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.