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.

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…