Category: Misc

 

 

If there is one main issue that many of my clients deal with outside of our sessions that can completely render them feeling helpless and potentially to unbidden hospital visits, it is panic attacks.

 

I used to view panic as a category unto itself. As if panic and anxiety itself were two separate things. But my mentor: the “Yoda” of psychotherapy of whom I study under, has told me “panic is just anxiety.”

 

It’s the exact same physical response in the body-mind. The difference is that panic is anxiety that has gone to a level that it is out of control. It is unregulated, such as how you regulate the flow of water or steam from a pipe.

 

One symptom of traumatic experience, especially trauma that has repeated throughout childhood and adolescence, are panic episodes that seem to come out of absolute nowhere, with no known triggering events whatsoever.

 

One theory on this is that there is a global sense of being unsafe and that the other shoe is always about to drop. There are other ideas but it’s beyond the scope of this post.

 

I want to offer five means of working with panic in your day to day life, if you are suffering from anything like I have described. These may not cure your panic, but if you find at least two that work for you, your panic will be more and more under your control:

1. Breathing:

Breathing is the lowest hanging fruit for changing how one feels and reacts. Meaning, it takes the least effort over any other technique or exercise but beautifully tends to be the most powerful.

 

There are many methods of breathing. In an episode of panic or near panic, breathing incorrectly can make everything worse or cause a full blown panic. The correct ways of breathing can change everything. So it’s very important to know how to breathe just right when you’re in a place of anxiety.

 

Here is the general method that I teach my clients to calm themselves, both in session and as a skill to use in everyday life:

 

• Take a gentle but full breath into your upper belly, where your ribs end
• Breathe in for about 4-5 seconds
• Hold for about one second
• Let the breath out for at least 5 seconds until a pause.
• Allow the out breath to be entirely passive, taking no effort whatsoever

 

 

2. Listen to guided meditation

It may be passive but it can be highly beneficial to hear a soothing voice, guiding oneself into a different state.

I’m a fan of something called Open Focus, which is based off of something called Biofeedback. Here’s a 20 minute track on contemplating an Open Focused state of space:

 

https://www.tarabrach.com/guided-meditation-inner-space-gateway-to-open-awareness/

 

Youtube has a mix of quality, but there is a gigantic amount of material. Here’s a simple search for guided meditation for panic as an example:

https://www.youtube.com/results?search_query=meditation+for+panic+attacks

 

3. State the thought that you may be fixated on.

There is emotion, anxiety and reactions that are in direct relation to the outside stressor or even. These are called primary emotions, and then there are emotions and reactions that are in reaction to the primary emotions. These are called secondary emotions.

One feature of secondary emotions is that they tend to (but not always) involved some story or belief that drives them.

For example, in the case of anxiety and panic: imagine a person has a stressful reaction to their partner and automatically feels anxious, maybe frustrated and deflated. This is the primary reaction. Then, let’s imagine that this person has a long history with rejection and takes this stressful event as a rejection just as has occurred many times in the past. This person now thinks this over and over again. Or maybe another channel, as in imagines past and future scenarious of rejection. Suddenly the world becomes overwhelming and they are flooded with anxiety causing a panic attack.

To work with situations such as this, it is helpful to stop the process in its tracks. Ask:

• What is the thoughts or the stories that are driving this reaction?
• What is the primary or main experience or reaction that I’m reacting to?

 

-State or write down everything you can that is perpetuating and escalating what is happening inside you.

 

4. Use imagery to separate from the negative feelings that may be at the core of the panic

Different techniques and resources may work very differently for many different people. But I tend to consider this to be the most powerful technique if you can figure out a method that works best for you.

This is also called “clearing a space” which is used in the technique and paradigm of psychotherapy called Focusing.

It involves using inner dialogue and imagination to get a place of inner space from a problem or inner set of feelings.

 

Take whatever the inner feeling, reaction, or Felt-Sense and ask it to separate from you.

Imagine these things moving to the side of you, maybe in an empty chair where you can visualize it all and get more of a sense of.

Maybe imagine filing it away for later or moving into the next room. Or a safe room or locked chest in your imagination.

It can be helpful to begin by breathing and attempting to relax a little more before you can develop this healthy working distance from whatever is bothering you.

Not everyone can contact and separate from their inner experience using their imagination channel. Some people may be helped by acting it out. Like moving your arms in a pushing or throwing action, or dialoguing with this overwhelmed part in their inner experience.

 

Here is an introduction to focusing and and clearing a space:

https://www.focusing.org/gendlin/docs/gol_2234.html#hd3

 

More on this technique and merging with experience in a later post…

 

5. Listen to healing tones or find a go to app:

Again, there is a high rate of good and bad on youtube, but there is a wealth of material out there using meditative tones that can possibly be an adjunct to difficult and overwhelming states.

Look up healing tones for anxiety or relaxation. The main words for these tones are: binaural beats, monaural beats, and isochronic tones. DO NOT use beta or gamma tones for this, as they are highly stimulating. Also, be careful about using these sounds too much, such as for hours at time, as they can burn out the nervous system with too much use.

Look out for “sound entrainment” companies that make exaggerated and outrageous claims. Also avoid companies that charge hundreds to thousands of dollars for this technology in packages and tiers. This technology has been around a long time and should not cost so much anymore. There is some good science demonstrating that this technology can serve as an adjunct for anxiety and focus, but it’s still needs further study for the long term benefits.

Another idea is to find a go to set of apps. There are many mental health related apps these days. I cannot say I have used these personally, but here is a list of a few that sound helpful for anxiety:

• DBT Diary Card and Skills Coach, Breathe2Relax, Insight Timer, Headspace, iSleepEasy, Deep Sleep With Andrew Johnson

As always, when overwhelmed by any state of emotion or anxiety, reaching out to others, whether it be trusted friends and family, or professionals, such as therapists or crisis services is always the best option.

Note: I originally researched and wrote this post and the following in 2013 for a more clinical audience. After posting these two I will resume posting more accessible blogs posts.

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As I begin this exploration of the innovative edge just outside of the mainstream of the common paradigms of mental health and human psychosocial functioning, I want to introduce a rising idea in science about gut health. Why gut health? Well, there has been more and more information coming to light about the role of the gut in psychological health. This has been termed “the gut-brain axis.”

Because many in the mental health and social work professions lack in depth education in biology, I won’t go in too much depth on complex pathophysiology, but the main idea is that there are communication pathways between the gut and the nervous system.

For example, it has been known for some time that there is a subset of schizophrenic patients who seem to find remission after adopting a gluten free diet. This research goes back to the 1950’s (Kalaydjian et al. 2006). It is interesting to note that if schizophrenia was one disease caused by one genetic abnormality or biological mechanism, then why does a treatment such as this affect only a subset of the population? This lends more credence to the notion that schizophrenia is a collection of disorders.

Possibly dysfunctions in nervous system coming from different angles may easily cause similar presentations of symptoms.

Food sensitivities are one area of research into mental health, the gut microbiome is another. The microbiome is simply a term used to describe the micro-organisms living in our intestines. This is a classic symbiotic relationship where the body and the bacteria require each other to live. On a brief survey of a few articles on my former university’s search engine I discovered several studies pertaining to the status of the gut microbiome and mental health.
For starters, there is a link between a compromised gut and the concentration of serotonin in the central nervous system (Clarke et al. 2013). This study as well as the reference that follows compare animals with a “germ free” or GF gut compared to a “colonized” system. The compromised or GF males appeared to have significantly higher metabolites of serotonin compared to the animals with normal gut health. Another finding was that the animals that had compromised microbiomes early in life had difficulty normalizing their system later in life and may not have been able to reach a fully functioning system even after their intestines were re-colonized.
According to these authors there are mechanisms in the gut microbiome that regulate the autonomic nervous system via the vagus nerve and the neuroendocrine response to stress leading to changes in behavior. Case in point, GF rodents demonstrated an exaggerated response to HPA axis activation leading to heightened corticoid levels (cortisol in humans). When treated with probiotics the pathological behaviors of GF animals appeared to normalize.
In a similar article that reviewed the present literature on the subject, Cryan & O’Mahony (2011) stated that there are multiple pathways by which a compromised gut, either by colonization by parasites or other alterations in gut flora effect behavior. One is direct communication with the nervous system and the other is inflammation.
Inflammation is an interesting player in this story. For those with little background in biology, inflammation is a normal bodily process of healing when there is some insult to a bodily tissue. Think of a small burn or bumping your knee and the subsequent swelling. Consider rubbing your skin with sand paper and think of how red and inflamed it can become. Now think of the lining of your digestive tract as internal skin. What if it is constantly being rubbed by sandpaper? It would become pretty inflamed right? One quality of inflammation is cellular permeability. The gaps between cells widen so more healing materials can move to the tissues that need this healing. What occurs in an inflamed gut, let’s say by gluten sensitivity or severe alcoholism is heightened gut permeability or leaky gut. The gut leaks out what it is supposed to keep in.
When this occurs there are many bugs, chemicals, and materials that can travel all over the body. Our own immune system will also leak out and attack ourselves. For example: chemicals called pro-inflammatory cytokines and lipopolysacharides that are produced from gut bacteria cause an inflammatory response in the nervous system and even cross the blood brain barrier causing some symptoms of major depression (Maes et al. 2008). This seems intuitive to me, the nervous system is in a state of illness, thus the body puts itself in a state of recuperation: depression. Why does the flu come with a subjective experience of depression? Because it knows that it is in a state of illness and needs to conserve energy and the body needs to slow down and rest. Interestingly, the majority of antidepressants have anti-inflammatory properties (Maes 2008). The first article (these are two different papers by the same author) described a high comorbidity between people with IBS and other gut inflammatory conditions and depressive illnesses. If we settle the inflammatory bowl conditions of this population, how much effect is left with the use of antidepressants acting on serotonin and other neuroendicrine pathways? Is this simply a subset of the population of those who suffer from clinical depression that have a compromised gut and benefit from the anti-inflammatory effects of their meds?
It is interesting how the simple hypothesis of a “chemical imbalance” ends up not so simple. I would dare posit that it is but a piece of the puzzle if not simply describing a subset of the population of the mentally ill. More research on this topic to come.

I apologize to those in the service fields who are not innately akin to biology for my beginning this blog venture on a topic that may be complex to some. I plan to cover a variety of topics here. Some deeply biological, others more psychological or sociological and clinical. Stay tuned.
References:
Clarke, G. et al. (2013). The Microbiome-Gut-Brain Axis During Early Life Regulates the Hypocampal Serotonergic System in a Sex-Dependant Manner. Molecular Psychiatry. 18, 666-673.
Cryan, J. F. & O’Mahony, S. M. (2011). The Microbiome Gut-Brain Axis: From bowl to behavior. Neurogastroenterology & Motility. 23, 187-192.
Foster, J. A. & Neufeld, K. M. (2013). Gut-Brain Axis: How the microbiome influences anxiety and depression. Trends in Neurosciences. 36, 305-312.
Kaladjian, E. A.; Easton, W.; Cascella, N.; & Fasano, A. (2006). The Gluten Connection: The association between schizophrenia and celiac disease. Acta Psychiatrica Scandinavica. 113, 82-90.
Maes, M. (2008). The Cytokine Hypothesis of Depression: inflammation, oxidative & nitrosative stress (IO&NS) and leaky gut as new targets for adjunctive treatments in depression. Neuroendocrinology Letters. 29.
Maes, M.; Kubera, M.; & Leunis, J. (2008). The Gut-Brain Barrier in Major Depression: Intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Neuroendorcrinology Letters. 29, 117-124.