Fear of Fear Itself: Why Panic Isn’t Dangerous

Everyone has experienced intense fear at some point. Our hearts start racing when we realize we forgot to pick up the kids at school, our hands tremble and sweat as we struggle to unlock the door as a dark stranger looms in the shadows, or we feel dizzy and nauseous as we get up to present that speech we haven’t really prepared for. Whether a threat is great or small, the people and things we care about might get hurt if we don’t respond quickly.

We evolved the sympathetic nervous system to prepare us for threat

The physiological response we feel during intense fear and panic is a result of the body’s sympathetic nervous system. The sympathetic nervous system evolved to help us prepare to respond to dangerous situations.  Activation of the sympathetic nervous system leads to the kinds of biological changes we experience in fear and panic, including changes in heart rate, blood vessel dilation, breathing, digestion, and perspiration. These changes make us ready to face challenges to our safety through fighting (i.e., overpowering the threat), fleeing (i.e., getting away from the threat), and freezing (i.e., holding your breath and hiding by being still – think about the T-Rex in the movie Jurassic Park). Intense fear (i.e., panic) can be a real life saver, so be glad it’s there for you!

Panic involves an unnecessary but harmless misfiring of the sympathetic nervous system

The biological readiness we call panic mostly evolved to help us deal with immediate threats in the external environment (e.g., being chased by an actual lion), but in humans the same system can also get activated just by vividly imagining threats (e.g., anticipating having a heart attack or going crazy). It’s kind of like going to a scary movie – you can easily forget you’re actually in a nice safe theater and become so engrossed in the movie that you end up being afraid. When we get so caught up in our heads, it can start to feel (i.e., in our body) very much like we are in danger, when in fact we are safe. Even if there are “real dangers” in the distant future, such as dying of old age, actively anticipating them without a sense of perspective can make our bodies respond as if there were imminent danger right here and right now. This is where worry and anxiety come from – imagined threats. Nonhuman animals don’t worry and get anxious about things that aren’t actually happing right here and now – but people do. This ability to imagine future possibilitiess, plan for them, and feel emotions about them is an important part of what makes us human, but it also has this dark side.

In panic, people misinterpret normal bodily signs of anxiety as threatening

People who have recurrent and repeated problems with attacks of panic (sometimes called panic disorder) experience their bodily sensations of anxiety and fear as if there were an imminent threat happening here and now. That is, their minds accidentally interpret fear itself as a being a threat. A classic example is when someone interprets an elevated heart rate as evidence of a heart attack, and then takes this interpretation too seriously. The vividly imagined threat of a heart attack activates the sympathetic nervous system, which then further elevates the heart rate, which then provides more “evidence” of a heart attack, and so forth until the person is totally convinced that he or she is going to die. Feedback loops like this can lead to a major meltdown. A “panic attack” is just that – a catastrophic interpretation of otherwise harmless bodily sensations, leading to more and more fear and panic. The problem lies with how the sensations of fear and panic are interpreted, not with the sensations themselves.

The solution to panic attacks

Stop running and instead, feel the fear. Get warm and cozy with it. After all, panic is your good buddy who is trying to keep you safe, not an enemy looking to harm you. A friendly relationship with panic can be very counterintuitive at first – after all, panic doesn’t feel safe. You may be tempted to try to get rid of it with medications (fighting), or to try to stay away from situations in which you might panic (fleeing), or maybe if you just hunker down and wait it out it won’t happen again (freezing). See the problem here? That is all more panic! You can’t fight fire with more fire, but the good news is you don’t need to in the first place. If instead you learn to “hang out” with panic, you can learn that it is in fact perfectly safe despite how it feels.

This can of course be a fairly difficult thing to learn; a “just do it” approach to accepting panic sensations is often not helpful. Fortunately, you can find guidance in learning how to be less reactive to your own thoughts and feelings – a mindfulness practice is a great way to help gain perspective, and there are good self-help books out there that can be helpful. Furthermore, there are evidence-based psychotherapies that have been proven to help people with panic disorder – give me a call if you’d like to schedule an initial consultation.

If there is a real threat out there in the world – attack it, run from it, or hide! But your own sympathetic nervous system is not your enemy. You are safe with yourself.

Anxiety Treatment at Portland Psychotherapy

Pain and values: two sides of the same coin

 “Where there is love there is pain” –Spanish Proverb

I’ve known and lived with many amazing dogs and cats in my life. Each animal I’ve known has been special and wonderful in their own way. But then there is Dalai. She is my lifetime dog. When we adopted that scared little dog all those years ago, I could never have imagined how she would change my life. She’s the canine version of my soul mate.

The problem is Dalai is growing old

Dalai

We’ve shared many, many years together, and unfortunately the fact of nature is that our canine companions’ time on this earth is way too short. Dalai (pictured to right) is somewhere between 16 and 18 years old now. Gone are the days when we would end our early morning walks by chasing each other outside of the Brookings Institution (you should have seen the security guards out in front of that stodgy DC think-tank laughing at us each morning) or of overhearing people at the park say things like “Wow, look at that little rocket dog run!”

We still have our daily walks, but they’ve become slow strolls– sometimes it takes her 20 minutes just to get around the block. More frequently we simply spend time together with her curled up and snoring away beside me on the couch, perfectly content to let her younger adopted sister take over ball-fetching duty. And nearly every day when I’m walking Dalai or sitting with her on the couch, I feel a deep sadness in my heart. As I am with her I am constantly reminded that her time with me is getting ever more finite. And sometimes that sadness is so intense that I have the thought that I can’t bear the feeling.

But here’s the thing…

If I’m not willing to have those thoughts and that sadness that shows up when I’m with Dalai, I can’t actually care for her in the way I would choose to during this time in her life. The only way to get away from these difficult thoughts and feelings is to not be around her. In order to spend time with her, to care for her and love her as my constant companion, then I have to experience my sadness at her impending loss. It’s the price of admission to be in this relationship.

My experience has been that those things that I care about the most, that are most meaningful in my life, are also the things that come with the most pain.

Check that out with your own experience. Are there areas in your life or relationships that you care about so deeply but that also bring a great deal of pain? Is it perhaps the case that the more you care about something, the more you’re opening yourself up to feeling pain?

Here’s an exercise I often do with clients around this struggle…

Step 1: Find some activity or relationship in your life that you value, but from which you find yourself pulling away. Maybe it’s a relationship you care about deeply but in which you’ve noticed you’ve been less engaged. Maybe it’s an activity you care about but you aren’t taking much action on.

Step 2: Now take out an index card or piece of paper. On one side, write down what you value in that relationship or area of living. Who do you really want to be to that individual? What are some descriptors of how you would like to be in that area of your life?  Now turn the card over. On the other side, write down what difficult thoughts and feelings might show up for you when you start taking action toward that value. For example, for my card with Dalai it might look something like

Front of card

 

Value:

 

Being a caring steward and loyal companion to Dalai for as long as she lives with us.

 

Back of card

Pain:

  • The thought “I’m not going to be able to handle it when she dies”
  • The thought “This is too painful”
  • The feeling of anxiety of not knowing when her death will happen

Step 3:  Now take that card and put it in your pocket, wallet, or purse. For the next week, take it out and ask yourself: “Am I willing to have that card, both sides of it, in its totality or would I choose to walk away from it?” Because, it’s a package deal, you can’t have one side without the other.

Values are freely chosen; we get to decide whether we will pick up the card. What we don’t get to choose is what’s on the other side of the card. Those things just come along for the ride.

 

Dalai and I are in this together. So Sadness, strap yourself in because Dalai and I still have a ways left to go on this ride together!