What the ER Doctor Won’t Tell You About Treatment for Panic

This is a guest post by Dr. Elizabeth Michas.

Usually, the first place a person goes when they are having a panic attack is straight to the ER. Thinking they are having a heart attack, they are desperate for medical intervention. But once they are diagnosed with a panic attack, they are sent away, usually with a prescription for anti-anxiety medication and a referral to a therapist. Brain-based interventions for panic disorder aren’t usually discussed in the ER, yet to be able to conquer panic you have to target the whole brain for change. The good news is you are having a brain response that may be priming a fear of physiological sensations, not a heart attack. Emotional Pain Intervention (EPI®) can be effective in as little as one session for treating panic disorder.

The Problem: Fear and Avoidance of Normal Sensations

When I was scuba diving for the first time with a mask on and regulator in my mouth, this altered my breathing and brought on a rapid heartbeat. At first, I instinctively panicked and tried to flee the water by popping up a few times in the pool before taming and retraining my emotional brain to keep calm and keep on diving. I told my brain that these new sensations were because I was breathing differently and I was not in danger. A person with a panic-prone brain might make this connection and attribute what they are experiencing when scuba diving for the first time as a panic attack. They might never think their brain just had to learn to correctly attribute what they were experiencing as a novel but “normal response” to scuba diving.

Consider how some of the physical symptoms you experience aren’t responded to with automatic fear and avoidance. How about body sensations associated with beginning to run to catch a bus, or running a mile on a treadmill? While they might mimic the same symptoms associated with a panic attack, they are not dangerous. Have you ever had your heart beat rapidly and not panicked, such as by running, watching a suspenseful movie, or being excited about something about to happen?

In the case of a panic attack, the person experiences the same symptoms that they would when working out or learning to scuba dive, but because they experience a needless fear of the sensations, the sufferer is in emotional pain—which worsens the experience by conferring a negative or catastrophic meaning to what is happening to their bodies. Although people who have an anxiety disorder perceive their physiology as out of control, it actually isn’t. University of Rochester professor Jeremy Jamieson’s studies on anxiety show that when subjects learned to view stress responses positively that their cognitive reappraisal of panic altered it. By severing this link, arousal-reappraisal techniques help shift negative stress states to more positive ones, leading to a reduction in negative affect, more adaptive patterns of physiological reactivity, reduced attentional bias for threat cues, and improved performance.

Panic disorder clients’ cardiovascular and autonomic responses look just like those of a non-anxious person. Everyone experiences an increase in heart rate and adrenaline at some point in their lives—whether when they are in love, opening a new gift, watching a scary movie, working out, or running to catch a bus. People with anxiety perceive those changes differently, however. They may be more aware of the sensations of their heart beating or the changes in their breathing. And they make more negative assumptions about those sensations, fearing a panic attack. But their physical response is not fundamentally different.

The Cure: The Brain Learns From New Experiences

You might find it surprising that the way to conquer panic is to first bring it on. We do this through interoceptive exposure: a whole-brain-based intervention that is designed to intentionally activate bodily sensations through a hyperventilation or movement exercise. This is necessary not to cause discomfort or pain, but in order to expose you to the range of physiological and cognitive symptoms you experience to rewire the neural patterns of fear and avoidance of sensations, and associate new meanings, beliefs, or thoughts. The primary aim of interoceptive exposure experience is to reactivate the fear neural circuitry in the brain. In interoceptive exposure, you will replicate actual symptoms experienced during an anxiety or panic attack and in the process, desensitize the previously fear-conditioned response to the physical sensations. We can train the brain to no longer be bothered by its own survival-threat detection triggering.

You can retune the brain by using either humor or indifference to show the brain how to respond to sensations when they are first noticed and experienced. The fear of sensations is an emotional pain response seen with panic disorder that is then reconditioned using the opposite emotional state, such as making the fear response seem funny, silly, or something you don’t care or worry about, or regard as totally unimportant. The emotional impact of this response is that uncomfortable physical symptoms are reactivated and present in the moment but experienced in a new way as benign or not threatening.

Our brains have the capacity to rewire the old emotional pain response of fear and stop automatically avoiding sensations. Pills from the doctor or talk-only therapy are not the only options for addressing panic; you can rewire your brain by using interoceptive exposure exercises for taming and training new responses to panic sensations. Gaining mastery and skill to play the brain as an amazing organ of change and transformation will enable you to conquer anxiety and panic at any time, and in any place.

You can acquire the skills to play the brain that will enable you to gain mastery over—and freedom from—whatever is holding you back from living with joy, purpose, and meaning.

To find a therapist, please visit the Psychology Today Therapy Directory.

Dr. Elizabeth Michas is a licensed Psychologist who has praciced for 30 years in Destin-Fort Walton Beach, Florida.