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Walking therapy: what is it, why do we do it?

“walking is exploring the mystery of presence” -Frederic Gros

“the journey of a thousand miles begins with a single step” -Lao Tzu

“I only went out for a walk and finally concluded to stay out till sundown, for going out, I found, was really going in” -John Muir

The formula for talking therapy is a similar one across many different modalities. Whether the client is offered cognitive behavioural therapy, person centred or psychodynamic therapy, the client sits more of less opposite the therapist in various rooms or offices (such as school classrooms, rooms in GP surgeries, spa-like therapy centres and so on). It’s a sitting down practice, and quite a cognitive one, too.

But there is a growing recognition that clients can be offered more; they often do not want to go from an artificially lit office with their heads full of work into yet another one, inevitably inhabiting the same sense of cognitive, stuffy bias. So, since 2017 I have offered clients the opportunity of engaging in walking-as well as talking-therapy.

This is not so new. Freud would walk with his clients around the Ringstrasse in Vienna, literally walking the talking. Clay Cockrell, founder of Walk and Talk therapy in New York sees around 40 clients a week in Central Park. Jonathan Hoban has published a book Walk with Your Wolf (2019) about just this[1]. Duval[2] in a research paper suggests that walking creates improvements in both mood and attentional functioning; Morgan et al sum up the psychological and relational benefits of walking neatly in their research paper called Walking Towards a New Me[3]. Miyazaki’s book Shinrin-yoku: the Japanese way of forest bathing supplies us with solid evidence of walking in his chapter the science behind nature therapy[4].

It’s catching on.

I first experimented with this in 2011 when I undertook the Studies in Mindfulness post graduate diploma through Aberdeen University; as well as an exploration of Buddhist psychology and the neuroscience of compassion, mindful walking was included as a foundational practice in the programme, and after reflecting on the impact on me-lowered blood pressure, less stress, improved mood and a general feeling of being more friendly to myself (a new me!)-I began to focus on it as a core mindfulness practice whilst training others, and then I brought it into the therapeutic space.

I found myself inspired by the poetry of walking, heeding Mary Oliver’s words in Wild Geese: You do not have to walk on your knees/for a hundred miles through the desert, repenting./You only have to let the soft animal of your body/love what it loves” or Rilke, who writes in A Walkwe are grasped by what we cannot grasp” as particularly redolent of an embodied connection that can be found in walking the talking. These things are not always so noticeable in sitting therapy; when walking, clients appear to achieve insights which are more poetic, expressive and at times more flowing. The person centred therapist Nick Totten[5] writes of the experience of the liminal self that is experienced when we lean in to the threshold of our wilder side; I would suggest that this is akin to Rachel Corby’s notion of rewilding ourselves[6] and Mark Colemans[7] concept of “uniting our inner and outer wilderness.” It is finding our whole self, a self that we have, at times, lost in our busy living, step by step.
I have had feedback from clients that walking therapy works particularly well in helping to treat stress, anxiety, depression and furthermore enables the client to achieve what the neuropsychologist Rick Hanson[8] calls “installation” or a more fully embodied experience and understanding of their situations and history, as opposed to a purely cognitive one; a sense of somatic change. Added to which, the positive impact of walking on the beach (in summer, barefoot) or in parks with trees and open skies is well researched[9]-immersing ourselves in nature helps us to ground and lowers our fight, flight and freeze responses considerably.

Walking outdoors helps us to connect, and importantly it helps us to connect with the somatic or animal side of us that we spend so much time splitting off in our daily working lives.

How does this work?

Walking therapy may not take a whole 50-minute session (though some clients have asked for extended 90 minutes sessions) but can be 20, 30-minute parts of sessions. We co-construct an agreement around confidentiality, what to do if either us chances upon somebody we might know, and the terrain itself with its challenges. I then invite a prewalk reflection and, of course a postwalk one too. Then we’re off, walking at the client’s pace.

Sometimes we have focussed on breathing, exploring our sensory experience, and processing issues and problems, or aspects of personal development in this ambulatory manner. Sometimes we just stop, sit and reflect on the walking or the discussion we have had. Sometimes we just sit and look at the sky, the sea or the trees around us, alive in the sense of presence. We explore posture, physical feelings of the sun, the wind or the rain on us.

Clients who are CEOs and managers, leaders of all kinds who are close to, or who have experienced burnout, find this walking therapy especially beneficial: we take 50 minutes to do an unwinding walk, then back to work the leader goes, anchored and refreshed.

Parents of babies or very young children, who would find their child a distraction in the therapy room or cannot find a babysitter to do indoor work find walking therapy useful; the baby is in the buggy, often asleep and we walk the talk.

One of the subjects that comes up regularly in walking theory is spirituality. Perhaps being close to nature allows us all to decompress and reflect on our wider, transpersonal selves that might connect to something vaster and more meaningful, which finds its expression in what Corby calls “the dark cry of the soul”[10].

Clients have also chosen to walk around places where they used to live or where family members lived in the past, using the actual terrain as a way of evoking and processing past memories in a very real and concrete way.

Supervision whilst walking has been successful, with the supervisees reporting increased vitality and showing creative reflections on casework; again, it is often the embodied “permission to pause and notice” within the work that many find deeply facilitative.

I’m building on this, and in the next few months am going to collate more case studies and plan to deliver a continuing professional development (CPD) workshop on my findings.

Watch this space and go in by walking out!

[1] Its not just in therapy where this occurs, coaches are walking too see

[2] Duvall, J. (2011). Enhancing the benefits of outdoor walking with cognitive engagement strategies. Journal of Environmental Psychology, 31, 27-35.


[4] Professor Yoshifumi Miyazaki Shinrin-yoku: the Japanese way of forest bathing for health and relaxation

[5] Nick Totten Wild Therapy

[6] Rachel Corby Rewilding Yourself: becoming nature

[7] Mark Coleman Awake in the Wild: mindfulness in nature as a path of self-discovery

[8] see Choden, Nairn and Regan Addis From Mindfulness to Insight

[9] and

[10] Rachel Corby Rewilding Yourself: becoming nature


The feeling of me, the idea of me

“what began simply as a sensory experience has become part of my identity. It has come into my existence as a thing instead of a passing object of perception and experience”[1]

“first there’s me, then there’s mine, then there’s trouble”[2]

This June morning is sunny and warm. I’ve left my house and walked the 10 minutes or so to the beach. I take my sandals off and I can feel the sand beneath my feet, hundreds of particles of sand rubbing into my toes. The surf comes and goes; it’s cool and as I walk into the water it refreshes my feet and ankles. The horizon seems vast and cloudless. I can smell the salty air. I stand still and allow my attention to gently focus on my senses: touch, taste, smell, sight, sound. Standing still I can also bring my attention to the feeling of me, the sensations inside me, the feeling of being, sensations which, like the surf itself relentlessly come and go, as if they belong to something vaster. The feeling of me.

This feeling of me feels connected, embodied, energetic and free. It feels open and untroubled. Phenomena comes and goes and it always will. There is a sense of dynamic movement within me, yet a feeling of being grounded, connected.

Then something else happens. I begin to-in a flash-get an idea about this feeling of me. I reflect on my experience, ask myself some questions such as “what’s this about?” or make a statement such as “this feels good” and wonder how I might have the good feeling again. I begin to label my experience, attempting to capture or package the feeling of me.

Something’s happened. The feeling of me has turned into an idea of me. The surf, the sensations of being have paused, frozen into concept.

This is, perhaps the way it happens. As soon as I switch to the idea of me, I compare my experience, place it in a category that helps explain the feeling of me. It’s almost as if my mind or my brain wants to predict or classify my experience and base it on past experience. Why would I want to do this? Now I’m becoming identified with this idea of me-and what might be mine.

This takes around a second, or less.

I experience the embodied, sensory me. There then is an involuntary (where does it come from?) need to conceptualise this, to anchor it by comparing it to previous experiences. I reify the experience as mine, and grasp, attach, fuse to this as idea and identity. This is me. This is my story, my narrative, mine. Its happening, though I’m not sure exactly what it is that is happening. But it is me, mine, and I’ll defend it as such. This way I am real, solid; I have an identity, I’m somebody and I will spend much of my time fused to this and justifying this somebody.

This idea of me, I begin to notice, occurs with more frequency as I grow and experience bad things. I actually appear to have a bias in my ideas towards negative experiences, they really mean something to me and I can recall them with a vividness that simply is not present around good experiences. They tell me that the world can be bad-and they tell me to be careful. They also tell me that I can-am-bad and should be ashamed to be like this. I seem to prefer these stories about being bad so cling on to them, sort of identify with them as me, mine.

I don’t really have a very satisfying, happy life, I seem to have taken the feeling of me, with all of its life and liberty and turned it into an idea of me, filled with dead concepts; am I this, this cognitive prison camp? I’ve taken my pain and turned it into a huge story of suffering: I am my suffering.

Is there no way out?

I turn my attention to the suffering self with kindness, as if I could hold this suffering in a sense of compassionate embrace; I see it with eyes wide open and try to wholeheartedly befriend it. I fail. I try again-are we not all like this in one way or another? I take my attention to the feeling of me, where I am, standing on the beach. For a moment or two the idea of me disappears (where does it go to?) and I am immersed in the embodied sensation of not me, but just this, just this. I suddenly realise that my suffering vanished (where did it go?) as if it was never real.

Then something else happens. I begin to-in a flash-get an idea about this feeling of me. I reflect on my experience, ask myself some questions such as “what’s this about” or make a statement such as “this feels good” and wonder how I might have the good feeling again. I begin to label my experience, attempting to capture or package the feeling of me.

Something’s happened. The feeling of me has turned into an idea of me. The surf, the sensations of being have paused, frozen into concept.

And so, the cycle continues.

Yet every time I bring my attention to this, gently and with a mindful, compassionate embrace the grasping, the fusion, weakens slightly, the story of suffering is not the only story; in fact, the story is replaced by the feeling of just being, a “seeing from the heart”[3].

And so, the cycle continues. Yet in kindly facing, rather than ignoring, my habit of creating and defending an idea of me and mine, perhaps here lies some kind of mindful liberation.


[1] Rob Nairn, Choden, & Heather Regan Addis From Mindfulness to Insight

[2] Akong Rinpoche

[3] Rob Nairn, Choden, & Heather Regan Addis From Mindfulness to Insight


mindfulness and the mountains: a remarkable trek

“Going to the mountains is going home” -John Muir

“Mountains should be climbed with as little effort as possible and without desire” -Robert Persig Zen and the Art of Motorcycle Maintenance

During most of April this year my wife-Kim-and I went on what might be called an “adventure holiday” for nearly 20 days. This was a guided trek of sorts through Nepal, Bhutan and Tibet, ending up with a daylong stopover in Dubai, then home to Newcastle.

We’d long hauled a few times and we’d visited countries before that could be called “exotic” or “different” but this was, well, quite different.

From out the window of the plane the first Nepalese greeting was a craggy “namaste” in the form of the country’s hills and valleys spread out below us, a welcoming vista indeed. Landing, then exploring Kathmandu was an eye opener; this city expands and tucks itself with vigour into the surrounding hillsides and is a sensory riot of colour, sound, taste and smell. It’s as if your senses suddenly become dialled up to overload.

Travelling from Kathmandu to Pokhara for 8 hours, stopping and walking along the Nepalese valleys and small towns with fruit stacked up along the roadside and cows ambling through rubble-strewn thoroughfares, destitute by Western standards yet thick with life (colour! Nobody wears our signature black and browns!) and road dust billowing and blinding our eyes and filling our throats. The sight and sound of Hindu festivals, of incense and fire flooding the air.

tigers-nest-2691190_1920Then, by contrast, the order, simplicity and clean air of beautiful Bhutan; bustling towns such as Thimbu and Paro, the nation’s countryside studded with Buddhist dzongs rising like sturdy white fortresses alongside rushing rivers, stupas and flags around every corner and a punishing yet finally rewarding hike up, up, up the steep hillsides to the Tiger’s Nest Monastery.

One afternoon, hiking up a hillside to visit a stupa, we stopped midway, sitting for a while to turn the prayer wheels on the path, listening to the sound of the bells ringing out over the snowcapped and monumental panorama: as Li Po writes in his zazen on Ching-t’ing Mountain “we sit together, the mountain and me/until only the mountain remains”.

Then to Tibet; flying over the Himalayas we began to grasp the sheer vastness of the land-endless white capped majestic mountains like jagged, rugged, luminous ghosts, hostile yet breathtakingly beautiful. Walking in Tibet is an effort; Lhasa where we stayed is the holy city of Tibetan Buddhism and the political, economic, cultural and religious centre of the Tibet Autonomous Region. It stands over 3,600 metres above sea level, and at that altitude mindful breathing is a lifesaver in helping you keep going and staving off the inevitable headaches.

We visited the Potala Palace where His Holiness The Dalai Lama lived and was partly brought up, struggling to absorb just how the Tibetan culture has been changed since 1959, yet, ringfenced as it is by snow-capped mountains, how much still stands.

These three countries: wherever you go, there you are, with mountains.

Finally, Dubai; flying over sand dunes into the airport, sampling the city’s modern cafes and restaurants, its steely malls and cool air conditioning; the mountains we “climbed” were skyscrapers, such the Burj Khalifa. At a roof height of over 830 metres it is known as the tallest structure in the world, yet what a contrast to the heights of the ancient mountain spirituality we had just experienced.


Two weeks later, we are still processing the trip, and Kim and I are at the Star and Shadow, a small cinema in Newcastle, listening to Vin Harris give an introduction to the film Akong: A Remarkable Life. We began to deeply appreciate Akong’s life and deeds, and his escape from Tibet, through the Himalayan mountains and into India, how this flight impacted on his resolve to deliver compassion in action.tibetan-984267_1920

How might all of this impact on my practice of mindfulness? This is what I took to supervision. Gareth, in conversation, asked me to allow an image to begin to form and explore it.

There’s a mountain, white, hostile and unforgiving, unbroken and sound in its majesty, resolute in intent and meaning. Its top scrapes the sky and its base sinks deep into the Earth; it seems to say before you were thought of, before and before the ones who thought of the ones who thought of you, and long after you, I am.

Perhaps it’s no coincidence that when we sit in meditation, we adopt a kind of mountain posture, our heads the tip and our crossed legs a sturdy base. Perhaps also there is something here in the teaching of mindfulness that-as with the works of Akong-remind us to wake up to the body of the Earth, wake up our earthly senses and our presence in the world, our essential being and connection and, like the mountain embody this being, this I am in our lives.


mindfulness: when nothing happens and it’s no big deal

You don’t have to act crazy anymore— We all know you were good at that, /Now retire, my dear, from all that hard work you do/Of bringing pain to your sweet eyes and heart. /Look in a clear mountain mirror/See the beautiful ancient warrior and the divine elements/You always carry inside -Hafiz

I’ve been practicing mindfulness now for around 20 years, first a kind of informal practice where I would sit on a cushion at the French windows looking out into the back garden. Day in, day out, winter, spring, summer, autumn; dark mornings and bright mornings, then repeat. After a few years I formalised my practice by taking the Post Graduate Diploma in Studies in Mindfulness through the University of Aberdeen[1].

So, 20 years later and I’m still sitting on my cushion (okay: I admit, I upgraded the cushion, it’s a splendid Tibetan black number I bought at Samye Ling) and I’m following the same old practice. At the window: winter, spring, summer, autumn, winter. Rinse, repeat!

At first the results were amazing! I started to experience a crashing waterfall of thinking thinking thinking that I’d never experienced before (in retrospect, I was of course merely becoming aware of the drama which had always been present) -a cavalcade of spectacle, figures leaping up like infernal salmon from my unconscious and I relished each and every opportunity to take part in this internal cinema. Then things calmed, stress fell away and I felt more spacious in my head, more connected to my bodily sensations. At times I felt light, intimate with myself in a way I’d never known.

And then progress stopped.

For about two years now, nothing’s happened. I’ve sat there, on the cushion for nearly two years now getting myself more familiar with…nothing, really. Have I been wasting my time? Think of the books I could have been reading, the films I could have watched, the calls I could have made (though, calling my friends up at 7am might not curry much in the way of favour with them).


My practice is more akin to waiting for a bus than anything magical.

What’s (not) going on?

A few weeks ago, I took part in a weekend retreat delivered by the Mindfulness Association called The Compassionate Warrior. In a guided visualisation practice we were taken through I was greeted by a slim figure who all but dismissed me as I threw down my black rucksack into a corner full of dozens of other black rucksacks. The figure spoke: “oh, you’ll be back again; its no big deal” and continued working, ignoring me.

There’s something here which goes to the very nub, the very centre of things for me. The baggage that we carry-the shadow side of us-we keep collecting it, we work to let it go and yet it keeps returning; but we can also move from a place where it’s a huge drama to one where it’s no big deal. The path, then, is the practice itself. Perhaps this is what Jon Kabat-Zinn meant when he talked about mindfulness practice as “bucketing out the pond”[2]

On the other hand…

Yesterday was a practice day, and I had the privilege of spending the day sitting, reflecting and walking on the beach. Last night I had-I can’t recall any details-frightening visions that (apparently!) had me twitching in the bed. I have no clear recollection of these guests in the guest house[3] yet my reflections are that it could-just could be-that when nothing’s happening, something really important is happening, we just have to be patient and trust that something will emerge, like a lotus flowering out the mud.

How do I know that I’m not just spiritually bypassing here? That’s a really important question. What is “spiritually bypassing”? John Welwood, talking to Tina Fossella[4] describes it as “a widespread tendency to use spiritual ideas and practices to sidestep or avoid facing unresolved emotional issues, psychological wounds, and unfinished developmental tasks.”  In other words, we turn away or numb out from our wounds and bliss out a bit, then a bit more.

It’s here where we-I-probably need to be aware that as well as mindfulness practices, psychological practices, or developmental practices need taking on board, too. If, in my mindfulness practice I am trying to find ways to wake up, then it might be best accompanied by ways to grow up[5]. This accords with Maria Calpan’s thinking, where we have to cultivate discernment[6] on the path.

Okay, when we open this up, there’s quite a lot here for “nothing happening” to be full of “happening”.

Urghh! It’s a bit messy and contradictory!

My take on this is that when there is nothing happening, it’s no big deal, but if we stay close to our experience, no big deal might turn out to be a very big deal indeed!

As always in mindfulness, the path is the practice we return to.





[2] Jon Kabat-Zinn Wherever You Go, Here You Are


[4] Google On Spiritual Bypassing, Relationship, and the Dharma




What happened to you? Are you more than this?

“People are having wounds open for the sake of having wounds to point to” Heather Heying[1]

What happened to you?

You probably-most definitely I would say-experienced some pain in your life, perhaps recently, possibly long ago in the past, so long ago that the detail of the pain lies shrouded, obscured by the living you have done since then, sublimated or buried in somatic memory.

But our pain-essentially that which first happens to us as we are born-does not just stay as pain. It becomes suffering. It might have been the Buddha who first saw this with any degree of insight in the Sutra of the Second Arrow, when he described our pain as a first arrow that, well, causes us pain, physical or psychological. Into that wound of the first arrow another arrow falls (and then more) until we build up a story, a narrative of suffering.

The suffering did not happen to you. Pain happened to you. So how is that you carry this narrative of suffering, how is that you came to believe, grasp onto and identify with this suffering, as if to say this is me, I am what has happened to me, however much this is lost in time and shrouded in the past. I suffer and will hold onto my suffering, in spite of any evidence to the contrary, this is me.

Perhaps we worry that if we lose our suffering, we will have nothing to call our own, to call us? Perhaps can see this played out in current culture, where identity politics creates multiple sects and tribes of victims, many of them attempting to be the tribe that shouts the loudest and therefore claims themselves as the biggest victims.

The issue here is that the shadow of the victim is a persecutor, and in order to keep the victim energy going, contemporary tribes have perpetuated the story of their suffering; interestingly-ironically-they seem quite happy to do this. Douglas Murray has called this a kind of culture of masochists, who have in truth never really engaged with true sadism. Perhaps there is a suggestion that there is a kind of faux suffering at work here, what Carl Jung called illegitimate or bourgeois suffering? Or perhaps this is too harsh?

What happened to you?

Did you hold onto the story of your suffering, whether born from real pain or foisted onto to you by the world until you became married, not to your spouse or lover but with reciprocal stories of suffering that find some solace but not true meaning in this arrangement; only further suffering, suffering spun into fine gold garments, yet suffering all the same?

You are not your suffering. You can mindfully reverse engineer your suffering, notably through psychotherapy to unpack your story, and mindfulness to drop the story.

You are more, much more that your suffering.

You are no more your suffering than the clouds are the sky.

What happened to you, is not you; it’s what happened to you.

You are a case of mistaken identity; you think you are your suffering-and it’s in that thinking where you make the biggest mistake; you are not your suffering or the clinging thoughts that say this is me.

You can be the awareness of what happened to you and begin to dis-identify from your suffering, slowly, gently.

Mindfulness has a potent practice to facilitate this, called RAIN practice[2], where we can

  • recognise what’s happened to us
  • accept and allow it
  • inquire into the heart of this
  • non-identify with it

We can break free of the false chains of our suffering and become what are truly meant to be: fully human.






BBC 2’s Winterwatch and mindfulness: take notice!

“Who affirms that crystals are alive?/I affirm it, let who will deny:/Crystals are engendered, /wax and thrive,/Wane and wither; I have seen them die.

-From Snow by John Davidson


Like many folks in the U.K. I enjoy following the seasonal wildlife programmes on BBC 2 presented by Chris Packham and Michaela Strachan. Packham, of course, became famous in the 2009 Springwatch series when he slid a few references from the songs of David Bowie and The Smiths into the programme, but it is his decade old devotion to the wildlife of the Nation’s woods, fens and fells-and back gardens-that strike me as most remarkable. Packham and the programme really make me take notice of the wildlife right outside my doors.

Of course, Chris Packham is also known for his courage and openness around his mental health, being, as he is, a person who was bullied at school, has experienced severe depression with thoughts of suicide and has Asperger’s Syndrome[1].

Winterwatch late January 2019[2] contained an interview between Chris Packham and Joe Harkness, whose book Bird Therapy will be published in June 2019[3]. Around the subject of mental health and wellbeing, Packham called the book a “natural cure” whose activity-bird watching-heavily promotes mental and emotional wellbeing.

Joe and Chris stood and talked at the edge of a lake, counting ducks as they glided by. I was struck by these two courageous men, wholly open and yet balanced in their self-acceptance, discussing their shared experience of thinking about taking their own lives. Both had been dark places and in dark times, and when Joe remarked “I will extol the virtues of those undervalued and underrated birds” I couldn’t help wondering if he was subtly telling us to take notice of behaviour, thoughts and feelings we also might undervalue or underrate.

Joe talked about how he valued the notion of “start at the bottom” and perhaps it’s true, we need to take notice of the ground or foundation of all things to ensure we are well rooted into life; we’re so inclined to be top heavy with thinking, at times it’s a wonder we don’t fall over!

During his dark days Joe had received therapy from Mind[4] with input from some medication and mindfulness. He pointed out Mind’s 5 Ways to Wellbeing Programme: connect, be active, take notice, learn and give and then talked about the birds, and flocks of birds having “freedom and fluidity” in their flight.

Reflecting on this, I was struck by how much of this intersects with my own experience, work and practice in mindfulness with the Mindfulness Association[5] and mindfulness in general.

Take notice. There is so much around us that we often don’t take notice of: at this time in late January the soft flakes of snow silently fall on my back lawn, a tiny robin, red breasted in anger pecks and dances; two collar doves court in the frost, tiny droplets of ice cling to the tangled and leafless branches of clematis as the day further breaks open. In my own back garden, in your park or through our windows we can take notice of another life, a life of nature. Being with nature is much like being with the natural rhythm and movements of the Earth; being with nature is being with a body vast and yet inexplicably personal in nature, for in taking notice of the outer we can also turn inwards, noticing the inner nature of our bodies, our breath and the feeling of our being.

In this spaciousness our thoughts, feelings and concepts can have the same freedom and fluidity of birds in flight, and live in this spaciousness itself, which is so often underrated and undervalued by our craving to do and be distracted.

Joe and Chris could be right: rest at the edge of your own lakeside and take notice, perhaps count, and mindfully observe what passes in the current, being present and being presence itself. As the popular Buddhist teacher and nun, Pema Chödrön says: “If your mind is expansive and unfettered, you will find yourself in a more accommodating world, a place that’s endlessly interesting and alive. That quality isn’t inherent in the place but in your state of mind.”[6]

Take notice: you owe it to your own wellbeing.







[6]Pema Chödrön Living Beautifully with Uncertainty and Change


I’m having a panic attack! how can mindfulness help?

For over 10 years I worked at two G.P. Surgeries in the North East of England. Common themes and issues that patients brought to my clinic included low mood, relationship problems, anxiety and bereavement. Around 2010 things changed, perhaps it was part of a social phenomenon, but incidences of panic attacks spiked. By 2012 it was unusual if 40% of my caseload (up from 10% in 2007) was not panic-related therapy.

But what is a panic attack? There are a number of ways of defining or describing panic attacks, but most agree that a panic attack is a sudden and very intensely gripping experience of fear, it includes shortage of breath, palpitations, shaking, sweating and numbness. The attack might last 15 to 30 minutes itself, though the after affects might last considerably longer, and though they are not typically fatal, having a panic attack can feel like you are about to die.

Here’s a fuller list from the DSM 5[1]

  • Palpitations, and/or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or being smothered
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control or going insane
  • Sense of impending doom
  • Paresthesias (numbness or tingling sensations)
  • Chills or hot flashes

Wikipedia says they affect 3% of the U.K. population (that does not gel with my clinical experience, I’d say it’s larger, but then I would do, I see these folks rather often) and impacts more on women than men.

There are a number of “causes” of panic attacks, for example the trauma of loss or a marriage breakdown, a road traffic accident, phobias, negative self talk or a habituated response to a threat (e.g. having a panic attack sets up the habit-response of having a panic attack) -these are just some of the ways that a panic attack might be triggered.

Essentially a panic attack is our sympathetic nervous system (SNS) being triggered. This is often more colloquially known as our fight or flight system (there is also a more primitive aspect, freeze). It’s no surprise that our nervous system is, well, a “nervous” system; we can get triggered by threats, real or imagined (to the brain it makes little difference) and our hypothalamus recalls this and gleefully allows us to trigger and trigger again. Whoopee.

Okay, but what is a panic attack, beyond the pain and symptoms?

There is an increasing school of thought[2] (and I belong to this school) that a panic attack is your body’s way of waking you up (okay, it could try a beep alarm not this nightmare wakeup, but you would probably not take as much notice) to its presence, that it’s really time to become more embodied[3]. You see, a lot of us try to fight panic attacks by thinking or battling our way through, but practices in mindfulness have shown that if we pay attention and stay with the experience of panic (okay, much easier said that done) we can treat panic attacks, and treat then quite quickly, too.

When we are treating panic attacks, we are fundamentally bringing back on line the PNS or parasympathetic nervous system, sometimes called the relaxation response or soothing system; the panic throws you into fight and flight, the “para” calms you down, most effectively by bringing you back into your body, safely and grounded.

How to get back to the body?

There are a number of methods used. They can be collated, I believe under the heading of mindfulness of the body:

  • Breathing: practice deep breathing into the belly. Breathe in to the count of 4/5 and out again. This should be done proactively, for around 3-5 minutes of the day, it’s a great way to start and energise your day
  • STOP practice: stop (pause), take a breath, observe what’s happening (perhaps naming, touching the world around you), proceeding
  • Learning about what a panic attack is. Go back to the top of the page
  • Medication: see your G.P. for advice
  • Therapy: a cognitive behavioural type of therapy to you help challenge beliefs, lifestyle and any cognitive distortions that are skewing your life
  • Mindfulness: to help you bring self compassion to you and ground back into your body
  • Walking in nature, the beach, gently getting back into the body

Panic attacks are seriously debilitating, but they can be worked with and though: there is an effective treatment path, don’t suffer needlessly, get help!







[2] E.g.



Walking therapy: what is it, why do we do it?

“walking is exploring the mystery of presence” -Frederic Gros “the journey of a thousand miles begins with a single …


The feeling of me, the idea of me

“what began simply as a sensory experience has become part of my identity. It has come into my existence as a thing instead …