How to Overcome Panic Disorder

Reasons Why Professional Help Can Improve Your Mood

The amygdala learns primarily through experience. While observing others can influence the amygdala, the most effective learning for anxiety patients occurs when they directly interact with the object or situation that causes them fear (Olsson, Nearing, and Phelps, 2007). You could logically argue with someone with anxiety for hours, but if the goal is to change amygdala-based anxiety, such strategies are ineffective. Direct experience, even for just a few minutes, is much more effective.

To change the amygdala's fear response to mice, for example, the person must first be in a location where they are exposed to mice to activate the memory circuit related to them. This exposure is necessary for new neural connections to form. Because the amygdala learns based on associations and connections, modifying or changing circuits within the amygdala requires experiencing changes within these associations. Naturally, being near a mouse would activate the anxiety patient's mouse memory circuit, triggering immediate anxiety. However, it is important not to retreat. Unfortunately, people often avoid direct confrontations like this, and such intentional avoidance prevents the amygdala from forming new connections.

Returning to the example of mice: an anxiety patient tends to avoid even thinking about mice. The mere thought triggers an amygdala response that induces anxiety, leading to instinctive avoidance.

Generally, the amygdala tends to preserve pre-existing emotional responses learned from past experiences by avoiding exposure to anxiety triggers. This avoidance reduces the chances of altering the established circuits.

The cerebral cortex allows us to anticipate and imagine future events, enabling us to prepare in advance—an ability that can be both a blessing and a curse. Anticipation refers to the cortex's ability to predict what might happen next and vividly imagine it, allowing us to be prepared.

Anticipation primarily occurs in the prefrontal cortex, located just behind the forehead on the left hemisphere, which is responsible for planning and executing actions. The idea of preparing to act in a certain way comes from this part of the brain.

The key takeaway is this: When experiencing intense anxiety, relying on cortical-based coping strategies, such as telling yourself to stop being afraid or convincing yourself that there's no logical reason to be anxious, is often ineffective. Once the stress response is triggered, it cannot be stopped. By this point, conscious thought has been overtaken by emotion. At times like this, you need strategies that target the amygdala, not the cortex.

How to Prevent Panic Attacks - The Cortex

The cortex cannot directly induce a panic attack. Other brain regions, including the amygdala, must be involved to trigger such a process. However, the cortex can create a state of preparedness for a panic attack or exacerbate an ongoing one. Sometimes, thoughts generated in the cortex are sent to the amygdala, triggering or worsening a panic attack. Therefore, the following cortical-based coping strategies can be useful, especially if employed before a panic attack starts.

Remember that what you're feeling is just a feeling (although it may be very intense). When the three main responses—fight, flight, or freeze—are activated and experienced as physical symptoms, accepting the cortex's interpretation of these symptoms without filtering can render anxiety uncontrollable. If you experience panic attack symptoms and think you might be having a heart attack, losing control of your judgment, or about to go insane, the panic attack will worsen. Recognizing that you're experiencing a panic attack and preventing the cortex from misunderstanding amygdala-based symptoms can help you recover quickly from a panic attack.

Redirect your attention. Distraction is another cortical-based strategy that can be used against panic attacks. Simply focusing and ruminating on symptoms can worsen a panic attack, so you should deliberately try to think about something other than the panic. (Chapter 11 provides more detail on how to effectively redirect your attention.)

Do not worry about what others are thinking. People experiencing panic attacks often think everyone is watching them or presume that others will somehow embarrass them. If you feel panic symptoms, do not waste energy guessing what others might be thinking. Most people neither notice nor care what you're doing. Worrying about what others think only adds more stress to an already uncomfortable stress response.

Remember that although a panic attack is an extremely uncomfortable experience, it does not endanger you or cause actual harm.

If you've experienced meditation or are interested in it, consider trying this practice. Numerous studies have shown that regular meditation can alleviate stress-related conditions, including high blood pressure, anxiety, panic, and insomnia (Walsh and Shapiro, 2006). However, the most important news for anxiety patients is that meditation has a direct and immediate calming effect on the amygdala. Meditation is effective in reducing amygdala responses in the short and long term, suppressing amygdala activation and activating the parasympathetic nervous system in various situations (Joreges et al., 2012). Meditation is undoubtedly an effective relaxation strategy. Including regular meditation in your morning routine can reduce overall anxiety and better equip you to handle the day's demands.

Triggers

We have learned that the language of the amygdala is based on "associations." More specifically, the lateral nucleus of the amygdala recognizes connections between events that occur very close together in time. We learn to fear triggers associated with negative events, regardless of whether those triggers actually lead to negative experiences. In other words, when a trigger is paired with a negative event, the amygdala is programmed to generate anxiety.

A person who fears dogs might feel terrified just hearing a growl similar to a dog's. Regardless of the reason, you can retrain your amygdala, even if you're unsure what creates an emotional memory.

Fear of flying, for example, does not affect someone who has no reason to fly or can easily choose alternative travel methods. Our goal is to modify anxiety responses that must be resolved to live the life we desire.