How Anxiety is Felt in the Toes

by Micaha | Sep 2, 2026 | Anxiety/Depression

Anxiety is usually defined by its most common and most prominent symptoms. We often talk about issues like rapid heartbeat, sweating, shaking, and other physical symptoms that most of us recognize when we’re feeling nervous.

What is a bit more complicated about anxiety – especially chronic anxiety – is that there are many more physical symptoms a person can experience. Some types of anxiety, like panic disorder, are especially prone to these issues because chronic and severe anxiety can change how a person’s body and nervous system react.

It’s not an exaggeration to say that anxiety is felt from head to toe. With that in mind, let’s talk about the many different ways anxiety can, quite literally, be felt in the toes.

Toe Symptoms with Anxiety

Anxiety is a misfiring of the “fight or flight response” to danger. It activates the sympathetic nervous system, which is the body’s built-in alarm. Blood vessels constrict, heart rate climbs, and blood gets redirected toward the major muscles and organs that would matter most if a person truly needed to run or fight.

This causes many short term changes to the body:

• Blood is moved from the extremities to the areas that need it most.
• Hormones and neurotransmitters send excitatory messages throughout the body.
• Our mind scans our body for strange feelings, and makes us hyper aware of them.

The hands and feet are some of the first areas that circulation pulls away from, because in a genuine emergency, warm toes are not the priority. Over extended periods of time (as with chronic anxiety) the reduced blood flow can also lead to changes in the way your toes feel.

Numbness, Tingling, Pins and Needles, and Burning

The most common toe sensation with anxiety can be experienced differently despite being basically the same symptom. Some people have that “pins and needles” feeling similar to what it’s like when a body part “falls asleep.” Others may feel numbness, or a burning or buzzing sensation.

Two things tend to cause it:

• Reduced blood flow limits oxygen to the nerve endings in the feet, as blood moves to other extremities that need it.
• Rapid or shallow breathing changes carbon dioxide levels in the blood, causing blood vessels to constrict and move slowly through the body, leading to paresthesia (the pins and needles feeling)

The sensation usually resolves once breathing slows and the body’s alarm response stands down. During a panic attack, that can take anywhere from a few minutes to closer to half an hour, and the tingling often eases in step with the breathing rather than lingering long after.

Cold Toes in a Warm Room

Vasoconstriction, the tightening of blood vessels, doesn’t just limit sensation. It limits warmth. A person can be sitting in a heated room, socks on, and still feel their toes go cold the moment anxiety spikes. It’s the same mechanism as the numbness and tingling, just experienced as temperature instead of texture.

Curling, Clenching, and Cramping

Anxiety doesn’t only affect blood flow. It causes muscles to tense up. Under stress, those muscles can involuntarily curl or clench the toes – a bracing response left over from a much older survival instinct, the same one that would help a person grip the ground before running or pushing off. There’s rarely anywhere to run in a stressful meeting or a crowded subway car, but the reflex fires anyway.

Held long enough, that clenching can cramp. It can also leave the arches sore or tight well after the anxious moment has passed, in the same way a clenched jaw can leave someone with a headache hours after the stress that caused it.

A Low-Grade Restlessness

Some people notice something closer to fidgeting than tension. They feel an urge to wiggle their toes, shift their feet, or tap them against the floor. This kind of restlessness shows up in a lot of anxious states and isn’t unique to the feet, but the feet are often where it’s most noticeable, since they’re already carrying some of the body’s stress response.

Long Lasting Symptoms That Don’t Leave With the Anxiety

Most of the anxiety symptoms in the toes are temporary and only occur while the anxiety is occurring. Some may feel like they’re happening “all the time” but that could be because the person is experiencing generalized anxiety all throughout the day.

In some cases, the toe symptoms of anxiety may feel like they persist even when the anxiety goes away. This may be because:

• Chronic hyperventilation can make the body more reactive to minor breathing disturbances.
• Ongoing anxiety can cause “hypersensitivity.”

That last part is especially important, as it affects the entire body. When a person has ongoing anxiety, especially panic attacks, their mind may be constantly scanning the body for changes and feelings. It may then notice even the slightest change in the toes that a person without anxiety would never even feel. Once it notices that feeling, it then amplifies it.

In other words, without anxiety, you may have a toe that tingles very slightly here and there and you never notice it’s occurring, but with anxiety, you not only notice it, but it feels more severe.

How to Address Anxiety in the Toes

The best way to stop these symptoms is to address the anxiety itself with a therapist. But because some of these symptoms start with the body rather than a specific anxious thought, it’s possible to address some of the symptoms through what are known as “grounding” techniques. For example:

• Press Your Feet Into the Floor — Firm, deliberate pressure through the soles gives the nervous system a concrete signal of contact and stability, which can interrupt the spiral of an escalating panic response.
• Wiggle or Stretch the Toes — Small, intentional movement counters the involuntary curling reflex and brings a person’s attention back into their body rather than the anxious thought driving it.
• Tense and Release — Curling the toes on purpose for a few seconds, then fully releasing, teaches the muscles what “relaxed” feels like, which is often the fastest way to unwind the same tension anxiety created involuntarily.
• Warm Them Up — Socks, a blanket, or a warm foot soak can counteract the cold that comes with vasoconstriction and give the nervous system one less signal to read as threat.

None of these techniques are a substitute for treatment, but they’re a reasonable place to start, and they tend to work best alongside it.

This is also where somatic approaches to therapy tend to be especially effective, since they work directly with the physical patterns anxiety creates in the body instead of addressing only the thoughts behind them — somatic experiencing in particular has a lot to offer people dealing with panic attacks specifically. At Flourish Psychology, therapists trained in somatic therapy and CBT for anxiety often use exactly these kinds of body-based techniques as part of treatment for panic disorder and generalized anxiety, alongside the cognitive work that helps address what’s driving the anxiety in the first place.

Anxiety rarely stays contained to the chest or the mind. It moves through the whole body, sometimes all the way down to the toes. If toe tingling, cold feet, or cramping toes have become a familiar part of your anxious moments, a therapist can help you get to the root of what’s driving them. Reach out to Flourish Psychology at 917-737-9475 or schedule a consultation to get started.

Why Some People Are More Restless Than Others

by Micaha | May 22, 2026 | Anxiety/Depression

Most people assume restlessness is a form of anxiety. The person who can’t sit through a movie without checking their phone, who gets up from the couch repeatedly for no clear reason, who feels an almost physical need to be doing something even when there’s nothing that needs doing — they must be anxious, right?

Not necessarily – at least, not exactly. They may have an anxiety component, but they may not have restless thoughts. Restlessness and anxiety can coexist, and often do. But restlessness has its own distinct roots, its own neurological and psychological explanations, and its own patterns that persist even in people who feel calm, content, and untroubled. For some people, the inability to sit still has nothing to do with a specific worry. Rather, it’s how their nervous system has been wired.

The Nervous System Baseline

Every person has a baseline level of nervous system activation — a resting state that reflects how much stimulation the brain seeks and how it responds to the absence of it. This baseline varies considerably from person to person, and it’s shaped by a combination of genetics, early environment, neurological development, and life experience.

People with a high activation baseline need more input to feel comfortable. Not because anything is wrong, and not because they’re anxious — but because their nervous system registers low stimulation as a kind of discomfort. The quiet, the stillness, the absence of something to engage with — these register as unpleasant in a way that the same person would not experience if they had a lower baseline.

The body’s response to that discomfort is movement. Fidgeting, pacing, changing positions, reaching for a phone, starting a task and abandoning it for another — these are all ways the nervous system generates its own stimulation when the environment isn’t providing enough. The behavior looks like restlessness from the outside. From the inside, it functions as self-regulation.

ADHD and the Stimulation-Seeking Brain

One of the most common neurological explanations for persistent restlessness is ADHD — and one of the least understood aspects of ADHD is that it isn’t fundamentally an attention problem. It’s a dopamine regulation problem.

The ADHD brain has a different relationship to dopamine — the neurotransmitter most centrally involved in motivation, reward, and the experience of interest — than a neurotypical brain. Dopamine release in response to routine, low-stimulation activities is less reliable and less sustained. The brain compensates by seeking out novelty, movement, and stimulation that produces dopamine more readily.

Restlessness in ADHD isn’t a failure of willpower or discipline. It’s the brain doing what brains do — seeking the neurochemical state it needs to function. The person who can’t stay seated in a meeting, who drifts constantly during a quiet afternoon, who needs background noise or movement to focus — that person isn’t choosing discomfort. Their nervous system is actively looking for what it needs.

This is worth naming specifically because ADHD in adults, particularly in women, is significantly underdiagnosed. Many adults who have lived with chronic restlessness their entire lives have never considered that there might be a neurological explanation for it — partly because ADHD is still culturally associated with hyperactive young boys, and partly because high-functioning adults develop coping strategies that mask the symptoms effectively enough that the underlying condition goes unrecognized.

Trauma and the Hypervigilant Nervous System

Trauma produces restlessness through a different mechanism, and it’s one that doesn’t always announce itself as anxiety. When the nervous system has been conditioned by past experiences of threat or unpredictability, it learns to stay alert even when the current environment is objectively safe. This is hypervigilance — a state of sustained readiness that the nervous system maintains as a protective measure based on what it has learned.

The hypervigilant nervous system struggles to settle. Not because the person is consciously worried about something, but because the body has learned that settling creates vulnerability. Stillness, for a nervous system shaped by trauma, can feel dangerous in a way that has nothing to do with present-moment thought. The restlessness that follows isn’t experienced as fear — it’s experienced as an inability to relax, a physical urge to keep moving, a discomfort with quiet that seems irrational but persists regardless.

This is one of the reasons that somatic therapy and EMDR can be particularly effective for trauma-driven restlessness. Talk-based approaches address the cognitive understanding of what happened. Somatic and EMDR approaches address the stored physiological state that keeps the nervous system in motion — which is where the restlessness actually lives.

The Role of Mood

Depression is commonly associated with lethargy and slowing down, which it is — but depression also produces a form of restlessness that isn’t always recognized as such. Psychomotor agitation, a formal feature of certain depressive presentations, involves a physical restlessness that coexists with low mood, difficulty concentrating, and loss of motivation. The person is exhausted and unable to sit still at the same time — which is disorienting to experience and easy for others to misread.

Generalized anxiety disorder includes restlessness as a clinical criterion — the difficulty sitting still, the inability to relax, the feeling of being keyed up or on edge. But the restlessness in GAD often doesn’t feel like anxiety to the person experiencing it. It feels like physical agitation, like irritability, like a body that simply won’t settle. The cognitive component of anxiety — the worrying — may be more or less prominent, but the physiological component runs continuously regardless.

Brainspotting and DBT both address the physiological and emotional dysregulation components that drive restlessness in mood and anxiety presentations, offering approaches that work with the body’s experience rather than asking the body to simply be still through willpower.

Temperament and Personality

Not all restlessness has a clinical explanation. Some people are constitutionally oriented toward activity, novelty, and engagement — a temperament that reflects how they’re built rather than anything that needs to be treated. High sensation-seeking is a well-documented personality trait associated with a preference for novel, complex, and intense experiences and a lower tolerance for routine and monotony. People high in sensation-seeking aren’t restless because something is wrong. They’re restless because their nervous system is calibrated for more input than ordinary daily life typically provides.

The distinction between temperament-driven restlessness and clinically significant restlessness matters because the response to each is different. Temperament doesn’t require treatment — it benefits from environments, activities, and lifestyle structures that provide the stimulation the person genuinely needs. Clinical restlessness benefits from treatment that addresses its underlying cause.

When to Pay Attention to Restlessness

Restlessness that has always been present, that doesn’t cause significant distress, and that doesn’t interfere meaningfully with daily life may simply be a feature of how a particular nervous system is wired. Restlessness that is new or worsening, that is accompanied by other symptoms, that is interfering with sleep or relationships or the ability to function, or that feels like something has changed — that restlessness is worth bringing to a professional.

Therapy for anxiety, trauma-informed approaches, and therapy for high achievers who have been managing a high-activation nervous system their entire lives through relentless productivity are all relevant entry points depending on what’s driving the restlessness for a specific person.

If you’ve spent your life feeling like you can’t fully settle — and you’re curious about what might be underneath it — Flourish Psychology works with adults in Brooklyn and throughout New York City on exactly this kind of question. Call 917-737-9475 or reach out through the contact page to schedule a consultation.

“I Refuse to Carry the Burden of Having to Hide My Emotions” – Victor Wembanyama

by Micaha | Apr 30, 2026 | Anxiety/Depression

Wemby and the Weight of Holding It All In

Earlier today, San Antonio Spurs center Victor Wembanyama sat down for an interview with journalist Maxime Aubin and said something that cut through the noise in a way that sports quotes rarely do.

Speaking about his own mental health, Wembanyama said, as a response to people calling him “soft” for caring about his feelings: “I refuse to carry the burden of having to hide my emotions.”

For a 21-year-old athlete operating under one of the most intense spotlights in professional sports, that’s a striking statement. It’s also, as it turns out, one of the most psychologically sound positions a person can take.

The pressure to hide emotions is not unique to professional athletes. It is one of the most pervasive and quietly damaging expectations in modern life — embedded in workplaces, families, relationships, and the internal narratives most people carry about what it means to be functional, professional, or strong. The cost of meeting that expectation, day after day, is significant in ways that psychology has been documenting for decades.

Emotional Suppression and its Effects on Mental Health

Emotional suppression is the deliberate inhibition of emotional expression. It’s different from emotional regulation, which involves managing how emotions are experienced and expressed in constructive ways. Suppression is something more blunt: the active effort to prevent an emotion from being visible, and often from being fully felt.

Most people engage in some degree of emotional suppression regularly:

• The tears held back in a meeting.
• The anger swallowed before it reaches the surface.
• The grief set aside because there isn’t time for it right now.

In small doses and appropriate contexts, this is a normal part of navigating social life. The problem is that for many people, suppression isn’t a tool used selectively — it’s a chronic operating mode that runs in the background of everything.

The difference matters enormously. Momentary suppression in a specific context has different effects than sustained, habitual suppression across all areas of life, and the research on what habitual suppression does to a person is consistent and problematic.

What Happens in the Body

Emotions are not purely psychological events. They are physiological ones. When an emotion arises, it triggers a cascade of activity in the nervous system — changes in heart rate, cortisol levels, muscle tension, breathing pattern, and neurological activation. The body is preparing to respond to whatever the emotion is signaling.

When that emotion is suppressed rather than expressed or processed, the physiological response doesn’t simply disappear. It continues. The activation persists even when the outward expression is shut down. Several decades of research have demonstrated that suppressing emotional expression actually increases physiological arousal rather than reducing it — the opposite of what most people intuitively expect.

James Gross at Stanford, one of the leading researchers on emotion regulation, has documented this pattern extensively. In studies where participants were asked to suppress their emotional reactions while watching distressing or emotionally evocative material, physiological measures showed sustained or elevated activation compared to participants who were allowed to express naturally. The suppression worked at the behavioral level — people looked calm — but the body told a different story.

Over time, that sustained physiological activation takes a toll. Chronic emotional suppression has been associated with elevated blood pressure, dysregulated cortisol patterns, weakened immune function, and increased cardiovascular risk.

The body was not designed to maintain an ongoing gap between what is experienced internally and what is expressed externally. Sustaining that gap requires effort, and that effort has a biological cost.

What Happens in the Mind

The psychological costs of chronic suppression are equally well-documented and perhaps more immediately recognizable in daily life.

One of the most consistent findings in the research is that suppression doesn’t reduce the intensity of an emotion — it amplifies it. The act of trying not to feel something, or not to show it, tends to make the emotion more intrusive rather than less. This is sometimes called the rebound effect, and it mirrors what most people have experienced: the harder you try not to think about something, the more it occupies your attention.

Suppression also consumes cognitive resources. When a significant portion of mental bandwidth is dedicated to monitoring and inhibiting emotional expression, less is available for other cognitive tasks — memory, attention, decision-making, social engagement. Studies have found that people who are actively suppressing an emotion perform worse on memory tasks and have more difficulty processing information during conversations. The effort of hiding is quietly taking up space that would otherwise be available for thinking.

There is also a relational dimension that is often underappreciated. Emotional suppression doesn’t just affect the person doing it — it affects the people around them. Research on social interactions consistently finds that suppression in one person creates discomfort and disconnection in their conversation partner, even when the partner can’t articulate why. People are more attuned to incongruence between expressed and experienced emotion than they consciously realize.

Relationships built around significant emotional suppression tend to feel superficial or unsatisfying to both parties, even when neither person fully understands what’s missing.

The Culture of Suppression

Emotional suppression doesn’t develop in a vacuum. It is learned, rewarded, and reinforced by specific cultural and social environments. Several forces consistently produce habitual suppressors.

The most well-documented is gender socialization. Men in most Western cultures are socialized from childhood to suppress a broad range of emotions, particularly those associated with vulnerability — sadness, fear, uncertainty, hurt. The messages are pervasive and start early: don’t cry, toughen up, hold it together. What gets rewarded is stoicism. What gets punished is emotional visibility. The result is a significant proportion of adult men who have spent decades developing highly efficient suppression mechanisms and have little practice with the alternative.

Women face a different but equally constraining version. The emotions deemed acceptable for women to express are often narrow — warmth, enthusiasm, gratitude — while anger, frustration, ambition, and certain forms of distress are met with social penalties. The policing looks different, but the outcome is similar: a learned orientation toward hiding specific emotional states.

Workplace culture adds another layer. Most professional environments implicitly or explicitly reward emotional suppression. Composure under pressure is admired. Emotional reactivity is stigmatized. Over years of professional life, the suppression habits developed at work can generalize to all other contexts, producing people who are no longer sure how to turn them off when they leave the office — or whether they want to.

High achievers are particularly vulnerable to this pattern. The same drive, discipline, and performance orientation that produces professional success can also produce a rigid relationship with emotional experience — emotions become things to be managed, controlled, optimized, or set aside in service of performance. The idea that an emotion might simply need to be felt, rather than used or processed into something productive, can feel almost foreign.

What Suppression Is Often Confused With

One of the reasons emotional suppression persists so reliably is that it gets confused with qualities that are genuinely valuable — self-control, professionalism, resilience, strength. These conflations are worth examining carefully because they shape how people think about their own emotional lives.

• Self-control is the ability to choose how to respond to an impulse or emotion. It is a skill, and a valuable one. Suppression is the blanket inhibition of emotional experience or expression regardless of context. They are not the same thing. A person with genuine self-control can feel an emotion fully and choose how and when to express it. A habitual suppressor cannot access that choice because the emotion is blocked before it fully registers.
• Resilience is the capacity to recover from adversity. Research on resilience consistently finds that emotional processing — the ability to experience, acknowledge, and work through difficult feelings — is central to it. Suppression and resilience are essentially opposites. The people who recover most effectively from difficulty are not the ones who feel the least. They are the ones who can tolerate what they feel and move through it.
• Professionalism is context-specific appropriateness. Choosing not to express every emotion in every setting is a normal part of social functioning. It becomes problematic when the professional setting bleeds into all other contexts, leaving no space where genuine emotional experience is permitted.

The distinction Wembanyama was drawing is essentially this last one. He wasn’t refusing to exercise judgment about when and how to express emotion. He was refusing to carry the ongoing burden of hiding — the chronic, effortful maintenance of a gap between inner experience and outer expression. That is a psychologically meaningful distinction, even if it rarely gets named as clearly as he named it.

What Emotional Expression Requires

If suppression is the problem, expression is not simply the solution — at least not in the form of unregulated emotional discharge. The research makes clear that venting, ruminating, or amplifying emotional experience without any processing element doesn’t produce relief. What produces relief is something more specific: the ability to acknowledge an emotion, experience it without being overwhelmed by it, and move through it in a way that allows for integration rather than just discharge.

This is a skill set, and it is one that many people were never taught. Families that modeled suppression don’t produce adults who know how to do this naturally. Neither do schools, workplaces, or the broader cultural environments described above. For a significant number of people, learning to relate differently to their own emotional experience — to stop hiding and start processing — is something that requires deliberate effort and often support.

Therapy provides exactly that kind of support. Several modalities have particularly strong evidence for helping people work with emotional experience in healthier ways:

• Somatic therapy works directly with the body’s experience of emotion, helping people develop awareness of and tolerance for the physiological dimension of emotional states that suppression keeps out of reach.
• EMDR addresses the stored emotional material from past experiences that often drives chronic suppression in the present.
• DBT builds the specific skills of emotional awareness, tolerance, and regulation that habitual suppressors typically haven’t developed.
• ACT works to change the relationship to emotional experience itself — shifting from avoidance and control to acceptance and flexibility.

What all of these approaches share is a recognition that the goal is not to feel less. It is to develop a more workable relationship with what is already being felt — one that doesn’t require the chronic expenditure of energy that suppression demands.

The Burden Wembanyama Was Describing

The word he used was burden. Not habit, not strategy, not tendency. Burden — something carried, something that requires effort to sustain, something with weight.

That framing is accurate. Emotional suppression is effortful. It consumes resources. It has costs that accumulate over time in the body, in relationships, in the quality of a person’s inner life. The people who carry it longest often don’t recognize how heavy it’s become until something disrupts the pattern — a loss, a health crisis, a relationship that finally creates enough safety to put it down — and they feel, sometimes for the first time in years, what it’s like to not be carrying it.

The burden can be set down. That process isn’t always simple, and for many people it doesn’t happen without support. But it is possible, and the research on what happens when people do it — the improvements in physical health, the deepening of relationships, the increase in psychological flexibility and resilience — suggests that it’s one of the more consequential changes a person can make.

If you recognize yourself in what’s described here — if chronic suppression is something you’ve been carrying for a long time without naming it — Flourish Psychology offers therapy in Brooklyn and throughout New York City for anxiety, depression, trauma, and the kind of deeper work that addresses what’s underneath the surface. Call 917-737-9475 or reach out through the contact page to get started.

How Some Panic Attacks May Be Explained by Polyvagal Theory

by Micaha | Mar 3, 2026 | Anxiety/Depression

Panic attacks don’t make sense to the people experiencing them. Your heart races, your chest tightens, you can’t catch your breath, and your body floods with terror — all while you’re doing something completely ordinary like sitting at your desk, shopping for groceries, or watching TV.

There’s no tiger chasing you. No obvious threat. You don’t feel under stress. Nothing happening that should trigger this level of physical alarm. Yet your body is responding as if you’re in mortal danger.

For people who experience panic attacks, this disconnect between their physical response and the actual situation is confusing, and in some cases actually creates fear. There’s no clear reason this occurs – nothing that feels like it can easily be explained by mental health – so something *must* be wrong physically. Your doctors have to be missing something. Something must be wrong with you.

But polyvagal theory offers a different explanation — one that helps panic attacks make sense. With polyvagal theory, your body isn’t malfunctioning or overreacting. Your nervous system is doing exactly what it’s designed to do when it perceives threat, even when that perception doesn’t match the reality you’re consciously aware of.

What Happens During a Panic Attack

A panic attack is your sympathetic nervous system activating at maximum intensity. Within seconds, your body shifts into an extreme fight-or-flight response.

Your heart rate spikes. Your breathing becomes rapid and shallow. Your muscles tense. Blood flow redirects away from your digestive system and toward your large muscle groups. Your pupils dilate. You start sweating. You might feel dizzy, nauseous, or lightheaded. You may even have chest pains and a pounding heart.

These physical symptoms aren’t random. They’re your body preparing to fight or run from a life-threatening situation. Your heart races to pump more oxygen to your muscles. Your breathing quickens to take in more air. Your muscles tense to ready for action.

The problem is that there’s nothing to fight or run from, which makes you intensely aware of how you’re feeling in a way you would likely not be if you were being chased by a predator. The threat your nervous system detected isn’t there. Your body is reacting to something, but it’s not always clear what.

Why Panic Attacks Happen Without Obvious Triggers

Panic attacks can – and often do occur – when a person is under severe stress. But they don’t always. Panic attacks often occur when there’s no external stressor, no obvious trigger, and nothing you can point to as the “reason” you’re panicking.

People with panic attacks don’t always have high-stress lives. You might have a stable job, good relationships, and no major life crisis happening. You’re not constantly anxious about specific things. Your life might actually be going well. Then suddenly, out of nowhere, your body floods with panic.

This is where polyvagal theory provides clarity. Your nervous system doesn’t just respond to external threats. It also responds to *internal cues* — sensations in your body, changes in your heart rate, shifts in your breathing, or even subtle changes in your blood sugar or hydration.

Your nervous system is constantly scanning for signs of danger through a process called neuroception. This happens below conscious awareness. You don’t decide whether something is threatening. Your nervous system makes that determination automatically based on cues it picks up from your body and environment.

Sometimes your nervous system misinterprets those cues. A normal increase in heart rate from climbing stairs gets interpreted as the beginning of a threat response, which triggers more activation, which increases your heart rate further, which your nervous system reads as confirmation that something is wrong. Within seconds, you’re in a full panic attack.

Other times, panic attacks are triggered by sensations that your nervous system associates with past danger — even when there’s no current threat. If you once had a panic attack in a specific situation, your nervous system learned to associate that situation (or anything similar to it) with danger. The next time you encounter something even vaguely reminiscent of that situation, your nervous system might activate before you’re consciously aware of any connection.

The Role of Interoception in Panic

Interoception is your awareness of internal body sensations — your heartbeat, your breathing, hunger, thirst, the feeling of your muscles tensing or relaxing. For most people, these sensations stay in the background. You notice them when they become intense, but otherwise they don’t demand much attention.

People who experience panic attacks often have heightened interoception. You’re more aware of subtle changes in your body than most people. A slight increase in heart rate, a small shift in breathing, a flutter in your chest — sensations that others might not even notice can be very apparent to you.

This heightened awareness isn’t a bad thing in itself. But when your nervous system is primed to detect threat, those subtle body sensations can trigger panic. Your nervous system interprets normal bodily fluctuations as signs of danger and responds accordingly.

The panic attack then creates more intense physical sensations — racing heart, difficulty breathing, chest tightness. These sensations confirm to your nervous system that something is wrong, which intensifies the panic response. You’re trapped in a feedback loop where your body’s alarm system is responding to the alarm itself.

Why Understanding This Matters

When you understand that panic attacks are your nervous system responding to perceived threat — not evidence that something is medically wrong with you or that you’re losing control — the experience changes.

Panic attacks are terrifying. The physical sensations are intense and genuinely frightening. But they’re not dangerous. Your body is doing what it’s designed to do when it believes you’re in danger. The sympathetic activation that creates those symptoms is the same activation that would help you survive an actual threat.

The symptoms feel unbearable, but they’re time-limited. Your nervous system can’t sustain that level of activation indefinitely. Even without intervention, panic attacks typically peak within 10 minutes and begin to subside. Your body physically can’t maintain fight-or-flight at maximum intensity for extended periods.

This doesn’t make the experience less frightening in the moment. But it does mean that panic attacks, while intensely uncomfortable, are not dangerous. You’re not having a heart attack. You’re not dying. You’re not losing your mind. Your nervous system is overreacting to perceived threat.

How Polyvagal-Informed Treatment Helps

Traditional approaches to panic disorder often focus on challenging catastrophic thoughts or gradually exposing yourself to feared situations. Those approaches can be helpful, but they don’t address the underlying nervous system dysregulation that creates panic attacks.

Polyvagal-informed therapy works directly with your nervous system. Instead of just challenging your thoughts about panic, you learn to recognize when your nervous system is shifting toward sympathetic activation and how to interrupt that process before it escalates into a full panic attack.

This involves learning to notice subtle cues that your nervous system is activating. You might feel your heart rate increase slightly, your breathing shift, your muscles begin to tense. These early signs of activation happen before the panic attack fully develops. When you can recognize them, you have a window of opportunity to intervene.

Interventions might include breathing techniques that activate your ventral vagal system and signal safety to your nervous system. Slow, deep breathing — specifically extending your exhale — stimulates the vagus nerve and shifts your nervous system out of fight-or-flight.

You might use grounding techniques that help you orient to your current environment rather than getting caught in the internal experience of panic. Noticing specific details around you — the texture of fabric, the temperature of the air, sounds in the room — can help your nervous system recognize that you’re in a safe place rather than experiencing an actual threat.

Movement can also help discharge the sympathetic activation. During a panic attack, your body is flooded with energy meant for fighting or running. Gentle movement — walking, stretching, shaking out your arms and legs — can help release some of that activation.

Over time, you also work on helping your nervous system feel safer overall. Chronic stress, poor sleep, irregular eating, or ongoing relationship difficulties can keep your nervous system in a heightened state where it’s more likely to trigger panic in response to minor cues. Addressing these foundational issues reduces your overall nervous system activation.

What This Means for Treatment

Effective treatment for panic attacks needs to address the nervous system, not just thoughts or behaviors. Cognitive behavioral therapy can help you understand that panic attacks aren’t dangerous and challenge catastrophic interpretations of symptoms. That’s valuable.

But you also need tools for working directly with your nervous system. This might include somatic approaches that help you recognize and respond to body sensations without triggering panic. It might involve vagal toning exercises that strengthen your ventral vagal system’s ability to regulate sympathetic activation.

For some people, understanding the polyvagal framework itself is therapeutic. When you know that panic attacks are your nervous system responding to perceived threat — not evidence of a medical emergency or sign that you’re losing control — the fear of the panic attack itself decreases. That fear often maintains the cycle of panic, so reducing it can break the pattern.

Therapy also addresses any underlying trauma or chronic stress that might be keeping your nervous system in a heightened state. Trauma therapy can help resolve experiences that sensitized your nervous system to threat. Stress reduction strategies can help lower your baseline activation.

Getting Support

If you’re experiencing panic attacks, working with a therapist who understands nervous system regulation can make a significant difference. Panic attacks are treatable. You don’t have to live with the constant fear that another attack might happen at any moment.

At Flourish Psychology, our therapists integrate polyvagal principles into treatment for panic disorder and anxiety. We work with you to understand what’s happening in your nervous system and develop practical tools for managing activation before it escalates into panic.

We offer therapy in Brooklyn and online therapy throughout New York. We work with individuals experiencing panic attacks, anxiety disorders, trauma, and other challenges that involve nervous system dysregulation.

Contact Flourish Psychology at 917-737-9475 or through our contact page to learn more about treatment options. Panic attacks might not make sense when they’re happening, but with the right support and tools, you can learn to work with your nervous system rather than feeling controlled by it.

Why Does Depression Make Some People Sleep More?

by Micaha | Jan 21, 2026 | Anxiety/Depression

Depression can have many symptoms and take many forms. But one of the more common symptoms may not feel like a mental health symptom at all. Depression affects sleep, often in complex, biological ways.

Some people with depression struggle to fall asleep or wake up multiple times during the night. But for others, the problem is the opposite — they sleep constantly. Twelve hours, fourteen hours, sometimes more. They wake up exhausted, go through the day in a fog, and collapse back into bed as soon as possible.

If you’re sleeping excessively and still feeling drained, it may be a symptom of depression. Depression can fundamentally change how your body regulates sleep, and while some parts of it are directly related to thoughts and feelings, others are related to the way that depression rewires and affects hormones in the brain.

How Depression Affects Sleep Regulation

Depression doesn’t just make you feel sad or hopeless. It disrupts the biological systems that control sleep, energy, and alertness.

Your brain relies on neurotransmitters like serotonin, dopamine, and norepinephrine to regulate mood, motivation, and wakefulness. Depression typically involves imbalances in these chemicals, which means the systems that keep you alert and energized during the day aren’t functioning properly. When these neurotransmitters are depleted or dysregulated, your brain struggles to maintain normal wakefulness, and sleep becomes the default state.

Depression also affects your circadian rhythm — the internal clock that tells your body when to sleep and when to wake up. When this rhythm is disrupted, you can feel tired all the time regardless of how much you sleep. Your body loses the ability to distinguish between rest time and active time, so exhaustion becomes constant.

The result is hypersomnia, which is the clinical term for excessive sleeping. People with hypersomnia sleep far more than the typical seven to nine hours but wake up feeling just as tired as when they went to bed. The sleep isn’t restorative because the underlying brain chemistry issues remain unresolved.

Depression and Fatigue

Depression causes profound physical and mental fatigue that goes beyond ordinary tiredness. Everything feels harder — getting out of bed, making decisions, holding conversations, even basic tasks like showering or eating. This overwhelming exhaustion makes sleep feel like the only relief available.

Part of this fatigue comes from the mental and emotional work depression creates. Your brain is constantly processing negative thoughts, managing feelings of worthlessness or hopelessness, and fighting against the weight of despair. That takes enormous energy, even if you’re not consciously aware of it. By the end of the day — or even by mid-morning — your brain is depleted, and sleep becomes the easiest escape.

Depression also reduces motivation and interest in activities that would normally energize you. When nothing feels rewarding or enjoyable, there’s no reason to stay awake. Sleep becomes preferable to facing another day where everything feels pointless.

For some people, excessive sleep also functions as avoidance. When you’re asleep, you’re not dealing with the pain, the negative thoughts, or the overwhelming sense that nothing will get better. Sleep offers a temporary reprieve from the emotional burden of depression, which makes it incredibly appealing even when you’ve already slept for hours.

Why Some People Sleep More While Others Sleep Less

Not everyone with depression experiences hypersomnia. Some people develop insomnia instead, lying awake for hours unable to shut off their racing thoughts or falling asleep only to wake up repeatedly throughout the night.

The type of depression you have can influence which sleep pattern emerges. People with atypical depression — a subtype characterized by mood reactivity, increased appetite, and sensitivity to rejection — are more likely to experience hypersomnia. Those with melancholic depression, which involves a persistent inability to feel pleasure and early morning waking, tend toward insomnia instead.

Your brain chemistry, stress levels, and individual physiology also play a role. Some people’s bodies respond to depression by shutting down and conserving energy, leading to excessive sleep. Others experience heightened anxiety or rumination that keeps them awake despite their exhaustion.

Treatment Options for Depression-Related Hypersomnia

If depression is causing you to sleep excessively, treatment needs to address both the depression and the sleep disturbance.

• Therapy — particularly Cognitive Behavioral Therapy (CBT) — helps identify and challenge the negative thought patterns that fuel depression and the behaviors that reinforce excessive sleep. CBT for insomnia can be adapted to address hypersomnia by focusing on sleep restriction, activity scheduling, and gradual reintroduction of structure and routine.
• Light therapy can help reset your circadian rhythm, especially if you’re sleeping through daylight hours. Regular exposure to bright light in the morning signals your brain that it’s time to be awake and alert, which can gradually restore a more normal sleep-wake cycle.
• Establishing a consistent sleep schedule — even when you don’t feel like it — helps retrain your body’s internal clock. Going to bed and waking up at the same time every day, limiting naps, and creating boundaries around sleep can gradually reduce hypersomnia.

Another option is exercise. Physical activity, though difficult when depression saps your energy, can improve both mood and sleep quality. Even short walks or gentle movement can help regulate your sleep cycle and boost the neurotransmitters that depression depletes.

Getting Help for Depression and Sleep Problems

If you’re sleeping excessively and feeling trapped in a cycle of exhaustion and depression, reaching out for professional support can help you break that pattern. Depression-related hypersomnia responds well to treatment, but it requires addressing the underlying depression rather than just trying to force yourself to sleep less.

Flourish Psychology’s therapists in Brooklyn specialize in treating depression and understand how sleep disturbances complicate recovery. We use evidence-based approaches like CBT and other modalities to help you regain control over your sleep, your energy, and your life.

You can reach Flourish Psychology at 917-737-9475 to schedule a consultation, or connect through the website to learn more about services and availability.