San Diego Therapist Blog: Regina Huelsenbeck, PhD

The truth is that our finest moments are most likely to occur when we are feeling deeply uncomfortable, unhappy or unfulfilled. For it is only in such moments, propelled by our discomfort, that we are likely to step out of our ruts and start searching for different ways or truer answers.

~ M. Scott Peck

It's quite possible that these uncomfortable and even terrifying experiences are the very times when we may grow the most, sprout wings and learn to fly.

Whatever you may be feeling internally is simply passing through at this moment. 

Breathe in and breathe out.

Your feeling state does not make you personally right, wrong, weak, strong, good or bad. Feeling states and thoughts float through us all day long. We are in a constant state of change. Nothing is permanent and nothing lasts forever. Thoughts, feelings, and even our basic biology is constantly in a state of change. Cells are changing every single minute. Some say we get cancer many times a day through flub-ups in cell DNA replication, but this does not always become a diagnosis of "cancer" per say, because we are constantly in a state of repair, replication and change. And the same is true for thought and feelings. They come and they go. Nothing is permanent. They float in and they float out.

It is only when something stops the stream, the flow, that things get out of whack. With thoughts, when we identify with the content of a thought, we get into trouble. For example, pretend the thought: "I can't do this" floats by. If I notice this thought for what it is: just a thought, then I can release it and the thought is free to continue floating by, and another thought will float through and so on and so on. However, if I get "hooked" or identify with the thought content by saying, "yes!, that is me, I can't do this... and...actually... in the past I could not do those other things...", then the spiral begins. The mind has gotten stuck in this content, hooked into the thought and a spiral has begun. This is one way depression or despair begins (which is anger turned inward)....through faulty thought identification.

To stop this spiral from happening you can pull out the hook. You can practice releasing thoughts. They are not really yours anyway. They are simply thoughts and feeling states. They come and they go. Getting hooked means identifying with or conversely fighting a thought or feeling (trying to push it down, deny it, or anesthetize). Either way, through identification or avoidance, you have engaged the thought/feeling state. It will usually stick around until you cut bait or gently release it. Try the fisherman's practice of Catch and Release.

Also note, there is usually a quality of rigidity and self-judgment to this downward spiraling. Add compassion and flexibility, to catch and release and see what happens.

A word on compassion from Pema Chodron:

Resource: Get out of your mind and into your life by Steven Hayes, PhD.  

In my work at the university, I see many trauma survivors; releasing guilt is a major focus in treatment. It's often imperative to release guilt to loosen the hold of PTSD symptoms (see below for general definition and description of PTSD symptoms).

Truly, many of us carry guilt about different things that have happened in our lives. We often believe that if we had just acted differently that things may have turned out better. "IF I had only taken his keys that night". "IF I had just been a nicer person or a better student, mom and dad would have stayed together". "I never should have gone out with her, I had a bad feeling and I should have trusted myself". 

3 basic ways we experience guilt:

1. We feel guilty that we did something that we should not have done, OR we feel guilty that we didn't do something that we should have done. (behaviors)

2. We feel guilty that we thought something that we shouldn't have thought or we feel guilty that we didn't think something that we "should" have thought of. (thoughts)

3. We feel guilty that we felt something we should not have felt or we feel guilty that we did not feel something that we should have felt.(feelings)

Kubany, a Posttraumatic Stress Disorder (PTSD) clinician and researcher has said that if he only had one hour to work with a trauma survivor (specifically he works with domestic violence trauma survivors) he would spend it on releasing her guilt. He went further and said that if he only had 10 minutes to spend with a victim of DV he would spend it on Hindsight Bias.

Hindsight Bias is basically blaming yourself now for decisions that you made before you knew what you know now. You cannot make a decision back then from the knowledge you hold today (knowing the outcome of the event). But we argue, "no, I had a feeling that something bad might happen". However, this is NOT the same thing as knowing the specific outcome of the traumatic event. You only attained that specific knowledge after the event, and not before. This is an important thing to keep in mind when we are blaming ourselves. We simply can't possibly know then what we know now. 

"A loving heart is the truest wisdom" ~ Charles Dickens 

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3 basic symptom categories of PTSD:

First time panic attacks are incredibly scary. They are especially scary because you usually don't know you're having a "panic attack". More often than not, you think you're having a heart attack or going crazy.

Here's a very common first experience with a panic attack:

"I woke up in the middle of the night, it was about 2am. My heart was beating really really fast. I felt like I couldn't get enough air. I sat up in bed and I could hear my heart beating, pounding; it was pulsing in my ear. I finally woke up my partner to tell him something was wrong with me and I didn't know what was happening to me. I was really scared. We both sat up in bed and I described my symptoms- my fast heart rate, difficulty breathing, and chest pressure. And then this fog-like haze started coming over me. I couldn't see straight, it was like misty- hazey- I started blinking to try to see more clearly. I felt almost like I was going to pass out or something. We talked about maybe going to the emergency room to get my heart checked out. The more we talked about it, the more I pictured myself at the hospital, and the more I worried about what could be wrong with me, the worse my symptoms got. Finally I jumped up and said, "lets go to the hospital". I was 100% positive: I was either having a heart attack or I was going to have one! We got to the ER around 4am, they hooked me up to all these heart monitors and took my blood. I sat on the table donning a hospital gown, freaking out, waiting for the results. It was humiliating. Finally they came back and told us that all the results were normal. My heart was fine".

This woman is not a hypochondriac and she's not losing her grip on reality. The bodily sensations are very real, and her interpretation of these sensations is extremely common. Many people who have a problem with panic, worry that they might be losing their mind and feel frustrated that they cannot just "get a hold" of themselves, or believe they are having a heart attack.

The truth is, sometimes we simply are not cognitively aware of how over stimulated and stressed we are. Panic attacks are infamously reported as an experience that seemingly came on "out of the blue". But truly a panic attack is not entirely out of the blue.

Panic attacks sometimes occur when a person is experiencing an extreme acute stress (just lost their job, heard they have cancer or learned they're daughter is going to prison). But more often than not, they occur for the first time when a person is under chronic stress for a prolonged period of time with little or no break. Chronic stress includes the big unexpected stressors of life and also the general stress of daily living (relationship, children, financial worries, job stress, lack of exercise and self-care, etc.).

We have an internal stress response system designed to respond to and save us from dangerous situations (for more on the stress response see "The Stress Response"). When we experience fear or anxiety the stress system gets activated. If this stress response system is activated too often for long periods of time, with very little time to recover, the system can actually become more highly sensitized to stress, making panic reactions more likely.

The first step is to figure out whether or not you've had a panic attack. Review the list of symptoms below. It's also wise to get a medical evaluation by a physician, just to rule out anything organic (hyperthyroidism for example).

What are the symptoms of a panic attack?
The DSM-IV TR says, "The essential feature of a Panic Attack is a discrete period of intense fear or discomfort in the absence of real danger that is accompanied by at least 4 of the 13 somatic or cognitive symptoms"
1. palpitations, pounding of the heart or an accelerated heart rate
2. sweating
3. trembling or shaking
4. shortness of breath or sensation of smothering
5. feeling of choking
6. chest pain or discomfort
7. nausea or abdominal stress
8. feeling dizzy, lightheaded, unsteady or faint
9. derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. fear of losing control or feel like you are going crazy
11. fear that you are dying
12. numbness or tingling sensations (paresthesias)
13. chills or hot flashes

If you have had a panic attack, get some help before it develops into panic disorder. Panic Disorder is characterized by the "presence of recurrent, unexpected panic attacks followed by at least 1 month of persistent concern about having another panic attack". People who develop panic disorder often begin to avoid situations, people and places where they have had panic attacks in the past.

Please remember that having a panic attack or panic disorder does not make you insane or weak. It just means you're human and you're overstressed. Your body is simply letting you know that you could use some help. 

The point of intervention can occur at many places to stop attacks. A pre-emptive strike could mean changing some habits and taking better care of yourself, or looking at some ways to reduce your stress level. Ask for help. Another intervention point occurs at the point in the woman's story where she sat on the bed with her partner talking and worrying about her symptoms: We talked about maybe going to the emergency room to get my heart checked out. The more we talked about it, the more I pictured myself at the hospital, and the more I worried about what could be wrong with me, the worse my symptoms got.

Once the fear system (which is mediated by the amygdala) has been activated and we are feeling the bodily sensations associated with panic attacks, we can either keep it going or turn it down with the thoughts that we think. The amygdala is an old part of our brain, it's an automatic, highly reactive, fast acting little sucker. However, the higher functioning parts of our brain- those responsible for cognitions have the ability to act upon the amygdala.  In the situation detailed above, the woman did not know she was having a panic attack; she was fully convinced that she was having a heart attack. Her fearful thoughts (I'm going to die", "I'm having a heart attack") about her body's sensations perpetuated the fear response, which serves to perpetuate the fight or flight reaction - increasing the bodily sensations and the panic attack.

Most importantly, if you've experienced panic attacks, have compassion for yourself. Ask for help and regain control over that pesky amygdala.

This is Jeff's story:

"My wife, Mary, and I were invited by an old friend, Steven, to join his balloon crew at the annual hot air balloon festival...We said yes enthusiastically. As crew members, Mary and I joined a team of several others, all of whom were needed to handle our balloon...

Now, to be perfectly honest, I have never been that comfortable with heights...[but] I have learned to work with it over the years, and it has not limited my activities...

Everything was fantastic for the first few minutes, as the ground fell away and I looked around, feeling the cool air and captivated by the spectacle of other balloons rising in the beautiful Albuquerque dawn. Then I felt the basket move sideways as the balloon caught a wind current. I looked down over the railing and saw the ground crew, the vehicles, buildings, everything, shrinking. Then I felt the first wave of fear. 

My experience of fear was the usual one. There was a feeling of slight dizziness, some weakness in the knees, a sense of my heart pounding, and a tightening in the throat and gut. My hands were already clutching the railing. I didn't want to move in any direction and wasn't sure that I could...

I wished I had stayed on the ground, but knew at that point there was no going back.

The realization that I had to cope was actually helpful.
There was no choice except to deal with the fear. There was literally no way to get relief until the balloon landed. I remembered that I did have many years of meditation experience and decided that I would likely need all of it! So I began to focus my attention very deliberately and sharply on the experience of my breathing.

Just as I had been taught and had done in my own meditation practice over the years, I let the breath be just as it was and let the situation be just as it was.

I directed my complete attention to the unfolding sensations of my breath, especially my outbreath. After just a few breaths, I noticed some relief. I was able to locate the feelings of fear in my body. I was able to breathe in and out with the fear, holding the sensations in the cradle of the breath. I was able to soften some around the sensations and the situation...I started to move about in the basket and began to take more interest in the ride.

I rode quite a distance with fear that morning. In fact, fear came and went and came back again many times. But each time it came, I was able to meet it the same way, using awareness of the breath as an anchor and consciously breathing in and out with the unfolding experience.

Through this practice of mindful breathing, I was able to change my relationship to the fear experience in a fundamental way. I was able to stop relating from the fear, or as the fear, and instead relate to the fear..."

I tell Jeff's story because I think it is an excellent example of effectively utilizing mindfulness practices in real world situations.

Jeff was completely stuck in this situation, there was literally no way out but through (as is such in so many of life's challenging experiences, we often can't just stop the ride!).

Jeff stopped fighting against his experience and essentially surrendered to it; he began breathing through it. He remembered the ANCHOR - his breath. He surrendered & took control simultaneously in remembering and using this ever constant friend. 

Jeff Brantley's above experience was quoted directly - almost verbatim- from his book "Calming your anxious mind". This book is an excellent resource for coping effectively with fear, anxiety and even panic disorder.

Dr. Jeff Brantley is the founder of the Mindfulness Based Stress Reduction Program at Duke University's Center for Integrative Medicine.