By Annabelle Parr

I spend a lot of time reading articles related to enhancing mental health, to highlight and repost relevant pieces, as I value spreading awareness in this area. It’s wonderful that the conversation around mental health and anxiety is more open than it used to be, reminding us that our struggles are deeply human and we are not alone. But one thing I notice is that sometimes the way anxiety is discussed – even with the utmost compassion, can still imply that anxiety is bad.

Don’t get me wrong; anxiety can lead to problems in our lives. Anxiety can turn into a full blown anxiety disorder, and by definition, anxiety disorders cause significant distress and impairment in a person’s life. And even if we are not in the realm of a full blown anxiety disorder, it can be very uncomfortable. So uncomfortable that sometimes we make choices designed to avoid or get rid of anxiety at the expense of what matters to us.

It’s true that anxiety, and the way that we respond to it, can be a problem.

However, I think when we focus exclusively on the negative parts of anxiety, we are missing a big piece of the picture that can empower us to change how we relate and respond to it. Anxiety – like any feeling – is information. And most of the time, at least part of that information has to do with what is most important to us in our lives.

For example, if someone experiences a lot of social anxiety and fear of judgement, what might that say about what matters to them? It might mean that they deeply value connection and relationships. Maybe it is really important to them to show up in their relationships as kind, compassionate, engaged and authentic, and maybe the anxiety has to do with worrying that something they could say or do will be incongruent with those values.

The problem with anxiety occurs when we take our anxious thoughts at face value,

and when our behavior is driven not by our values, but by trying to avoid the feared outcomes our minds generate. For example, social anxiety might involve thoughts like “I can’t go to that party. What if I make a fool of myself or say something stupid or am too anxious to even talk, and my friends don’t want to hang out with me anymore?” Such thoughts can feel very real and powerful, and our instinct is not usually to get curious about what they might indicate about what is important to us.

Instead, our instinct is often to think that outcome is likely, and to decide to stay home from the party to avoid anxiety and try to prevent rejection. But if instead, we can notice that thought, get curious about why it is visiting us and what it says about what is matters to us, we might recognize that in fact we deeply value connection. So much so that it feels excruciating to risk the possibility of rejection. And yet, in not going to the party, we are certainly missing an opportunity for the connection we so deeply crave.

When we can identify the values underneath the anxiety, we then get a choice about what to do next.

Getting curious about our values and what is really meaningful to us in our lives then allows us to identify actions that would move us in our valued direction. For example, you could choose to go to the party even though you are feeling anxious in service of your value of connection, or you could choose to stay home in order to experience relief from the anxiety.

From an Acceptance and Commitment Therapy perspective, our pain and our values are like two sides of the same coin: if we flip the pain coin over, we find what means the most to us in our lives. Or, as one of my clients said, anxiety is like a metal detector: when it starts beeping and getting loud, it means there is treasure under the surface, and that treasure is your values.

Sometimes it can take some curiosity and creativity to get to the core of what the value is, because anxiety can be sneaky and tricky and it’s not always immediately apparent. But if we can look at anxiety as important information, it can help us change how we relate to it. We don’t need to make it go away, we just need to figure out what really matters to us and make choices toward our values.

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, MINDFULNESS, AND TELEMENTAL HEALTH SERVICES. SAN DIEGO PSYCHOTHERAPY CAN HELP. WE CAN BE CONTACTED AT 619-269-2377.

by Annabelle Parr

It’s a regular Thursday morning and John is driving to work along the same stretch of freeway that he drives every day. He is having a stressful week, but his mind isn’t dwelling on anything in particular. His thoughts bounce from what to make for dinner to an errand he has to run during lunch to a meeting he has this afternoon. He doesn’t feel particularly anxious.

Suddenly, his heart starts racing and his palms begin sweating. He can’t explain what is happening; it doesn’t make sense to him. First he feels confused, then he begins to worry that something is wrong. He starts to feel short of breath and then he begins to feel as if he is going to faint. Because he is driving, he is afraid that if he passes out, he will crash and die.

John doesn’t know what happened to him. He worries it may have been a heart attack, but when he goes to the doctor, he learns that it was actually a panic attack. He is confused because he didn’t feel afraid or anxious prior to the attack. His doctor explains that you don’t have to feel panic to experience a panic attack.

Our body is built to respond adaptively to danger.

At some point or another, we have all experienced the feeling that our safety is being threatened. We know what it’s like to feel consciously afraid and to feel our body physiologically preparing for danger. Our heart starts racing, our palms start sweating, our breathing gets shallow, and our muscles tense up. Our body goes into fight-flight-or-freeze mode to help us respond adaptively to whatever threat we are facing.

Panic attacks are the body’s way of trying to prepare us for an unconscious perceived threat.

Sometimes, our body responds to a threat that our conscious mind is not aware of. This is what happened in the above example. When we do not feel afraid, the physiological response itself can feel threatening and overwhelming. This exaggerated and unexplained response can result in a panic attack. Panic attacks create the feeling that your body is turning against you rather than working to help you. What may once have been an adaptive response to an external threat has morphed into what feels like a threat coming from within.

What is a panic attack?

A panic attack is defined as the abrupt onset of intense fear or discomfort that peaks within several minutes. Panic attacks can emerge from a calm state or an anxious one, making them difficult to predict. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V), a panic attack includes at least four of the following symptoms:

Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed or faint
Chills or heat sensations
Paresthesia (numbness or tingling sensations)
Derealization (feelings of unreality) or depersonalization (being detached from oneself)
Fear of losing control or “going crazy”
Fear of dying

What’s the difference between a panic attack and panic disorder?

Panic disorder can develop when a person experiences recurrent and unexpected panic attacks, and develops a persistent concern or worry about additional panic attacks or their consequences and/or significant maladaptive behavior changes related to the attacks. It is possible to experience panic attacks without having panic disorder.

Are panic attacks dangerous?

People experiencing panic attacks often end up in the Emergency Room worried they are having a heart attack. While uncomfortable and overwhelming, a panic attack itself is not dangerous. But because they can arise unexpectedly, it can feel as if they are. If we have just been on a long run or are about to give a big presentation, we know why our heart is pounding or our palms are sweating. But when our heart begins pounding and we start trembling and we can’t figure out why, these symptoms are frightening. They seem to originate within our body rather than as a response to something external.

Is it all in my head?

Absolutely not. While panic attacks are psychologically rooted, they result in a very real physiological response. And though a panic attack may seem to arise out of the blue, there is always an external trigger. Our minds detect a threat, whether consciously or not, and our body responds accordingly. A feedback loop then ensues as our mind interprets our physiological response as threatening, and our body continues to attempt to prepare us to address a threat.

If you experience a panic attack, there is nothing to be ashamed of. It’s not a sign of weakness or that you are going crazy. It’s not your fault. Though it doesn’t feel this way, a panic attack is your body trying to help protect you.

Are panic attacks permanent?

No, panic attacks do not have to be a permanent fixture in your life. Though you do not cause yourself to have a panic attack, you can learn how to prevent and manage them. Panic disorder is one of the most treatable disorders, and Cognitive Behavioral Therapy has been proven to be a highly effective form of treatment.

Cognitive Behavioral Therapy

Psychoeducation and understanding what is happening in the mind and body during a panic attack is a big part of healing. Treatment also involves examining triggers, teaching clients skills to address the acute symptoms of the attack as well as the overall stress level, and using repeated exposures. Exposure therapy incorporates an experiential piece into treatment, where the client is incrementally exposed to the feared situation and learns that they will survive.

Cognitive Behavioral Therapy can help clients to overcome the fear of panic attacks themselves, and empower them to face the situations that they may have previously avoided in order to try to prevent an attack. Clients can learn that not only will they survive a panic attack, but that they can actually move on and begin to thrive.

If you are experiencing panic attacks, avoiding situations you fear could trigger an attack (driving, crowded spaces, public speaking, etc), or find that your day to day functioning is impacted by anxiety, you could benefit from Cognitive Behavioral Therapy. Dr. Shoshana Shea can help. She can be contacted at 619-269-2377.