A panic attack is an experience of being overwhelmed by unresolved emotional trauma, an event in the past revisited in the present as if it is happening again. The long-term therapeutic resolution of that trauma is personal and therefore different for each person. In the short-term, the psychosomatic (emotional and physical) alarm response may be calmed by an exercise which brings the person back into the safe here and now. The first part of this article explains the therapeutic theory behind the body calming exercise; and the second part is the exercise itself, available as a downloadable MP3.
Emotions are physical events
All of our emotions are physical events, involving brain activity, biochemicals, heart rate, posture, and muscle tension. For example, our posture is larger when we are happy and smaller when afraid; our heart rate is slower when calm and faster when excited or scared; we can think more clearly when feeling safe and less clearly when worried. (For more detail, see Psychosomatic symptoms: are they all in the mind?) The exercise in this article aims to address the effects of emotional/physical overload by relaxing posture and muscle tension, calming the heart rate, reducing stress biochemicals, and engaging the mind in the safe present rather than the traumatic past.
When we experience fear or anger that is beyond our capacity to process, our emotional/physical system goes into the fight, flight or freeze response. The amygdala, the brain’s alarm centre, is activated, so the adrenal gland secretes the stress hormones cortisol and adrenalin, and the immune system is temporarily shut down so all energy is invested in fight, flight or freeze. Which of those responses we have depends entirely on the meaning we give to the event. For example, given the same situation, someone who feels equal to physical confrontation is most likely to want to take control by responding with fight; someone who doesn’t want to or can’t fight but still has presence of mind will go into flight to get away; and someone who feels overwhelmed and helpless will freeze. The event being responded to in each case is the same: the response depends on the way the person makes meaning of it.
When emotions from a traumatic experience are not processed, those emotions stay with us and can rebound in what we might variously call emotional overwhelm, or anxiety, or panic attack. A conscious or unconscious trigger leads to the person revisiting their unresolved trauma, the past transferred to the present, so the internal sense of danger is not proportionate to what is happening in the external world.
Imagine, for example, an ex-soldier walking through a busy town centre at the end of a working day, as shops are closing. Behind him, he hears a metal shutter come clanging down. Instantly he dives for cover, curled into a ball inside a shop doorway. The sudden sound of the shop shutter has activated his amygdala, the brain’s alarm centre, his heart rate is speeding, and he is aware only of the need to make himself as small as possible. Consciously or unconsciously, he is replaying the unresolved trauma of sudden noise, of being shot at, of bombs exploding around him, of seeing his friends being blown to pieces. When he was on the front line he coped and he got on with the job. Now he’s home he doesn’t have to cope with it, so he has a backlog of unprocessed and suppressed experience to deal with. This is often how trauma is: we don’t always feel its full force when we’re in the situation – the weight of unresolved emotions often comes when we let down our guard because the danger has passed.
There are three key reasons why someone would suppress their emotions at the time, that the strength of feelings is delayed:
1. A sense of responsibility, putting one’s own needs beyond reach so as to care for others, such as a senior member of a team in a life-threatening situation, or a parent/teacher in a situation of danger responsible for a child or children, or someone more concerned about their partner’s safety than their own.
2. A personality structure in which one of the four basic emotions – happiness, anger, fear, sadness – is disallowed. If fear or anger is disallowed in a threatening situation, it will inevitably ‘leak’ after the event, as no emotion can be successfully suppressed indefinitely. (For more on disallowed emotions, click here.)
3. The situation is so unexpected and the emotional response feels so colossal that the person cannot take it in and is in emotional shock, unable to process.
In any one of these cases, there is the possibility that the emotions associated with the traumatic event(s) will not be processed because the person does not know how to, or they think the emotions are ‘bad’, or their emotions are ‘not allowed’ because others come first. Not being processed, the emotions are stuck. Being stuck, those emotions grow in intensity. Now those emotions are more intense, the person has to make even more effort to suppress them. This makes it more likely the suppressed emotions will leak. They might leak in:
- bouts of anger or sadness, without any explanation the person is aware of;
- self-harm, as the person uses self-inflicted pain to try to stop the feelings from taking over;
- or the person becomes depressed, i.e. s/he suppresses emotions to the point that s/he feels emotionally blunted, no longer able to feel anything, sometimes interspersed with periods of abundant crying or anger;
- or those stuck and suppressed emotions break out as panic attacks.
Memory and re-enactment
It is helpful to make a distinction between memory and re-enactment.
With a memory, no matter how vivid it is, we are aware that it is in the past. You might hear Do you really want to hurt me? by Culture Club on the radio, for example, then remember the first time you saw Boy George on Top of the Pops, how you quite liked the song, how you were secretly amused by your dad’s outraged response to seeing a flamboyant man looking like an androgynous man/woman. It’s vivid, it’s a little funny, and there’s a definite sense of it happening back then. It may be an unpleasant memory, like remembering being a child on a bicycle, riding on a pub car park towards a dog, then hurriedly peddling in the opposite direction, realising the Alsatian is bearing his teeth and bounding towards you. This was scary at the time, but there’s a definite sense of it happening back then.
The re-enactment of trauma in a panic attack is not a memory of back then, but physically reliving the unresolved past in the present. The trigger may seem small, but it is significant because it is associated with and leads back to the original trauma. It may be hearing a tone of voice or form of words which sounds like the abuser; or a room with an atmosphere like the one the person was locked in; or someone standing a little too close for comfort, leading to a feeling of being cornered; or simply a sudden unexpected recall of the event, no longer suppressed. The person is not always consciously aware of the trigger until it is discussed and deconstructed in a therapy session. This re-enactment is typified by such physical and cognitive effects as: quickened heart-beat, possibly leading to chest pain and difficulty breathing; agitated or shaking limbs; a sense of panic with racing thoughts; disregulated body temperature (going hot or cold); feeling faint; dissociation (feeling disconnected, the result of an increased level of stress hormones).
We want to avoid anything we fear. Paradoxically, that means we are always on the lookout and primed for anything that reminds us of it. Being primed means we exaggerate the triggers that are real, imagine triggers that aren’t there, and these real or imagined triggers blow the lid off suppressed feelings.
Ultimately, our task together in therapy is to understand the original traumatic event(s) and its effects on you; build your emotional strength by giving you the support now you didn’t have then, so you can safely process the stuck emotions at whatever pace feels safe; and give you back your sense of control, making it possible to live in your own safe space in the present tense.
Using the body to calm traumatic emotions
In the immediate here and now, that sense of panic and danger needs to be calmed, and the following exercise is a way of slowing down emotional/physical alarm, using your own body and mind to reverse the fear reaction and move from dissociation back into sensing your own body. The various parts of this exercise have been developed by psychotherapists specialising in trauma.
The text below is available as a spoken MP3 to follow as an exercise. To listen on this page or to download, follow the instructions at the end of this article.
I strongly suggest you practice this exercise when all is well. Practice it until you’re familiar with it. You may want to do this alone, or practice it with someone you trust. This way, when you need to calm your body’s alarm system, you already know what to do, and possibly someone you trust also knows how to help you when you need it.
It’s important that you take your time in this exercise, so at some points I’ll suggest you pause the recording until you’re ready for the next step.
Find a comfortable chair to sit in. The best chair is soft with arm rests. Sit back in the chair and completely relax. Be aware of your body and let the chair take the weight of it. Relax. Have both feet flat on the floor. Put each arm on the arm rest or, if your chair doesn’t have arm rests, place each hand gently on top of your legs. Stretch out and relax your fingers. Let your hands fall gently down and release the tension.
Now we’re going to focus on your breathing. Close your mouth so that your lips are gently touching but your teeth are apart. This way you can reduce any tension in your jaw. The aim is to breathe only through your nostrils, slowing down your breathing. Take your time: if you need to breathe through your mouth for now, that’s fine. Go at your own pace, and try to breathe increasingly gently and slowly through your nostrils. As you do so, it may help to choose an object in your line of vision and focus on that, or focus on the sensation of the cool air entering and leaving your nostrils.
You may want to pause at this point while you focus on slowing your breathing, only through your nostrils, ever more slowly.
Once you’re breathing slowly and calmly though your nostrils, you have calmed down your heart rate and are ready to make contact with your own body, calming it further. You could try one or two ways of doing this.
The first is to place two fingers of each hand on each knee. Slowly and gently move each hand up to the top of your leg, then back to your knee, and back to the top of your leg, and so on. Feel the gentle sensation. Be aware of your own gentle touch, that you are in the here and now, that you’re safe.
The second way is to place each hand on your opposite shoulder. Move each hand down your arm to the elbow and back up again, slowly and gently. Again, be aware of your own gentle touch, that you are in the here and now, that you’re safe.
You may want to pause at this point while you focus on making contact with your body.
The final stage is to focus consciously on being in the present tense. To do this, notice three things you can see. For each of the three objects, tell yourself five things you notice about it.
Pause at this point, while you notice three things you can see and tell yourself five things about each one.
Now notice three things you can hear. For each one, tell yourself three things you notice about the sound.
Pause at this point, while you notice three things you can hear and tell yourself three things you notice about each one.
Now notice three things you can touch. You may want to rise from your chair and touch each one. For each object you touch, tell yourself five things you notice about it.
Pause at this point, while you notice three things you can touch and tell yourself five things about each one.
So now you’ve noticed and released the tension in your body; slowed down your breathing and by this slowed down your heart rate, calmed the amygdala, and reduced the flow of cortisol and adrenalin; you’ve come out of dissociation by making gentle contact with your own body, and you’ve observed some details about what you can see, hear and touch, bringing yourself back into the safe present tense.
The exercise above as a recording:
To download this recording as an MP3, click here and a new window will open. Go to the top right corner and click Download, then select Save File to download it to your computer.
About Ian Pittaway
Ian is a psychotherapist and writer with a private practice in Stourbridge, West Midlands. Ian’s therapy is integrative, chiefly comprising key elements of transactional analysis, object relations, person centred therapy and self-psychology. Ian has a special interest in trauma recovery and bereavement.
To contact Ian, call 07504 269 855 or click here.
© Ian Pittaway Therapy. Not to be reproduced in any form without permission. All rights reserved.