Taking Back the Body: Combining Body

and Mind Treatments to Handle Panic Attacks

Bobby Newman, Ph.D., C.B.A.

Millions of individuals world-wide experience panic attacks each year. They are so crippling that the very fear of experiencing one may make an individual a virtual "shut in" who is afraid to leave his or her home. When this happens, the person is said to become "agoraphobic." What are we really dealing with here? In a simplest analysis, the physical symptoms are a manifestation of an evolutionary adaptation called the "fight or flight" reflex.

The fight or flight reflex has been experienced by everyone. In times of anxiety or stress, breathing automatically becomes quicker and shallow. Blood flows to the body's muscles. Pupils dilate, and adrenalin begins to flow freely in the body. This reflex is a holdover from the old days, when threats to the person tended to be physical (for example, a large animal who wanted to evict your family from the cave). The fight or flight reflex prepares the body to fight off the threat or to run like hell away from it.

The funny thing, though, is that for most of us in the modern world, most of our threats are social and not physical. One of the requirements I have for my students of experimental psychology is that they go to the library and get an article from an experimental psychology journal. The kicker, though, is that the students have to present an oral summary of the article to the class. It is during the oral reports that we see the fight or flight reflex rearing its ugly head. When making an oral presentation, it would be most efficient to be calm, to sound assured and confident. Unfortunately, the vast majority of students stutter and panic their way through their presentations. The fight or flight reflex over-energizes the body through the release of adrenalin and interferes with the ability to give the type of presentation the student wants to give. In this situation, the fight or flight reflex is not the help it was intended to be. It is a detriment to our effective functioning in social situations.

We see here how the fight or flight reflex more often works AGAINST us these days, and how it can upset our functioning. Once we experience such feelings of anxiety, the mind can take over and cause us to make very inappropriate attributions regarding the anxiety. According to some researchers, people with a heart disorder known as mitral valve prolapse or hyperthyroidism or hypoglycemia are more prone to suffering from panic attacks. The person feels a physical sensation as a result of their condition, and may mistakenly label it as a heart attack. The person then develops a fear of ever having such a feeling again, and the fear of this fear becomes an overwhelming aspect of the personality. We "talk" to ourselves all the time, providing ourselves with observations and feedback about our own behavior and situations. Sometimes what we think of as a serious psychological problem is simply a matter of having learned bad labeling. We may make global assessments that may be very self-defeating. For example, a failure at work is not regarded as a simple failure, but as an indication that we are stupid and will ALWAYS fail at WHATEVER we try. Sometimes this is the result of ways we have been taught to think, internalizing what we have always heard from others. We develop global and self-defeating ideas that form of the root of many depressive and anxiety disorders.

In considering panic attacks, therefore, we have to be cognizant of both the body and mind in treatment. We must proceed, as Arnold Lazarus suggested, multimodally. To address the physical symptoms of the panic attack, we head them off. We do not allow the body to become fully energized into a full-blown panic attack. At the first sign of physical feelings that we come to associate with anxiety, we begin a deep breathing and progressive deep muscle relaxation regimen. We concentrate on taking back the body, not allowing the symptoms to spiral out of control. Shallow breathing will lead to a faster heart rate and may lead to feelings of panic. We need to break that chain before it begins.

Simultaneously, we must work on the cognitive element. We all sometimes feel the physical symptoms of anxiety. We all sometimes feel that we have not done as well as we would like in particular endeavors. As a wise person once put it, however, it is not what happens to us that is crucial, but what we make of what happens to us that is important. If we label the physical symptom as a heart attack, we will panic. If we label the failure as a result of our inherent inferiority, depression will result. We must learn to think rationally, avoiding self-defeating and global assessments. Intensively analyzing our internal dialogue and developing more rational thinking patterns is essential. Yes, I failed this exam. That does not mean, however, that I will always fail all exams and that I am a failure and will always be a failure.

In addition to the physical and cognitive side of panic attacks and other anxiety states, there is the behavioral component. People tend to avoid situations where they have had panic attacks, or situations where they believe they will feel anxious. If one continues to avoid, one will never have the chance to let the fear extinguish. Those "anxiety-provoking" situations will remain forever frightening unless the individual can experience those situations without feeling the anxiety. It is essential to go into the situation, armed with the coping skills one has learned to counteract the anxiety. Such exposure can be gradual, as in systematic desensitization, or sudden as in flooding. The exposure can take place through imagery exercises, or in the real-life situation. That is a decision for therapists and clients to make. Many different techniques can be used to combat anxiety, by approaching it on its various levels. They need not be the orthodox ones commonly found in behavior therapy textbooks. The key is to remember what we are trying to teach the individual to do: to take back control of the body and cognitive processes. A technique I once adopted from tantric educators Paul and Niyaso Carter can serve to illustrate.

I came across a tape of Paul Carter's entitled Journey to the Source of Your Pleasure. In this seminar, he described techniques for helping people to open up and feel physical pleasure again. Paul used the physical sensation we call tickling as his mode of physical interaction. Most children enjoy being tickled, Paul observes. By the time many people become adults, however, they loathe and even fear the sensations. This is generally, Carter observes, due to the fact that many people have been abused by people who tickled too long and did not respect limits or when the individual told the tickler to stop. Soon, the individual stops enjoying tickling, associating it with being out of control. Feelings similar to panic are elicited in such situations.

The Carter treatment for this is simple, and is similar to what was described above. We must break the association between tickling and feelings of being out of control, just as we had to break the association between anxiety-provoking situations and anxiety. To do this, Carter has the individual experience tickling in a "safe" format. The individual is tickled by trusted others, until the split second that the individual says "stop." At that instant, the tickling stops. Gradually, the feelings of being out of control disappear. The person comes to feel in control of the situation, and can learn to relax and enjoy the situations again, just as they did when they were children. They find that they don't need to say stop as often, and they can accept the physical pleasure. This feeling generalizes to other forms of physical sensation.

I was impressed by the parallels between Carter's ideas and those I was trying to use in anxiety-reducing behavior therapy. Perhaps there was a parallel between the feelings of helplessness of being tickled and those associated with panic attacks. I asked clients to recreate Carter's tickling exercises at home. Using a trusted significant other, the individual lays back and allows tickling to occur. At the split second the person feels uncomfortable, they call an immediate stop to the action. What we are creating is a parallel situation. The person learns to listen to their body's signals and to call an end to stimulation when they feel overwhelmed. They learn to take control back. They realize that stimulation, either from without or from within, is just a physical sensation and that there are ways to handle it. They tend to develop the ability to cope in a reasoned manner, rather than going into a full-blown panic. Clients for whom I suggested the technique at home confirmed the effect I had suspected would occur.

Panic and other forms of anxiety need not be life-long conditions. It merely requires an understanding of the physical, cognitive, and behavioral processes at work. From there, techniques can be used to retrain the mind and body so that such conditions can be properly handled, and stop being ever-present threat hanging over a person's head.

Dr. Bobby Newman has offices in Manhattan, Long Beach, and, Long Island.            

http://www.room2grow.org       e-mail at darkoverlordaba@prodigy.net

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