How to Untangle Anxiety, Step by Step

An overlooked idea from the 1980s yields a promising new treatment approach that anyone can use

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I’m a psychiatrist who struggles with anxiety.

I had my first full-blown panic attack when I was in residency training. It woke me from a sound sleep like a freight train suddenly blowing its whistle in my ear. Heart pounding and short of breath, I felt like I was going to die.

Instead of calling 911, I went through the psychiatric diagnostic checklist in my head. Check, check, check. Yup, those were all the symptoms of a panic (rather than heart) attack, I reassured myself. And with a hefty sleep deficit as my sleeping pill (thank you, residency), I nodded off again.

I had a few more panic attacks during those years, but had learned something in medical school that helped me not develop a full-blown panic disorder (which I might have otherwise been prone to). For someone to be diagnosed with panic disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), panic attacks “must be associated with longer than one month of subsequent persistent worry about: (1) having another attack or consequences of the attack, or (2) significant maladaptive behavioral changes related to the attack.”