Putting your panic system at ease

In another post, I wrote about about Panic and what it is.

I ended it by suggesting patients need to learn how their alarm system needs to be put at ease when it’s discovered it has gone off unnecessarily or needs to be reset once danger has past or been adequately dealt with.

Once this occurs, you can expect, with practice, to see permanent shifts in the ability of triggers to set off this alarm system, and your ability to dampen it once you shift your focus from your panicky feelings to doing things differently. I must emphasise the word “practice” and indeed introduce you to a variation known as “deliberate practice”.

This is akin to recognising you have some distance to go before you become an expert (in whatever you choose to do) and must go out and try various techniques and see what works and what doesn’t. But it goes further, because under guidance from a therapist or mentor or coach, you will receive feedback and go out and tweak your experience, getting better each time things go wrong, rather than when things go right. The latter confirms you’re on the the right path, but the former – getting things wrong – is where you will do the most learning, and thus changing.

This means you must summon up qualities of curiosity and courage to engage in such a learning process. Contrary to what some helpers will advise, if it’s scary you’re on the correct path. If you  experience no fear, or the therapist tells you they’re using painless, easy methods, which require little effort on your part (“I am speaking to your subconscious” is a good example), it might be worth asking how you will learn and make long-term changes.

Indeed, take a little audit of your life, and ask if anything you now value came easy, and whether there were times you wanted to give up but pushed hard past your self-imposed limitations (or the “advice” of others) and achieved a breakthrough that has stayed with you as a template for future endeavours. If your preference for change is “painless and easy”, psychologists who work like me from an evidence-informed base are not for you. Above all, Caveat Emptor. (Buyer beware).

How to recalibrate your Alarm System to make it more accurate and reliable

I once found a friend a rundown house in a good suburb to which she put her talents to renovate. Once finished, she put in a sophisticated alarm system that detected movement, and when activated would send a signal to a monitoring company who attended the house. It worked perfectly for a while, until she decided to install on one wall a very large mirror.

On one weekend away, she was repeatedly phoned by the monitoring company telling her the alarm was being constantly set off. It was clear false alarms were occurring and she needed the alarm system investigated and if needed, recalibrated.

The original installer was summoned, and asked if anything has changed since he installed the alarm system – had the house “shifted” or some other alteration. The friend said no, only that she had installed a mirror.

Well, that seemed to be the trigger, with the sensor sending out beams of light to detect movement now bouncing around the room and off the mirror, sending the alarm into a false loop – what I have written elsewhere as “false positives”.

The alarm system needed recalibrating to take into account the mirror, altering its sensitivity – not too low or otherwise a break-in would not be detected (a miss) and not too high or more false alarms would occur.

What I have just described is a metaphor for how the human alarm system works, triggering feeling, thoughts, actions and behaviours. But as humans who are feeling beings who also think, we can use our intelligence to self-correct our fear responses, or use it to make it worse!

So while it may have required some quite severe turbulence to upset us at one time, it can also be the case that as time goes on it can be quite small events that now upset us to the same degree, such as the seatbelt sign going on during the usually smooth cruise phase. Even when no turbulence has been experienced. The intelligent part of us which utilises language can help us  have both a sense of history and that of future, where we can anticipate events occurring which  trigger future discomfort, but experienced in the here and now.

We psychologists refer to this as either Discomfort Anxiety or Anticipatory Distress.

Because anxiety is always an anticipatory response to some future perceived danger, it’s important to know what to do in the here and now – in the next few moments or minutes.

This means that you need to be able to make all parts of your brain work seemingly in unison to achieve a goal or keep to a plan.

Think of panic not so much as a collection of unpleasant sensations but as more than that. I explain it to my patients as the unpleasant effects of:

losing the plot, going off course, feeling stuck, not knowing what to do next. overwhelmed by having to make a decision without all the needed information, conflicted between two courses of action, and above all, the loss of composure.

 

I want to focus on “composure” for a moment, since a better understanding will lead to more successful interventions and outcomes.

A definition of Composure is “the state or feeling of being calm and in control of oneself”. It has its origins as a Middle English word from the French “composer”. We think of a composer nowadays as someone who creates music, but in its original usage it was someone who literally put together things.

So when we lose composure, we often also say “I lost the plot… I couldn’t get my act together… I just fell apart…” When intimate relationships with another end, we say “I broke up with Julie”, or when contracts reach a sticking point, we say “discussions have broken down”. 

Even more recently, individuals suffering a major depressive episode, perhaps requiring a brief hospitalisation, were said to have suffered a nervous breakdown.

When a boss in unhappy with an employee’s work on a project, we may hear her say, “Pull it  together, Dave” or more emotionally charged words, but you get the idea.

So one useful way to think of panic is to relate it to a loss of composure – a losing of the plot. This suggests that the more you have a plan, a set of goals, a set of skills to achieve those goals, and opportunities to practise those skills in a deliberate way is the key to overcoming panic and most other anxiety conditions.

If you see a therapist or counsellor or helper of some sort who promises an easy, painless, no -practice-needed, means of achieving your goals, you need to see if there is any merit to their procedures. Always remember, Extraordinary claims require extraordinary evidence.

So if you see such a counsellor in preparation for a series of flights across Europe, make sure you build in a short flight post-treatment to test out its effectiveness before you take on the major flights.

So how does knowing this help to recalibrate the brain’s fear response mechanisms?

CostanzaThere is a famous scene in an episode of the 1990s comedy, Seinfeld (The Understudy), where George Costanza’s father, Frank (Jerry Stiller),  meets up with an old flame from the Korean War. Driving her down one of Manhattan’s avenues, he suddenly brakes, flinging his arm across her chest as if to reflexively “protect” her from crashing into the dash (despite her wearing a seat belt). She complains that he is still using his “old moves” from decades ago, and refuses to see him again.

What Frank has done is probably done millions of times a day in cars around the world: drivers braking suddenly and reaching across to protect passengers or even their shopping from moving about the car, endangering themselves.

I often ask patients if they’ve ever experienced this as a driver or passenger and about half say they have. When I further ask where a driver’s hands should be during such an emergency procedure, their smile shows they’ve understood the exercise, and they remark, “Both hands should be on the steering wheel, of course!”

And I then remind them that what we’re discussing is an old biological reflex, maintained in humans for scores of thousands of years, meeting newly learnt human behaviour (driving a car) which is only a hundred years in existence. Biology invariably wins out. This should also exilian why you grip the seats in turbulence or on takeoff, even though it doesn’t help.

If you are to stop this behaviour – useful if you trip over a loose stone on the footpath or fall off a ladder when you reach out to anything nearby to grasp – you need to practise not doing it.

Practising not doing something isn’t easy.

If you want to stop a reflexive behaviour – or speed one up such as hitting the brakes earlier but in a more controlled manner so as not to lock them up, producing a skid – you need training and practice. Driving more calmly will not do it for you. Being a more composed driver, and experiencing less stress while driving, will come as a result of an increased skillset leading to more confidence and certainty about one’s abilities. In other words, less misses and fewer false positives.

I’ve had to do this when I was driving taxis during my undergraduate years, and later as a research assistant for a government road safety authority when I received advanced driving skill training. It contained a great deal of deliberate practice where my base driving skills were initially evaluated and then a plan developed to improve upon them via practice lessons with a driving instructor with exceptional skills, both as a driver and teacher.

So, what should this practice comprise?

1. An accurate understanding of the biology of the fear response is a good place to start. It’s why I spend time on this website and in my practice working with patients using multimedia so they have a foundational knowledge to work with, especially when the going gets tough.

2. Recalibrating the fear response, starting with altering your breathing patterns. The patterns to change – to tell your fear response system to be at ease or stand down – is where to initiate your breathing, and the frequency of breaths per minute.

When we’re not aware of our breathing patterns while we’re awake and conscious (it’s different when we’re sleeping) we rely on automatic set-and-forget mechanisms (located in the oldest part of the brain, called the brain stem). Our breathing is usually centred around our chest at about 15 breaths or cycles per minute. That’s a single breath every four seconds.

By definition, it’s called chest breathing and is rather shallow. The tidal volume of air moving in and out is small. As long as you’re not confronted with a fear trigger, you can get by with this breathing pattern, although there will be health professionals who will suggest an alternative style, one called diaphragmatic or belly breathing.

Have a look at the movie below which comes from a great free site you can visit here, which is connected to Augmented Reality apps and posters. It shows the location of the diaphragm and how the lungs expand and contract as the diaphragm moves down and out (inspiration) and up and in (expiration).

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