Managing Escalating Anxiety – Ask a Therapist #3 with Scott Neal

I’ve been struggling with anxiety for years, but lately it seems to be getting worse. I get heart palpitations, sweaty palms, and panic attacks that make it hard to leave the house. I’m exhausted from the constant worry. Do you have any suggestions for calming my anxiety so I can get back to enjoying my daily life?

Instantly, I felt the world caving in around me. I entered into a dream where nothing was real. My heart raced. I was nervous. Was I dying? All I could think about was getting outside and breathing fresh air. Just then, a person I knew saw me, walked over, and began casually talking to me. As she did, it seemed as if I was watching our conversation from a distance. I was physically present but mentally I was somewhere else. Was I having a heart attack? A stroke? I did my best to maintain a conversation, but I wanted to escape. As soon as I was able, I dismissed myself, packed everything, and left. I got in my car and drove back to my office. 

After about 20 minutes, everything calmed down. I was back to normal – whatever normal is.

The panic attack I described above was, unfortunately, the first of many. And the coffee shop was not the only place. I endured attacks at home while watching TV, while on vacation with my wife, in my church while talking with people in the lobby, while shopping, while sitting at my desk in my office, and in restaurants surrounded by family and friends. Do you want to know one of the worst places to have a panic attack? While giving a public address in front of hundreds of people. One day, just before I mounted the stage to be the featured speaker for the day, my vision blurred, I felt as if I was listening to people talk while I was underwater, my tongue tingled, and I was convinced I was going to pass out. And at the peak of it all, I was introduced to speak. 

Anxiety and panic are miserable experiences. And I’m sorry you are experiencing them. As you know, they often come out of nowhere, and make life a living hell. Fortunately, each day, we are learning more about anxiety, panic, trauma, and how our brains work. We are far from knowing everything, but we know enough to help. 

Here are three things that helped me:

First, remind yourself, “I’m not alone”.  I can’t count how many times I wondered, “Am I the only one who experiences this?” When you experience panic and anxiety, it is easy to feel isolated. You begin to think, “No one understands what I’m going through.” That’s not true. Did you know an estimated 31.1% of U.S. adults experience an anxiety disorder at some time in their lives?1 That’s nearly 80,000,000 adults! To put this into perspective, if you are reading these words in a coffee shop or a crowded store where about around 100 people are gathered, realize more than 30 of the people you see have either suffered, are suffering, or will suffer from an anxiety disorder at some point. So, you are far from alone! In fact, there are probably a few people gathered around you right now who are wondering the same things about anxiety and panic as you are right now.

Second, enlist a couple of allies. Who is your first ally? Your doctor. If you haven’t, speak with your primary care physician. I did. And my doctor immediately linked arms with me and prescribed effective medications. After a few weeks, I had an edge in the battle. I cannot emphasize enough the importance of speaking with your physician. And if you think your physician doesn’t take you seriously or treats you as if your symptoms are “all in your mind”, find another physician! There are wonderful, caring, skilled, and knowledgeable physicians willing to assist you in your journey toward mental health. If you haven’t found one, keep looking. Your second ally? Find a well-trained and competent mental health professional. When you do, your therapist will assist you in understanding panic and anxiety, help you recognize “triggers”, and even learn a few ways to de-escalate a panic or anxiety attack if it happens again. We each need someone to walk beside us on our journey, help us achieve realistic goals, and provide us with the knowledge, skills, and encouragement to overcome some of the most perplexing challenges of life.  

Third, resource yourself. In other words, arm yourself with knowledge, skills, habits, and hacks. My most powerful breakthrough was the day I refused to allow panic and anxiety to control me. I knew I may never get to the point where I no longer experienced emotional setbacks, but I refused to be held captive by racing thoughts, fearful imaginations, and paralyzing anxiety. How did I know? Because I decided to talk it over with my physician, study, read, ask questions, seek therapy, and learn to overcome. Trust me, attitude is everything. I love this quote, 

Watch your thoughts. They become words. 

Watch your words. They become actions. 

Watch your actions. They become habits. 

Watch your habits. They become your character. 

Watch your character. It becomes your destiny.2

Refuse to lie down and let panic and anxiety win. Yes, they are formidable enemies, but you (with help) can defeat them. Allow me to share one “hack” I learned.

I noticed every anxiety and panic attack I experienced began with particular thoughts. When those thoughts were left unchecked, they induced my fear, panic, and anxiety. So, rather than concentrating on my panic attacks, I began to pay careful attention to the thoughts preceding my panic attacks. And for me, patterns began to emerge. I now refer to these thoughts/patterns as “voices in my head”. 

In other words, certain voices began to speak to me, and the more I listened and the more time I gave those voices, the faster negative emotions built, eventually erupting into a volcanic overflow of worry, doubt, fear, and anxiety. Want to know one of the most insightful revelations I had about my voices? They lie. For too long, I believed the voices in my head. The day I realized many of the voices were skilled liars, the more I began to call their bluff and put them in their place. 

Then it occurred to me, “my voices” were not me. Yes, my voices were a part of me. They represented pieces of my life – my parents, my friends, my church, my pain and disappointment. And they constantly spoke to me. But they were not me. The real me is deeper, higher, bigger, and larger than my voices. Suddenly, the spell broke and I began speaking back to my voices. I began to direct them, rather than them directing me. And that made all the difference. 

For a while, I didn’t know what to call my “hack”. All I knew was I began to pay careful attention to my thought patterns and began to take note of certain voices inevitably leading me down a dark path. It wasn’t until I read some of the writings of Dr. Ethan Kross that I began to not only understand what I was doing but I had the ability to take it a step further. Let me explain.

Dr. Kross in his book, Chatter: The Voice In Our Head, What It Matters, And How To Harness It 3, describes the practice of becoming “a fly on the wall” about our thoughts. In other words, we can learn (through practice) how to “distance” ourselves from the voices in our head, evaluate them, judge them, and interact with them from a zoomed-out perspective. We don’t merely watch them from a distance, we engage them but from a removed, yet involved, place.

From this new distant perspective, you interact with your thoughts, question them, and determine if they are right or wrong, positive or negative, helpful or hurtful, worth following or worth discarding. When you do, you become in control of your thoughts rather than your thoughts being in control of you. For too long, my voices were in the driver’s seat of my life. I went where they told me to go. Not anymore.

So, today, when the negative dark voices begin to speak – and they do – I rise above them, realize they are not me – interrogate them, and ask, “Do I want to go where these voices are leading me?” If not, I say, “No, thanks. Today is too gorgeous for you to mess it up.” 

Trust me, there is still much left to explore.4 We’ll save the rest for another time.

Until then, remember, you are not your thoughts. You are bigger, higher, deeper, and more beautiful than your thoughts will ever reveal. And . . . you are an overcomer. I believe in you. And so do a lot of other people.

Let’s overcome, together!   


1.     Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from . Data Table 1: Lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.

2.     Unknown.

3.     Kross, E. (2022). Chatter: The Voice in Our Head, Why It Matters, and How to Harness It. Crown.

4.     Consider the following books: Brewer, J. (2022). Unwinding anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind. Penguin;  Gawdat, M. (2022). That little voice in your head: Adjust the Code that Runs Your Brain. Pan Macmillan; Chansky, T. (2012); Freeing Yourself from Anxiety: 4 Simple Steps to Overcome Worry and Create the Life You Want. Hachette UK.

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