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I've had quite a number of students during the last 20 years who presented with panic attacks, both in my one to one sessions and the "Towards Optimum Wellbeing" programme. All those who completed the training got rid of the problem. Some did relapse but came back onto the programme to reinforce their skills and to the best of my knowledge never had another attack. Many of them have found the books of Claire Weekes - "Self Help for Your Nerves" and "Peace from Nervous Suffering" a useful starting point for recovery, although I tend to shy away from the idea of "nervous" disorders.
From an Applied Psychophysiological point of view, there are two components to this frightening disorder - hyperventilation and a cognitive (mental) process that is the key to unlocking it. At the outset, i.e. the first time you have one, what you will experience is a normal stress (fight or flight) response. Rapid heartbeat, gasping for breath, sweating etc. Where this differs is that the individual may not have experienced the feelings before or had them and didn't notice, or is feeling particularly low. This is where the cognitive side comes in with a "What's that? What's happening to me", providing a fear element that then increases the adrenaline flow and the symptoms. The individual then starts thinking - "Oh my God, it's getting worse," leading to a further increase in adrenaline/symptoms and "I'm going to die". The initial reaction thus leads to an escalation of the problem and a fully-fledged panic attack.
As usual the training begins with exactly the same components as the two previous disorders in the "Disorder File".
After helping the student to become more self aware, training begins by looking at breathing patterns, teaching the student to change to slow, relaxed diaphragmatic breathing. We then go on to use myographic biofeedback (muscle) and finally temperature feedback of the hands and feet as an indicator of SNS arousal. All of these are augmented with general relaxation training, the biofeedback being used to check that quite specific criteria are being reached.
Thus a self-help-training programme begins with:
- Diaphragmatic breathing.
- Relaxing the muscles of the head, neck and shoulders.
- Learning to dilate the blood vessels in the hands and feet using relaxation and mental imagery techniques producing a reduction in SNS activity.
- Looking at precursing thoughts and behaviours that might trigger the panic attacks. (I'll say more about this later.)
- Changing the self talk that may occur during the panic attack.
Now the most important elements of the process are the diaphragmatic breathing to counteract the hyperventilation component and changes in thinking which counteract the escalation component. Many suggest using a paper bag to breathe in and out of to solve the former but I prefer to teach my students how to do it without, after all there may not be a paper bag handy. The biofeedback itself provides an important element, not just in ensuring that the relaxation (reduction in SNS activity) criteria are met, but in giving the individual the knowledge and confidence that they can control their body in an easily visible way.
The change in thinking I tackle by helping the student to write out and internalise a self-talk script, using sweating response biofeedback in the final stages, in the same way that I would a phobia. The self-talk is usually on the lines of "I've been here before, it's not going to kill me, the worst that can happen is that I'm going to pass out. Now let's use the relaxation and breathing techniques I've been taught, etc." By the way, passing out very rarely happens anyway, and is the body's way of regaining control when you try and screw it up! Basically the body says: "Aye up lads, they're going to try and scupper themselves. Close down all systems for consciousness so we can take over again." In other words it's the bodies way of ensuring you don't permanently damage yourself. Having said that, during a panic attack make sure you are safe were you to pass out and IF YOU HAVE A PANIC ATTACK WHILST DRIVING PULL IN TO THE SIDE OF THE ROAD AS SOON AS IT IS SAFE TO DO SO.
Now, the above algorithm for panic attacks works very well, as in essence it does for most other disorders providing the student comes to training on a regular basis and practices the techniques taught. Most do not have another panic attack or at worst gradually gain control of them as they practice the techniques over a longer period. There are, however, a couple of points that are of interest to the student.
The first is that many will say they don't have the thought processes that produce the exacerbation that leads to the panic attack. I can assure them that they would have had at some point. All that's happened is that they have programmed the reaction in, i.e. they go straight from stimulus to response without the intervening thought processes, in the same way that having learned to drive a car you don't think about how you are going to change gear, you just do it. Ever moved home in the same district and found yourself arriving at the old house on your way home from work? Many labile individuals programme the response in very quickly, perhaps after just one or two occasions of having the panic attack. If this interests you, you can follow it up by coming on the "Towards Optimum Wellbeing" main programme, especially Unit 3 and/or the "Understanding Dissonance" workshop.
The stimulus aspect is also of interest. Many students know what the trigger is, perhaps talking in public or meeting the in-laws, but lots of others say it just happens! I was at a Stuart Hall lecture a few years ago when he pointed out that many repetitive illnesses, not only panic attacks, can be triggered by anything that was around the first time you had it. This might have been a piece of music or a particular colour of wallpaper. Fascinating isn't it? Whatever it is, it is linked to the response so that the problem occurs every time you hear the piece of music or see that colour!! Wow! How do you resolve it? Well, becoming aware is the first step and then practising what I teach you is the next.
Once the panic attack problem has gone, has it gone for good? The answer is likely to be yes if you over practice the skills and replace the original mental programme. If you only practice occasionally I find that the students can normally keep the problem at bay, but if they get over tired it re-surfaces, warning them to (1) get some rest and (2) get back to their practice.
DISORDER FILE TENSION HEADACHE CC & IBS
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Copyright © Derek Webster 2003 |
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