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ANXIETY..the delayed response technique, the PANIC attack and others

Have you ever found yourself rethinking a conversation or overplanning, or being kept awake at night by thoughts? Have you ever found it impossible to shut down your thinking? Do you sometimes succumb to panic attacks where you are paralyzed by fear?

You may suffer from anxiety.


If ever there was a prevelant mental health condition, it is surely anxiety. Anxiety is a normal response to a threat but at times we respond to threats that are imagined or could happen in the future. Thus the reaction that is meant to protect us from an imminent danger becomes sabotaged and we react with the same intensity to a perceived threat.


If we were on a walk and saw a bear running towards us. We would immediately be flooded with neurochemicals which would cause us to flee for our lives. The reaction would be intense, immediate and leave us feeling exhausted. However anxiety, when disordered, evaluates even a perceived threat as actual and we react in the same manner. This means that the anxious individual is frequently hypervigilant and almost always exhausted.


Anxiety is a learned response to situations where we feel threatened. Sometimes this response is learned in childhood where due to dysfunction we have had to face too many situations out of our control. See my earlier blog on the chaotic families. Anxiety in these cases is actually a way to keep us safe. Unfortunately, if this habit is not controlled it can quickly control us.


THE ANXIETY RESPONSE

Since we are fearful of the unknown and imagine what could happen one of the most typical anxiety responses is avoidance. Thus, if I have a test in two weeks I will get progressively anxious as the date approaches. Such that the day before the test I will suddenly feel ill and get a doctor's note. The illness was brought on by the accumulation of anxiety which eventually with lack of sleep and constant worry I could no longer support. As a result I miss the test, and my anxiety drops.


While this avoidance technique 'worked' in my high school days, such a response is no longer beneficial to me as an adult as I will have to face the test, or the meeting or the class at a later date and now I will be behind.


The avoidance response comes about because we imagine dire things will happen. If I go to the office Christmas party I will not know what to wear or what to say..people will judge me, I will say something silly and so on and so forth. We rehearse what could happen and inflate it to the point that we simply give up and avoid the stressor completely.


In my practice I have seen clients who imagine people judging them and become too anxious to even leave their apartments.


It is no use telling them it is in their imagination as to them it is real.


The delayed response technique


One technique I found very helpful for situational anxiety is what I term the delayed response. Rather than challenging the thousands of probable and possible outcomes I tell them not to challenge them but rather accept them but to test them.


Thus my client advises me that theyare worried about so many outcomes that they cant think, or sleep or eat. I tell them to write down all that they are worried about and put it aside. At an appointed time in the day set yourself one hour to worry and deal with the matters at hand. My clients often think one hour is not enough so I say ok two hours that will mean for 22 hours you are worry free.


The result of course is during that hour, they find that they can easily address the concerns and that many are simply variations on the theme. They are then freed from the crippling effects of anxiety.


My high school self could have benefitted and spared me many an anxious night worrying instead of simply preparing.


Social anxiety and timed exposure


I have found that in cases of social anxiety which is very prevalent in these post covid days, a variation on the delayed response is very helpful. I have clients who are terrified to be in crowds and go out of their way to avoid gatherings of more than 10 people. They will get off a bus, leave a restaurant and stay home.


I tell them what would happen if there are 11 people. They look pale and anxious. I advise them stay in that room for only 5 minutes. Please set your watch. After 5 minutes leave. They agree but then in our next session proudly tell me they could stay for 10 minutes. By gradually exposing themselves they learn to manage their social anxiety by simply testing it.


THE PANIC ATTACK


A panic attack occurs when all our defences are exhausted. We have worried in our heads and now we have an intense physical reaction. Our heart pounds, we sweat, we feel dizzy, I have had some clients go blind, we collapse. It is the body's reaction to overwhelming stress we are litterally paralyzed and it is terrifying.


Many therapists will advise deep breathing at this point but in my experience this simply does not work. The other advice that is often given is to ground yourself or to look at your surroundings again this is futile.


A panic attack can be likenened to someone who is drowning. As a former dive master I rescued a man in full panic who was drowning. His eyes were wide and he was flailing. There is no way he could have responded to any instruction let alone ground himself. I merely swam beneath him using my scuba tank and grabbing his tank towed him to safety.


Given that a panic attack short circuits our brain we need to look for an automatic response in our bodies not our brains. There is only one system in the brain that is more powerful than anxiety and that is pain. When the brain senses pain all other systems including anxiety cease and all responses go to the source of the pain. Pain is our five alarm fire.


I have a client a middle aged woman who had a panic attack in my office. Much like the drowning man she was incapable of reason and flailed and scattered all my papers. I told her to do exactely what I was doing and did a wall squat. That is sat in an imaginary chair. Unless you are a high level athlete with thunder thighs this will cause pain and discomfort within a minute or two. She obeyed and 30 seconds later collapsed but her panic attack was gone.


I have gone on to recommend this very simple technique to all my clients and it was enabled them to enter places where normally they could not because of panic. The wall squat is simple and can be explained by saying you have back issues.


This is of course not exhaustive and is born entirely out of my experience as a practitioner of some 30 years. I hope it is of assistance.















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