Anatomy of a Panic Attack

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It’s hard when the people close to you don’t understand what you’re going through with anxiety and panic attacks. The NY Times put out a great article this month on “The Anatomy of a Panic Attack,” which may give you a little more insight into either your own experience or that of someone close to you. Or maybe you’ll choose to share it with someone to understand what you’re going through. If it’s of interest, I’m sharing the article here and I’ve included some important ideas in this newsletter that the article leaves out. 

Panic Attacks Article, NY Times, Nov 10, 2022​

“Thanks Panic Attack! (Sort of!!).”  The article is helpful for learning some of the physiological processes that occur in a panic attack. But what it doesn’t clarify, and what has been really helpful for me and my clients to remember, is that a panic attack is a misplaced protective response. All the processes that occur in panic, the epinephrine and norepinephrine, the racing heart rate, the sweating, and even the digestive discomfort: they are all part of the body’s attempt to keep us safe. We call them panic attacks because they are not appropriate to the situation we are in — but the same body-mind response would save our life in an emergency situation. Shifting our mindset to realize the value of those physiological responses, can shift our reaction to a panic attack, valuing our body’s strength even if the reaction is not quite right for the moment we find ourselves in.

“Story follows state.” The article states that: “During a panic attack, the amygdala is hyperactive, while the prefrontal cortex is less responsive, causing us to spiral.” In a panic attack we have more access to the amygdala which is sometimes referred to as “the body’s smoke alarm” because is associated with threat detection, and less access to the prefrontal cortex, (logic, reasoning). I think a little more info here would be helpful to many people to understand the thoughts and impulses to move that come with a panic attack.

Somatic trauma therapist Deb Dana coined the phrase, “story follows state,” to refer to the idea that our thoughts and the story we tell ourselves about what we’re experiencing are largely shaped by our nervous system state. When one has thoughts during a panic attack that they are going to die, or other outsized thoughts or emotional responses, or an impulse to run for instance, we can know that these are the “stories” which are shaped in large part by one’s current neurological state of threat response. This includes that ”hyperactive amygdala” and a ”less responsive” prefrontal cortex. It’s incredibly challenging to access rational thought in that moment and friends and loved ones’ attempts to encourage you to do so are likely going to be unhelpful at best. Instead, it’s so much more helpful to access relief through a body-based approach. 

What to do.  The group of psychiatrists and psychologists who put together this article mostly recommend body-based approaches for when you’re in the midst of a panic attack, which I agree with, and yet their long-term solutions are talk therapy in the form of CBT and psychiatric medications. Of course these have been helpful for many folks, and therapy was helpful for me when I was having panic attacks 20 years ago, but the authors completely leave out what something that was essential to my panic attacks subsiding: Body-based approaches for growth and healing, including Somatic Experiencing and Feldenkrais Methods, approaches which have been so crucial to my own life. Our culture is in some ways just waking up to the realization that somatic practices can be a powerful way to work with emotions — “story follows state,” after all.