endanxietyblog

Dr Pamela Polcyn Phd, MFT


Let Go and Live: 5 Keys to letting go

“Do everything with a mind that lets go. Don’t accept praise or gain or anything else. If you let go a little you will have a little peace; if you let go a lot you will have a lot of peace; if you let go completely you will have complete peace.”  Ajhan Chah

Each day we faces challenges, novelty, adversity, conflict and the resulting feelings of discomfort, uncertainty, fear and frustration. We easily get stuck in either our focus on the events, the people involved or our reactions to them. We get caught in the merry go round of thoughts or feelings that are triggered and lost in the resulting internal chaos. We end up holding on to situations that neither warrant our attention or our focus.  Our moods are affected, our concentration is interrupted, our ability to be present to those around us impacted and our behavior is not what it could be.

Each of these situations offers us the possibility of seeing the situation and our reaction for what it is and letting go.

 

How do you let go of something that is bothering you or that is an obstacle to happiness? Do you feel irritated about mistakes or behaviors that fall short of your expectations and go over them again and again in your mind? Are you worried about how someone has reacted to what you said or did and can’t stop thinking about it? Are you facing situations where you feel a lack of control or feel powerless and worry constantly? Are you having difficulty letting go of unproductive thoughts or behaviors?

When uncomfortable or unpredictable life events occur, how you react determines the possible emotional and psychological fallout from the situation. If you have grown up with erratic individuals  or unstable circumstances, there is a stronger likelihood that your response to stressful occurrences will be to increase attempts to control yourself and your surroundings. Moving a lot, alcoholism, or changing schools repeatedly in childhood contribute to the development of feelings of vulnerability and can contribute to the development of maladaptive behaviors, coping mechanisms or styles of control. This can sabotage the letting go process.

The habit of controlling uncomfortable feelings interferes with learning to acknowledge, process, and let go of the feelings themselves. Frequently these attempts to control are rigid and ineffective. Unrecognized or discounted feelings, especially when combined with attempts to control, can fuel severe anxiety or a tendency to hold onto things rather than let them go.  Situations as mundane as missing a stoplight, getting the wrong change at the cash register, or waiting for someone who is running late can provoke an excess of anger and stress. When unrecognized, the resulting stress accumulates and leads to behaviors such as inappropriate anger, out of control anxiety, and possibly illness.

Learning to face these moments of stress with equanimity prevents small stressors from building to a problematic level and enables the process of letting go. Holding on is the opposite of letting go. This reaction keeps us stuck, unproductive and unhappy. We hold on when we attempt to control.

When we continue to feel irritated about mistakes in ourselves and others we are holding on to both the feelings of irritation and the thought that things should be different. When we do not notice or are not present for feelings that are evoked in difficult situations we end up unconsciously holding onto the situation and the feelings. We can get stuck in wanting to let go while at the same time engaging in old behaviors that promote holding on such as ruminating or engaging in continual distraction.

Letting go is the key to not getting stuck in these old habits. Letting go of thoughts, feelings and behaviors is possible and can be facilitated through the development of skills such as changing an attitude, altering a perspective or using an emotional release or regulation process.

5 Keys to letting go to letting go are:

1. Attitude Change: Note thinking patterns such as all or nothing thinking, catastrophizing, or underestimating your ability to cope that are perpetuating negative or perfectionistic thoughts about a situation, yourself or another. Switch to a more realistic attitude.

2. Feelings Release: Write your feelings out until fully expressed. Spend time being compassionately present for them. Exercise to release anger residue. Practice a conscience attitude of acceptance until the feeling passes.

3. Problem Solve: Use the abc’s of problem solving: a. identify the problem; b. brainstorm as many options as you can; c. list the pros and cons of each; d. decide on your first, second and third choices; e. action the first choice; f. evaluate the result and if dissatisfied try the second option. Continue until a solution is found.

4. Perspective Shift: Zoom above the problem and yourself and look at it from a distance, think Google maps, as though looking at a specific location from space. Put the problem in a prayer box to be resolved by something bigger than yourself. Imagine the advise you would give yourself five years from now about the situation.

5. Breathe into the Here and Now: Take three complete breaths focusing on the release of tension with each exhale. Slowly and steadily note and label 10 objects in your environment as you breathe. Notice and accept what your body and emotions are doing as if observing someone else.

By changing the habits that perpetuate holding on when stressed you can learn to let go of events as they happen. Rather than accumulate stress you can learn to release it when noted before it becomes problematic. Tackling smaller challenges is easier and more effective than waiting until they become overwhelming. Letting go can become a good habit when practiced. Learn to let go and live.

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Loss During the Holidays: The Art of Losing

In the process of searching for the owner of a lost dog in the neighborhood, a 4 pound pomeranian who had run off and joined a walk with some large rather tough looking dogs, I received several calls from distraught owners of lost animals hoping that somehow we had found their pet. They had seen the sign or the Craig’s List ad and hoped we had found their animal companion. I was reminded when talking with each of them of the many people who are suffering, probably silently, in some stage of grief and loss during this festive season. I was reminded of how difficult it can be to celebrate the holidays when sad and when missing something that was beloved in life.

Holidays don’t take away these grief experiences  In fact they can heighten the experience, emphasizing what is missing or absent. Distraction can temporarily alleviate the pain of loss but invariably something brings the loss back to mind. The holiday expectations of happiness and joy, of companionship and family, often act as a hard backdrop to the realities of changed circumstances involving loss that have evolved in many people’s lives.

Intense grieving can last from three months to a year after a loss and frequently continues for several years. Emotions need attention, understanding and compassion during this period in order to be processed and integrated. Giving oneself kind attention calms the often painful feelings of sadness or anger or emptiness. Making some formal expression of remembrance, giving a donation, planting a tree, planning a memorial, can help to create a positive context for the loss. Allowing grieving space in amidst the festivities can help to soothe uncomfortable emotions.

Although there are different theories about grief, there is no right or wrong way to grieve. Finding a balance between grieving and continuing on with a productive life after the initial shock of a loss will aid in incorporating loss into life. Loss is part of our life and part of what make us cherish what we hold near and dear to our hearts.

One of my favorite poems emphasizes the importance of developing this capacity in our lives, this capacity to lose. Elizabeth Bishop describes this as the “art of losing.” What better way to describe this valuable life lesson and challenge, this truth about living.

One Art

The art of losing isn’t hard to master;
so many things seem filled with the intent
to be lost that their loss is no disaster,

Lose something every day. Accept the fluster
of lost door keys, the hour badly spent.
The art of losing isn’t hard to master.

Then practice losing farther, losing faster:
places, and names, and where it was you meant
to travel. None of these will bring disaster.

I lost my mother’s watch. And look! my last, or
next-to-last, of three loved houses went.
The art of losing isn’t hard to master.

I lost two cities, lovely ones. And, vaster,
some realms I owned, two rivers, a continent.
I miss them, but it wasn’t a disaster.

– Even losing you (the joking voice, a gesture
I love) I shan’t have lied. It’s evident
the art of losing’s not too hard to master
though it may look like (Write it!) like disaster.

The important lesson she teaches us is to notice small losses and to put them in perspective. In doing so we prepare for losses that are more challenging.  We develop the ability to integrate loss with an attitude of acceptance.
As we assimilate these losses and the accompanying emotions, we create room for new things to come into our life. Our focus moves to the many possibilities that surround us and opens to things we may never have imagined. We gain, as we have lost. We develop resilience, the ability to rebound from the difficult internal reactions we have to challenges in life.

When we stop and appreciate the  wonderful moments shared with those lost to us, it helps us to focus on the gift of their presence in our lives. An attitude of gratitude has been shown to help in dealing with many uncomfortable or distressing emotions. Gratitude reopens closed hearts and reorients us to difficult situations with a new perspective.

So, after several hours of putting out the word, the teacup pomeranian was lost and found no more and was reunited with his tearful and grateful mom. We left, a little at a loss, after having been absorbed into the life of this fun and rambunctious tidbit. Our gain was the delight of this lightweight curious creature for a few moments who goes through life with no fear and with love, warmth, and curiosity. Our gain was the reminder of the importance of learning the art of losing and the importance of lending a compassionate ear to those dealing with loss.


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WHICH MEDICAL TESTS TO HAVE FOR YOUR MENTAL HEALTH

 

You are experiencing increasingly disturbing feelings such as stress, worry, hopelessness, sadness, irritability, or guilt.  You are breaking out into a sweat, experiencing tingling in your extremities, have shortness of breath, feel faint or dizzy, or feel continuously weak and exhausted. You find yourself questioning whether you are exaggerating, physically ill, or going crazy. You wonder who to turn to for help and wonder if you should see a doctor, a psychotherapist, or go to an emergency ward.

It is often difficult to discern which course to follow to get the most accurate diagnosis and treatment for confusing symptoms. Certain medical tests can help to exclude medical conditions as the cause of your suffering. Although physical conditions may not be the sole cause of the discomfort you are experiencing, they may be a contributing factor in the development and depression of depression and anxiety symptoms.

Low thyroid function, or hypothyroidism, is the most frequently associated medical condition with symptoms of depression. Thyroid hormones control cellular activity in the brain and the nervous system. Symptoms of forgetfulness, fatigue and slowed thinking can occur along with physical discomfort such as coldness in the extremities, reduced body temperature, weight gain and constipation when the thyroid is not functioning correctly. A diagnosis of this condition is made through blood tests that measure hormone levels.  If treatment is necessary, daily supplementation of hormones can reduce much of the discomfort.

Anemia is another possible contributor to depression.  It involves a decrease in the number of red blood cells that carry oxygen.  It can result in drowsiness, fatigue, irritability, depression, anxiety, insomnia,  and difficulty concentrating.  Anemia is diagnosed through a blood panel and treated with supplementation.

Hyperthyroidism can cause both anxiety and depression symptoms such as edginess, irritability, insomnia, palpitations, sweating, exhaustion, and anger outbursts. Radiation, drugs or surgical suppression of the gland  treat this disorder.

Other conditions that can cause mental health symptoms include some of the following disorders.

*Cushing’s Disease, which involves a low functioning adrenal gland, can cause fatigue, nausea, impotence, decreased appetite and other physical problems.  Blood tests will determine if this illness is a factor in causing your symptoms.  Supplementation and other treatments are effective in controlling this disease.

*Hypoglycemia, or low blood sugar,  can cause symptoms of confusion, fatigue, faintness, sweating, and nervousness.  Blood tests determine if this is a factor in causing the symptoms that you are experiencing. Treatment recommendations include eating frequent meals and decreasing the intake of  simple carbohydrates.

*Central nervous system injury and illness such as stroke, multiple sclerosis, head trauma,  tumors, and some cancers are associated with depression symptoms.

*Medications can also trigger depression and anxiety.  Sleep medications  can cause depression, drowsiness, amnesia or forgetfulness.  Prednisone and cortisone can lead to restlessness, confusion, hallucinations, mood swings, and personality changes.   ADD medications  can cause anxiety, irritability and insomnia.  Seizure medications  can cause depression, irritability, fatigue, and mental slowing.  Allergy and asthma medications can lead to agitation, insomnia, nervousness and drowsiness. Anxiety medications have the possible side effects of insomnia, depression, mental slowing, and confusion.  Antidepressants  have the possible side effects of irritability, insomnia, and agitation.   Beta blockers  can cause fatigue and insomnia.

Although this is only a partial listing of possible diseases or medications that can cause mental health symptoms, a physician can help you in determining the diagnosis of possible physical conditions and in assessing the proper use and dosage of any prescribed medication.  A medical professional can also assist you in assessing possible nutritional deficiencies, sleep problems, food allergies or other physical problems that may be contributing to your mental health condition.

A psychotherapist can work with you to reduce your mental health symptoms and to reevaluate any lifestyle factors which are contributing to your mental health condition.  A combined medical and mental health evaluation will offer you a more complete picture of  the factors that may be contributing to your discomfort.  This can result in developing a more effective treatment plan for your symptoms.


A Sigh of Relief in the Presence of Kindness

Listen to this post  “Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”  –Leo Buscaglia, author (1924-1998)

Suffering and pain are such a part of life, and yet our response to these states in ourselves and others is often ripe with confusion and discomfort.  How are we with the pain that occurs on a regular basis?  How present can we be with the discomfort in ourselves and others so that we can move to a deeper level, find resolution and relax into acceptance and being available to ourselves and others.

We tell ourselves we are fine and brush off the “I’m fine” in others in order to avoid a dialogue with ourselves or with them, or to avoid the possibility of moving into a deeper connection. We’ve all experienced a sigh of relief when we speak to someone and feel listened to and understood, as though we could sink a little deeper into whatever surface on which we sit, the jaw drops, shoulders relax, toes uncurl.  Superficial discomfort and confusion disappears.

Emotions, even the very painful, become less uncomfortable and  more tolerable, even if there is a temporary escalation in discomfort .  Suffering dissipates. Turning inward, observing from that same unconditional part of ourselves, totally present for the emotional reaction of current or past experiences, offers that same sense of being understood.  Taking a small step back from being overly identified with  thoughts and feelings offers an opportunity for the pain to loosen and let go.

Self-regulation is this relaxed alert state from which the embodied states of suffering can be calmly witnessed. Rather than judging, evaluating or pushing away these reactive feelings and thoughts, allow yourself to observe, soothe and calm these parts of you.  Make room for the feelings and thoughts you or others experience, for the the human experience.  Contain these feelings within a state of compassionate understanding.

See these experiences through the eyes of compassion and with the ears of understanding. And next time you see suffering in the eyes of another or sense suffering in the eyes of some younger part of you, take a breath, be present, and become part of the transformation process, offering a little kindness.   Move towards rather than away from the pain and watch calm replace fear and suffering.


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SIX WAYS TO HEAD OFF A PANIC ATTACK

Panic attacks are terrifying, one of the most intense states you can experience. They are sudden and accompanied by a variety of physical symptoms including tingling in the hands and feet, shaking, trembling, sweating, dizziness, feeling weak or like you are going to faint, shortness of breath, choking sensations, or heart palpitations. Psychological fears include fear of dying, fear of losing control, fear of severe illness.  These fears cause can lead to feelings of unreality, a strong impulse to run away, or a freeze response. The experience of one attack can precipitate a pattern of reoccurrence, a panic disorder. Panic disorders occur in about one out of seventy five people and usually begin in the late teens or early twenties.

Although extremely uncomfortable, panic attacks are not dangerous. The body mind reaction is part of a built in mechanism in the body called the fight or fight reaction, a survival mechanism millions of years old.  This instinct prepares you to fight or flee in a potentially dangerous situation. It mobilizes the body to withdraw energy from non essential areas of the body and focus them on the areas required to survive an emergency situation.

There are short term and long term strategies that are essential for responding to panic attacks. Behavior patterns frequently develop in reaction to the feared state and can increase the likelihood of developing the panic habit. Although you may only have one attack, or periodic attacks every few years, you may also be one of the people who begins to have them in increasing frequency and duration and develops a panic disorder.

Specific changes in lifestyle can affect the likelihood of panic reoccurring.

1. Exercise: Research has shown that increased levels of physical activity can prevent panic attacks as well as antidepressants.  People who exercise are less likely to experience anxiety disorders in general.  People who work out regularly have improved blood flow to the brain and improved mood. A combination of aerobic, stretching and strength training is recommended. This increases energy, distracts from the worry habit that feeds anxiety, lowers stress levels in the body and mind, and releases the feel-good chemicals in the body.

2, Relaxation: The relaxation experience is at the opposite end of the spectrum from anxiety. Although research has not shown an improvement in the treatment rate of panic disorder patients when relaxation is combined with the use of Cognitive Behavioral Therapy and Desensitization, the use of relaxation in treatment has been found to assist in the recovery process. Relaxation exercises include breath training, progressive muscle relaxation training, and visualization.  Some treatment methodologies employ a biofeedback type of training that involves learning a new style of breathing that can counter the tendency to hyperventilate during the panic attack itself.

3. Reevaluation of mistaken beliefs/ Demystify the condition : The initial phase of treatment for anxiety disorders usually involves an educational process where the fears an individual experiences about having panic attacks are dispelled by facts.  The essential experience of panic is a lack of control over the body which leads to fears of death, losing control and illness. Education about the factors that contribute to the origin and reoccurrence of panic are helpful.  Information regarding the tendency to overestimate the danger and threat of a panic attack is an integral part of cognitive therapy which has been shown to be highly effective in the treatment of panic disorder.

4. Supportive self talk: What an individual says to him or herself prior to and during a panic attack can be helpful or hurtful.  Misinterpretation of the symptoms experienced during an attack increase the likelihood of the reoccurrence of the attack. Supportive self talk that is based on a more realistic estimation of the situation and that assists the panicked individual in either heading off or shortening the experience can be learned. Combined with the use of proper breathing, the person with a tendency to panic can prevent much of the panic normally experienced. The use of phrases such as  ‘so what’ , and  ‘this is just anxiety and I am not going to let it get to me’  are helpful forms of self talk that can minimize the escalation of the uncomfortable symptoms experienced.

5. Float:   Attempting to resist or fight the possibility of anxiety can exacerbate the likelihood of it occurring.  Claire Weeks developed a four-step approach for coping with panic that includes facing the symptoms rather than running away from or fighting them.  She suggests floating through the process of the escalation of symptoms in the body, allowing time to pass so that the adrenalin-based symptoms can naturally abate and the body can calm itself down.  If the fear is not fed by self talk like  ‘I can’t handle this’ or ‘something bad will happen,’ panic will begin to subside in a few minutes as the adrenalin released in a panic attack is reabsorbed into the body.  The key to this floating through process is developing the ability to take an observer’s stance and step back from the experience, to observe the body’s reaction without reacting to it.  The use of phrases such as ‘this too will pass’  or ‘this is not dangerous’ can be both reassuring and supportive  in the process of moving through a panic attack.

A structured approach to the treatment of anxiety after a thorough assessment is the best approach to the resolution of this condition.  A course of medication can assist the panic disorder sufferer in recovery, however research on methods such as Cognitive-Behavioral Therapy have been shown non pharmaceutical approaches to be equally effective.  This is a treatable condition.  Successful strategies can be learned and practiced that can prevent the reoccurrence of panic attacks.


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Anxiety 101

ANXIETY 101

Anxiety is the number one mental health issue for American women according to the National Institute for Mental Health and the number two issue for men after addictions. Only a small percentage of those with this condition receive treatment despite the fact that over 40 million adults suffer from it.

The average person experiences some worry over everyday concerns such as finances, health, work, relationships, or abilities. The anxiety sufferer experiences constant fear and preoccupation with these issues, and avoidance of situations that might trigger further anxiety arousal. The anxiety can range from a mild disturbance to a full blown panic attack.

Why does anxiety seem to be on the rise? Stressors and the resulting stress experienced by the general population has been on the rise in the last 50 years. Americans report an increasingly uncomfortable level of stress in their lives. The pace of life is rapid, the time to adjust and accommodate to changes is diminished.  Different sources estimate that anywhere from 50 – 90 % of adults conclude that they are experiencing stress in at least one area of their life. A period of stress usually precedes a bout of anxiety.

Stress is an arousal response to a situation, distress.  Anxiety is a reaction to the stress response, that includes worry, nervousness and panic. Stress is defined as emotional, physical or mental strain usually precipitated by an external situation or event, a stressor.  Anxiety is a subjective state of tension or uneasiness whose source is unclear, where the focus is internal. When stressed, an individual may experience a gap between what is being demanded of him or her in a situation and the perceived resources he or she has available  to respond to the situation. When anxious, the danger may be unclear, the feeling  that “something bad is going to happen.”

Thoughts, feelings and behavior are affected by stress.  The physiological responses to stress include headaches, muscle tension, fatigue, changes in sex drive, sleep difficulties, chest pains, or digestive problems. Emotional responses include irritability, inability to focus, sadness, or tension.  Behavioral responses include an increase in addictive behaviors such as smoking or drinking, social withdrawal, or angry outbursts.

A major stressor can trigger anxiety. Anxiety affects the body, mind, and emotions and can range in severity from mild uneasiness to severe panic.  The anxiety sufferer gets caught in a worry cycle of constant concern about daily activities, exaggerated focus on possible dangers, or persistent apprehension of a catastrophe. Fears of dying, going crazy or loss of control are common.  The body responds with heart palpitations, trembling, shaking, nausea, dizziness, hot flashes, and shortness of breath. Concerns mount about facing one or more of the feared situations. This worry or anticipatory anxiety leads to persistent avoidance of situations that might trigger or worsen the symptoms.

Anxiety is an integral part of today’s lifestyle. Sometimes when anxiety  arises in response to a specific situation, it is a reasonable reaction. Events that have the potential for loss or failure are challenges frequently faced with some anxiety. The anxiety provoked in these types of situations can provide momentum for facing these situations with increased attention and preparation if it is manageable.

Situational anxiety is a specific type of anxiety that differs from fear in that it is unrealistic and overblown.  Fear of driving on freeways, fear of conflict, fear of dentists or doctors are examples of this type of anxiety. The anxiety has not yet progressed to the phobic stage where anxiety producing situations are consistently avoided but they still induce uncomfortable symptoms for the individual facing the activity.

Even thinking about a particular situation can create distress and uncomfortable physical symptoms.  This is called anticipatory anxiety.  It is on the severe end of the worry spectrum. Thoughts are persistent and have an obsessive quality especially when the sufferer is faced with the feared situation. Anticipatory panic is the label given to a  pattern of the the worsening and intensification of the anxiety symptoms.

These experiences make it difficult for the anxiety sufferer to experience a sense of stability in their everyday life.  Daily life becomes either mildly or extremely unpredictable. Completing everyday chores, work, or even taking care of oneself can become overwhelming. Sleep can be disrupted, as can relationships and careers.

Treatment is about coming home to to a more consistent and manageable response to work, relationship and life challenges. Recovery is about developing an increased ability to cope with the stressors that arise. Finding an internal sense of calm from which one can respond to life in a more relaxed, authentic way is the result of a clear, focused approach to the treatment of anxiety, not as just a collection of symptoms but as a treatable condition reflecting the individual’s lifestyle. Effective treatment addresses the individual, not just the body’s reactions.


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PANIC ATTACKS: FIVE EFFECTIVE WAYS TO RESPOND

Your body has a mind of its own during a panic attack. A built in fight or flight alarm mobilizes the body to react in an extreme fashion to neutral and sometimes indeterminable triggers. Psychological rather than physical dangers become threatening. You perceive a situation as overwhelming and your body reacts. An argument with your boss, going to a party, driving in a new area, or virtually any situation is seen as dangerous and can lead to a sudden episode of extreme fear and apprehension.

Panic Attacks are a type of anxiety disorder.  They are characterized by out of the blue, recurrent episodes of extreme fear and apprehension.  Fear of death, loss of control, or illness, or more generally fear that something bad will happen accompany these attacks. The attacks can last a few moments or can continue in waves over a few hours. It is estimated that 10-15% of the population experience panic attacks occasionally with about 2% developing a panic disorder.  These panic disordered individuals begins to avoid circumstances that remind them of the prior panic attacks.

The causes of  these frightening attacks are not clear.  Genes appear to have some influence as twin studies show at least a 40% likelihood of occurrence. There are numerous factors that contribute to their onset including biological triggers, environmental triggers, childhood triggers and an accumulation of stressors. Both nature and nurture converge to launch an individual into this pattern. A combination of predisposing factors which occur biologically, environmentally or in lifestyle contribute to the development of  this condition.

Panic attacks occur in the area of the brain called the amygdala which is the fear center of the brain. This area becomes over activated during a panic attack.  When people experience stress, the sympathetic nervous system mobilizes quickly, energy is released and the body prepares for action to cope with predators or other survival threats. When the parasympathetic system , whose job is to to calm the body down, is unable to cope with this sudden arousal and stabilize the body, the individual may experience the heightened arousal state of panic where feelings of choking, a heart attack, fainting, going crazy or dying erupt.

These episodes of panic usually occur rapidly, abruptly and intensely. The adrenals release a large amount of adrenaline which revs ups the body leading to feelings of dread or terror. An individual experiences shortness of breath, excessive sweating, cold hands and feet, shaking or trembling, dizziness, contractions in the chest and throat leading to a sensation of being unable to breathe. The body is jolted into preparation to run or fight even though muscle contractions activated by the sympathetic nervous system can trigger a freeze response and a sense of immobility.

The panicked body triggers a change in breathing which affects carbon dioxide levels in the blood. The amount of carbon dioxide in the body accumulates building up quickly and activating a terror generating system in the body. Carbon dioxide experiments at the University of Iowa indicate that not all individuals with these imbalances in the body experience panic. For those that due, the panic feels unbearable.  Those with panic attacks appear to be more sensitive to carbon monoxide inhalation than those without the condition.

Hyperventilation occurs if you over breathe or breathe through your mouth either causing panic attacks or contributing to them through the aggravation of physical symptoms. The body increases in alkalinity resulting in feeling jittery. The level of carbon dioxide decreases and causes your heart to pump harder and faster. This can  result in lights appearing brighter or sounds appearing louder. Brain vessels constrict  and decrease the amount of oxygen that gets to the brain resulting in dizziness, disorientation, or a sense of unreality.

Due to the multi causality of panic attacks, a multidimensional approach to dealing with them is appropriate.  A few effective approaches include:

1. Reevaluate breathing patterns: Although conventional wisdom has recommended deep, slow purposeful breathing techniques for coping with panic attacks, current research is suggesting something different. Breathing shallowly, as though sipping air, can reverse shortness of breath, dizziness and other panic attack symptoms. Breathing slower and shallower can feel strange at first as though you are not getting enough air. Treatment modalities are available that employ objective mechanical feedback on the level of oxygen in the blood as you get used to this new type of breathing. The daily practice of 15 minutes of breathing twice a day is recommended to develop good breathing habits. There are many other types of breathing whose goal is to regulate the breathing pattern and slow the breath. Practicing these techniques when you are not anxious is of great benefit.

2.Do regular exercise: Exercise contributes to a reduction in muscle tension and stress and therefore all types of anxiety. There is growing evidence that  developing an enjoyable exercise regime that incorporates light aerobic exercise 4 times per week can reduce both anxiety and panic. Exercise has been shown to enhance mood, improve sleep quality, reduce physical and mental tension and improve energy levels. It can reduce stress hormones implicated in the development of anxiety symptoms, produce mood enhancing chemicals such as endorphins which regulate stress reactions in the body. It decreases anxiety sensitivity which is an individual’s sensitivity to the symptoms of stress. Research also indicates that exercise reduces the intensity and frequency of panic attacks.

3. Streamline your diet: Identify and eliminate food triggers through keeping a food diary. Certain foods appear to contribute to either the likelihood of anxiety or the intensification of the symptoms of anxiety or panic, decreasing sleep quality and increasing panic attack frequency. One of the biggest culprits is caffeine. It can trigger feelings of nervousness, irritability, anxiety and panic. Sugar can also lead to panicky feelings in the body.  Research indicates that heavy sugar consumption followed by abstinence can cause a dopamine imbalance that can increase anxiety. Other studies indicate that sugar consumption can affect the body’s ability to fight anxiety. It can cause mood swings, agitation and blood glucose irregularities which can all contribute to anxiety. Monosodium glutamate, a flavor enhancer, can cause dizziness, sweating, nausea and panic attacks. Observing and keeping track of your own reactions to what you eat and drink can assist in deciding what to increase or decrease in your diet to reduce anxiety symptoms.

4. Alcohol: Although many people drink alcohol as a way to calm down and relax, it can increase anxiety.Alcohol consumption causes blood sugar fluctuations and a build up of lactic acid which can increase agitation, stress, and anxiety. Limiting intake can be an effective part of an anxiety reduction program.

5.Observe, problem solve or distract: Catch your symptoms at an early stage: Although panic attacks appear to come from out of the blue, research indicates that changes in  physiology occur about an hour before a full blown attack. Recognizing your own anxiety warning signs and developing a constructive response can alleviate or minimize symptoms. Exit a situation that is increasing tension until the symptoms subside. Talk to someone to distract yourself and to decrease the extra stress that comes from trying to hide the anxiety. Remain in the present moment by noticing the details of external objects preferably using your other senses such as smell, touch and hearing. Use your ability to focus and concentrate on an activity such as a game, planning your day’s activity, solving a puzzle, or counting backwards by 3. Move to a different area.  Go outside or to a different room. Practice breathing along with coping statements such as I can ride through this, all is well and this too shall pass.

Seeing a physician to rule out any physical causes for your symptoms or to discuss the possibility of a short term course of medications is a good initial step to take in beginning your treatment  for panic attacks.  It is a treatable condition.  Many options for treatment are available and can be successful in ameliorating symptoms and in developing a panic free lifestyle.  The right approach can result in much needed relief for this condition.