Strengths Based Biopsychosocial Approach to Recovery from Panic
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
CEs available at: https://allceus.com/member/cart/index/product/id/505/c/
Objectives
– Define panic
– Examine how the fight or flight reaction can be corrupted to prompt panic attacks
– Examine the cognitive, emotional, behavioral, biological sources of the stress reaction
– Explore a variety of interventions that may assist people in counterconditioning the panic response
Why I Care/How It Impacts Recovery
– Panic attacks can feel overwhelming
– Panic attacks are exhausting and can leave people feeling out of control of their own body
– People can avoid things they have phobias of, but panic attacks seem to come out of the clear blue
– People with panic attacks often restrict what they do (superstitiously) to avoid panic triggers
– Awareness of what a panic attack is and what triggers them for each individual is crucial to recovery.
The Body's Response to Anxiety/Panic
– We have a primitive response system that protects us from danger “Fight-Flight-Freeze”
– To prepare to take on the threat, the body sends out “excitatory” signals
– Increase in heartrate
– Increase in respiration
– Numbness or tingling in hands (blood to the core)
– Sweating (temperature and slipperiness)
– Pupil Dilation (blurred vision/spots/brightness)
– Muscle Tension
The Mind's Response to Panic
– Oh CRAP!
– Something bad is going to happen or I wouldn't be feeling this way
– Catastrophic thinking— I'm going to
– Pass out
– Die
– Throw up
– —
The Panic Cycle
Track Panic Symptoms: Anxiety Log
– Log your anxiety episodes (not just panic)
– What were your symptoms
– Physical
– Cognitive
– Emotional
– What triggered it
– Why did that trigger it
– What may have made you more vulnerable to your triggers
Life Through Panic Colored Glasses
– If you are hypervigilant about panic triggers, you will find them
– Review your Anxiety Log
– Identify your triggers
– Make a plan to deal with them
– Identify vulnerabilities
– Make a plan to prevent them
Body Awareness | Physical Mindfulness
– Body Scan
– What am I experiencing
– What might be causing it
– Blood Sugar
– Stimulants
– Adrenaline Rush
– Orthostatic Hypotension
– Excitement or Panic
Its only a False Alarm
– Mindfully attending to panic
– Feel the sensations
– Focus on breathing
– Use positive self-talk
Exercise
– When the body is on high alert because it is getting stress signals, but you are sitting still, there is a disconnect which causes:
– an increase in stress chemicals
– may trigger catastrophic thinking
– One way to get the mind and body back in synch is to move
– providing a reasonable explanation for the increased heartrate and respiration
– Using the stored energy that has been released to fuel the fight or flight reaction
– Exercise also releases serotonin (a calming effect)
Nutrition
– Stimulants, medications and certain supplements can trigger a stress response.
– Caffeine
– Decongestants
– Guarana
– Hot peppers can trigger indigestion and a stress response (sweating, increased heart rate, difficulty breathing/chest tightness)
– Low blood sugar can trigger
– Cold hands
– Dizziness
– Trembling
Nutrition
– Eat frequent small, balanced meals
– Drink enough water
– Explore green tea which is thought to have anti-anxiety effects
Breathing, Meditation and Guided Imagery
– Interventions
– Mindful Breathing
– Combat breathing
– Aware breathing
– Body Scan
– R – Recognize what is happening
– A – Allow life to be just as it is
– I – Investigate inner experience with kindness
– N – Non-Identification
Relaxation
– Practicing relaxation techniques and biofeedback can reduce stress symptoms by:
– Slowing your heart rate
– Lowering blood pressure
– Slowing your breathing rate
– Reducing activity of stress hormones
– Increasing blood flow to major muscles
– Reducing muscle tension and chronic pain
– Improving concentration and mood
– Lowering fatigue
– Reducing anger and frustration
– Boosting confidence to handle problems
– Provide a sense of control over your bodily responses
Physical Conditions that Increase Anxiety
– Exhaustion
– Diabetes/hypoglycemia
– Hypertension
– Hyperthyroid
– PMS
– Pregnancy
– Postpartum
– Anemia
– Bronchitis/Emphysema
– Cardiac Issues
– Side effects of medications including SSRIs
Behaviors That Increase Panic
– Poor Time Management
– Taking on too much
– Procrastination
– Type-A Personality
– Perfectionist
– Overachiever
– Conscientious
– Phobia of wasting time/Lack of time perspective
– Difficulty falling asleep
Thinking Patterns That Increase Anxiety
– All-or-nothing
– Egocentric/center of attention
– Catastrophic thinking
– Need for approval
– Activity
– Write down 5 things that cause you anxiety
– Annual evaluations, going to the doctor, going to a new place (especially a big city)
– Identify the underlying thoughts that trigger your anxiety
– Dispute those thought patterns
Emotions That Increase Anxiety
– Shame/Embarrassment
– Inadequacy
– Going Crazy
– Anxious Anticipation
– Activity
– For each of the above, identify
– What causes the emotion, or what the emotion means about you
– Dispute it
Stress and Time Management
– You can feel time-stressed because
– You are over committed
– You procrastinated
– Sometimes procrastination is caused by anxiety (Philosophy 101)
– Activity
– Make a list of all the things you have to do (I use index cards)
– Separate the lists into 3 categories: Must do, Need to do soon, Like to do
– Prioritize and delegate the must dos
Apply It
– Identify 3 ways you could have used this information in the past week.
– What was the situation-
– What did you do-
– How effective was that for you-
– Short term
– Long Term
– If you would have had this new information, what could you have done differently-
– How would that have changed the outcome-
– How can you start integrating this knowledge into your routine
Summary
– Panic is caused by the fight or flight reaction
– Many things (mostly benign) may cause symptoms of the stress reaction
– Cognitive interpretations of these symptoms can cause a full blown panic attack.
– Body scan and breath awareness help some people
– RAIN and Distraction may work better for others
– Eliminating vulnerabilities can also eliminate low-grade chronic stress which can increase the likelihood of a panic attack.