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.

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.