How can you deal with panic attacks and social anxiety?
CBT could help thousands of people change their angst-ridden lives, says Harry Barry
A panic attack is where, out of nowhere, a person suddenly finds themselves short of breath, heart pounding, mouth dry, dizzy, stomach in knots, muscles tensed up, shaking, sweating and feeling as if they are going to die.
Hundreds of thousands of people in Ireland suffer from panic attacks. They learn to dread that awful moment when waves of physical sensations sweep over them and their body feels totally out of control. Many find panic attacks take over their lives and some may have lived in this shadowy world for up to 20 years.
Countless people suffer from social anxiety. Are you one of those dreading the next social occasion where you will have to expose yourself to the perceived scrutiny of others? Are you dreading the feelings of anxiety and embarrassment that this occasion will bring? Are you terrified to be asked to speak in public situations?
Others suffer from phobias. They may find themselves terrified of getting on a plane, driving on the motorway, visiting shopping centres and churches, open areas, entering lifts, being exposed to blood or simply of spiders.
Some live in the world of general anxiety. They may find themselves worrying, in a constant state of dread as to what might happen next. They may feel tired all the time, as a result.
People may suffer from post traumatic stress disorder. They may find themselves living in a state of hyper-vigilance, always seeking out danger.
Hundreds of thousands of Irish people, including many reading this article, live in the shadowy world of anxiety. And yet despite the countless people affected by anxiety and panic in all of its forms, many struggle to access any meaningful help for these conditions.
Of particular concern is the increasing incidence of anxiety, in all its forms among our adolescents. It is one of the causes of the self-harm epidemic among our school- going teenagers.
And yet, many of the conditions above can be overcome by an understanding of modern neuroscience and the application of simple CBT exercises. The reality is that there is an absence of knowledge of both. To try to improve this situation my book, Flagging Anxiety and Panic, was born with some new insights into these conditions.
The first insight is that anxiety pathways in our brain can be reshaped by our mind – a process called neuroplasticity. This is best done with the harnessed use of our mind. Targeted CBT exercises can reshape our anxious mind and, in turn, the very anxiety pathways creating the problem.
The second insight is that anxiety is not only a cognitive condition, where we worry and catastrophise all the time, but also a strongly physical condition triggered by our emotional brain activating our internal stress system.
The physical symptoms we experience in all forms of anxiety and panic are created by the firing of our internal stress system by a little organ, in our emotional brain, called the amygdala.
The amygdala is an ancient organ, there in the Dinosaur, whose job it is to see or sense danger and “fire”. Its job is to keep us alive when faced with danger, by firing our stress system to pump out, for example, our fear hormone adrenaline.
The amygdala is also the gunslinger of the stress system – shoots from the hip often without thinking and does not really worry about the consequences. The gunslinger is not particularly smart, has a long memory, does not respond to talk therapies and regularly disregards instructions from our logical brain. So one of the objectives of Flagging Anxiety and Panic was to highlight new techniques to disempower the amygdala.
A third insight is that the worrying side of anxiety comes from the left prefrontal cortex part of our brain and the catastrophising comes from the right prefrontal cortex.
In Flagging Anxiety and Panic, we meet people suffering from panic attacks, social anxiety, general anxiety, phobias, post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD).
In each case we see how the person, from the moment they sit down to open up to their distress, learn and apply the simple CBT techniques necessary to manage their anxiety or panic. The results are profound as many rapidly eliminate these conditions from their lives.
Two common conditions are panic attacks and social anxiety.
A panic attack is where, out of nowhere, a person suddenly finds themselves short of breath, heart pounding, mouth dry, dizzy, stomach in knots, muscles tensed up, shaking, sweating and feeling as if they are going to die. It can strike suddenly, for no obvious reason and literally terrify the sufferer. Many think they are going to die, go mad or run amok. Sufferers live in a state of constant fear as to when the next one is going to strike.
To understand a panic attack, we need to realise that the physical symptoms experienced by the person are created by an adrenaline rush. This occurs when our stress system is activated by the amygdala, or gunslinger, firing inadvertently and seemingly without warning.
We now know that the amygdala or gunslinger responds only in panic attacks to a concept called flooding. This involves learning how to go with the physical symptoms caused by the adrenaline rush. This in turn resets the amygdala and the gunslinger settles down.
What is quite extraordinary is how once the person understands what is going on and how the amygdala works – and learns to accept the discomfort that challenging the gunslinger will induce – panic attacks rapidly become a thing of the past.
Social anxiety is where we are anxious and embarrassed in case people will pick up some signs that we are anxious and end up judging us as inferior. Once again it is associated with very distressing catastrophic visualisations in our mind and associated physical symptoms which are very uncomfortable.
It is also associated with a lot of avoidant and safety behaviours which are described in detail in the book. Once again the two main players are the gunslinger amygdala which is misreading danger in other people’s faces which is not actually there, and the catastrophiser. They give rise to most of the cognitive and physical symptoms we experience.
A real understanding of this condition, with some targeted CBT exercises and a lot of hard work, can help us to challenge the thinking, physical and behaviour driving this condition.
For most people their lives can be transformed with these new insights and techniques – often within a few sessions.
Dr Harry Barry is a pyschologist and author of Flagging Anxiety and Panic (Liberties Press). He is a regular broadcaster on RTÉ and has been a contributor to The Irish Times.