“Physical comforts cannot subdue mental suffering, and if we look closely, we can see that those who have many possessions are not necessarily happy. In fact, being wealthy often brings even more anxiety.”
Let's start with two examples.
Example one: Someone stands behind a door with a balloon, and as soon as you walk by, they pop it right behind your head.
Example two: Driving down the road, you suddenly become short of breath, and your chest starts to feel tight like you have a heart attack.
Biology of Anxiety
The Neurological/electrical response: This is a quick as lightening response. This runs down the electrical wire-like tendrils of your body. This response turns on quickly, but the big key here is it also turns off fast.
The endocrine response is the release of adrenaline into your bloodstream. This takes 1-2 minutes to pump in and 10-15 minutes to pump out after the triggering anxiety is passed.
The anxiety response elevates your physiology from its normal level, to its baseline. Different people often have different "normal levels" and those "baseline" levels can change for the better, or worse.
Psychology of anxiety;
Common driving thoughts are some version of "I am in danger," "I am not okay", "I am going to die," or "something bad is going to happen to me."
Second-tier thoughts: "If ____ keeps happening, I will never be okay." "Unless I get _____ this will never end."
IMPORTANT: Anxiety thoughts can continue pushing this elevated anxiety state for hours or days.
How this plays out in the above examples.
Example 1: The response is to quickly jump in the air and then turn to look or run. Once it is obvious the danger was a ruse then the electrical will calm down. However as your friend keeps laughing your heart will keep beating quickly, and your hands might be shaking. You will likely experience the effects of the adrenaline for the next 10-15 minutes.
Example 2: The second example will also cause distress as it feels like you are having a heart attack and are short of breath. However, instead of knowing that you are safe, your mind will likely continue to convince you that you are not safe. This continued fear and uncertainty means that both the electrical and chemical responses stay turned on. Eventually either on your own or in the ED the person will figure out that they are not dying. This will turn off the electrical. It will still take another 10-20 minutes for the adrenaline chemicals to work their way out of the blood stream.
What about medications?
Preventative: These are typically antidepressants. They reduce the emotional reactivity of a person. They reduce how "jumpy" someone is. These should reduce the intensity and frequency of panic attacks.
Abortive: These often benzodiazepines like ativan (lorazepam) and xanax (alprazaolam). Benzodiazepines work very well, but they often lead to problems down the road; they should be short-term use medications. Other medications frequently given include Vistaril (hydroxyzine), and Neurontin (gabapentin).
Psychology of Anxiety:
Anxiety can stem from many things but let's not focus on where it comes from as we have little control there. Let's focus on where it goes because we have much more control over that. Anxiety often leads to more anxiety and becomes a feedback loop, breaking this loop means saying "I am fine, I am going to be fine." Understanding that you will be fine is step one of coping.
Coping skills:
Coping skills are developed like any other skill and the more you practice them the more effective they become. If you have anxiety issues, schedule a daily time to practice calm. Remember you practice before the real thing, not during. Remember it takes 10-15 minutes for the adrenaline to get out of your system and so your expectations should be that no how effective you are at your coping skill, you are still working with biology.
There is no off switch in the brain. The way to turn off the anxiety cycle is to turn on every other light in the house and drain it of power. I will explain how these go about below.
Help for Anxiety:
The most commonly recommended coping skill is slow breathing. Let's slowly walk through the intentionally small and important parts. See how it engages at least seven different parts of the brain. Additionally, this method engages so many parts of the brain it can be difficult to "think" about other things.
Breathing: The heart: Half of the heart is dedicated to the lungs, the other half to the remainder of the body. Controlling breathing puts manual pressure on the heart to slow down, and it helps balance the oxygen-carbon dioxide ratio of the body. (movement/breathing section of the brain engaged)
Breathing: Speaking: As we breathe, we count out loud, "out one, two, three, four, and in through the nose, one, two" We do this slowly. Find a balance, and don't make yourself dizzy. (Engaged: hearting, speaking, listening, counting, four separate sections of the brain)
Breathing: Sensation: We focus and picture in our imagination the sensation of the air passing over our lips, into our lungs, and out again. (Engaged: sensation and imagination.)
Other coping skills can be adapted to the above method:
Recitation of a memorized prayer or scripture
Recitation of a positive affirmation or poetry
Development of coping skills is crucially important and the goal use of medications should be felt to be temporary. Preventive medications (months to years), abortive (less than a few times a week initially, then less as you go on).
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