Five Things You Didn’t Know About Panic Attacks

Anyone who’s ever had panic attacks will tell you that they feel horrible and science knows so little about where they come from. Here are some things we definitely do know:


Panic attacks feel like a sudden feeling of being overwhelmed or out of control of your mind and body. There is often a significant increase in heart rate, respiration, and blood pressure. People may shake or sweat and it is really common to think that you are having a heart attack or going insane. Lots of people get GI issues including feeling nauseous or getting an upset stomach. Panic attacks generally feel dreadful, like your body and mind are running wild without your consent.


Panic attacks can be triggered by many different thoughts or experiences and it’s not uncommon to have no idea what triggered your most recent attack. Sometimes just the fact that you’ve had an attack in a specific place (like the produce aisle at Trader Joe’s) can trigger another attack when you are in that setting again.  When people get repeated panic attacks outside of their home this can cause agoraphobia which, in it’s most extreme forms, keep people shut inside their homes for fear of feeling panicked and out of control should they go outside.


One of the best things we can do to treat panic attacks is realize that although panic is really uncomfortable, nothing catastrophic is going to happen. In other words, we learn to tolerate the feelings of panic, which then gives panic less and less power over time. One way to do this is to think logically about the worst thing that could actually happen as a result of panicking. At work, the worst thing that could happen is usually that you need to spend some time recovering in the bathroom or by talking to a trusted coworker. At the grocery, the worst thing that could happen is you get so distracted by panicking that you don’t get your shopping done and you have to come back another time. You might have thoughts of humiliating yourself in front of others but realistically nothing seriously embarrassing or awful happens during a panic attack. You just feel uncomfortable.


Usually the thing that people do to worsen a panic attack is allow themselves to believe that this time something catastrophic really will happen. The more you believe that a panic attack is actually something dangerous the more likely you are to feel more panicky. For some people a mantra like “it’s just a panic attack, it feels bad but I’m safe” can be really helpful to defuse the pattern of panic (and avoid panicking about panic).


One hypothesis about the origins of panic attacks is that people misinterpret harmless body sensations as being indicators that a panic attack is starting and then panic about the possibility of panicking. Before you know it, you are in a full blown panic attack. For that reason, a therapist will often teach you some basic skills and knowledge and then encourage you to do things that simulate panic. You might be encouraged to spin around (so that you feel dizzy), hold your breath (so that you feel hot and short of breath), or do jumping jacks (to get your heart rate and adrenaline elevated) and have you notice that feeling the symptoms of panic is actually not dangerous like your mind tells you it is.

The bottom line: panic attacks can be caused by lots of different thoughts and situations and panicking feels dreadful. However, panic is never actually dangerous, it’s just uncomfortable, and one of the best treatments for reducing panic over time is to learn to tolerate the feelings that you get during an attack.

If you are someone you know is struggling with panic attacks, reach out and schedule an appointment.

Getting Over Guilt

Everyone feels guilty over a social faux pas or missed opportunity now and again but, for some, guilt is an intense and overwhelming experience. If you feel:

  • Plagued by a mistake from long ago
  • Discomfort with opportunities and privileges
  • Disabled by thinking “I’m wasting time”

… this blog is for you.


Our society (and especially the Millennial generation) is becoming more comfortable disregarding our genuine struggles as “no big deal” and some even reproach themselves for experiencing hardship in the first place. Identifying the loss of a job, end of a relationship, or indecision about your life’s direction as “first world problems” generates a sense of guilt. It tends to make us think that we are undeserving of feeling distressed. The problem with thinking this way is that your distress is genuine and pretending that it doesn’t exist (or shouldn’t exist) often gets you stuck in a cycle of distress and guilt and more distress and more guilt.

Gratitude Over Guilt

Guilt is considered a negative emotion because it results in your mind shutting down. When we feel negative emotions we go into survival mode and all of our creativity gets put on hold. This means that guilt tends to limit your ability to see other options and that can lead to feeling stuck in a problematic pattern.

The positive emotions, however, are opening in nature. They inspire creativity, social connections, and exploration. Gratitude is one of the most powerful positive emotions. Gratitude and guilt occupy opposing sides of the same coin – where guilt removes us, shamefully, from relationships, gratitude inspires connection and generosity.

The first step in changing your guilt to gratitude is to acknowledge your guilt triggers. Perhaps you tend to feel guilty when you:

  • Notice your partner doing more work than you around the house
  • Encounter homeless or underprivileged people
  • Delay on completing a project at work
  • Recognize that you don’t call your grandmother as often as you’d like to

Once you’ve determined what your biggest guilt triggers are, consider writing them down. Jot down some of your trigger thoughts/feelings like “I’m such a bad grandchild and I must not appreciate my grandmother much” or noticing how you tend to avert your eyes and distract yourself when walking past a person begging on the street.

Now that you have those down, start brainstorming some ways in which you can notice what you are grateful for when your guilt gets triggered. When you notice you are beating yourself up over not calling your grandmother perhaps you can redirect your feelings, lingering on what you love about her and how grateful you feel that she is alive and part of your life. Likewise, if being around homeless people makes you uncomfortable, consider focusing on the aspects of your life that you are most fortunate to have: a safe home, a dependable food source, and a caring support system. Really dig into these thoughts and allow yourself to relish how grateful you feel for having the opportunities that you do. The closer we get to feeling gratitude the more likely we are to act generously (which happens to reduce guilt)!

Practice, Practice, Practice

It is totally normal to struggle to institute this practice. Guilt is a strong emotion and doesn’t like being pushed out of the way so it will force its way back in often. For many of us, guilt is a well-worn path in our brains and it will take time to wear down an equally clear gratitude trail. Our “success” at how grateful we feel in any give moment is significantly less important than keeping at the ritual of redirecting our thoughts to gratitude when we notice unnecessary guilt being triggered.

Learning from Guilt

Much of our daily guilt is unnecessary and doesn’t teach us anything instead it just makes us feel bad. However, guilt can also be a useful feeling. When we have done something to hurt someone or have acted recklessly, guilt is often helpful. It’s our own Jiminy Cricket telling us not to do that again. We can learn to discern helpful from unhelpful guilt by deciding if there is something we need to learn from how we are feeling. Oftentimes, we learn these lessons quickly (because guilt is uncomfortable!) and if we continue to feel guilty, we have crossed from the realm of helpful to unhelpful guilt.

The Power of Positive Emotions

We spend so much time identifying and thinking about our “negative” emotions like fear, doubt, disgust, anger, and sadness. The negative emotions play an extraordinarily important role in our lives but so do positive emotions and the positive emotions don’t get nearly as much screen time. Let’s get to know the “big ten” positive emotions.

Wait, What’s Important About Negative Emotions?

Good question! Most people assume that feeling sad or angry is a problem and it’s best to stop feeling that way and feel something good instead. Not so. The negative emotions give us important information and provide safety when needed. Anger, for example, is a defensive emotion and communicates “back up!” when you want something upsetting further away from you. Sadness elicits empathy and support when we need it most and fear keeps us from getting hit by cars by telling us “run!” when we are in danger. The negative emotions serve so many important functions that maximize safety and promote desirable boundaries. However, if all we ever felt were the negative emotions, we’d feel pretty miserable.

The “Ideal” Ratio

Some research says that people tend to function best when they experience about 3-5 instances of a positive emotion for every instance of a negative emotion. This is not to say that we should be down on ourselves if we tend to feel more frequent negative emotions, quite the opposite. There’s no need to criticize yourself instead lets consider some ways in which you can make more room for positivity.

Beyond Joy

Thinking of positive emotions usually evokes images of joy or happiness but there are ten positive emotions in all! What they all have in common is that they encourage exploration, playfulness, and creativity. The negative emotions tend to tell us to shut down but the positive emotions help us broaden our horizons.

Joy – a buoyant, playful feeling of happiness

Gratitude – recognition of one’s opportunities and gifts that often encourages giving

Serenity – a state of savoring calm

Interest – being intrigued and wanting to explore

Hope – the emotional belief that things will turn out how you want them to

Pride – recognizing accomplishments and feeling driven to dream big

Amusement – laughter at life’s guffaws and surprises

Inspiration – feeling moved to aspire to excellence

Awe – a sometimes-overwhelming recognition of what’s possible (as in noticing nature’s unbelievable beauty)

Love – deep respect and caring for another

Think Positive

If you’d like to feel positive emotions more often here’s an exercise:

Step 1: Choose a target emotion like love or serenity that resonates with you.

Step 2: Collect items (pictures, youtube clips, articles, etc.) that activate that feeling. Keep the collection somewhere that’s easy to access like in a file on your computer desktop.

Step 3: Review the contents of the file periodically and allow the target emotion to wash over you. Consider reviewing it when you are already feeling positively to savor that state. Alternatively, review the contents when you are feeling upset for a way to refocus your attention and boost your mood.

Five Things You Didn’t Know about OCD

When most people think of OCD they might think of extreme orderliness or the tv character Monk. It gets thrown around as a way to describe people who are neat but most people don’t actually know what OCD is. Here’s a beginner’s guide to the ins and outs:

OCD Stands for Obsessive Compulsive Disorder

Most people already know the meaning behind the acronym but may not know what obsessions and compulsions actually are. An obsession is an unrelenting thought or mental image that is bothersome or distressing. Some common examples of obsessive thoughts are “what if something bad happens to my family?” or “what if I get a serious illness?” Everybody has doubt and worry thoughts from time to time but most people with OCD would describe their obsessive thoughts as haunting. They often feel like these concerning thoughts won’t leave them alone and even if they try to rid themselves of the thoughts they return uninvited.

Compulsions, on the other hand, are usually observable actions that provide some kind of relief from the distress elicited by an obsessive thought. The most common example of a compulsion is repetitive hand washing (often in reaction to an obsessive thought about contracting a serious illness or being dirty). Compulsions can take many forms including running through a mental checklist, touching a specific object, or checking to make sure that the stove is really off. Just like obsessions, everyone does actions that could look like a compulsion occasionally but people with OCD often feel compelled to do these actions over and over to seek relief from their distress.

OCD is Really Common

About 1 in 50 people (more than 2% of the world population) have OCD. In the United States, it affects more than 3 million adults. For most people it develops in childhood, adolescence, or early adulthood and may stick with them for a long time until they seek treatment. The delay is caused by a lack of understanding of what OCD really is. This means that most people with the disorder suffer in silence and without a diagnosis for years (or decades) until someone is able to identify their symptoms as OCD and refer them for appropriate treatment.

Many Shapes and Sizes

When we think about OCD a lot of people picture someone who is extremely neat or washes their hands often. While these behaviors can be indicative of OCD, they are just a small piece of the pie. OCD can be as different as the people it affects. There are many subtypes that point the affected person toward specific obsessions and compulsions.

Some people fear accidentally or unknowingly doing harm to themselves or others while others are preoccupied with thoughts that their partner is dishonest or unfaithful. People with these subtypes may often check to make sure that the thing they fear has not happened or may ask others to reassure them that nothing is wrong. OCD can also manifest as a fear that our thoughts can be dangerous or spiritually/morally wrong which may lead people to try to “correct” their thoughts by being on the look out for “bad” thoughts and replacing them with “good” thoughts. Others count, touch, or hoard in an attempt to feel less distressed.

For more reading check out these resources:

You Can’t “Just Stop It”

To an outsider, OCD may not make much sense and the assumption is that the person should “just stop” acting strangely. This is an unfair and inaccurate assumption. Most people with OCD have tried time and time again to stop the cycle of worry and reassurance to no avail. In fact, most people with the disorder know that what they are doing doesn’t make them feel better but they can’t find an alternative way to cope with their distress. Once OCD has become distressing enough to interrupt your life you can’t “just stop” and it’s a good time to seek help from a professional.

OCD Responds Well to Treatment!

Good news! There are several highly effective treatments for OCD that allow people to feel less distressed and distracted.

The gold standard in OCD treatment is Cognitive Behavioral Therapy. This typically involves working with a specialized therapist to build healthy coping skills and challenge your problematic beliefs. OCD tells you that you can’t handle the worry or distress caused by your obsessive thoughts and that you have to do compulsions to feel better. Through therapy we can start to identify these thinking patterns and recognize that it is OCD lying to you. Through a treatment called Exposure and Response Prevention you are able to notice that there are other ways to feel better when your worry thoughts are triggered and that you can tolerate the distress caused by your thoughts. Meditation, medication, building support, and finding healthier coping skills can all supplement therapy.

The bottom line: OCD is a treatable mental illness that needs more accurate exposure because it effects millions of people, many of whom will never receive effective treatment. Be an advocate and spread the word!

If you or someone you know is struggling, reach out and schedule an appointment.

“What if…” and Coping with Chronic Doubt

Doubt is an excruciating emotion. It makes us question if we made the right choice in our partners, if our friends and coworkers actually like and accept us, if we will ever achieve (or even deserve) success. For some, doubtfulness is crippling to the point of worrying that our loved ones will be safe from harm. We can learn to live with doubt (and even quiet it) but how?

Some People are Doubters

Some people are plagued by chronic doubt and others just aren’t. The good news is that there is nothing wrong with people who tend to feel doubtful. People who tend to feel doubtful have brains that are ‘sticky.’ This means that an idea that might normally pass a non-doubter by gets stuck to a doubter’s brain and nags them constantly. Sometimes it’s a big thought like “I wonder if my partner is cheating” or “I don’t know if I should leave my job” and sometimes it’s a small thought like “I wonder if that waiter thinks that I was rude” or “Maybe I won’t have anything interesting to say at the meeting.” The difficult thing about chronic doubt is that it makes even small thoughts feel huge. Doubters know that if you think a small doubt enough times then it can easily turn into a big one.

Social media and our comparison-encouraging culture have led to many people being plagued with doubt about their lives not measuring up. I so often hear “How come everyone else seems to have their lives/relationships/careers figured out and I don’t?” Being barraged by images of people having children, buying homes, and going on exotic vacations leads many to wonder “What’s wrong with me?”

Don’t Run from Doubt

For chronic doubters, the impulse when having a doubt thought is to withdraw. If you’re afraid that you’ll be perceived as dull or awkward at a party then you might decide not to go. You might end a relationship for fear that your partner is dishonest or stop trying at your job because you think that you’ve already failed. However, this only serves to strengthen doubtfulness. You never get a chance to prove doubt wrong. Perhaps you would have had a few really nice conversations at that party but you only get to find out if you go. When doubt keeps us from our lives we not only miss out on valuable experiences but the doubt thoughts are often stronger next time.

Instead of giving in to doubtfulness, stop and check out what it’s saying. Sometimes doubts are legitimate and sometimes their not. If you have extensive evidence to contradict your thoughts (i.e.: I’m afraid that I’m looked down upon at work and going to be fired but I consistently get pretty good performance reviews) then you’re doubt thoughts may only be serving to upset you.

Doubt and Mindfulness

Doubt’s mortal enemy is mindfulness. Mindfulness is the idea of attending to your experiences without judgment. Doubt loves judgment and when you remove its power source, it starts to quiet down. Turning your doubt into an observable experience rather than getting sucked into it’s mind tricks means that you take the power back.

Some people like to think of their doubt thoughts as little characters that they can tell to ‘go away’ or ‘shut up.’ Turning your doubtfulness into a tangible idea can make it seem more under your control – you can talk to your thought and set boundaries with it. Even consider turning it into a character that you find silly and harmless. Likewise, some people like to set appointments with their thoughts. Deciding that “doubt time” is Mondays and Thursdays between 1 and 1:30 means that when doubt comes knocking outside of that time that you can tell it to get lost and return at the appointed time. You may find that when your appointment arrives that there’s not much to think about.

If you’re a doubter you may continue to experience these thoughts regularly but over time they can become quieter and less overpowering.

How to Cope with the Holidays

Problem #1 – “I Feel Overwhelmed!”

There is rarely enough down time during the holidays and we often feel pulled too thin. We may feel compelled to do and be everything all at once, which often leads to feeling immense pressure. This can be compounded by television and social media depicting everyone else seemingly effortlessly enjoying themselves. So what do you do?

First, know that almost everyone experiences high levels of stress during the holidays. Some feel overwhelmed financially and others feel unable to meet all the expectations thrust upon them. Know that you are not the only one.

Consider making a list of all of your to-dos. Write each down and decide which ones fit in each category:

  • Things that I have no control over and need to accept as they are
  • Things that will work themselves out with time
  • Things that I can do something about right now
  • Things that I can work on but need to wait until later

Pick the top two or three that you can work on right now and make an action plan for yourself (i.e.: what small steps can I take to address this today?)

If your worries persist, set aside a specific time each day to worry for half an hour and if your worries try to get your attention outside of that time tell them that they need to wait for their appointment.

To limit your stress, limit your commitments. Consider shortening your gift buying list or spending less time at the office party. Give yourself more time to breathe. Choose to attend just the celebrations that you are really looking forward to so that you allow yourself more time to enjoy the people and activities that you care most about.

Problem #2 – “The Holidays are Sad for Me”

For many, the holidays are a reminder of something that is lost or missing in life. This may be the first year that you spend without a loved one or you may feel far away from the people you love. Coping with loneliness and loss is a struggle for a lot of people during this time of year.

If the holidays remind you of pain or loss, it is essential to allow yourself ample time to grieve. Consider giving yourself a break from the merriment to remember the person or thing that you miss. Write a journal entry or speak to a friend who also remembers that person fondly. Don’t force yourself to feel joyful if you don’t, allowing space for sadness and absence.

Reconnect to the people with whom you do feel close. If you know that a particular day is challenging for you, consider making plans to be with people who love you on that day. If your loved ones are far away, schedule a few phone calls or write emails. You can also connect with meaningful experiences that may include prayer, meditation, or quiet reflection.

Problem #3 – “I Just Don’t Feel in the Spirit”

There’s nothing wrong with feeling like the holiday spirit eludes you. Some people just aren’t “holiday people” and sometimes even the most festive of us have a year that feels less than merry. When this happens, consider doing a quiet holiday. This might involve making minimal plans with only the most important people, not participating in gift exchange, or taking the holiday as an opportunity for quiet reflection.

If you want to feel in the spirit but you just don’t, consider turning your attention towards others in need. Call a relative who you know tends to be lonely or volunteer for an entire day at a soup kitchen or animal shelter. If you feel like you could use a fresh start in preparation for the new year, go through your clothes, shelves, and cupboards and find items to donate to charity.

There’s no one way to participate in the holidays so find what works for you.

The Season of Gratitude

This is the time of year when many of us pause to reflect on the parts of our lives that we are most grateful for. Why do we practice gratitude just once per year? How can we make this experience part of our regular lives?


Most people think that you need to be happy in order to feel grateful but, amazingly, it’s the other way around. Those who regularly practice expressing thanks tend to, over time, become happier. Gratitude can be expressed in many ways and leads to noticing the beautiful things that we may ordinarily miss, encouraging us to linger on them.

Gratitude even lessens the symptoms of anxiety and depression. When we focus on feeling grateful the parts of our brains that control stress and positive emotions are activated leading us to feel a decrease in stress and an increase in pleasure. When we act grateful we also tend to be better communicators. People like talking to you when you are gracious and it is a great way to diffuse those who are angry or resentful.

Outside and Inside

When we think of expressing gratitude we typically call to mind an image of expressing thanks out loud to another person. This is called external gratitude. When we write a letter to a loved one, say ‘thank you’ to a stranger, or smile at someone who was helpful, we are expressing gratitude externally.

There is another form of being grateful that is just as important: internal gratitude. Internal gratitude is a momentary reflection on anything we are thankful for, a chance to put the spotlight on our gifts, accomplishments, and opportunities. Internal gratitude can include taking a moment to name three things that we appreciate about our lives and noticing beautiful experiences during our day.

What’s great about internal gratitude?

  • It’s quick – take five seconds to name something that’s great in your life right now
  • You can do it anywhere
  • It’s a quick pick-me-up when you are feeling down

What’s great about external gratitude?

  • It’s a chance to do something kind for another person
  • It builds relationships
  • It takes us out of our internal worlds and builds empathy for others

The Big and the Small

Sometimes it’s hard to figure out what we are thankful for. To make gratitude a part of your daily life, start small. When you are about to go to sleep, write down three things that you are grateful for from your day (internal gratitude). Some days, thinking of three things is really difficult. Here’s a starter list:

  • My ability to breathe (try taking a deep, slow breath and appreciating that feeling)
  • That I can walk and use my hands
  • My hearing and vision
  • The sun rises every morning
  • There is another person who loves me
  • My home is safe and warm

Items both big and small count. Notice that you have friends and family, access to work, and that you live in a country of opportunity and prosperity. Also notice that you saw an awesome subway performer, the sunset was incredible, and you remembered your wallet every day this week. No item is too small.

We can practice being grateful for the small things externally, too. Start to get in the habit of writing one email/text/letter every morning to someone who you love reminding them why they are special to you or thanking them for something they did. Consider making sure to thank the first stranger you come in contact with: thank the lady who held the door for you or the barista who made your coffee. If available, give to those who are less fortunate than you.

Practicing gratitude daily improves your emotional health and the lives of those around you.

gratitude, coping, depression, anxiety, positive thinking

Read more in a recent New York Times article on the topic here.