What is a panic attack?
Experiencing a panic attack is like being trapped in a turbulent storm of fear and physical sensations. Your heart races, your breath becomes shallow, and a sense of impending doom takes hold. It feels like losing control as your thoughts spin and your body trembles with adrenaline. Time stretches, and each second feels like an eternity. It's an overwhelming and disorienting experience.
Can panic attacks get better?
Generally, yes! Panic attacks can be overwhelming and debilitating, but there is hope for recovery. In this blog, I will explore concepts and techniques to anchor yourself in your safety state, promote self-regulation, and grow from these challenging experiences.
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Panic Attack and the Polyvagal Theory
It helps to understand better what a panic attack is, and the Polyvagal Theory provides the perfect lens. But first - what is the Polyvagal Theory explained very, very briefly?
The Polyvagal Theory Explained Very, Very Briefly.
The Polyvagal Theory is the science of connection. It explains how we connect in safety and how we respond to danger. So you can exist basically in either your body's safety state or one of your body's defensive states. (See? Very very briefly! But here is a longer explanation.)
Let's go one step further...
The defensive states of the Polyvagal Theory
The Polyvagal Theory has two primary defensive states and one secondary. These are:
flight and fight sympathetic (primary)
dorsal vagal shutdown (primary)
freeze mixed state (mixed state)
Think of flight/fight as mobility. And think of shutdown as immobility. It's possible to have both of these Polyvagal states active simultaneously. That equals freeze, which is the mixed state.
In freeze, the body is prepared to mobilize due to danger but is also immobilized at the same time. This potentially results in panic - the body is activated specifically in flight but immobile. That's why you feel the intense reactions of a panic attack but can't move. Here are some examples:
Heart palpitations: A feeling of a rapid, fluttering, or pounding heart.
Sweating: Excessive perspiration unrelated to physical activity or heat.
Trembling or shaking: Uncontrollable shaking, often in the hands and legs.
Shortness of breath or feeling smothered: A sensation of being unable to breathe or feeling like you're being smothered.
Chest pain: Discomfort or pain in the chest area, which can sometimes be mistaken for heart-related issues.
Coping with a Panic Attack vs. Grounding in Safety
The next step is differentiating between coping with defense and grounding in the Polyvagal safety state. These are not the same thing, and accurately understanding the two will help you to anticipate what to do and what is likely the next time you have a panic attack.
What is coping with a panic attack?
When we cope, we tolerate a panic attack and attempt to get through it by reducing its intensity until it subsides. With coping, we are not truly grounded in our Polyvagal safety state. Examples of coping could be:
distracting yourself with tv
snacking on something
reading a book
get reassurance from someone nearby
I think of "coping" as dealing with or managing. You're getting through a panic attack. The goal of coping is to reduce the negative impact on you and reduce the pain of it.
The ideal way of coping may be through distraction. Distraction does not involve feeling your feelings. It does not involve mindfulness or welcoming discomfort. Distraction is about getting through the panic attack.
There is absolutely nothing wrong with coping, by the way. If you need to get through a panic moment through distraction, that's fine. You can learn from it and set yourself up with safety grounding for the next time.
Polyvagal Safety Grounding & Panic Attacks
Safety grounding is accessing your body's state of safety. It's more than coping. It's mindfully attuning to what makes you feel safe. Examples of safety grounding might be:
going for a mindful walk and noticing your surroundings
feeling your muscles moving as you release your panic energy through movement
using your senses to connect to the present moment
Safety grounding is not easy. But practice helps — a lot.
If you are brand new to the idea of safety grounding, you won't be able to utilize it the next time you have a panic attack. You need to do these three things before you can realistically anchor yourself in safety:
Experience your safety state, maybe for the first time.
Figure out what brings you to your safety state again.
Practice accessing your safety state regularly.
As you practice accessing your safety state, you build up your potential to be able to do so again and again. And yes, this includes even moments of escalating anxiety and even panic. As you strengthen your safety state, defensive activation becomes more tolerable. Likewise, as defensive activation becomes more bearable, you will have more capacity to feel panic attacks coming on before they are full-blown panic attacks.
Frustratingly, accessing the Polyvagal safety state is more difficult for traumatized individuals.
Identifying Early Signs and Taking Action:
A panic attack may be triggered rapidly. But often, a sequence of events leads to a panic attack. These smaller events alone may feel like anxiousness or stress. But compiled, they may begin to feel more intense and even overwhelming. And then a panic attack may trigger from just one more event, even something otherwise benign.
Please recognize the potential for panic attacks as early as possible. Then, you can immediately reduce its intensity by identifying even slight dysregulation.
For example, if you notice panicky freeze energy building up, you can engage in more active strategies, such as walking around the block. Walking may be enough to utilize your panic early on and get relief.
Taking action early during the build-up to a panic attack is the ideal time to do safety anchoring. Early on is when the emotions are more manageable. But more importantly, it's when you have more access to your safety state.
In a full-blown panic attack, there is far less access to the safety state. But with practice, it's possible. During a panic attack build-up, there is much more potential to access your feelings of safety.
Check in with yourself regularly, gauge your anxiety and overwhelm levels, and practice feeling safe. If you can successfully ground in safety when slightly activated in anxiety, you can practice how to self-regulate. And, of course, also practice being in safety when you don't have anxious feelings.
Moving from Coping to Active Safety Grounding:
You may need to cope with a panic moment and get through it. And that's fine. But you can also transition into safety grounding after coping.
Instead, what you may be doing is coping through phone numbing. Once the panic subsides, you might ignore what you just went through and continue with your day, sleep it off, keep numbing out, or give yourself a boost through substance use. Once the initial dysregulation subsides, you can instead shift your focus toward actively grounding yourself in the safety pathway.
Coping is the first step, but the goal is to go beyond coping and take proactive measures to anchor yourself in safety. So after the noticeable panic has reduced, do something to decrease the activation further. For example, if you use your phone to numb the panic, stop once the activation has reduced. Don't ignore what you just went through. Instead, give yourself a pat on the back for successfully managing a panic attack. Then do something to help yourself recover and anchor in your safety state.
It may help to do a self-assessment after the initial panic. Ask yourself how much panic activation you have on a scale of 0-10. It might be time to use safety grounding techniques if six or below. If a six is still too high for you, continue using your coping mechanism until you reach a tolerable level.
Use Safety Anchors to Reduce Panic Attacks:
Passive safety cues
Set yourself up with passive safety cues. These are things in the environment that you get ready ahead of time. Things like lighting, sound, and scent are passively taken in through your senses. You could use these passive cues during a panic attack, but I recommend having them active and ready before a panic attack.
You should also be familiar with what passive safety cues bring you to safety well before a panic attack. So don't wait for a full-blown panic before figuring out what scents ground you in your safety state.
Active safety anchors
Active safety anchors are things that you actively do to ground yourself in safety further. For example, sunshine might be a passive safety cue for you. But walking may be an active safety anchor. Exposing yourself to sunshine is great, but walking in the sunshine is even better.
You can utilize many more potential active safety anchors to ground further in safety. A short list of examples is:
art & creativity
Should you also feel your feelings during a panic attack?
If you can handle it, then yes! If you cannot handle it, then probably no.
You should feel your feelings if you can handle feeling your feelings. Meaning you allow defensive state activation, including panic attacks, when you can tolerate them. If you can feel them without further dysregulation, go right ahead.
How do you know if you can handle it? If you're curious about what panic feels like for you, then you may be able to allow mild panic activation to be present. Curiosity is a good indication that you can feel your feelings. Other signals could be:
You should not feel your feelings if you can't handle them. Meaning you should probably not allow panic to be present if you will spiral deeper into dysregulation. Signs that you cannot handle feeling your feelings include:
unwelcome or intrusive cognitions, like flashbacks
thoughts of self-harm
If you can't yet feel your feelings and allow mild panic activation, that's okay! That doesn't mean you won't be able to forever. You can develop your capacity to allow defensive state activation that is tolerable. Yes, even panic activation.
Panic attacks can get better.
Strengthen your safety state to improve your panic attacks.
Defensive activation decreases as you practice accessing and being in your safety state. Strengthening your safety pathways allows more distress tolerance. More distress tolerance means allowing and tolerating more defensive activation without dysregulation.
Mindfully experience small amounts of anxiousness to improve your panic attacks.
Notice your lower-level panic activation, like mild to moderate anxiety or stress during the build-up to a panic. If you can notice it at this time, then mindfully experience it while anchored in your safety state, you will further strengthen your distress tolerance.
No, it's not an easy process. And it's not a short one, either. It takes work, and it takes dedicated practice. But these two elements are key to success in emotional regulation, including panic attacks:
practice being in safety and building your distress tolerance
mindfully allow tolerable dysregulation while anchored in your safety state
These are large goals, and it seems like an impossible task. That's why I created two courses that guide you through the process of how to accomplish these two goals:
Building Safety Anchors: this course teaches you how to identify safety, experience it and strengthen your safety pathways.
Unstucking Defensive States: this course teaches you how to mindfully allow and experience your defensive states without overwhelm.
Luckily, you don't need to choose which one to go with. I created the Total Access Membership that unlocks all my courses and private community for you. For on subscription price, you get it all.
Learning to anchor in your safety state is the key to reducing your panic attack intensity and frequency. It's also the foundation for further trauma recovery work if you are heading in that direction.
Do you trust in your ability to self-regulate?
As a biological organism, you are compelled to self-regulate. You must. However, trauma gets in the way. Do you still have trust that you can self-regulate?
Q: What is the Polyvagal Theory, and how does it relate to panic attacks?
A: The Polyvagal Theory explains how our body responds to danger and connects to safety. Understanding it can provide insights into managing panic attacks and accessing your safety state.
Q: Should I cope with or ground myself during a panic attack?
A: Coping with a panic attack helps reduce its intensity, but grounding in your body's safety state is more effective for long-term management. Learn the difference and discover techniques to ground yourself during panic attacks.
Q: Can panic attacks improve over time?
A: Yes, panic attacks can generally get better with practice and self-regulation. Strengthening your safety state and distress tolerance can reduce the frequency and intensity of panic attacks.
Quotes from this blog:
Coping is dealing with or managing. The goal of coping is to reduce the negative impact on you and reduce the pain of it.
Practice accessing your safety state, and you build up your potential to be able to do so again and again.
Mindfully experience small amounts of anxiousness to improve your panic attacks. Notice your lower-level panic activation, like mild to moderate anxiety or stress during the build-up to a panic.
Justin Sunseri is a licensed Marriage and Family Therapist and Coach specializing in trauma relief. He is the host of the Stuck Not Broken podcast and author of the book Trauma & the Polyvagal Paradigm. He specializes in treating trauma and helps individuals get "unstuck" from their defensive states.