Wellbeing. Counselling

Transcription

1 Wellbeing Counselling Panic Attacks

2 What is panic? A panic attack is an extreme fear response which occurs when a person is convinced they are in extreme danger, even when no real danger exists. Symptoms Intense fear or apprehension Palpitations Shortness of breath Racing heart Chest pain Sensations of choking or smothering Trembling, or feeling like your legs are turning to jelly Feeling light headed or dizzy Nausea or a sudden urge to empty your bowels Sensations of tingling, numbness, or pins-and-needles, usually in the arms or legs Churning in the pit of your stomach butterflies Sweating Feeling out of touch with your body or detached from things around you During a panic attack you might feel very afraid that: you re losing control you re going to faint you re having a heart attack you re going to die For most people it occurs without warning, leaving them shaken. The frequency of attacks varies. On average, attacks tend to last between 2 and 20 minutes, although you may remain on the verge for days, fearing the onset of another panic attack. What is happening in my body? Fear is designed to alert us to the presence of any dangers which could be potential threats and warns us to pay attention and get ready for change. The part of the brain that is activated by perceived threat is the amygdala. Its job is to protect you by getting you ready to either run away from danger or fight it. People call this response fight or flight. If your amygdala senses trouble, it will automatically give your body what it needs to be strong, fast, and powerful. It will flood your body with oxygen, hormones and adrenaline that your body can use as fuel to power your muscles to run away or fight back.

3 Fight or flight response When faced with a life threatening danger it oftenmakes sense to run away or, if thats not possibl, to fight. The fight or flight response is an automatic survival mechanism which prepares the body to take these actions. All of the body sensations produced are happening for good reasons - to prepare your body to run away or fight - but may be experienced as uncomfortable when you do not know why they are happening. Thoughts racing Dizzy or lightheaded Changes to vision Dry mouth Breathing becomes quicker and shallower Heart beats faster Adrenal glands release adrenaline Nausea and butterflies in the stomach Hands get cold Bladder urgency Palms become sweaty Muscles tense

4 During a panic attack, your body is working really efficiently to prepare you to respond to danger. The problem is, sometimes the amygdala thinks there is a threat and fuels you up even though there is no real danger at all. Have you ever made toast that has got a bit burnt and set off the fire alarm? The fire alarm can t tell the difference between smoke from a fire and smoke from burnt toast and it doesn t care. In the same way, the amygdala can t always tell the difference between something that can hurt you and something that can t. The amygdala doesn t take time to check anything out. It s a doer, not a thinker, and this is how it keeps you safe. Although you might feel like you are dying or going crazy, panic attacks are actually harmless. What Can You Do About It? Muscle Relaxation To prepare for action, muscles must become a lot more active and energetic. This is referred to as muscle tension and has an obvious survival value. However, prolonged tension often results in muscle pain, headaches, jaw problems and stiffness and may contribute to the maintenance of anxious thoughts. By becoming aware of tension as it is building up, you can alert yourself of an imminent panic attack and instruct your body to calm itself before the fight or flight response is triggered, gradually reducing the intensity of the arousal of the nervous system. Relaxation encourages an attitude of acceptance, choosing neither to fight nor flee, but rather to be in the present, knowing you can withstand it. By spending a few moments on trying to relax your body, you can start to improve some of your physical discomfort as well. Mindful Breathing Just as a car is fuelled by petrol, the physical symptoms you experience during a panic attack are fuelled by oxygen. While things like increased blood flow or the release of adrenaline are automatic functions outside of your direct control, breathing is something you can voluntarily control. By slowing down your breathing rate, you can slow down the whole process. This exercise can be done standing up or sitting down, and pretty much anywhere at any time. All you have to do is be still and focus on your breath for just one minute. Start by breathing in to a slow count of 4, hold the breathe for a few seconds, and then breath out to a slow count of 6. Breathe in through your nose and out through your mouth, letting your breath flow effortlessly in and out of your body. Remember the technique of slow breathing sounds very simple and is very effective, but takes practice. Progressive Muscle Relaxation (PMR) involves letting go of the tension in your body to bring a sense of relaxation. It is performed by constricting and releasing your various muscle groups. The premise of PMR is that by relieving the stress you have built up throughout your body, you are able to quiet and calm your mind. Before you begin, get into a comfortable position in a place that is free of distraction. Take a nice deep breath and give your thoughts permission to take a break from problem solving for a while. Close your eyes if that feels best for you and then work your way through the following steps: Lower arms - Make a tight fist with each hand and feel the tension around the knuckles and up the forearm. Hold for 5 seconds and then relax for 20 seconds, letting your arms sink down on the arms of the chair. The pattern of tensing for 5 seconds followed by relaxing for 20 seconds should be used for all the remaining exercises. Upper Arms Push your elbows into the arm of the chair. Do not tense the lower arms, leave them loose by your side, feel the tension in your upper arms. Tense, then relax.

5 Face Raise your eyebrows as far as possible. Hold the tension in your fore head then relax, feeling your skin become smoother. Screw up your eyes and wrinkle your nose. Feel the tension in your cheeks and around your eyes hold then relax. Bite your teeth together and pull back the corners of your mouth. Hold then relax. Neck Push your chin down towards your chest, but don t let it touch. Tense the neck then relax Chest, shoulders, back Push your shoulders back into the chair and feel the tension in your chest, shoulders and upper back. Tense and then relax letting the shoulders drop. Stomach Pull your stomach muscles in, holding your breath while you tense. Then relax. Leg Straighten your right leg by lifting it off the ground and point your big toe inwards whilst stretching the foot. Feel the tension all down your leg, then relax, letting the leg sink to the floor. Repeat with the other leg. Discontinue any tensing that causes you pain. Do not tense any muscle group that you know is damaged in some way. Notice any differences you feel between tightening your muscles and relaxing them. Now notice how your body feels resting against the chair or bed, so at peace and so aware of its need to let go. Take another deep breath in and repeat to yourself, My mind and body can be relaxed and calm. I can know peace and stillness whenever I chose. End your practice by taking a few more deep breaths, noting how much more calm and relaxed you feel. Just like learning any new skill, PMR requires practice. By practicing PMR several times a week, you will become more aware of what it's like to feel relaxed. Understanding this feeling can help you to more readily let go of tension when anxiety rises. Being able to quickly relax your body can also help you in managing stress and panic attacks. Challenging Thoughts As the level of adrenaline rises in your bloodstream, the number of thoughts of what if? tend to increase also, encouraging you to overestimate the danger and begin rehearsing for a catastrophe. This exaggeration has survival value in that if you take over-the-top measures, you can better ensure your safety. While in theory this is a good idea, once you learn that you are in fact safer than you realised, you will see that this catastrophizing is unnecessary, and usually unhelpful. By learning to identify and disempower these thoughts, you can uncouple these thoughts from the rest of the panic response and move from fear to safety Catch yourself having these thoughts and question whether they are fact or opinion. Facts are truths supported by evidence and are driven by rational thought, while opinions are personal views and driven and reinforced by emotion. When we catastrophize, we may distort opinions or emotional responses to fit into facts, rationalizing our beliefs, for example, If I hadn t run out of class just in time, I would have not been able to breathe and probably would have collapsed. This type of self-statement ignores any real evidence and assumes that there is in fact real danger. Although the danger feels real, it is not. You survived not because of luck or rescue just in time, but because you were never in any real danger in the first place. If you learn to regard thoughts as guesses or theories rather than as solid facts, and decide that before you make a judgment you will examine the evidence for thinking that way, these fearful and unhelpful thoughts with begin to lose their power. By breaking the cycle of emotional reactivity, you are less likely to be carried along or controlled by the fear if you decide to make a choice about allowing yourself to be frightened or not. By doing so, you also stop the reaction from spreading to involve other sensations and behaviours that then spiral into a panic attack. Ask yourself, what are the real chances of this happening? Has it ever happened to you or anyone before? If not, then what makes you think this time will be any different?

6 2. Deflate the danger using coping statements. These sensations will soon pass. If I breathe slowly I will feel calmer. I don t have to fear my heart beating strongly. These are just thoughts I can choose to let them go. I can survive the judgment of strangers, and I can explain to those who know me, so I have nothing to fear. 3. Thought Stopping Remind yourself that what you re doing is just a bad habit and unhelpful and to stop it! like a mental slap on the hand. Switch to another set of thoughts, like planning what you ll cook for dinner every night for the next week or what you did for your birthday last year. Alternatively, you could move into a behaviour that sets off a different train of thought, like watching a movie or cleaning your room. Or you could introduce a feeling that runs contrary to distressing thoughts, like relaxing in a bath or listening to music. Meditation Mindfulness has been shown to reduce feelings of stress and anxiety and induce a state of relaxation that counteracts feelings of panic. The goal is to train your mind to be in the present with whatever is happening, without reacting to it. The follow mediation can be used when experiencing panic to help slow down feelings of anxiety and the accompanying body sensations. First, find a place where you can sit quietly and undisturbed for a few moments. Begin by bringing your attention to the present moment by noticing your breathing. Pay attention to your breath as it enters and then leaves your body. You are breathing and you are getting enough air. If you weren't, you would not be conscious right now. You will always be able to take in air, even if it feels like this breath is your last. Your body knows how much air it needs. If it feels like you cannot catch your breath right now, you probably are breathing a great deal of air in, but not exhaling enough. We can fix that right now. Blow out through your lips, as if you are blowing air through a straw. Hear the air whoosh out, emptying your lungs completely. Notice your lungs refilling automatically as you breathe in. Exhale again through your mouth, blowing the air out. Allow your abdomen to gently expand as you breathe in, and flatten as you breathe out, keeping the chest as still as possible. Keep breathing naturally... making sure to exhale completely with each breath. You are okay right now. Panic attack symptoms are unpleasant, but they are not dangerous. You aren't in any danger, even if you feel physical discomfort.. Let's add some affirmations: I am safe right now. Overcoming panic attacks is possible. I am able to deal with this. I know that anxiety cannot hurt me. Anxiety is a natural and normal process, and it will pass. It is okay to be anxious. It is okay to not like feeling anxious. I accept the way I feel right now, good or bad. It is perfectly safe to have a racing heart and I can feel my heartbeat becoming slow and regular. I know that I am getting enough air. My muscles are starting to relax. My eyelids are feeling heavy. I am starting to feel calm. I am more relaxed right now than I was a moment ago. My relaxation increases with each passing moment. My fears cannot hurt me right now. My mind can focus on images of peace and safety. I can picture a relaxing place right now. I can imagine what it would feel like to be completely relaxed. I can imagine what it would feel like if my hands were relaxed. I can imagine how heavy my arms would feel if I were relaxed. I can imagine what relaxation feels like. I can imagine a feeling of relaxation filling my body and mind. My whole body is starting to feel relaxed and heavy. I am safe right now. I am feeling calmer. There is nothing I need to do to feel more relaxed. My body and mind can relax all on their own.

7 Now that you have heard some affirmations, you may notice that you are even calmer than you were before. You will probably find that you are feeling relaxed and even a bit sleepy. To further deepen your relaxation and allow you to achieve a state of complete tranquillity, you can count your breaths as they arrive. Without trying to change your breathing in any way, simply notice each breath as the air goes smoothly in and out of your body. Take a breath in, and as you breathe out, say "one" in your mind. Wait for the next breath, and as you exhale, count "two." Continue to count each breath for the next few moments. If you lose count anywhere along the way, simply begin again at "one." It does not matter how many breaths you count, or how fast or slow your breathing is. Simply turn your attention to each breath, seeing how your body breathes naturally without any input from you. Notice and count each breath. You are now feeling deeply relaxed. Totally relaxed and comfortable. Calm and peaceful. Notice how you can use affirmations and relaxation to handle panic attacks and decrease symptoms of anxiety and panic. Overcoming panic attacks is possible. Notice how you naturally return to a state of calm. Memorize this relaxed state. You can return to this relaxed feeling anytime you need to. When you are ready to resume your regular activities, allow your mind and body to reawaken, while maintaining a feeling of calm. Let your muscles reawaken by rolling your shoulders... now turn your head... move your arms and legs a little... Return your attention to your surroundings, noticing where you are, and taking in the environment around you. When you have returned to your usual level of alertness and wakefulness, you can resume your usual activities, feeling calm. When Panic Turns Into Phobia A phobia is the avoidance of a situation or place because of fear or panic when no real danger exists. Because that first attack can be so disturbing, most people will go to great lengths to avoid another. Your intellect may be saying, Don t be such an idiot! Get a grip, no copping out, but at the level of our primitive life-and-death protective mechanisms, you re hearing Are you crazy? No way am I going there again! This instinctual part of you makes you hold back and find other ways to go around it, finding excuses and strategies that would get you off the hook and keep you safe. This may mean avoiding situations altogether, or relying on various safety measures being in place before going out, such as taking medication, avoiding eye contact with others, getting lots of reassurance from others, having an escape plan, following certain rituals or only going to certain places at certain times or if accompanied. What happens if we avoid? Whilst avoiding people or situations might help you feel better at the time and provide instant relief, it doesn't make your anxiety any better over a longer period. If you're frightened that your anxiety will make you pass out or vomit in the supermarket aisle, you won't find out that won't actually happen, because you don't go. So the belief that it will happen remains, along with the anxiety. Avoidance can also increase anxiety levels because the anxiety or worry beliefs become stronger when we don t test our fears. This is known as imagined anxiety. This is what people think will happen if they don t do something about the anxiety they visualize the worst case scenario. Over time, this leads the brain and the body to learn that it is good to avoid or escape a situation, adopting the better safe than sorry principle. This makes it harder and harder to stay in an anxiety provoking situation.

8 ANXIETY How do we stop avoiding? It would be really difficult to just stop avoiding all anxiety provoking situations at once. Instead, try gradual exposure. This involves setting a goal and then breaking it down into smaller, more manageable steps, gradually and repeatedly going into feared situations until you feel less anxious. First, rate your anxiety on a scale from 0-5. For example: TIME (The anxiety-producing situation is avoided, and the person receives a feeling of relief. However, next time the anxiety will be worse) As bad as it could possibly be full panic attack Really bad, can barely stand it extremely anxious, distressed, heavy breathing, heart racing Afraid, distressed, difficulty focusing on anything else Starting to feel nervous, unsure, uncomfortable, but can stand it Feeling alert, mild worry 0 No problem! I can handle this. Next, identify a specific goal and then list the steps needed to achieve that goal. The goal ladder should include some steps you can do now with mild anxiety, some that you can do now with moderate anxiety, and finally, the steps you find too difficult to do now. Start at the top with what your goal is then work out the easiest steps towards the bottom, filling in the gaps in between. Use your anxiety thermometer above to help rate each step from 0-5. Make sure that each step is specific and clear so that you know what to do and when you ve done it. It is important to start really small and take gradual steps. Some steps on the ladder can be broken down into smaller steps if you find you are having difficulty reaching the next rung. Additionally, you can break steps down into shorter lengths of time, for example, try for 1 minute, 5 minutes, 10 minutes, etc. or adjust other factors that might make each step more difficult, such as going alone rather than being accompanied.

9 Example of a goal ladder Peter gets anxious around co-workers and has not been able to make any friends at work. He tends to avoid the staff room and social situations. Peter would like to able to make new friends and feel comfortable interacting with his co-workers Attend staff party Share personal information about self with co-workers Go out for lunch with a group of co-workers Ask a co-worker to go for a coffee after work Eat lunch in the staff room and make small talk with co-workers Eat lunch in the staff room Sit in the staff room during a coffee break Ask a co-worker what they did on the weekend Ask co-workers questions about how to complete tasks at work Say hi to co-workers Working on your ladder Starting at the bottom, keep practising the first step until your fear comes down to a 0 or 1. Make sure you can consistently reach a 0 or 1 on several different occasions and are confident about each step before moving on to the next. If you find one of the steps is too hard, try breaking it down into smaller steps. It will also be important to start eliminating various safety measures, for example, sitting near exits, constantly seeking reassurance from others, or being accompanied by a trusted companion. When you are working this hard at something you deserve a reward! This can be a really useful tool to help keep you motivated. Some rewards I could use are:

10 Notes

11 Notes

12 Useful Resources: Books When Panic Attacks by Dr. Aine Tubridy Websites Get Self Help Panic Attacks, Panic Disorder & Agoraphobia W: Mood Juice Panic W: Helplines No Panic T: Adult Line (charge of 5p per minute, open 10:00am 10:00pm everyday) Youth Line (13-20yr olds; open 3:00pm 6:00pm Monday to Friday - landline rates apply) W: - Click on Get Help and then Having a Panic Attack? to listen to an online recording during panic attacks To make a counselling appointment: Telephone: counsellor@uwl.ac.uk Visit: Counselling Service, Paragon House, 1st Floor PR105, Boston Manor Road, Brentford, TW8 9GA Webpage: Counselling Service Opening Times: Monday 9am 5pm Tuesday 9am 5pm Wednesday 9am 5pm Thursday 9am 5pm Friday 9am 5pm NB: Telephone or Skype counselling is also available if accessibility is an issue. Samaritans T: E: jo@samaritans.org Wellbeing Counselling Disability Mental Health Disability Faith