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The Soul of Therapy

“My Worst Panic Attack Ever Came Out of the Blue!”

The body has its own way of processing emotions. “The rush of symptoms people experience in a panic attack is a tsunami of fear being released in the body. The question is: What’s deep below the surface that keeps building up fear that needs to be released?”

Q: I’ve had panic attacks every month or so for years. Usually they are mild or moderate, but last week my worst panic attack ever came out of the blue! I felt like I was choking, like I couldn’t breathe. I was pretty sure I was going to die. I have young children and I was afraid I would leave them motherless. My husband took me to the E.R. and they said it was a panic attack. This one really scared me. What can I do to stop having them?

I received your email when most of the country was on lockdown because of COVID-19. That’s a perfect time for your worst panic attack ever! Maybe it came out of the blue and out of the blues you fear your children will have for the rest of their lives if you die young. Panic attacks have many different symptoms, but I am struck by how the one you singled out—choking—has to do with breathing, a body function attacked by this virus.

I have come to think of some mind-body symptoms as similar to earthquakes. Long before an earthquake is felt on the surface, massive tectonic plates deep in the earth are pushing on one another and building up pressure. When that energy is released it causes earthquakes or tsunamis. The rush of symptoms people experience in a panic attack is a tsunami of fear being released in the body. The question is: What’s deep below the surface that keeps building up fear that needs to be released?

On the chance I might be right that the global pandemic had something to do with your recent attack, I suggest you listen to your body. It might be saying something like, “I’m really afraid and I have nowhere to go with all this fear. Please talk about it with someone. Give it somewhere to go so I don’t have to keep releasing it this way."

Bessel van der Kolk’s bestselling book The Body Keeps the Score is about how the body keeps reenacting trauma. When we try to tell ourselves we’re over trauma, the body says: “Yeah, sorry I’m not there yet.” Try getting out a notebook or journal and writing a dialogue, maybe something like this:

You (to your panic): Why are you here?

Panic: Because there’s too much fear building up.

You: But why have you been visiting me for years?

Panic: Because there’s also fear in here from early life that I don’t know how to release.

You: What can I do to help?

Panic: Get therapy so you can help me live closer to peace than panic.

If you do get therapy, I encourage you to look for someone who integrates mindfulness and somatic approaches (working with the body’s fear or trauma loops). Stephen Hayes, the creator of Acceptance and Commitment Therapy (ACT), has a TED talk on how confronting his own panic attacks was instrumental in developing ACT. You might want to give it a look.

Keep Reading: “Dreading the Next Family Gathering?”

Send your questions to [email protected] Questions may be edited for clarity or length. Dr. Anderson cannot respond to all letters. Sending a letter, whether answered in this column or not, does not create a doctor-patient relationship. Information in this column is for general psychoeducational purposes and is not a substitute for assessment and care provided in person by a medical or mental health professional.

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