If you have assessed a situation and found no immediate threat, have followed advice from medical professionals, but still find yourself feeling a sense of panic, here may be a way to use cognitive therapy on your own behalf.

Panic is usually an inner state resulting from thoughts about believing one is helpless. Believing there’s no way out understandably causes what we’ll term the brain’s “feelings processes” to overpower the brain’s “thinking processes.” The antidote is to regain access to one’s ability to think, then to use both feeling and thinking processes to consider helpful possibilities. According to research by the Gottmans, regaining this ability takes about 20 minutes.

1. Say, “I am feeling panicked.”

Simply naming what you are truly feeling, whether to yourself or aloud, requires you to think, thus beginning the process of bringing your thinking “back online.” You activate your brain’s innate ability to work with reality by approaching it rather than avoiding it.

2. Move.

With the physical abilities you have, stand up, shift your posture, pick up an object, pat your pet.

Deciding what to do and doing it, again, activates the thinking processes of your brain.

3. Identify the thoughts you had prior to feeling panicked.

This, too, helpfully activates your thinking processes. Try to be as specific as possible. One thought is usually along the lines of “I feel helpless to __________.” Many thoughts may be in the form of “if-then” doom, i.e. “If ________, then it’s all going down!” Writing down your thoughts may offer additional clarity.

4. Challenge any thoughts that are “shoulds” with this fact: “I feel as I feel.”

The odds are good that feeling what you feel under the circumstances is legitimate. “I shouldn’t feel this way” is a belief that isn’t true. Further, thinking “I shouldn’t” deepens distress. Simply shift your attention away from any beliefs you hold about your feelings.

5. Imagine adjusting the volume knob on your inner state down a notch.

The brain has an innate ability to restore itself to stability. Simply becoming aware of one’s inner state eases it. Although one’s inner dialogue may be “I should/shouldn’t be feeling/thinking this way,” again, simply shift your attention to quieting the intensity of your inner experience.

6. Do all this with neither judgment nor rah-rah.

Unfortunately, the cure for thinking negatively is not positive thinking. Both require energy to sustain beliefs that may not be supported by facts. Reality is the groundwork upon which your brain primarily operates. Gently let the brain be real and do what it does.

7. Acknowledge that often beneath panic, sometimes at a nearly inaccessible level, is sorrow.

We feel so sad that things are as they are and that things have gone as they’ve gone. We may regret the past, ache for the present, and worry about the future. We may wish ardently that we could change things. Panic is often the brain’s way of putting distance between us and what we are so very, deeply sorry that we can’t change for ourselves, others, or our world.

8. Ask yourself, “What can I do to help myself with this?”

And there it is. By asking that question, you have accessed the very best of your feelings – your empathy and compassion for yourself – and the very best of your thinking – solving problems with facts. You can examine thoughts that have troubled you with your full humanity. In dialectical behavior therapy, the ability to access the synergy of one’s most skillful feeling and thinking is termed “Wise Mind.”

Giving oneself time to skillfully call forth one’s own inner wisdom can be the antidote to panic.

. . . . .

Image adapted from ” Mindfulness Handout 3: Wise Mind: States of Mind,” DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan, 2015.

The content of this post is a synthesis by Anne Giles, M.A., M.S., L.P.C. of work in cognitive theory by Judith Beck, Ph.D., Marsha Linehan, Ph.D., Patricia Resick, Ph.D., Daniel J. Fox, Ph.D., and others.

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Although it seems counterintuitive, research suggests that receiving counseling through video conferencing is as effective as receiving it in person. For conditions ranging from post-traumatic stress disorder to illness-related depression to chronic pain to substance use issues, people can achieve desired treatment outcomes through telehealth counseling sessions.

Disclosure: I offer evidence-based counseling protocols via telehealth through HIPAA-compliant SimplePractice and am listed in Psychology Today’s database of providers. I can offer counseling services only to residents of Virginia.

I have been studying research on electronic delivery of counseling services since 2008. I was part of several startups attempting to take a counseling software platform and a substance use disorder treatment mobile application to market.

In 2013, the popular term used in the field was “mHealth” for “mobile health.” I presented at the mHealth Summit in 2012. (The mic didn’t work at the conference so I rerecorded my presentation here.) Here’s the content for a related presentation I made at the Virginia Counselors Association in 2013.

My point is that research has reported on the effectiveness of electronic delivery of counseling protocols for over a decade.

I have contributed to developing online counseling software, have researched it, and have both offered online counseling and received it. My personal experience corroborates the research data.

The easiest ways to get online counseling are to find a licensed counselor who offers telehealth counseling or to use an online counseling service with licensed practitioners. In the United States, licensing occurs by state so the counselor needs to be licensed in the state in which an individual resides.

Counselors can apply to be listed in Psychology Today’s database of therapists. If they pass Psychology Today’s screening process, they can pay a monthly fee to keep a current listing. Once database users indicate their location, the site offers a menu of options for conducting a search, including “Online Counseling.” Clicking or tapping that option reveals a list of counselors who offer telehealth counseling services in one’s area.

(I found the assistance of Melanie Bosco, LPC through online counseling service Talkspace very helpful when I needed extra support upon learning of my father’s neurocognitive disorder. She offers cognitive behavior therapy and is licensed in Virginia. In the Blacksburg, Virginia area, Stephanie Fearer, LCP, offers a variety of evidence-based protocols through telehealth counseling services.)

Although individuals will have their own questions to ask, here are three specific questions I recommend asking a potential online counselor:

1. Does the telehealth software we will use meet federal regulations to protect my private health information? Is the software HIPAA-compliant?
2. What are the evidence-based counseling protocols you offer for the conditions I have?
3. What percentage of your clients achieve their treatment goals? How effective is what you offer?

The answer to #1 needs to be “Yes.” [Updated 3/14/20: If HIPAA-compliant video conferencing is not available, your counselor may ask you to sign a release indicating you understand that is the case.]

The answer to #2 needs to at least exist. The answer to #3 needs to be answered without defensiveness and in a way that makes sense to the listener. Simply put, we need to receive as many reassurances as possible that we are receiving value for the precious dollars we are spending.

I was a teacher for nearly a quarter of a century before I studied counseling and earned a master’s degree in 2006. In my experience working with people of all ages in stable times and challenging times, when people simply wish to feel better and do better, counseling can help.

. . . . .

The accompanying image by Kelsey Sarles demonstrates the mobile version of our startup’s cognitive behavior therapy-based counseling software platform. We engaged with a research hospital for a pilot study that cleared the Institutional Review Board (IRB) but did not receive sufficient enrollment. Our efforts to develop counseling software were regretfully abandoned in 2013.

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.