Fear and anxiety are normal. Our brains are wired to keep us alive. Unfortunately, sometimes our brains get things wrong and tries to protect us against situations that aren’t actually dangerous. Our brains can erroneously tell us that our own anxiety is dangerous.
The good news is that learned fears can be unlearned. Given enough time and effort, we can re-train our brain to recognize that our feelings of anxiety are harmless and don’t require a flight or fight response. There are many scientifically-proven treatments for panic attacks such as exposure therapy (or CBT with exposure), relaxation, flooding, cognitive restructuring, and others.1 2 3
Understand what’s happening
Your body will automatically react to what’s happening around you. If somebody jumps out of a closet to scare you, your body will automatically trigger a flight or fight response. The autonomic nervous system (your “unconscious brain”) may dump adrenaline into your body and make your heart beat faster. You will suddenly pay a lot of attention to the “danger” occurring around you. Your brain may erroneously think that your body’s reaction to anxiety is dangerous, causing you to have more anxiety, causing a greater physical reaction, etc. etc. This can create a nasty feedback loop that causes your anxiety to skyrocket. You may feel like you are having a heart attack or that the world is about to end.
If you’re not sure if you are having a heart attack or not, please call 911 and get immediate medical help because it’s better to be safe than sorry. If you have already seen a doctor, it is likely that the doctor has told you that panic attacks won’t hurt you. Please remember this. The reasons why doctors don’t take anxiety attacks that seriously (even though they can have a serious impact on your life) is because they are not medically dangerous. Your brain is perceiving danger where there is none. Remember that anxiety is not dangerous.
Exposure therapy isn’t complicated
If you’ve ever gone to an amusement park and overcome your fear of roller coasters, then you’ve already experienced exposure therapy. Here’s what happens: when your first learn to overcome the fear, you probably started with the least intense rides. As you experienced the ride, your brain understood that the falling sensation does not indicate that you are about to die or become seriously injured. After a while, the same ride will become less thrilling and less intense. Your brain figures out that roller coasters aren’t dangerous- you may even get bored of that ride. When you’re comfortable, you move on up to the more intense rides. Starting small and then gradually challenging yourself with more difficult scenarios is referred to as graded exposure.
To do your own exposure therapy, start by thinking of a memory or scenario that causes some illogical anxiety but isn’t overly traumatic. Feel free to start with something extremely minor before challenging yourself with harder scenarios. Play through the memory/scenario in your head. As you imagine it playing out, you may feel a small amount of anxiety. Actively tell your brain that the memory/scenario is safe: “Hey brain, thank you for warning me about danger whenever somebody touches me. Thank you for pumping me full of adrenaline in case I need to fight or run away. But this is a perfectly harmless scenario. This person touching me is my friend and has my best interests in mind; they will not hurt me. There is no danger here so you can relax and stop making me feel anxious. Ok thanks bye.” Replay everything in your mind until your anxiety comes down and your brain begins to understand that there’s nothing dangerous going on. If you’ve picked a memory or scenario that is too traumatic, tone it down and work on something less traumatic first.
Once you’ve mastered that, the next steps are:
- Make the leap to more traumatic memories and scenarios. Build a list of things in your head that cause you a great deal of anxiety. Start with the easiest items on the list and slowly work your way up.
- If there are Youtube videos that trigger your anxiety, work on those. There are plenty of disturbing videos such as police shooting videos where people die, disgusting medical videos (e.g. spider bites), insects (e.g. mangoworms), supercuts of scary moments in horror movies, etc.
- Finally, challenge your fears with real-world scenarios that are safe. (Do not do anything dangerous.) Work on everyday activities that shouldn’t cause anxiety but do. This can be anything such as physical contact, social anxiety, the sound of people being angry, cues that remind you of abuse that you have experienced, etc.
What to do when you are experiencing a panic attack
Have a conversation with your brain and remind it that you are not in danger: “Hey brain, stop being illogical”. While it may feel like terrible things are happening to you, you are safe because your anxiety is not going to hurt you. Your brain is reacting to dangers that don’t exist.
If you engage in coping behaviours such as getting out of the situation, be mindful that you aren’t actually avoiding danger. You did not successfully flee from or avoid danger because there was no danger to flee from. If you were to go to a hospital, the doctors would likely tell you that you were never at risk of being harmed. It’s like riding on a roller coaster… your brain tells you that you are about to die but the danger is not real.
It is fine to use coping behaviours as a crutch but do not rely on them. Deep breathing and muscle relaxation can bring your heart rate down and reduce your anxiety. Benzodiazepines like Xanax can reduce the anxiety in the short-term. (Long-term use of benzodiazepines is not a great idea as they are addictive, they have withdrawal symptoms, and your body gets used to them..) Ultimately, you want your brain to understand that these coping mechanisms are completely unnecessary because there was never any need for them in the first place.
Dr. Harry Barry has a short 13-minute video that gives an overview on overcoming panic attacks while you’re in the middle of one:
The late Dr. Claire Weekes has written various books on anxiety (e.g. Hope and Help for Your Nerves, Freedom from Nervous Suffering). You can find a copy at your local library or a used copy on websites such as Amazon. You can find her ideas on Youtube:
- The Floating Technique: For Anxiety & Panic Disorder – This is a great overview so start here.
- Hour-long interview with Dr. Claire Weekes
- Dr. Claire Weekes – How to overcome Anxiety (Freedom from Nervous Suffering)
Both doctors advocate for the acceptance of your feelings of anxiety as you experience them. By facing your fears, you can teach your brain that fear is False Evidence Appearing Real.
Panic disorder is a heavily studied condition in the scientific literature. You can use tools such as Google Scholar and Sci Hub if you really want to dig through the academic papers on it. Research has found various proven and effective treatments for panic disorder out there such as cognitive behavioural therapy with exposure, which is described earlier on in this post. It works for most people. It is normal for people to develop weird fears (e.g. snakes, public transportation + confined spaces) and to overcome them via exposure therapy. If the various free self-help resources outlined in this article don’t work for you, then please consider going to a psychologist as effective treatments do exist.
Take care of yourself!
- This meta-analysis found CBT to have the largest effect sizes compared to medication and combined therapy.
Gould, R. A., Ott, M. W., & Pollack, M. H. (1995). A meta-analysis of treatment outcome for panic disorder. Clinical Psychology Review, 15(8), 819–844. doi:10.1016/0272-7358(95)00048-8 (full paper on sci-hub)
- This study found that CBT with exposure, relaxation, and both therapies combined were effective in treating panic disorder.
Barlow, D. H., Craske, M. G., Cerny, J. A., & Klosko, J. S. (1989). Behavioral treatment of panic disorder. Behavior Therapy, 20(2), 261–282. (full paper on sci-hub)
- This meta-analysis found that psychological coping strategies involving relaxation training, cognitive restructuring, and exposure yielded the most consistent effect sizes.
Clum, G. A., Clum, G. A., & Surls, R. (1993). A meta-analysis of treatments for panic disorder. Journal of Consulting and Clinical Psychology, 61(2), 317–326. doi:10.1037/0022-006x.61.2.317 (full paper on sci-hub)