When your body thinks you're dying
Key facts
Your heart pounds. You can't breathe. The world tilts. You're absolutely certain you're having a heart attack, that you're going to die right here, right now. Then it passes and you're left shaking, exhausted, terrified it will happen again.
You've been to A&E. They ran tests. Your heart is fine. But the panic attacks keep coming. Now you're afraid to go places, do things, be anywhere you can't escape from if it happens again.
Many approaches to panic focus on symptom management: breathing exercises, exposure therapy, medication, or learning to ride out the physical sensations. These can be important, especially when panic is narrowing your life.
Panic attacks can feel as if they arrive from nowhere. From a psychodynamic perspective, it may be worth asking whether your body is reacting to something that has not yet become fully conscious: feelings you can't tolerate, situations that echo past trauma, needs or truths about yourself that feel catastrophic.
The panic may be what happens when something unbearable is trying to surface and your system is trying to keep it down. Your body floods with adrenaline to mobilise you for fight or flight, but there may be nothing external to fight or flee from. So you're left with all that terror and nowhere to put it.
Psychodynamic therapy asks what your panic attacks may be protecting you from. What feeling, thought or truth has become so overwhelming that your body responds as if you are in danger?
We meet weekly or twice-weekly and work with what the panic is trying to communicate. Not by triggering attacks deliberately, but by paying attention to what's happening in your life when they occur.
Sometimes panic attacks cluster around specific situations: before conflict, after intimacy, when you're alone, when you're trapped. These patterns are clues. They may point to what your system is trying to protect you from.
We'll also work with what happens in the room. The moments your breathing changes, when you dissociate slightly, when anxiety spikes even though we're just talking. Your body may be communicating before language has caught up.
Over time, as the feelings around the panic become more thinkable, the attacks may feel less mysterious and less solitary. This isn't a promise that panic will disappear. It is a way of taking seriously what your body is trying to say.