Tuesday, 25 February 2014

Dealing with Panic and His Friend, Anxiety

Anxiety comes over me like a cloud of indefinable darkness and confusion. My heart starts beating faster, my stomach goes into overdrive (like a washing machine) and my abdominal muscles go into spasm. Two years ago these spasms had gone on for over five days, which resulted in my suffering from vomiting reflex once or twice every hour. Eventually, I was exhausted and in total despair and so was forced to go to A&E. Anyone who has never suffered the effects of truly debilitating panic or depression may wonder at the impact on the body, but do not tell me that there is no link between my physical and mental well being.


Since beginning Dialectical Behaviour Therapy I have learned to focus on the signs from my body, including my breathing patterns, so that I recognise anxiety before it can develop into full blown panic attacks. Essentially, when under stress, I actually stop breathing for short periods of time. It doesn't take a genius to work out that if you stop breathing your body will get the signal that something is very wrong and that it is time to ignite the 'fight or flight' response. In other words, I was signalling my body to release as much adrenaline as possible - guess what? Heart rate rises and blood rushes away from where it's needed to where the body 'thinks' it's needed. The same goes for shallow, rapid breathing. Does that make sense? It did to me when my therapist pointed it out to me. So, the very first thing I do is acknowledge that my body is in panic mode which indicates that I am anxious about something.

Mindful Breathing

1. Notice your breathing, what it is doing and focus on returning it to a more measured level.
2. Just focus on the in...and...out, no need for deep breathing, just breathe normally and naturally.
3. Observe, the effect on your nose, in your lungs.
4. Watch the rise and fall of your ribcage and stomach.
5. Don't let worry thoughts distract you from this task.
6. Just focus.

But what about the trigger to the panic? First of all it helps to be able to name the emotion. Sometimes anxiety causes our thinking to become muddled as the reality is that the things we worry about don't come in one by one so we can manage them easily. Instead, they gang up on us and crowd in, bullying and badgering us for not finding immediate solutions. Having acknowledged that I am anxious, I focus on my breathing to relax my body, so I am not entering an inexorable physical and emotional spiral as I did previously. There are a number of mindful exercises that I have learned.


Thought Diffusion

The first and easiest one for me to manage is to attach my worries in my mind to the leaves of a tree and allow the leaves to drop gently towards a flowing river, which carries them away one by one. This exercise takes practice and a basic knowledge of mindful breathing, but is effective in everyday situations.

Guided Imagery (The White House)

Another one I use is called 'The White House'. (Here is the link: http://www.themindfulword.org/2012/guided-imagery-scripts-children-anxiety-stress/) This is a guided imagery exercise for children, but is so effective for anyone. I have found it very useful when I am overwhelmed by the size or number of my problems and worries. The most important thing about this exercise is that you cannot move into the part where you can relax until you have set down the large 'rucksack' of worries at the bottom of the stairs to the big White House. (obviously if you haven't read the instructions yet this won't make much sense, so please take a moment to have a look).

Problem Solving Questionnaire

I have recently found myself working through the 'Yes', 'No' questions of problem solving:

1. Are you worried about a specific Problem? If No, then don't worry. (Accept)

2. If Yes, is it a problem that can be solved? If No, then don't worry. (Accept)

3. If Yes, do you know the solution? If Yes, then don't worry. (Change)

4. If No, then don't worry because there is nothing you can do by worrying. (Accept)


Acceptance and Change
This process reveals two of the principle skills of DBT, in fact they are foundational: Acceptance and Change. The serenity prayer is so called because it holds these two truths in balance and releases us from wasting our energy on those things that are outside our control. My Anxiety can be controlled by using these skills, and by realising that if I can change the circumstances of my problems, then I don't need to worry. Also if I cannot change them but can learn to accept them as beyond my control, then there is no point in my worrying and I am losing out on the here and now.

Not one of these ways of managing my anxiety is either natural to me, or easy. As long as I have had panic attacks and suffered from anxiety I have defaulted to spirals which mean that the anxiety has controlled me. I therefore need to put in as much effort and time to developing the habit of preventing anxiety from (literally) taking me over and making it impossible for me to function to any effective degree.

Maybe you've tried some ideas like these and they've not worked immediately - stick with it. I know there are times when I still slip back, but never again has my whole body gone into spasm from an emotional response.

Again, I would say the key to me making use of these skills is, practise, practise, practise. I cannot change as and when the panic will rise, but I can change my responses to it and its little friend, anxiety.