Panic Disorders

In this blog I am looking at anxiety and it’s sibling panic attacks. I’d like to try in this blog and explain a bit about the brain and emotion along with the appropriateness of different forms of therapy. At a scientific level our understanding of neuropsychology and therefore our understanding of the neuropsychology of anxiety has come on leaps and bounds.

The human brain is different to all other mammals and primates in that we have the developed the higher cortex that gives rise to cognitive function, including speech, language, reasoning and self awareness. This we may term the “New Brain” and is the result of millions of years of evolution. If there is truly a difference between humans and other hominids this is it. The “Old Brain”, shared with many other species, that is also the result of millions of years of evolution, is dominated by the amygdala and the brain stem. The difference between these two parts of the brain is the difference between worry and fear.

Panic and fear based anxiety is emotional

Fear is an instinctual response, often a reflex, in the amygdala of the old brain that may lead to the physical, fight, flee and freeze responses that are activated in the brain stem. This tends to be highly emotional, often below awareness and may be triggered by thoughts, sounds, smells, colours and so on. When people have an old brain anxiety/panic attack it is a fear reaction and they will appear to be temporarily out of control. Once they have calmed down and the cognitive new brain is back on line they may be filled with remorse and be shocked and horrified by their instinctual behaviour.

The amygdala is a dual almond shaped organ, one in either hemisphere of the brain though usually termed in the singular. The difference between the two amygdalas, which  in Ayurvedic neuropsychology is recognised as a part of our intuitive function, that sense of knowing without knowing why we know. As such its function is both above and below our awareness. When it is functioning above our awareness we call it intuition. When it functions below our awareness we see it as the primal response of instinct. This is where we processes fear, yet we may never understand why we are afraid.

Panic

A dictionary definition is a sudden uncontrollable fear or anxiety, often causing wildly unthinking behaviour.

The Mayo clinic defines panic as…

“ …a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you’re losing control, having a heart attack or even dying”.

Symptoms 

Panic attacks typically begin suddenly, without warning. They can strike at any time — when you’re driving a car, at the shops, sound asleep or in the middle of a business meeting. You may have occasional panic attacks, or they may occur frequently.

Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides.

Panic attacks typically include some of these signs or symptoms:

  • Sense of impending doom or danger
  • Fear of loss of control or death
  • Rapid, pounding heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath or tightness in your throat
  • Chills
  • Hot flashes
  • Nausea
  • Abdominal cramping
  • Chest pain
  • Headache
  • Dizziness, lightheadedness or faintness
  • Numbness or tingling sensation
  • Feeling of unreality or detachment

Worry Based Anxiety is cognitive

Worry based anxiety is completely different to emotional based panic anxiety. The anxiety that is experienced in the new cognitive brain is completely different to primal amygdala responses, in that it is experienced as a reasoned response based in logic.

The reasoning and the logic may, in reality, be faulty but it is experienced by the person as factual. People will say “it is a known fact that…” when it is nothing of the sort. Worry based anxiety comes from the person not living in the present moment. They have projected themselves forward into ideas and experiences that may never happen but they are living them in the present as though they have. The tools of worry based anxiety are obsessing, which may lead to obsessive compulsive disorder or OCD, rumination, dog with a bone syndrome where we cannot let it go and tend to go over and over the same issue again and again.

Ayurveda

In Ayurveda, worry based anxiety, in the cognitive cortex, is seen as part of the process of the imagination. People with a poor imagination do not get worry anxiety because they have difficulty imagining negative futures to become anxious about. Cognitive anxiety is dealt with by Tantric therapy, which is not all about sex it is about dealing with and controlling the imagination. Worry in the amygdala is dealt with in the Raja therapy.

Tantric therapy is based in using visualisation to create future images that are positive and do not have the worry attached to them. The habit if attaching worry anxiety to a particular thought or image is replaced with new positive images that are the new worry free habit. Raja based therapy is mindful relaxation and meditative practice that reduces the levels of stress hormone in the body system reducing the instinctual feelings of fear.

Cognitive behavioural therapy

Over the years I, and many other therapist, have a stream of people presenting with emotional anxiety who will state how they have had CBT for their anxiety and how it worked really well, although it is not for everyone.

What happens is someone presents for therapy with amygdala based emotional anxiety. Because the world of therapy is awash with CBT practitioners the patient will almost certainly see a CBT therapist who uses their learned tools for dealing with cognitive anxiety. What happens is that the therapist uses a set of cognitive exercises that suppress the patients fear based emotions. it is as though they force in a cork to trap the emotions in a bottle of fizzy emotions. Because the emotions have not been processed or resolved over time the emotions gradually push the cork out of the bottle and the patient ends up just where they began with the same emotional anxiety.

Don’t get me wrong I am not against CBT, just the way that it can be limited or misused. The bottom line is cognitive therapy works best for cortex based worry anxiety. Emotional therapy works best for amygdala based fear anxiety and panic. The trick is that you need to know the difference.

If your anxiety if based in logical reasoning seek out a cognitive therapist they will be great for you.

If your anxiety is fear based find a therapist skilled in emotional work they maybe psychodynamic, cognitive analytical (CAT), Mindfulness based therapies or sit an 8 week Mindfulness based stress reduction (MBSR) course and you should get what you need.

Most importantly none of us need to suffer anxiety, If you do then please do something about it.

Take care and be happy

Sean X