How To Prepare For a Panic Attack

You're probably going to have another panic attack. Sorry!! But what if you could prepare for it in a way that actually moves your recovery forward? In this episode, I walk through the mindset shift that changed my own recovery, the neuroscience of why you can't think your way through panic in real time, and a practical toolkit for setting yourself up before the next adrenaline surge hits, including how to talk to the people closest to you, why language matters, and what to actually do in the moment. If panic attacks have been running your life, this is your starting point!

Sources:

• Heart Attack or Panic Attack | American Heart Association
• How to tell the difference between a heart attack and panic attack | American Heart Association
• Heart Attack vs. Panic Attack: Key Differences | Cleveland Clinic
• Panic Attacks & Panic Disorder: Causes, Symptoms & Treatment | Cleveland Clinic
• Mayo Clinic Q and A: Panic attack isn't life-threatening, but can be frightening experience
• P.S. Thank you Jenny Matthews from State of Mind Therapy for the term "adrenaline surge"! 

Get your FREE Fear to Freedom Guide here! 

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Transcript

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SPEAKER_00 0:23

Welcome to the 18 Minutes Podcast. I'm Amanda, and this is the show where we talk about everything that is confusing, scary, and isolating about disordered anxiety and turn it into something we can actually work with. If you've had a panic attack and you are walking around bracing yourself for the next one, this episode is for you. We're not talking about how to never have another panic attack again. We're talking about something way more useful. How to be prepared for the next one so that it stops running your life. So let's get into it. Quick reminder before we get into today's topic: I am not a therapist or a medical professional. Everything in this show comes from my own experience with disordered anxiety, my experience in recovery, and the research I do for the show. This is not a replacement for therapy or medical care. Please listen to your doctors and your mental health professionals first. If you're new here, hi, I'm so glad you found this. Please go hit follow or subscribe wherever you're listening. This podcast is built around showing up for you consistently, and I don't want you to miss the next one. If you're a regular listener, thank you. Truly. This show exists because of you. Okay, so today's conversation is one I've wanted to have for a while because I think it's one of the most practical conversations we can have about disordered anxiety. We're talking about how to be prepared for your next panic attack. Not how to never have another one again, not to never feel anxious again, but how to meet the next one in a way that moves you forward instead of keeping you stuck. If you have panic disorder, the truth is you're probably going to have another panic attack at some point. And I know that's not what you wanted to open this podcast with, but it's the truth. And stay with me because what we're going to talk about today could literally change the way you experience anxiety. I want to tell you something that took me a long time to figure out. For most of the 15 years I had panic disorder, my attitude and posture was please God, do not let that happen to me ever again. Every morning I woke up doing the math on how I was feeling and what it meant for the rest of my day. Every time my heart did something weird, I would freeze and start scanning the rest of my body and inevitably find other things that weren't feeling perfectly okay. My whole existence was oriented around my next panic attack not happening. What I didn't understand back then is that as long as my goal was never have another panic attack, every time I had one, it was proof that I was failing. I'd have a panic attack, and instead of using it to my benefit, I would get more scared and more avoidant and more stuck in this anxiety cycle. Every panic attack made the next one even more likely because the fear was already taking up so much of my energy. A major shift happened for me when I accepted that I was going to have more of them. Not because I wanted to, but because pretending that that wasn't going to happen when that's what panic disorder is was not moving me forward. So I changed the question. Instead of how do I make this never happen again? I asked, How do I change the way I handle this situation in the future so that I can get better? Once I made that switch, I started getting almost excited for the next one. Strange, I know. Not because panic attacks felt fun all of a sudden. They don't, they're miserable, but because every single panic attack now was an opportunity. They became a chance to practice and a chance to prove to my brain that I could meet this thing differently than I had the past thousand times. That mental flip from fearing panic to preparing for it made my recovery easier, faster, and sometimes even empowering. So that's what this episode is all about. How to set yourself up so the next one doesn't catch you off guard. And so that when it does come, you can use it to move yourself forward toward recovery. Here's something you've probably experienced, but maybe weren't aware of or didn't know why it was happening. But you cannot think your way through a panic attack in real time. When your nervous system flips into fight or flight, it reallocates blood and other resources to parts of your body that are going to help you with survival. Your heart speeds up to move oxygen, your muscles get flooded, your breathing rate changes, and the part of your brain that's responsible for clear, logical, rational thinking, the prefrontal cortex, basically goes offline because it's not needed in a survival situation. Meanwhile, your amygdala, the alarm system, takes over. This is well-established neuroscience. This is not a personal failing. It doesn't mean that you're weak. This is how our bodies are built. The same system that would help you run from a bear is the same system that's going off during a panic attack just with no bear around. What this means in practice is that trying to think your way out of a panic attack is like trying to learn the directions to a new board game while your house is on fire. The decision-making part of you is genuinely not available, which is why just breathe, just think rationally feels like useless instructions when you're in the moment. You don't have access to those tools when you need them the most. So we plan ahead. We make decisions now when our prefrontal cortex is online and we're sitting at home in a regulated state. Future you, the one who's running around mid-panic, is not going to make thoughtful choices. You will be running on whatever script has already been handed to you. And our job is to make sure that script is one that moves you toward recovery instead of deeper into the fear cycle. Everything else in this episode is about writing that script. The first thing we can do to set ourselves up well is to let our people in on what we're practicing. The people you spend the most time with, your partner, your roommate, your best friend, your mom, whoever it is, need to know two things. They need to know what moves you toward recovery, and they need to know what is keeping you stuck. Because here's what happens: you start spiraling and you turn to the person next to you and you say, I'm feeling weird, I'm freaking out, do you think I'm okay? And because they love you and care about you and want you to feel better, they say, Yes, you're fine, you're gonna be okay, everything's okay. And with every loving intention, they're actually helping to keep your panic disorder alive. That's reassurance seeking. And we've talked about it on the podcast before. Every time someone reassures you that you're okay during a panic attack, your brain logs the reassurance as the thing that kept you safe from danger. And it starts to understand that the only way to stay safe is to be reassured. The next spike comes and the loop gets stronger and more intense. What you actually need from the people around you is not reassurance, it's their logic when yours is offline. So sit down with people you care about. This could be a 60-second conversation. Tell them when I'm spiraling, I might ask you for reassurance. And the most loving thing you can do is not give it to me. Instead, you can say things like, I trust you to handle this, your body is doing what it does, you don't need me to check, or this is a great opportunity for you to practice the principles you already know will move you toward recovery. Give them the script, and they'll probably be so relieved. The people who love you are probably walking around watching you struggle, feeling helpless, and it would be really relieving to know there's something they can actually do to help you. When the panic comes and you reach for one of your safe people, instead of getting reassurance that you're not gonna die because you already know that, you can lean on their logic to help move you forward instead of keeping you stuck in this loop. The next thing we can do to help prepare ourselves for the next panic attack we have seems small, but matters more than you might think. I want you to try something. Instead of calling what you're experiencing a panic attack, try calling it an adrenaline surge. I know that's maybe sounds like a semantic trick, but the words we use to label what's happening in our body absolutely have an effect on how our nervous system processes it. Panic attack sounds like something is attacking you, like an external force is doing something that needs to be defended against. Your body hears that framing and braces for it. Adrenaline surge sounds like what it actually is. Your body dumped a bunch of adrenaline into your bloodstream and it's going to peak and then it's going to leave. It's a chemical event and it has a beginning, a middle, and an end. It's not coming for you, it's just happening in you. And this isn't a denial situation. You're not pretending that it's not intense or that it's not scary because it absolutely is those things. But the language reframes it from something is attacking me to my body is doing a body thing that I'm uncomfortable with. And the second framing leaves you a lot more capable of riding it out. Try practicing this while you're feeling good, and then the next time you start feeling anxious. When the symptoms start, instead of thinking, oh no, a panic attack is starting. Try, okay, an adrenaline surge is happening. And notice how that lands differently. Your body is paying attention to the language that you use. So you've prepared your people know the script, you're calling it an adrenaline surge, and now it's actually happening. So what do you do? The short answer is acceptance and willingness instead of avoidance and safety behaviors. I'm going to give you the quick version here because there's a whole episode called how to practice acceptance. And if this is the part that is most needed for you right now, um, I recommend going and listening to that episode after this one. But here's a kind of working summary. Safety behaviors are the things we do to try to manage or escape panic in the moment. Checking your pulse, calling someone for reassurance, not driving on the highway, drinking water in a really specific way, um, sitting down because you're scared that you're gonna pass out or have some kind of cardiac event. Whatever yours are, they all share one thing in common. And that is teaching your brain that panic is dangerous and that these things are needed to keep you alive and safe. Acceptance and willingness are the opposite. You let the surge be there. You let your heart do whatever it's doing, you let the dizziness be dizzy, you let the panic sit there in your chest and the feeling of dread that you have sit in your body wherever it's sitting. You don't argue with it, you don't run from it, you don't try to make it go away. And this is an important part, you keep doing whatever you were doing before the panic set in. If you were going grocery shopping, you keep grocery shopping. If you were driving on the highway, you keep driving safely, of course. If you're in a conversation, you stay in the conversation. Claire Weeks wrote about this decades ago in her book called Hope and Help for Your Nerves, which I highly recommend if you haven't read that yet and you struggle with panic disorder. That is such a foundational book to everything that I talk about. And Claire Weeks calls this behavior floating. You float through the panic, you don't tense against it and you don't fight it, you let it flow through you while you stay in your life. That word and that concept was really helpful to me and has been really helpful to a lot of other people. So I wanted to pass that along to you. You don't have to like it. You don't even have to feel brave about it. You just have to let it happen and not abandon yourself by running from it. That, repeated, is what teaches our brains that those surges are not dangerous and we don't need protection from them. I need to say this part as plainly as I can because this was something I needed to hear so badly when I was struggling, and I missed this information for years and years and years while I was struggling. A panic attack will not kill you. It will not give you a heart attack, it will not make you stop breathing, it will not make you go crazy, it will not give you a psychotic break. If you don't believe me and you want more assurance that that's the case, I have links in the show notes with more information. Our bodies have been building this response for hundreds and thousands of years because it's survivable. It's an alarm system. Alarm systems make a lot of noise, but they don't cause damage. If you have lingering health concerns, please see a doctor. The peace of mind alone is worth a lot. But once you get that assurance from a doctor, practice being sure of it. Adrenaline surges feel catastrophic, but they are not catastrophic. Those two things can be true at the same time. This is the foundation of all the other stuff that I've talked about today. The reason that you can practice acceptance and willingness is because you're not actually being threatened. And the reason you can tell the people in your life not to reassure you is because you don't need reassurance to save you from a natural chemical event happening in your own body. And the reason you can call it an adrenaline surge instead of a panic attack is because that's exactly what it is. The fear of panic attacks is way bigger than the panic attack itself. I have a whole episode called The Fear of Fear if you want to dive deeper into that. But for now, just know that you are not in danger. Even when it feels like you are, even when every cell in your body is screaming at you that you are, you are not. I want to do a quick rapid fire on a few things you can do before the next surge shows up. Have a small toolkit of things that you've tested. Not 20 things, not a bunch of safety behaviors, just two or three. Maybe it's a phrase like this is just adrenaline, it will peak and it will pass. Maybe it's a body posture like standing straight up instead of curling in on yourself. These behaviors signal to your brain that you're not in danger and they can help you move through a panic attack easier. But the trick is to practice them when you're feeling good so that you can trust them when you're mid-panic. Another thing you can do that could be really helpful is to know your early warning signs. Most of us have tells that we're about to experience an adrenaline surge. Maybe it's your jaw getting tense, maybe it's a feeling of your stomach dropping all of a sudden, maybe a specific kind of thought or what if pops up right away. If you know your tells and you practice being more and more aware of them, you can meet an adrenaline surge with the awareness you're trying to have instead of feeling completely blindsided by it. Another thing you can do is lower your baseline nervous system activity. This will not prevent an adrenaline surge, but it can help make moving through it easier. Sleep, hydration, regular meals, uh, less caffeine, some kind of daily movement. None of this is the final answer, and these things could be used as safety behaviors, so use them intentionally. But a regulated nervous system has more room to practice in an effective way when we do have adrenaline surges than an overcaffeinated, dehydrated, exhausted one does. I'm going to say again that those things can be safety behaviors. You are still safe to have a panic attack, even if you are overcaffeinated, dehydrated, and exhausted. But if you want to make your practicing exposure and response prevention more effective, you can take better care of yourself when you're feeling good. Have a post-panic protocol. That's got like a really fancy uh corporate sounding ring to it. Post-panic protocol. This one is a big deal, and I don't hear a lot of people talking about it. How you treat yourself in the hour or so after you experience a panic attack matters just as much as what you did during it. The temptation is to analyze, replay, figure out what triggered it, and ask everyone around you if they think you're okay. That's all reassurance seeking, and it tells your brain that the event that happened was in fact dangerous and it needs to be treated and prevented. The actual move is to just go back to your regular life. Make that cup of tea, send the email you were gonna send, continue in the conversation that you were having. That unceremonious, boring return back to regular life is what teaches our brains over time that that experience was not dangerous, it doesn't need to be investigated, and over time it will learn that it doesn't have to dump that adrenaline into our system in the first place. The last thing we can do to prepare for having our next panic attack is to keep the bar low. We're not aiming for handling the situation perfectly and not feeling terrified. We're aiming for I didn't run, I didn't check, I let it pass. That is as good a win as any. I want to be really clear about something before we wrap this up. This is not easy. Recovery is not a straight line. You're going to have anxiety, you're going to have panic attacks. There will be weeks where you feel like you're getting it and you're on the right track, and then a big adrenaline surge will happen to you and you'll wonder if any of this is working at all and if you're back to square one. That's all part of it. That's not a sign that any of this is broken or that you're doing it wrong. When I was in the worst of my panic disorder, I legitimately believed that I was born a little bit broken. Like I was just one of the unlucky people whose brain didn't work totally right and it never would. I cannot tell you how wrong I was. Recovery is not about never feeling anxiety or fear ever again. It's about changing our behavior to teach our brains that fear itself is not something to be afraid of and to live the beautiful, rich lives we want to live despite going through hard things sometimes. That's a learnable skill. And I know you can do it. I know that because I did it, and I'm not anyone special. I just kept showing up and practicing the same handful of things over and over. Every adrenaline surge you experience without running or fighting moves you in the right direction. The version of you that has done this a hundred times is going to feel different in their body than the version of you that's just starting. Both versions are you. The work is how you get from one to the other. You are not broken. You are working with a nervous system that has learned a pattern, and patterns can be unlearned. I believe in you and I'm rooting for you. Three things I want you to take with you today. One, decide right now that the next adrenaline surge is going to happen and that you're going to use it instead of fight it. Two, pick one or two people who you can tell about what moves you forward towards recovery and what keeps you stuck so they can lend you their logic when you need it. And three, the next time you start to panic, call it what it is an adrenaline surge. Let it be there and stay present to your life while it happens. That's the whole practice. If you have questions about anything I covered, or you have a topic you want me to dive into on the show, I would love to hear from you. You can send me an email at amanda at the 18minutes.com or send me a DM on any of my social channels. I read everything in this podcast. Is shaped by what you tell me you need. If today's episode was helpful and you want a deeper guide on some of these things, I have a free guide available on my website at the18minutes.com. It walks through some of these principles in more detail and it's totally free, you just need to grab it. And if you haven't yet, please follow or subscribe so that these episodes land automatically in your feed. And if you have a second, rate or review this podcast. It really helps other anxious people find this resource. Thank you so much for being here, and we'll see you next time.