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Panic Attacks Explained: What's Going On, What Keeps Them Going, and What Actually Helps · Moving Minds Forward

• 0:00
  Gary Johannes: Hi. My name's Gary Johannes. I'm a solution focused hypnotherapist, founder of Inspired to Change, and a senior lecturer at CPHT. I left school at 14 with no qualifications, One of nine kids, in the RAF at 16, and in sales, I run bars and nightclubs and restaurants. Around thirty years of that work life.
• 0:26
  Then in my late 40s, I met a hypnotherapist, and whatever I felt was fixed about me wasn't. So I retrained, and then built Inspire to Change, and later completed a Master's in Psychology and Neuroscience of Mental Health at KCL in London at the age of 60. This podcast is everything I've learned from the therapy room, the training room, and life itself. We look at one condition per episode, what's going on with it, what's keeping it going, and what actually helps. If you find it useful, hit subscribe.
• 1:05
  Let's get into it. So panic attacks. Before we get into anything else, I want to say something that I think matters. If you've ever had a panic attack, there's a good chance that at some point during it, you genuinely thought you were dying or having a heart attack or losing your mind completely, and I want you to hear this clearly. That's not what was actually happening.
• 1:36
  Your body was doing something very specific, something it's been doing for thousands of years. And when you understand what that is, really understand it, something changes. Not straight away, but it does change. That's what this episode is about. What panic attacks actually are?
• 2:01
  What's happening in your brain and your body when one hits? What causes them? What keeps them going? And what actually helps? And I'll leave you with one practical thing you can use today.
• 2:17
  If you find it useful, hit subscribe wherever you're listening. There's a lot more to come. Most people who've had a panic attack describe it in the same way. Sudden, overwhelming, out of nowhere. One minute you're fine, or you think you're fine, and the next, your heart is going.
• 2:38
  Your test is timed. You can't get a proper breath. And every part of you is screaming that something is catastrophically wrong. That's what a panic attack feels like. Intense, fast, and it catches you completely off guard.
• 2:56
  Something that surprises most people when I tell them. They usually breathe. Most panic attacks last somewhere between five and twenty minutes, peaking within the first ten. In the middle of one, that might as well be a lifetime. Well, that's what's actually happening physiologically.
• 3:17
  The body goes up hard and fast, and then it comes back down. So what's actually going on when all of that kicks in? Pass your mind back to what we covered in the anxiety episode. The fight or flight response. The amygdala.
• 3:36
  The alarm system deep in the brain fires off a signal. Breath detected. The body responds instantly. Adrenaline floods in. Heartbeat spikes.
• 3:49
  Breath goes fast and shallow. Blood rushes to your muscles. Everything shifts to high alert in a generally high threatening situation. That response would save your life. It's actually a remarkable thing.
• 4:07
  Your whole body mobilizing everything as it has to fight or run. The problem with a panic attack is the alarm fires loudly, completely full throttle, and there's actually no threat. Nothing to fight, nothing to run from, Just your own nervous system going from zero to a 100 in seconds with no obvious way to switch it off. And then something happens that makes it worse. You notice the symptoms.
• 4:46
  Racing heart, the tight chest, the breathlessness, and the brain, already in threat mode, reads those symptoms as evidence that something is genuinely wrong, which ramps up the anxiety, which intensifies the physical symptoms, which increases the fear, which increases the symptoms round and round. A loop that feels completely out of control. That's a panic attack. Not you breaking, not you going mad, your threat response system firing without a real threat, and then amplifying itself because the symptoms feel threatening. Because the symptoms feel threatening in their own right.
• 5:38
  I want to spend a moment on what it actually feels like. Because if you've never had one, it could be hard to understand why someone can't just calm down. And if you've had one, I want you to feel properly understood, not just heard, understood. The physical symptoms, racing or pounding heart, chest pain or tightness, which is why so many people end up in A and E convinced they're having a heart attack. Shortness of breath, dizziness, hot flushes, or chills, tingling in the arms and the hands, sweating, shaking, nausea, dry mouth.
• 6:25
  And alongside all of that, the feelings, a sense of dread, like something terrible is about to happen, and you can't stop it. Fear of losing control, fear of going mad, fear of dying. Sometimes a strange feeling of unreality, Like, everything around you is slightly off or like you're watching yourself from a distance. The last one can be particularly frightening if you don't know what it is. Put all of that together.
• 7:03
  Every signal your body is sending says danger. And your rational mind, the part that might know somewhere that this will pass gets completely drowned out. I've sat with people in the Therapy Room who've described their first panic attack as the most terrifying experience of their life, and I believe them every time. Because in that moment, everything is telling them they're in the worst kind of danger. The fact that it passes doesn't make it any less real while it's happening.
• 7:40
  So what causes them? This is where it gets a bit more complex, because panic attack don't always have one obvious cause, and that's part of what makes him so unsettling. They can feel completely random, but they're not random. There's always something going on underneath. Sometimes the triggers are obvious.
• 8:07
  Specific places or situations the brain has come to associate with danger. A crowded supermarket, a motorway, a medical appointment, a social situation. If you've ever had a panic attack somewhere before, the brain can start firing the alarm before you've even arrived. Sometimes it's less obvious. Stress that's been building quietly for months, a significant life change, bereavement, a relationship ending, a new job, moving house, the kind of pressure that doesn't feel dramatic, but it's been quietly filling the bucket until eventually it overflows.
• 8:54
  Caffeine is worth mentioning. High intake can trigger panic attacks in some people. It activates a nervous system in ways that can push someone over the edge when they're already running close to that anxiety threshold. Sleep deprivation makes everything worse. It lowers your threshold, leaves you more reactive, more easily chipped into that threat mode, and there's a vulnerability element too.
• 9:25
  If you've been through trauma or anxiety disorders running your family, you may be more predisposed. Panic attacks are slightly more common in women, but they absolutely affect men too. Often men have no idea what's happening to them because no one's ever described what a panic attack actually feels like. This is something I think about a lot in the context of men's mental health. Panic attacks in men often go undiagnosed or misdiagnosed because the man doesn't report it, assumes it's something physical, pushes through, hopes it stops.
• 10:07
  It doesn't always stop on its own. And the longer it goes unaddressed, the more complicated it gets. Now there's an important distinction worth making here between a panic attack and a panic disorder. A panic attack is a single event, terrifying, but a single event. Panic disorders is what can develop when attacks become reoccurring and when the fear of having another one starts to quietly shape how you live your life.
• 10:40
  It's not just about the number of attacks. It's about what happens between them, the constant monitoring of your own body for warning signs, the changes in behavior, avoiding places or situations where attacks have happened or where you're afraid they might, that's where panic disorders become genuinely disabling, not just because of the attacks themselves, because of what you start doing to try and prevent the next one. You stop going certain places. You stop going out alone. You start planning every journey around exits.
• 11:21
  You need someone with you just in case. Your world gets smaller and smaller. And the cruel irony is the avoidance that feels protective is actually feeding the problem. Every time you avoid something because of the fear, you're sending your brain a message. That was dangerous, which makes it more vigilant next time, which makes the anxiety worse, which makes avoidance feel even more necessary.
• 11:54
  I've seen people come in who haven't been on a motorway in years, who haven't been in a supermarket alone, who plan every journey around where the exits are, not because they choose that life, but because panic attacks gradually took it from them, One avoidance at a time. And there is generally good news, is that the cycle can be broken consistently, reliable with the right approach, but you have to understand what keeps it going first. So let's talk about that. Avoidance is the biggest one. Every time you avoid the thing that makes you anxious, you get short term relief.
• 12:41
  That relief is real. It generally feels better in the moment. So the brain learns. That worked. Let's do more of that.
• 12:51
  The avoidance gets wider. The comfort zone gets smaller. The anxiety gets bigger. The thing that feels like it's protecting you is keeping you stuck. Sit with that for a second, because it's one of the most important things I can tell you about panic disorders.
• 13:13
  Then there's what I call the body scan. People with panic disorders often become hypervigilant about their own physical sensations. Constantly checking. Is my heart racing? Am I dizzy?
• 13:31
  Is my chest high? And because they're looking for symptoms, they find them, or they read completely normal bodily sensations as signs of danger. A slightly elevated heart rate from walking upstairs becomes evidence that something's wrong, which triggers anxiety, which creates more symptoms, which confirms the fear. It's a trap, and it's very easy to fall in without realizing. Sleep.
• 14:02
  Poor sleep lowers your threshold for everything. When you're not getting proper REM sleep, the brain can't process the emotional experiences of the day properly. You wake up more reactive, more likely to read neutral things as threatening. And then there's a thinking. I feel this.
• 14:25
  Something terrible is about to happen. If I go there, I'll have a panic attack. If I have one, I won't be able to cope. Each of those thoughts feels completely true in the moment, but they're fear predictions, not facts. And they feel real enough to drive behavior.
• 14:46
  And they feel real enough to drive behavior. And that behavior keeps the cycle going, and then withdraw. When panic disorder takes hold, people pull back. They stop seeing people. They stop doing things they enjoy.
• 15:04
  The world contracts. Serotonin drops. The serotonin means more anxiety. More anxiety means more withdrawal. A spiral that can go very deep, very quietly without the right support.
• 15:20
  We understand what's keeping it going. Now let's get practical. What can actually help in the moment when a panic attack hits? The most important thing, and this goes against every instinct, is to resist the urge to fight it or run from it. I know how that sounds.
• 15:43
  When the alarm is going off at full volume, everything in you wants out. But fleeing reinforces the message that there was something to flee from, and fighting it, trying to force the symptoms to stop, tends to intensify them. What actually helps is acknowledgment, not defeat. More like, I know what this is. This is a panic attack.
• 16:11
  It's uncomfortable. It's not dangerous, and it will pass. That's not minimizing it. That's just accurate. Because it will pass.
• 16:25
  Every panic attack does. The body cannot sustain that level of activation indefinitely. It goes up. It peaks. It comes back down, usually within ten to twenty minutes.
• 16:42
  Redirecting your focus, counting backwards from 100, noticing five things you can see, four things you can hear, three things you can physically feel, anything that gives the rational brain something to hold on to while the primitive brain does its thing. Breathe in. Not false dramatic deep breaths that can actually make things worse, but slowing the breath down gently, making the out breath slightly longer than the in breath. In for four counts, out for six, steady, not urgent. That activates the parasympathetic nervous system, the part of you that brings everything back down from high alert.
• 17:33
  And if you can, stay where you are even just for a few minutes, not because it's comfortable, but because staying starts to tell your brain a different story about that place. Now let's talk about lasting change. Because managing a panic attack in the moment is one thing. Getting to a place where they stop or where you can face situations without dread, that's something else entirely, and it's completely achievable. The solution focused approach doesn't start with the panic attacks.
• 18:11
  It starts with you. Where you are when panic isn't driving? What does a normal day look like when this isn't hanging over you? How do you feel when you wake up? What are you doing?
• 18:26
  Where are you going? We call this the preferred future. Get in genuinely clear on that in real detail. It's not a fluffy exercise. It's purposeful because the brain moves towards what we focus on.
• 18:45
  Give it a direction, and it starts to find a way. From there, we work on the foundations. Sleep. Getting proper restorative sleep is one of the most powerful things you can do to lower your baseline anxiety. It's not glamorous, but it's fundamental.
• 19:05
  REM sleep is where the brain processes emotional experiences, resets, and consolidates learning. Without it, everything is harder. Without your capacity to cope and think clearly goes up significantly. Then the three pillars, positive interaction, positive action, and positive thinking, the building blocks of serotonin. When panic disorders has taken hold, all three tend to fall away.
• 19:42
  You withdraw. You stop doing things. Your thinking gets darker. Rebuilding these slowly, one step at a time, literally changes the chemistry of the brain. Not a life overhaul, not overnight.
• 20:00
  What's one small thing that would feel slightly better than what's happening right now? One conversation, one short walk, one situation you've been avoiding that if you faced it would tell your brain a slightly different story. That's where real progress happens gradually with support. Building new experiences that start to update what the brain believes is dangerous. I've seen people do this work who thought their lives were permanently smaller, who had quietly accepted that certain things were just off the table now.
• 20:41
  They were wrong. Not because they went from weak to strong, but because they understood what was happening to them, got the right support, and took one step forward at a time. And before I close, one thing you can do right now, start keeping track, Not in an anxious, obsessive way. Not in an anxious, obsessive way, but after a panic attack, after a moment of high anxiety. Just note a few things down.
• 21:20
  Where were you? What were you doing? What you were thinking? How you'd been sleeping? Whether something stressful had been building?
• 21:32
  Whether you've had a lot of caffeine, you're not looking for a single cause. You're looking for a pattern, because panic attacks rarely come from nowhere. They follow threads, And when you can see the threads, they become less mysterious, less terrifying, more manageable. That shift alone from this comes from nowhere and I have no control to I can see what's happening here, is often where the real change begins. Just a note on your phone after the fact.
• 22:06
  That's all it takes. Do that and notice what you learn. If you're listening to this because panic attacks are part of your life right now, I want to be straight with you. This is not something you have to just live with. It's not a personality flaw.
• 22:24
  It's not a weakness. It's not proof that you're broken or different or beyond help. It's a brain doing exactly what brains do. They're trying to keep you safe just with the sensitivity turned up far too high. And that sensitivity can come down.
• 22:44
  The patterns can change. The world that's been shrinking can start to open back up. I've watched it happen across fifteen years of practice in people who came in barely able to leave the house, in people who've been managing this alone quietly for years, not even knowing that help existed. They've changed, not overnight, but they've changed. Starts with understanding what's going on.
• 23:14
  You've just done that, and that, quietly, without any fanfare, is a step forward. If this episode has been useful, and I really hope it has, hit subscribe wherever you're listening. Every episode, one condition. The same lens, what's going on, what's keeping it going, and what actually helps. There's a lot more to come, and I don't want you to miss it.
• 23:43
  See you on the next one.