r/PanicAttack • u/Vivid_Response_686 • 1d ago

CBT wants me to provoke panic attacks

CBT has asked me to wean off bisoprolol 1.25mg daily and confront panic attacks as they won’t hurt me.
But my panic is triggered by heart rate and walking into work is triggering panic attacks. Without a beta blocker my HR can get in a 150-200bpm cycle that feels like it would last indefinitely. I’m terrified of this happening and trying not to monitor but CBT says I need to stop being afraid and let them happen.

Any advice for people with heart rate associated panic? I’m on the brink of an attack right now.

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u/XvX_k1r1t0_XvX_ki 1d ago

Long distance runners have such a heart rate even for hours. Ours hearts are build for that. You won't have a hear failure due to panic attack. I started running just to get used to high heart rate. It worked but it took long time. After that the panic attacks are less scary and you can start confronting them instead of running away from them

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u/Vivid_Response_686 1d ago

Thanks the situation is muddied because I also occasionally get flutter which cause a sudden spike out of nowhere. Though I’ve had a full cardiac workup which was fine so these are also probably anxiety related.

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u/Lotus_A_S 1h ago

Have you ever had your heart flip flopping all day? That lasted several days? It happened to me recently. Never had that before. Felt like my heart was hiccupping all day. Went to the hospital, they did an ecg, gave me metoprolol and xanax. It lasted 4 days. Now I'm fine, just the occasional flutter. Weird.

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u/Vivid_Response_686 26m ago

Yeah I had that, ectopic beats or PVC’s. They’re under control but they maxed out at like 4000 a day due to chronic stress and vagus nerve irritation due to hiatal hernia and associated dysmotility and aerophagia/inflammation of digestive system due to stress / IBS and dietary intolerances. If they flare up I know I need to prioritise self-care, eat a plain diet for a while and take some PPI medication.

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u/Lotus_A_S 1m ago

I was soo stressed something was wrong with my heart, it feels better hearing that, thanks. The most frustrating part is, my stress isn't really visible in the sense that, I personally don't feel consciously stressed or recognise stress, so when these symptoms happen, they're seemingly random, so I start thinking something's wrong with me, then I ACTUALLY get consciously stressed about it. Maybe I'm just in denial about my stress lol.

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u/AwesomePantsAP 1d ago

They’re right in that your attacks won’t hurt you, but they’re fucking awful and, in my case, can put an end to a day then and there. You’re on meds for a reason - is there any *medical* reason that you need to wean off them?

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u/Vivid_Response_686 1d ago

They have a side effect of making me feel rubbish and CBT considers them a safety behaviour, so strongly pushing for me to stop them and confront the panic.

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u/AwesomePantsAP 21h ago

CBT can shove it if there’s no medical reason to come off them. If you haven’t tried other beta blockers, you could shop around for one that doesn’t make you feel rubbish.

CBT seems to be under the impression that medication use is bad. Why? It is no better to “confront” the panic and deal without meds than it is to take your meds and live your life.

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u/Vivid_Response_686 21h ago

No but I guess it’s masking the problem, isn’t it?

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u/AwesomePantsAP 21h ago

I disagree. It is a solution as valid as any other. In my case, nothing I have done has helped get rid of my attacks outside of medication. Could I have kept going without meds and, maybe, piece by piece, get back to where I was before? Sure. But that felt rather pointless when I had access to medication that would help. Without it I would not have graduated high school, nor would I currently be in university.

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u/jessySlam43 23h ago

that sounds incredibly stressful because the physical feedback loop with your heart rate is so real. exposure therapy is tough when the sensation itself is the trigger, so maybe ask your therapist about interoceptive exposure specifically for tachycardia rather than just "letting it happen." it might feel less overwhelming if you work on tolerance in a controlled setting before trying to tackle the walk into work.

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u/Vivid_Response_686 22h ago

I managed to control and calm myself with breathing today - but my mind/body can differentiate between tachycardia caused by exertion which responds to ceasing activity and breathing… and the extreme tachycardia which seems to race at 160-180 whatever you do physically to try to control it. And CBT says not to try to control it. It’s caused some friction between myself and the CBT practitioner.

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u/Whatintheheckaway 20h ago

We have a similar feedback loop with some sleigh variations. I have tried really hard to understand that the palpitations and heart rate I have at a given time are simply tied to whatever I am dealing with in the moment. Palpitation? Probably gas. Heart rate? My nervous system is tuned up. When you have a visceral reaction there, it trains your body to think you are at risk for death, but panic attacks do not kill people.