Anxiety Attacks

 

Panic Attacks—Most of the clients I have seen have had at least one Anxiety Attack in their lives.  They find tremendous relief in the first session finding out what is physically happening to them. (see section on A Handy way to see the Brain).  My job is to be sure the client knows they are experiencing an activation of the Flight, Fight, Freeze and Flop (FFFF) response.  Prior the 1995 revision of the Diagnostic and Statistical Manual (DSM-IV) two types of acute anxiety reactions were differentiated. I still find the difference useful because of the likely difference in the recovery process.  A Panic Attack generally comes on quickly, lasted from 1-20 minutes and ends abruptly.  People report the end being so sudden it takes their breath away.   An Anxiety Attack comes on gradually, lasts up to two hours and slowly loses its force.  People reporting Panic Attacks almost always say they felt like they were going to die. Both types of episodes have residual effects.

The worst part of Anxiety Attacks is their chronicity.  People become worn-out from the effects of the last one and fear of the next one.  The worst part of a Panic Attack is its intensity.  Sufferers will be exhausted afterwards and may remain afraid of the next one for years or decades.  The sudden onset of a Panic Attack often gives us an advantage of having a recognizable set of circumstances we can help the client illuminate.  Recognition at an ever earlier moment is the primary part of recovery.  When the client can notice precursors and relax before the Frontal Lobe turns itself off, they have a much greater likelihood of the FFFF response not being initiated.

With all forms of Anxiety Disorders the thinking leading up to and during the episode will include a declarative internal statement of: “I can’t________, but I must___________”, or “ I have to________, but I don’t want to_________”.  The most frequently reported place people experience this trap in their thinking is in the grocery store.  The etymology of the word Agoraphobia  (one of the types of Anxiety Disorders in the Diagnostic Manual) is fear of the market place.  I always imagine a herder coming over the rise to see the longed-for market place.  He has been alone with his animals and thoughts.  On many levels he wants to go into the market place.  His business and resupply need to be done there.  He wants involvement with people. On the other hand he is afraid of being taken advantage of,  or be ridiculed or criticized.  The worst fear comes if he has experienced some type of anxiety reaction in the past. His  biggest fear is he will have an attack.  The modern day person has to go get their groceries to survive. It is a perfect setup for an Anxiety or Panic Attack.  “I have to go to the store, but I can’t do it if I have a Panic Attack”.  If they don’t go they increase their desperateness and add more tension to the next attempt.  If they do go and have an attack they get nothing accomplished they increase their desperateness and add more tension to the next attempt.  The word, “but” is used here as a contradiction.  The only way out of this dilemma is to consciously choose one side of the equation or the other.

If the herder chooses to not go into the market he will slowly starve to death, besides becoming less capable of being around people.  If he prepares by relaxing himself thoroughly and survives the encounters with others he can repeat this ritual the next time.  Most exaggerated fear of endangerment is built by avoiding the repetition of historical situations and feelings leading up to an episode of exaggerated fear of endangerment.  This self-fulfilling cycle only gets interrupted when the sufferer becomes aware of the cycle and relaxes.

Anti-anxiety medications have cause as much trouble as they have provided relief for anxiety.  They are a class of medicines called Benzodiazepines.  Benzodiazepine is the depressant chemical released when alcohol is broken down in the body.  It is particularly active as a Frontal Lobe depressant.  The Frontal Lobe will have diffuse activity and less over-all activity.  In order to modulate impulses from the brain stem, like anxiety, concentrated Frontal Lobe activity is required.   The benefit of these medicines comes because it is harder to be aware of brain stem impulses if you are compromised in your Frontal Lobe.

Valium was the first developed benzodiazepine.  It had a half-life of longer than a day.  A person took it to go to the grocery store and had a depressed Frontal Lobe for the rest of the day.  Xanax, one of the later developed benzodiazepines, has a much shorter half-life, which may mean the next dose needs to be taken sooner. The ability to observe an exaggerate sense of endangerment returned fairly abruptly.  People tended to need to take the fast dissipating benzodiazepines more frequently, or face the same feelings they avoided a few hours ago. This cycle can lead to a type of dependency.  Any prolonged use of a benzodiazepine challenges the Frontal Lobe’s inhibitory function of anxiety.  In the short-term, seven to ten days, benzodiazepines allow a person to not notice the anxiety welling up from their brain stem.

Recovery is definite if you are treated by a knowledgeable practitioner.  At the bare minimum the client will learn the phrase, “This too shall pass”.  Hippocrates, the father of medicine, wrote about Anxiety Attacks.   In all our document history since, no one has died yet of a Panic Attack.  People do build-up fatal musculature around their hearts because of the rapid heartbeat of FFFF.   Either type of attack is a built-in survival mode to deal with a life-threatening situation.  This built-in reaction won't kill you.  It is very unfamiliar and if you are afraid of it, it gets magnified.

In a psychoanalytic sense anxiety is caused by a lack of an attuned response to a felt sense of endangerment.  By feeling attuned to by a therapist who seems to understand their anxious feelings, the client is no longer alone with the unbearable affect.  The “I can’t, but I must” situation can be looked at objectively.  Recovery is about make a choice of which side of this contradiction to act on.  The beauty of the recovery process is related to the repetitive nature of the problem. If the client can develop a realistic response to thinking they are trapped, they can use the same response in many other situations.