Exposure Therapy for Panic Attacks & Panic Disorder

Does it ever feel like panic attacks are limiting or even controlling how you live your life? A panic attack is a sudden rush of intense fear and physical sensations.

It can be so scary and overwhelming that even when we’re not panicking, we’re anxious, worrying about when the next one will happen. And this fear about having another panic attack can impact our lives as much or even more than the attacks themselves.

And so we start avoiding anything we think could bring on a panic attack. And this pattern defines panic disorder.

We look at how to calm a panic attack in progress in another video. Here, we’re going to focus on how to make panic attacks less frequent and reduce our anxiety about them.

We start by not avoiding things we’re afraid will bring on a panic attack. Instead, we willingly go into these situations without trying to actively control or prevent panic to just see what happens.

This is called exposure, and it changes our relationship with fear both psychologically and physiologically.

Psychologically, we start to see that the situation isn’t as threatening as we believed. We learn that sometimes we don’t even have a panic attack. Sometimes it’s milder than we expected. And even when it’s intense, eventually it passes and we’re okay.

When we put ourselves in these situations and stay in them even if we’re feeling really anxious, we teach our brains that these things aren’t actually dangerous. They might make us really uncomfortable and sometimes even cause a panic attack, but we get through them and survive.

And over time, they stop triggering the same level of fear.

And physiologically, our body stop reacting so strongly because the situation is no longer being treated like a threat every time it shows up.

This reduces our fight orflight response. the body’s automatic reaction to perceived danger that causes physiological reactions like increased heart rate and rapid breathing, lowering the intensity of the sensations we experience during a panic attack and making it more manageable.

There are a couple of ways to do exposure. Exposure therapy is a more structured approach that we cover in another video, but we can also use scenarios that come up in everyday life, the ones we usually avoid out of fear, as opportunities to practice exposure.

It can help to set things up as an experiment beforehand. We note what we’re worried and expect will happen. My heart will start racing and I’ll feel like I’m going to die. People will notice I’m acting weird and think something’s wrong with me. I’ll have to rush out and I’ll make a scene.

Then we approach the situation with an open mind to test our hypothesis.

And then afterwards, we reflect on what actually happened to see how accurate our predictions were. My heart did start beating faster and I felt a little panicky, but I reminded myself it’s nothing dangerous. It’s just anxiety.

I didn’t feel the need to escape. And I don’t think anyone was even aware of what I was going through. This helps us form a more accurate understanding of the things that make us anxious and learn that things aren’t always as bad as we fear. And even when they are, we get through them.

Someone did notice something was up with me and came over and asked if I was all right. And this was really embarrassing. But even though I wanted to escape, I made myself stay. And eventually the panic passed and I was pretty shaken up. But I survived without having to leave.

So exposure builds more confidence about our ability to handle these situations. And as a result, our anxiety about future attacks decreases, lowering the chances that we’ll start to panic.

And if we do start to panic, we’ve had practice managing it, which makes it likely things won’t get as bad as they’d been in the past.

And when we’re doing exposure, it’s important not to use safety behaviors, things we do to try to prevent or reduce anxiety in these uncomfortable situations.

Like scanning the room for exits or places to escape, or bringing a trusted friend with us in situations that make us anxious.

We’re carrying with us at all times a specific medication, a water bottle, a paper bag in case we start to hyperventilate, or a lucky charm. While these might make us feel safer in the moment, they prevent us from learning that the situation isn’t truly dangerous and that we can manage it even without these behaviors and items.

They may help us experience less fear while doing something. But they don’t have any lasting positive effect on our levels of anxiety. Instead, they often increase anxiety and make us more dependent on these safety behaviors.

And if for some reason that safety behavior isn’t available, that alone can cause us to start to panic.

And sometimes, especially with panic disorder, it’s not just panic attacks we fear. We can start fearing the physical signs themselves that we associate with panic.

And so, in addition to avoiding things we’re afraid could trigger a panic attack, we might start avoiding things out of fear that they’ll bring on these sensations. This can include exercise, even walking, which raises heart rate and can cause shortness of breath, or caffeinated drinks, which can cause jitters.

Or wearing tight collars or scarves that can trigger feelings of choking or breathlessness.

But these are all normal body sensations we can experience throughout the course of the day. They’re not dangerous and they don’t harm us, so we don’t need to try to avoid them.

This is where what’s known as interoceptive exposure comes in, which means intentionally bringing on some of the physical sensations that scare us in a controlled way to learn that they’re not a threat.

These exercises are safe for most people, but if you have any concerns about how they might affect you, please consult with a doctor before trying them.

So, we might exercise until our hearts start beating faster and we’re a little out of breath, or gently spin around on a chair until we’re a little dizzy.

Or swallow quickly 10 times without water to mimic throat tightness or choking sensations that can feel like suffocation.

Or breathe through a straw for a minute while pinching our nose to cause feelings of breathlessness or choking.

Or hyperventilate by taking rapid deep breaths for a minute which can make us dizzy, lightheaded or experience other sensations.

The goal is to bring on these sensations we usually associate with panic. Allow ourselves to fully experience them and see that nothing harmful happens.

This helps us learn that while these sensations can be really uncomfortable, they’re nothing serious and they’re not always signals that we’re about to have a panic attack.

So, we stop interpreting them as signs of danger and instead start to recognize them as just natural physical sensations that happen in our body sometimes. And so, we don’t need to be afraid of them or try to avoid them.

And so, our brain starts to realize that these sensations are just a false alarm. And the fight or flight response is less likely to get activated, which makes it less likely we start to panic.

And we begin to be able to tolerate these uncomfortable body sensations without reacting to them with fear and stop feeling the need to avoid situations where they might occur.

Now, exposure is scary. Nobody wants to do things that make them anxious, especially if they’ve led to panic attacks in the past. But exposure is the most effective way to reduce how often panic attacks happen and to manage panic disorder.

We face the situations we fear will trigger panic attacks to learn that they’re not really as threatening as we think. And so there’s no need to keep avoiding them.

And we intentionally bring on the physical sensations we’ve come to associate with panic. So we learn that these aren’t dangerous and we don’t need to avoid them or things we think could trigger them.

And as we stop relying on avoidance to manage anxiety, we’re able to do more of the things we want and that are important to us because they don’t scare us as much. and we’re not constantly worrying about when the next panic attack will happen, which makes it less likely that we will start to panic.