Eszter Noble is an RTT® practitioner, Clinical Hypnotherapist, and Coach, specializing in anxiety, fears, and depression. Her method utilizes the most effective techniques from CBT, NLP, psychotherapy, and hypnotherapy, with the ability to provide freedom from any issues and deliver permanent, lasting solutions.
Panic: a word that gets thrown around a lot. It’s used more often in our conversations than dancing shoes on a Friday night and has more ways of debilitating people’s lives than we can count. Panic disorder is a type of anxiety disorder characterized by recurrent, unexpected panic attacks. These attacks are sudden episodes of intense fear or discomfort accompanied by various physical and cognitive symptoms. These symptoms include worrying about future attacks, fear of losing control, and concerns that panic attacks could cause harm, such as triggering a heart attack.
For anyone dealing with panic attacks or panic disorder, the question is never about what it is exactly or its minute details. Instead, it’s about when it will rear its ugly head again. If you’d like a more detailed and scientific explanation, however, we can examine what recent research has revealed about the neurological underpinnings of panic disorder.
Panic disorder brains work differently
Brain imaging shows that panic disorder is not a character flaw or personality weakness. It is associated with biological changes in the brain. Brain SPECT (single-photon emission computed tomography) scans reveal that overactivity in the basal ganglia is commonly seen in people with anxiety and panic disorder. However, other areas of the brain may also exhibit abnormal activity.
With panic and other types of anxiety disorders, it’s important to consider additional potential causes, such as hormonal imbalances, exposure to toxins, and chronic infections. Occasionally, toxic mold or Lyme disease can also contribute to anxiety issues, including panic attacks.
Panic disorder (PD) is associated with distinct patterns of brain connections and activity. According to neuroimaging research, the brains of individuals with panic disorder handle threat-related information differently. During threat-related tasks, patients with panic disorder exhibit increased activity in the amygdala and brainstem, coupled with decreased activity in various prefrontal regions.
Fear network: Panic disorder involves abnormal activation in an extended fear network, including the brainstem, anterior and midcingulate cortex, insula, and prefrontal cortex.
Amygdala function: While the amygdala plays a crucial role in fear processing, its hyperactivation in panic disorder is not as consistent as previously thought.
Prefrontal cortex: Decreased activity in prefrontal regions may reflect deficient top-down control of threat responses.
Neurotransmitter imbalances: Alterations in serotonergic, noradrenergic, and glutamatergic neurotransmission contribute to panic disorder pathophysiology.
Actions keeping you stuck
As we’ve seen, there can be a lot of factors and key differences in how the brain processes threat-related information in PD patients, but how might you be contributing to these episodes, perhaps without even realising it.
I’m sure you’ve all heard the classic and largely useless advice to ‘just calm down’ or to breathe!
Unfortunately, the more you try to control your panic attacks and symptoms to avoid them, the more you are reminding your brain that those symptoms are dangerous and a threat.
Some of the ways you may be keeping the cycle going:
The words you say to yourself
Most of us don’t even realize just how powerful our words are and how they can quickly create a very vivid vision of doom in our minds. One of the most important steps to overcome panic attacks is to recognize the stories you tell yourself. After all, the language we use influences how we perceive and interpret the world around us. Our words shape our thoughts, which in turn influence our actions.
Picturing the worst-case scenario
When we use descriptive language and add emotions to tell ourselves these reoccurring stories, worst-case scenarios that run on repeat, we paint a very detailed image in our mind. The brain distinguishes reality from imagination based on the strength or vividness of the signal, therefore if an imagined signal is strong enough to cross the "reality threshold," it can be mistaken for reality.
Going back to what you know
When we experience stress, our brain and body are knocked out of balance, also called homeostasis. Stress hormones like cortisol and adrenaline are released, giving the body a rush of energy. Over time, we can become dependent on this energy rush, leading to an addiction to stress. On top of that, our minds don’t do well with uncertainty or the unfamiliar. It will always try to pull you back to ‘what you know’ to the comfort zone as that is deemed familiar and, therefore, safe.
Your mind doesn’t take no for an answer
When you attempt to calm yourself down and say things like “I’m not going to worry”, “I can’t think of it this way”, “I can’t focus on the worst possible outcome anymore” your brain will remain unresponsive. Sounds strange? What if I told you not to think of a red gorilla in a room? Would that work? Probably not! Telling yourself that you are safe, you can cope, and you can handle it is much more useful than trying to talk yourself out of a feeling by describing it in detail.
No one understands
Besides the pounding heart, the sweaty palms and many other similar symptoms of panic attacks, I would say that perhaps one of the most common sensations associated with it is that of isolation, feeling alone and misunderstood.
We have heard about it before, and we know that others experience it as well, but there can be a very strong feeling of seclusion, separation from others, and feeling like no one will understand. Of course, everyone’s experience is unique, but it can be so liberating to speak to others and just share how it makes you feel. No one should ever suffer in silence. Sharing stories and experiences is fundamentally about human connection, transforming personal experiences into bridges of empathy and understanding. When we speak to others, it enables emotional processing and helps us handle difficult experiences while offering stress relief and healing.
Often, we just need to be heard to feel understood. That is already a tremendous help.
Indecision can paralyse
Plan and prepare to protect your piece of mind. Fear is, of course, a big part of panic attacks, and nothing feeds fear more than uncertainty. Not knowing what the future brings or how you will possibly handle difficult upcoming situations can be enough to trigger the panic process.
Indecision can exacerbate panic in several ways:
Increased anxiety: Indecision often leads to overthinking and excessive worry, which can heighten anxiety levels and potentially trigger panic attacks.
Heightened physiological arousal: The stress of being unable to make decisions can lead to elevated heart rate and rapid breathing, which may be misinterpreted as signs of an impending panic attack.
Cognitive overload: Struggling with decisions can overwhelm your mind, making it harder to use coping strategies that could otherwise be effective when panic symptoms arise.
Increased anticipation anxiety: The fear of making wrong decisions can create a cycle of anticipatory anxiety, which is a common trigger for panic attacks.
Disrupted daily functioning: Difficulty in making even simple decisions can interfere with daily activities, creating additional stress that can contribute to panic.
Now reverse that. Planning your day, having structure and adhering to a schedule can help a lot with reducing the frequency and intensity of panic attacks. It provides a sense of control, a feeling of security and even safety. You will know what is happening and when. I call it putting your hands firmly on the steering wheel.
Change the way you look at panic
Panic has a thousand faces, it’s more versatile than a Swiss army knife and can appear in countless ways. Sometimes, I like to joke and say that panic is the new alcohol. It impairs your judgement as it descends on your brain like a nasty fog. It restricts your ability to make good decisions and will most certainly make you do and say things you will regret later. Panic can make you rude and impatient and snap at people who don’t deserve it. And perhaps the most significant of all is that, in the long term, it’s detrimental to your health.
Panic is like a bad mother-in-law. It can exist, but it doesn’t have to be an active part of your life. It’s extremely important to become aware of all the ways panic disorders can affect our lives so that we can address all aspects. It starts with the stories we tell ourselves every day and the language we use because that will inevitably contribute to creating our reality. Granted, you may have a very bad situation, difficult circumstances but you can start to change them now.
Don’t reinforce any old stories you may be carrying from years ago. Don’t reinforce your reality but rather focus on what you can change from this moment onwards and take full ownership of your situation and the choices you make from now on. It’s simple just may not be easy.
Unfortunately, traditional psychiatry typically takes a one-size-fits-all approach to diagnosis and treatment, but panic disorder isn’t a simple or single disorder. Giving everybody the same treatment will never work. You need to address all the factors in your life that contribute to your symptoms.
Unconventional treatment for panic
I always like to think outside of the box, take a different approach and I’m sure that most of you have already ‘tried it all’ anyway. Allow me to offer some alternative ways of dealing with panic:
Gratitude
Throughout the day, we find countless opportunities to complain, but what if we start the day by setting the tone right with a gratitude practice? Nothing to be grateful for? How about the simple fact that you can read this article? Take nothing for granted!
When we practice gratitude, a sense of calmness takes over, and it reduces anxiety levels significantly. It also triggers the release of positive neurotransmitters (serotonin, dopamine), leading to reduced stress levels and helps with immune system functioning.
Honesty is the best policy
Not being honest with yourself, chronic emotional suppression can lead to a wide range of health issues, affecting nearly every system in the body and significantly impacting overall well-being and longevity. We all have something to hide, but truly getting in touch with yourself and living an authentic life will have very unexpected positive outcomes, increasing the quality of your life immensely.
Get creative
By engaging the right hemisphere of the brain with creative activities like drawing or painting, we can trigger the release of positive neurotransmitters like serotonin and dopamine, as mentioned earlier, to improve mood and reduce anxiety. Research cited in the book "Your Brain on Art" by Ivy Ross and Susan Magsamen shows that engaging in art, such as painting or playing an instrument, for as little as 45 minutes significantly reduces the stress hormone cortisol and calms the nervous system.
Meaning and purpose
When you have clearly defined goals and a direction in life, it becomes much harder to be derailed, to overthink and worry about what tomorrow may bring. Otherwise, you could end up drifting like an aimless little boat out on the endless sea of life. You might get knocked down or derailed, but when you set your goals, it will be so much easier to literally get back on track.
Open your eyes
Often, when something is scary and uncomfortable, we may have the tendency to shy away from it, not want to face it. I remember on one occasion, I was flying home, and throughout the years, I made a habit of closing my eyes, trying to sleep while landing. Sometimes, when we pass through clouds, it can get a bit bumpy on the way down, so I would close my eyes and pretend to be somewhere else. Little did I know that the control freak in me wasn’t happy with that solution at all. One day, curiosity trumped my nerves, and I just started looking out the window. It turns out that facing the fear and being fully present in the moment does work, so I say, keep your eyes open!
On that note, I would like to conclude with perhaps the simplest and most effective way to combat an impending panic attack. When you feel that it’s starting to happen, lean into it.
Acknowledge your panic story
You will have told yourself the same story before, and it won’t be the first time. Acknowledge it and remember that you’ve gotten through this before. You survived, and you will be safe.
Break the cycle, have a ‘bring it on’ attitude
Much like with the flight story from earlier, open your eyes and face it head-on. Take back your power and take control.
Control yourself, but not the way you may think
If you start to tremble or shake, I want you to shake more. If your legs are twitchy, I want you to move them more. Show your mind and body that you are commanding your movements and that you are in control of what is happening. You are not an innocent bystander, and you have all the power.
I know it may sound scary at first or counter intuitive but it’s a lot like driving on a slippery road, you have to steer into it! Healing is a journey and having the right understanding and tools will certainly contribute to getting onto the right path. No one is born with panic disorder, so much like that unwanted mother-in-law I mentioned earlier, you don’t have to live with it!
Read more from Eszter Noble
Eszter Noble, Clinical Hypnotherapist & Coach
Eszter Noble is an established Clinical Hypnotherapist using the RTT® (Rapid Transformational Therapy) method, trained by world-renowned hypnotherapist Marisa Peer. She is known for dealing with extremely difficult cases and clients who have been stuck for years and who have tried it all. Specializing in anxiety, fears, and depression, she is extremely intuitive and honest, dedicated to empowering her clients to become the best possible versions of themselves. Offering her expertise in English, German, and Hungarian, Eszter’s mission is to take the taboo out of therapy.
