Episode Three: The Panic Cycle and Mis-Interpreting Bodily Sensations
One of the key questions I ask clients about their panic attacks is;
“When it’s happening, when you are having a panic attack, what is the absolute
worst thing that you think, in that moment, might be happening to you?”
I’m afraid I can be a bit like a dog with a bone with this one! I just won’t let go until I uncover the ‘catastrophic’ outcome that the person most fears (as a result of their panic attack).
The most common answers tend to be;
Each of these very specific fears can always be directly linked to a matching ‘bodily sensation’, such as a racing heart or a feeling of dizziness. This of course makes perfect sense because it’s NOT normal (to have a racing heart, a dizzy head, a feeling of ‘depersonalisation’ or extreme hyperventilation)! Also, during a rush of anxiety, the adrenaline is sending us a signal that we should be afraid and we should ‘flee’.
Most people understand that, during the very primitive ‘Fight/Flight Response’, our heart rate increases to pump more blood to the larger muscles in our legs and arms, strenghtening them. Also, our breathing becomes more rapid and shallow - to take in more oxygen, in preparation for swift action. All our muscles tense – including chest muscles and throat muscles. The flow of blood changes direction, moving away from the extremities (head, hands, feet) and towards the vital organs. All our attention focuses completely on the impending attack, making it impossible to concentrate on anything else.
The main reason that we continue to get panic attacks is because we are so terrified by these rapid and intense physical changes happening in our bodies. These changes happen AUTOMATICALLY when we BELIEVE that we are in danger. In the case of a panic attack, because we see no obvious external danger, we start to think the danger is coming from within us – a heart attack, a lack of air, a sudden loss of control or death even!
To eliminate panic attacks it is vital that we fully understand (and then accept!) these ‘scary sensations’.
Let’s take a closer look now at some of these sensations.
Fact # 1: Thankfully, most of us have never experienced a heart attack. But we know it can involve chest pain, pounding heart, pins and needles, and nausea - so no wonder then that we worry that our panic attack may, in fact, be a heart attack!
One of the first things that most panic attack sufferers do is to get their doctor to check their heart and rule out any real cardiac problems. And rightly so! It is really important to be satisfied that all necessary and appropriate checks have been carried out and that the heart has been declared fit and healthy.
Sometimes people worry though, that if they get anxious enough, and their heart races enough, then this might actually bring on a heart attack. In fact, a HEALTHY HEART is capable of beating very rapidly for long periods of time without doing any damage.
Fact # 2: When the fight/flight response kicks in, the body automatically takes in extra oxygen to help pump blood to the vital muscles. This means that, temporarily, we have too much oxygen and not enough carbon dioxide. This is not harmful and will always re-balance itself. This imbalance is known as ‘hyperventilation’. Hyperventilation accompanies approximately sixty percent of panic attacks but may also help trigger a panic attack too.
The symptoms that hyperventilation produces include;
According to Dr Neuman, director of the Anxiety and Phobia Treatment Centre in New York,
“Sometimes the panicky person concentrates on breathing. The heightened respiration of the fight or flight reaction is experienced subjectively as a shortness of breath. Trying to get a deep breath, he/she overbreathes. This is a common phenomenon. People who are not anxious will overbreathe if they try purposely to breathe normally. We seem to think we need to breathe more than we actually do. Overbreathing is called hyperventilation.”
The term ‘Hyperventilation Syndrome’ refers to a tendency to regularly ‘over breathe’ and the person may be unaware of what they are doing. The solution to regular hyperventilation is, thankfully, very simple! Just practicing a simple breathing exercise for about five minutes, a few times a day for a couple of weeks can re-set our breathing habits. For a free helpful audio guide on this breathing exercise, click on image below.
Fact # 3: During the fight/flight response, our blood pressure actually increases to meet the challenge of the perceived threat. Fainting occurs when there is a decrease in blood pressure. Remember that a panic attack is the fight/flight response kicking in by mistake. This ancient and primitive response is designed to maximise our ability to protect ourselves – fainting really wouldn’t be a very helpful way to protect ourselves!
However, while it is extremely rare, a person could possibly faint during a panic attack if, either they persisted in hyperventilating for long enough or there was some other physical problem.
It might be helpful then to remember the following;
If you have never fainted before now then it is highly unlikely that you will, due to a panic attack or anxiety. If you have fainted before now then you already know how harmless it is!
Fact # 4: Because a panic attack is actually the fight/flight response kicking in, your attention and focus is meant to be only on the supposed threat or danger and nothing else. If, however, as in the case of a panic attack, the threat is not apparant, this intense focus can actually feel like an inability to focus or concentrate. Thoughts may feel distorted, and one may experience blurry or tunnel vision. Also, a normal and important part of the fight/flight response is a very strong sense that something is wrong and a powerful urge to flee whatever situation you are in.
While panic attacks are quite distressing and frightening while they are happening, it is a FACT that they do not cause people to lose control.
Fact # 5: Another common-enough sensation that can be experienced during a panic attack is what is formally known as depersonalisation or derealisation. These sensations are often described as ‘a sense of being separate from oneself’, ‘feeling like a robot’, ‘disconnected emotionally’, ‘as if one is an outside observer of themselves’.
This is widely believed to be a natural response of the brain to a perceived catastrophe. It has been found that healthy individuals almost always report experiences of depersonalisation and derealisation in situations where they were facing a life-threatening situation.
A very common fear that people have about having a panic attack is that people around them will consider them to be strange or odd. Most of this fear is based on the previous fears of losing control physically and mentally. We now know that this will not happen. Worst case scenario, you may appear unwell to those close to you (although most people admit that onlookers probably wouldn’t even realise that anything was wrong).
People become unwell in public places all the time for very mundane reasons – coming down with the flu, feeling lightheaded or dizzy after an illness, feeling hungover after a party the night before..... If you do attract some attention and you don’t want to tell people about your anxiety, you can easily give a variety of other very plausible and acceptable excuses.
Once we know the FACTS, we can remind ourselves of them regularly so that we can gradually overcome our FEARS. Writing out some quick and helpful facts on small cards or saving them on our phone can help too.
Knowing the facts gives us a choice, but also a responsibility! We can now either continue to focus on our FEARS (which will only maintain our panic attacks) or we can push ourselves to focus on the FACTS and begin to overcome and eliminate the panic attacks.
Episode Two: What is my brain doing whenever I’m feeling anxious or having a panic attack?
In this diagram of the human brain you can see an area called the limbic system. This includes a network sometimes referred to as the Fear Circuit or Threat System.
Now within this Fear Circuit, the amygdala is a structure that is responsible for matching a stimulus with an appropriate emotional response (for example, a bull in a field equals danger equals fear). The hippocampus acts as a sort of memory bank, helping us to recognise something that was dangerous in the past (for example, a traumatic memory of a earlier trip to the dentist). And the hypothalamus is involved in signalling the release of adrenaline.
Now, let’s go a little deeper!
The brain contains billions of neurons. These are nerve cells that carry information between the brain and other parts of the body. These neurons are separated from each other by tiny little spaces, called synapses. The information crosses these spaces with the help of certain message carriers called neurotransmitters. The neurotransmitter Adrenaline, stimulates or excites us, while Serotonin and GABA, calm us down when the danger has passed.
Now, for a variety of reasons, these neurotransmitters can sometimes get a bit out of balance. The belief then, is that our Fear Circuit can sometimes become overly-sensitive, a bit like a faulty house alarm that keeps going off. This over-sensitivity could be the result of a traumatic event - or maybe just a build-up of stress over time.
So, with Panic Disorder, certain places, certain situations, and even certain ordinary bodily sensations, cause our Fear Circuit, to act like an over-eager bodyguard and decide – superfast - that we are in trouble. It shoots out an alarm signal through those neurons, releasing adrenaline and causing the body to go into the Fight/Flight Response. Like lightning, this release of adrenaline is felt intensely and terrifyingly, throughout the whole body – an experience we label a panic attack.
Now the most important point here, is that you absolutely can, with proper support and guidance, re-train your emotional brain and re-balance those neuro-transmitters so that they don’t continue to over-react like a faulty alarm!
If you, or someone close to you, is unfortunate enough to be experiencing recurring panic attacks, then you may want to find out more about this psychological treatment called ‘Cognitive Behavioural Therapy’ (CBT). As a ‘talk therapy’, CBT does a lot more than just talking! It is an active treatment and requires a real commitment on the part of the person engaging with it. While it is not a ‘magic quick fix’, by any means, it has most certainly proven itself (through countless studies and clinical trials) to be very effective - for the majority of people who avail of it.
Rather than overwhelm you with tonnes of information – about both CBT and Panic Attacks
– perhaps it would be more helpful if this information arrived in episodes!
Episode One: What exactly is a panic attack?
A panic attack is probably best described as a sudden, and overwhelming, sense of terror along with some extreme physical sensations. It can seem to occur without warning and quickly rises to its most intense level within about ten minutes or so. There are thirteen symptoms, or sensations, associated with a panic attack – ten of them are physical and three are more ‘psychological’. These symptoms, at least four of which must be experienced to ‘properly diagnoses’ a panic attack, are;
While figures vary greatly on this, some suggest that as many as a third of us will experience at least one panic attack in our lifetime. The reasons for our FIRST (if not only) panic attack can be brought on by some random ‘glitch’ in the body - although approximately eighty percent of cases reportedly coincided with a build-up of stressful living!
The term ‘Panic Disorder’ is used when the panic attacks are recurring, and when we begin to live our lives in fear of the next one – where might it happen and just how catastrophic will the outcome be? Naturally, when this starts to happen, most people make adjustments and begin to withdraw and avoid potential panic attack sites. Now we have another problem – Agoraphobia! Agoraphobia simply refers to a fear, and avoidance, of any situation or place from which escape (or rescue) would be difficult or embarrassing, in the event of a panic attack.
The key ‘drivers’ of panic disorder are;
While panic attacks and panic disorder (with or without agoraphobia) are incredibly upsetting and frustrating, they are also very treatable! When it comes to seeking treatment, always start with your doctor. There are some medical conditions which can mimic panic attacks and your doctor can check for these. Remember that the first key driver of panic disorder is that stubborn, lingering doubt that there ISN’T anything seriously wrong – so make sure that you are satisfied that you are basically healthy and safe from any real ‘catastrophe’!
In Episode Two, we will go inside the body – and the brain – to see what is causing that intense and terrifying experience we call a Panic Attack.
Hi there, my name is Rosario and I am a human being. I share my planet with about seven billion fellow human beings. Over millions of years, we humans have been evolving; modifying and adapting, in order to survive and thrive. Biologically, our brains have evolved too. This has transformed our capacity for cognitive processing, resulting in great strides having been made in the ‘civilisation’ of our world.
To be human is to be able to, not only have thoughts, but to have thoughts about our thoughts! To be human, is to have an ability to imagine – and communicate to others what it is that we imagine or visualise. The last one hundred years – a blink of an eye in terms of our evolutionary journey – has seen fantastic leaps in engineering, medicine and technological advancement.
Paul Gilbert (The Compassionate Mind) reminds us though, that “evolution is not perfect”. Our brains have held on to a powerful, more primitive, element – our emotional brain, as some would call it. The amygdala is an area of the brain which scientists have found to be a key player in how we humans react emotionally to different situations. Universal emotions such as anger, fear, love, hurt, jealousy, and grief are, after all, the stuff of a million stories, plays, films, songs and poems!
The study of how we understand and manage our emotional brain (old brain, if you like) is a quite a recent one, but thankfully now a very popular one. Daniel Goleman’s, “Emotional Intelligence” is a fascinating book on this subject and well worth a read!
My own interest in the study of the emotional brain, began more than twenty years ago. Like many, I’m sure, my journey began with reading endless ‘self-help’ books. This was followed by years of formal and informal studies and, eventually, a complete change of career to become a practicing psychotherapist. What had started out as curiosity and a search for personal growth and development, then led on to a desire to guide and assist others in their search for an understanding of their emotional brain.
Along the way, in both my personal and professional life, I have been drawn to the theories and practice of cognitive behavioural therapy (CBT), Emotional Intelligence and Evolutionary Psychology as an explanation for, and a way to make sense of, our ‘human being-ness’. I share the view of Paul Gilbert (The Compassionate Mind), when he says;
“On a personal level, the way we use our ‘new brains’ to think and ruminate about ourselves can be a source of stimulating, powerful, primitive emotions and feelings, which we can become locked into and, in that way, drive ourselves deep into anxiety and depression.”
Knowledge is Power!
Inventions such as the internet, as well as personal computers and smartphones, have given us unprecedented knowledge – literally at our fingertips! We have a vast library of information to choose from and most of it is free. As wonderful as this is, it can be a bit overwhelming and confusing too. Often, we just want a simple, straightforward answer to our particular problem or question. We don’t always have the time, or the interest, to wade through countless websites and articles, many of which may turn out not to be relevant.
The blog posts that follow here, aim to inform you and keep you updated on the latest developments in this fascinating field of psychology and neuroscience. In particular, these blog posts will be concerned with anxiety and depression and ways to best manage our moods and behaviours. Looking forward to your feedback!