An Anxiety Expert Explains How to Make Panic Attacks Your Bitch

I'm not a starfucker. When people ask, "If you could have dinner with three famous people," I say, "No. I have anxiety. I would much rather eat alone in a dark corner." Yet there is one person on this earth who I kind of consider a celebrity and would maybe eat with, and that's anxiety coach Barry McDonagh.

As I talked about in my last column, I found Barry's ebook, Panic Away, at a time in my life when nothing else was working to lessen my panic attacks. I was suicidal as a result of my suffering and thought there was no way out. One thing that was different about this book than the many other books I'd read is that Barry had been an intense panic attack sufferer himself. The ideas he presented—that we can create new narratives around our symptoms—were pretty revelatory for me.

Nowadays, Barry is a big fish in the anxiety pond, but back then the book was literally a Microsoft Word document with a pic of him skydiving on the cover. After all these years, I want to interview Barry here, in the hope that he can be as helpful to you as he has been to me.

VICE: Can you tell me us a little bit about your own, personal history with panic attacks? Barry McDonagh: My anxiety problem started with a panic attack. It was on a Sunday afternoon in a church in Dublin. I was 18 years old and had been out celebrating my final school exams the night before. I was desperately hung over, sitting a few deep in the church pew, when a series of really intense bodily sensations suddenly overcame me. My heart was pounding through my chest. I couldn't catch my breath, and pins and needles started to spread down the side of my chest and arms. It was the most alarming series of bodily sensations I had ever experienced.

My first thought was, What if I'm having a heart attack? As soon as I had that thought, my anxiety spiked into a state of panic! I left the church in a terrified state and eventually made it home. I told no one and hid in my house for days. That was week one. What followed were about 500 more days of really high general anxiety as well as additional panic attacks.

I went from being a young man who could travel the world with ease to someone who became afraid to leave his house. During that period of time, I experienced just about every anxious sensation possible. It was like a crash course in anxiety disorders. You name it, I felt it, from strange bodily sensations to intrusive thoughts and depersonalization.

The turning point came one evening. I remember it clearly. I had really hit rock bottom and was lying on the floor of my bedroom, wishing the anxiety would end, when this flash of insight came to me. It was like seeing my thought processes from a distance. For the first time, I could clearly see how I had been approaching this all wrong. I was fuelling my anxiety problem by the way I was responding to each and every anxious thought that crossed my mind. That one insight eventually led to the end of my panic attacks and constant anxiety. It was like a complete retooling of my thought process related to anxiety from a wrong way, to a daring, new way.

The illusion of fear that the anxiety held me under was shattered, and from that point forward I started to win back my freedom. From there I began to share what worked for me with others online. I was not doing this as a 'mental health professional' but rather as a former anxiety sufferer sharing an unconventional approach that had helped me.

How easy was this retooling process? Did fearful feelings continue to come up after that as a response to panic attack symptoms, or was that fear totally removed right then?
The fear of fear did not go away overnight. It was there for quite some time after that but through constant practice I started to realize that as uncomfortable as these sensations were, it did not feel as life threatening to me anymore. That paradoxical approach helped me come out from under the spell of threat that panic/anxiety creates.

An exercise I teach to make this process even more effective is to demand that a panic attack get as bad as it can possibly get but with the specific time frame of '21 seconds.' If your anxiety cannot deliver a panic attack in 21 seconds then maybe it really is just a bluff and you can start to trust that as uncomfortable as all these sensations are, they are just sensations. Just anxious thoughts and feelings of an oversensitized nervous system—not a real threat to your life.

It of course takes a lot of courage to do this. I am not pretending that it is easy but I know of no better way to escape the trap anxiety creates in your mind. "The only way out is through."

What often confuses people about the approach I teach is that it is not designed to make you feel calm and relaxed. It's designed first and foremost to get you comfortable with the discomfort that anxiety creates. When you no longer react with fear to this discomfort you strip the fear away from the sensations you feel and that helps you exit the anxiety loop your mind has created.

So you're saying we should literally talk to the anxiety: demand that it get as bad as it can, even though that might seem counterintuitive. Can you walk us through a scenario where, when a person starts to feel symptoms, she might talk to her anxiety once it comes on? What if it is a social situation in which the person is expected to be talking to a person across from her as well? My worst panic attacks are often in intimate social situations—not in a group where I can hide, or alone, but one on one. Restaurants are difficult for me, as is any meeting with a person whom I perceive to be in a position of power. Even amongst friends though: if it's a situation where it would seem "weird" if I left, or if I've already gone to the bathroom and don't feel like I can get up again without seeming strange, that's the most triggering.

What you are talking about there are 'socially trapped' situations which is any situation where you feel you can't easily leave or excuse yourself from it because of some kind of social embarrassment.

You mention the restaurant which is a very common one but other examples might be:

• getting your hair cut
• standing in line while shopping
• sitting in a work meeting
• sitting in a row of seats (e.g., the cinema or church)
• sitting in the passenger seat of someone's car
• riding an elevator

All of these situations have similar "what if " thoughts about feeling trapped and the social embarrassment that might follow. The thing you must remember is that you're not really "trapped" in any of these situations. There is no one holding you there against your will. Your sense of being trapped has more to do with your fear of what others might think if you decide to suddenly excuse yourself.

First of all you need to defuse those "what if " thoughts as they are the fuel that flames anxiety. You do that like this:

"What if I start to panic and need to leave my shopping behind?"

So what? If I really need to, I'll just walk out the door—simple. Who gives a flying f*** what these people think of me.

"What if it's too awkward or difficult to leave?"

So what if it's awkward? If I want to go, I'll go. I'm nobody's prisoner. So what if it means upsetting a few people? They're adults. I'm sure they'll get over it.

You're not answering these "what ifs" in order to come up with a plan of avoidance; you're answering them so that they don't spark more anxiety and trap you into an ever-increasing cycle of fear.

I'm going to use "getting a haircut" as an example as it's one that comes up a lot and it feels even more awkward to excuse yourself from.

Before you go to get your hair cut, acknowledge to yourself that you're most likely going to feel anxious. Fully expect the anxiety so that when it does show up, it doesn't catch you off guard.

As you relax into the salon chair and begin to make small talk, you'll feel your anxiety peak a little bit. It may be a bodily tension or some other uncomfortable sensation. As the anxiety rises, so too will the "what if " fears, so immediately defuse them:

"What if I need to leave halfway through?"

So what? F*** it, I'll make an excuse and tell them I'll be back shortly. No big deal. This happens all the time.

You then start to allow all that nervous energy to just be there with you as you get your hair cut. Genuinely invite it to sit with you. Remind yourself that for the next little while as you're getting your haircut, you're going to be totally OK with any anxious discomfort you feel.

There may come a point—usually only a few minutes after sitting down—where your anxiety can spike and you feel a sudden rush of adrenaline. Normally, this would scare you and be an indicator of a panic attack coming on, but not anymore because now you know about a very different approach. You run toward it. You get excited and demand more.

You turn that fear of panic into a rush of excitement and demand that your anxiety make the sensation you feel more intense. Your mind might keep flashing with "what ifs," but they get canceled out by the very fact that you're demanding more. You know this is all just a flood of adrenaline and it will pass.

In fact, you're so familiar and comfortable with this rush that you demand even more of it just to see what happens. You're in a playful, excited mood; you're not panicked.

Do this with real commitment, and the adrenaline flood will quickly pass, leaving you with the same nervous, jittery feeling you had when you first sat in the chair.

Finally, start to engage with something. You could read a magazine, but it's even better to engage in conversation with the person cutting your hair. Conversations are always better as they require more of your attention, plus they trigger a social connection, which has a positive mood-enhancing effect.

You're then back to allowing the nervous arousal to just be with you and talking about where you're thinking of going on your next vacation.

Lastly I would like to emphasize that it's really important to work through your anxiety in the situation as best you can. If you leave early because of the anxiety, you'll feel defeated, as if the anxiety has the upper hand.

The above is an example that can be applied to almost every situation from which you feel you can't easily excuse yourself.

I identify with the idea that it's important to work through rather than leaving, although, as a perfectionist, that can also make me feel more trapped, as though I am a failure if I leave. A few years ago I bailed on a lunch situation because of a panic attack. I did something I rarely ever do, which is I told someone I was having a panic attack. This triggered a whole set of further panic attacks for months. It was like, oh no, now the panic is really affecting my life. People can tell something is wrong with me now. So I panicked about that and became hyper aware of any sensations that came up in the weeks that followed. Also, I've gone through periods of agoraphobia and avoidance prior to getting into situations in the past, where I was avoiding many things. One of my therapists theorized that some of these situations were things I deep down really didn't want to be participating in anyway. As though the anxiety were coming from a place of intuition or being true to oneself. Like an alarm system for bullshit. Do you think there is any truth to that in some scenarios?
So there are a few things here. First I think type A personalities (driven, impatient, perfectionist types), are very prone to anxiety and are also extremely hard on themselves when it manifests in their lives.

Type A people derive so much of their self esteem from achieving goals and performing well. When anxiety gets in the way of this they can be incredibly good at beating themselves up over it. This self berating then leads to frustration, tension and therefore more anxiety! This is where therapeutic approaches like CBT are helpful in order to tame the inner critic when things don't go to plan. There are lots of great approaches on how to soften that voice of that inner critic. My favorite tools for this are any of the Buddhist meditations on self compassion.

As far as letting others know about your anxiety, of course speak to your doctor or mental health professional as soon as it becomes a problem but after that I think you need to be selective about who you tell. Most people have no idea how to respond when someone is having a panic attack in front of them. They get anxious, then you get more anxious because they look anxious and before you know it it's like a scene from a bad Woody Allen movie.

Having said that there are people who are very comfortable letting everyone know about their anxiety and if that works for them, great. In my own case I dreaded the thought of other people acting uptight or awkward around me when I was feeling anxious so I ended up telling very few people. It really comes down to what you think will make you feel more comfortable in the moment.
Then to your last point about anxiety manifesting as a sign that you might not be living true to yourself. I imagine it really depends on how much mental anguish you feel in the situation. For example if a vegan was forced to work for a butcher then I could well imagine how that values conflict would cause high anxiety or panic attacks, but generally most situations that are incongruent with your 'true self' are felt as a low level discomfort or unease.

People put up with inner conflict all the time for better or for worse. They live with the unease for years on end, going to the wrong job, living in the wrong city, married to the wrong person. Ultimately it comes down to how each individual person manages the sense of unease these inner conflicts create.

What is something only a panic attack sufferer can understand that other anxiety coaches might fail to recognize?
If someone has never had a panic attack I think they often fail to appreciate the sheer mental and emotional terror it creates. For many it's a blend of fearing your imminent death mixed with the fear of losing your mind.

I have worked with many people from the "bravest" professions around. Firemen, policemen, soldiers. All of them admired by others for their bravery yet almost all of these individuals would actually prefer to run into a burning building or face a firefight with insurgents than be terrorized by panic attacks.

The good news is once the person has triumphed over their anxiety, they develop an inner strength that the average person never gets to develop. That is the hidden opportunity anxiety presents. To become a more resilient person than you were before.

Do you still have any symptoms? Do you ever fall prey to your old thinking about them or would you say you are "on the other side," so to speak?
I experience anxiety now like everyone else. That is I get stressed and worried by life in the same way most people do but the key difference is that anxiety does not play a more dominant role than that. On occasion if I am extremely exhausted, drink too much coffee or am hungover, I get the heightened sensations of nervous arousal (tight chest, pounding heart, etc.) but those sensations no longer trigger a panic attack because my brain no longer associates those sensations as dangerous. They are flagged as unpleasant sensations but not something to trigger the panic alarm over. It's the stripping away of fear from the thoughts and sensations that gets the necessary results.

That's the place I am trying to get my readers to and the good news is that it's a very achievable place to reach if you are willing to do the work.

If you are concerned about your mental health or that of someone you know, visit the Mental Health America website.

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