I have panic attacks

What it looks like

Your heart starts racing, your chest is heavy and you feel like you can’t breathe normally. You think you’re having a heart attack and go to the ER. Tests show nothing is wrong and the doctors refer you to a psychiatrist.

Then it happens again and again, and still you can’t predict it. You can’t stop it from escalating when it begins. Now you’re constantly waiting for the next attack, certain it’s already manifesting in your body.

What have you already tried?

• Went to the emergency room multiple times
• Got full cardiac workups
• Took a benzodiazepine when you felt one coming
• Tried to breathe through it
• Avoided the places where attacks happened
• Exercise and diet changes
• Therapy to understand what triggers the panic
• Took an SSRI
• Spent hours researching heart conditions

The attacks still happen.

Is it panic disorder?

Panic attacks are sudden episodes of intense fear. Your body goes into full emergency response even though nothing dangerous is happening.

After the first attack, fear of the next one becomes the real problem. You’re panicking about panic itself.

Do any of these apply:

• I get sudden episodes of intense fear without warning
• I’m certain I’m having a heart attack or dying during the attack
• I’ve been to the ER convinced something is medically wrong
• I’m afraid of having another attack
• I avoid situations or places where I’ve had attacks
• I monitor my heart constantly
• The attacks have changed how I live

Is this a panic attack or something else?

Why nothing worked

You’ve tried to manage it by treating it like a medical problem. You take medication. You avoid triggers. You try to calm yourself during an attack.

Even though the tests show you’re medically fine, you panic anyway.

Benzodiazepines stop the panic in the moment. You take the pill and the fear goes away. But your mind still generates panic responses. You build tolerance fast. You need more. You become dependent. You’re trading one problem for another.

SSRIs reduce how much the panic bothers you. You still have the attacks. You’re just numb enough not to care. They take weeks to work, if they work at all.

Talk therapy that explores why you panic doesn’t stop it. Understanding where it comes from or analyzing your entire childhood just won’t stop it from attacking you.

When you avoid going to certain events or places out of fear of a panic attack in public, that avoidance strategy confirms to your brain that those places are dangerous. You expand the list of what to avoid. Your world gets smaller.

Panic disorder often runs with generalized anxiety and social anxiety . If you worry constantly or get anxious around people, more than one pattern is running. CPTSD is common underneath panic. If you grew up in an unsafe environment, your mind learned to treat uncertainty as a threat.

How we work with it

Strategic therapy ends the trigger that fires the panic response, not the panic itself. The pattern has a vulnerable point where it can be interrupted, and that’s where the work happens. Your attacks stop because the thing that has been launching them stops launching them.

You stop bracing for the next attack. The next attack doesn’t arrive.