Psychological therapy for stress, anxiety, phobias, panic attacks

Dr Lara Lagutina, London Rotherhithe, UK



...I was walking down the street, and suddenly it hit me like a tonne of bricks, this panic... my heart is beating like crazy, legs get weak, I am sweating and shaking all over... And since then it happens from to time, in cinemas, supermarkets ... I tend to stay home more and more, but it is just getting worse...

Panic attacks are quite common, with about 1-3% of the adult population suffering from panic disorders. And how many more people avoid flying, driving, or going out in order to to avoid intense fear or panic...

Why does it happen?

Often the reasons are not apparent, and to get to the core of the problem it may helpful to recall the course of events around the time when your panic attacks started. For example, a 10-year-old  girl developed a phobia of bugs. Her parents could not make sense of it, until, during a therapy session, she recalled the following episode: “I am in a park with my mother ... We are walking on a lawn, when she tells me that they are getting a divorce and my dad will be moving out... I remember feeling sick and scared, my tummy started aching ... so I bent down... and saw this huge bug in the grass... “

Although the trigger is not often that obvious, one basic principle is this: a stressful situation generates intolerable feelings. This can be a suspected affair of the spouse, instability at work or move to a new country, which subconsciously resonates with our childhood experience, when life changed dramatically and uncontrollably say, following the parents’ divorce... And attempting to help us, our subconscious connects this stress and fear with something we can have more control over. Usually it is something in our close environment or bearing symbolic resemblance to the feeling, such as an enclosed space of an elevator: “A trap!”.And then it is no longer feeling trapped at work, when and staying in it feels equally terrifying. It is simply panic in the elevator, which is much easier to avoid. However, gradually the number of these fear-provoking situations grows and life becomes more and more limited, because when we avoid these situations, we do not deal with the fear as such, we simply put it “in the back yard”, where it continues to grow.

Tips for managing fear and panic:

  1. 1.Panic attacks are based on a vicious circle. The first step is to recognise it.

The vicious circle is a chain of thoughts, feelings and sensations, which reinforce each other and contribute to the build up of panic. For example, upon entering an elevator, I notice that my heartbeat increases, breathing becomes shallow and constricted, and I feel fear.  My brain takes a snapshot of the situation and responds: “Watch out! You’ve got a panic attack coming!” How does my body react to this thought? That’s right, - the fear increases, the heartbeat and breathing rate quicken, you start shaking, feeling weak and helpless . The brain: “Here it comes...!”

  1. 2.Fear is simply a signal of danger.

Having registered signs of danger (e.g. a snake in the grass), the brain activates the sympathetic nervous system, which triggers the archaic fight or flight response. The rush of energy in the body, increased heartbeat, rapid shallow breathing, and other “unpleasant symptoms” are necessary in order to prepare the body for fight or flight. The subcortical brain structures (phylogenetically older than the cortex) monitor our general safety and react much faster than our consciousness manages to evaluate the situation. Therefore, before we even manage to take a closer look, think and tell ourselves: “This isn’t a snake, this is just a twig...”, we jump or freeze on the spot; and although this rational re-evaluation helps: “Phew, this is just a twig (deep sigh...) nothing scary”, sometimes we feel scared of the sheer intensity of our fear, thus setting in motion the vicious circle.

There are also other ways to lower the arousal:

3. Notice your breathing.

As we already know, rapid shallow breathing is related to activation of the sympathetic nervous system. By contrast, slow abdominal breathing is linked to the parasympathetic nervous system, responsible (among other things) for rest and relaxation. The good news is that we can consciously control and alter our breathing. 

Notice how you breathe in your daily life. If your habitual pattern is shallow breathing from the chest, start practicing breathing from the abdomen when you are at home and feel calm. You may want to lie down and place a hand (or even better, a heavy book) on your belly. In order to feel this area better. Start practicing the abdominal breathing in normal daily situations, and later in situations of danger: notice how you breathe, and start breathing slowly from your abdomen. Focus on this exercise for a few minutes, and as you do it, notice (very important!), how this deep slow breathing is helping the rest of your body...

  1. 4.Feel the ground and you whole body.

Another common habitual reaction in stressful situations is narrowing of our awareness to the discomfort zone. “Oh no... , I feel this lump in my throat...”, - and all our attention focuses on that, leading to the increase of tension... This is another vicious circle, probably familiar to most... And you can easily imagine what happens next... The problem is that we forget the rest of the body and thus lose touch with its resources. Next time, try something different:

  1. Notice the discomfort zone (calmly, as a simple fact, rather than “Oh my God, this is horrible!”) and at the same time sense the rest of your body, particularly the support of the ground (or of the chair and the areas of the body where the sensations are more comfortable (relaxation, warmth, expansion or energy moving).

  1. Notice possible shaking in your arms or legs. There is a widespread belief that shaking is a sign of weakness or loss of control. Actually, shaking is often a very body reaction, common to both humans and animals. It is our bodies’ natural way of lowering activation and discharging the excess of energy.  Simply observe the shaking and notice how it helps the rest of the body.

Next time, when you notice the familiar symptoms, focus on this practice for a few minutes... And notice any small changes and improvements: your breathing becoming a bit freer, feeling lighter in the chest, the heartbeat slowing down... And feel the difference!

It is best to start practicing these steps in less disturbing situations first, and as you build your confidence, start tackling more challenging ones. Make a list of such situations, from less to the most scary, and gradually move down the list. You may also want to enlist the support of your friends and family, or that of a professional psychologist. No matter how you decide to go about it, the best thing is that by doing this work, you utilise your body’s own resources and thus take back control over your fear and your life.

  For information about the practical aspects of therapy, such as length of sessions please see FAQ.


Fear, anxiety and panic attacks:

understanding and management