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Worst Case Scenario – Afraid to Panic

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A common problem of panic disorder is being afraid of a panic attack happening. In its basic form, it’s a fear of fear itself. The fear is usually in the form of “what if” statements, such as what if I go to the mall and start to panic? The thoughts of “what happens if” bring up a lot of possible doomsday scenarios, such as what if I faint when I am at the mall, what if I lose control and start screaming for help, what if I can’t handle that panic attack? All of these questions run a similar theme of a FEAR of the FUTURE. Even if you are afraid of having a panic attack “right now,” the message still concerns what will happen next or after the panic.

An example scenario: “I am all alone right now, and I feel a panic coming on. If I can’t handle this panic right now, what if this is actually a heart attack and no one can help!?” In this situation, even though the panic is immediate, it is still about the future. When the panic is in the present, you simply deal with it until it passes, but its message is always about protection from the future. The future we fear could be years away or seconds away, but it cannot be in this exact second. The same thing applies to a fear of something that may have happened in the past. You can’t be scared of the past; the fear of the past is a “fear of fearing” it can occur again in a future.

With a fear like this, it is helpful to remind yourself that a panic is a worst-case scenario. When you first started having panic attacks, they were probably very scary and incomprehensible. Many people’s first panic attack often results in a visit to the emergency room because they thought they were having a heart attack.

One thing that is certain is regardless of whether you’ve had five panic attacks or five hundred, they all ended the same way – the panic subsided, and you eventually calmed down. I’ll bet that whatever terrifying thing you imagined would happen, didn’t end up happening. This is what makes a panic attack a worst-case scenario.

All panic runs its course, even if you are afraid that you will be locked in an everlasting panic attack (impossible) or that you’ll panic extremely frequently; they still all end the same. If you have a fear of the latter in which you’ll constantly be going in and out of panic attacks, that is also nearly impossible (I say “nearly” because it depends on what you define as frequently) and temporary. If you aren’t sure that’s true, get your favorite dessert and eat it “extremely frequently” and see how long it takes until you no longer can eat it. Frequent panic attacks are the same in which your body and mind will no longer be able to sustain having them once they are “too frequent.” 

Feeling like you almost lost control or almost died IS NOT the same as actually losing control or dying, so when fearful feelings about panicking come up, try to remember that you have never lost control, “gone crazy” or died from a panic attack before and that it is only fear that makes you believe you will the next time. 

Staying in The Calm Zone

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Most people with anxiety problems are better at keeping anxiety at bay than they are at harnessing calmness. Anyone experiencing anxiety starts out looking to cope with the unpleasant feelings it creates and find ways of relief and rationalization. How much anxiety we will have from day to day and year over year is ever changing. It can be affected by stress, seasons, thoughts and even things we cannot detect or control. We all go through periods of highs and lows.

I believe most tools and coping strategies created when we’re feeling low. We create an arsenal of weapons for combating anxiety, some being helpful and productive, and others being harmful and self-destructive.

We usually know when we are in a period of strong anxiety (whether we admit it to ourselves or not). But we usually don’t acknowledge when we are feeling great and anxiety-free. Even in the worst of anxious times, there’s always a break of feeling better, and it is far too easy to sabotage those moments.

We will do anything to minimize a period of strong anxiety, but we rarely put the same effort in maximizing calm periods. Many struggle to gauge the levels of stress they feel, and worse, many feel anxiety and calmness as binary states as compared to a spectrum.

The common issue when things are going well is dropping the helpful tools and exercises that helped alleviate anxiety because the “coast is clear.” We will pack on more stress because the threshold increases during the period in which you feel more at ease. This is not the time to pile on more unnecessary stress. You must first take note that these calm moments exist. You will not jinx it by stating that you have been feeling calm or that you are currently.

It is important to recognize these more pleasant states because it will make it easier to get through the difficult states. When you become overwhelmed by anxiety, one of the first things to go is the feeling and memory of how calm states exist, but belief must be built that they do exist, and we build it by acknowledging when we feel good. You must work hard to build upon and prolong these moments so that they become the norm, not the exception.

It’s not about maximizing and obsessing about staying calm, which would be very unproductive as it would likely come from a fear of slipping back to anxiety. But it is about creating a better balance between the states and having more confidence to handle the anxieties when they arise, versus having them be all-consuming.

I believe many anxiety sufferers are actually quite a bit better at handling low-level stressors than those without anxiety experience, and that is why it is so easy to pile on additional stress. The additional stress is made even worse because it is just as easy to stop your supportive processes when things are “fine”.

Even subtle stress can make an impact, and you have to pause and check every now and then to see what’s got you feeling anxious. Ask yourself: Has anything been bothersome or gotten in my way of feeling at ease and comfortable?

Not every little problem will need to be examined. Just make the mental note that little stressors can cause discomfort. If you don’t believe that’s true, then place the smallest peddle you can find in your shoe and see how great you walk with such a tiny irritation.

You don’t have to add much to find your state of calmness; it is a constant. You rediscover that state by decluttering the stress and mess that will inevitably come your way.

What I wish I knew before starting therapy

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Are you sick of old issues and patterns arising unannounced and disrupting your life? Have you finally decided that you need guidance to unroot your problems and solve them once and for all?  Then, congratulations! As a society, we are finally losing the stigmas around psychotherapy and emphasizing the importance of emotional hygiene. I believe that EVERYONE should have a mental health professional in their life. Not having a counselor, therapist or coach because “things aren’t so bad” is like not having a doctor because you don’t plan on getting sick. I started my journey in therapy as the anthesis of what I recommend below, and I write so that you may avoid the unnecessary challenges I encountered.

You may have envisioned someone as an ideal candidate to be your anxiety professional. Perhaps you said to yourself, “I think I need woman with at least 20 years of experience and a PhD in psychology because of all the rich experience,” or maybe you said, “I would like a younger male counselor who understands my generation better.” While these aren’t bad places to start your search, they aren’t extremely important in the bigger picture. Which brings me to my first point:

  1. Shop around

Don’t pigeonhole yourself as a difficult patient who could only benefit from one type of therapist. When you are first looking for a professional, try everyone out whose specialties resonate with you. Most therapists offer a 20-minute, free “get to know each other” session, and you should absolutely take advantage of it. A great therapist doesn’t take everyone they can get; they also look for the candidates for whom they can be of service. If they believe they cannot help, they will refer you to someone else who can. My personal experience and research show that age, degree, years of experience and gender aren’t major factors in determining the quality of service you’ll receive. The most important factor, in my opinion, is the ability to trust and feel safe with your therapist. All of the experience and education someone has won’t do you any good if you are working with someone that you can’t open up to or someone who doesn’t relate to/understand your problem. Which leads to my next point:

  1. What works for someone else may not work for you

Many professionals have many tools in their kit to help tackle and solve your problems. All of them will have varying degrees of success, so I recommend trying anything you feel comfortable with. Therapy isn’t a perfect science; far too many factors contribute to whether it will help you or not, so don’t dismiss something right away. Try to be as open as possible with your therapist on how you feel about them, their recommendations, any concerns and overall experience. The only way your counselor will be able to provide the best service is if you provide feedback. There are many great modalities that professionals recommend. Some of the popular ones are:

  • EMDR (Eye Movement Desensitization and Reprocessing)
  • Acceptance and Commitment Therapy
  • Cognitive Behavioral Therapy
  • Hypnosis
  • Lifespan Integration
  • Exposure and Response Prevention Therapy

 

  1. It won’t be easy

Most people envision starting therapy much like visiting a doctor for a cold, where you tell her your problems, and she gives the perfect regimen where day after day, you increasingly feel better.  However, that is rarely the case. I compare it much more to visiting a physical therapist after an injury, where solutions will be found through hard work. I think the best advice I could give that I wish I had received is not to wait to start therapy as a last resort when you are finally at your lowest. The fact is that you may feel worse before you feel better, but that is a part of the healing process. Of course, if you are at your lowest point, don’t wait to get help – just know that the work will be more about getting you back to a good baseline rather than digging through old issues. Don’t expect a complex problem that you have carried for years to go away permanently overnight. It’s a journey with many ups and downs. Lose any expectation you have for how long it may take to heal because it will take exactly the right amount of time. For many people, it takes just a few short sessions, but for others, it takes years of work. It is all about making small yet sustainable changes as you work toward your goal of being free from suffering from anxiety. The progress and outcomes of your efforts highly depend on your commitment toward changing your relationship with anxiety.

Lastly, don’t get hung up on a diagnosis. Especially if you have what I like to call “elusive anxiety,” where the specific triggers and symptoms evolve into new fears over time. Many therapists nowadays don’t even like to diagnose clients with a disorder but will for insurance purposes. If the diagnosis helps you, then great! But focus on solving your problems and not just curing your diagnosis.  If you feel as though your problems are getting worse after starting therapy, ask yourself:  Are the problems getting worse, or are they just more visible? Shining a spotlight on the issue can bring about more memories and awareness of problems and should not be mistaken as regression.

 

Reference

https://pdfs.semanticscholar.org/5d66/a389514f35c75f005afb719a4dc9ccff5c16.pdf

The Best Way to Calm Anxiety and Panic Attacks Right Away

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The number one most important thing to do when experiencing anxiety is mindful breathing. When we are in the “fight or flight” mode, our sympathetic nervous system is turned on. We need instead to regulate the body’s arousal into the “rest and digest” mode, which is called the parasympathetic nervous system.

Deliberate calm breathing stimulates the vagus nerve and will send a signal to begin calming down the body. 75% of this signal is transmitted from the body and going to the brain. That’s why it is far more important to calm the physiological symptoms of anxiety than it is to try to calm psychological symptoms in the moment of intense anxiety.

The technique that I recommend doing is alternative nostril breathing. The great part about deep, slow breathing exercises is that you don’t have to believe in it working or helping. It works in calming down the body whether you want it to or not.

How to practice it

  • Sit comfortably in a chair with your back upright and shoulders relaxed or sit on the ground with a cushion under you and your legs crossed.
  • Rest your right hand on your right knee.
  • Bring your left hand up by your nose.
  • Position your left hand into the Shaka Sign (also known as the “hang loose” sign). To do this, have your hand open and your fingers spread out. Now, fold your pointer, middle and ring finger into your palm.
  • Exhale completely, then use your left thumb to close your left nostril.
  • Inhale deeply through your right nostril until you get a deep inhale, then close the right nostril with your pinky finger.
  • Open the left nostril and exhale through the left nostril until you get a deep exhale.
  • Inhale through the left nostril until you get a deep inhale, then close the left nostril.
  • Open the right nostril and exhale through the right nostril until you get a deep exhale.
  • Repeat this cycle for 5 minutes.
  • Complete the practice on an exhale and take a deep inhale through both nostrils.

Make sure that you are inhaling and exhaling the same amount of time for both nostrils when doing the exercise.

 

For your first time, I recommend setting a timer for 2 minutes to practice it. Very rarely, some people feel a slight increase in anxiety when starting out. This IS NOT a sign that it isn’t working or that something is wrong. It is usually a sign a sign that old anxiety is being released, anxiety that is already present is just more visible, or there is a worry about anxiety related to the exercise, all of which are absolutely okay.

The exercise will work best with commitment and consistency. It is very important to do the exercise every day for at least 5 minutes. I recommend doing it once in the early afternoon and once right before bed. It is also important to do alternative nostril breathing not only when you are feeling anxious, but also when you are already calm.

If you are feeling very intense anxiety, you can boost the results of the exercise by splashing very cold water onto your face. The face has a lot of receptors, and cold water also stimulates the vagus nerve.

 

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404375/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334714/