Living in Japan as a foreigner and experiencing panic attacks can be extremely frightening. Often, panic attacks feel like they come “out of the blue,” but after exploring more, we can usually identify specific triggers.

Common Triggers in Japan

• Crowded train
• Language barrier
• Physically distant from friends and family back home
• Challenges accessing essential support services
• Demanding work schedule
• Cultural misunderstanding
• Social exclusion and feelings of isolation

What is a Panic Attack?

Panic attacks are simply false alarms. When our brain perceives a threat, it sends us alarm signals in an attempt to get our attention and keep us safe. These signals are very uncomfortable and feel the same as when we are in harm’s way.

Panic is a unique type of anxiety described as a “fear of the fear.” That is, the physical sensations themselves become the trigger of anxiety. Maybe a crowded train in Tokyo sparks the anxiety, but the real fear is of the sensations themselves, what they could mean, and the sensations getting worse and causing harm.

This is an easy trap to fall into because the intensity of the sensations is the same physical experience our brains would initiate if we were in extreme danger. They feel the same. So, it’s common to mistake these sensations for a medical emergency.

What can be Done for Panic Attacks?

The gold standard treatment and often the first recommended intervention is Cognitive Behavioral Therapy and Exposure Therapy. CBT and Exposure Therapy assist clients in increasing awareness and challenging thoughts that contribute to panic episodes. Often, panic is accompanied by thoughts like, “What if this is a sign of a heart attack?” or “What if I’m not able to breathe?”

Therapy also assists in increasing awareness and changing behaviors that maintain panic. For example, it’s common to avoid situations that trigger panic episodes. The more a person avoids a situation, the more they inadvertently reinforce the “fear of the fear.” Collaboratively, the therapist and client will identify situations to gradually “expose” the brain to situations it urges someone to avoid. Slowly, the brain learns new, more helpful, and realistic lessons about generally safe situations.

Therapy may also include the therapist and client working together to recreate feelings similar to a panic episode, such as shortness of breath, racing heart, or dizziness. The therapist and client will begin to practice responding to these sensations in new, more helpful ways that are likely also to teach the brain that these feelings aren’t always a sign of danger and are generally safe.

Finding a Qualified Therapist in Japan

Finding a suitable English-speaking therapist in Japan can be challenging. Since the pandemic, most therapists have started offering online therapy, making it easier to access English-speaking treatment and therapists with specialized experience, regardless of the client’s and therapist’s locations.

I like to inform potential clients that the practice of therapy and counseling is not regulated in Japan as it is in other countries like the U.S. This means anyone can open a private practice and offer counseling services. This results in providers not meeting the standard of care that may be expected in the country that you’re from.

So, before choosing a therapist in Japan, I recommend checking a few things:

• Is the therapist licensed in the country they are from?
• Is the therapist part of a reputable organization that has high ethical standards and offers the public a way to make formal complaints of unethical behaviors? For example, International Mental Health Professionals Japan.
• Are there any articles or posts about the therapist online besides the therapist’s website? Are there consistent complaints about the therapist?
• Specific to panic attacks, look at the therapist’s background and training. Does the therapist mention anything about panic attacks in their list of services? Do they describe their general approach to panic attacks?

Though calming and relaxation techniques can be beneficial, in general, using relaxation strategies in direct response to a panic attack can maintain panic long-term.

Also, panic attacks can be the result of trauma, but just because you are experiencing panic episodes doesn’t necessarily mean it’s trauma-related. So, it’s important to find a therapist who does a thorough assessment and doesn’t immediately assume it’s trauma-related, as this will direct the type of therapy and intervention strategies.

If you have more questions about my therapy & counseling services, please see the Fees & Therapy page and read through the “Frequently Asked Questions” section.

You’re also welcome to a no-fee 15-30 minute consultation. This is a time for us to meet and see if we might be a good fit for one another. It’s also a great time for you to ask questions about my services and other concerns you may have.