What Do You Do When You Have a Panic Attack

Summary

Highlights

• Panic attacks often present more as physiological symptoms than purely mental ones 🤯.
• Understanding your panic attack triggers and signals can help in better managing them 🔍.
• Getting a panic attack and fearing another one creates a vicious cycle of anxiety 🔄.
• Medical evaluations can uncover non-panic related health issues with similar symptoms 🏥.
• Both psychotherapy and medications are validated treatments, though they have different impacts 💡.
• Knowing the function of your mind and body during a panic attack aids in demystifying the experience 🧩.
• Breathing techniques exist but success varies; expert-guided practices can prove more beneficial 🌪️.
• Seeking medical input first can streamline effective management of panic-related symptoms 🙌.

Key Takeaways

• Panic attacks can feel physically overwhelming and are often mistaken for cardiac issues 🚑.
• They're symptoms, not diagnoses—ulterior conditions like panic disorder may underlie them 🧩.
• A medical check-up is vital to rule out severe medical causes, even if it seems like just anxiety 🩺.
• Psychotherapy can help manage panic attacks by addressing behavioral adaptations to them 🧠.
• Breathing techniques have mixed success in treating panic attacks; they aren't one-size-fits-all 🌬️.
• Medication can be as effective as psychotherapy, offering different approaches for relief 💊.
• Panic disorder is rooted in the fear of future attacks, leading to life-altering adaptations 🔄.
• Initial panic attacks justify an emergency room visit to ensure it's not something more serious 🚨.

Overview

Chapters

• 00:00 - 01:30: Introduction to Panic Attacks In this chapter, the focus is on panic attacks, discussing how it is not the original problem that impairs our function, but rather our adaptation to the issue. There's a reference to Dr. K's guide to anxiety which includes a video on panic attacks. The aim is to delve deeper into understanding panic attacks, distinguishing them from broader discussions on anxiety, and highlight some key points about panic attacks.
• 01:30 - 03:00: Personal Experience and Symptoms The chapter explores the sudden onset of panic attacks in adults, starting with a personal narrative. The speaker, at 25, describes living a normal life until experiencing their first panic attack two months prior. The immediate aftermath involved severe anxiety and reluctance to leave home or even get out of bed. However, over time, there is a gradual improvement in managing anxiety and returning to normalcy.
• 03:00 - 04:30: Misunderstandings About Panic Attacks The chapter titled 'Misunderstandings About Panic Attacks' addresses common misconceptions about panic attacks. It begins with a personal account of symptoms such as muscle weakness, heavy limbs, and random blood rushes to the head, highlighting uncertainty about whether these are related to anxiety. The individual expresses disbelief about such symptoms persisting for two months and doubts that panic and anxiety could start suddenly at their current age. The chapter aims to clarify these misunderstandings, emphasizing the need for accurate knowledge about panic attacks.
• 04:30 - 06:00: Panic Attacks as Symptoms This chapter discusses the common misconception that panic attacks are purely a mental health issue, associated only with the mind. It explores how many people believe they should see a psychiatrist because they think panic attacks originate mentally. However, the chapter hints at a more complex origin of panic attacks, suggesting that the understanding of panic attacks as exclusively mental phenomena can be misleading.
• 06:00 - 07:30: Diagnosis and Symptoms of Panic Disorder In this chapter, the discussion focuses on the diagnosis and symptoms of panic disorder. The narrative describes how individuals often experience unexpected panic attacks, even when not feeling particularly anxious or fearful. It highlights the confusion between the physical symptoms of a panic attack and anxiety, emphasizing that panic attacks can occur in individuals living otherwise normal lives. The chapter aims to clarify that these experiences, though seemingly unrelated to mental anxiety, are indeed consistent with panic disorder.
• 07:30 - 09:00: Fear and Behavior Adaptations This chapter discusses panic attacks as a symptom rather than a standalone diagnosis. It draws an analogy to fever, explaining that just as various conditions like COVID-19, cancer, strep infection, pneumonia, and staph infection can cause fever, panic attacks can also be triggered by different underlying issues. The focus is on understanding panic attacks in the context of broader behavioral adaptations.
• 09:00 - 12:00: Mechanisms Behind Panic Attacks The chapter titled 'Mechanisms Behind Panic Attacks' discusses the underlying causes of panic attacks, particularly focusing on panic disorder as a primary source. It draws an analogy between medical diagnoses and the etiology of psychological conditions. The transcript uses COVID-19 as an example of how a diagnosis leads to a variety of symptoms like fever, shortness of breath, and other physiological changes, implying that panic disorder similarly triggers a constellation of symptoms, which could manifest as panic attacks.
• 12:00 - 15:30: Medical Assistance and Evaluation The chapter titled 'Medical Assistance and Evaluation' discusses how a constellation of symptoms can be caused by a single underlying condition. It specifically highlights the case of pneumonia, explaining that pneumonia can result in multiple changes or symptoms. Furthermore, it introduces the concept of Covid-related pneumonia, which adds complexity to the medical evaluation and assistance process.
• 15:30 - 18:30: Treatment Options: Psychotherapy and Medication The chapter 'Treatment Options: Psychotherapy and Medication' explores the distinction between symptoms and diagnosis, specifically in the context of panic disorder. It emphasizes that many people may not understand these differences clearly, but they are important for effective treatment. A key aspect discussed is the experience of a panic attack, highlighting that it is primarily a physiological experience. During a panic attack, common physical symptoms include an elevated heart rate, which is an essential part of understanding the disorder and its treatment.
• 18:30 - 25:00: Breathing Techniques and Effects This chapter discusses the physical symptoms associated with stress or anxiety, particularly focusing on breathing techniques. It describes how a person may experience a rapid heartbeat, shortness of breath, nausea, sweating, muscle tension, and shakes. These physical reactions contribute to a sensation where the individual feels something is wrong physically, often leading to a sense of impending doom.
• 25:00 - 30:00: Meditation, Mindfulness, and Other Interventions The chapter discusses a different approach to handling panic attacks by focusing on the physical feelings of the experience rather than the psychological aspects. It points out that asking whether the person felt like they were going to die can be a more effective way to determine if it was a true panic attack, as opposed to anxiety-related episodes. This method highlights a shift in understanding and treating panic attacks through direct questioning about specific sensations experienced.

What Do You Do When You Have a Panic Attack Transcription

• 00:00 - 00:30 what really impairs our function is not the original issue it's the way that we adapt to the issue we're going to talk a little bit about panic attacks so uh if you all have seen dr k's guide to anxiety you know that we have a video on panic attacks but generally speaking we talk a lot more about anxiety than panic attacks so what i'd love to do today is to talk to y'all a little bit about panic attacks and a couple of key things about panic attacks okay
• 00:30 - 01:00 so has anyone else been mostly fine their whole life then randomly got a panic attack as an adult and haven't been the same since just wondering i'm 25 and i used to be able to live a perfectly normal life then i had what i believe was my first panic attack two months ago the first month was so hard i didn't want to leave the house at all i struggled to even get out of bed this month i'm getting better and slowly getting back to normal my anxiety
• 01:00 - 01:30 symptoms persist muscle weakness heavy arms and legs randomly and i get blood rushing to my head for no apparent reason i'm not even sure if it is anxiety but it's been two months and i'm still alive i'm having trouble believing my symptoms are just anxiety i also find it hard to believe anxiety and panic like this could onset at my age so this is a really important post because and the reason we're talking about panic attacks is because there's a lot of stuff that people don't understand about panic attacks the first is that we assume that panic
• 01:30 - 02:00 attacks and anxiety are related right so there's sort of this idea that like okay if i have panic attacks i should go see a psychiatrist it's a mental health issue if it's a mental health issue that must mean that it involves my mind and this is what confuses a lot of people who have panic attacks because they assume that the origin of the panic attack is mental in nature and then as you start the more perplexing thing is that sometimes
• 02:00 - 02:30 like you know you'll see something like this where people are like i'm not even sure if it's anxiety because i'm not even anxious particularly like i don't have any particular fears it's like a random like i'm living a perfectly normal life and then suddenly i had a panic attack and then i have all this weird crap going on with my physical body and like it just doesn't feel mental it doesn't feel like anxiety and so what i'd love to do today is talk to y'all a little bit about how that is absolutely what a panic attack and panic
• 02:30 - 03:00 disorder is is like so the first thing to understand is that panic attacks are a symptom they're not a diagnosis so it's kind of like fever right so this is another example of a symptom so what causes fever well covid could cause fever cancer could cause fever you know strep infection could cause fever pneumonia could cause fever staph infection in the skin could cause fever all kinds of things can cause
• 03:00 - 03:30 fever it's a symptom now the most common source of panic attacks is a diagnosis called panic disorder now a diagnosis is like an etiology so it's like a source of a problem so if we take a diagnosis like covet infection this is going to create fever it's going to create shortness of breath it's going to create maybe changes on your x-ray it's going to create uh you know runny nose
• 03:30 - 04:00 so it's like a constellation of symptoms that all lead are caused by one thing now the interesting thing is that pneumonia can also cause all of these changes right and you can have a covid related pneumonia so that gets a little bit more complicated but do you all sort of get how oh whoops um let me move this do you all sort of
• 04:00 - 04:30 get how there's a difference between a symptom and a diagnosis and there are a couple of key features to the diagnosis of panic disorder which a lot of people don't really realize but it's actually quite elucidating so when someone has a panic attack what what what is the primary experience of the panic attack so the first thing to understand about the the primary experience of the panic attack is that it's predominantly physiologic so people oftentimes have um elevated heart rate so their heart is
• 04:30 - 05:00 beating super fast they'll have difficulty breathing so they'll get shortness of breath they'll have nausea they'll get sweaty they'll get muscle tension or shakes right so it's a very physical thing it feels like something is wrong with you physically and what this actually does is this results in a sense of impending doom
• 05:00 - 05:30 so when people when someone has a panic attack instead of asking them what are your deep dark fears instead of approaching it psychologically oftentimes what i'll ask him is like did it feel like you were straight up gonna die did absolute like did you feel like you were gonna die and like the world was like ending and then they'll often times if they have a real panic attack they'll say yes whereas if it's more like you know anxiety related oddly enough that may not actually be a panic attack
• 05:30 - 06:00 so this is the first thing to understand if you've got a panic attack is it's very physiologic in nature okay so now that we know that what we're going to do is talk a little bit about panic disorder and then what we're going to do is look at some of the mechanisms through which this happens and then we're going to tell you all what to do about it okay so the interesting thing about panic disorder is that in order to be diagnosed with panic disorder you need one really important feature and that is
• 06:00 - 06:30 adjusting your behavior or a persistent fear of future panic attacks so this is really important to understand oftentimes what causes us problems in life what really impairs our function
• 06:30 - 07:00 is not the original issue it's the way that we adapt to the issue and what we see in panic disorder is not just the panic attack what really cripples people in panic disorder is not actually the panic attack it's the fear of the future panic attack so a good example of this is something that people call agoraphobia what is agoraphobia it's fear of leaving the house fear of going outside this is truly what's debilitating about panic
• 07:00 - 07:30 disorder it's not the panic attack itself it's the fact that what will happen if i have a panic attack at work what will happen if i have a panic attack at the movies so what people end up doing is they stop going to the movies they stop going to work right you don't even have to be necessarily agoraphobic like even if you're okay with like going to the grocery store and leaving the house and you enjoy going for walks but what i tend to find in people a panic disorder is that they come up with like
• 07:30 - 08:00 contingency plans for if they have a panic attack so it's like okay i'm willing to go to a restaurant but like only a restaurant that has three stalls in the bathroom and i'll be like why do you need to go to a restaurant that has three stalls in the bathroom they're like well i recognize that oftentimes one stall may be occupied and in some cases like you know if one stall is occupied and someone else goes in the second stall will be occupied but i absolutely need access to a bathroom
• 08:00 - 08:30 stall if i have a panic attack because i need to hunker down for like 20 minutes there so the only restaurants i'll go to are the ones that have three stalls or i need some kind of safe escape this is really common for people who have panic disorder they need to know how to get out of a situation if they have a panic attack okay so the key thing here is that if we look at like a lot of what causes us problems it's not the original insult it's the consequences of the insult or the adaptation we also see this for example
• 08:30 - 09:00 in like the dating world right so if i have a bad experience with a particular person i can generalize things about that person so i can generalize things about their gender oh this gender can't be trusted this gender is cruel i can generalize things about their race or their ethnicity i'll never date this race or ethnic ethnic of a person again or this kind of ethnicity again because all of the people of that race or ethnicity are like this it's not just the original problem in the date it's the adaptation that we
• 09:00 - 09:30 make to our negative experience which actually causes us problems so a key feature of panic disorder is actually adjusting your behavior or a persistent fear of future panic attacks okay now what we're going to do is talk a little bit about the mechanisms a panic disor panic attacks and this will also set us up for what you can do about panic attacks
• 09:30 - 10:00 so the first thing to understand is that we tend to get signals so these are things like heart rate blood pressure sweatiness nausea shortness of breath things like this we get these physiologic signals and then our brain is trying to interpret these signals because it's like if i'm just like if i'm 25 years old and i'm healthy and i just every organ in my body starts
• 10:00 - 10:30 like getting messed up like my heart is pounding in my chest i can't breathe i feel like vomiting my i'm shaking it's like what on earth is going on then what happens is there's an interpretation and then there's a conclusion i'm dying and then what there is is based on that traumatic experience there's an adaptation does that make
• 10:30 - 11:00 sense now if we look at things like therapy like psychotherapy psychotherapy really works here and potentially here but it doesn't actually work here oftentimes okay so let's try to understand a little bit about what we know about this right here and what we can do about that so
• 11:00 - 11:30 there are a couple of really interesting things the first is that we know that there's an interesting hypothesis that we have a suffocation reflex so when we start to suffocate so if someone's like choking me or like i'm drowning or something like that there's a reflex a very strong survival mechanism that activates and we have this kind of suffocation reflex so the suffocation reflex is going to activate
• 11:30 - 12:00 cause all kinds of changes to our amygdala also cause physiologic changes like adrenaline rush and then this in turn will lead to things like heart rate increased respiratory rate right shortness of breath all that kind of stuff now the interesting thing about the amygdala so this is our fear center of the brain is that the amygdala also has
• 12:00 - 12:30 an apnic response so apnea is the cessation of breathing so when we're very very scared right i don't know if y'all have ever seen like videos of like animals on the hunt or whatever when we're terrified what happens to our breathing we freeze
• 12:30 - 13:00 so what activation of the amygdala can do is actually make like alter our respiratory rate and actually make us stop breathing which in turn will increase our co2 and will cause a hyperventilation consistent with a panic attack so what's going on in a panic attack i suspect so there's a data to support this but we don't really know 100 that a panic attack is actually
• 13:00 - 13:30 physiologic in origin and what you actually get is an inappropriate activation of your suffocation reflex so sometimes something happens and like this reflex the survival reflex turns on without it supposed to be turned on and so then we get this adrenaline rush that explains all these symptoms we also get activation of the amygdala which gives us a sense of fear right which then turns into these thoughts like i'm dying and then also
• 13:30 - 14:00 triggers this whole cascade which affects our respiratory rate which in turn ends up affecting this and by the way this all the way goes back over here and then we get our panic attack does that make sense so the key thing to understand if you've got panic attacks is like oftentimes people think and panic attacks think i'm dying or some you know something's fundamentally wrong with me and arguably i mean obviously if you're having a panic attack there is something going on that's not supposed to be going on but instead of having cancer or impending doom or things like that chances are
• 14:00 - 14:30 it's actually just a misactivation of certain parts of your brain that's the theory that i think has the best support behind it and also is consistent with what people actually experience okay so in a sense like you'll be okay but there's also treatment for this okay so what should you do if you have a panic attack what do the first thing is that if you're actually having a panic attack and if it's your first panic attack i think
• 14:30 - 15:00 it's completely appropriate to seek emergency medical services this is completely appropriate so in the u.s you can actually call 9-1-1 you can go to the emergency room this is important to understand so a panic attack generally speaking is not going to kill you but emergency medical services are not just for things that are going to kill you
• 15:00 - 15:30 emergency medical services are for things that we don't know if this is going to kill us or not does that make sense like it's not your job as someone who's experiencing a panic attack to be able to differentiate between a cardiac arrhythmia which could absolutely be lethal and a panic attack so i'm not trying to you know stress you all out here what i'm saying is that if this is your first panic attack and you really don't know what's going on or if you have another one and you've never gotten diagnosed or
• 15:30 - 16:00 something like that you should absolutely seek emergency medical services because the important thing here and we'll get to this in a second and let's say the panic attack has passed and you didn't seek emergency services what should you do the next day the next couple days things like that you should absolutely seek a medical evaluation and why do i say a medical evaluation instead of a psychiatric evaluation so this is one of the things that i think is unfortunate about the way that we train therapists
• 16:00 - 16:30 is you may say okay i'm having a panic attack i need to go see a therapist the problem is that there are all kinds of things that can cause these symptoms and while a panic attack may be the most likely there could be things like cardiac arrhythmias so a cardiac arrhythmia is irregular activity of the heart irregular electrical activity of the
• 16:30 - 17:00 heart and these can be transient so you can get a heart that's like starts beating very very fast when it's not supposed to or and when it beats or beats uh not properly so it's kind of like you know the way that our heart beats so our heart is kind of shaped like this and it's filled with blood and then what it starts doing is actually like it contracts from the bottom and then it contracts higher and then it contracts higher so that if you think about it if i if i'm squeezing something from the bottom and
• 17:00 - 17:30 the opening is at the top what i'm actually going to do is facilitate the flow out but if i start squeezing from the top that's not going to help things you know leave blood leave the heart it's actually going to push it downward and then i start squeezing from the bottom and then like the heart doesn't empty appropriately so arrhythmias can cause all kinds of weird things like this there are also issues for example with thyroid so if you're hyperthyroid you can sort of get uh symptoms of a panic attack
• 17:30 - 18:00 pretty easily sometimes so the key thing for the key reason for medical evaluation is that there may be medical causes to your quote-unquote panic attack that's why you need to go see a medical professional and unfortunately i have seen cases where people will go to therapists the therapist you know if you're like a licensed clinical social worker like you don't regularly order lab tests for your patients right like you don't you're not taught how to interpret lab tests so hopefully what happens is is a good
• 18:00 - 18:30 therapist will say by the way have you gotten a medical evaluation why don't you talk to your primary care physician or gp and then like we can work on the panic stuff but let's just make sure that it's not medical in origin so a good therapist will do that but you should get a medical evaluation because the key thing here is i've had some patients with panic attacks who will like find a medical cause and once we find a medical cause they'll like fix the medical cause so they'll start medication or maybe even have a procedure or something like that and then their panic attacks are
• 18:30 - 19:00 like literally cured like done never a panic attack for the rest of your life you're fixed so that's what's really important about getting medical evaluations even if you have something like a panic attack now a couple of other things to consider so let's talk about psychotherapy so this is where i think psychotherapy and medication are equally effective generally speaking so if you look at effect sizes that
• 19:00 - 19:30 compare the improvement from psychotherapy and medication they tend to be about the same so one isn't better than the other but if we look at how psychotherapy works i personally find psychotherapy to be very effective especially this adaptation step so it's not just the panic attack itself it's the way that i have to account for the panic attack that the way i adapt to it the way that i mal adapt to my panic attacks the way that my panic attacks start controlling
• 19:30 - 20:00 my life because i'm afraid of the panic attack that is where psychotherapy can really really do a lot of good work because it can help you reclaim your life it can help you notice what these adaptations are it can help you conquer some of those maladaptations and hopefully start to live a pretty healthy life the other interesting thing is that psychotherapy depending on what kind of psychotherapy you can do you can stop this cognitive process of interpretation so when i um
• 20:00 - 20:30 you know when i feel these signals my mind interprets those signals and makes me conclude that i'm dying and then this conclusion that i'm dying is going to create all kinds of other you know effects so stopping that interpretation can be very very useful sort of understanding and coming to appreciate oh this is just a panic attack it's my suffocation reflex inappropriately activating it's amygdala hyper reactivity i actually don't have
• 20:30 - 21:00 too much to worry about and interestingly enough i know it sounds kind of weird can you just tell yourself that and that's where the therapy sort of helps you train skills to avoid cognitive mistakes and it can help absolutely so there are medications for panic disorder this is where um you know a lot of people think and hope and unfortunately still prescribe things like benzodiazepines
• 21:00 - 21:30 and benzodiazepines can be effective for treating an individual panic attack so things like xanax or alprazolam or cl klonopin or clonazepam these are the benzodiazepine class of medications they're basically work on the same receptors as alcohol can be highly addictive in habit forming these
• 21:30 - 22:00 are not actually the best first line treatment the best first line treatment is actually ssris or snris these are selective serotonin reuptake inhibitors um serotonin norepinephrine reuptake inhibitors so these are medications that are also in the antidepressant class they seem to be pretty effective
• 22:00 - 22:30 now the interesting thing is a lot of people talk about breathing so let's talk about breathing for a second so i'm a big fan of breathing i teach a lot of brain i am i'm all into like oh i'm dr k and i love like my meditation and like oh like let's learn how to meditate meditation is effective at reducing symptoms of panic disorder by the way the problem is that if you look at studies if you look at meta-analyses of studies
• 22:30 - 23:00 for breath training for panic disorder or panic attacks it turns out that the evidence is average it's not up it's not down it's kind of in the middle so breathing a lot of people may think that so i personally have certain interpretations of the literature but if you look at it on the whole breath training does not seem to be a consistently effective
• 23:00 - 23:30 intervention for panic attacks which oftentimes is very confusing for people because when they have panic attacks which the vision that you have is someone breathing into a paper bag right so i personally still use uh breathing techniques for people who have panic disorder and panic attacks um i personally think that the problem with the research is that they'll call things breathing technique or breath training but if you've studied things like brown i am or chi gong or real yogic
• 23:30 - 24:00 meditation uh breath techniques you'll realize that they're wildly different right so not all breath techniques are appropriate for panic attacks the problem is that there's no uniformity in terms of what they call breath training so it's basically if you do something with the breath does it help panic attacks and the answer is generally speaking we can't conclude that the answer is yes so it doesn't mean no it just means that there's variable responses and i suspect that's because
• 24:00 - 24:30 of the way that you do breath training really matters there's good breath training and there's bad breath training the problem is that the people who are doing the breath training aren't experts in like yogic science and don't understand like they're just like oh like it's a meditation technique and like oh like let's just use it and it turns out that i don't think that that's very effective so i personally will still teach this stuff and i see good clinical effect sizes but if you look at the whole of the literature
• 24:30 - 25:00 it turns out that breath training is like a plus-minus kind of intervention it doesn't seem to be as consistently effective as psychotherapy or medication and part of the advantages of something like medication is that it's standardized right like it's standardized whereas things like breath training or not so mindfulness or meditation does help so you can definitely do that but this is where you know i hate to break it to you but if you're having a true panic attack
• 25:00 - 25:30 or you have true panic disorder sometimes like later on we're going to talk about you know things that will offer answers in a different kind of way so this isn't medical advice but this is just to explain that based on if someone were to ask me a general question if i have a panic attack what should i do i'd say go see your doctor and that may be like a little bit of a disappointing answer but sometimes that's actually the right answer right like i think talking about cognitive patterns and talking about
• 25:30 - 26:00 this meditation and that meditation it can help you in this way in that way and that's like all good like i'm not saying that there aren't additional things that you can do but part of the part of what i learned in medical school is that some of this like new age kind of even like meditation stuff which i'm a huge fan of like sometimes it just doesn't work as consistently as some of this other like western medical stuff and we could talk about yoga and some scars in the mind and focusing and all this kind of good stuff but sometimes what you really need to do is like go to
• 26:00 - 26:30 the emergency room sometimes what you really need to do is like go talk to a doctor and get your thyroid checked and if if you're honestly asking me like if i had a family member who had a panic attack what would i do if they were having a panic attack i would send them to the emergency room if they told me hey i had a paying attack yesterday what would i do i would say hey you should go see a doctor and like get yourself like physically checked out and then after that you know we can explore some of these things like psychotherapy and medication and then if you want to you can try breathing
• 26:30 - 27:00 techniques and you can try meditation and mindfulness but it's really important to understand that these things should not be a substitute for these things now if you don't want to put medications in your body that's totally fine then by all means go do psychotherapy questions yeah so aaron robin is saying deep deep breathing didn't really work for me it just made me more nauseous i you know it's really unfortunate but like
• 27:00 - 27:30 that is sometimes people's experience right is it possible to frequently experience signals but never had a panic attack very possible i mean all kinds of stuff is possible that's where you know and that's where the mechanism is kind of important right we don't know if it's like the suffocation reflex or there's some amount of amygdala hyper reactivity so if someone is already using ssris do they have a lesser chance of a panic attack i would guess that the answer to that question is yes can a panic attack
• 27:30 - 28:00 make you feel like you're having a heart attack like big chest pain absolutely so isn't bellow's breath breath of fire completely shallow i've had great success with it yeah so this is where there's a lot of nuance to the technique that we use so let's talk about bellows breath or breath of fire so for those of y'all that don't know these techniques they're in dr k's guide you may be able to find them on youtube as well because i think we've taught both of those on stream before so the key thing about bellows breath and breath of fire is that what you're actually doing is hyperventilating to become hypocapnic
• 28:00 - 28:30 so when you increase your respiratory rate you drop your co2 level and when your co2 level drops really really low what that forces your body to do or not force but what it sends your signals to your body to do is actually breathe slowly so then it's like wait a second our co2 level is too low let's slow down our respiratory rate to get our co2 level back up and as you have that physiologic
• 28:30 - 29:00 suppression of the respiratory drive and your rate of breathing goes down you're taking like two breaths a minute three breaths a minute that is incredibly relaxing someone else is asking so you're saying that the literature lacks technical specificity with brown i am 100 that's a great way to put it so we're starting to see this where now people are doing studies on something called cardiac coherence breathing cardiac coherence breathing is naughty
• 29:00 - 29:30 deep bronio they just call it a different thing right and then they say oh cardiac coherence breathing is effective at all these kinds of things but then people will continue to say oh broniom is like alternative medicine right it's and so i i hope that we can sort of continue to move things in that direction where we test these different kinds of bronium and start to see different differentiating physiologic effects and treatment benefits um so how do you help a friend who's
• 29:30 - 30:00 having a panic attack in the moment you get them to emergency medical services and make sure that it's not something more serious what do i do if i'm at the point if i have agoraphobia already great question that's why you need to see a therapist right so the process of overcoming that agoraphobia is absolutely something that a therapist can help you with so shadow7578 is asking if i feel like my heart is actually skipping a beat and my breath gets heavy but in 15 seconds i'm fine is that a panic attack
• 30:00 - 30:30 so that's the kind of thing where like that you need a medical evaluation for that right so here i am educating you all about the specifics of panic attacks but this is important to understand if you have a particular constellation of stuff i don't know what that is because in order to confidently answer that i would actually need to do a medical evaluation on you right i would need to ask you a bunch of questions like how often does it happen what happens what happens to your heart rate let's check your like in order to answer
• 30:30 - 31:00 that question i would check your thyroid i would also potentially send you for uh you know uh general practitioner evaluation maybe get something like an ekg i don't think akg is super appropriate in that situation my point is that the more specific your question is hey dr k i have this constellation of weird things what is it that's exactly why you should go see a medical doctor because the information that you're giving me may not be the relevant information and figuring out what it is that's why doctors ask a bunch of questions
• 31:00 - 31:30 uh so marmalade is asking would you agree that expiration is what makes breathing relaxing i personally only feel better when i focus on breathing out instead of in so it's not it's partially true the key thing is that the length of exhalation generally speaking correlates with the degree of relaxation so it's not just exhalation chances are
• 31:30 - 32:00 since you're focusing on exhalation what you're really doing is slowing down your exhalation because when you focus on your breathing you tend to slow it down and as you slow it down chances are you start to feel more relaxed um do i have a paper on cardiac coherence breathing i mean you can just search for it but cardiac coherence it it's not about so people will do studies like on
• 32:00 - 32:30 particular conditions right does that make sense so there are i i mean there may be papers on just straight cardiac coherence breathing but usually what people are doing is it's like cardio cardiac coherence breathing for ptsd if that makes sense but i don't have a particular study on hand is there a difference between an anxiety attack and a panic attack are they synonymous anxiety attack is not a medical term panic attack is a medical term so
• 32:30 - 33:00 i i generally think of them in the common like usage is synonymous when someone says and that's why like when someone says i had an anxiety attack that's where i will assess them right so i'll do a clinical assessment i'll ask them what did you feel when did it start how long did it last how do you feel now has it happened before and then i'll determine whether something called an anxiety attack was a true panic attack or not
• 33:00 - 33:30 okay yeah so maluka is saying three years ago i had a series of panic attacks and i didn't know what they were now i'm kind of in fear of having another one i think i should see a therapist for that i think you should too seiko five is saying i've only reached a no mind state once now i'm trying to reach it a second time it's way harder any tips yeah so the funny thing about about meditation is the first no mind state you reach is easier than the second the second is actually the hardest the reason that the second no-mind state
• 33:30 - 34:00 is harder than the first no-mind state is now you have an expectation of the no-mind state and so since you're looking for the no mind state your mind remains active because it's wanting a no mind state right does that make sense it's like you stumble upon something and so the reason it's easy to stumble on it the first time is because you have no expectation of it now that you have an expectation
• 34:00 - 34:30 that expectation exists within the mind and is like harder to let go so what you have to do is stop looking for the no mind state in meditation and then you'll find it again you