Panic Attacks as False Alarms: What Two Comedians and a Psychologist Learned

The Short Version

A panic attack is the nervous system at full alert. In clinical psychologist Nicole LePera's words, it is "that ultimate state of nervous system activation," set off by a threat-detection system that judges danger by what happened to you in the past, "even if it's not really happening" now [1]. Comedians Joey Diaz and Raanan Hershberg describe what that feels like from the inside: Diaz was certain he was about to have a heart attack before a set at the Comedy Store [3], and Hershberg had panic attacks at nearly every show for three months [2]. All three agree on one more thing. Knowing it's a false alarm is not enough on its own. LePera knew panic mimics a heart attack and still lay curled up ready to call 911 [1]. What helped them was training the body: breathing practiced outside the crisis, as LePera teaches [1]; performing through the panic until the brain learned it wasn't dangerous, as Hershberg did [2]; and, after a sedative habit that backfired, Diaz's slow return to breath, sleep and calmer mornings [3].

Table of contents

What They Said

Joey Diaz: I thought I was going to have a heart attack

Diaz's story comes up on The Joe Rogan Experience while he is promoting his memoir Tremendous. It is one of the most vivid accounts in these sources of what a panic attack does to someone who has to walk on stage anyway [3].

It was a Saturday night at the Comedy Store. Diaz was in the back, "talking bullshit with Paulie," when he was told he was up next, following Morgan Murphy in the Original Room [3]. Walking up the steps, he knew something was wrong: "damn I don't fucking feel good. Like this is not working. I was starting to get anxiety. I couldn't breathe. I couldn't breathe." [3]

He had a coping ritual for that room. For years, whenever anxiety hit him there, he would look at a window on the right of the stage that faced out onto Sunset: I had a window. When I'm on stage. I got a window on the right... I was always good. [3] That night the anchor failed him: "That day particular when I went in there I didn't see a fucking window." [3] He walked down the stairs just to look at the door, and things escalated: "I got worse. I got worse. I couldn't breathe. I thought I was going to fucking have a heart attack." [3] He told Paulie, "I can't get on stage. I'm having a horrible anxiety attack." [3]

Then came the strangest part. Diaz went up anyway and lost the next stretch of time completely: I woke up at the 12 minute mark... I remember walking past Paulie and that's it, Joe. That's it. And then I remember waking up on stage and people laughing. And I was probably on automatic pilot. [3] He admits that when he first told Rogan the story he played it for laughs: "I didn't explain to you correctly because I was cracking a joke." [3] Retelling it now, he calls it what it was: "That was scary." [3]

That night was the start of a long chain. A couple of weeks later, Diaz says, "I kept having these little panic attacks, little panic attacks. But I was okay. I wasn't going to go to a psychiatrist. We were working our ass as well. We didn't know what the fuck was going on." [3] So he began taking Xanax, first prescribed in 2012, and "it would help in a little bit. I would take it on the road. If I went on a plane or something like that." [3]

He is blunt about what he was doing to his own nervous system: I'm eating 2,000 milligrams of THC and scaring the fuck out of myself. Right?... Then the Xanix, I would take the Xanix to calm me down. [3] The response in the conversation was a flat "Come on, man. That's not going to work." [3] Refills arrived automatically every month, thousands of pills piled up in a closet, and during the pandemic he was up to eight to ten small pills a day, taken just to get out of the house or into the car [3].

The sedative had stopped being a fix for the alarm and become a source of alarm. Two days after he moved to New Jersey, Diaz says, "I had something like a weird mild heart attack. My heart didn't stop pounding and that was because the Xanx turned on me." [3] During his knee surgery, an assistant noticed he couldn't sleep and told him he was withdrawing from benzodiazepines, that this was why his heart rate was up, and that quitting on his own was dangerous: You just can't quit... you could die. [3] He tapered over six months from about eight pills a day, splitting his doses into morning and night [3].

His description of that withdrawal shows how hard a nervous system can rev: Your heart constantly beats. I'm talking constantly. You could be watching TV and you could see it. Do you know how scary that is?... So your body is just freaking out that it doesn't have a system. [3] He calls it "central nervous system shit" and describes coping by putting his feet in the grass, going to the pool every day, drinking a lot of tea and changing his diet [3]. At his worst, "I should just sit on my bed on my hands and look straight." [3] In the end he noticed he felt great at the gym and worse after every pill, so he stopped and never took Xanax again [3]. His warning sticks: "When your doctor gives it to you, you think it's normal." [3]

Diaz traces the reaching-for-something habit back to childhood. After arriving from Cuba he hid pacifiers in strategic places around the house and ran upstairs to suck on one whenever he felt anxious. "I always had something," he says, to smooth out the bumps [3].

What replaced the pills was plain and daily: "So you have to work at anxiety. You have to really breathe." [3] He does breath work and meditates a little, which he calls going back to his Boulder roots. He fixed his sleep after a Whoop band showed him he was getting about four and a half hours a night, and he now sleeps roughly 11:30 to 8. He also stopped going on the computer first thing; instead he sits on his balcony with coffee for 20 to 30 minutes, looking at the mountains, doing a little gratitude and thinking of his friends [3]. He used to take Xanax just to get himself to jiu-jitsu. Now, he laughs, he just goes and gets beat up [3].

Raanan Hershberg: keep performing until the brain learns it isn't dangerous

Hershberg, also on The Joe Rogan Experience, describes a lifelong relationship with anxiety: screaming fits and self-harm as a child, cocaine and severe anxiety in college, and about ten years on Paxil [2]. He weaned off Paxil five years before the interview, and now thinks that was a mistake: he had felt fine only because the drug was working [2].

The stage panic came later. Around the time he released a special, a scare about moles on his back set off a wave of anxiety, followed by three months of constant dizziness and panic attacks at nearly every show [2]. He eventually started Prozac, which helped somewhat [2].

What helped most, by his account, was not running. He kept performing through the panic until his brain learned it wasn't dangerous [2]. A detail that matters here: audiences usually didn't even notice [2]. The catastrophe he felt inside was mostly invisible from the seats. His advice to anyone with stage panic is not to run from it, because avoidance makes anxiety grow [2].

His history includes one episode that sits at the edge of this topic and is worth keeping separate. During his Adderall addiction, when he couldn't get his usual supply, he took a synthetic drug from an acquaintance and had a terrifying panic reaction at an H&R Block. He called his twin sister to say goodbye and was taken by ambulance with a heart rate he recalls as around 190 [2]. He went to rehab and weaned off [2]. That episode had a chemical cause and a real medical emergency, which is different from his later stage panics, and the difference matters (see Where It Applies).

He also lives close to real cardiac crisis. His girlfriend had open-heart surgery for a mitral valve problem four months into their relationship, and later had a stroke that left her with a blind spot that may be permanent. He jokes, "I never thought in a million years I'd be the healthier one in the relationship." [2] His stage panics happened in someone who knows what an actual medical emergency looks like.

Nicole LePera: a threat detector calibrated by the past

LePera, speaking with Lewis Howes on The School of Greatness, brings two things: a mechanism and her own history. She says she was diagnosed with anxiety and depression, and "I speak as someone who did suffer from debilitating anxiety and panic attacks. And I know how overwhelming and out of control that can feel." [1]

What panic is. Asked what is happening in a panic attack, she says: It's that ultimate state of nervous system activation when your body is literally geared up to fight... or flate, which is usually what happens next. [1] She flags that this is a simplification "for understanding purposes" [1]. It feels different for different people: Some of us actually think it can feel, as I once did, like a heart attack... Some of us it's just that elevation where my heart feels like it's through the roof. I might get that panicked feeling like I'm crawling out of my skin. And it's very, very scary. [1]

Her own episode. She tells a story from her book. During her psychoanalytic training she spent Saturdays in courses, one of them a group in which she took part in group psychoanalytic therapy. After a particularly emotional session she came home and "started to feel sweaty. I started to feel clammy. I almost turned gray looking." [1] Her heart "was pounding. It just felt weird." [1] Then comes the key admission: "I'm someone who had had panic attacks before. I know a panic attack can mimic a heart attack. Yet I was in my down puffy coat, curled up in a ball with my cell phone in my hands, just waiting to call 911 because I was convinced that this must be something that's physiologically wrong with me." [1]

This is the most important caveat in the sources. A clinical psychologist who had been through panic before, and who knew intellectually what it was, still couldn't talk herself out of the conviction in the moment.

Why it happens: neuroception. For the root of panic, LePera says, "It becomes all of it over time because our nervous system works outside of our awareness." [1] She names the function: It's called neuroception. It's essentially where we're constantly scanning the environment... Our body or my eyes and it's primed to look for threat. However, threat gets defined based on our past experiences. [1] The consequence: "something that felt overwhelming back here continues to color my world in my now moment. Even if it's not really happening. Outside of my awareness." [1]

This is the false-alarm idea in her terms. The detector is working; it is just using old settings. She compares it to the feeling of walking into a room or up an alley "and just something feels off," and adds: "Our nervous system is always responding to everything in the moment. However, it's doing so based on our past moments. So we could throwing ourselves, unbeknownst to ourselves, into nervous system activation. And some of us are living in it all day long." [1]

The breath loop. LePera explains how a body can keep itself on alert. When she first paid attention, she found "I always breathe very shallow from my chest, and at times I would stop breathing. And that correlated with stress. The more stressed I am, the more I'm actually holding my breath throughout the day." [1] Because the mind is scanning the body, shallow breathing reads as a sign of danger. The mind then hunts for a cause: "It's going to scan the environment for what's wrong. And as we all know, we're very good at identifying what's wrong in that moment." [1] The stressful thoughts it finds activate the body further: "now we're caught in a loop." [1]

The remedy, and its timing. Asked for the best coping strategy, she says: "We have the access to the most powerful regulator of stress through our breath." [1] If you are overactivated, direct the breath down into the belly; if you are flat and low on energy, a faster, chest-based style she likens to Wim Hof breathing can raise it [1]. She stresses the sense of control this gives: "I can control my body. And my body doesn't have to control me when it hits that peak of panic." [1]

Then she adds the warning that ties this whole article together: "those of us who are in the throes of a panic attack and have never practiced intentional breathing or breathwork probably aren't going to be successful." [1] The skill has to be built outside the crisis: "outside of that acute where panic is crashing down around me, we want to consistently learn how to drop into our bodies. Take a temperature check. How safe is my body? Am I in activation mode or am I calm?" [1] Practiced that way, "as I feel my panic, obviously increasing over time, I can learn how to downregulate myself." [1]

She also says plainly why insight alone falls short: "we can't just think, I'm safe and then my body is like, oh, right, we're cool. And my heart rate goes down and I, right, we might have to help it along." [1] More broadly, she explains why affirmations and positive thoughts often do nothing: people are living in physiological dysregulation, and she calls anxiety and depression "messengers of something deeper" that may include inflammation and a nervous system stuck in one state [1].

Where They Agree, and Where They Don't

They agree that the experience is terrifying and convincing. Diaz thought he was going to have a heart attack [3]. LePera, a psychologist, was ready to call 911 [1]. Hershberg went through three months of panic at nearly every show [2]. None of them treats panic as minor.

They agree, in different words, that the danger is mostly internal. LePera's neuroception gives the theory: the threat is defined by the past, "even if it's not really happening" [1]. Hershberg's experience gives the evidence: he kept going on stage, nothing catastrophic happened, audiences usually didn't notice, and his brain learned the situation wasn't dangerous [2]. Diaz's story fits too, in a strange way. Even after blacking out, he was on stage "on automatic pilot" with "people laughing" [3]. The disaster his body predicted didn't happen.

They agree that knowing isn't enough. This is where the planned just reframe it message needs correcting, and all three sources correct it. LePera knew panic mimics a heart attack and was still convinced something was physically wrong [1]. Hershberg didn't think his way out; he performed his way out over many shows [2]. Diaz's window ritual worked for years and then failed the one night it mattered [3]. The false-alarm idea is the map. Each of them still had to walk the ground.

They differ on the main tool. LePera's main tool is breath: regulate the body directly, and practice it beforehand [1]. Hershberg's main tool is exposure: stay in the frightening situation and don't avoid it, because avoidance makes anxiety grow [2]. Diaz relied on sedation for years and found it backfired. His recovery now combines breath work, more sleep, some meditation and a calmer morning routine [3]. These tools don't really compete. Breathing lowers the body's arousal in the moment, and staying in the room teaches the nervous system over time that the room is safe. Neither speaker frames them as a pairing, though; each describes what worked for them.

They differ on medication, and the reasons are personal. Diaz's experience with Xanax is a cautionary tale: it "would help in a little bit," then use climbed to eight to ten pills a day, it "turned on me," and coming off took six hard months [3]. Hershberg's experience runs the other way. He thinks stopping Paxil was a mistake, since he had felt fine only because it was working, and Prozac helped him somewhat during the stage-panic months [2]. LePera doesn't address medication in these passages. Her emphasis is on breath and on the body's physiology more broadly [1]. The sources don't settle this, and their stories differ in important ways: Diaz was taking a fast-acting sedative alongside very high doses of THC and getting automatic refills, while Hershberg was on long-term antidepressants and in therapy.

They differ on where the alarm comes from. LePera locates the root in past experience and an underlying physiological state, a nervous system that some of us are living in... all day long [1]. Hershberg's wave had specific triggers: a scare about moles and the pressure around releasing a special, on top of a lifelong history of anxiety [2]. For Diaz, the sources point to a mix: childhood anxiety soothed with hidden pacifiers, heavy THC use, years of very little sleep and about eight espressos a day during his comedy years [3]. None of these accounts contradicts LePera's model, but they show the alarm can be primed by many things at once.

Why It Works

The sources give a fairly clear mechanism, almost all of it from LePera, with the comedians' stories as illustrations.

1. The detector runs below awareness and uses old settings. Neuroception scans constantly for threat, and "threat gets defined based on our past experiences" [1]. A body can therefore go to full alert in a situation that is objectively safe, like a comedy club where you have performed for years. Nothing in the present needs to be dangerous for the alarm to sound.

2. Panic is the top of the scale. When activation peaks, the body is geared up to fight... or flate [1]: heart pounding, sweating, clamminess, the urge to escape. Those symptoms resemble a cardiac event closely enough that LePera says plainly that a panic attack "can mimic a heart attack" [1]. That is why Diaz and LePera both thought their hearts were failing [1][3].

3. Breathing feeds the loop, in both directions. Shallow or held breath tells the mind something is wrong; the mind finds a reason; the reason activates the body further [1]. Diaz's first words about his panic are "I couldn't breathe," repeated several times [3]. Because breath is a signal the mind reads, changing it on purpose (down into the belly when overactivated) sends the opposite signal [1].

4. The body has to learn it, not just be told. "We can't just think, I'm safe," LePera says; "we might have to help it along" [1]. She describes the body as neuroplastic, which is why she emphasizes teaching the body safety through repetition [1]. Hershberg's experience is the clearest example: show after show of panic without catastrophe until his brain learned it wasn't dangerous [2]. His observation that avoidance makes anxiety grow is the other side of the same coin. Every escape confirms the alarm was right [2].

5. Practice has to come first because a panicking body can't learn a new skill. LePera's point that people in the throes of panic who have never practiced breathwork "probably aren't going to be successful" [1] follows from the mechanism. At peak activation you fall back on whatever is most practiced. In her words, "We go into that old coping tool or that old resource that we once used." [1]

6. Quick chemical fixes can become part of the alarm. Diaz's story shows how relief can turn into a new source of activation. A sedative taken to calm a nervous system he was also over-stimulating eventually produced its own racing heart, first through dependence and then through withdrawal [3]. His description of his body "freaking out that it doesn't have a system" [3] is a nervous system in real, chemically driven distress.

The evidence here is personal testimony and one clinician's explanation. The sources cite no studies on panic, and LePera's broader claims about brain structure and epigenetics are her stated beliefs, not reported findings [1].

Where It Applies, and Where It Doesn't

It applies to panic in safe situations. All three stories involve panic arriving in places that were not physically dangerous: a familiar comedy club [3], ordinary shows [2], an apartment after a therapy group [1]. That is where the false-alarm idea fits best.

It does not mean every racing heart is a false alarm. The sources hold several cases where the body was signaling something real:

• Hershberg's reaction to a synthetic drug, with a heart rate he recalls as around 190 and an ambulance ride, came from a chemical [2].
• Diaz's nonstop pounding heart in New Jersey was benzodiazepine withdrawal, which the assistant told him was "very dangerous" and which he says can kill you if you just quit [3].
• Hershberg's girlfriend's vision loss on the subway turned out to be a stroke [2].

LePera's own instinct to have her phone ready to call 911 [1] is a reminder that only a medical check can rule out a physical cause. Treating symptoms as panic makes most sense once that has been done.

It applies to people who practice, not just people who understand. LePera's warning is specific: breathwork used for the first time mid-panic probably won't work [1]. The false-alarm idea pays off for people who have built the skill beforehand.

Exposure has its limits in these stories. Hershberg's don't run from it worked for him while he was also on Prozac and with a long history of therapy [2]. Diaz did go on stage through his panic attack, and it ended in a 12-minute blackout [3]. He did not describe pushing through as healing; he went on to rely on Xanax for years. The sources don't explain why the same move went so differently for the two men, but the conditions clearly differed: Diaz had smoked "maybe a joint before I got there" that night and was regularly taking very high doses of THC [3].

Medication decisions are outside what this idea covers. Both comedians' stories show that starting or stopping these drugs on your own can go badly: Diaz with dependence and withdrawal [3], Hershberg with regret over coming off Paxil [2].

If you have chest pain, a racing heart or breathlessness, see a doctor first to rule out a physical cause. Make any decisions about anxiety medication, especially reducing or stopping benzodiazepines, with a qualified professional.

What To Do With It

1. Get the physical checks done, then name the pattern. The false-alarm idea is only safe once a doctor has ruled out a cardiac or chemical cause, as Hershberg's drug reaction and Diaz's withdrawal show [2][3]. After that, LePera's description gives you a name for it: an "extreme state of that nervous system activation," not a body breaking down [1].

2. Take a body "temperature check" several times a day. Ask LePera's questions: "How safe is my body? Am I in activation mode or am I calm?" [1] Notice whether you are breathing shallowly from your chest or holding your breath, which she found tracked her stress [1].

3. Practice belly breathing when you're calm, not only when you're panicking. Direct the breath down into the belly when you notice activation [1]. The point is rehearsal, because without prior practice, breathwork during panic "probably" won't work [1]. Diaz's version is simple: "You have to really breathe." [3]

4. Don't avoid the situation where panic happens. Hershberg kept performing through months of panic until his brain learned it wasn't dangerous, and he warns that avoidance makes anxiety grow [2]. Remember his observation that audiences usually didn't notice [2]. What feels like a public catastrophe is often invisible.

5. Have an anchor, and don't rely on only one. Diaz used a window over Sunset for years, and the night he couldn't find it, he spiraled [3]. A breathing skill you carry with you is more dependable than a feature of the room [1].

6. Lower your baseline arousal. LePera says some people live activated "all day long" [1]. Diaz cut the overload he had piled on: years of four and a half hours of sleep, about eight espressos a day, and heavy THC use alongside Xanax [3]. He now sleeps from about 11:30 to 8, and he credits more sleep, breath work, some meditation and time outdoors with steadying him [3].

7. Protect the first half hour of your day. Diaz swapped the computer for 20 to 30 minutes on his balcony with coffee, looking at the mountains, doing a little gratitude and thinking of his friends [3].

8. Be wary of the quick chemical fix, and never quit one alone. Diaz's "I always had something" runs from childhood pacifiers to a closet full of Xanax refills [3]. If you are on a benzodiazepine, he was warned that stopping abruptly is dangerous; his taper took six months [3]. If you are on an antidepressant that is working, Hershberg's regret about stopping Paxil is worth weighing with your prescriber [2].

9. Expect knowledge to lag behind the body. If you "know" it's panic and still feel sure you're dying, you're in good company: LePera was there too [1]. Her line is the one to keep: we can't just think, I'm safe... we might have to help it along. [1]

Sources

1. How to Heal Your Painful Memories, Thoughts & Beliefs to Create a Greater Future with Dr. Nicole LePera · The School of Greatness
2. Raanan Hershberg on Comedy Craft, Adderall Addiction, Anxiety and Conspiracy Theories · The Joe Rogan Experience
3. Joey Diaz on His Memoir Tremendous, Quitting Xanax, Felony Life and Comedy Store Days · The Joe Rogan Experience