CBT Panic Attacks

panic disorder and panic attacks can be so debilitating it can be so overwhelming and over time really impact your life so significantly now I want to give you the good news right up front which is that it is possible to fully recover from panic disorder I'm going to talk you through some of it give you a framework for thinking about it and it is possible to get over having panic attacks for the long term the symptoms of panic attacks the sweating the palpitations the heart racing the fear that you might be dying or the fear you're going crazy sometimes people have a feeling that they can't swallow or breathe their stomach can be upset some people get dizzy laded I mean panic attacks are just horrible and what happens when you have your first one maybe is it's so so horrible you never want to have that again which is perfectly understandable but the problem is that what happens is that then that fear of having another panic attack gets greater and greater you might avoid more and more things to avoid having one in the future but that anticipation of having one is actually what leads panic attacks into panic disorder so fully knowing the symptoms of panic attacks can sometimes be helpful because a lot of people have these so instead of feeling like something is bizarrely wrong you can be like okay no these are panic attack symptoms I know sometimes when I read a list of symptoms people feel like oh this is making me more anxious but I just want you to know that yes those are the symptoms some others could be chills hot flashes derealization which is a feeling that things aren't real or deep personalization which feels like you're being detached from yourself all of those are symptoms of panic disorder and you don't have to have all those symptoms in fact to be diagnosed with a panic attack it's really only four of those symptoms but it is an intense burst of fear and anxiety it usually Peaks within 10 minutes and then resolves afterwards not always but usually it's a very quick onset very intense Peak and then resolves within not too long a Time although you might have all sorts of symptoms sort of on a carryover leftover basis and of course each time you have one the fear of having another one gets worse so I also just recorded a video that can help you like in the midst of a panic attack and it also can help you if you are anticipating having one but it's really in the moment techniques that can help you calm your phys physiological response so I am going to have that linked right around here but hopefully for watching this you're not in the middle of a panic attack you just want to learn how do you get rid of this problem how do you overcome this for the long term now cognitive behavioral therapy has been very well proven to be very effective with panic attacks really like cure them and the techniques I'm going to talk you through today will be CBT based techniques because it has also been shown that people can help themselves with these issues quite a bit through self-help but it also might be that you do need a trained specialist to help you even further if you're new here my name is Barbara hefin I was a psychotherapist for over 20 years and I had a private practice specializing in anxiety and Trauma and I know firsthand that people can recover from panic disorder through talk therapy but let's start at the beginning with understanding the cycle of what happens with a panic disorder so in general cognitive behavioral therapy really focuses on how our cognitions our thoughts interact with our feelings both physical feelings and emotional feelings and then those interact with our behaviors and all three inter act with each other influence the other it doesn't start in one place you will hear people say everything starts with a thought sometimes but sometimes people with panic disorder it starts physically doesn't there was no thought there so it doesn't matter where it starts all three things interact so I'm going to run through this with an example for somebody where it does begin with a thought and then I'm going to run through it with an example of for somebody who it just begins with those physical symptoms okay I think you'll be able to relate to both and let me know in the comments because I always do want to hear from you about whether the material is making sense and whether it's helpful okay so let's take Robert who had a horrible experience playing basketball when he was in like ninth grade he was reasonably tall he was pretty athletic he loved to play basketball but during his very first game in front of an audience he ran to the wrong basket and made a basket but he felt humiliated in front of the crowd obviously people were shocked and gasping and making noises and then his teammates were very upset and he felt totally humiliated he also had skin that showed blushing and therefore he felt like everybody could know how humiliated he was he couldn't even stand going to school the next few days so this was a pretty traumatic event for him understandably and it really got lodged in his emotional brain and then pretty much any time he was sort of on display or being watched by a crowd he began to panic so normal reaction avoid it whenever you can avoid it and avoid it and then when you can't avoid it like you have to give a presentation at school or you have to go in front of a crowd and do something he would anticipate blushing doing something terribly WR strong panicking and he developed over time a panic disorder so for him how this cycle worked would be that some kind of external event was coming up something where he would be in front of other people his Panic would start with a cognitions I'm going to be humiliated I'm going to blush everybody will know that I am embarrassed I'm going to do something wrong all of these anticipatory anxiety thoughts long long before the event are escalating his anxiety and then those thoughts as I said connect to the behaviors which is to avoid whenever you can but then when you can't it's even worse because you have not been giving your old brain what we would call restorative experiences but because that old brain doesn't have other experiences where it can be like okay well I got embarrassed that one time but I degrate this time because you've been avoiding avoiding then those big events just get more and more anxiety-provoking so the avoiding and the cognitions are leading to anxiety in the moment both the emotional feeling of it and the physical escalation and then for Robert as it would get closer and closer to the date of some kind of presentation he needed to make at work or a social event where he was called on to give a talk or something his anxiety would keep going up to the point that he began to have full blown panic attacks before the event and therefore couldn't do them so this I think gives you an idea of an example of where the panic disorder cycle is triggered by thoughts now those thoughts are connected to an earlier event and we will be talking a little bit about triggers and I think I'm going to be recording a whole video on triggers for panic attacks so let's take somebody totally different who has their first panic attack completely out of the blue as a young adult so in this case I'm going to talk about Susie who was hit with a panic attack in the middle of a grocery store all of a sudden she felt like she was having a heart attack her heart rate was Skyhigh she wasn't having any real thoughts of not wanting to do something or anything she was definitely feeling somewhat rushed at that moment there were a few other things bothering her but totally unrelated to the panic attack and it just hit out of the blue she really did think she was having some kind of stroke or heart attack even though she was only in her mid 20s other people noticed that she was very distressed and she leaned down and then eventually sat down on the floor and people came over and 911 was called and she was taken to the hospital and they put her through a whole lot of tests and at the end of all of it the doctor said nope you're having a panic attack nothing physical now that doctor was not quite right because panic attacks are physical it's just that the cause is not a quote unquote medical problem it's anxiety where something else happening in the brain now I think we are all integrated right so this separation isn't always that helpful but many people with panic attacks will be told it's in your head but in our heads a second we think something anxious we produce adrenaline which is chemical in our body anyway back to Susie so she goes home she's embarrassed that she used 911 all the time she spent in the emergency room she feels like there's nothing wrong with me and she feels terrible about it but the first thing that she's really thinking about is I don't ever want that to happen again is it going to happen again now in this situation this hit her out of the blue it started physically why that question actually leads to something I'm going to talk about a little bit later in the video today about going deeper on our triggers because with everybody I ever worked with for those people where the panic attacks really hit physically and out of the blue there almost always was some type of experience or early childhood event that was fairly traumatic or highly upsetting let's just say that kind of got lodged in that old brain and so on a subconscious level was triggered by something so usually you can over time do some kind of Investigation to figure out where did that come from but in the moment it feels like it is just boom physical so how does the cycle work in that case well with Susie she had all these physical symptoms what was her interpretation of them her interpretation was something's wrong with me I'm in physical danger I might be dying I might be having a heart attack so her interpretation of those symptoms was that there was a major problem and the behavior she was able to make the phone call go to the emergency room get checked out and then told nope no problem here but that didn't actually make her feel better right and then the problem with a panic attack is that then the next time it happens people don't say oh well I know there's nothing physically wrong with me so something weird must have triggered my physiological anxiety response and I don't really have to worry about it because there's no danger here people don't do that they go into the same Loop of thoughts well maybe now I'm really having the heart attack maybe there really is something wrong with me and the doctors didn't find it so again the thoughts that interpret the physical anxiety symptoms are going to contribute to the anxiety and then the behaviors are going to end up being either of avoidant or compulsive so avoidant Behavior would be to avoid going to that grocery store ever ever again maybe begin to avoid going any place where there's other crowds of people maybe avoid going outside on a Tuesday if it happened on a Tuesday eventually you might avoid going outside altogether so those that behavior contributes to the anxiety and I do have a video on the avoidance anxiety cycle that's worth watching if you tend to avoid because that avoidance truly does increase your anxiety and then the other behavior that I've seen very commonly in these situations is somebody begins to compulsively research health issues on and on and on and on and that compulsive behavior of constantly researching might give you a temporary relief in the anxiety but longterm increases it so that's also in that avoidance anxiety cycle video a little bit more on how that all works but hopefully you're getting a sense of how our thoughts physical Body Sensations emotional feelings and behaviors spiral out of control so the Cure is to figure out where can I intervene and you will see a lot on the internet intervene with your thoughts change how you think change how you think and yeah I think changing how you think is helpful but for a lot of people that's not the easiest place to start or the best place to start so cognitive behavioral therapy for panic attacks will help you outline a plan of where you can intervene and the other piece I would like to communicate about this CBT cycle is that people primarily want to change how they feel right you don't want to feel these panic attacks anymore and I understand but you can't directly Target your feelings now there are some techniques that help those feelings for sure but to change how you feel it almost always requires that you change how you behave or how you think so the interventions are going to be in the behavioral realm and the cognitive realm and on the internet you'll see everybody focus on cognitive cognitive Cog change how you think change how you think your whole life changes well you can't always do that I know that so changing certain behaviors now I'm going to focus on the behaviors that help you physiologically relax that would be one of the first points of intervention for almost everybody who suffers with panic disorder and if you hate breathing exercises I know they sometimes can make people angry I so that video that I just recorded went through some grounding techniques and I have another video on grounding techniques I won't be able to link them all right here but look for something called grounding techniques if you hate the breathing and then over time developing the capacity to do some of those breathing techniques because that is really the way to communicate to that old brain that you are safe and that's what we want to do we want to really communicate to the old part of the brain which is what's driving the panic and that part of the brain doesn't have language centers so it's almost like if you were to calm a puppy how would you calm the puppy you wouldn't calm the puppy by saying you have nothing to be anxious about why are you panicking you would get down on the floor you'd pick up the puppy you'd hug him right you would physically help the puppy relax physiologically so those are the first tools to add to your Arsenal right and don't try to use those when you're in the middle of a panic attack if you have not been practicing them those tools need to be practiced really on a daily basis I did put together a three-week program and it's free and on YouTube the a miniseries and that one I will definitely link here for you but it's a thre week series of guiding you through daily practices of safe place exercise diaphragmatic breathing and grounding exercises because when you practice these things on a daily basis you are not only keeping yourself less anxious but you're also increasing your capacity to access these tools when you do begin to get super anxious so when people say these things don't work it's because they forget about them until they're in the middle of panic and then yeah they may not work so well right then okay so that's the first area to put together a series of tools that help you relax physically another really important thing to think about as you think through the behavioral interventions that are going to help are the behaviors that are avoidant or the behaviors that are compulsively focused on the anxiety so identify in those behaviors and then not avoiding or not engaging in the compulsive behavior that gets a little more complicated I do talk about this in some of my other videos and let me know in the comments if you want me to speak more on that but identifying those behaviors you do that actually contribute to your cycle and then how do you intervene so you're not engaging in those but a category that is a little more clear-cut what you're consuming so right now I'm just going to talk about caffeine Alcohol Tobacco caffeine is a stimulant caffeine for pretty much everybody increases your heart rate it can feel like it's giving you a energy but it often is an anxious type of energy and caffeine can increase anxiety and people have anxiety and it can actually cause panic attacks if consumed in large enough amount M A friend of mine is actually an emergency room doctor and he has talked to me about how often people will show up in the emergency room thinking they're having a panic attack and then when he talks through with them what they consume during the day like one person had just had eight cans of Red Bull the amount of caffeine was unbelievable and you can have a caffeine overdose so caffeine can directly contribute to panic attacks I know it's a hard habit to stop but when you think about how painful panic disorder is how much it's impacting your life maybe it's worth it now on the other side alcohol and tobacco and then there's other drugs that could fall into this category but they are basic it means they have two phases so alcohol first phase it makes you feel more relaxed so unfortunately people with anxiety will sometimes feel like well the anx the alcoh alcohol relaxes me but that's its initial impact on you once the halflife is reached of the alcohol you are actually left with fewer internal relaxation chemicals because the alcohol kind of makes them all rush in at once and then you're left with less so when you wake up in the morning if you've had a drink or two the night before you are likely to be more anxious in the morning than you would have been without the alcohol and tobacco very often people will feel well tobacco relaxes me when I inhale it which could be connected to how good inhalation can be for anxiety but the chemical of tobacco also can make people feel both relaxed and alert but then it's basic when that is out of your system you are more anxious than you would have been otherwise so those are three of and there's obviously others but those are three things to avoid if you get panic attacks okay the cognitive interventions so the cognitive part of the panic disorder cycle is largely about how you are interpreting the Panic symptoms that's one part of it and the other part of it is the anticipation of having the panic attack so let's start with the interpretation of the panic symptoms so the interpretation in one of the cases I talked about today was really a L focused on sort of social anxiety on being embarrassed on being publicly humiliated on what was going to happen and therefore once those panic feelings began the fear I'll blush other people will notice I won't be able to continue in the other situation the interpretation of those Panic symptoms was that it was something physically extremely dangerous I'm going to die other common cognitions that go with panic disorder are I'm going crazy I'm going to go crazy this will never end I won't ever be able to function right the thoughts go on and on and they can really catastrophize and I know those thoughts feel very very true I know it I know how true they feel but they're not true now with the medical Thoughts by all means people should have a thorough workout with a doctor if they think there's something wrong with them I am not a medical doctor right I'm licensed as a therapist and I would never want to tell somebody not to go to a doctor however if you've already been you've already had the doctor review everything you've already really confirmed that you have the symptoms of panic disorder then it would be really really helpful to begin to create distance from your thoughts we don't have to believe all of our thoughts a lot of my anxiety videos can be helpful on this so I can't cover it all in this one but meditation mindfulness therapy really thinking thoughts about your thoughts that's called metacognition right what we think about what we think but beginning to realize not all our thoughts are true that just because we feel a thought is true does not mean it's true and creating more of an observer mind more of a curiosity mind that can look at the thoughts like oh yeah okay well there I am again that's a that's a common theme why do I have that theme is that theme helping me so really being able to distance from the thoughts question them and then reframing them and I know this is way easier said than done totally get that and it takes a lot of work right so it takes a real effort sometimes guidance but I really want you to know that you can do this right I do have a free webinar on rewiring your brain for joy and confidence and part of it really talks about how to get the brain to focus on the joyful things so that you can live a happier life but it's also about rewiring these patterns that we set up because uh you know this whole panic disorder video that I've given here so far is really a description of how we create certain Pathways in our brain and they often are created by original traumatic big tea littl tea traumas very upsetting events and then a whole story develops and then a whole Super Highway in the brain but the brain can be changed neuroplasticity we even when you're older your brain can change and improve and you can begin to rewire it it by a combination of thoughts and behaviors and connecting different things together so it is not all about changing the thoughts okay so I talked a bit about the thoughts in terms of how they interpret the Panic symptoms I also want to talk about the thoughts in terms of the anticipation which is actually one of the real things that drives panic disorder is as I mentioned earlier after you have your first panic attack or maybe your second then you begin this anticipation cycle and I do have a video on anticipatory anxiety and almost all anxiety is anticipatory but that anticipation of expecting one fearing one trying to avoid one trying to manage one all of that energy is contributing to your anxiety and contributing to the panic disorder so a real key here is to stop fearing the fear right because so much energy is is going into fearing that panic attack and I know it's horrible it's something you never want to experience again but there's a whole technique and you can find a number of videos on this called ride the wave like just beginning to be like okay some waves can be scary if I'm surfing I don't surf but I can only imagine but I'm just going to ride it so I can get through this next panic attack I've already gotten through five right maybe if you've had five panic attacks already you can been like okay yep I did end up okay after that was over it was horrible I don't want it again but you know what I know it's not going to kill me I know I can get through it so it's kind of like relaxing with the thought that yep okay maybe I'll have a panic attack is going to help you not have a panic attack because you'll be letting go of all that anticipation which is pretty much guaranteeing the panic attack so riding the wave stop being so afraid of them again I know easier said than done but trying to give you thoughts that you can then work with because it'd be hard to cure this with a 20- minute video but these are things you can begin to work with integrate explore more information on if you have a therapist talk about it with them do some journaling really think it through but riding that wave and the last thing I want to mention is really once you have learned these physiologically pming tools and you're practicing them daily um or very regularly right and then you begin to work with your thoughts question them have a little distance from them then it'll be time to really work through the triggers for your Panic so there's you can think about the triggers both as being sort of like the in the moment triggers the things you avoid the things you're afraid of the situations you don't want to get into so you could see those as Tri triggers for people where the Panic hits out of the blue and there's no preconceived thought it could be a trigger of smell sight sound but then eventually to do the deeper work on these triggers where did they really come from and how do you heal them now EMDR ey movement desensitization and reprocessing very effective therapy technique I found it super helpful for helping people recover from panic disorder and I will do a video on EMDR for panic disorder but I'm also about to record a video on triggers for panic and so subscribe to my channel if you haven't if you liked this video please do give it a thumbs up because it's very helpful and motivating for me and leave me comments let me know what questions do you have what do you think what sounded helpful and if you have ideas about something else that helps you put it in the comments it could help somebody else thank you I so appreciate you being part of this community if you think somebody else could benefit from this video please share it with them and I am here to try to spread information and help people live joyfully around the world all right thanks see you next week

Channel: Barbara Heffernan

Views: 6,310

Keywords: barbara heffernan, @awakenjoy.life, CBT Panic Attacks, panic disorder, panic attacks, anxiety disorder, anxiety attacks, panic attack, cognitive behavioral therapy, panic attack treatment, panic disorder treatment, panic disorder symptoms, CBT, cbt therapy, cbt for anxiety, How to stop panic attacks, cognitive behavioral therapy for panic, CBT panic disorder

Id: iaCzbxcyFOo

Length: 29min 22sec (1762 seconds)

Published: Tue Feb 27 2024