Panic attacks Laura Gardano, PhD Biochemistry.
I hold a PhD in biochemistry and I’ve conducted research in biochemistry and cell biology in Academia for over 20 years.
I started practicing yoga in early 2000 and breathwork over 15 years ago when I was living in Scotland. A couple of years later, I started my training to become an International Certification in Breathwork Mastery RBM practitioner with Alakh Analda, who is the originator copyright holder of the curriculum training programme and skills and knowledge syllabus in the 1990s and I have been giving Breathwork Mastery RBM sessions in groups and one-to-one since shortly after my certification in the training with Zentium International.
This had helped me overcome panic attacks by teaching me to stay present to body sensations and mind content. The sessions allowed the surfacing of old memories and body sensations that I was finally able to integrate. I recognized the origin of my reactions and malaise, and reprogramed my self-limiting thoughts.
Laura writes
It’s Tuesday morning something after 8.30 am after dropping kids to school time to go to work. Stepping into the car quickly on the road. Same road, same path everyday. The flow of thoughts of what I had to do today, lectures meetings, students, colleagues. What did he tell me yesterday? What does she want me to do again? I think working in this lab is crazy, I cannot take it anymore. Oh yes next stop there is a cross, I wonder if I have problem at crossing it, the guy coming quickly from the left will he let me pass? I don’t think so. The guy just behind will be angry at me if I don’t drive into the road quickly enough. For that project will we have enough? Did I answer that email. No awareness to the road, I don’t even know where I am but in fact, no awareness because the road is always the same which allows me to think about something else all the time. It allows to get lost in my worries and my preoccupations and my expectation for the future and the memories from the past. At every thought a sigh. A sigh is a deeper breath that physiologically is a response to stress because taking more air, the exhale becomes longer and it stimulates the parasympathetic nervous system that is the branch of the autonomous nervous system that calms you down(Li and Yackle, 2017). I keep thinking away and every thought a sigh. I am at the ramp to the motorway now, there is a lot of traffic and getting in the motorway means make myself space between cars. I am worried to irritate people, will they allow me to get it? Will they allow me to find my space? I keep stressing and sigh. Siiiiiiiigh … and the impression that my brething is not right. My neck is tight, I only use my upper chest to breath. Tension accumulats in this region of the body. Breathing is difficult now so I perceive that something is not right. I breathe obviously but I have the feeling that I am not breathing enough. Thoughts of suffocating come to mind. I am not breathing enough, I can die….and from thought a spiral of black thoughts just keep coming into my mind. Mechanically, I want to breathe more but my body is so tight now that I can only breathe with the top of my chest and that triggers in my mind the idea that it is not enough. My mind gets confused, I feel tightness in my head. Shall I pull over? No way, keep going all it’s fine. Indeed, a voice inside says that nothing is terrible, that I experience this so many times and I always survived. There is no reason I cannot survive now. I look for something to eat to distract my mind, but I have nothing in the car. So I sing, singing helps. I used to think that singing was helping because it allows the mind to focus on something else, the lyrics, the music, the vibrations in the body. There is value to it but also when we sing, we automatically slow down ourexhale which helps to stimulate the parasympathetic nervous system and helps also to re-equilibrate the CO2 in the body (see beyond). A panic attack has a peak and after the climax all returns a bit to normal: I am left still shaky, hands tingling, a bit of tightness in the entire body but the mind finds its calm again. Rational thoughts are back, plans, programs, things to do, things to say. After many other traffic jams and stops I finally arrive at work, still shaken by the experience. Now I breathe normally even if the memory of the experience lets me sad and unhappy, with another defeat. The defeat of not being able to control this happening.
We may think that the panic starts in the mind with lots of thoughts, stress, uncontrolled emotions. William James and ……, however, claimed that the perception of an emotion starts with body sensation. In the panic, an altered breathing pattern triggers the body and mind reaction (Gerritsen and Band, 2018) (Russo et al., 2017). We try to sigh because it calms us down but too much sighing, deep breath cycles that are too close to one another leads to hyperventilation or hypocapnia characterized by a decrease in the level of CO2 in the body below 35 mmHg (Nardi et al., 2009) (Meuret and Ritz, 2010). It is true that CO2 is what we exhale and so what we eliminate with an exhalation but in the body CO2 serves to balance the blood pH so the level of CO2 must not decrease much in the body (REF). Indeed, a rapid decrease of CO2 as a result of hyperventilation leads to increase of blood alkalosys(pH increases). In people that are chronically in hyperventilation, blood pH is kept under control by the buffer system in the blood regulated upstream by the kidney (Nardiet al., 2009). The involvement of the kidney is particularly interesting here because in Traditional Chinese Medicine (TCM), the emotion linked to the kidney is fear. Fear is very important physiological response that allow animals to keep safe and a find safety in emergency. The instinct to look for safety is what is called the fight-or-flight response which depends on the hormone adrenaline produced by the surrenealglands. In the fight-or-flight response adrenaline accelerates the heart beat digestion is stopped, and the body is ready to run away from the danger. However, when this system is triggered in absence of “real” danger, the body is under the influence of adrenaline, breathing accelerates, the heart beats faster, body temperature rises, and hyperventilation is triggered. In TCM good functionality of the kidney indicate good perception or danger/fear/ keep safe. However, when the kidney energy is out of balance we might perceive danger when there is no need or our response to uncomfortable situations become excessive translating into the emergence of fear and panic attacks. Also, a permanent feeling stressed and overwhelmed can consume the kidney energy and so perturbing its function of balanced fear towards and uncontrolled fear state. Actually, the stimulus to breathe is given by the brain in respect to the level of CO2 not of O2 because the level of O2 does not vary as fast as the one of CO2 so unless we are in a place with no O2 or too low to be sustainable, our internal level of O2 stays pretty constant even when we have that sensation of ‘there is not enough O2 in this room’ (REF).
Hands start to tingle and sometimes even tighten so much that we have the feeling of not being able to move them. Same for the rest of the body. Some people can go into spasms, a condition defined as ________ (REF).
Before going into this extreme state, the body tries to regulate itself and the regulation is to breathe less. I felt my body doing this, start skipping breaths as to say you are breathing too much. And this is what can actually increase the distress to someone having a panic attack. Singing helps because when we sing we are obliged to breathe more slowly. When we sing, we take a breath in and to make the sound go out we close the vocal chords to make a beautiful sound to go out. So, in producing the sound we are not breathing if we close perfectly the vocal chords. One of the remedy to counteract a panic attack is to take a breath in hold the breath for few seconds and letting it go slowly. Few rounds of this allows to control the panic. Singing works on the same principle but it is not always the easiest of the solutions to adopt.
The fight or flight response is a natural way of responding to danger. The problem is when this response is initiated and entertained when there is no danger outside of us. And the issue is the mind does not indeed a danger outside, but people who suffer from panic attacks perceive a danger inside. And the danger are the thoughts, the loop of thoughts that never stops. It is the voice that enumerate all the mistakes you made, all the time you did not behave as expected, all the occasion when you did not do the right thing. The chain of thoughts can go in the far past thanks to the flow of associations in the brain. That is what the mind does.
The panic attack happens in the body not in the mind. The flow of thoughts will just stay as a flow of thoughts unless it transforms into a physiological response. The body gets ready to run away but you cannot run away from yourself, from your own thoughts. The panic forces you to put your mind into something else than your mental flow. It is a way to force you in the here and now because when you are in a panic you have to take care of it. Either you sort it out or you scream so that someone will come to it.
In my history of panic attacks in normal life, I just communicated that I was having a panic a couple of times and it did not help. I rather deal with them by myself. But this is because from the very first time I felt the panic, in the mist of the strong feeling that I was dying, there was something in me that was saying that it was not the end, and that I was going through something very powerful and devastating but that was death even if I had the strongest impression of it. Freud in the introduction to psychoanalysis defines this, when animals are in front of a danger the adrenaline-dependent response allows to evaluate whether fight is worthwhile or running away is a better option. In either case, an action is evaluated not a freezing response as in the case of panic (FREUD Sigmund, 1922). The peculiarity of panic is this tremendous fear that life is in danger but no action comes out of it apart feeling exhausted at the end of it. Nevertheless, the quality of life is at stake for people who suffer from panic attacks. I realized that when the panic starts it has to go till the end but there are ways to not make the panic starting at all.
Since the panic affects so much the breathing pattern, the best way of controlling the panic attacks is to learn how to breathe consciously. Consciousness in breathing brings in the present moment and it allows to learn how to stay in the present without becoming the victim of an uncontrollable flow of thoughts.
…. ADD here ….
SLOW BREATHING
Human beings breathe 12-15 times per minutes. Slowing down the breathing relaxes because there is less intervention of the sympathetic nervous system and more contribution ofthe parasympathetic nervous system which allows slowing down the heart rate. In fact,
PNS controls the vagus nerve, that in turn, allows the heart to slow down and a sense of calm is felt (Porges, 2007).
Coherent breathing is a typical technique of slow breathing. The breathing is slowed down to 5-6 breaths per minute and there is no pause between inhale and exhale. This particular breathing rhythm allows the coordination between the heart and lungs activity. During inhalation the blood is called to the lung where it gets oxygenated and during the exhalation the blood goes back to the heart to be pumped into the body to oxygenate the tissues (Stepehen Elliott REF). In this breathing the diaphragm is used and its regular movement is what allows the blood to go to the lungs and to go back to the heart at the exhale. So in this type of breathing, the diaphragm contribute to the blood transport along with the heart (Ehrmann Wilfried, 2017)
REFERENCES:
FREUD Sigmund (1922). Introduction à la Psychanalyse.
Gerritsen, R.J.S., and Band, G.P.H. (2018). Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front. Hum. Neurosci. 12, 397.
Li, P., and Yackle, K. (2017). Sighing. Curr. Biol. 27, R88–R89.
Meuret, A.E., and Ritz, T. (2010). Hyperventilation in panic disorder and asthma: Empirical evidence and clinical strategies. Int. J. Psychophysiol. 78, 68–79.
Nardi, A.E., Freire, R.C., and Zin, W.A. (2009). Panic disorder and control of breathing. Respir. Physiol. Neurobiol. 167, 133–143.
Russo, M.A., Santarelli, D.M., and O’Rourke, D. (2017). The physiological effects of slow breathing in the healthy human. Breathe 13, 298–309.
Ehrmann Wilfried (2017). Coherent Breathing.
Porges, S.W. (2007). The polyvagal perspective. Biol. Psychol. 74, 116–143.
