Panic attacks and emotional regulation

Emotions are useful, but not in the extreme. Photo by Christopher Ott on Unsplash

In my therapy practice, clients present suffering from many types of problems with emotional regulation.  This is the posh way to say they regularly feel bad in some way, but are unable to control that bad feeling.


Emotions are flows of feeling.  They can give us signals about what to do.  For instance, these main emotions give us these messages:

  • Happiness tells us to continue a valuable experience
  • Peace tells us we do not need to worry about threats
  • Attachment tells us to hold something close to us
  • Sadness tells us we have lost something valuable or close
  • Anxiety tells us there is a conflict or inconsistency in our lives
  • Fear tells us to avoid a painful experience
  • Disgust tells us to avoid a distasteful experience
  • Anger tells us to confront a threat to our happiness, pleasure or values


Historically, our emotions have developed in a way that continues our existence, or that of similar beings.  Happiness, peace, and attachment can keep us close to what sustains us.  Sadness and anxiety can warn us that something is not right.  Fear, disgust and anger can keep us away from danger.


A certain amount of feeling bad is part of life.  It tells us when something is wrong, and might need correcting.  As long as we have human bodies, we cannot choose to be without pain.

However, negative emotions are unreliable and prone to exaggeration.  In particular, anxiety, fear and anger can offer a disproportionately painful feeling.  They can make mountains of molehills, and make us over-anticipate conflict, pain and threat.


Our emotions use particular sets of chemical messengers and body patterns to get our attention.  Unfortunately, anxiety, fear and anger are heavily dependent on arousal, and disturb our peace.  They involve chain reactions: when life only needs a 30% response, these emotions will offer a 70% response.  This explains the escalation of panic attacks, and also the escalation of angry arguments.


Emotional regulation is the art of taming our emotions, so that we spend less time embracing negative, painful ones.

There are several methods of emotional regulation, some more natural, and some that require learning or intervention.


At times of stress, many people instinctively stay close to friends, develop regular habits, participate in social routines (e.g. jobs, religious practices), participate in meal routines, and seek entertainment (e.g. TV, going out).

  • Attachment to reassuring friends or family
  • Repetitive habits
  • Socially controlled routines
  • Feeding and nutrition
  • Distraction and entertainment

Unfortunately, anxiety and depression can make us lose those instincts: we can withdraw from support, disrupt our habits and routines, disturb our diet, and lose our interest in leisure and entertainment.  But they remain important, and any good therapist will encourage a client to attend to them.


Also available are some less instinctive interventions which can help.    Learned practices include meditation, mindfulness, and therapies.  Also, health services offer drugs to reduce anxiety and depression, which alter the behaviour of the chemical messengers in our body.

  • Meditation
  • Mindfulness
  • Counselling and therapy
  • Medication

Again, the nature of anxiety and depression is to impair our ability to make decisions or follow instructions.  This can mean difficulty concentrating on meditation  or mindfulness, and a haphazard relationship with medication.

A good therapist will encourage a mindful approach, involving awareness of triggered reactions, and their translation into regulated responses.


When suffering any form of emotional dysregulation, these options are available:

  1. Get close to safe friends
  2. Develop regular habits
  3. Participate in social routines with others
  4. Eat regular meals, ideally with others
  5. Participate in leisure and entertainment
  6. Develop a meditation practice
  7. Develop mindful behaviour
  8. Start counselling or therapy
  9. Explore medications