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How Brian Stopped Having Panic Attacks Almost Overnight

In this series of articles exploring themes from my Stress Resilience Blueprint, it's useful to illustrate some of the ideas using case studies. So in this article I'd like to tell you about my client Brian, not his real name, who came to me suffering panic attacks on an almost daily basis.

In Brian's case a panic attack affected his breathing. He would start to feel like he couldn't get enough air, even though he would be breathing pretty heavily. In fact he sometimes called them breathing attacks. He feared he was about to die, and even away from the attacks he worried that there was something deeply wrong that was causing the attacks, which he didn't understand.

His panic attacks happened on a daily basis, sometimes several a day, and the strange thing was they seemed to come out of the blue, without any obvious trigger – except for perhaps one thing: his worrying that it might happen.

After one session my office, Brian only had one or two more panic attacks, then they stopped.

How was it that we got such a dramatic change in such a short space of time?

I could tell that Brian's attacks involved hyperventilation (over-breathing). (I've described the connection between over-breathing and stress elsewhere.) I measured Brian's breathing in the office (using a capnometer, plus other devices) and found a baseline of mild over-breathing that made Brain vulnerable to spiralling into hyperventilation.

I explained the science behind hyperventilation, and helped Brian make sense of his paradoxical experience of feeling like he couldn't get enough air – his brain wasn't getting enough oxygen, leading him to breathe more, and creating a vicious spiral of worsening hyperventilation. The only way Brian could break out of the attacks was by going out and walking quickly. This too made sense – the exercise created some extra carbon dioxide that helped balance his system.

Effectively we had reframed his breathing attacks. They went from mysterious, dangerous and terrifying events to something he could understand, and could even hope to control by learning to manage his breathing.

Of course we did some breathing training and of course it helped but really this reframe was the key. His fear of the panic attacks was in fact a major factor in precipitating them. They were a classic example of what I've called the quicksand trap, where trying too hard, or trying in the wrong sort of way, actually made things worse. Understanding what was happening helped him let go of this fear.

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