Now that we’ve realised we are going to be uncomfortable at times while we learn to deal with our anxiety, it’s time to delve a bit deeper into the discomfort.  Why does an anxiety attack feel so terrible, at times almost unbearable?  Remember, anxiety attacks can produce both physical and psychological symptoms.  Physical symptoms are felt as sensations in our body.  Psychological symptoms are felt as perceptions and emotions in our minds.  One of the main psychological symptoms is usually a feeling of fear or terror, which may be accompanied by a feeling of dread or impending doom.  It can feel like a big dark wave approaching, ready to sweep us away.

The symptom scan is one of the most useful tools I have found to deal with anxiety attacks.  It takes this perception of an anxiety attack as one big wave of doom sweeping over us, and breaks it down into its component parts.  The technique is very simple:  scan through your body, noticing each symptom, where it is and how it feels, and then describing it to yourself.  For example:  “very tense abdominal muscles, buzzing sensation in tummy area, rapidly pounding heart, tight feeling in throat, dizzy feeling in head”.  It’s important to actually describe your observations very specifically in words to yourself.  By breaking the overall anxiety attack down into smaller, distinct sensations, our perception of it can change from a single “wave of doom” to a collection of uncomfortable physical sensations in the body.  It also helps move our perception of the attack away from being mainly inside our head, out into the various parts of the body.

Remember that our brain may interpret the physical fear response as emotional fear.  We can learn to reinterpret our fear response as just a collection of uncomfortable physical sensations.  In fact, we can even use these kinds of terms in our self-talk to reassure ourselves and convince our brain that we really are safe and there is nothing to fear.  The pounding heart is just from adrenaline making our heart beat harder and faster.  It’s just a physical symptom producing an uncomfortable sensation.  When we reinterpret what we are feeling in this new way, the “wave of doom” goes away.  By reducing our emotional fear, the intensity of the fear response may be reduced, because we are no longer feeding the anxiety cycle with more fear.  Sometimes, just practising this technique is enough to stop an anxiety attack completely.

One of the difficulties in learning this technique is that you have to go “into” the sensations, when our natural instinct is to avoid and resist them.  By having the courage to really feel the symptoms, we can learn to be more accepting of them.  We also become better at observing what is really going on in the body, rather than being overwhelmed by the perceptions and interpretations our mind puts on the situation. 

So the symptom scan technique can have two benefits.  Firstly, by reducing our interpretation of the anxiety attack as “fear”, we stop feeding the anxiety cycle, and so the intensity of the anxiety attack may be reduced.  Secondly, even if anxiety symptoms persist, by reinterpreting the symptoms as not fear but simply a collection of uncomfortable physical sensations, they becomes easier to accept and more tolerable.  The more you practise this technique, the easier it will get, and the quicker you’ll be able to feel these benefits.

Okay, so you’ve committed to change, and you’re ready to learn new skills and practise them.  The next step is to accept that sometimes during this process you are not going to feel great.  One of the problems with taking medication to remove our anxiety is that it can work too well.  We take the pills, our anxiety goes away, so we feel great!  We stop taking the pills and our anxiety returns, so we feel terrible.  In this scenario we are never going to learn to deal with anxiety, because it is either overwhelming us, or it is absent, so we cannot begin to learn how to deal with it.

Our society has become used to being comfortable at all times.  When we are uncomfortable, we believe something is wrong and needs to be fixed, preferably as soon as possible.  There is a quick fix for everything.  Headache?  Pop a pain pill.  Too cold?  Turn on the heater.  Too hot?  Turn on the air conditioning.  You get the idea.  We can’t stand being uncomfortable even for a minute.  What we need is a shift in our thinking.  Maybe we need to learn that a little discomfort really isn’t that bad.  Sometimes it may even be necessary.

If you want to learn to deal with anxiety (without numbing it away with pills), you are going to be uncomfortable sometimes - maybe for quite a while, because the new skills can take some time to learn.  You need to fully understand that it is all right to be uncomfortable.  Discomfort won’t hurt you - it just feels a bit unpleasant.   I really want to emphasise these points, as they are so important:

1. Experiencing discomfort may be necessary to the process.
   
2. Experiencing discomfort is OKAY.
   

Important: the discomfort referred to here is that produced by anxiety symptoms.  Some more serious medical conditions could produce similar symptoms, so be sure to get a medical check-up.

Warning: if you are taking medication for anxiety, do not suddenly stop taking it.  See the resources page for a link about this.

Someone once said “If you keep on doing what you’ve always done, you’ll keep on getting what you’ve always got”.  We are all hoping for a magic cure for whatever it is that ails us.  We hope that the result we want will be provided for us by our doctor, our medication, our psychologist/therapist/counsellor, the expensive workshop/seminar/retreat/book/CD/whatever-it-is that we bought.  The bottom line is:  nobody can really change you except you.  It all comes down to you making changes, taking some action. 

In general this action will need to be taken repeatedly, in order to build new patterns and habits.  It takes sustained effort.  It doesn’t come in pill form.  Yes, there are pills that can be prescribed for anxiety, but being dependent on a pill is disempowering, and comes with its own set of problems.  Instead you can empower yourself with tools you can carry around inside you for the rest of your life. 

Some people may try to convince you that you have some kind of permanent defect and will need to be medicated for the rest of your life.  Do not buy into this attitude.  You are not broken, and you don’t need fixing.  There is something in your life that is not working well for you, and you want to change it.  This is a learning process.  We don’t send children to school because they are broken and need fixing, we send them to learn, to expand their knowledge and skills.  If you really want to help yourself, then you need to learn new skills and practice using them until they work well for you.  Gaining new skills is incredibly empowering.  Commit to this process as a positive learning experience.

So now we have looked briefly at the normal sympathetic nervous system responses and the normal fear responses, let’s look at anxiety attacks.  Technically an anxiety attack is the same as a panic attack, although personally I think of an anxiety attack as being the milder version and panic attack as the more extreme version.

An anxiety attack or panic attack occurs when these normal responses occur suddenly in an extremely exaggerated way, especially when the situation does not seem to warrant it.  Sometimes there is an obvious trigger, particularly something we are fearful of, but sometimes there is no obvious trigger, or the cause may be something physical that we are not even aware of.

Symptoms of panic attack can be psychological or physical or both.  Psychological symptoms can include a feeling of impending doom or dread, intrusive thoughts, fear of losing control, going crazy or that life as you know it is over, feeling restless or agitated and unable to relax or stay calm.  Physical symptoms include racing and/or pounding heart, feeling hot and/or cold, faintness or dizziness, shakiness or shivering, ‘butterflies’ in the tummy, nausea/vomiting, tightness in the throat, tingling hands, breathlessness, feeling of ‘air hunger’, feeling of vibration in the chest and many more.  Hyperventilation is an abnormal breathing pattern that is often associated with anxiety and panic attacks.  Rather than just a collection of symptoms, the attack can feel like an intense wave of doom sweeping over you, which may invoke feelings of helplessness and despair.

Panic attacks can even mimic heart attacks because hyperventilation can cause constriction of coronary arteries, giving people a sensation of tightness in the chest.  People having panic attacks may call an ambulance or race to their local A&E clinic worried about their hearts.  Doctors can run tests, such as an ECG, to determine whether there is a real heart problem or not.  Also, sometimes the heart can beat in strange rhythms, when it feels as if there are missed beats or double beats.  Some heart arrhythmias are dangerous and others are not, and again doctors can check these out to make sure.  Many people have mild arrhythmias occasionally that are not dangerous and nothing to worry about.

Most of the symptoms of anxiety attacks are caused by the hormone adrenaline (otherwise known as epinephrine).  The sympathetic nervous system communicates to the adrenal glands that adrenaline is needed and it is quickly secreted into the bloodstream and away it goes to every part of the body to do its work.  Remember, we need to run from the threat to our safety, and so adrenaline stimulates our heart to pump harder and faster, and our breathing to increase, our blood vessels to route blood to our skeletal muscles to help us run faster.  Our senses become more sensitive, our brain becomes more alert, our pupils dilate to allow more light in so that we can see better.  Our bodies are preparing for extreme action.  Our bodies can cope with these effects, and they do this normally in situations such as intense exercise at the gym or when running to catch the bus.  When we are on the treadmill at the gym, a pounding heart feels quite normal and expected.   But when we are just sitting at a desk, say, we are not expecting the thumping heart and it feels very strange and uncomfortable and it might even scare us. 

Before going into more detail about anxiety attacks, let’s first take a quick look at the body’s fear response, because anxiety is all about fear.  A fear instinct can be very important to the survival of a species.  When an animal senses danger, the fear response is triggered so that the animal can respond to the danger appropriately.  This is known as the ‘fight-or-flight’ response (or sometimes the ‘fight, flight or freeze’ response).  The animal may flee to safety, or prepare to fight an enemy, or may even ‘freeze’ in an attempt to avoid detection.  In modern-day life we do not often have to run from predators or fight enemies, however the response can still be useful in some situations of physical danger.  

Many present day situations that cause us to feel fear are not about physical danger.  We may feel fear in situations where we are under pressure to perform, such as when taking an examination or giving a speech to a large group of people.  We may also worry and feel fearful about things we have very little control over, such as being a passenger on an aeroplane.  Whatever the trigger, the physiological response is much the same.  The sympathetic nervous system is stimulated.  

In our bodies, the autonomic nervous system (‘automatic’ part of the nervous system) has two subsystems called the sympathetic and the parasympathetic.  These two subsystems are in a kind of balance with each other, so that when one is more active the other is less active.  The sympathetic side is more active when we are more active, and the parasympathetic is more active when we are at rest and our body is digesting nutrients and doing repairs and restorative work.  During the fear response, sympathetic activity increases hugely, and parasympathetic functions such as digestion and repair shut down.  The body is preparing for action, possibly of an extreme kind – fighting for or running for your life.
 
Various parts of the brain and nervous system are involved in this response.  The adrenal glands (which sit on top of the kidneys) release a hormone called epinephrine – otherwise known as adrenaline – which produces a whole set of responses in the body.  Everyone has heard of adrenaline – we talk about an ‘adrenaline rush’ when we do something scary and/or exciting such as go on a roller coaster ride.  The body can’t really tell the difference between excitement and fear, it’s all in how we perceive the event.  If we enjoy roller coaster rides, we won’t be afraid and it will seem exciting, but if we don’t like them it may seem very scary.

What happens in the body during the ‘fight-or-flight’ response?

• Breathing rate increases – to get plenty of oxygen into your blood
• Heart beats faster and stronger – it needs to pump lots of oxygenated blood to your muscles
• Blood is redirected to the skeletal muscles – so that we can fight or run away
• Digestive processes reduce – you might experience stomach ache or nausea
  
• Salivation reduces  – you might experience a dry mouth
• Perspiration increases
• Pupils dilate – so you can see (the danger, your escape route, etc.) more clearly
• Increased alertness, senses may become more sensitive
  

These things also happen during some normal activities that are not associated with fear, such as during physical exercise.  The sympathetic and parasympathetic are always finding the right balance according to the needs of the body at the time.  When we are exercising, we expect to breathe faster and harder, we expect our hearts to pump faster and for our skin to perspire.  This is all normal stuff and not scary at all to most of us.

So far, so good, this is all normal stuff…