Anxiety

How to Stop a Panic Attack and Keep It From Happening Again

This preventative measure works automatically, unconsciously, and consistently.

Posted Jun 15, 2020

You can stop panic and keep it from happening again. First, understand the process that leads to panic. Second, stop the process before panic can start.

1. The amygdala, as it monitors what is going on, may react. 

Based on genetic programming, the amygdala releases stress hormones when it senses something unfamiliar or when something unexpected happens. Based on learning, the amygdala reacts to things associated with traumatic experiences in the past. Traumatic experiences often involve being unable to escape. Thus places where escape is not immediately available—elevators, bridges, tunnels, high places, MRIs—can cause the release of stress hormones.

2. Stress hormones activate the sympathetic nervous system (SNS).

When stress hormones are released, your SNS prepares you to fight or run. The SNS increases your heart rate and breathing rate to send more energy to your muscles. It reroutes your digestive system's blood supply to your muscles. It increases perspiration so evaporation will pre-cool your body. If what the amygdala is reacting to turns out to be a threat, you are ready to take action.

3. Stress hormones cause alarm.

Do you need to fight? Do you need to escape? What is your amygdala reacting to? Your inner-CEO's high-level thinking needs to determine whether there is danger or not. Stress hormones cause feelings of alarm to grab its attention.

4. Alarm needs to be down-regulated.

Your inner-CEO needs to identify what the amygdala is reacting to, determine whether it is a threat, and decide what, if anything, to do. But your inner-CEO is frozen and can't function until the feeling of alarm is down-regulated to curiosity about what is happening. That's a big shift. But your inner-CEO functions only when it is cool, calm, and collected.

5. Our down-regulation system.

How is down-regulation accomplished? We all have a down-regulating system. It is called the parasympathetic nervous system (PNS). The name has meaning. The prefix "para" means against.

When activated, the parasympathetic system works against the sympathetic system. When fully activated, the parasympathetic system overrides the sympathetic system and restores your inner-CEO's ability to function

6. How down-regulation is activated.

  • Dependent activation is inborn

Neurological researcher Stephen Porges discovered we are genetically programmed to be calmed by the face, voice quality, and body-language/touch of a person who accepts us. Such a person's signals—unconsciously transmitted and unconsciously received—activate the PNS.

This is why we are comfortable with people who, instead of judging us, criticizing us, or giving us advice, accept us. Even if stress hormones are being released, the right person can make us feel calm.

But what can activate the PNS if we are alone? What allows us to control anxiety and panic independently?

  • Independent activation can be developed

A child who is consistently responded to expects to be responded to. When alarmed, the child expects the caregiver's face to appear, their voice to be heard, and their touch felt. The child's imagination of the caregiver's face, voice, and touch activates the PNS and calms the child before the caregiver arrives. As this scenario is repeated, it establishes a program in the child's mind that attachment theorists call an "internal working model of secure attachment".

A fully developed internal working model is like an app.

  1. When alarm takes place, it elicits a memory of the caregiver.
  2. The memory of the caregiver activates the PNS.
  3. The PNS down-regulates alarm thereby freeing the inner-CEO's high-level thinking to determine whether danger exists, and what, if anything, needs to be done.

If action needs to be taken, your inner-CEO plans what to do. At the moment your inner-CEO commits to a plan of action, it's a "done deal." The inner-CEO signals the amygdala to terminate the release of stress hormones.

If your inner-CEO determines there is no danger, that is also a "done deal." The amygdala is signaled to stop releasing stress hormones.

Either way, your inner-CEO resolves the matter and ends the release of stress hormone. Panic does not develop.

7. Without down-regulation, panic may develop.

Many of us—perhaps 40%—lack the mental programming needed to activate the PNS. If you do not have an "internal model of secure attachment" that can activate your PNS, alarm persists. Continued alarm is a problem. It is like a light so bright that nothing else can be seen, or like noise so loud that you can't "hear yourself think." Continued alarm overwhelms your Inner-CEO It is unable to determine whether what the amygdala is reacting to is a real threat or an imaginary one.

If a person has experienced trauma, the feelings of rapid heart rate, rapid breathing rate, sweatiness, and tension are associated with danger. The association between these feelings and danger may cause an overloaded inner-CEO to accept imaginary danger as real. Overwhelm may also make it impossible for your inner-CEO to develop a strategy to combat the danger or to escape the danger. With no control and no escape, your inner-CEO sees the situation as hopeless. When down-regulation of alarm does not take place, it does not matter whether the amygdala is reacting to a real threat or to an imaginary one. Panic can take place in either case.

8. How to make sure automatic down-regulation takes place and panic is prevented.

We can see the difference between panic and no panic is down-regulation of alarm. When alarm is down-regulated, Executive Function is able to determine whether a threat exists and what, if anything, needs to be done. When alarm is not down-regulated, Executive Function is unable to separate imagined threats from actual threats.

Down-regulation of alarm depends upon activation of the parasympathetic nervous system. Activation of the parasympathetic system depends on an app, an adequate internal working model of secure attachment. According to research, only about 60% of us develop secure attachment. This means about 40% of us did not have a relationship with our caregivers that promoted development of the app needed to automatically calm us down when hit by a release of stress hormones.

Eliminating panic on your own has been made possible by a convergence of neuroscience (Stephen Porges) with attachment theory (John Bowlby) and Object Relations Theory (Fairbairn, Klein, Guntrip, and others) and in my "lab" at 30,000 feet where I worked with people who had been unable to fly due to panic.