Why You Can’t Talk Yourself out of a Panic Attack
“Your next client is in the quiet room, she’s in crisis and not making any sense. No one can seem to talk to her.”
I put the phone down and ran down to the quiet room. I knocked on the door. After no response, I slowly opened the door. The lights in the room were dim. Before I saw my client, I heard her crying and whimpering. Her words were hard to make out, but they led me to her.
She was hiding behind the small sofa, curled into a ball. As I approached, she cried out, “No, no! Go away, please go away, he’ll find me,” and scrunched herself even smaller. Her entire body trembled, and she shrank back as I reached for her. I spoke her name, but she behaved as if she couldn’t hear me, mumbling and crying. When footsteps on the floor above created a pounding noise, she burst out a muffled scream, and her body startled.
I sat on the floor by her, took her hand in both of mine, holding it firmly. I asked her if she could feel my hand. She looked at me, but I could tell she didn’t see me. I squeezed her hand again, and she said she could feel it. In a soft, soothing voice, I spoke her name, told her my name, and told her she was safe.
I asked her to pay attention to my hands on hers. She said she could feel my hands. I asked her what sensations she felt, were they warm or cold, rough or smooth. She responded that my hands were warm and smooth, but a little rough in spots. By this point, she had stopped crying.
As she calmed, I asked her to breathe in as I squeezed her hand and to breathe out when I let go. As she did this, I spoke her name, told her mine, explained where she was and that she was safe. With her breathing under her control, she came to full awareness and could describe things in the room. Feeling more present, she told me what happened.
In her early 50s, she escaped domestic violence 15 years prior; however, as this woman sat in the waiting room, something triggered a flashback. In her mind, her abusive ex-husband found her at the clinic. She ran to the front desk, and they took her to the quiet room, but from her perspective, he was in the building looking to hurt her, and she had to hide. She re-enacted her living nightmare and did not recall what started it.
What the brain does
Flashbacks and panic attacks are similar because they both involve the reptilian and limbic brain taking over and disengaging the rational brain. A simplified explanation is that the fight, flight, or freeze mode is on auto-pilot and does not respond to verbal engagement. As explained by trauma researchers Bessel van der Kolk, Peter Levine, and others, talking to people during a panic attack or flashback doesn’t work because it is a top-down regulation model that seeks to engage the rational brain through language.
But the rational brain isn’t home.
To speak to the reptilian/limbic brain, you need to speak its language from the bottom up. This means getting in touch with the autonomic nervous system through sensation, breath, movement, and touch and engaging it to calm itself using those modes. The body needs to understand it is safe in the present moment. The other staff in the clinic could not talk to my client because her cognitive brain was hijacked.
Whether someone is experiencing a flashback, panic attack or overwhelming strong emotion does not matter; in all those situations, the limbic brain takes over to ensure the person’s survival. This means talking to someone, yelling at them, or asking them what is wrong is a waste of time, and it’s the same whether it’s a child in mid-tantrum or an adult having a panic attack.
What to do instead
Make a bottom-up connection through sensation, breath, or movement to bring them back to the present and engage the rational brain.
Establish a safe physical touch in a way that will not re-traumatize the person, like firmly holding their hand. Direct their attention to that sensation. If they do not feel it, use something cold or textured like a cold drink, ice cube, or spiky koosh ball to focus their attention. The cold serves a secondary purpose by directing the brain to a new site of discomfort. If using ice, do not keep the ice in one spot on the person’s skin because it will cause injury.
As you draw their attention to the physical sensation, invite them to take control of their breathing. Count with them while they do it. Slowing the breath engages the parasympathetic nervous system, which will bring the body out of the fight, flight, freeze mode. As they notice their surroundings, ask them what they see and hear. Give them other things to notice through their sense of touch and get them to describe it. Engaging multiple senses will further ground them in the present.
Once they are fully aware and in the present, then talk.
This also works well with children who are experiencing fear or strong emotions. Depending on the child’s age, engaging their senses may be difficult. A good trick between caregivers and children is to hold the child close and ask them to listen to your heartbeat. Then ask them if they can feel theirs. Invite them to breathe with you as they listen.
Another tactic is to hold their hand and draw a letter or shape in their palm with your finger and ask them if they can guess what it is. Or help them feel the fur of a favorite pet or stuffed animal. Children also respond to rhythmic movement, so rocking them or swaying with them can also help orient them to the present. Once your child is calm, then talk to them about what happened.
Remember, you can’t talk someone out of a panic attack or flashback. Sometimes it’s hard to talk to someone amidst strong emotions. Instead of trying to reach the rational brain that’s been hijacked by the reptilian/limbic brain, establish safety in the present by connecting through sensation, breath, or movement.
NOTE: If you or someone you love experiences flashbacks and panic attacks, please find a therapist who specializes in comprehensive trauma treatment. Psychology Today has a therapist finder where you can search by zip code and specialty or get a referral from someone you know.