How I Tamed Panic

A Comprehensive Guide to an Unfortunate Experience

Generated by DALL·E 2

For most people negative emotions are like being stuck in neck-high water. We have the feeling that if we just tense up, stand on our tiptoes, and wait it out while we keep focusing on what we need to do, the water will eventually recede. Usually, it does.

But sometimes, for some people, the water keeps rising until first our mouths are submerged, and then our noses go under. It keeps rising until we feel like we are literally drowning. We experience a burning sensation in our chest, which demands to be filled again and again with air until we’re gasping loudly and clutching our rib cage while our loved ones stand over us wondering if they should call an ambulance.

This is a panic attack.

When it first happened to me, it felt like a terrifying one-time event. When it kept happening over and over again, it felt like something that might ruin my career—and maybe even my life. 

It took me almost 10 years, but I eventually learned that I could start to see my first panic attack not as the end of the road for me, but as the start of a new way to be in the world. A way to play in the deep water, rather than paddle desperately to avoid it.

This is the story of my first panic attack, what I learned about the science of panic, and what helped me tame it.

My first attack

In 2014, I was in the middle of a big transition. I sold a startup I had co-founded, graduated college, and moved to New York all in the span of a few months. 

There was a lot to like. I suddenly had money. I gave myself an unlimited book budget and ate out guilt-free whenever I wanted to. Pega was an ideal acquirer. They are a big public company, and they gave me the budget to hire a larger development team so we could build more features more quickly. They also gave me the freedom to run the product the way I wanted. I was hopeful that we could finally sell what we’d built to the big companies we’d always dreamed would love it, but who would hardly give us the time of day when we were a small startup. 

You might expect founders in this situation to feel great. I expected that, too. Instead I felt terrible. 

After the acquisition, my identity as a founder evaporated. It was much harder for me to explain what I did when I met people. I had money, yes, but I was terrified it was the last money I would ever make, so I lived with roommates in a rundown apartment. Family members were suddenly asking me for financial support in ways that were very hard to refuse. I could no longer ignore all of the personal emotional issues that I had avoided while I was running the company, and which had now become more dire.

It was Michael Phelps syndrome: after he won those gold medals he was so depressed he couldn't get out of bed. I can relate. It’s cliché, but once you achieve a big goal, you lose the thing that gives your life shape and meaning. Your self-esteem collapses around you like a tent without a tentpole.

This is kind of embarrassing when it happens to you. I never intended to participate in the privileged melodrama of the success-doesn’t-make-you-happy-money-doesn’t-solve-all-of-your-problems cliché. 

But I believe that by allowing myself to excavate the ecology of my emotions, I’ll be able to understand that day better. I’ve come to think that it will give the experience some meaning and, maybe, allow me to unearth and resolve whatever it was that led my body to revolt against me. I think that will help me, and I hope it will help you, too.

.    .   .

It was a normal day: after an early morning call from bed with our dev team in India, I got up and, still in pajamas, walked into my living room to start a demo with a big insurance company, John Hancock. (You know, the guy who put a giant signature on the Constitution? He also, apparently, had an insurance company.)

Our product was a co-browsing tool—basically screen sharing for customer service agents. If a customer has a problem with a website and calls in for support, co-browsing allows an agent to help them through the site in real time, without any extra downloads or installations. 

Customer service agents are frequently trying to explain things to customers who don’t understand computers, or how to follow instructions. (A classic: an agent asks a customer to open a new window in their browser. The customer proceeds to get up and open the window in his house.) Co-browsing lets agents diagnose and resolve issues for customers more quickly—at least in theory.

This was one of the first demos I’d done since the acquisition, and I was feeling a sense of existential dread. I pushed away the sneaking post-acquisition imposter syndrome that filled me with the sensation that my product was trash and I had gotten away with murder by selling it. I walked out of my bedroom to greet my then-girlfriend. She was sitting at the dining table paging through a medical school study guide. 

I give her a kiss, and she motions for me to sit down. “I can’t,” I say. “I have to get on this call.” 

She puts out her hands for me to hold. I do the quick sweat test: running my forefingers along my palms to measure their moisture. Result: a decent amount, but I can’t wriggle out of this one. I put my wet hands in hers. I can see her face change as we touch. 

“Feeling okay?”

“Yup,” I lie and quip, “Excited to close some deals.” 

She looks at me quizzically. “You sure you’re okay?”

“Totally,” I say with a tight smile. I settle onto the couch in the living room and prepare to dial in to the meeting when the blue chat bubble pops up on my Microsoft Link.

“You ready for this, big guy?” It’s Roy, the sales guy on the John Hancock account. “I told them all about you last week, and they’re excited. Runway is cleared for landing—all you gotta do is hit the target.”

I send Roy a thumbs up and rub my temples. He’s well-meaning, but it’s not helping me feel better. Roy’s presence on this call is like your mom watching a presentation at school. On the surface it’s supportive, but in reality, it ramps up the pressure to perform. 

I close out of the chat with Roy, and the WebEx starts. The John Hancock executives seem excited. “So this thing is going to decrease handle times?” one of them asks. Handle time is the amount of time it takes, on average, for a customer service agent to take a call from start to finish.

“That’s the idea,” I say. Technically it’s not a lie, but I feel a twinge of guilt saying it. The truth is that we haven’t found the perfect customer for co-browse yet, because it's hard to train agents to remember to use it. If you’re an agent, and you’re dealing with an irate customer who can’t figure out where to go on the website, you’re more likely to reach for your most reliable tool—talking slowly and clearly with a friendly tone—than some complex gizmo like co-browse.

The call goes silent, and I know it’s time for me to start my pitch. I do a sweat check. Palms are gushing. 

Just keep going. It’ll be fine once you start talking. I think to myself. I’m usually right. It’s in those first few moments when I have the stage and everyone is waiting on me that my anxiety peaks. But a second later it’s over, and I’m usually enjoying myself. On the other side of the anxiety peak is an experience where time slows down, and everyone is hanging on each word I say. It’s a magical kind of flow state. That’s where I’m trying to get to.

So I start talking. I explain what co-browsing is. I can feel the anxiety spike and subside. But it doesn’t subside all of the way. I keep going, but my brain isn’t thinking about the presentation anymore. 

It’s decided that there’s a problem, and it’s searching for its source—trying to get the anxiety to quiet down. Worse, it’s also wondering: can anyone else tell how nervous I am?

So my brain does what an anxious brain does. It runs a test to see how I’m being perceived. My mind flashes to the John Hancock executives on the other end of the line. 

I can almost see them huddled around a conference room in Boston, 18th-century powdered wigs on their heads, clutching large quills, and wearing starched shirts and khakis from Jos. A. Bank—not formal so as to keep up with the youth, but not too casual because insurance is serious business.

“Are you nervous, kid? I think you’re nervous. You know, you’re not going to get that famous John Hancock from us if you’re nervous,” they say. 

The anxious feeling intensifies. It begins to travel from my stomach toward the bottom of my rib cage. 

I get up to pace. Maybe that will help.

It doesn’t. Instead, my mind flashes to someone else on the call: Roy. 

“This is it? This is the kid we acquired?” he says, squeezing a pink stress ball. “I teed it all up for him. All he had to do was land the plane!”

I pace down the hallway toward the front door. My breathing is now irregular. I’m starting to feel strangely out of breath. I’m sucking in air, but it doesn’t relieve me of the feeling that I need to breathe in more. So I’m holding in the air as much as I can, not wanting to exhale too much before my next sentence. 

My voice gets louder. My words come out faster. It catches the attention of my girlfriend, who is still sitting at the dining room table. She looks up at me, and our eyes meet. And then something peculiar happens: I become her. I see myself as I believe she sees me. Through her eyes, I see a scared boy, desperately trying to keep it together. Not calm or confident, but terrified, and hiding deep, dark secrets that are now plain. 

I am not successful or even likable. I have no value, and I have conned my way into my position. I deserve to be alone. (What else could anyone reasonably conclude by witnessing me crumble in the face of such an ordinary phone call?) And on this call, in the sweat of my hands and the nerves in my voice, the truth is being revealed.

In that instant, the room disappears. The floor and ceiling fall away. The dirty windows zoom out into space. I see myself, still pajama’d and beslippered, floating in a vast darkness surrounded by John Hancocks, and miserable customer service agents saying Co-browse? Yeah, we have it, but I’ve never used it, and irate customers who think their disk drive is actually a large-sized retractable cupholder for diet soda drinks. 

When I return to my body, I am unable to breathe. I clutch my chest. I heave great gasps of air. I try to get back to the living room couch, struggling all the while to get words out to the people on the phone. “We don’t…we don’t have any downloads or installations for the…cust…cust…”

Somehow I make it to the couch. I drop the phone. My girlfriend stops reading her textbook and rushes over. “Are you okay?” she asks. “Are you having a heart attack?”

Roy’s voice emanates from the speaker on my phone: “Dan, are you still there?”

The camera shutter of my flashbulb memory clicks and whirs. Everything is recorded, and not just in my memory—into my muscles, into my lungs, into my perceptions of the world itself.

The science of panic

We don’t really know why people have panic attacks, and we also don’t know why they keep happening over and over to some people. But we do have some theories.

I’ve read as much of the science about panic as I can get my hands on, and the theory that makes the most sense to me, and has empirical support, goes something like this:

When I was on the phone with John Hancock, clutching my chest, what was really happening is that my brain thought I was suffocating when I wasn’t.

The human brain has a highly evolved suffocation alarm system. It’s designed to detect when you’re running out of oxygen and spur you to take action to remedy the situation if it’s set off. 

The way it does this is complicated and not totally understood. It analyzes a number of different inputs—some chemical, some cognitive, some physiological—to determine whether to trip the suffocation alarm. My brain, and the brains of many other people who suffer from panic attacks, happens to have a sensitive alarm bell. It’s like the smoke alarm in the kitchen that goes off when I’m searing a steak: not useful. [Note: The suffocation alarm hypothesis, of course, has its critics. For an alternative account see Pilecki et al. 2011]

One way that your brain can tell if you’re suffocating is that it has a set of receptors whose job is to measure the CO2 level in your blood and make sure it’s within a safe range. High CO2 means you’re probably stuck in a cave-in and need to get out, stat. 

We know that some people’s CO2 detectors are more sensitive than others because if you put a person in a room and have them unknowingly breathe air enriched with CO2, those (like me) who have panic attacks (or a family history of panic attacks) start to hyperventilate, and those who don’t just twiddle their thumbs and wonder what’s for lunch.

Having a hypersensitive suffocation alarm wouldn’t matter so much if it was gentle, like a yoga teacher correcting your warrior pose, when it got set off. But what it actually does is force you to expel as much CO2 as possible as quickly as possible via hyperventilation, creating a visceral urge to flee the situation. In short, it puts you in full-blown freak-out mode. 

Perhaps it evolved this way because our ancestors faced different types of risks than we do—such as being suffocated by a cave-in—and writhing around violently was a good way to get out of those situations. Alas, it did not help me much with John Hancock. 

So that’s the theory. It answers some basic questions, but it still leaves some important ones unanswered. For instance, if you have one once, why does it keep happening over and over again for some people like me? I had one bad experience, and from then on every time I was about to pitch our product, I had another one. It was like a golfer that develops a jerk in their swing that they can’t get rid of. 

The short answer is that having a panic attack is a traumatic experience. You might not be about to suffocate in a cave-in, but it sure as hell feels like it. This kind of experience conditions you to expect a panic attack in response to certain previously normal experiences—like an elevated heart rate, sweating hands, or doing a demo of your co-browsing product—which paradoxically increases the likelihood that one will occur. 

It’s what Proust called a “geological upheaval of thought”: suddenly the topography of your mind and your experience of the world are completely changed.

The familiar rivers, valleys, streams, and mountains written in relief in your day-to-day experience are twisted, varied, broken, smashed—turned into dangerous gulleys, sheer cliff faces, and frayed sinkholes. Green fields are now radioactive marshes; once green forests are burned to a crisp. 

Inside of me a mountain of shame twisted around a hyper-alertness to bodily experiences. Heartbeats became earthquakes. The placid stream of my breathing, once flowing automatically, could start, stop, or flood at any moment without my constant monitoring. Relationships—with co-workers, customers, friends, family—became winding, high-altitude passes fraught with danger and calamitous falls lest they find out that I could suffer an attack at the slightest provocation. 

You can’t put a world like this back together through sheer will. Believe me, I tried. I told myself not to be nervous. I did power poses in the mirror. I did push-ups to try to psyche myself up. But this was like trying to demolish the new mountains in my mind with a bulldozer, or sew together the gulleys with a fragile thread, or drain the marshes with a leaky bucket. I needed far more leverage than those tools could provide.

Instead I had to walk the land, to become at home in its new texture and terrain, and to see the beauty there, too. Along the way I learned to drop sunflower seeds from my pockets and hope that they would bloom.

Annie Dillard writes that “the texture of space is a condition of time.” Indeed, I came to understand that time created the geology of my mind—and that time could recreate it, too. 

How I tamed panic

Luckily, as a therapist once told me, panic attacks are pretty labile. Labile might sound like a sexy word, but it means “changeable” in science lingo. 

Panic attacks are also, likely, heterogenous: their underlying mechanisms might be different, so it’s safe to assume that no one has a monopoly on what panic attacks are or how to fix them. Mine are probably going to be different from yours. All I can do is tell you what worked for me. 

(I use the word “tamed” here explicitly rather than “cured.” I haven’t had a panic attack in a long time, but I know I could have one again. I also know that if I do, I’m much more confident I’ll be able to handle it even though it will be difficult. In that way, it’s become like having a cold or food poisoning. Not fun, but not the end of the world.)

Therapy

Womp. Womp. Yes, if you’re experiencing panic, your next move should almost certainly be to see a qualified medical professional rather than take advice from some dude on the internet.  Therapy was incredibly helpful for me, and I tried several different therapists and methods over the years. Here’s what I learned:

  1. Allowing a compassionate other to support me in my distress helped to untangle the knot of shame I was feeling. Expressing vulnerability in therapy is deeply uncomfortable, but it can also allow you to walk your internal terrain with much more confidence and compassion.
  2. Cognitive behavioral therapy (CBT) helped me to restructure thoughts and feelings about panic, such as I’m going to die!, so that they were less believable. I learned a lot from CBT apps and books, like When Panic Attacks.
  3. Somatic experiencing therapy—which concentrates on helping you get in touch with your own internal physical experience rather than getting stuck in your head—taught me how to have a deeper connection with my own bodily experience and prepare myself to experience panic-like sensations without them being too overwhelming.
  4. Acceptance and commitment therapy helped me to learn that panic and anxiety are like a feedback loop: you’re afraid you’ll have a panic attack, so you start to worry about it, which increases your heart rate and anxiety level, which increases your heart rate—and on and on and on until you can’t breathe. I started to break the feedback loop by focusing not on resolving my panic but instead on what matters most to me in any given moment—like connecting with a customer on a sales call—knowing that panic-like feelings will come up, and that will be okay.

Medication

The first time my panic went away it was because of beta blockers: pills that you can take as needed that block the adrenaline response so that you don’t experience panic. Of course, it does nothing for the psychological experience of anxiety; it can also produce paradoxical effects, like your body straining to produce the adrenaline response so that you have to up your dose to get the same effect over time.

I found that if I took the right dose, I could prevent or significantly weaken the panic. The trouble was finding the right dose at any given time: too much, and I felt like I was going to pass out; too little, and I risked having an attack. But they were an excellent spot solution for me over the years as I tried other things that have seemed to help in a more sustainable way. 

I’ve also tried supplements like inositol that have been shown to improve panic symptoms (I did so only after I spoke with a doctor). I started taking a low dose every day and increased it as my tolerance rose, and my symptoms became less acute. It could’ve been a placebo effect, but I’d think it helped.

(Psychiatrists also prescribe SSRIs, like Zoloft and Paxil, for panic. I tried them, but had bad side effects and chose not to continue. Your experience could be different, and they’re helpful for many people.)

Exercise

The first time my panic went away without beta blockers it was because I was working out a lot. I was doing weight training in combination with high-intensity interval training with bike sprints. I think the bike sprints are what did it. After a heavy workout I spent 10 minutes doing 30-second bike sprints, with the bike set to high resistance, and 30 second breaks in between. When I started I could only do one, and by the end I was doing 5-8 sprints at full bore. 

There are studies that show this kind of exercise can be effective. In a non-randomized controlled trial from 2019, patients who did 10 high-intensity sprints for one-minute intervals at 77-95% of their maximum heart rate for 12 days had moderate-to-large effect sizes. 

Bike sprints probably help for a few reasons. First, it’s always possible that it’s a placebo—and if that’s all it is, that’s fine with me. Second, it exposes you to the feelings of panic that you might be afraid of, like a pounding heart and breathlessness. By allowing you to experience them in a well-understood and safe context like exercise, you learn that the sensations can be safe. Third, it increases your aerobic capacity, which could make your suffocation alarm less sensitive or the panic response less severe because your body is used to handling large doses of adrenaline. This is pure speculation on my part, so do not take this as gospel.

Whatever the case, it was effective but also a difficult regimen to maintain. I found that if I wasn’t doing this three times a week on average, the effects started to wear off.

Meditation

I hesitate to credit this because it’s cliché and it might give people the wrong impression—that if you meditate enough you’ll be zen and never have another panic attack. 

That’s not quite it. You can be an avid meditator and still suffer from panic. For me, it makes it easier for me to ground myself, direct my attention where I want it to go, and unhook myself and simply observe my experiences. Rather than “curing” panic, for me, meditation prevents it from getting worse.

When I’m meditating frequently, I’m less likely to ruminate on symptoms like accelerated heartbeats or feelings of breathlessness. It keeps my physiological activation low enough so that my suffocation alarm doesn’t go off. [Note: It’s worth noting that meditation is not for everyone, and that for some people it actually makes panic worse. If you’re already sensitive to physical processes like breathing or heartbeats, focusing on them intensely can be triggering. If that’s the case, using an external anchor like watching a candle or listening to distant sounds can be another way to achieve a similar state.]

Breath biofeedback

For about a month I used FreeSpira , a biofeedback device that measures the amount of carbon dioxide you’re expelling on your exhale and teaches you to breathe differently to make panic attacks less likely.

It’s unclear why this works. One theory is that the new breathing pattern increases the level of carbon dioxide in your blood, which raises the threshold of your CO2 alarm and makes panic less likely. Another is that it helps you pay better attention to your breathing so that feels safer—like a fancy form of exposure therapy. A third is that it’s just a placebo effect. While it was neat to try, it didn’t seem to have a significant effect on me (though studies show it can be very helpful for some people.) 

Exposure

After reading When Panic Attacks I created an exposure matrix with a therapist—a list of increasingly stressful situations to which to expose myself. The idea is that you test your own experience again and again in the hopes that you can re-teach your mind and body that situations that seem dangerous aren’t. If it works, you learn that you can handle much more than you think you can.

Make sure to do this in the care of  a therapist so that you don’t go too far, too quickly and accidentally set off an attack that you are not prepared to handle.

My most effective exposure session took place on my podcast “Talk Therapy” that I do with my Every co-founder Nathan Baschez. In the episode, we reviewed the recording of another podcast we had done together during which I was experiencing panic symptoms. We listened together and talked it over. It was a healing experience: I was able to hear how he saw me while I was in the midst of a panic attack, and he didn't judge me as much as I thought he would.

Starting another company

I wouldn’t recommend this (off-label) treatment in most cases because the side effects are extreme, but starting Every helped me a lot. I regained my founder identity and felt like I belonged around other people in tech again. I felt confident, energized, and purposeful in ways I hadn’t for years.

Of course, in some ways it’s just papering over larger issues, and it comes with many stressors, so proceed with caution. 

Learning to play in the deep water

We never did sign John Hancock as a client, though we did go on to sell the product to lots of banks and insurance companies.

These days the terrain of my mind is a much more hospitable place. I’ve explored many of the new gulleys, and caves, and mountains—and I’ve planted enough seeds to make things bloom where they didn’t before. While it’s always possible for me to fall again into a crevasse, I’ve become much more used to the sensation of falling, and confident in my ability to pick myself back up again. I’ve even had moments where I can sometimes even appreciate falling. 

This is what psychologists call “transformation of stimulus function”: the same stimulus (panic) can stop bringing up thoughts of failure and brokenness and instead start to feel like an opportunity for growth. 

What leads to this transformation is different for everyone, but this is what did for me.

I started to realize that if I paid close attention to my own experience, I might be able to write about it. And if I wrote about it, there was a chance to help other people going through the same thing. So writing gives me a reason to explore the feelings of panic that sometimes bubble up inside of me, making them far less scary than they would be otherwise.

I also started to connect the dots on the CO2 alarm, the idea that a panic attack is probably your brain thinking that you’re dying of suffocation. I realized that if I believed that to be true, it meant that confronting panic is an attempt to move closer to, and work with the feeling that, I might die—or, worse, be abandoned.

Seen in that light, working with panic became less of a drag and more of a spiritual journey—or even a hero’s journey. 

This started to unravel the knot of panic for me. It’s not about covering up or fixing my own weakness. It’s an opportunity to encounter life’s biggest challenge: learning to face death. And learning to face that inevitability, rather than being isolating, is a fundamentally connecting experience because it is something that all of us must face. It presents an opportunity to become bigger, more compassionate, and more connected to every other human being.

Of course, it has to be approached with reverence, compassion, and skill. There’s nothing more dangerous than trying to climb a mountain without the proper equipment. But even baby steps in the right direction add up to a lot of change over time.

There’s a line from the Bhagavad Gita that has been helpful to keep in mind as I’ve dealt with panic over the years:

On this path effort never goes to waste, and there is no failure. Even a little effort toward spiritual awareness will protect you from the greatest fear.

This piece is my little effort. I hope it points you in the right direction.


More Resources

In addition to When Panic Attacks these books have been helpful for me:

There is also a good primer from SlateStarCodex on panic disorder here.

If you're looking for more, below are a few of the articles that I used to write the science section of this article.

Theory of Panic

False Suffocation Alarms, Spontaneous Panics, and Related Conditions 

Blood, Breath, and Fear

Neuobiology of Panic and pH Chemosensation in the Brain

Biofeedback

Feedback of End Tidal pCO2 as a Therapeutic Approach for Panic Disorder

Respiratory biofeedback-assisted therapy in panic disorder

Opposing breathing therapies for panic disorder

CO2 Challenge Studies

Respiratory Psychophysiology of Panic Disorder

Finding a Therapist

If you're looking for a therapist to work with I recommend reading through a few of the above, and finding an approach that resonates with you. With that in mind go through Psychology Today and filter for the modality you've chosen—or email one of the authors of a book that you connected with and see if they have someone they recommend. That's how I found my therapist, who has been life changing.


Thanks to Kate Lee and Jack Cheng for editing this piece.

Thanks to Clarissa Ong, PhD for reviewing the science. Thanks to Chris Lu for the cover images.

And thanks to Nathan Baschez, Sam Koppelman, Sib Mahatpara, Alex Lieberman, Sam Parr, Libby Britain, Alex Godin, Casey Rosengren, Fadeke Adegbuyi, Katie Parrott, and Evan Armstrong who read drafts and provided incredible feedback.

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