Anxiety & Panic Attacks

Anxiety and Panic – the terrifying pumpkin ghost

© Jorgan Harris.

1. Just a pumpkin ghost

A panic or anxiety attack is probably one of the worst experiences one can ever experience. This is probably the single psychological disorder that feels the worst of all disorders. It feels as if you are busy dying. It can feel as if you are having a heart attack, an asthma attack, a stroke or a fatal disease. It can feel like you’re going to lose your mind and it can feel as if you can die at any time.

The good news is however – although this is the one psychological problem that feels the worst, it is the least dangerous psychological problem and it is very easy to treat.

What you fear is actually just a pumpkin.

A pumpkin ghost is a hollowed-out pumpkin with eyes, nose and a mouth usually with a candle inside to make it look spooky. In the dark the pumpkin ghost can be experienced as very scary, especially when it appears out of the blue. In ancient Britain there was a superstition among the Celts that the souls of people who died the previous year on 31 October (Halloween day) may arise in various forms. They therefore made a fire by lighting a candle inside a pumpkin to shake off these creatures. It would hopefully terrify the creatures into leaving, but it is still just a cold pumpkin. The holes for the nose, mouth and eyes were just there for the heat to escape.

Panic and anxiety attacks can be compared to this idea of a pumpkin ghost.  Initially, it appears to be a terrifying embodiment of a ghost but without the holes that give it this ghostlike appearance, the fire would burn out.  By giving the pumpkin “holes”, or feeding the anxiety, you are creating the ghost.

Although anxiety and panic feel terrible, it’s just a pumpkin ghost scaring you. This pumpkin ghost can easily be treated. Hypnosis will help you to relax, to find the causes of anxiety and panic and then treat it effectively. Hypnosis, together with information about the disorder, was found to be one of the most effective treatments for panic and anxiety.

2. What exactly is panic and anxiety disorder?

When you begin to feel panic or become anxious, you experience brief episodes of intense fear accompanied by multiple physical symptoms (such as palpitations, dizziness, nausea, tingling sensations, out of breath and chest pains) which appear repeatedly and sometimes suddenly. These “panic attacks” which are the hallmark of panic disorders, occur when the brain’s normal mechanism in response to a threat – the so-called “fight or flight” response, is mistakenly activated. Most people with panic disorder also feel anxious about the possibility of getting another panic attack and avoid situations in which they believe they would get these attacks. Anxiety about another attack and avoiding what causes it, can lead to a panic disorder. Some people get panic about their panic about another panic attack!

3. A nervous breakdown?

I’ve always wondered what a nervous breakdown is. It sounds quite dramatic. It’s just a pity that I have not spotted that question at university. It sounds like the demolition of a building after a dynamite implosion or like a balloon deflating. Rest assured, there is no such thing as a nervous breakdown. It’s just a panic or anxiety attack.

What are the symptoms of a panic and anxiety disorder?

Typically, a first panic attack seems to arise “out of the blue”, occurring while a person is engaged in some ordinary activity like driving a car or walking to work. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms. These symptoms often include terror, a sense of unreality or a fear of losing control.

Diagnostic Criteria for panic/anxiety attack according to the DSM 5

A panic attack is:

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

Which of these symptoms are you experiencing?

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed, or faint
  • Derealisation (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control or going crazy
  • Fear of dying
  • Paraesthesia (numbness or tingling sensations)
  • Chills or hot flushes

If you have three or more, you are suffering from panic/anxiety attacks.

The only difference is:

  • A panic attack: These mentioned symptoms come out of the blue.
  • An anxiety attack: These symptoms are experienced only in a specific context, e.g. when driving a car, when in a lift or a shopping centre, etc.

This barrage of symptoms usually lasts several seconds but may continue for several minutes. The symptoms gradually fade over the course of about an hour. People who have experienced a panic or anxiety attack can attest to the extreme discomfort they felt and to the fear that they had been struck with some terrible, life-threatening disease or are “going crazy”. Often people who are having a panic attack seek help at a hospital casualty department.

Most of the time people who have panic/anxiety attacks believe they are:

  • dying;
  • having a heart attack;
  • going crazy;
  • having an asthma attack;
  • having a stroke;
  • developing a serious disease.

The good news is:

There are no documented cases of any of the above situations being caused by a panic attack. Even though this illusion may be created and causes distress, it’s not as bad as it seems but more about it later.

A panic attack usually takes a person completely by surprise. This unpredictability is one of the reasons it feels so devastating.

Even though people who have panic attacks may not show outward signs of discomfort, the feelings they experience are so overwhelming and terrifying that they really believe they are going to die, to go insane or be totally humiliated. These disastrous consequences don’t occur but it seems quite likely to the person who is suffering from the panic attack.

4. More about panic and anxiety disorder

In panic and anxiety disorder, panic attacks recur and the person develops an intense apprehension of having another attack. As noted earlier, this fear – called anticipatory anxiety or fear of fear – can be present most of the time and seriously interferes with the person’s life even when the panic attack is not in progress. In addition, the person may develop intense irrational fears called phobias about situations where a panic attack has occurred. For example, someone who has had a panic attack while driving may be afraid to get behind the wheel again, even to drive to the local supermarket.

People who develop these panic-induced phobias will tend to avoid situations because they fear it will trigger a panic attack and their lives may become increasingly limited as a result. Their work may suffer because they can’t travel or get to work on time. Relationships may be strained or marred by conflict as panic attacks or the fear of it rules the affected person and those around them.

Sleep may also be disturbed because of panic attacks occurring at night, causing the person to wake up in a state of terror. Some people are even terrified to sleep because they fear the terrible dreams that might occur. The experience is so harrowing that some people who have nocturnal panic attacks become afraid to go to sleep and then suffer from exhaustion. Also, even if there are no nocturnal panics attacks, sleep may be disturbed because of chronic, panic-related anxiety.

Many people with panic disorder remain intensely concerned about their symptoms even after an initial visit to a doctor yields no indication of a life-threatening condition. They may visit a succession of doctors seeking medical treatment for what they believe is heart disease or a respiratory problem. Their symptoms may cause them to think they have a neurological disorder or some serious gastro intestinal condition. Some patients see many doctors and undergo a succession of expensive and unnecessary tests in the effort to find out what is causing their symptoms.

5. It was a pumpkin ghost all along

No one ever developed one of the above conditions during an anxiety or panic attack. A panic or anxiety attack, although it may feel as if you are going to die, is just a cold pumpkin that is cut to look like a scary ghost, but is just a harmless shell.

Panic attacks catch you completely by surprise and this unpredictability is one of the reasons why they feel so awful.

The good news is: a panic or anxiety attack is just a release of adrenaline. We share this with animals. When an animal is in danger, he has got only one of two reactions. He fights or runs away (the so-called fight-or-flight response). In order to enable him to fight or to run away, the body releases adrenaline which puts more power at their disposal than usual to become stronger to fight or to run away faster. The animal’s heart rate, for example, runs faster to dispose blood faster through his body, the animal’s body temperature gets warmer to fight harder or to speed away faster, breathing is accelerated in this state of readiness and sweat then cools the body. Do you see the panic symptoms here?

Once the danger is over and the animal has won or has successfully gotten away, he goes to sleep to rebuild his adrenaline levels.

In humans, the process is exactly the same and yet so different. There is a danger. In this sense, we are the same as animals. Adrenaline is building up and our heart beat increases, our breathing becomes faster to put us in a state of readiness to fight harder or to run away faster and we sweat to cool our body off. In society, however, we cannot fight or run away. You cannot take a stick or a stone and beat the head of the Receiver of Revenue in. You can also not put on your running shoes and run away from your bank manager and as a result, this adrenaline gets trapped in our body. We are not able to use it and it remains trapped in our body.

If your stress levels remain high after the initial fight or flight response, another phase may follow. During this phase, the activity of your sympathetic nervous system starts to reduce, but the secretion of cortisol (your hormones suppressing physical and emotional pain) remains the same. If your stress levels during this phase continue to increase and your body is unable to deal with it, there is a good chance that your body will release adrenaline and nor-adrenaline into your brain and it may get trapped there which will then lead to anxiety and panic attacks.

However, to our detriment, we are also different from animals in the sense that when we recall a traumatic event or remember such an event – when we picture the traumatic event in our head, or when we think that it may happen again, we are using exactly the same part of our brain that we use when the trauma is actually happening. When we think of a traumatic event in our lives or when we create it in our mind, the fear that it might happen again – the brain records it as a realistic threat and your brain will release adrenaline and nor-adrenaline – and the fight or flight response occurs again.

A person can’t do anything about it and the release of adrenaline cannot be used. This adrenaline remains in your body and as a result you get panic and anxiety attacks.

The truth is – it’s just your natural fight-or-flight response. These symptoms are harmless and there is absolutely nothing wrong with you. You are medically safe and you will not die. You will not have a heart attack or a stroke. You will not faint. You will not go crazy. It feels like death but you will not die.

Just as you yourself frighten yourself to death when you suddenly see a pumpkin ghost or when you imagine that you have seen one – it’s just a pumpkin ghost and when you realise it’s just a pumpkin ghost, all these symptoms of anxiety will disappear within a minute or three. It will disappear just as quickly as when it started, when you realised that there is no danger.

6. Knowledge is power

A panic attack cannot cause heart failure or cardiac arrest

Rapid heartbeat and palpitations during a panic attack can be frightening sensations but they are not dangerous. Your heart is made up of very strong and dense muscle fibres and can withstand a lot more than you might think. A healthy heart can beat 200 beats per minute for days – even weeks – without sustaining any damage. So, if your heart begins to race, just allow it to do so, trusting that no harm can come of it and that your heart will eventually calm down.

A panic attack will not cause you to stop breathing or suffocate

It is common during panic to feel your chest close down and your breathing become restricted. This might cause you to suddenly fear that you’re going to suffocate. Under stress your neck and chest muscles are tightening and reducing your respiratory capacity. Be assured that there is nothing wrong with your breathing passage or lungs and that the tightening sensations will pass. Your brain has a built-in reflex mechanism that will eventually force you to breathe if you’re not getting enough oxygen. If you don’t believe this, try holding your breath for up to a minute and observe what happens. You will feel a strong reflex to take in more air. The same thing will happen during a panic attack if you’re not getting enough oxygen. You’ll automatically gasp and take a deep breath long before reaching the point where you could pass out from a lack of oxygen. (And even if you did pass out, you would immediately start breathing!) To summarise, choking and sensations of constriction during panic attacks, however unpleasant, are not dangerous.

A panic attack cannot cause you to faint

The sensation of light-headedness you may feel with the onset of panic can evoke a fear of fainting. What is happening is that the blood circulation to your brain is slightly reduced, most likely because you are breathing more rapidly. This is not dangerous and can be relieved by breathing slowly and regularly from your abdomen, preferably through your nose. It can also be helped by taking the first opportunity you have to walk around a bit. Let the feelings of light-headedness rise and subside without fighting them. Because your heart is pumping harder and actually increasing your circulation, you are very unlikely to faint (except in rare instances if you have a blood phobia and happen to be exposed to the sight of blood).

A panic attack cannot cause you to lose your balance

Sometimes you may feel quite dizzy when a panic attack comes on. It may be that tension is affecting the semi-circular canal system in your inner ear, which regulates your balance. For a few moments, you may feel dizzy or it may even seem that things around you are spinning. Invariably this sensation will pass. It is not dangerous and very unlikely to be so strong that you will actually lose your balance. If sensations of pronounced dizziness persist for more than a few seconds, you may want to consult a doctor to check for infection, allergies or other disturbances that might be affecting your inner ear.

You won’t fall over or cease to walk when you feel “weak in your knees” during a panic attack

The adrenaline released during a panic attack can dilate the blood vessels in your legs, causing blood to accumulate in your leg muscles and not fully circulate. This can produce a sensation of weakness or “jelly legs” to which you may respond with the fear that you won’t be able to walk. Be assured that this sensation is just that – a sensation – and your legs are as strong and able to carry you as ever. They won’t give way! Just allow these trembling, weak sensations to pass and give your legs the chance to carry you where you need to go.

You won’t “go crazy” during a panic attack

Reduced blood flow to your brain during a panic attack is due to arterial constriction, a normal consequence of rapid breathing. This can result in sensations of disorientation and a feeling of unreality that can be frightening. If this sensation comes on, remind yourself that it’s simply due to a slight and temporary reduction of arterial circulation in your brain and does not have anything to do with “going crazy”, no matter how creepy or strange it may feel. No one has ever gone crazy from a panic attack, even though the fear of doing so is common. As bad as they feel, sensations of unreality will eventually pass and are completely harmless.

It may be helpful to know that people do not “go crazy” in a sudden or spontaneous way. Mental disorders involving behaviours that are labelled “crazy” develop very gradually over a period of years and do not arise from panic attacks. No one has ever started to hallucinate or hear voices during a panic attack (except in rare instances where panic was induced by an overdose of a so-called recreational drug such as LSD or cocaine). In short, a panic attack cannot result in your “going crazy”, no matter how disturbing or unpleasant your symptoms feel.

A panic attack cannot cause you to “lose control of yourself”

Because of the intense reactions your body goes through during a panic attack, it is easy to imagine that you could “completely lose it.” But what does “completely losing it” mean? Becoming completely paralysed? Acting out uncontrollably or running amok? I am not aware of any reported instances of this ever happened. If anything, during a panic attack your senses and awareness are heightened with respect to a single goal: escape. Running away or trying to run away are the only ways in which you would be likely to “act out” while panicking. Complete loss of control during panic attacks is simply a myth.

The first step in learning to cope with panic reactions is to recognise that they are not dangerous. Because the bodily reactions accompanying panic attacks feel so intense, it’s easy to imagine them being dangerous yet in reality no danger exists. The physiological reactions underlying panic are natural and protective. In fact, your body is designed to panic so that you can quickly mobilise to flee situations that genuinely threaten your survival. The problem occurs when this natural, life-preserving response occurs outside the context of any immediate or apparent danger. When this happens, you can make headway in mastering panic by learning not to imagine danger where it doesn’t exist.

You will not have a stroke or an asthma attack

No one has ever had a stroke or asthma attack during an anxiety or panic attack.

Nothing can be that serious and nothing can go wrong

Nothing can ever go wrong. Nothing is ever that serious. You have no incurable disease, though it feels as if you have. Even though it feels like it and your medical tests proved the opposite, keep in mind that your doctor is not uninformed.  You are simply producing too much adrenaline and nor-adrenaline and that is making you feel terrible.

7. Overcome this pumpkin ghost forever

You can use the following tips to help you to conquer this pumpkin ghost forever. Psychotherapy will assist you further in this process.

You can simply take the following steps and all anxiety will subside completely within a minute or three. You will find that you will begin to follow these steps automatically without even thinking about it, until you realise that it is not even happening at all anymore.

  • Keep in mind that the feelings and symptoms you experience might feel very frightening, those symptoms are not at all dangerous or harmful. It’s your body’s natural secretion of adrenaline and nor-adrenaline that causes the so-called fight or flight response that isn’t finding expression as with animals or in ancient times.
  • Understand that what you experience is only an exaggeration of your normal bodily reactions to stress; the so-called “fight or flight” response.
  • The more you fight your anxiety and panic, the more adrenaline and nor-adrenaline you will secrete and the more anxious you will become. You just need to keep in mind that the more you fight your fear of this pumpkin ghost, the more power you give to this ghost. But this ghost is powerless and will burn itself out. You can also think: “Oh, what a childish ghost. It scares me because it is attention seeking. It is desperate to remind me of the souls who died when it is just a pumpkin that wants to scare me for the sake of a useless myth”. You can let it lose its’ power over you by realising that it’s just your body’s natural fight-or-flight response.
  • If you try to fight against the panic, you are making the situation even tenser, which makes you even more anxious. If you have exactly the opposite attitude and just let go, the feeling will automatically pass. Let your body simply react (with palpitations, chest pains, sweaty hands, dizziness, etc.), it will allow you to quickly and easily move through the anxiety. The key here is to be able to just watch (as you would watch a movie) your body’s physiological arousal, no matter how unusual or uncomfortable it feels without further fear or anxiety.
  • Allow time to pass. Panic is caused by a sudden surge of adrenaline. You need to simply let your body feel the reactions caused by this surge of adrenaline which will stabilise within three to five minutes. When this happens, you will start to feel better. Panic attacks have a time limit. In most cases, panic will reach its peak within just a few minutes and will start to subside. This will most likely quickly pass if you do not fight it or aggravate it by responding with even more fear (causing secondary fear) by terrifying yourself.
  • Practice deep breathing – by breathing from and into your stomach and abdomen. You always have full control over your breathing, which is a proof that you are always in control.
  • Relax your body and with every breath that you breathe out, you can relax and check your body for tension and then can relax the different parts of your body. You can relax your forehead and then just to let go. You can then relax your shoulders and neck and then relax your abdomen and stomach going deeper and deeper into relax mode with every breath that you exhale. You can get the rest of your body to simply relax with every breath that you exhale.
  • Do not fight your feelings or try to wish it away. The more you are willing to look them in the eye, the less intense they will become. Whatever you fight, will persist; the more you fight against it, the stronger it will become. The more you fear that it is dangerous, the worse the fear gets and the more this pumpkin ghost thinks that it has control over your life with its modified candles to make you afraid with simple images of yesterdays dead. The more you fear the fear, the more you will evoke fear in you and the more you will end up in the fear, the fear you really wanted to avoid. It is a vicious circle – stop the cycle.

Ask yourself:

  • What is the worst thing that can happen?
  • If it happens, how bad can it be anyway?
  • What are the chances that it will really happen?

The worst that can happen is that you can die. But how bad is it anyway?

If you have faith, death is not terrible, because you go into a state of enlightenment, a place where there is only joy and completeness. If you do not belief, death is then just a void. The same state that you were in before you were born. A state of nothingness, devoid of any consciousness.

How bad can death be anyway?

If these things were to happen, how bad is it anyway?

Most of the things we fear never happen. Think of the past and how many times you were worried about things. How many of your concerns ever happened? They were not that bad. You are still here and you’re still alive. Indeed, nothing is terrible.

What are the chances that it’s going to happen anyway?

The truth is that the things we fear never happen and we make ourselves miserable for nothing.

And realise:

Every anxiety and panic attack passes. It can’t and never will go on forever. It’s going to take a few minutes to disappear completely. Nothing funny will happen to you. It is, once again, just a cold pumpkin and a scary illusion.

8. Co-existing conditions

It is generally recommended that patients be carefully evaluated for other conditions that may be present along with the panic disorder. These may influence the choice of treatment. There are conditions that are frequently found to coexist with panic disorders.

You can read more about this on my website.

9. Beck Anxiety Inventory (BAI)

 

Scoring:

Score of 0-21 = low anxiety
Score of 22-35 = moderate anxiety
Score of 36 and above = potentially concerning levels of anxiety

 

References: Beck, A.T., Epstein, N., Brown, G., & Steer, R.A. (1988). An inventory for measuring clinical anxiety:
Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893-897.