Panic attacks are one of the most easily treatable conditions in the whole area of mental health, according to Drogheda-based GP Dr Harry Barry. “The more you try to run away from them, the more they will run after you,” he says.
“The key message is that, yes, panic attacks are uncomfortable, but they are not dangerous. I get people to write that down. By fully understanding how your brain works and accepting the temporary discomfort and understanding that it is just your body’s ‘gunslinger’ firing off when it doesn’t need to, the fear lessens.”
Dr Barry has met people who have been suffering with panic attacks for 20 years. “That’s the tragedy. Many people spend their lives running from panic attacks, fearing them, fearing embarrassment when they happen, fearing that they won’t be able to breathe, that they’ll have a heart attack and die. Many would have gone to A&E departments when they occur. Once they understand what’s happening in their body, though, and accept that the panic attack will pass, they can get rid of them out of their life.”
Often there isn't a trigger
Fear often centres around not knowing what has triggered the attack, he says. “People are afraid of panic attacks because they generally can’t identify a trigger for them. That makes them so much more frightening. The vast majority of people will tell you that they weren’t necessarily worrying about anything at the time the attack occurred, but, bang, out of nowhere it arrived, but it’s important to understand that in the vast majority of cases, there isn’t a trigger.”
'Gunslinger' to blame
“The ‘gunslinger’ or amygdala is a small group of nuclei in the brain that is in charge of your stress system. Its job – and this is key to panic attacks – is to look for danger, internally or externally,” he says.
“If it senses danger on the outside or in something to do with what you’re thinking about, it fires, because its job is to look for danger and then fire. When it fires, it triggers your adrenalin gland to secrete adrenalin, which is your fear hormone, and that then sends all the physical symptoms of panic attacks.
“It gives the little burst and you get the physical symptoms of sweating, stomach in knots, tense muscles, palpitations. That starts the ball rolling. Then you try to fight the attack or escape it and your subsequent thoughts make the panic attack worse.”
Underlying anxiety
While panic attacks can happen to anyone, there would be a percentage of people who get panic attacks who have an underlying tendency to be anxious in general, he says. “If I’m a worrier, I’m inclined to get the physical symptoms of anxiety more easily and therefore it is much easier to trigger an attack.”
It was Dr Barry’s insight into the working of the gunslinger that helped him make sense of what happens – and explain it in an easy-to-understand way to patients and readers.
“I’d known that cognitive behaviour therapy (CBT) techniques worked for treating panic attacks for years having used them, but it wasn’t until I fully grasped what was going on from the brain – the neuro-science – point of view that I could explain it fully. In the past, I’d have explained that it was our stress systems that cause panic attacks, but now I can be a lot more specific.”
Key messages about gunslinger
Dr Barry nicknamed the amygdala the gunslinger because of its similarity to gunslingers in old cowboy films who were trained to be quick-draw shooters.
“They were trained to fire fast, without really thinking about it, just like the amygdala. The amygdala is what I call stupid, as in it acts without thinking, it has a very long emotional memory (remembering fears) and fires easily. Getting rid of panic attacks involves retraining this gunslinger.”
Breathing exercises
The gunslinger doesn’t do talk therapy, he says. “What’s happening, however, is that literally thousands of people are going to either counsellors or therapists, even specialists, who recommend talk therapy (counselling) to stop panic attacks, but the gunslinger doesn’t respond to this.
“The counselling might help you sort out particular problems in your life, but it’s not going to sort out a panic attack for you.”
The most common thing that happens with counsellors, psychologists and therapists, he says, is that they tell the person that they should use breathing exercises.
“It’s fine to teach people breathing exercises as a way of reducing the physical symptoms of anxiety in general, but it’s of little help when you’re stuck in the middle of a panic attack.
“Most people say to me ‘thanks be to God you’re not asking me to do breathing exercises’ because they’ve tried it and they find it’s made them worse. Overall, it’s the behaviour of people in the panic attack that keeps the problem going.”
All about doing nothing?
Trying to stop the panic attack is where people go wrong. “One person rang into Liveline show when we were on and said – ‘so you really have to do nothing’. She wasn’t far off. “People fear they are going to stop breathing and die, but while panic attacks are uncomfortable, they are not dangerous. I tell people to imagine hugging the panic attack while it lasts, rather than trying to escape it.”
Success rate
But what’s his success rate in treating people with this condition? “It’s 90% usually after one to two sessions. If it takes longer than that, it’s usually because there is underlying depression or alcohol or drug misuse, particular hash addiction.
“Panic attacks are more difficult to treat if addictions are present, because if a person is addicted to a substance, the way the brain works is that the pleasure centre of the brain which is in charge of addiction is talking to the gunslinger all the time.
“If I stop buzzing my brain’s pleasure centre with hash or alcohol, my gunslinger doesn’t like it and is then constantly re-triggered.
“It’s then a lot more difficult to get rid of panic attacks if the person is re-triggering the gunslinger all the time. You’re fighting against that.
“The way the treatment sessions work is to retrain the gunslinger. It’s the reshaping of it that helps the gunslinger to switch off for the long term.”
Tranquiliser use not advisable
Dr Barry also makes a point about tranquiliser use. “If you use tranquilisers to treat panic attacks, you stop the gunslinger changing its memory. That means it’s much harder to teach the person how to get rid of panic attacks.
“While tranquilisers have a role as part of a package of treatments for depression, including CBT and exercise, I don’t believe they have a role in stopping panic attacks.”
Dr Barry is now seeing people in groups of three because of the demand for help.
“We’re asking people to read the book and look at the YouTube videos before they attend. The ‘Doctor Explaining How To Stop a Panic Attack’ video done for www.PanicAware.com has been particularly helpful, according to feedback from patients.
“Some people have told me that this and the book have helped them switch off panic attacks already. Others attend for the one-hour sessions. Some who come because of panic attacks may need to attend general anxiety group sessions afterwards to help them deal with that.”
Top tips for dealing with panic attacks
There is absolutely no tip to avoid panic attacks apart from learning what to do with them, Dr Barry says. “The best way to avoid them is to learn skills that help you quieten the amygdala, including:
1. Controlled use of technology, particularly for young people. “I call it mobile phone hygiene. There is too much information coming in. There are people keeping a mobile phone on at night, even answering emails in the middle of the night – that’s dreadful for your gunslinger or amygdala, as it is getting no time to calm down. There should be rules around mobile phone use.”2. Stop demanding perfection. “This interacts with the technology part, because young people are being fed the line that they must look perfect, everything about their life must be perfect and that they can never fail. This is a critical thing, so it’s important to teach young people resilience skills – how to cope with failure and issues of life and teach them that there is no such thing as perfection. As adults, we have to be doing this too. There is no point in the adult who is busy looking for perfection themselves trying to say to the young person that they must be prepared to fail when they themselves are not prepared to fail.” 3. Regular physical exercise is also vital. “Overall, the gunslinger will respond to some mindfulness, but not in the middle of a panic attack – it’s a waste of time then. Exercise helps too, but not in the middle of a panic attack. Exposure or flooding – learning to cope with the symptoms using CBT methods – is what works.” The response to Flagging Anxiety and Panic: How to Reshape Your Anxious Mind and Brain has been phenomenal, he says, proof that panic attacks are a widespread problem in Ireland.
He attributes the response to the book to offering solutions as well as explaining what is happening in the brain and body in simple terms.
“The videos have helped too. Sometimes people struggle with learning from books and prefer to watch a video, but most people find a combination of reading and hearing to be most effective.”
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Panic attacks are one of the most easily treatable conditions in the whole area of mental health, according to Drogheda-based GP Dr Harry Barry. “The more you try to run away from them, the more they will run after you,” he says.
“The key message is that, yes, panic attacks are uncomfortable, but they are not dangerous. I get people to write that down. By fully understanding how your brain works and accepting the temporary discomfort and understanding that it is just your body’s ‘gunslinger’ firing off when it doesn’t need to, the fear lessens.”
Dr Barry has met people who have been suffering with panic attacks for 20 years. “That’s the tragedy. Many people spend their lives running from panic attacks, fearing them, fearing embarrassment when they happen, fearing that they won’t be able to breathe, that they’ll have a heart attack and die. Many would have gone to A&E departments when they occur. Once they understand what’s happening in their body, though, and accept that the panic attack will pass, they can get rid of them out of their life.”
Often there isn't a trigger
Fear often centres around not knowing what has triggered the attack, he says. “People are afraid of panic attacks because they generally can’t identify a trigger for them. That makes them so much more frightening. The vast majority of people will tell you that they weren’t necessarily worrying about anything at the time the attack occurred, but, bang, out of nowhere it arrived, but it’s important to understand that in the vast majority of cases, there isn’t a trigger.”
'Gunslinger' to blame
“The ‘gunslinger’ or amygdala is a small group of nuclei in the brain that is in charge of your stress system. Its job – and this is key to panic attacks – is to look for danger, internally or externally,” he says.
“If it senses danger on the outside or in something to do with what you’re thinking about, it fires, because its job is to look for danger and then fire. When it fires, it triggers your adrenalin gland to secrete adrenalin, which is your fear hormone, and that then sends all the physical symptoms of panic attacks.
“It gives the little burst and you get the physical symptoms of sweating, stomach in knots, tense muscles, palpitations. That starts the ball rolling. Then you try to fight the attack or escape it and your subsequent thoughts make the panic attack worse.”
Underlying anxiety
While panic attacks can happen to anyone, there would be a percentage of people who get panic attacks who have an underlying tendency to be anxious in general, he says. “If I’m a worrier, I’m inclined to get the physical symptoms of anxiety more easily and therefore it is much easier to trigger an attack.”
It was Dr Barry’s insight into the working of the gunslinger that helped him make sense of what happens – and explain it in an easy-to-understand way to patients and readers.
“I’d known that cognitive behaviour therapy (CBT) techniques worked for treating panic attacks for years having used them, but it wasn’t until I fully grasped what was going on from the brain – the neuro-science – point of view that I could explain it fully. In the past, I’d have explained that it was our stress systems that cause panic attacks, but now I can be a lot more specific.”
Key messages about gunslinger
Dr Barry nicknamed the amygdala the gunslinger because of its similarity to gunslingers in old cowboy films who were trained to be quick-draw shooters.
“They were trained to fire fast, without really thinking about it, just like the amygdala. The amygdala is what I call stupid, as in it acts without thinking, it has a very long emotional memory (remembering fears) and fires easily. Getting rid of panic attacks involves retraining this gunslinger.”
Breathing exercises
The gunslinger doesn’t do talk therapy, he says. “What’s happening, however, is that literally thousands of people are going to either counsellors or therapists, even specialists, who recommend talk therapy (counselling) to stop panic attacks, but the gunslinger doesn’t respond to this.
“The counselling might help you sort out particular problems in your life, but it’s not going to sort out a panic attack for you.”
The most common thing that happens with counsellors, psychologists and therapists, he says, is that they tell the person that they should use breathing exercises.
“It’s fine to teach people breathing exercises as a way of reducing the physical symptoms of anxiety in general, but it’s of little help when you’re stuck in the middle of a panic attack.
“Most people say to me ‘thanks be to God you’re not asking me to do breathing exercises’ because they’ve tried it and they find it’s made them worse. Overall, it’s the behaviour of people in the panic attack that keeps the problem going.”
All about doing nothing?
Trying to stop the panic attack is where people go wrong. “One person rang into Liveline show when we were on and said – ‘so you really have to do nothing’. She wasn’t far off. “People fear they are going to stop breathing and die, but while panic attacks are uncomfortable, they are not dangerous. I tell people to imagine hugging the panic attack while it lasts, rather than trying to escape it.”
Success rate
But what’s his success rate in treating people with this condition? “It’s 90% usually after one to two sessions. If it takes longer than that, it’s usually because there is underlying depression or alcohol or drug misuse, particular hash addiction.
“Panic attacks are more difficult to treat if addictions are present, because if a person is addicted to a substance, the way the brain works is that the pleasure centre of the brain which is in charge of addiction is talking to the gunslinger all the time.
“If I stop buzzing my brain’s pleasure centre with hash or alcohol, my gunslinger doesn’t like it and is then constantly re-triggered.
“It’s then a lot more difficult to get rid of panic attacks if the person is re-triggering the gunslinger all the time. You’re fighting against that.
“The way the treatment sessions work is to retrain the gunslinger. It’s the reshaping of it that helps the gunslinger to switch off for the long term.”
Tranquiliser use not advisable
Dr Barry also makes a point about tranquiliser use. “If you use tranquilisers to treat panic attacks, you stop the gunslinger changing its memory. That means it’s much harder to teach the person how to get rid of panic attacks.
“While tranquilisers have a role as part of a package of treatments for depression, including CBT and exercise, I don’t believe they have a role in stopping panic attacks.”
Dr Barry is now seeing people in groups of three because of the demand for help.
“We’re asking people to read the book and look at the YouTube videos before they attend. The ‘Doctor Explaining How To Stop a Panic Attack’ video done for www.PanicAware.com has been particularly helpful, according to feedback from patients.
“Some people have told me that this and the book have helped them switch off panic attacks already. Others attend for the one-hour sessions. Some who come because of panic attacks may need to attend general anxiety group sessions afterwards to help them deal with that.”
Top tips for dealing with panic attacks
There is absolutely no tip to avoid panic attacks apart from learning what to do with them, Dr Barry says. “The best way to avoid them is to learn skills that help you quieten the amygdala, including:
1. Controlled use of technology, particularly for young people. “I call it mobile phone hygiene. There is too much information coming in. There are people keeping a mobile phone on at night, even answering emails in the middle of the night – that’s dreadful for your gunslinger or amygdala, as it is getting no time to calm down. There should be rules around mobile phone use.”2. Stop demanding perfection. “This interacts with the technology part, because young people are being fed the line that they must look perfect, everything about their life must be perfect and that they can never fail. This is a critical thing, so it’s important to teach young people resilience skills – how to cope with failure and issues of life and teach them that there is no such thing as perfection. As adults, we have to be doing this too. There is no point in the adult who is busy looking for perfection themselves trying to say to the young person that they must be prepared to fail when they themselves are not prepared to fail.” 3. Regular physical exercise is also vital. “Overall, the gunslinger will respond to some mindfulness, but not in the middle of a panic attack – it’s a waste of time then. Exercise helps too, but not in the middle of a panic attack. Exposure or flooding – learning to cope with the symptoms using CBT methods – is what works.” The response to Flagging Anxiety and Panic: How to Reshape Your Anxious Mind and Brain has been phenomenal, he says, proof that panic attacks are a widespread problem in Ireland.
He attributes the response to the book to offering solutions as well as explaining what is happening in the brain and body in simple terms.
“The videos have helped too. Sometimes people struggle with learning from books and prefer to watch a video, but most people find a combination of reading and hearing to be most effective.”
Read more
Iron overload - haemochromatosis
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