Recently, I hurt my back… stay with me, this is still a piece about anxiety and panic attacks. My back went into spasm. I had very limited movement and was in acute pain. I did not realise at the time that the spasm was a protective measure by the body to prevent myself from doing more harm to prolapsed discs. This occurrence, although negative, created an awareness that I needed to protect myself. It counselled me to change my behaviour and to listen to my body. This came in the form of cessation of running as it was causing damage to my joints, better technique in the gym and work on my core muscles. On reflection, the warning signs were present, for example shooting pain yet I chose to ignore these warning signs. I highlight this example because anxiety and panic can serve the same function in acting as a warning mechanism and to encourage us to engage in mental fitness.
In Sherrington’s law of reciprocal innervation, he outlines that “posture accompanies movement as a shadow” (Barlow, 2002). By using a similar analogy; “anxiety accompanies intellectual activity as a shadow” (Barlow, 2002). The more we know about the nature of anxiety, the more we know of intellect and of panic. Predominantly, the reaction to panic is to eradicate it. This is an understandable position; however, my argument is that if we can understand anxiety and panic better, we can get to know how to deal with it in an appropriate way.
With anxiety there is a neurotic paradox. D.Hobart Mowrer put it well when he said, “common sense holds that a normal sensible man, or even a beast to the limits of his intelligence will weigh and balance the consequences of his acts, if the net effect is favourable, the action producing it will be perpetuated”. In Neurosis, however, one sees actions which have negative consequences, yet they persist over a long period of time or even a lifetime. Anxiety occurs as people attempt to control what they cannot control (others) or to avoid controlling what they can control (themselves) (Guerin, Fogarty, Fay, Gilbirth, 2010).
What are Panic attacks?
According to the Diagnostic and Statistical Manual Volume 5 (which is used by doctors and Psychiatrists across the world to diagnose condition) “A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four (or more) of the following symptoms occur” (APA, 2013). The symptoms referred to are:
- Palpitations (pounding heart or accelerated tachycardia)
- Sensations of shortness of breath.
This can be similar to the sensation of smothering and is also known as dyspnoea. Other symptoms include feeling of choking, chest pain, nausea or abdominal distress, feeling dizzy, unsteady, light head or faint, chills or heat sensations. Paraesthesias refers to numbness, tingling sensations and is another symptom along with derealization (feelings of unreality) or depersonalization i.e. being detached from oneself. Another sign is the fear of losing control or “going crazy”. The final symptom is the fear of Dying along with the physiological effects of a substance” (APA, 2013). This is commonly drug abuse, medication or another condition. It is important to note that panic attacks can be explained by other mental disorders for example in response to social situations, social anxiety, circumcised phobic objects/situations, obsessions, PTSD, attachment and separation (APA, 2013). Panic attacks can also occur as a result of grief.
Physiologically, panic is a sudden surge of adrenaline into the bloodstream” (Tubridy, 2007). This is a primitive survival reflex. This is the Fight or Flight response. Once the adrenaline molecules are released, it quickly rises to a crescendo and slowly dissipates. Tubridy put it best:
“Psychologically panic is a disorder of perception. This is referred to as the adrenaline cascade and it is the hyper-arousal of the adrenal system. Internal sensations of the fight or flight response are being misread as life-threatening and dangerous. This misinterpretation triggers panic in supposedly safe environments” (Tubridy, 2007).
The fear can then be the panic experience itself; “you have three specific fearful thoughts, you feel certain fearful sensations in your body, and you begin behaving in fearful ways”. Fight or flight is preparing oneself to fight the threat or flee the threat. However, if this threat is perceived as coming from inside you, the first instinct is to resist it. It does not get expressed.
There is a discrepancy in that the external world appears calm and neutral, yet one experiences urgency of feelings inside that alerts an individual to danger. As a result, one censors what one is feeling internally i.e. the outward expression of one’s fear as one judges it to be inappropriate for the calm surroundings one is in. As a result, there is no outward explosion (explosion into action). This is replaced by an implosion and it is felt throughout one’s body. In the human body the nervous system consists of the parasympathetic nervous system and the sympathetic nervous system. The sympathetic nervous system is the emergency involuntary (autonomic) part. In times of panic it releases neuro transmitters and adrenaline to get one’s body ready for action. The parasympathetic system is the restoration system. In times of panic this is alerted to return the system to equilibrium. The parasympathetic system ensures that the panic has a limit and helps reduce its impact and duration.
To understand how this system operates is vital, to know that there is a “shut off” mechanism is important for the client. By definition of the mechanism, the person cannot biologically stay in panic mode. I think it is important to repeat that one cannot stay in panic mode. In our next post, we will discuss the benefit of understanding and talking about panic attacks in relation to psycho-education.
Thanks for reading,