Why Do Panic Attacks Happen? With Dr. Martin Brunet

Why Do Panic Attacks Happen with Dr. Martin Brunet

If you're struggling with anxiety, panic disorder, and agoraphobia, chances are that you've experienced a panic attack at some point in your journey. Whether it was a single panic attack that led to a bunch of disordered thinking and more panic, or you experience them regularly, this episode will really help to demystify panic attacks and explain why they make you feel the way you do!

On this episode I'm joined by Martin Brunet, General Practitioner and medical educator from the UK to talk all things panic attacks, I'm so excited for you to hear from him, I really enjoyed this one! Let's get to it!

What is a Panic Attack?

Panic attacks are a type of fear response, where your normal response to danger, stress, or excitement gets dialed way up.

Martin describes panic attacks as anxiety on steroids. If you have anxiety, you may be familiar with with the symptoms at a low level, but with a panic attack these symptoms build up and can overwhelm you.

Martin and I discussed the two main causes of the symptoms of a panic attack. The first is a surge of adrenaline, also called epinephrine. This is our fight-or-flight hormone, which is released when we are doing something exciting or scary. It can lead to symptoms like a fast heartbeat, feeling shaky, sweating or causing an upset stomach. However, during a panic attack, these symptoms occur without a purpose or clear external threat, making them overwhelming and scary. Because you're not about to fight something, or run away, you just feel panicked.

The second main cause is our breathing. That surge in adrenaline causes faster breathing, as your body prepares you for that exciting or scary moment. Taking in lots more oxygen and breathing out carbon dioxide changes the acidity in our blood, which while not harmful, can cause some unpleasant symptoms like feeling lightheaded, dizzy or tingly.

Knowing what's going on inside your body can be a big help in dealing with panic attacks. Acknowledging them, understanding them and using past experience to build resilience will all be helpful tools to move forward.

Why Do We Panic for "No Reason?"

One of the scariest and most frustrating parts of struggling with anxiety and panic is having panic attacks when you know they're happening for no good reason! You're not alone in thinking this. Martin explains that there is usually a logic behind panic and anxiety, but it's not the necessarily the one you'd expect.

If you're prone to panic attacks, or have experienced them before, your brain will consciously and unconsciously link certain things with panicking. Maybe you've had a panic attack in the supermarket. Suddenly, everything about the supermarket will remind your brain about that time, and it will feel a sense of threat. Even if you logically know there's nothing to fear at the supermarket, the conditioned association can still provoke panic. Over time, this conditioning can lead to panic attacks without any external triggers, as the brain has become primed to expect them in certain situations.

The good news, is that our brains are so capable of relearning and rewiring though patterns to create new experiences and help us to work through panic and anxiety.

Practice & Exposure

Exposure Therapy for anxiety as part of lots of healthy action really works. Martin compares exposure therapy, where you gradually allow yourself to experience the things that make you feel anxious, to practicing a skill.

Martin is increasingly interested in the concept of practice. Exposure therapy can be quite a scary thing to consider, so it can be helpful to think of it as simply practicing the things we'd like to get better at, gradually learning how to overcome anxiety through small and healthy steps.

Okay, so that covers a few of the highlights from this episode. I loved chatting with Martin and we dove into lots more good stuff together. Make sure you check out the full episode for lots of practical and helpful advice on panic attacks, burnout, exposure therapy and more!

Connect with Martin!

Instagram: @doc_martin_gp

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TRANSCRIPT

Shannon Jackson  00:02

Okay, today I have another really awesome guest with me and we're going to chat about panic attacks. So I am so excited to welcome Dr. Martin brunette here with me. He's a general practitioner who works for the National Health Service in the UK. So if you're like whom, what's that you can translate it to Martin as a family doctor. So, Martin, welcome to a healthy fresh podcast. Brilliant. Thank you very much. I'm delighted to be with you and amazing to be across the Atlantic like this. Right? Right. I'm so excited when I came across your Instagram. I was like, dang it, the way that you present things. It's just so great. So practical, like just very easy to digest. So I'm really excited just to hear your perspective on a lot of different things. So let's just start with what are panic attacks, and like, what happens physiologically in your body when you have a panic attack? Yeah. So I think I see panic attacks, really the anxiety on steroids if you like. So a lot of what you're gonna feel when you're having a panic attack is similar to when you have anxiety, but it kind of kind of builds up and it crescendos and then overwhelms you when it's a full panic attack. So. So a lot of the symptoms, if you have anxiety, you might be familiar with them in a low level. But normally, you can manage them. And the two main causes of the symptoms and I find it quite helpful to think about it like this, and then it helps me understand the different types of symptoms. So basically, it's has to do with adrenaline, or epinephrine is it called epinephrine in America rather than adrenaline

Martin Brunet  01:47

to remember how to translate. And it's to do with our breathing. So adrenaline, epinephrine, this is our flight Fight, fight hormone. This is the hormone that gets released when we need to do stuff and do exciting or dangerous stuff. And we're all very familiar with it, when we when for a boss, or we're very excited about something because we're watching our favorite football team or something. adrenaline kicks in, and it makes our heart race and it makes us potentially a bit shaky. And it will then brings blood to to the skin. So we might get flushed, it can upset the bowels. So we're all familiar with, you know, having to rush to the toilet because we're nervous before an interview or something. Well, that's adrenaline affecting the bowel, so it affects the whole body. And if you're running for a bus, or doing something where you expect to have adrenaline, then that's fine. You expect your heart rate to ace. But it's when you're getting adrenaline when you're just sitting doing nothing. And it's really racing. And then you feel your heart going fast and really pounding away and you feel very shaky, and sweaty, and just ill and sometimes your sense of impending sense of doom is is a term that's used to describe panic, and that a lot of that all relates to adrenaline. And I think of it as adrenaline without a purpose, which is why I can feel so overwhelming. Because you're not about to fight something or run away, you just feel panicked. So part of it is adrenaline. And then the other part is to do with your breathing. So one of the things that we do, we tend to breathe faster. And part of that is adrenaline makes us pretty fast. Because you're gonna run for us, you want to breathe faster. But when we breathe too fast, then we we breathe in more oxygen, which is fine. Doesn't matter how much oxygen you have, but we breathe out carbon dioxide. And when we breathe out carbon dioxide that changes the acidity of our blood, which is not dangerous, but it gives you all sorts of unpleasant symptoms. So particularly it makes you lightheaded and dizzy. It often gives you tingling in your fingertips and your toes, sometimes the end of your nose. And if you really push breathing far too fast, you can even get what's called tetany width, which is where your muscles cramp up and feel like they're looking. But you've got a really modified ventilation for you get that but the tingling and lightheadedness are very, very common. So that yeah, majority of the symptoms.

Shannon Jackson  04:18

Yeah, I'm glad that you've had on so many of them. I'm sure people are like, yes, yes, I've experienced this, that what you said adrenaline without a purpose. It is so good. Because I think the most frustrating and scary part about struggling with panic disorder and having panic attacks is you know that they're not really happening for any good reason. And it can make it so incredibly hard because you're like what, like, I'm just standing here right in the store waiting in line like why the heck is this happening? And so I think that's sort of the next thing to roll into. Like when Why do we get them? Especially in those scenarios? Where if nothing is really warranting us to have this response, right?

Martin Brunet  05:10

Yes, I think there's always a logic behind anxiety and panic, but it's not necessarily the one you'd expect. So often people would say, you know, why are you worried, nothing to be worried about, or why you kind of think there's nothing to panic about. And it just doesn't really work like that. So, I think there's always a difference between the very first panic attack you have. And if you're prone to panic attacks and getting them regularly. So let's just say you're, you're prone to panic attacks you've had them before, you then just become conditioned to consciously and unconsciously your brain links certain things with panicking. So if you've panicked in the supermarket before, then everything about the supermarket will remind your brain about that time, and it will feel a sense of threat. In the same way, you know, we've evolved to panic when there's an uncaged lion that might attack us. And so it makes a lot of sense that as soon as we see anything that looks vaguely lion shape, we're ready to panic and run away. So it's, it's instinctive, that our brain then is on the lookout for that threat that left an imprint, the last time we panicked. And then you can find yourself thinking, Well, you know, it's nothing to be anxious about with going to a supermarket. But if you know that every time you go near a supermarket, you have a panic attack. Actually, it becomes very logical to panic when you go to supermarket because that's one of the most unpleasant things that can happen. So once you've become conditioned, you don't need to look for any other reason as to why it's happening other than it's because I've become conditioned to have panic.

Shannon Jackson  06:44

Oh, that's, that's so good. Because they think, right? We're always wanting to make sense of everything, right, and analyze and figure things out. And we're like, why, why is this happening? Why am I experiencing this symptom? Why am I experiencing panic. And so that's really helpful. And I always say, right to acknowledge it makes sense. Like, as much as you don't like it, and you don't want to be panicking. It makes sense that your body's having this response, especially if you're putting yourself in a place or situation that often you experience anxiety or panic in you, the way you word things is so good. It's just like your brain is on the lookout, right? It's like, and when it had that proof, it just like, high ends at all. You get that I'm sure you've worked with people, right? Where they've panicked here, there and everywhere. And so they're like, I am no longer going here. They're everywhere, which can then lead to that agoraphobia aspect. Yeah,

Martin Brunet  07:42

absolutely. Because it's such a frightening thing, you therefore the instinctive thing is to avoid anything that might cause panic, natural thing thing of, well, I won't go to the supermarket, I won't go on a train because I had a panic attack on the train. You know, actually, that just adds fuel to the fire and makes the panic have more power over you. And, you know, once you understand anxiety, the role of avoidance and how instinctive and yet damaging avoidance can be is, you know, something you've got to crack. But it's, it's hard to crack it because everything in your instinct is saying, avoid, avoid, avoid those feelings. So I think you're like just reassuring yourself that it does make sense. And then not trying to analyze it too hard beyond that. But just say, Okay, I'm panicking. I know, I know, this happens. I know what's happening. And I can deal with it, rather than trying to dissect it in its minutiae, either, and then it's,

Shannon Jackson  08:39

it's right. So what about that maybe first time cuz they think, you know, people get really hung up on this, like, I don't know why, you know, I'm now struggling and and once you understand, you know, physiologically, what's happening, you can make sense of it. But I think when you have that first panic attack, a lot of people say right, I didn't even know what was happening. I had no idea that I was having a panic attack. Why? Why does that happen? Like, why do we just panic seemingly out of the middle of nowhere, sometimes?

Martin Brunet  09:15

I think I mean, for some people, that first panic attack won't necessarily have an obvious cause. But I think it's often worse worth going back. If you have panic, too, they will try and remember the very first one, because there might be some stuff there that you can understand. So, for instance, it might be that your first ever panic attack was on a train, you had a stomach bug, so you had the ones there wasn't a toilet, and you became really panicky that you were going to, you know, have an accident on the train, which will be awful. And, and then whenever you go near a train, you start panicking. So sometimes there's something quite concrete like that, you know, a traumatic event or a thing that really made you very anxious in that situation that was unique to that time. But then you've now become conditioned. Sometimes I think it can be just the end result of burnout. For instance, sometimes when someone's really stressed and burnt out, and they've been going 100 miles an hour, then, you know, maybe they're on the commute to work. And they suddenly, you know that the journey, getting close to that workplace that's really stressing them out starts to make the heart race and they start then worrying about what's going on. I think one of the things about panic, especially if you've never had it before, is it feels so much like your body is physically falling apart, or something terrible is happening. So quite often, once your heart starts racing and, and you might start getting chest pains and your breathing is not right, well, you might well complete that you're having a heart attack, or you're about to die, or that something terrible is happening. And that's what makes it crescendo. Because the panic itself gives you physical symptoms, that are a good thing to panic about. Because they're so you're so used to them, and they're quite scary. You know, if your physical symptoms of a panic attack, were just that your little toe started itching, you wouldn't panic about it, because like it says on your test where your heart and your lungs are on the really important bits, and then you feel dizzy and lightheaded like you might pass out. And that's your brain. And so, you know, that's very frightening.

Shannon Jackson  11:20

Yeah, yeah. And we create all these stories, right? I mean, I know, everything that you were just saying, I was like, bringing myself back to you, all the panic attacks I had. And I think even sometimes, knowing physiologically, what's happening it like doesn't isn't helpful in the moment, because you can't like talk logic into your brain when you're in that very anxious state. So you're like, I know, I'm not going to have a heart attack. I know, I'm not going to, you know, pass out and die. But I sort of can't convince myself of that. And it's, it's really unhelpful, right to to try to do that. It's like, allowing it to make sense, right? It makes sense that my heart is racing, it makes sense that I feel shaky, it makes sense. And I feel like had it and trying not to go along with all those stories. But that's, of course incredibly hard when you're in that highly anxious state, right?

Martin Brunet  12:12

Yes, yeah. No, it's very difficult. I think. I think it's always important. We don't sell or tell ourselves, we can't do something. Because if I say, Well, I can't control my panic attacks, then well, there's no point trying because you can't, and there's no room for maneuver with can't. Whereas I find it very difficult to control my panic attacks. You can work with that, you know, that allows you to imagine the possibility that you can, you can overcome them, and you can handle them, which we imagine that something's possible. That's the first step in actually being able to make progress.

Shannon Jackson  12:46

Yeah, yeah, for sure. I'm glad that you mentioned that, that burnout aspect because I think for for me, and I know for many people that I've worked with, it's sort of been this, like, slow burn, have just like so much stress, so much overwhelm. And it made sense that your body got to this point, or it was like, Hey, I'm gonna throw all these, you know, signals at you. And, of course, if you don't know what it is, it can be super terrifying. And even if you know what it is, it can be really scary. So something that I hear a lot, and I'm curious what your thoughts are in this. People ask rate, can i Is there any way to make it less scary? Like, I feel like the goal is I'm supposed to panic and feel really uncomfortable and really anxious, but I'm not supposed to be so scared by it. Like, how do I become less scared by it? Like, what are your thoughts on that? I'm curious.

Martin Brunet  13:41

I think I think the first thing is just to, to understand it, to acknowledge it to say, Yeah, I'm having a panic attack. And to remind yourself how you've managed before, because sometimes when you're thinking Well, shall I go and do that thing, when I might panic, it can feel like having a panic attack would be a disaster. So therefore, you don't want to do it. And yet, actually, if you can do something in the panic, and you will come through that, and that then gives you another successfully managed panic attack in the bank if you like that you can then remind yourself of so you know, even if you have a bad day and you end up panicking a lot more than you thought, That's experiences in the bank that you can draw on when you panic another time and just say, okay, you know, when I've had panic attacks before I've often thought you know, this is it this is the end well, actually never has been I've always come through them I you know, I do know they pass so you can you can go to past experience, definitely. And there's definitely techniques you can do to bring down your panic and you know, we'll talk about breathing. We'll come on to that I'm sure because that's very key. Managing breathing. And, and I think trying not to over interpret it is important. So particularly with your physical symptoms, just reminding Self yet, okay, this is adrenaline this memory thing, rather than my heart's going 130. But last time it went 140 Is that? Does that mean now? Now I'm having a heart attack? Or how do I know? I'm not? You know, if you're asking yourself loads of what if questions? Or how do I know if that you need to try and study that thinking? Because it doesn't get you anywhere?

Shannon Jackson  15:23

Right? It's like that. What if, what if? What if, and, you know, I thought was, oh, gosh, I lived in that space. And I know so many people live in that space. And it the thoughts can be so tricky, because you know, the more you go along with the thoughts, there comes even more feelings. And you're like, oh, my gosh, it just feels like this never ending loop. Let's, let's jump into that. So I'm curious, what can actually relieve panic, because a little bit on what you touched on, right was when you're panicking, you're panicking, right? You're sort of not you. You can't actually like make it go away, make it stop when it's happening. And I think that's so much of what people are focused on when they're panicking, like, how can I make this stop right now? How can I make this go away? So how can you actually allow yourself to like, work through it in a way that's going to be helpful and not work against you? I

Martin Brunet  16:20

think I think it's really important. There's two aspects as well, there's what how can you help someone who's panicking? And then how can you help yourself, and I might start with the first one, because if you can imagine what someone else would do, then maybe you can tap into that a bit as well. So when when someone's panicking, they, if you're with someone who's panicking, the most useful thing you can do is be really calm. And so if I'm with someone who's having a panic attack, I need to talk him down, I will deliberately slow my speech, so that I talk nice and slowly and just say things like, Okay, you're having a panic attack, you're going to be okay, you're, you know, I'm here to help you, we'll come through this. And by talking slowly and calmly, the person panicking will get a sense of what you're saying, and the tone and the mood of what you're saying far more easily, than they will understand the words. Because when you're panicking, you're not really listening to the words, but you still sends tone. And, and sometimes when I've seen panic attacks really get out of hand, it's when there's someone well meaning who's trying to help, but they're doing it in either by panicked way themselves, or in a slightly aggressive way, you know, Stop panicking, you know, what are you doing to being silly, doing this, you know,

Shannon Jackson  17:48

calm down, is just

Martin Brunet  17:50

so unhelpful, so well. But if you just are completely calm yourself, and make it clear that you're, you're not thrown by this, then that's the most useful thing. So then you can talk to someone about helping their breathing. And I think breathing is really key is the first thing to work on. Because you can't immediately slow heart rate down, you know, if I said, change your heart rate, it's not something we're physiologically able. But you can get in control of your breathing. And, and what what happens is the adrenaline makes you breathe fast. And then that gives you these awful symptoms because you're hyperventilating over breathing, the dizziness, the tingling. And then that makes you panic more. So if you can slow someone's breathing. And again, people sometimes get this wrong. So sometimes they think, Oh, you got to get reached for a paper bag. So you we breathe to come outside. And that's really not helpful. So don't, don't reach for a paper bag. Sometimes they'll say, Take deep breaths. And that means then someone goes from sort of to which is not, you know, you don't want to take

Shannon Jackson  19:05

let's get even more lightheaded. Exactly. So there's no deep

Martin Brunet  19:09

breaths, it's slowing your breathing, particularly slowing the breath out what people when they're panicking, they'll often breathe right at the top of their lungs. So they'll take little sharp pants in and they won't breathe out slowly enough. And, and they won't be holding their breath between breaths at all. So if you can say right, we're going to breathe really slowly, and talk someone through it. And there's there's a technique or box breathing, which you can do yourself, if you're the one having a panic attack. And it's if you imagine going round the outside or the inside of a box, and it's a square box, and each side is three seconds. And so when you go up one side, you breathe in and you take three seconds. So one, two, You three, and then the top and the bottom are holding your breath. So then hold your breath 123. And then coming down the side, it's breathing out 123 and then hold 123. And if you're with someone, you need to talk them through that, demonstrate it, but taught through the 123. And put your hands, show your hands going around the box, and you need to do it few times, they won't be able to do it immediately. But if you keep doing that, and just keep congratulating them when they do it, right, don't tell them off when they do it wrong. You just congratulate and say that it's brilliant, you've held your breath really well. Now we're going to breathe out. That's fantastic. I'm going to hold a breath again. And as they're going around, just with encouragement, they can gradually gradually slow down, and then they're more able to hear what you're saying. And then eventually, if you can get them to talk about, you're far better to get them to talk about you know, I don't know the weather or something or make a joke with them or something. Rather than say, why are you panicking, you don't want to talk about the panic. But if someone's breathing is controlled well enough that they can then just give you some banal information like, oh, you know, where are you going? or what have you got on later, or have you had your lunch. Actually, it's quite hard to hyperventilate and talk at the same time. Once you bought, you can't get someone to talk when they're hyperventilating, because they'll just be too panicked. But once you've brought their breathing down a bit, then you can get them talking and then their breathing naturally starts to settle down. Then you can remind them and again for yourself is we're more likely to hyperventilate, when we have we breathe through our mouths, we tend to do science or math, we can breathe much more quickly through our mouth. And I know so another thing you can just say is right, close your mouth, we're just going to be through your nose. And keep in mind that beats in those. So and that's something if you get used to doing it, that you can do yourself, if you're really panicking if you're over breathing, you can go back to nose breathing. And remember, box breathing is just a way of bringing yourself down.

Shannon Jackson  22:13

Yeah, so I love that because I think that's, you know, a lot of, of people who struggle with panic have a really hard time telling somebody to like how you can have they can be helped when they're feeling really anxious and panicky. And I always encourage, like the ways that you find to be helpful for yourself to work through it, like communicating that to other people of what's helpful for you, will help them to help you in those moments too. Because usually, of course, if you're struggling with panic disorder, you're very familiar with having panic attacks, and you sort of know what is helpful and what isn't helpful for you. And definitely not having somebody just tell you calm now you have nothing to be panicking about. It's like, yeah, thanks. I know that I'm very aware of that. So if somebody wants to help themselves, right, they don't have somebody with them to help them work through it. They're alone, what can they do themselves, of course, in addition, because you can, you can, right, slow things down, practice slowing things down, breathing, all of that.

Martin Brunet  23:21

So they can do that. I think another really key thing is how you think about your anxiety and your panic, because we can, we can imagine anxiety and panic in lots of different ways. And one, we might imagine, it's like a monster that might jump out at us at any time. And we kind of hope it's not going to turn up. So we go and do the thing that makes us anxious, and we just hope it doesn't happen. Hope it doesn't happen. And it's like we're running down sniper alley, and sometimes you get away with it. And sometimes we don't. And the trouble is, when the anxiety turns up, it all goes horribly wrong. And it's like, everything falls apart. So that's not terribly helpful, but it's a very natural way to think about it. Another way we might think about it is we've got to fight this anxiety. You know, it's like a monster to be defeated, and I've got to somehow crush it. And the trouble is, I think, thinking about fighting and crashing and winning and defeating, that's all very aggressive terminology, and you've got enough aggression. In terms of the adrenaline going on in your system. You don't really need any more. So I think that's not very helpful. But if you can imagine your anxiety, I think sometimes the term is objectifying your anxiety. So you imagine it in a certain way. That actually helps you to to see and pitch your anxiety in a helpful way so you can either see it, I quite like two analogies one is where you have a daft silly monster. Maybe you do imagine your anxieties a monster, but you give it a silly name and Had I I've done a couple of wheels on Instagram I call it karma Wilbur, if anyone's listening in there I'm sorry. But but the reason why Wilbur would work for me is I don't know anyone in my life called wielder so it doesn't color whom I would be if I was imagining and then I'd imagine it with I don't know silly teeth or you know fluffy hair or something and I'd imagine it coming with me and being there or you might imagine it like a yappy puppy that needs training and is naughty but not something to hate. And to try and push away or to be fearful for so if you imagine your anxiety is something that is inherently not frightening like a yappy puppy, I think that's a big start. Because then you go okay, here's my anxiety again, you know, maybe you've called your yappy puppy. I don't know, rover or Bilbo or so who knows what.

Shannon Jackson  25:54

But then you can say, These are fabulous names Martin fabulous things, the more

Martin Brunet  26:00

the more you can find yourself smiling when you think of it, rather than screaming when you think of it, the better. I think you know, there's a lot of I love the concept of silliness, and how being silly can actually be really helpful with helping us with our imaginations. And so if we can think of anxiety and panic in a slightly silly way, and a slightly sort of recognize that, that it's sort of trying to help us but it's a bit a bit like a false alarm. So it's a bit like a smoke alarm, or maybe your yappy puppy is trying to be a guard dog. The trouble is, you know, it's going off every bird that flies past the house, not just the burglars. So it's going off at the wrong time. It's not there. Although it was designed to keep you safe. It's not actually that firing off keeping you safe. It's it's firing off all the time when it shouldn't be. And you just need to train it and help it to learn when to really start barking, or yapping as this little puppy is and when to be quiet. So I think that's just, you know, takes time to think how do I manage my anxiety, and you need to prepare yourself before you start panicking. Because you're not going to manage imagine that for the first time in the middle of a panic. But if you try to think, Oh, here's my panic, this is how I objectify it. That can be really helpful. I don't know if you've come across people have used that technique. Successfully.

Shannon Jackson  27:28

Yeah, yeah. And some people find it to be really helpful. I never personally did, because I don't think anybody told me that back when I was struggling, but I can see how it would be really helpful. I sometimes had that response with my thoughts, like when the what if thoughts would get going? I'd be like, okay, yeah, thanks brain. That's cute. That's silly. Like trying to make light of it and not, you know, just going along with them. I do like that. I think that a lot of people find that to be helpful. And to some people find it to be helpful to sort of say, alright, like, let's Wilbur, let's panic, let's go there. Like, show me what you got. Let's do this. And allowing yourself to to really bring it with you and have it be there and like, alright, well, we're let's just do this, that some people have found that to be helpful. I think you hit on something that's really important, though. And I think this goes along with the breathing too, is not just waiting until those anxious or panicky moments to practice. Yeah, I think it's so incredibly helpful to practice these things when you're not in those anxious states so that your brain has that opportunity to use the things that the tools, I think you hit on two really good things like one of the biggest things that was helpful for me was dropping that, that fight like, I swear, every time I panicked, I would have this armor, right, I would put all my armor on and be like, I am going to get rid of this, like, I am going to destroy this thing. And I realized, you know, after many, many times of having panic attacks, I don't know when it finally clicked, but it did that, like the panic wasn't the problem. I had to stop putting up all the armor and fighting it and resisting it. Yeah. And that was massive. And I think the other thing that you hit on is really big too, is like how you think about it, like not telling yourself right? I'm gonna go get in the car and go to the store and I'm not going to panic and I'm not going to feel anxious and it's going to be great and fine. I really like learned, okay, no, I have to, I have to reframe right, I have to say, we're gonna go we're probably going to feel anxious. We're probably even gonna have a panic attack because we usually do, and that's okay. But we're going to do it and we'll just see what it looks like. Like we don't know. And we're going to try not to paint all the stories but like, let's take anxiety with us. Not try to tell myself right. I'm not going to panic. I'm going to be fine. I used to do that all the time. And it didn't work out doesn't

Martin Brunet  30:00

at all, but it's a natural thing. And I love the concept of practice, I've been thinking a lot recently about the word, or the term exposure therapy. Because exposure therapy where you gradually allow yourself to experience the things that make you feel anxious is one of the most helpful things for anxiety where you stop avoiding you start doing, but that word exposure is quite scary. You know, when you're exposed, it's not what you want, generally, you know, lies all sorts of unpleasant scenarios, if you start imagining what exposure might be. And yeah, and yet, if it's kind of like practice, so I quite like the term anxiety we have, it's a bit like, you know, if you're an athlete, and you've, you're out to condition, you need to go and do your exercises, they're boring and painful, and you wish you didn't have to, but it's to do the goal of, of getting back on the track or whatever sport you're in. And so, in the same way, you need to do mental health exercises. So you go and practice and, and that way, you can almost say, Well, I'm gonna go to the supermarket, if that's where you get anxious. For instance, I'm going to practice I'm going to bring my anxiety with me, you know, I'm expecting him to turn up or her to turn up. And almost it can be disappointing if, if she doesn't turn up, because then you think, Oh, I didn't get to practice. You know, when actually when you start feeling anxious, so yeah, that's good. I'm doing my exercises, you know, I'm practicing. And that's how I will gradually, you know, learn how to control and overcome this anxiety. And, you know, eventually, it will greatly lessen. And you'll find yourself doing stuff and thinking, Gosh, I've even forgotten that that made me anxious. Yeah. So I love that kind of like that. And also, that you can practice the opposite. You can practice just worrying. More you practice worrying. And then, you know, fretting about am I gonna become anxious or not. You know, the more your brain will just get used to worrying. So you're not trying to practice worry, trying to practice living alongside anxiety, and being okay with it.

Shannon Jackson  32:11

Yeah. I like that. I like that a lot. I know, because a lot of people find exposure therapy, of course, to be just like, really, really hard. And yeah, you're right. It doesn't sound good. It doesn't sound like something that I want to do. But I like that it's practicing. Right. It's like rehab. I'm curious, sort of one last thing that I want to ask because they know, I don't know my brains gone there. I'm sure others brains have gone there with you being a doctor, a GP, when somebody comes in to see you and says, like, I know that this is what I'm struggling with. Right? I'm I'm having panic attacks. I'm clearly struggling with panic disorder. Maybe they don't know it, and you help them figure that out. Right? And give them education. A lot of people have had that experience of, okay, great. You're struggling with panic attacks. Here's a medication? Yes. Is this is what's going to be helpful for you. What are your thoughts on medication for panic disorder?

Martin Brunet  33:12

So yes, it's very, it's very natural that people might say, look, could I just have something so I feel calmer? And there are two, if you're going to talk about medication there, there would be two strategies. One would be I wanted to have a pill that I could take when I'm anxious that calms me. Or the other would be, is there a pill I could take all the time that would help with my anxiety. And it's interesting that the first feels like less of a deal, because you're not going to take it all the time. I'm only going to take it when I'm anxious. But generally, it's not a great idea. And that's for two reasons. One is we don't have very good tablets to do that. We have Valium, diazepam, that works very well. It will make you feel calm, but it's very addictive, and you'll just get used to it. And the other one that we sometimes use a beta blockers, which don't make your brain any calmer, but they calm basically, they block the effect of adrenaline epinephrine. And so I can reduce the physical symptoms might have a little bit of a place, although the guidelines on anxiety don't actually recommend. But even if they work brilliantly, even if I had a sugar pill that would make you feel calmer, had no side effects perfectly safe. You're not learning how to manage your anxiety yourself. You're not getting any, you're not being empowered by taking a pill. You're just managing to do the thing by taking the pill rather than learning so you're not practicing, you're not learning you're not gaining anything. So I'd say that sort of pill has very limited value. Now it might be useful to have a beta blocker if you're going for one interview that's scaring you, you know, on an exam or something thing but it's it's definitely limited rally. The other type of medication that doctors will prescribe and I do prescribe when it's appropriate is antidepressants is it's not very helpful that they're called antidepressants, when actually, we'll often use them just for anxiety. But this would be tablets like sertraline, citalopram, fluoxetine, those sorts of tablets. And they, they have a place because sometimes you're so overwhelmed by anxiety, you want to engage in therapy, but you just you can't do it, you can't concentrate, you're just frazzled. And something that brings down your overall level of of overwhelmed can then mean you can engage in the treatment, that's the real thing that's going to help you overcome. So they're the tablets that you have to take all the time for six months or so. I think they're, they're not a panacea. They're not for everyone. And they're certainly not a substitute for trying to develop the skills to learn to overpower, you know, to manage your anxiety, but they might be something that helps you in the short term. So, yeah, for anxiety, particularly, I think talking therapy and learning about your anxiety and learning how to manage it is always the more important thing, medication. But also, the other thing, I'd say, it's very important. We don't stigmatize medication for mental health, because people stigmatized themselves about it. And they often feel very bad about being on tablets, or whenever I post something on Instagram about antidepressants, most people find it very helpful, but there's always going to be one or two people that will just say, they're a terrible drug. No one should ever be on them. And I just, that was saddens me, because for some people, taking an antidepressant has changed their life. And you know, made a big difference to them. So we mustn't have stigma on medication. But neither should we just prescribe drugs because either the doctor or the patient don't want to do the really important stuff, which is learn how to manage your anxiety.

Shannon Jackson  37:05

Yeah, so good. You said all the things. I have nothing else to say on that. So Martin, it has been such a good conversation. If people want to find you connect with you learn more from you watch your really good reels that you have on Instagram. Where can people find and connect with you? So

Martin Brunet  37:23

on Instagram at doc underscore Martin underscore GP? If you just search for Doc Martin, you'll find an actor Martin Clunes, who's in a British TV soap. It's a comedy program about a terrible GP. But don't Martin GP on Instagram as well post most of my reels

Shannon Jackson  37:54

Did you want to mention anything about your book?

Martin Brunet  38:07

Yeah, that would be really, really nice. So I am writing a book about anxiety and burnout. It's just gone to the publisher is being published by jkp. Publishing. And it's going to be out in about a year's time. So it's not not out yet. But it will cover a lot of this sort of thing. Why do we get anxiety? The fact that it makes sense, it's this. So often I have patients come to me and they say, I know it's stupid doctor, but because they're embarrassed of anxiety. And and actually your anxiety makes perfect sense. And that's a big part of it. But then also understanding that avoidance makes sense. And yet, it really isn't a great idea, and how to manage that. There's a bit about burnout. And then there's gonna be bits on, on our breathing on sleep on CBT or medication. So yeah, what's your space? Um, if anyone's interested in it coming out that if you follow me on Instagram, you will definitely hear before it comes. And it should be out within 12 months.

Shannon Jackson  39:11

Awesome. I love it. Well, thanks again, Martin for coming on. It's been such a good conversation. Yeah,

Martin Brunet  39:16

brilliant. No, thank you for inviting me and carry on the work you do. I think you have a great podcast and you're doing a really good service. So keep that up.

Shannon Jackson  39:26

Thank you.