking.  Once you have identified your triggers it then becomes a process of management, how can you personally best manage your anxiety, because what works for one person will be different for you personally as no two people experience anxiety in the same way due to the sheer amount of symptoms that come along with anxiety. (Over 100 listed symptoms).  The reason I say management over avoidance is simply because if we avoid we are really just kicking the can down the road for later which is of course beneficial in the moment but later it's still anxiety or it's a panic attack. Management leads to still being able to live the lifestyle you want while maybe adjusting things you do or how you do them. Without knowing more context it would not be ethical of me to highlight what to do, nor would it be ethical of me to say ok do this or that, that would be best explored in the therapy space between yourself and your chosen therapist. However there are tools that can be effective for anxiety. Some involve distraction which works like a magician pulling a rabbit out of a hat in terms of a hey look over here while the thing that is triggering the anxiety is over there type of scenario. Such tools of course involve breath work, breathing in for so many seconds holding it and then breathing out, in through nose out through mouth, that one helps to get us breathing and breathing correctly because when we are anxious we tend to hold our breath which can cause an anxiety response in of itself. Some such tools involve thinking distractions, because when we are anxious we tend to start over-thinking about many subjects and we start to clutch at straws but not really get anywhere except for more anxiety. These involve things such as counting or listing and can be cars, countries, movies, objects or things from your favorite hobby and more. They work by focusing the brain on logical thought and grounding us in that one thought allowing anxiety to pass. There are also tools that engage all of your senses, seeing, hearing, smell, touch, taste, called the 5 senses technique but is essentially another way of grounding ourselves in the moment. There are also Mindfulness tools, one being a book called "I am here now" by the mindfulness project, which has a variety of activities in that if we can do either during panic attacks or anxiety or before can have a calming effect. That is a few possible options for you for dealing with it in the moment, however it cannot be underestimated of the benefit of the therapy space on getting to the bottom of why you might have anxiety and how to deal with it going forward etc. Warmest regards, Kai

Why Now?  I appreciate this question, and here's why: You are aware that something is irregular and that it started at some point to be different than it was.  Often people struggle with things, and they think that it has affected them longer than it really has, or they will apply the problem retroactively, saying it has always been there. You acknowledge that this response is to something that has been there for about a year and a half. Why now? What has changed in your life causing this reaction? Please explore this with a therapist, as they can help you see things you can't see yourself.  One question I like to ask is, what are you noticing about your world and yourself in this world? Are you vulnerable? Are you only loved when you perform, and you've had some setbacks recently? What have you become aware of that you weren't before, or what has actually changed?  What Do We Do About It?  When It comes to what we do about anything, the first step is to accept that we have this thing. Acceptance is not agreeing with having it, and it's not giving up, it's acknowledging what is already there. You are admitting that, leading to the question. What we do next is to really accept that we have this thing. By that, I mean we make space for its possible certainty in our life. When we get stomach aches or a nervous response, our denial or wish that it wasn't there or some comparison to some ideal leads us to hate this symptom so much. So, again, make space for that part of you that gets nervous, and maybe the stomach ache or anxiety of a stomach ache will subside. Own anxiety as a part of your life and understand that it is your body's way of telling you it is noticing something.  The subconscious part of our brain is unbeknownst to humanity because it is, after all, the subconscious. We've learned a lot about the amygdala, the limbic system, and the autonomic nervous system and how these systems respond without conscious awareness but as a body that says, fight, fight, or freeze. Do you know what happens when we experience this reaction to subconscious stimuli unbeknownst to us? Our digestive tract shuts down. Do you know what can also happen? A discharge of bowels. So, what do we do? 1. we accept that we have anxiety in social situations and allow ourselves to feel this anxiety and not let it distract us or cause us to run. We allow ourselves to get anxious because it is a natural part of life (did you know animals get anxious- they aren't aware of it like humans are). 2. Do the work in therapy or journaling to better understand what threat we are experiencing and how we can do the work on understanding this threat and why it triggers us so much.  These steps sound like a cop-out, but if you don't do the work on identifying what is really going on and how things relate to you and your belief about yourself, then you are merely putting a bandaid on it. Instead, you look at anxiety and ask, "what are you telling me? Why now? What do you want me to do?" Start to view the anxiety as a friend with bad advice. You don't hate the friend. The friend is just telling you that all people are bad/out to get you and that you should run away. Running keeps you safe, and the subconscious is just trying to get you to remove yourself. We can appreciate that friend, even if it does give us bad, overly cautious advice.  Distance from your thoughts and remember that your body's interpretation of situations may not always be accurate, especially if there have been any changes lately.  Thank You,  Luke

Hello, So first of all, be proud of yourself for reaching out for help with an issue that you've struggled with for a long time. You probably thought about getting help in the past but for whatever reason (well, probably social anxiety) chose not to follow through. You took the first step, and whether you decide to participate in therapy now or try other strategies for coping with social anxiety, you're addressing the issue.  You're not worthless. Social anxiety is a common problem, and it's not always easily recognizable; many people who appear to lack any social anxiety are overwhelmed with it frequently. Social anxiety is also something that Cognitive Behavioral Therapy can treat quite effectively. It does take some work, and it's not something that's going to be resolved in one or two sessions, but at the same time you may notice some reduction in social anxiety relatively quickly. The basic principle of CBT is that we can change what we tell ourselves (our self-talk), and when we do this we change how we feel (and therefore can approach social situations with less anxiety). The first step is to figure out where the social anxiety comes from. Our beliefs determine our thoughts, and these determine our feelings, such as anxiety. Some people experience social anxiety because of trauma. Others experience social anxiety because of a poor self-esteem. While therapy shouldn't focus largely on your past, addressing where the social anxiety stems from can be an important first step. By the way, if trauma is the reason you are experiencing social anxiety, I highly recommend working with a therapist who is trained in EMDR therapy. Even if you don't immediately "get over" social anxiety, it doesn't have to control your life in the way that it has. Reducing social anxiety can take work, but it's quite doable, and I've seen many clients make remarkable progress. I urge you to seek further help, whether that be here or elsewhere. It could be a life-changing decision for you. If you have any additional questions, just let me know, and do take care of yourself. Thanks, Nicholas DeFazio, MRC, LPCC-S, LICDC