Group Therapy – Panic and Anxiety, Session 2

This is the second of an 8 week series reviewing panic and anxiety from a group therapy point of view. It is based on the group therapy services available through Langley Memorial Hospital. Feel free to follow along and answer the questions posted in each section.

Session 2: Don’t Fight Panic

Did You Know:

  • Resisting or fighting initial panic symptoms is likely to make them worse.

In her popular books “Hope and Help for your Nerves” and “Peace from Nervous Suffering”, Clair Weekes describes a four-step approach for coping with panic.

1. Face the symptoms – don’t run from them.

Attempting to suppress or run away from the early symptoms of panic is a way of telling yourself that you can’t handle a particular siutation.  In most cases, this will only create more panic.  A more constructive attitude to cultivate is one that says “O.K., here it is again.  I can allow my body to go through it’s reactions and handle this.  I’ve done it before”

2. Accept what your body is doing – dont’ fight against it.

When you try to fight panic, you simply tense up against it which only makes you more anxious.  Adopting just the opposite attitude, one of letting go and allowing your body to have its reacitons (such as heart palpitations, chest constriction, sweaty palms, dizziness and so on) will enable you to move through panic much more quickly and easily.  The key is to be able to watch or observe your body’s state of physiological arousal – no matter how unusual or uncomfortable it feels – without reacting to it with further fear or anxiety.

3. Float with the “wave ” of a panic attack rather than forcing your way through it.

Claire Weekes makes a distinction between first fear and second fear.  First fear consists of the physiological reactions underlying panic: second fear is making yourself afraid of these reactions by saying scary things to yourself like “I can’t handle this!” “I’ve got to get out of her right now!”  “What if other people see this happening to me?”

While you can’t do much about first fear, you can eliminate second fear by learning to “flow with” the rising and falling of your body’s state of arousal rather than fighting or reacting fearfully to it.

Instead of scaring yourself about your body’s reactions, you can move with them and make reassuring statements to yourself like: “This too will pass.” “I’ll let my body do its thing and move through this.” “I’ve handled this before and I can handle it now”

4. Allow time to pass.

Panic is caused by a sudden surge of adrenalin.  If you can allow and float with the bodily reactions caused by this surge, much of this adrenalin will metabolize, and be reabsorbed in 3-5 minutes.  As soon as this happens, you’ll start to feel better.  Panic attacks are time limited.  In most cases, panic will panic and begin to subside within only a few minutes.  It is most likely to pass quickly if you don’t aggravate it by fighting against it or reacting to it with even more fear (causing “second fear”) by saying scary things to yourself.

Coping Statements for Panic

Use any or all of the following positive statements to help you encourage attitudes of accepting, “floating” and allowing time to pass during a panic attack.  Many people find it helpful to repeat a single statement over and over for the first minute or so when they feel panic symptoms coming on (a “mantra”).  You may also want to try deep abdominal breathing (see the instructions later in this session) in conjunction with repeating this mantra.  If one statement gets tiresome or stops working, try another.

  • “This feeling isn’t comfortable or pleasant, but I can accept it”
  • “I can be anxious and still deal with this situation”
  • “I can handle these symptoms or sensations”
  • “This isn’t an emergency.  It’s OK to think slowly about what I need to do”
  • “This isn’t the worst thing that could happen”
  • “I’m going to go with this and wait for my anxiety to decrease”
  • “This is an opportunity for me to learn to cope with my fears”
  • “I’ll ride this through – I don’t need to let this get to me”
  • “I deserve to feel OK right now”
  • “I can take all the time I need in order to let go and relax”
  • “There’s no need to push myself, I can take as small a step forward as I choose.”
  • “I’ve survived this before and I’ll survive this time too”
  • “I can do my coping stategies and allow this to pass”
  • “This anxiety won’t hurt me – even if it doesn’t feel good”
  • “This is just anxiety – I’m not going to let it get to me”
  • “Nothing serious is going to happen to me”
  • “Fighting and resisting this isn’t going to help – so I’ll just let it pass”
  • “These are just thoughts – not reality”
  • “I don’t need these thoughts – I can choose to think differently”
  • “This isn’t dangerous.”
  • “So what?”
  • “Don’t worry – be happy” (Use this to inject and element of lightness or humor)

If you have frequent panic attacks, consider writing your favorite coping statements or “mantras” on an index card and carrying it in your purse or wallet.  Bring the card out and read it when you feel panic symptoms coming on.

4-Step Deep Breathing

There are two systems in the body.  One caused the fight or flight response that occurs when anxiety or panic are triggered.  There’s also a relaxation response that can be triggered to override the fight or flight response.  This is why learning deep breathing and other relaxtion techniques is important to one’s recovery.

Many people with anxiety are prone to breathing very rapidly and shallowly (“Chihuahua breathing”) throughout the day.  This causes you to breathe out too much CO2 too quickly.  You need a certain amount in your bloodstream to balance out the pH or acid level in yoru blood.  Breathing out too much CO2 too quickly is what causes tingling or numbness in the extremities (eg fingers, toes, nose) as well as some lightheadedness or dizziness.  This why people need to breathe into a paper bag when hyperventilating to help breathe back in some of the necessary CO2.

We’re going to break down a slow, deep breath into 4 steps.  It may feel awkward or robotic at first.  It will get easier as you practice and will eventually feel like one fluid movement.

Step 1:

Contract your diaphragm downward.  This creates a vacuum and sucks air deep into the bottom of your lungs.  It looks like your stomach is a balloon filing with air, but it’s actually your internal organs moving forward as your diaphragm moves down.

Step 2:

Continue the slow, deep breath(through your nose) to fill up the top half of your lungs.  You’ll see your chest rising too as it fills with air.

Step 3:

Pause and hold the air in for as long as you feel comfortable.  The more you practice, the longer you’ll be able to hold it.

Step 4:

Slowly breathe out through your mouth with your lips pursed together as if breathing out through a straw.  You’ll notice your chest deflate and then your stomach deflate.  Repeat 3-4 more cycles, slowing the breathing down each time.  Caution: if you feel any dizziness or lightheadedness, you are deep breathing too quickly and need to slow down.

Many people intially worry that they are not getting enough oxygen if they are not gulping in air.  You will actually find that you get better quality oxygen throughout your body with 1-4 slow, deep breaths per minute, as compared to 30-60 of the “chihuahua breaths.”

If you are having trouble signaling your diaphragm to move, ensure that you are wearing loose, comfortable clothing and practice in different positions (eg sitting, standing, lying down, after aerobic exercise)

Practice only when you’re at your most relaxed until you develop this skill further.  If you wait to try when you’re having a panic attack, it most likely won’t work.

Carotid Body Massage

There are several simple ways to slow the heart down when it starts to race.  The most well known and perhaps the most effective is massaging the carotid body.  The carotid body is a lump that is located on the carotid artery, which carries blood from the heart to the brain.  It is found in the neck, just below the earlobe at the level of the angle of the jaw.

If you place your finger there, you will feel the artery pulsate.  Massaging the artery gently at that point causes a reflex slowing of the heart.  Never massage both sides together at the same time.  This can cause serious side-effects, including stopping the heart!

The carotid body is full of little receptors that check the rate of the heart and the pressure.  If the speed or pressure gets out of bounds, they send a signal to the brain to slow the heart by nerve action.  Massaging the carotid body tricks it into sending these “slow-down” messages out in greater numbers.  The result is that the nervous system works harder to slow the heart rate down.  In general, when the heart rate is slower, it is also less likely to produce skips.

Questions for This Week:

1. Describe your experiences of panic attacks when you have the first fear (the physical symptoms) and the second fear (you scare yourself with negative self-talk and fight not to have the symptoms)

2. Describe your experiences of panic attacks where you said more reassuring things to yoruself and allowed the panic symptoms to pass through your body (riding the wave)

If you are comfortable, feel free to share your answers in the comments section and I’ll share some of them in next weeks session!

Answers from Last Week:

Kelsey shared:

Q. How does panic or anxiety impact your spirituality:

A. It makes me doubt my intuition which I consider my spiritual guide. It makes me doubt my safeness in this Universe. It makes me question whether or not there truly is a guided path I am on or whether or not I’m vulnerable to all of life’s hardships with no way of coping.

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