From the September 2002 Idaho Observer:

Social confusion over flight/fight response equals panic

compiled by The Idaho Observer

Anxiety disorders are the most common mental health problem in America today. Between 13 percent and 25 percent of Americans (36-70 million) suffer from these problems, which can manifest themselves as panic attacks, phobias or obsessive-compulsive behaviors.

Last month we described the physiology of panic/anxiety disorder. Panic/anxiety disorder is simply the stress caused by confusion in the “flight or fight” response that all beings have inside them for self preservation. Panic/anxiety arises when the trappings of modern society confuse the chemical balances in the body which trigger the flight or fight response and one loses touch with the response most appropriate to self-preservation (and acceptable social behavior).

This phenomenon is more prevalent among our friends and family members than we think. It is a condition that can potentially affect anyone and may go a long way toward explaining peculiar behaviors being exhibited by our closest friends, family members -- or ourselves. This two-part series has been written to help people recognize and understand the signs of this disorder so that they may be better positioned to either help a friend or ward off the terrifying experience personally.

Everyone has an alarm reaction in their brain...we'd all panic if we were drowning. But for some, the regulation of the chemicals that induce the fight/flight response can be slightly out of balance. There is nothing alarming here. How our bodies function and how they are constructed is a matter of genetics -- just like hair and eye color.

People that have experienced panic attacks can eventually become frightened of the physical sensations of the emergency response itself, representing fear of fear, becoming akin to a phobia. However, in the case of panic disorder, the phobic object is internal in contrast to an external phobic object, such as an animal, which is usually predictable and escapable. Being afraid of something that is relatively unpredictable and inescapable creates a lot of anxiety about when it will recur and how to deal with it when it does recur.

Therefore, in some individuals, when the startle response is triggered, an overly reactive brain chemistry sends out a false alarm, preparing the body for action, supplying more oxygen and tensing the muscles. This accelerates the heart rate and can cause palpitations, trembling, nausea, numbness or tingling sensations, hot flashes, chest pain, etc. And it all can happen completely out of the blue, while engaged in some ordinary activity like driving a car or walking to work. Even though people who have panic attacks may not show any outward signs of discomfort, the feelings they experience are so overwhelming and terrifying that they really believe they are going to die or loose control and be totally humiliated. (For more details of the physiology of this disorder, see the August 13, 2002 edition of The Idaho Observer.)

Methods of healing to prevent anxiety disorders

There are a number of ways which people deal with these disorders. Self medicating with alcohol and drugs is the most prevalent because many people do not understand what is happening to them biochemically. Competent individuals very often self-diagnose these symptoms as “all in their heads”... to be conquered by self-discipline.

Twenty five percent of individuals with anxiety disorders never receive any treatment. The first step in conquering this trait is admitting and recognizing that something is wrong. We are all physiological beings with the same characteristics in dealing with the stresses and social confusion of today.

Alcohol and/or medication (xanax, prosac, paxil, etc.) are examples of methods used to self medicate, however, they all have a very high potential of leading to further problems of withdrawal and addiction. The only long lasting and safe methods are through natural techniques of keeping the body's physical functions in balance. This is done through proper diet, proper exercise and proper rest, which includes relearning breathing techniques and muscle relaxation. (Caution: Do not use any products that contain aspartame or artificial sweeteners such as diet colas, low fat items, etc.) Also, an understanding of the physiology of the fight/flight response is important so that our thoughts are kept clear, rather than confused, which was discussed extensively last month.

Overbreathing

When the startle response is triggered, it sends out signals to prepare the body for the fight/flight response. More oxygen is required and the muscles are tensed for action. Studies have shown that 50 percent-60 percent of people who panic show some signs of overbreathing or hyperventilation. Overbreathing is involved in panic attacks in two ways. First, overbreathing may produce an initial sensation that frightens you and leads to a panic attack. Second, overbreathing can develop as part of the panic reaction after the fear has begun.

The body needs oxygen to survive. When you inhale, oxygen is taken into the lungs where it is picked up by the hemoglobin (the “oxygen sticky” chemical in the blood). The hemoglobin carries the oxygen around the body where it is released for use by the cells. The cells use the oxygen in their energy reactions, producing a by-product called carbon dioxide (CO2), which, in turn, is released back into the blood, transported to the lungs, and exhaled.

Efficient control of the body's energy reactions depends on a balance between oxygen and CO2. This balance is maintained chiefly through the rate and depth of breathing. Breathing too much will increase levels of oxygen in the blood and decrease levels of CO2, because the oxygen is not used at the same rate that it is taken in. Breathing too little will decrease levels of oxygen and increase levels of CO2. The appropriate rate of breathing, at rest, is about 10-14 breaths per minute.

Although most of the body's mechanisms, including breathing, are controlled by “automatic” chemical and physical means, breathing may also be put under voluntary control. For example, humans can quite easily hold their breath when swimming or speed up their breathing when blowing up a balloon. Therefore, a number of “nonautomatic” factors, such as emotion, stress, or habit, can cause humans to change their breathing. These factors may be especially important in people who have panic attacks.

Interestingly, most people would consider oxygen to be the determining factor in breathing, yet, it is CO2 that the body uses as its “marker” for breathing rates. The most important effect of overbreathing is to produce a marked drop in CO2. This drop, in turn, produces a drop in the acid content of the blood and leads to what is known as alkaline blood. It is these two effects -- a decrease in blood CO2 content and an increase in blood alkalinity -- that are responsible for most of the physical changes that occur during overbreathing.

One of the most important changes produced by hyperventilation is a narrowing of certain blood vessels in the body. In particular, the blood flow to the brain is somewhat decreased. Together with the tightening of blood vessels, the hemoglobin increases its “stickiness” for oxygen. Thus, not only does less blood reach certain areas of the body, but the oxygen carried by the blood is less likely to be released to the tissues. Paradoxically, although overbreathing means a person is taking more oxygen, he or she is actually getting less oxygen to certain areas of the brain and body. This results in two broad categories of symptoms: (a) Centrally, symptoms are produced by the slight reduction in oxygen to certain parts of the brain, including dizziness, lightheadedness, confusion, breathlessness, blurred vision, and unreality. (b) Peripherally, some symptoms are produced by the slight reduction in oxygen to certain parts of the body, including an increase in heart rate to pump more blood around, numbness and tingling in the extremities, cold, clammy hands and muscle stiffness.

The changes associated with hyperventilating are those that prepare the body for action in order to escape harm, as noted earlier. If fleeing or fighting actually occurred, a state of overbreathing would not develop because the oxygen would be used at the rate it is taken in. However, hyperventilating is not dangerous and it is understandable for the brain to expect danger once acute hyperventilation has begun.

Breathing exercises

Once you fully understand the reasons and effects of overbreathing, the next step is to learn breathing retraining. This is a skill and therefore takes practice. The reasons for breathing retraining are (a) to decrease some of the physical cues to which you are very sensitive (i.e., the initial triggers for panic attacks), (b) to reduce physical sensations during panics, and (c) to facilitate general relaxation, which will reduce levels of tension and, therefore, impede the cycle of panic.

Exercises which have been found to work best involve two components. The first is slowing your breathing. You must learn to think about your breathing while you breathe smoothly and normally. This is difficult for many people, and you may find that when you start to think about and count your breathing, it speeds up. This is due to sensitivity to symptoms of overbreathing; because the symptoms have been associated with panic, they have become cues or signals of which you are afraid. Once you can think about your breathing, while maintaining a normal rate and depth, then you can begin to slow it down. The second component is a meditational one that helps you to strengthen your attention. Attention is very much like a muscle, and requires constant exercise to stay strong. Good attention is important because it will help you to concentrate on your breathing when you become anxious or panicky.

An outline of breathing techniques are; (1) learning to breathe from the diaphragm (the stomach) rather than the chest; (2) to control the rate and depth of breathing; and (3) to divert your thoughts away from the fight/flight sensations. These will be discussed in simple detail so as to lead one in the proper direction of the best methods of controlling anxiety disorders. For extensive instruction for extreme cases, a trained therapist should be consulted.

At first, count each breath while breathing at your usual rate and depth. Do not take in too much air and do not try to slow your breathing just yet. Just breathe smoothly and easily. To help yourself do this, place one hand on your chest and the other hand on your stomach with the little finger about 1 inch above the navel. Movement should come almost entirely from the lower (stomach) hand. Try to prevent the chest area from moving. If you are a habitual chest breather, this kind of breathing may feel artificial and cause feelings of breathlessness.

The goal is that every breath in should be accompanied by a ballooning out of the diaphragm, and every breath out should be accompanied by pulling in of the diaphragm. Do not gulp in a big breath and then let it all out at once. Also, breathing through the nose makes it more likely that you will breathe out slowly. Once you can do this, keeping your breathing smooth and fluid, begin to work towards breathing in as much air as you can, expanding the diaphram, then exhaling as slowly as possible, counting up to ten and thinking...relax...at the same time.

What this is doing is bringing your CO2 and oxygen balance back to normal while at the same time diverting your thoughts away from the sensations of the startle response.

Muscle relaxtion training

Tensing of the muscles is another component of anxiety and panic. Muscle tension has survival value because it is a necessary step in preparing for action. It is difficult to run or fight off danger when you are relaxed. Muscle tension is also part of the general state of alertness and vigilance that characterizes general anxiety.

The exercise found to be most helpful for reducing tension is called progressive muscle relaxation. It entails tensing of the muscles from major muscle groups in your body followed by release or relaxation, concentrating on the experience in an objective way.

First, the tension-relaxation mechanism is like a pendulum; the further you pull it one way, the farther it will go the other when released. The more tension you produce, the more easily you can relax. Second, purposeful tension lets you become aware of the differences in sensations produced by tension versus those produced by relaxation. This awareness will allow you to detect tension even at mild levels. Then, you will be in a better position to use the relaxation technique as soon as you are aware of tension, instead of waiting for it to build to high levels.

The muscle groups you want to build up tension in are the lower arms by making fists with your hands and pulling up on the wrists, the upper arms by pulling the arms back and in toward your sides, the lower legs by flexing your feet and pulling your toes toward your upper body, the upper legs, while sitting, by pulling the knees together and lifting the legs off the chair, your stomach by pulling your stomach in toward the spine, your chest by taking in a deep breath and holding it, the shoulders by pulling back toward your ears, your neck by pressing the back of your neck toward the chair and pulling your chin down toward your chest, around your mouth and jaw and throat by clenching your teeth and forcing the corners of your mouth back into a forced smile, around your eyes by squeezing your eyes tightly together for a few seconds and release, across the lower forehead by frowning and by pulling your eyebrows down and toward the center and finally the upper forehead by raising your eyebrows as high as you can.

At first you want to practice these separate groups individually, holding tension for up to ten seconds, then concentrating on the relaxed feeling after tension is released. Eventually, the goal is; (1) to be able to do all these groups at the same time; and (2) to automatically “recall” the relaxed feeling that you experience when tension is released, so you can initiate the calming effect in public as you do deep breathing, thinking...relax...when exhaling.

As time goes by and you begin to see this working, you will actually start loosing your phobia from the fear of the fight/flight sensations and at some point may never experience panic attacks again.

This is the guideline in its simplest form that only two pages can allow. We can tell you that with practice these simple techniques will help people to control panic and anxiety. There are books that can be found at your local library that elaborate on anxiety disorders. There is also a lot of information readily available online. Simply type “anxiety disorder” or “panic disorder” into a search engine and follow the links.