u/Vivid_Response_686

I’m having CBT for panic attacks which were controlled by a low dose beta blocker. But I didn’t like the sides and then my anxiety got worse and I had attacks whilst on them.

I referred myself for CBT and was accepted a text-based CBT treatment. I successfully had CBT face to face years ago which focused on coping with panic symptoms, lowering overall stress and exposure to trigger environments.

From the get go I found the text-based therapy unhelpful and critical, even though I think what they’re saying may be somewhat true. The CBT therapist feels I’m avoiding the attacks themselves, which is the root problem. During attacks my heart-rate goes extremely high (160-190) and gets stuck in a cycle of panic. The CBT therapist told me to come off the beta blocker and accept these attacks which happen every day. So far I have not been able to tolerate one without taking a beta blocker.

I’ve explained how unpleasant they are and how they last longer than 30 mins and can go on for hours so and asked how is sitting in that going to help. They have now stated that I am seeking reassurance by asking that and I just need to accept them. Or take Sertraline. But they told me I mustn’t take beta blocker long term for panic as it’s avoidance.

I have no confidence they’re solving this problem or are engaged in any way. They seem to just repeat a “gold standard” template, and tell me I’m wrong because it’s not working. Patently, sitting with an extremely high racing heart for hours on end is not going to solve my anxiety attacks on its own and is disruptive. Of course I want to avoid that.. I asked what I should be doing mentally and they offered no advice just cryptic “you know what you should do: acceptance”.

I just wanted advice here - my previous CBT therapists were really empathetic, thoughtful, invested. But the current therapists says they were bad therapists if they didn’t truly treat the problem.

I just have bad vibes about them, even if I suspect the theory is right. Advice?

I’ve had anxiety and panic attacks for over 20 years. Had a long period without any, but they returned due to chronic stress.

Previously I successfully had CBT focusing on lowering stress, managing symptoms and exposure to trigger environment.

During an attack my heart can climb to 120-150, but in the worst attacks it can get pushed into a cycle of 160-190, and stay there for 30-60mins. In these scenarios I have usually called an ambulance, and once at hospital my heart rate calms over the next couple of hours.

Two years ago I was prescribed 1.25mg bisoprolol daily to manage these attacks. Recently I had attacks whilst on the medication during which I would double up. In response my GP advised zoloft. I am not keen on this due to the sides, and I wanted to get off the bisoprolol as even 1.25mg has sides. So I decided on another course of CBT.

This time the CBT therapist has decided rather than lowering stress, managing symptoms and environmental exposure… I need to stop medicating and allow the panic to escalate to 160-190 if that’s what it will do and just sit in it, carry on my day, walk and commute and ignore it, and this will stop the fight or flight response as my brain realises it’s not in danger. But… 190bpm… is potentially a danger as the heart can’t refill effectively, plus it’s so terrifying to experience I don’t understand how I am supposed to ignore it and carry on. To make matters worse my HR is sensitive due to the rebound of coming off bisoprolol.

I’m speaking to my GP again, I guess posting here is seeking reassurance. If I thought pushing my anxiety to its limit and doing nothing about it would cure me I’d do it… but… I really don’t think exposure can work in this scenario and instead is causing a relapse.

Thoughts/advice pls?

Has anyone here successfully done exposure therapy for cardiac focused panic, like flutters, heart rate spikes, and heart rates during panic attack. Like 160-180-200, even.

I get into an anxiety loop when my heart rate spikes too high, and by monitoring can cause a mild to moderate attack. My therapist says if it happens I need to ignore it and carry on, and push my heart rate to those highs for exposure. I shouldn’t use normal CBT mindfulness etc as they reinforce the idea I’m avoiding something harmful. But in my head having 190bpm heart rate at rest is an emergency!

Has anyone here suffered with similar and successfully beat it? What sort of exercises or exposure did you do?

Thanks in advance.

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.