Anxiety, Managing emotions

Panic Attacks: Manage anxiety and return to calm

Panic attacks can be frightening and overwhelming. Many people worry about what’s happening to them, and they don’t know what to do to make it stop. We’re going to take you step by step through everything you need to know about anxiety, panic attacks, and some simple steps you can take (even today) to start resolving a panic attack.

What is a panic attack?

A panic attack is a sudden, painful collection of anxiety symptoms. Panic attacks often involve extreme tightness in your chest, a fast heartbeat, rapid breathing, and intense fear. Many people mistake panic attacks for heart attacks. Most panic attacks last for 15-60 minutes. After the intense period of anxiety, the pain decreases, and people usually feel exhausted from the heightened state of arousal. 

Panic attacks can be debilitating. Many people who experience panic attacks often worry about going out with friends, to work, social situations, or the grocery store. They worry they’ll have a panic attack in public and won’t be able to control their anxiety.

What Do Panic Attacks Feel Like?  

Panic attacks come on quite quickly and can be extremely overwhelming. Here’s how people often describe their panic attacks:

  • I’m afraid. During a panic attack, you will likely experience debilitating fear or sheer terror. 
  • I feel physically shaken. Panic attacks cause a variety of physical symptoms, including chest pain or discomfort, lightheadedness, or nausea. 
  • I feel like I’m dying. Many people who have panic attacks describe feeling as though they are dying. 
  • I can’t think straight. In the grip of a panic attack, you might have trouble making decisions or remembering simple things. 
  • I’m afraid I’m going to have a panic attack in public. Many people who experience panic attacks often will avoid public spaces for fear that they’ll have an attack in public.

How Anxiety works in your body

panic attacks

Before we can understand panic attacks, we need to understand how your body is built to handle anxiety. Anxiety is not a bad or destructive feeling. In fact, anxiety is the body’s natural and helpful response to a threat in the environment. Anxiety is like a fire alarm that signals your body is feeling unsafe. The anxiety response follows a normal rising and falling path, like a river. Let’s take a look at what happens in your body when you feel anxiety, and how your body calms itself and returns to normal.

  1. When your body senses a threat in the environment, your amygdala —the fear center of your brain—sends a signal down your spinal cord to your heart to increase its speed and tension. Your body then prepares to fight or run away, as if your life depended on it.
  2. Your mind scans your body and notices there’s tension in your heart and muscles. It recognizes your tension as a response to something scary, and —if it’s not a life-threatening threat—begins to soothe itself.
  3. Like a river, your mind flows down a familiar track for how to soothe anxiety. Depending on how you deal with anxiety, you might take a deep breath, remind yourself of your value, cry, tell yourself that it’s going to be okay, or ask for help. These skills are acquired by having care-givers who consistently respond with empathy and soothing to our anxiety. Essentially, those experiences created the river, the way we know how to sooth ourselves when we’re anxious.
  4. While you soothe yourself, your vagus nerve stimulates your heart, slowing it down, releasing tension, and helping you feel open and collected again. 
  5. Part of the soothing process is that you’re able to recognize why you were anxious. Because you feel calm, you’re able sense of your life and learn about what you’re needing.

How Panic Attacks Work in your Body

With a panic attack, the above anxiety “river” gets short-circuited.  Let’s take a look at what happens during a panic attack.

  1. Similar to the anxiety response, the first signal of a panic attack is from your amygdala. Your body senses a threatin the environment and sends a signal down your spinal cord to increase your heart rate and prepare to fight or run away. 
  2. Your body then senses your tension in your heart. In a panic attack, you don’t recognize this tension as normal or helpful.  Instead of soothing anxiety, the signal is ignored. The fire alarm is dismissed, not paid attention to. We often ignore the signal by working harder, by scrolling social media, by busying ourselves.
  3. Because the anxiety isn’t soothed, it continues to build inside until a breaking moment: the threat overwhelms the coping strategies. If our normal anxiety response is a river, then a panic attack is like a dam that, after holding back too much water, breaks. 
  4. It’s hard for the body to remain in a panic state for long. After the period of intense breathing, heart racing, and fear, the body will naturally calm itself down usually after 15-30 minutes, though occasionally it can take an hour or more. 
  5. Often the original cause of anxiety is forgotten, due to the overwhelming experience of panic.

Where Do Panic Attacks Come From? 

We’ve explored how panic attacks happen in the body, and it can also be helpful to know why you experience them. First of all, I recognize the limitations of a blog article to tell you – a specific and unique person – why you experience panic attacks. However, after treating many people in Downtown Los Angeles with panic attacks, here are some common themes I see in my practice. Panic attacks are often the result of: 

  • Ignoring stress. This is a common theme for people who suffer from recurring panic attacks. When they experience anxiety, they don’t pay attention to the feeling. Instead, they feel they’re being “weak” or “complaining”, or they feel guilty for needing to slow down at work. Instead of soothing their stress, they ignore it. They’re afraid to slow down or to take time for themselves to listen to the anxious feeling. Often when a person experiences a full panic attack, it’s after days, if not weeks, of suppressing (pushing down or avoiding) clear signs of being overwhelmed. While this strategy can work short term, your body needs a way to actually calm down and soothe itself.
  • Not getting help. Self-care is sometimes a dirty word. We can feel selfish or guilty: “Other people don’t need to slow down! Other people don’t take a day off when they’re overwhelmed! I don’t think I deserve to have a day off or to have time to myself.” It can be hard – especially in a culture that expects a lot of us. It’s sometimes difficult to see how well your body and mind can function when you have permission and space to take a breath in, to soothe yourself.

How To Conquer Panic Attacks 

The first step in conquering panic attacks: you can’t stop the panic attack. Now I know that doesn’t sound great. However, there’s a different and better way to help. Returning to that “river” versus “dam” analogy, when the dam breaks, all we can do is allow the feelings to be there. Here’s what you can do, step-by-step:

Set a timer

Most panic attacks last 15-60 minutes. While this experience is painful and sometimes scary, it can help to know that there is an end to the pain. Your body takes a while to calm back down from this experience. 

Accept the experience and allow it to pass naturally

Take a deep breath in through your nose, and out through your mouth, slowly. Allow your belly to fill with air when you breath in. Picture a place you feel safe. Allow the bodily feelings to pass naturally, knowing it’ll be over soon.

Once the panic attack is done, relax

You’ll feel exhausted after the panic attack. Don’t feel any pressure to get up and go. Let your body recover – act as if you’ve just completed a marathon. Drink some tea, put on white noise, eat something healthy.

Take stock of the last week or two

Ask your self what was different this past week. What things in your life have added to your level of stress or responsibility? What other, smaller signals was your body giving you about your level of stress before the panic attack?

Learn to soothe anxiety

Conquering panic means learning to listen to the smaller anxiety signals your body gives you early on. It means practicing soothing, finding that easy flowing river that helps you move through anxiety, rather than dam it up. That’s what we do. We help anxious professionals in Downtown Los Angeles overcome anxiety and live their best lives.

Managing a Panic Attack Worksheet

Want these questions in an easy to use free downloadable worksheet? This worksheet will help you take steps forward in dealing with anxiety. You’ll also get access to all our worksheets in Here Counseling’s Resource Library!

Connor McClenahan, PsyD
Connor McClenahan, PsyD

I help lawyers and other professionals work through difficult emotional and relational patterns through psychotherapy.

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Anxiety, Managing emotions

Reduce stress at work: Tips from a Psychologist in Downtown Los Angeles

Reducing stress at work is both simpler and harder than it seems at first glance. As a psychologist who specializes in anxiety and works in Downtown Los Angeles, I want to give you a few tips to reduce your stress at work… and be more productive.

Meet Ian. Ian just accepted a new job at a law firm in Downtown Los Angeles. Ian’s excited, and willing to put in whatever work is required to prove his value as a lawyer. The first 2 weeks go well, and while he’s tired, he also gets a bit excited when he gets an email from a client on a weekend – he doesn’t mind replying, after all, it seems to be expected of people at his firm.

But 2 months into his new job, Ian is exhausted. The things that he loves are less exciting. He used to go on hikes on the weekends, but now he needs to be around his phone in case a client calls. He wishes he could couch in at the end of the day and not check email, but he feels an implicit pressure to answer emails immediately, even late at night. Now he isn’t sleeping well, he’s not enjoying things he used to, and he is having trouble calming down.

How do you know if you’re stressed?

Have you ever felt like Ian? Each of us comes up against tasks, whether in our professional or personal lives, that feel too overwhelming. Our anxiety or overwhelm is often a signal that we’re “red-lining”, that our brains are taking in too much information to regulate effectively. While stress is a normal experience, it becomes problematic when the body can’t calm back down. This inability to regulate anxiety is what constitutes workplace stress and overwhelm. As a way to manage the stress, often we work harder. Here’s a list of common behaviors people engage in when they experience chronic stress at work:

  • Taking on more projects, despite busy schedule
  • Checking work email during personal times or breaks
  • Working or responding to email during weekends
  • Social expectation to match work load or habits of others
  • Giving unrealistic deadlines for finishing projects

How many of these behaviors do you struggle with? Often they co-occur – people stressed at work do all of these to a varying degree as a way to reduce their anxiety. The trouble is, working harder to avoid stress doesn’t work – it seems to entrench the person in the same exhausting and stressful pattern. The more you respond to your anxiety by working harder, the faster the train goes, and the more difficult it is to get off. There’s a different way to manage stress: caring for yourself and setting boundaries.

Caring for yourself increases, not limits, your productivity

It’s true. The only way to escape stress is to slow down. And when we escape stress, we actually free ourselves up to work in a more productive way… a way that’s actually backed by neuroscience.

How can this be? We usually think of “self care” or “setting boundaries” as something warm and fuzzy. Something that’s for “me” at the expense of work or other obligations. Yet there’s more going on here. Think about it this way: You wouldn’t drive your car without changing the oil, or getting regular maintenance, especially when the warning lights come on. Caring for your car isn’t simply about making the car feel good, it’s about the reality that a car has a very finite ability to push itself without receiving the care it needs to continue functioning.

Just like a car’s warning lights, when we don’t listen to our overwhelm, we increase our chances of getting sick, suffer from lack of focus and lower energy. You know the feeling, don’t you? I’m sure you’re familiar with how well your body performs on a task when you’ve had good, peaceful rest. The opposite is true when we don’t listen. We start to break down, effecting our mind and body’s performance in all areas.

There’s a few common things our bodies feel when they’re trying to get us to slow down and take care:

  • Lack of energy
  • Lack of focus
  • Irritability at work
  • Inability to be present in personal life and relationships
  • Overeating
  • Undereating
  • Lack of restful sleep

When we don’t listen to these signs, it’s impossible to avoid the cost of overwhelm. The only way to move past these things isn’t more caffeine, or a fresher cold-pressed juice. There’s 2 ways to reduce your stress at work, the short way and the long way. I think you’ll find both apply to most situations of stress at work.

How to reduce stress at work: The Short Way

Your brain is made to swing like a pendulum between two primary modes: active and passive processing. Active processing is when your mind is actively working on a task. Your brain receives, processes, and acts on information it receives from its environment. Passive processing is what your brain does when it doesn’t have a task to do. Rather than turning “off”, your mind actively sorts through all the connections made during active processing, pruning them back and retaining the important details.

If we don’t ever give ourselves room to pull back from a stimulus, our minds struggle to find new ways of approaching a problem and to stay focused on what’s important. When we never pull back from our task, we slowly lose energy, and approach tasks repetitively. Doesn’t sound like the smartest way to work, does it? Here’s some quick things you can do to allow that pendulum to swing back toward passive processing, so you can regain energy.

TURN OFF EMAIL NOTIFICATIONS. 

This is a quick win. You want to protect the time you spend away from your desk, so you can allow your mind to enter passive processing. Turn off email notifications on your phone. In fact, you can experiment with taking email off your phone, that way you’re only checking it when YOU decide to. Take Gmail off your phone, see what it feels like for 24 hours.

WALK.

Put down your phone, and take a walk in the middle of your work day. Maybe that means going out to lunch without your phone, or parking farther away from work so you need to walk. This is an easy way to give your mind space to passively process. Notice the energy you have when you return to your desk.

NEGOTIATE REALISTIC DEADLINES.

You might consider, just as an easy rule to start with, to extend your deadlines for projects by 25%. Most of us have a future bias concerning time, meaning we overestimate the free time we’ll have in the future. Account for this extending your expected time to complete a project. If you finish it early, you’ll have another win. Plus, you’ll be setting a different expectation for others about how available you are.

SET APPOINTMENTS.

Instead of jumping on the phone immediately with a client or colleague, give them appointment slots they can apply for.

“BUT! I can’t do those things!” Let’s think about this. There are some very real things that seem to inhibit you from following this list. You operate within a powerful culture of ceaseless work, constant availability, instant access. I’m very aware that I’m directly pushing back against that.

But let’s think about what happens if you don’t make these changes. There is an unavoidable cost to being constantly available. You’ll likely spend at least 50% of your waking hours at your job during your adult life. And these costs add up. It will be difficult to actually get off on weekends and holidays to enjoy your life. Maybe you can already feel the costs. You feel the exhaustion, the burnout, the “why did I get into this job?” feeling. So what is it worth to you to slow down? Is it worth possibly disappointing your co-workers? Or losing a client? Or having to find a different job?

Slowing down won’t just make you happier, it’ll help you work better too.

How to reduce stress at work: The Long Way

One very common voice that pops up, even as we consider letting go of being constantly available, is “I don’t want to”. The truth is, many of us, for many reasons, don’t want to make these changes. It’s not that we can’t, it’s that we won’t. The mind is like that – sometimes very divided and at-war with itself. We don’t just have a foot on the break pedal, there’s another foot on the accelerator that likes the speed.

Let’s take a look at some of the common reasons people like the speed of the Stress Train:

I enjoy feeling overwhelmed

“People pay attention to me when I’m busy”

“I’m only valuable when I’m busy, I feel good about myself when I accomplish a lot”

“I feel powerful when I’m busy and stressed”

“I’ve always had to do everything for myself, at least I have control over my life”

If I slow down I’m afraid worse things will happen

“People won’t understand my need to slow down, they’ll look down on me”

“People will be angry with me if I don’t meet expectations”

“I’m afraid I’ll be discarded if I don’t produce the value I feel is expected of me”

Now I realize often there are real expectations we’re up against. Our job may require a certain amount of hours or deadlines. Yet if we’re not careful, the employer can unknowingly collude with the parts of us that WANT to pick up speed, pressing two feet down on the accelerator. Only when we’re self-aware can we notice this happening and slow down. Slowing down means being willing to negotiate, to encounter conflict, and even disappoint someone.

So I challenge you today to slow down and care for yourself, no matter how difficult that might seem. Set a realistic boundary, even knowing it might invite a difficult conversation. A more productive and happier life is on the other side.

Connor McClenahan, PsyD
Connor McClenahan, PsyD

I help lawyers and other professionals overcome difficult emotional and relational patterns through psychotherapy.

Read More