What causes panic? Most explanations miss the mark. But the cause of panic is obvious if emotional regulation is understood. Here are some basics. When something unexpected happens, a tiny part of the brain—it's called the amygdala—releases stress hormones. The hormones cause feelings of alarm that make us drop what we are doing, figure out what is going on, determine whether there is danger or not, and if there is danger, what to do about it.
To do this, we need to make a cool, calm, and collected appraisal of the situation. So early in life, we develop mental software that calms us down as soon as alarm grabs our attention. The software activates our calming system. It overrides the stress hormones and shifts us from feeling alarmed to being curious about what is going on.
But not all of us develop this software. If we don’t, when stress hormones are released we stay alarmed until the hormones “burn off.” The continued feelings of alarm convince us there is danger whether there is or not. Then, on top of the alarm, we feel a massive urge to escape. If escape is not immediately possible, we feel trapped and we panic.
As a retired airline captain and licensed therapist, I work with people who are afraid they will have a panic attack on the plane. For example, when a plane is in turbulence, it repeatedly drops. Each drop releases stress hormones. The stress hormones cause alarm. But instead of experiencing just a blip of alarm, continued alarm can make passengers believe they are in danger. In-flight, escape is impossible, and they panic.
When therapists don’t understand panic, the solutions they offer rarely work. According to the Journal of the American Medical Association, only 17 percent of people treated with Cognitive Behavioral Therapy (CBT) become free of panic.
CBT suggests clear thinking can prevent panic. That’s true, but few of us think clearly when alarmed. We can “install” mental software that down-regulates alarm, but trying to think more clearly when alarmed rarely stops panic. At least that has been my experience. I used CBT with fearful fliers for years with very little success. But almost all my clients who have tried automatic down-regulation have become panic-free.
The following exercise from my book, Panic Free: The 10-Day Program to End Panic, Anxiety and Claustrophobia, offers panic sufferers a way to override stress hormones by activating their parasympathetic nervous system, which calms them down.
“Because the amygdala releases stress hormones every time it senses anything nonroutine or unexpected, we experience arousal several times a day. Link your actual feelings of arousal to your friend’s face, voice, and touch. When feeling relief, we sometimes say, “ahh.” Let each of those three letters remind you as follows:
- the letter “a”: of their attuned face,
- the first letter “h”: of hearing their voice, and
- the second letter “h”: of getting a hug.
Every time you sense arousal, imagine you see your friend walk into the room, come over to you, and give you a hug (or whatever form of touch is appropriate for your relationship). By imagining this in response to arousal or alarm, you cause the three elements that activate the parasympathetic nervous system—face, voice, and touch—to come immediately to mind.
Let your friend’s presence linger in your mind for a minute or two. You could imagine your friend sitting down with you. You might imagine talking over what triggered you. Hanging out with your friend in this imagined way keeps the parasympathetic nervous system active until whatever stress hormones are present burn off.
In just a few days, bringing your friend’s face, voice, and touch to mind each time you feel arousal will establish automatic alarm attenuation.
• Carry a photograph of the calming person. At work, keep it on your desk or wall. When you notice any level of arousal, glance at the photograph.
• When first noticing arousal, place your hand on the part of your body where you noticed the sensation of letting down your guard in your friend’s presence. Picture the friend’s face, remember their voice, recall their body language, and their calming and reassuring touch. The touch of your own hand becomes linked to your friend’s calming presence.
• If it isn’t easy for you to bring the calming person’s face to mind, just imagine their touch. Instead of visualizing that person coming into the room, pretend that the person is always with you, standing right behind you. When you feel stressed, imagine feeling the person’s arms reaching around you and giving you a hug. Imagine that you don’t even have to ask: they just do it when you need it.
• If possible, make an arrangement with the calming friend that you can call or text them when you feel arousal. You don’t necessarily need a reply. Just knowing that your friend has you in mind is enough.
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