I have found that many of the people who have read my book “Finding God: One Psychologist’s Journey” have asked for more information about coping with anxiety attacks. Therefore I will post about their physiology and coping strategies for minimizing them, hopefully even eliminating them.
Anxiety/panic attacks reportedly effect at least 40 million Americans. This is probably a low ball estimate as only those who have sought treatment were counted. If you go beyond that to the world the number of people suffering anxiety/panic attacks is well within the hundreds of millions. I myself suffered this after my grandmother, who lived with us, died when I was 9 years old. I could not accept the concept of death. Fear of death/illness is the primary cause of anxiety attacks. Claustrophobia runs a close second. Fear in general is by far the main cause of these attacks. Allow me to explain how this came about.
Just as our distant ancestors had two stomachs since their diet was largely roughage. We also developed two nervous systems. A parasympathetic nervous system that controls the functioning of the body throughout the day, and a sympathetic nervous system (often called the fight of flight system). When a threat is perceived the sympathetic nervous system takes over control of the body and causes massive physiological changes. Now the major threat to our distant ancestors was saber tooth tigers. Fortunately we do not have this worry, but it turns out that the sympathetic nervous system can also be activated by fears. When activated the very first thing to happen is that adrenalin and cortisol (stress hormones) are released into the body. Blood flow which is primarily in the stomach and liver where it is needed for digestion and metabolization is rerouted to the peripheral muscles to prepare the body for quick action. Stomach cramping and related issues can result from the lack of blood. In addition to needing extra blood flow the muscles also require oxygen. We start to breathe faster. Too much oxygen can cause light-headedness and itself is a threat to the body. Therefore the brain sends out a message to tighten the chest muscles to slow your breathing. In severe cases the throat muscles can tighten as well. People misunderstand that your body is trying to protect you, and Instead tend to think they are having a heart attack or some related illness. They then become more fearful, and flood their body even more with stress hormones. I have had patients open their window in the middle of the winter and stick their heads outside to get more air since they feel the chest and throat are so tight that they can’t breathe. People who have suffered from this for years are damaging their bodies by the constant release of stress hormones. Fortunately there are things that can be done to minimize even eliminate anxiety/panic attacks.
Strategies to minimize panic attacks
As the major cause of panic/anxiety attacks is fear the obvious solution is to rid ones self from fear. This is not easy but instead a longer term process that I will get into. I will focus first on the shorter term solutions. I was born in 1947 and suffered my first asthma attack in the hospital nursery. The nurses nicknamed me squeaky. My parents and all their friends were heavy smokers and the walls of my house were yellow from smoke. Not until the 1960’s did they have rescue inhalers for asthma. In the late 40’s and 50’s you just lied in bed struggling to breathe. Now as an adult my asthma is minimal but if I have a bad cold it has happened that I will wake up in the middle of the night suffering major anxiety over struggling to breathe. When this happens I have learned to get up, make myself a cup of hot tea, and sip the tea while distracting myself by watching TV and focusing on the content. Most important is to Believe that this will work. Fear will undermine the strategy. What I am doing is slowing my breathing by slowly sipping the warm tea and distracting my thoughts away from fear by concentrating on the TV. A week after returning from the hospital following a stroke I told my wife I have to get back to work (a one hour trip). While driving on the highway I suddenly remembered the doctor saying I could have another stroke at any time. I thought “Oh My God I could get into an accident and kill innocent people.” Immediately panic began. As soon as it did I began thinking “What am I stupid. Having a panic attack will increase my chances of having an accident.” I began thinking calming thoughts and slowed my breathing. Next I turned on the radio to a soft music station and listened to the very words of the songs (distraction). Within a few minutes I was back to normal. The anxiety was gone. The mind is a very powerful thing and you must Believe you can accomplish this. In a sense it is a form of self hypnosis which will work as you practice it and prove to yourself that you do have the willpower to alter your bodily functioning.
For years minor tranquilizers were prescribed by medical doctors for those suffering anxiety/panic attacks. When I received patients before they were under the influence of a psychiatrist I would teach them deep relaxation strategies with suggestions for initiating coping techniques at the first sign of an attack. In more severe cases I would tell people to go to their PCP and obtain a prescription for .5 m.g’s of Xanax and keep it in their pocketbook. If everything I had taught them didn’t do the trick, then and only then, were they to take a Xanax. A good number never took the pill. Just having the medication available provided what I think of as the “Teddy Bear Effect.” If Xanax or any similar pill is taken rarely it will work very well. When it is taken daily your body develops a tolerance for it. Tolerance develops largely for two reasons. First, long term exposure to a drug causes your body to find faster ways to eliminate it, and second long term exposure to a drug causes the protein receptors on cells to become desensitized. You will never find an M.D to explain this. I have seen patients on one drug for more than twenty years. When patients had been under the care of a psychiatrist and taking medication for long periods I had much less success. Why is this? The mind is all powerful and these patients had been taught that anxiety/panic attacks are biological events and can only be treated by biologicals. The truth is FEAR triggers off the release of stress hormones which then cause the physiological alterations to the body.
Today we have an event happening that I think is dangerous. In the early years minor tranquilizers (Benzodiazepines) were prescribed. The dangers were largely 1. becoming dependent, and 2. in major overdose breathing difficulty and possible death. The Drug Enforcement Agency, for some reason, reclassified Benzodiazepines as Class 2 or more dangerous drugs and so required careful monitoring and extra paperwork from physicians and pharmacists. Psychiatrists and other prescribers therefore started prescribing antidepressants for anxiety. Antidepressants are much less useful in treating anxiety (largely a placebo effect), and can have very serious side-effects. Side-effects can range from weight gain, loss of sex drive, suicidal ideology and inability of the body to regulate temperature when SSRI’s are suddenly stopped. This last can lead to death. Antidepressants must never be stopped suddenly. If you plan on stopping them it must be done under a doctor’s supervision. One thing that I found almost no one knew was that medical students only receive one class in pharmacology. Pharmacists and prescribing psychologists receive many, many more classes. I never met one PCP who could explain the pharmacokinetics of medication(this is how the body works to eliminate medicines from the body.) If any medicine, even aspirin, is not eliminated it will kill you. If you have questions your pharmacists may be the best source of answers.
Before proceeding on to the best solution to anxiety/panic attacks I want to give a few case examples that will make the fallacy of medication as the answer for anxiety/panic attack treatment crystal clear in almost all cases.
I will call her Ms. X. Ms. X had the same boyfriend though out high school and college. They became engaged their senior year. The wedding was set. Two weeks prior to the big day Ms. X comes home to a phone message. He is calling the wedding off, and leaves no reason for his decision. She is in a panic state. The wedding is all set. Her parents paid for the reception hall. Relatives had given gifts at the engagement and shower. The bridal party had purchased their gowns. He refuses to answer her calls. For two months she cannot eat or sleep. Panic attacks occur daily. She is becoming more and more depressed. Her parents take her to a psychiatrist. He prescribes Xanax and an antidepressant. Her problems continue. After eight weeks the psychiatrist ups the dosages. Not only is she still not sleeping or eating but the medication is causing nasty side-effects. Fortunately a friend referred her to me. For the first several sessions I allowed her to vent. she needed to get her embarrassment out. I followed this by teaching her deep relaxation and self hypnosis. I made sure to add suggestions for “Thank God you found out now what kind of person he was. Imagine if you were married with children and he suddenly does a disappearing act.” “You are young, attractive and educated. You will get on with your life and make him see what he has missed.” It took awhile, but she got the point. Ms. X became a teacher and went back to school nights. Her problems all but disappeared. She eventually met someone nice and they are now married and have a child. Pills can mask symptoms and do serve a purpose, but they cannot teach a person how to correct the issues causing the anxiety/panic in the first place.
For all the agoraphobics out there here is another case. I will call her Mrs. Y. Mrs. Y suffered panic attacks, and was unable to go outside by herself. Even when walking with her husband or driving in his car she would suffer anxiety attacks. I began by demystifying panic attacks. People need to know that they are not going to die and that anxiety attacks are caused by fears and the resulting stress hormone release into the body. Next I taught her strategies (distraction, slower breathing etc). This was then followed by putting her into a light trance with guided imagery full of suggestions. “God gave you one life here on Earth make the most of it. Each day you will walk one block further. At the end of the block you will take a deep cleansing breath and congratulate yourself.” Fortunately she lived in Brooklyn. By the end of about 4 weeks she was walking the four blocks to a main avenue and going to her bank and local stores. Not a major improvement but enough to improve her life and her husbands.
Finally I will offer a case that every one can relate to. Mrs. Z suffered panic attacks for years. She was also claustrophobic to a good degree. She would panic when her husband was driving over a bridge or God forbid going through a tunnel, and never went on trains because of feeling trapped inside. She had been taking Xanax from her psychiatrist for years, but now knew she needed something more. A friend recommended me. Mrs. Z had to go by train to a relatives bridal shower in Manhattan. Her daughter and several friends would be going with her. She was absolutely terrified at the thought of having a panic attack in front of these people. I only saw her for a half dozen sessions since it was this one thing that she needed immediate help with. As in other cases I placed her in a deeply relaxed state and used guided imagery. I had Mrs. Z picture the following “you are on the train. It is crowded and the several of you are standing around a center pole. You begin to feel nervous and shaky inside. Your breathing becomes rapid. Feel the sensations starting now. Your daughter asks if you are okay.” “You are to respond exactly like this: No I’m not feeling okay. I feel very nervous. I have had this before and know it will go away, but it is so scary.” I told her to say this and everything I promise will be okay. It turned out she went on the crowded train. It was crowded, and the women did all stand around the center pole. Mrz. Z did begin to panic and one of her friends asked if she was okay. She did exactly as I taught her to say, and immediately all of the women started to talk about their anxieties. Once they did her anxiety (anticipatory anxiety) disappeared. She was so pleased she continued to see me for two additional years.
Next I will begin writing about what I see as the ultimate answer for ridding oneself of fear of death/illness. As a heads up it has to do with spirituality, and recognizing that this life is a temporary existence leading to an eternal reality. It all began with a stroke. To heal my brain of symptoms of aphasia I began studying quantum physics, quantum biology and cosmology. Not only did I heal but it opened up an incredible new world to me.
In the last century science has learned more than in all the time before. Most amazing of all the findings occurred when we broke the atom. Now 99.9 % of the space in the atoms that make up your body is empty space, and remember atoms make up everything in the universe. 1% of energy particles are located almost entirely in the tiny nucleus. The nucleus of an atom is like a fly sitting on the 50 yard line of a football stadium. We appear solid because the electrons that surround the nucleus, and revolve around it millions of times each second, share bonds with other atoms and atoms are packed densely. All energy particles in our bodies, plants, rocks and outer space Do Not Obey any of the laws of physics we had come to believe for the last several centuries. Energy particles can be in multiple places at the same exact instant. Possibly even an infinity of places. This is called superposition and is the finding that underly’s the search for the quantum computer. Further, energy particles can communicate with other energy particles even if they are on opposite sides of the galaxy, and they do so in a timeless fashion. This is called nonlocal communication. It may also explain how quickly all parts of the human body know what is happening throughout the body. From a religious standpoint it can explain how God is omnipresent, as it was His energy that began the big bang, and is responsible for all the matter in the universe. If this is the case, as I believe it is, we are all part of our creators energy. Jesus did say look for God within. Most amazing to me was the finding that energy particles have been found to be able to alter behaviors that have already occurred. They can go into the past. Such findings have changed everything we thought we knew about reality, and led to metaphysical studies of such things as prayer. Studies of prayer are difficult with humans because it is virtually impossible to find a control group. Friends and relatives will always be praying for someone very ill. Studies with animals and plants, on the other hand, significantly prove that prayer does help. One human study done in a double blind fashion had women in an in vitro fertilization clinic prayed for or not prayed for. The women prayed for were twice as likely to conceive. There are many other such studies that have proven prayer does help. Additionally there are scientific studies that now prove conclusively that random evolution could not possibly have created mankind, and even further that consciousness can survive death. We do have a creator. Faith is the answer to eliminating uncertainty and anxiety/panic attacks from your life. This materialistic and hedonistic existence we share never was meant to be permanent. I agree with the authors and poets who believe the goal of this life is to face and overcome adversity thereby strengthening the soul. Fear of death has lost its hold over me, as we now know that there are things that are infinite, and our three dimensional minds are limited and cannot fathom the true reality. Faith in a creator who has unconditional love for us is the answer to fears of the unknown.
The solution to anxiety/panic attacks therefore is
- Slow deep breathing will slow the release of stress hormones into the body
- Distraction techniques will minimize fear and fearful thoughts.
- Meditation and self hypnosis will not only relax the body but will reinforce positive thoughts
- Faith in a creator will do away with fears of death and the unknown.
- Medications, such as tranquilizers, work well when used only as a last resort.
I suggest that anyone having a panic attack open this blog and concentrate on the words you are reading. Slow your breathing as you read, and please let me know if it helps and how much. Also please share the blog with anyone suffering anxiety/panic. I may be a retired clinical psychologist but I still want to help people suffering this terrible disease. My hypothesis is that people not taking medications will be helped greatly. People on long term medications will be helped but less so. I will let you know the results.