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Panic Attacks - a self help guide

PANIC ATTACKS

What is a panic attack? It is, to put it into its simplest form, an ancestral memory.

To our ancestors, a panic attack, which was a symptom of the “flight or fight” response to imminent danger, was a way of self preservation and survival.  We led much more physically challenging and dangerous lives then.  We had to be able to react very quickly to a threat. And in those days there were two simple choices. We could either run or we could fight. In this case, a panic attack is called the ‘fight or flight response’. You may have heard of it.

The Fight or Flight Response

The fight or flight response can be seen as one of the most important parts of our make-up - a highly efficient survival response for dangerous times. Back then, threats were simple and straight forward but often very dangerous – a threat from a member of an enemy tribe for instance, or being chased by a wild animal.

That is why the mind of a human being can trigger a panic attack fast and unconsciously. This is highly relevant and an important point to remember. People who suffer panic attacks often report that “they come from nowhere” and this is an essential part of the fight or flight response.

If you are in a threatening situation and you have to think before getting the hormonal changes associated with the flight or fight response, it may well be too late. Alternatively, you might make the wrong choice, so the unconscious part of our mind takes care of it. And of course, in a survival situation, it is better to respond as if danger is present when it’s not, rather than the other way round. As humans, we are usually operating from the point of caution, rather than stopping to fully evaluate the situation.

Bodily processes such as digestion, blood pressure and body temperature are controlled and monitored by the autonomic part of the nervous system (unconscious part of the mind). These functions generally occur outside of awareness. A panic attack is also controlled largely unconsciously, hence the feeling that they ‘come from nowhere’ – in other words, not under our conscious control.

If it is unclear how this relates to a panic attack in a supermarket, or in the street, then please read on - all will become clear. So, we’ve talked about the evolutionary reasons for panic, but what is actually happening to the body during a panic attack? Why does it feel as if you are out of control?

What happens during a panic attack?

Well, several things happen as your body alters its priorities from long term survival to emergency short term survival. In response to the release of hormones such as adrenaline, your blood pressure increases and breathing speeds up preparing you for muscular effort.

Blood is shunted away from the stomach to the major muscle groups where it will be used during an emergency. This is why people who experience regular stress often have digestive problems: blood is constantly being pumped to areas other than the stomach.

Your legs may shake as they are prepared for running; your hands may shake as the large muscles of your arms are prepared to fight. Your palms and feet may become sweaty to enable you to hold on to a "weapon".

Other changes that occur during a panic attack, or fight or flight response are that the pupils dilate to let in more light, so we can gain more information about the situation. You may also feel like vomiting, urinating or defecating, which too can be seen to have survival value. If you vomit, urinate  or defecate then you will be lighter to run from an attacker and are less appetising as a potential meal to a wild animal.

Remember… all these responses have survival value in the sort of circumstances that they originally evolved for. So why is it that so many of us experience a panic attack in a comparably safe modern environment?

Why do we have panic attacks?

So why is it that so many of us experience feelings of panic in a comparably safe modern environment? The answer is to be found in our history.

Human evolution has taken approximately 135 million years. Modern life can only be said to have existed for the last ten thousand years or so - less than one thousandth of one percent  of our evolution. This is not nearly long enough for us to adapt. So, in a very real sense, we are stuck in a modern world using ancient tools.

Knowing a panic attack is triggered by our ancient instincts may be comforting to some, but  it doesn’t explain why one person has a panic attack while another doesn’t or why we can suddenly just start to have them. For the answer to this question, we must look at the stress levels in our lives. Remember that stress is caused by the way we react to a situation. When a person is generally stressed, or anxious, the the fight or flight response is more easily triggered.

The subconscious mind will store an initial response as a memory, or template for future action.

Once a panic attack has happened in a situation, the mind can quickly learn to fear the situation itself. The panic response can be ‘conditioned’ to be triggered by anything that even slightly replicates the situation or "template". So, too much ongoing day-to-day stress can prime this ‘”trigger response “causing it to go off like a faulty car alarm every time someone walks past it.

We can reduce our ‘”trigger response” by making sure that we take enough time to relax every day. Even taking 10-20 minutes each day to completely "switch off" will have a positive effect on our overall stress levels. We’ve established that a panic attack is a response we all need sometimes. You can see your panic response as a guard whose job it is to protect you from harm. It needs to be there but it also needs to learn to distinguish between threatening and non-threatening situations.

Desensitising Panic
Sometimes, once a person’s subconscious mind has learnt to ‘attach’ panic or anxiety to a certain situation, ‘desensitisation’, needs to take place. Essentially, this means returning the situation or memory to its original state, with a non emotional response. This was traditionally done through ‘systematic desensitisation’ where a person is slowly re-introduced to the trigger situation (i.e. a tarantula on the hand for those frightened of spiders!!).

Agoraphobia and Panic Attacks

Some people, after having a panic attack, develop a fear of open spaces. This is known as agoraphobia and may appear as fear of being in crowds or busy places or just being outside the home. If we look at this from an evolutionary perspective it makes sense. Thousands of years ago we would have had to be careful of wide open spaces because of the possibility of being attacked by wild animals or members of an opposing tribe.

Agoraphobia can also develop as panic attacks ‘spread’ from one situation to another. As we saw above, panic attacks work via the subconscious mind. The subconscious mind ‘sees’ a pattern that was previously associated with a template for panic, and assumes that it is appropriate to panic again, because the situation somehow matches the original template.

Because this ‘template match’ is based loosely in similarities, mistakes can be made. So, for example, a client who was once treated for her first attack on a crowded underground train when it got stuck in a tunnel, may well have feelings of panic when surrounded by a crowd of people in an enclosed space. If at a party soon after the initial attack on the underground train,  she may well suffer another attack. It may be she was sitting on a sofa, surrounded by people; her subconscious mind decided that this was ‘the same’ as the underground (where she had been sitting surrounded by people) and trigger a second panic attack. It’s not too hard to see how this could escalate to other situations where the same client may find herself in an enclosed space with several people.

Reducing and then stopping the feelings of panic...
Once your panic attacks stop then your mind and body will get the message that the former panic situations are no longer real threats.

Although people having panic attacks often feel as if they are the only ones in the world with the problem, the thoughts that accompany panic attacks are usually very similar. Here are the most common ones encountered by clients:

Initial thought: I might die from a heart attack

Although it may not feel like it at the time, the strong muscle whch is the heart is designed to react in the way it does during a panic attack. It can feel unnatural because this type of heart activity is usually reserved for vigorous activity such as excessive exercise, when you don’t notice it quite as much. However, unless you have a heart condition, it is not usually a threat to the heart.

Follow on thoughts during panic attack episode: : I might die from suffocation

It may not feel pleasant, but you are less likely to suffocate during a panic attack than at any other time because you naturally take in more air. The shortness of breath you may feel is due to your body increasing its demand for oxygen, or because of short, shallow breaths, resulting in hyperventilation.

Another possible feeling: I’m scared of fainting

Fainting is not an option when being chased by a wild animal, in fact it could be fatal, so it is highly unlikely that panic will cause fainting. And what if you did faint? How bad would it be? Worse than death itself? Definitely not. Fear of fainting often comes about due to the sense of dizziness which accompanies hyperventilation, sometimes part of the symptoms of panic.

Another feeling: I’m losing control and going ‘crazy’

If you were really going crazy would you be aware about going crazy? You already know that the anxiety, panic, or ‘fight or flight’ response is a natural mechanism, so this one doesn’t make any sense.

When having an anxiety attack, it can feel like you have lost control. In fact, all that has happened is that control has shifted from your conscious to your unconscious mind, so things are still being regulated, just differently.

Another possible reaction: I am feeling so weak that I cannot move or I might collapse on the floor.
The feeling of weakness is caused by the shaking I mentioned earlier. In fact, you are stronger when panicking than at any other time as your large muscle groups, particularly in your legs, are being supplied with plenty of oxygen.

I might make a fool of myself...Believing that you are going to be embarrassed or humiliated......
How many times have you actually been humiliated or embarrassed by a panic attack? If you ever have been, was it really that bad? During an attack, it is very common and quite natural to worry that your body can’t take what is happening. The fact is that panic is a short-term response.

The worst part of a panic attack only lasts a few minutes ......it is similar to an emergency drill for the body. If you have panic attacks then at least you know that your anxiety or fight or flight response is in good working order, which will serve you well if you ever find yourself in real danger from that charging animal!

Now let’s take a look at hyperventilating (or overbreathing), which causes, or makes many panic attacks worse. It can be counted amongst panic attack symptoms, or amongst causes, as one ‘feeds’ off the other.

About 70% of attacks are accompanied by hyperventilation and many sufferers overbreathe even whilst relaxed.

The most important thing to understand about hyperventilation is that although it can feel as if you don’t have enough oxygen, the opposite is true. It is a symptom of too much oxygen.

With hyperventilation, your body has too much oxygen. To use this oxygen (to extract it from your blood), your body needs a certain amount of Carbon Dioxide (CO2).

When you hyperventilate, you do not give your body long enough to retain CO2, and so your body cannot use the oxygen you have. This causes you to feel as if you are short of air, when actually you have too much. This is why the following techniques work to get rid of hyperventilation.

Some hyperventilation and panic attack symptoms are:

 

How can learn to breathe more evenly and naturally?

1.   Hold your breath. Holding your breath for as long as you comfortably can will prevent the dissipation of carbon dioxide. If you hold your breath for a period of between 10 and 15 seconds and repeat this a few times that will be sufficient to calm hyperventilation quickly.
2.   Breathe in and out of a paper bag (if one is available!). This will cause you to re-inhale the carbon dioxide that you exhaled.

3.   A brisk walk or marching on the spot whilst breathing through the nose will counter hyperventilation. Regular exercise will decrease general stress levels decreasing the chance of panic attacks, as the parasympathetic part of your nervous system is triggered, bringing everything back down to normal levels.

TAKE DEEP BREATHS IN THROUGH YOUR NOSE AND OUT THROUGH YOUR MOUTH...

The important thing here is that the out breath must be longer that the in breath. This causes stimulation of the part of your nervous system responsible for relaxation (THE PARASYMPATHETIC NERVOUS SYSTEM).   If you breathe in this way then your body will have no choice but to relax.

It may take a few minutes but the body will respond regardless of what your mind is thinking.

Just become aware of your breathing, and breathe in to the count of four, and breathe out to the count of seven. You can hold for a couple of seconds at the bottom of the out breath if that’s comfortable for you.

It may be a little difficult at first, but doing this regularly causes your general anxiety level to come down. You may also find that you begin to breathe this way automatically if you feel anxious. Regular relaxation actually starts to inhibit the production of stress hormones in the body so it actually becomes harder and harder to panic. As you become more generally relaxed it actually becomes harder to get stressed!

Hyperventilation responds very well to this technique. If you practice this daily, hyperventilating should cease to be a problem very quickly. It can also give you much more control over panic attacks.

You are hopefully coming to understand that panic attack symptoms are natural physiological reactions.

When you have a panic attack, or become very anxious your emotional response can actually bypass your ‘thinking brain’ (your conscious mind).

The most common comment from people who have panic attacks is ‘It’s totally irrational’, which is quite right. It’s not the rational part of the brain that deals with panic attacks. This is why people often find it hard to make decisions during a panic attack.

This response has been termed an ‘emotional hijacking’ by Daniel Goleman, who wrote the best selling book ‘Emotional Intelligence’. By this, he means that your thinking, planning rational mind is hijacked by your emotional response.

The first sign that your panic attacks have gone may be when you notice you can’t have them any more, even if you try to think about the feelings!

Some techniques for reducing the effect of panic attacks:

Try this first:    if you experience anxious or panicky sensations, you can rate their intensity from 1 to 10, full-blown panic being 10 and deep relaxation being 1. So, for example, if you are in a situation and begin to feel uneasy you could say to yourself ‘I am now at a scale 5’. If you began to feel worse you might say inwardly ‘I am now at a scale 6’. As you begin to feel better, you can count yourself back down to a 2 or a 1.


By scaling anxiety attacks in this way, you are doing three things.

1.   You are “ringfencing”the experience so the limits are clear. After all, it’s impossible for panic to increase indefinitely. It has to stop at some point.

2.   You are using the conscious part of the mind. In order to stop and think about where you are on a scale of anxiety you have to use left brain; the part which is not so concerned with emotion but more with thinking .

3.   For the time it takes for you to grade the panic you are less ‘in’ the panic attack and more outside it. like an observer. This dilutes the emotional response.

4.   This gives you more control. Although it can feel that panic attacks go on for ever, they can actually only continue for short periods - they are short-term survival responses.

The simple rule is that by giving the conscious mind a task we diminish the experience of unpleasant emotion.

It’s good to write down the scale of your anxiety because then you can see how things are improving. It also gives you something to do during an anxiety attack, which again dilutes the emotional response.

Choose just to go with the experience. Fighting anxiety, getting angry or scared just fuels the fire. You now know a panic attack is a perfectly natural response, so although it can be frustrating, there is nothing to be afraid of.

Remember - you are more than just your anxiety – it is not who you are – it is a feeling you are experiencing at the time.

Behave normally and continue doing what you intended to do. Breathe normally focusing on extending the out breath. If you run from the situation your immediate anxiety will of course decrease but this may lead to an increase in future anxiety.

Staying in the situation helps ‘desensitise’ the panic response as your mind gets the message that it is not really threatening.

Continue accepting your anxiety, watching it and acting normal until it goes down to a comfortable level.

What you fear may never happen – remember your sub conscious mind is attempting to re-enact a memory.

Of course, getting rid of all anxiety is not desirable, or even possible, but getting rid of panic attacks is.

The next step in getting rid of panic or anxiety attacks for good is to re-educate the subconscious mind so that it understands that the situations that currently trigger your panic attacks are not actually dangerous.

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