Carlos Whittaker is new to me – a blogger I was introduced to a few months back by another of my fave peeps who also follows his blog, RagamuffinSoul. Carlos is a “faither” honest, sometimes raw, but seems (so far) to be authentic. The kind of person whose self comes through the words in every post. He’s funny, irreverent, questioning, and committed all at the same time.
This week I read a post that was particularly interesting to me. Apparently, after many months, he’s had a panic attack. His particular version wakes him up in the middle of the night ~ you can read about it for yourself here ~ and the post is his effort to process how he feels about this.
Anxiety is a disproportionate part of my practice (often combined with depression, but not always) and while the degree of anxiety falls along a continuum, I regularly have clients whose lives have deteriorated to a single-minded focus on avoiding panic. Their minds are constantly occupied with the dread thought that anxiety will overwhelm them in a place where they will not be able to manage the panic or recover themselves. Consequently, everything that could possibly trigger an attack is ruthlessly purged, and for some of my clients, this shrinks their lives to the four walls of home. Eventually, even the thought of going outside the front door brings on the impending symptoms of panic.
For some people, anxiety must be managed. Generalised Anxiety Disorder is just that ~ generalised. Even after years of hard work, some of my clients still have “lightning bolts of anxiety” without any discernible cause. And for others, anxiety is their first reaction to ambiguity, change, or disequilibrium in any context.
Here’s where the great divide happens – there are those who believe that panic attacks are the result of an emotional response to thinking; therefore, change the thinking and voile! no more panic attacks. The other side of the divide says this type of anxiety is hardwired into a person’s neurological system, and may be triggered by circumstances or thoughts but is essentially a body system run amok. The answer is normalising this inherent response and providing coping tools for management. (Anxiety is a normal response in appropriate circumstances and the goal of therapy should never be to completely eliminate the experience of feeling anxious.)
Having worked with anxious people for nearly 3 decades now, I (very unscientifically) observe that there does seem to be validity in the second perspective. Some people’s autonomic (not automatic) response to life is anxiousness. That rather than thoughts (automatic or subconscious) triggering the emotion which then leads to the panic, it is a response much more visceral than that. It’s not about what the client may think or not think, it’s about a body system that is highly attuned to the environment and a hair-trigger on the alert system that produces the adrenalin rush.
However, I would also observe that perspective is everything.
That adrenalin rush happening at 4 am is a shock. The same adrenalin rush happening as one jumps out of a perfectly good airplane is welcomed with exuberance and joy. Same body system, same neurological effect, same physical sensations. But one situation causes more fear and panic, the other produces euphoria. (They’re not called “adrenalin junkies” for nothing)
I’ve found the difference is in the meaning making. Clients who are experiencing middle-of-the-night panic attacks go through a whole thought process that is completely different than the skydivers. Most commonly I hear words of fear, self-criticism, rampant speculation, catastrophising, and disappointment. Almost universally my clients who struggle with what they would call ‘no reason panic’ also have great difficulty normalising the experience and gaining a realistic perspective on the episodes. If the client has been struggling with panic for a long time, the greater anxiety is almost never about the panic attack itself, it’s about having a panic attack.
It’s a bad place to be.
If there is no “cure” for a hardwired anxiety response, then how about management?
If you haven’t taken the time to read Los Whit’s blog about it, go ahead and do that. He manages his panic using techniques and skills that he’s learned over the years. His particular toolbox includes medication, an option not everyone will choose. But it is an option.
I spent a year doing Neurofeedback Therapy to change the brainwave patterns that pointed to being hardwired for anxiety, I learned relaxation techniques, how to recognise signs of an impending panic attack, and how to manage myself when one did happen. I personally feel the process was successful. The hair-trigger is much more manageable, and now my 4 am panic attacks happen rarely, and when they do, I manage them. I’ve also learned those attacks are much more likely to happen when I am overtired, stressed, or have stopped investing in the self-care rituals that refresh my soul, calm my mind, and recharge my psychological and emotional equilibrium. Mostly, I no longer castigate myself for the fact of the panic attacks. They just are, and I deal with them.
There are many, many things that can be done to ameliorate the discomfort of panic attacks, and I say this from a place of personal experience – life became so much more interesting when I stopped panicking about panicking. There’s no need for that, for sure.
Therapy works – primarily, Cognitive-Behavioural Therapy is the gold standard for this condition, but there other forms of psychological help that also work. Keep looking until you find someone who can help. It’s worth it.