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Bill

Emotional Rain

Did you ever go through a time when the emotional rain came, and it continued to pour for days on end? Oh, I suppose times like these come to most everyone, but I’m thinking a bit more frequently to panic and anxiety sufferers. How ‘bout you, what do you think?

Where does one go, and to whom and what do they turn, when it seems there’s no hope? I mean, when the punches just keep coming, how does one survive? And why would one even want to live for the next moment when all it brings is anticipation of the next jab? In the midst of this, what gives us the motivation and resolve to move forward? For that matter, what’s the true definition of “moving forward?”

For some, when the storms blow in there is no forward motion. In the grasp of their present circumstances, temperament, and life experience they simply shut down. In terms of personal resources the cupboard’s bare. And there’s no fuel to muster any manner of resilience and fight. For others, putting one foot in front of the other is at least possible, but that’s really the only sign of life in a mentally and emotionally dim existence. And then others forge ahead, seemingly unaffected by the downpour.

I wonder where you believe you fall on this spectrum of response. I wonder about my own pattern of reaction. You know, you take it and take it and take it, and then some. And you ponder two things, really. How much more to come, and how much more can I take? 

Feelings are amazing, aren’t they? They can bring us to the heights of joy and fulfillment, and they can lead us to distraction with their intensity and intrusion. When my funnel is full it weighs so heavily on me. But, then, as if out of nowhere, a surge of perspective presents and I experience a splash of thankfulness for having the ability to at least feel such emotion. Many don’t.

Can you tell I’ve been dealing with much over the past few weeks? Ah, what insight you possess.  It’s during times like these I learn exactly where I lie on the spectrum of response. And in times like these, somehow and someway, feelings and thoughts like these come to the fore. From my poetry…

In the end the words will come
Never worry, I know it’s true
And the very action you always doubt will be there
I’m certain

A strange kind of wisdom
Has grown so deep inside your troubled heart
And a miraculous power without notice is alive
And at call

I know
So be calm
All truth is there
And it waits so quietly by your side

Panic Attacks, Anxiety, and Anger: The Dynamics of Defense (Part 3)

Well, this is the final article of a three-part series on the role of anger in the occurrence and perpetuation of panic attacks and anxiety. In the first two installments we defined anger within two theoretical perspectives, and took a look at how anger presented in my life as an anxiety sufferer. I’d like to wrap-up the series by discussing what I did, and still do, to keep my anger in check.

The first technique came to life as I gained the insight to identify the relationship between my thinking, feeling, and behavior, and the obvious presence of anger. I can’t stress enough the importance of matching untoward mental, emotional, and physical sensations to what’s going on in and around you at the time; as well as the goings-on in the past when you experienced similar sensations. As you detect troubling mind, spirit, and body sensations, take a moment and ask yourself if you’ve felt the same phenomena in other situations, past and present. And try to recall the emotion involved. This little technique, which I call Symptom Identification and Association (SIA), will help you identify the feelings behind many of your special little internal quirks. And that can be incredibly helpful.

I became ready to see my anger for what it was and allow it, under supervision, to play itself out. When the feeling and symptoms arose, I didn’t run. No, I hung in there and opened my mind in an effort to examine as many contributing factors as I could. And this scrutiny always included looking beyond who or what was about to wrongly become a target. Usually, in time, the true sources of the agitation (often me) were revealed and action plans could be drafted and implemented. Please don’t ever forget about the potential for displaced anger, which I discussed in part two.

Now, while the anger processing was taking place, I’d support its deliberate work by doing anything I could to sustain a presence of calm and management. Activities such as exercise, journaling, guided imagery, and relaxation techniques were employed; as well as becoming involved in some sort of positive project. No doubt, anger equals energy; so why not use this energy to feed something constructive, as opposed to feeding mismanaged and destructive thoughts, emotions, and behaviors. All of these activities provided an environment of perspective and just enough diversion to inhibit the potential for becoming overwhelmed, while not losing focus on the work at hand. And I’d try to find a trusted party with whom I could talk and use as a sounding board, and from whom I could gain some perspective.

Heck, I just let myself be what my emotions were dictating, within the context of self-awareness and management. I would identify and acknowledge what I was feeling, said it was okay to feel that way, and dealt with it accordingly. And that included constructively expressing my feelings to anyone with whom I was in conflict. And if my anger was as a result of a situation over which I had absolutely no control, I did all within my power to process it and let it go. And, man, that sure wasn’t, and isn’t, an easy thing to do. Dang, it’s just so natural for us to harbor anger and become so traumatized by it, not to mention traumatizing others along the way. But, why go absolutely mad, and bring so much pain to others, over something that could possibly never change?  

I remember feeling a lot of stress and anger one steamy summer day several years ago, and taking a walk in a local forest preserve. While strolling about, I found the biggest stick I could physically manage and started cracking every tree and rock I could find in a selected isolated area of woods. When I started, the stick was about five feet long. When I finished it was down to about the size of a baseball bat. But, it didn’t end there. I took that stick home and it became my “anger stick.” To this day, when dire frustration and anger knock upon my door, I’ll reach under my bed, grab my anger stick, and beat on a pillow or my bed, verbalizing my frustration as I strike.

Another great anger management technique is screaming. Now, you may be saying, “Bill, how am I going to do that without my neighbors calling 911?” Hey, scream into a pillow or while you’re driving your car. I’m telling you, it works. Here’s another one. Go to your local dollar store and buy a set of drinking glasses and head for the woods or your garage. Throw those babies at a tree, a rock, or a wall as you express your anger (please be sure to clean up the mess). Or how ‘bout an anger-venting exercise using something as simple as a towel? Yes, grab a hand towel with one hand at each end. Now just start twisting like crazy, grunting and groaning while you’re at it. If you’re so moved, verbalize some thoughts and feelings.

Well, that’s all “he” wrote regarding anger’s role in the generation and perpetuation of panic attacks and anxiety. Hopefully, you’ve not only seen the relationship, but you’ve gained some insight and learned some techniques to help you identify and manage your anger experience. Finally, I can’t stress enough that I never let myself believe that feeling anger is wrong or bad. It isn’t. However, displacing, mismanaging, stuffing, and abusively displaying anger will only lead to misery for you and those with whom you interact.

Panic Attacks, Anxiety, and Anger: The Dynamics of Defense (Part 2)

In part one of this three part series we poured a solid foundation by defining anger within the context of psychoanalytic and cognitive theory. Well, now it’s time to have a look at how anger directly impacts panic and anxiety.

As I focused upon recovering from my disorder, it didn’t take long before I realized I was a pretty angry guy. And my stealthy anger deeply impacted my day-to-day living. Now, I wasn’t one to have an explosive temper, or to be verbally or physically aggressive in expressing my anger. No, my anger was very much internalized and folks with whom I came in surface contact would probably never have known any sort of anger problem existed. Truly, all smiles and “I’m just fine” was my public persona.

I really doubt that most sufferers of chronic anger really even know it’s rumbling within them, much less believing there’s any sort of problem. Yes, in most cases you just can’t put a finger on exactly what’s causing you to feel so uncomfortable. I mean, it’s not like someone came up to you and busted you in the chops, it’s just sort of “there.”
 
Anger is a very real and appropriate emotion for all of us. But, anger retained for long periods of time, because it has no means of being managed or resolved, is an entirely different matter. And the reason it never goes away is because, in most cases, its source, even its very existence, is never identified and acknowledged. I’d be willing to bet that even sufferers of chronic anger who express it daily, and admit it’s a major problem, have no clue as to its foundation. And on they go through life with displaced anger, blowing off steam at inappropriate targets, including themselves, without giving a thought to the fact that their aim is tragically off-mark. This is a huge and totally avoidable case of mistaken identity.
 
So, why might a panic sufferer like me, or you, have anger issues? Well, how ‘bout these for starters: self-hate, self-punishment, poor self-esteem, not being able to relax, not being able to go out, not being able to initiate or manage a healthy relationship, not being able to plan for the future, just being saddled with this panic and anxiety mess, unresolved internal conflict, having social interaction problems, being the source of ridicule, believing we’re constantly letting people down, and on and on. Think those will get the job done?

My anger presented itself physically and psychologically in a variety of ways. Let’s see - stiff neck, short attention span, next to nothing patience, impulsive eating, smoking, drinking, general tension and anxiety, irritability, poor concentration, and all sorts of other methods of constantly beating-up on myself for “the screw-up du jour.” So many times I’ve likened my emotional and behavioral expressions of anger to those clinically associated with “self-injury.” One could even make the case for comparisons to suicidal ideation, gestures, and attempts. Really now, what’s the difference?

Well, fortunately, after mucho suffering I was finally able to put two and two together and identify the relationship between my thinking, feeling, and behavior, and the obvious presence of anger. And with that kind of insight, I was able to detect when my anger button was being pushed, as well as having a plausible explanation for some funky everyday symptoms that were making me downright uncomfortable. Now, I may not have known exactly what was making me angry, or what best to do about it, but I sure as heck knew when I was feeling that way, and that was a good start. By the way, a counselor shared an interesting observation with regard to the physical expression of anger and fear. She said tension in the neck generally points to anger, and a tight gut usually points toward fear. Hmmm, what do you think?

Well, let’s go ahead and close part two and look to part three for details regarding how I approached and managed my anger.

Panic Attacks, Anxiety, and Anger: The Dynamics of Defense (Part 1)

I’d like to discuss anger’s role in the generation and sustenance of panic attacks and anxiety. To give the matter its due, I’ve decided to present the information in two parts. In this edition, part one, we’ll review what anger is in the eyes of the psychoanalysts and cognitivists. And in part two we’ll have a closer look at how anger directly impacts panic and anxiety. Well, are you ready? Let’s get to work.
   
The French psychiatrist, Jacques Lacan, a 20th Century pioneer in psychoanalysis, believed aggression is generated as a psychological defense against the threat of something known as fragmentation; the mental and emotional sense of losing control over self-cohesion. Now, fragmentation may present in a feeling of low-grade distress, or it may manifest in all-out panic and terror, for fear of total annihilation. Lacan took the whole matter to infancy where a human is simply a mish-mash of biological functions well beyond internal management. And the only goal one could have is to at least make an effort to pull everything together into some semblance of cohesive identity.

But, Lacan believed any achieved cohesion or collected personality is only a matter of appearances; just a front intended to mask one’s innate vulnerability and weakness. That said, when any outside force poses a threat, which to the individual would reveal the sad and terrorizing truth regarding her ever-looming potential to fragment, she calls upon her most natural and available defense; concealment of her innate frailty. And this is implemented by the immediate presentation of the illusion that she has scads of power right at her very fingertips. Well, that supposed power is aggression; so often expressed and received as anger.      

Now, according to the psychoanalysts, regression is a defense mechanism generated by the ego, the mediator between our primal drives (the id) and our social conscious (the superego), that forces an individual to give the heave-ho to healthy and mature coping strategies in the face of intense internal distress. In lieu of employing age-appropriate management strategies, the individual unconsciously elects to revert to patterns of thought, emotion, and behavior from a stage of psychosexual development in which he’s become fixated. Now, this fixation could take him back in time to anywhere from birth through adolescence. And the stage chosen for the reversion is generally one during which some sort of major unresolved conflict or trauma occurred. By the way, Sigmund Freud named the psychosexual stages oral, anal, phallic, latency period, and genital.

You know, interestingly enough, it’s possible that an individual may be unconsciously holding on to pain and anger in a misguided attempt to reconnect with the person who inflicted wounds and generated trauma during a developmental stage in which she’s fixated. And this occurs in a hopeless effort to achieve a wrap and a sense of healing. Indeed, even though the regression and fixation traps the individual within the walls of intense distress, they at least bring him close to the scene of the crime, and the perpetrator(s). And being at least close equates to having a shot at resolution. Does any of this connect with you?

Though not as detailed, I want to at least mention the cognitive point of view regarding anger. The cognitivists would submit that anger is an incredibly powerful emotion grounded in a real or perceived event. They’d go on to say that anger’s presence in our lives may be generated by any combination of genetics, life-experience, poor conflict-management skills, and learned behavior. And they’d probably suggest that most people who display anger blame others, and situations, for all of the hubbub; as opposed to taking responsibility for their misguided expectations. Indeed, if the events at hand don’t jibe with their perception and expectation of the way things should be, boom, all hell breaks loose.

Like the psychoanalysts, the cognitivists would remind you that anger is a deeply rooted defense mechanism that protects us from a variety of situations from which rescue is perceived to be necessary; its power and energy aiding in both emotional and physical survival. So that can be a good thing, but the downside is when anger becomes horribly mismanaged and taken beyond the boundaries of its biological and psychological purpose. It then becomes incredibly dangerous.

Well, that’s a wrap for part one. Hopefully, I provided a nice definitive foundation as we look to part two, and our discussion of how anger directly impacts panic and anxiety.

Panic Attacks, "Interpreaction," and "Interpreversal": A Mind Game

I’d like to share two concepts I believe will be of great assistance as we approach panic attacks, agoraphobia, derealization, and depersonalization - any of our anxiety and mood-driven misery, for that matter. They play so very big and need to be put into practice over and over again. And that’s exactly why I came up with names that are easily remembered.  

The first is “interpreaction,” which reminds us of the fact that interpretation always drives reaction. And the second is “interpreversal,” emphasizing if interpretation can create a negative reaction, it only stands to reason it must also hold the power to reverse this reaction to a positive. Do these make sense to you?

Well, how ‘bout more detail. Interpreaction is actually a double-edged sword because it ensures us of defensive, panicky, and self-destructive reactions if we interpret stimuli as being threatening. Conversely, interpreaction ensures us of managed, calm, and insightful reactions if we interpret stimuli as non-threatening. Interpreversal takes us to the next level of power and hope, as it gives us confidence in knowing that just as we’ve traditionally created our distress, it only stands to reason we can reverse these warped patterns of thought, emotion, and behavior.

And the best part about interpreaction and interpreversal is – and never forget it – they bang home the point that we have the authority and ability to manage reactions to anything our minds and bodies may throw our way. Now that’s power, because it means we can totally side-step panic attacks, agoraphobia, derealization, depersonalization, social anxiety, you name it. How could that not be true? 

But, to make interpreaciton and interpreversal work for us we have to train and discipline ourselves to accurately interpret stimuli within seconds of their occurrence, maintaining our edge until the impulse to react in desperation subsides. And we also have to believe in the good-common-sense principle that if our interpretations can create negative reactions, they must have the ability to create positive reactions. Now, the time it takes to fend off overreacting to a negative interpretation varies for each of us. However, with practice and success it can only decrease.

See, we just need to force ourselves to pause for a short bit of time after a panic trigger. Yes, we need to stop everything because our fear circuitry headquarters, the amygdala, is trying to figure out how best to respond to the potential threat. So, now is the time to take a few abdominal breaths and chill, as the amygdala sends a rather pokey message, asking for clarification, to the prefrontal cortex, the cognitive center of our brains. It’s here where we can ultimately determine what’s truly going on, putting an end to our self-defeating thought processing and reaction patterns. Well, after the prefrontal cortex determines the facts, we still need to employ our chill skills, buying time while the truth makes its way back to the amygdala. And, convinced there’s no true threat, the amygdala turns off the alarm.

You know, since we’ve suffered for so long, we’re so used to blindly receiving and accepting all of the negative and destructive little gems our minds and bodies throw our way. Well, I believe it’s time we stood up for ourselves and fought back. Don’t you agree?

Surely, if faulty interpretation can so easily generate disasters, why can’t reasoned and accurate interpretation flip things around? Well it can. And we have the authority and ability to make it all happen. 

Panic Attacks, Anxiety, and Your Primary Care Physician: Are You Getting the Best Care?

I found an editorial in the March 6, 2007 edition of the Annals of Internal Medicine that I believe is spot-on. It was written by Wayne Katon, M.D. and Peter Roy-Byrne, M.D., from the University of Washington School of Medicine. The subject matter was poor treatment practices, as well as outcomes, for anxiety disorder sufferers who receive primary care-based mental health care.

The editorial begins with Drs. Katon and Roy-Byrne referring to the anxiety disorders as “the neglected stepchild of primary care-based mental health care.” Curiously, there are mountains of research floating about with regard to primary care-based mental health care for depression. But, such is certainly not the case for the anxiety disorders. And that’s really very remarkable when you consider that the anxiety disorders are the most frequently occurring mind variances (my stigma-busting replacement term for “mental illnesses”) in the United States, if not the world. And let’s not forget about the devastating social, educational, and vocational havoc they can wreak.

It can’t be of any great surprise that anxiety disorder sufferers are frequent flyers at primary care practices. And that’s “primarily” because of all of the anxiety-generated physical symptoms we experience and endure. I mean, there’s chest pain, rapid heart rate, heart palpitations, breathing difficulty, gastrointestinal issues, and on and on. And on top of the physical hub-bub is a very tough layer of psychiatric comorbidities, such as mood disorders, other anxiety disorders, and substance abuse and dependence.

In their editorial, Drs. Katon and Roy-Byrne cite the research of Kurt Kroenke, M.D., of Indiana University and the Regenstrief Institute. Dr. Kroenke’s work reveals generalized anxiety disorder (GAD), panic disorder, social anxiety disorder (social phobia), and posttraumatic stress disorder (PTSD) as the most frequently presenting anxiety disorders at a primary care practice. Also noted in Kroenke’s research was the prevalence of comorbidities such as depression, somatization issues, and overall functional impairment. Kroenke’s study goes on to indicate there are several brief and reliable screening questionnaires that address all four of the disorders just mentioned, most notably the GAD-2 and GAD-7. And, finally, Kroenke’s work reveals that more than 40% of studied patients who presented with an anxiety disorder stated they weren’t receiving any mental health treatment whatsoever.

Now, certainly, screening for the anxiety disorders at a primary care practice is a crucial first step; however, according to Katon and Roy-Byrne, arriving at a diagnosis doesn’t at all equate to improvement in quality of care or outcomes. Indeed, studies show anxiety patients who are receiving primary care-based mental health care, and are accurately diagnosed, show significant gaps in care. Among these are poor physician follow-up, which often leads to meds non-compliance, and very limited exposure to efficacious psychotherapies. So, when you pull together the data, primary care-based mental health care just doesn’t appear to be an option for anxiety sufferers.

Drs. Katon and Roy-Byrne believe it’s time for major change and suggest looking at primary care-based depression screening protocols as a starting point. They go on to recommend greater emphasis upon anxiety screening and linking screened anxiety sufferers with proven treatment resources. And they propose the use of allied health professionals in supporting the work of the primary care physician. Imagine a qualified professional who provides anxiety education to patients and staff. And this same team member could monitor treatment compliance and outcomes, facilitating physician follow-up appointments should the patient’s circumstances not improve. This allied professional could even work with a psychiatrist on medication adjustments and recommendations, passing the information on to the physician.

Well, this is all very interesting and revealing information, don’t you think? And as distressing as much of it is, there’s every reason in the world to be hopeful. And that’s because studies show the recommendations of change suggested by Drs. Katon and Roy-Byrne work. Period. So, it’s time to identify barriers to correction and push them aside.

There’s absolutely no reason why an anxiety sufferer shouldn’t be able to see his/her primary care physician and benefit from a great initial, and ongoing, collaborative offensive against their nemesis. Anything less is simply an injustice and an overwhelmingly sad missed opportunity.

Panic Attacks and Mitral Valve Prolapse: A Mimicker's Deception?

A mimicker is a symptom or disorder that fools its victim, as well as medical and psych professionals, into believing he/she is suffering from something other than the true cause of the problem. And the likeness is so striking that the mimicked issue gets all the attention, allowing the real culprit to remain a mystery. Obviously, mimickers can cause all sorts of confusion, as well as unnecessary pain and anguish. One of the major mimickers of panic attacks and panic disorder is mitral valve prolapse (MVP) and mitral valve prolapse syndrome (MVPS).

As always, let’s start with definitions. If the heart’s mitral valve is functioning properly, blood flows from the left atrium to the left ventricle in a very tidy manner. And that’s because blood is prevented from going back into the left atrium by a tight seal formed as the mitral valve closes. But if one has MVP the flaps of the mitral valve allow small amounts of blood leakage because the valve flaps don’t close evenly; one, or both, collapsing backward.

The physical manifestations of MVP may include heart palpitations, atrial fibrillation (the atria, the heart's two small upper chambers, quiver instead of maintaining a normal rhythm, resulting in blood pooling and clotting because healthy pumping is interrupted - a stroke may ensue if a bit of blood clot breaks away and lodges in a brain artery), fainting, chest pain, and shortness of breath. MVP, a common and generally benign condition that presents in women three times more than men, is a genetic disorder typically confirmed by an echocardiogram. The only real potential for trouble is the very remote possibility of contracting an infection called endocarditis (an infection of the inner lining of the heart, the endocardium, and the possibility of blood clotting).

Now, here’s where things start to get panic-interesting. Just as a percentage of panic attack sufferers become panic disorder sufferers, so it is with MVP. Some 40% of patients with MVP also have something known as dysautonomia, an imbalance of the autonomic nervous system (ANS), which would indicate neurotransmitter and hormonal confusion as well. Well, the ANS has two components, the sympathetic and parasympathetic nervous systems. The sympathetic nervous system has the responsibility of ramping-up our biochemistry as our fight/flight response is switched on; and the parasympathetic nervous system returns our biochemistry to a state of normalcy as the threat is gone.

Indeed, an incredible number of bodily functions are directed by the ANS and when this system is out of balance the physiological results can be, as you may already know, panic attacks, anxiety, fatigue, migraine headache, irritable bowel syndrome, and many more little goodies. Well, when the situation becomes this complex one is said to suffer from mitral valve prolapse syndrome (MVPS). And it’s estimated that 40-60% of MVPS sufferers will experience panic attacks.

Are you saying to yourself, “Hmmm?” If you have ever suspected you suffer from mitral valve prolapse, or if members of your family have been diagnosed, please get to a doctor and have an evaluation. And even if you don’t have a family history, get tested anyway. A diagnosis of mitral valve prolapse or MVPS, and appropriate treatment, could dispose of your panic attacks and save you a whole lot of aggravation.

Perhaps you suffer from mitral valve prolapse or mitral valve prolapse syndrome, not panic. Women - are you paying attention?

Panic Attacks, Agoraphobia, Spatial Orientation: Perception is Everything

Raise your hand if you’ve ever been plagued by agoraphobia. Well, my arm’s fully extended upward. I can recall being all but housebound because of it in the early 1980’s. And if I did venture out it was with a few drinks under my belt, a few beers in the car, and about ten cigarettes in my mouth. I can’t tell you how thankful I am those years are gone. But, one of the huge upsides is my ability to offer very meaningful and efficacious assistance to those suffering from the same misery. Well, then. I’d like to share some interesting information regarding the relationship between agoraphobia and something known as spatial orientation.

First, let’s make sure we have a solid foundation. “Agoraphobia” is a compound word. “Agora” comes from the Greek for “place of assembly;” and, of course, “phobia” comes from the Greek, “phobos,” meaning fear. So, literally we have “fear of the place of assembly.” Now, as you may know, agoraphobia and panic attacks are attached at the hip. In fact, a formal diagnosis of panic disorder is made “with or without agoraphobia.” Simply put, agoraphobia is, well, anxiety about being in places or situations where a quick exit may be tough to pull off. And why don’t we throw into the mix feeling uneasy about who will come to the rescue should panic-like symptoms, or an attack, occur. Ultimately, things escalate to the point where places and situations of perceived threat are most often avoided; and if not, they’re endured with tons of angst. Again, been there and done that way too many times.

Okay, so just what is spatial orientation? It’s pretty cool, actually. How ‘bout we say it’s our ability to maintain a sense of body orientation and/or posture within the context of our surrounding environment in the immediate. And this applies to when we’re moving and static. Though it’s so wonderfully natural it seems as though it “just happens,” such is definitely not the case. No, to maintain sufficient spatial orientation our brains blend proprioceptive (from the skin, muscles, tendons, and joints - tactile) and vestibular (from the inner ear) cues with visual messages. And, of course, adjustments are made as changes in environment and/or positioning occur.

Well, research has discovered a relationship between agoraphobia and problems with spatial orientation that makes a whole lot of sense, and explains much. It seems as though many agoraphobics have weak vestibular functioning. As a result their brains are forced to rely solely upon visual and tactile cues for spatial orientation. Well, this becomes a major problem if visual cues are tough to come by; say, if one is standing in the middle of a desert. And problems also occur if the visual input is overwhelming, like what may be experienced if one is on the dance floor of a popular night club. Finally, those with spatial orientation challenges have difficulty with irregular surfaces or landscapes; say, one of those goofy rooms in an amusement park funhouse where the floor is severely tilted.

Hmmm. Standing in the middle of a desert, being on the dance floor of a popular night club, a severely tilted floor in a funhouse. Aren’t these places and situations that are generally very disturbing to agoraphobics and panic sufferers? You bet. And it’s all about having difficulty with processing atypical audiovisual input.

I really enjoy uncovering and sharing tidbits like this. And the cool thing is, once we make our “scientific” discovery we always end up saying, “Well, hey, that makes sense. It happens to me all the time.” So, how ‘bout we chalk-up another manifestation of anxiety to biology. And the next time we become distressed over an issue of spatial orientation, let’s first consider the facts as to what’s really going on and learn to leave panic and avoidance behind.

Panic Attacks, Guilt, and the Personality of Your Superego

Guilt can be absolutely crippling for anyone, but it hits panic attack and anxiety sufferers particularly hard. We’re so darned tough on ourselves, and hold ourselves accountable for so many things that simply aren’t fair or reasonable. And that makes guilt a major obstacle to overcome when it comes to recovery. Well, let’s have a look at this toxic phenomenon.

In any effort to examine guilt, Sigmund Freud and the psychoanalysts would submit one has to consider the superego; in effect, our active conscious. On the other end of Freud’s structural spectrum is the id, home of our primal wishes. For the record, according to Freud, the interplay of the superego and id is managed by the ego. Now, some theorists would propose that one’s superego can have, shall we say, a personality of its own; which can range from very easy-going to tough-as-nails. And within this context it would only make sense that a “mentally/emotionally healthy” person’s superego would lend a hand in feeling good about self. Yes, this particular superego, like a good parent, would administer discipline when one has thought or behaved badly; and the “punishment” is generally delivered in the form of guilt. But when the individual makes sincere attempts at making-right their transgressions, the superego awards due credit and forgives. This is the psychoanalytic dynamic of self-forgiveness.

It would follow, then, that the tough-as-nails superego isn’t so nurturing, as it pounds the individual with massive portions of guilt for a multiplicity of supposed offenses, causing one to constantly and desperately seek shelter. And each futile attempt at lightening the burden of guilt is greeted with truckloads of shame, instead of relief. Theoretically, it’s this dynamic that greatly inhibits any sort of “making things right,” and, ultimately, leaves the individual horribly trapped in infinite doses of self-disapproval and internal self-assault. Individuals with superegos this brutal are forced to find some way, any way, of relieving their overbearing burdens of guilt and shame. Sadly, this is accomplished by a variety of very unpleasant internal and external methodologies; the bottom-line being an extremely long and tragic life, suffocating in harmful thoughts, feelings, and behaviors toward self and others. Taken to the very extreme, physical harm to self and others may be an ultimate reality.

Now, the cognitivits, led by Aaron Beck, would agree with the psychoanalysts that guilt is a very powerful and potentially harmful emotion. They submit guilt is grounded in all matters real or perceived; and it’s highly influenced by genetics, life-experience, and learning. According to the cognitivists, one of the foundations of guilt is negative self-thought. That said, the guilt-ridden individual generally turns blame for unfortunate circumstances inward. Yes, though the behavior presentations associated with guilt hold the potential to be significantly outwardly harmful, it seems most of the harm is inflicted upon self. Any harm inflicted upon others is less directly aggressive, and more resentment or passive-aggressive based.

Well, for panic and anxiety sufferers, here’s the bottom-line. No matter what kind of personality your superego may happen to have, your first step in whipping guilt is to become proactive in making things right with yourself. Only then is it time to make things right with others. If, indeed, the task at hand involves another party, approach him/her and offer a sincere apology. If some sort of debt has been incurred, suggest and work out a settlement; and make sure you hold up your end of the deal. Then, move on with your life in an enlightened and recovery-driven manner. True friends and true loved and loving ones will gladly accept the sincerity of your thoughts and words, and the action backing them.

But, please, don’t ever forget to settle accounts with yourself. And now that you have insight into how absolutely cruel we can be to ourselves, and why; you may want to consider taking your circumstances to a therapist for resolution if you’re having a tough time pulling things together. Guilt can be absolutely crippling for anyone, but it hits panic attack and anxiety sufferers particularly hard. We’re so darned tough on ourselves, and hold ourselves accountable for so many things that simply aren’t fair or reasonable. And that makes guilt a major obstacle to overcome when it comes to recovery. Well, let’s have a look at this toxic phenomenon.

In any effort to examine guilt, Sigmund Freud and the psychoanalysts would submit one has to consider the superego; in effect, our active conscious. On the other end of Freud’s structural spectrum is the id, home of our primal wishes. For the record, according to Freud, the interplay of the superego and id is managed by the ego. Now, some theorists would propose that one’s superego can have, shall we say, a personality of its own; which can range from very easy-going to tough-as-nails. And within this context it would only make sense that a “mentally/emotionally healthy” person’s superego would lend a hand in feeling good about self. Yes, this particular superego, like a good parent, would administer discipline when one has thought or behaved badly; and the “punishment” is generally delivered in the form of guilt. But when the individual makes sincere attempts at making-right their transgressions, the superego awards due credit and forgives. This is the psychoanalytic dynamic of self-forgiveness.

It would follow, then, that the tough-as-nails superego isn’t so nurturing, as it pounds the individual with massive portions of guilt for a multiplicity of supposed offenses, causing one to constantly and desperately seek shelter. And each futile attempt at lightening the burden of guilt is greeted with truckloads of shame, instead of relief. Theoretically, it’s this dynamic that greatly inhibits any sort of “making things right,” and, ultimately, leaves the individual horribly trapped in infinite doses of self-disapproval and internal self-assault. Individuals with superegos this brutal are forced to find some way, any way, of relieving their overbearing burdens of guilt and shame. Sadly, this is accomplished by a variety of very unpleasant internal and external methodologies; the bottom-line being an extremely long and tragic life, suffocating in harmful thoughts, feelings, and behaviors toward self and others. Taken to the very extreme, physical harm to self and others may be an ultimate reality.

Now, the cognitivits, led by Aaron Beck, would agree with the psychoanalysts that guilt is a very powerful and potentially harmful emotion. They submit guilt is grounded in all matters real or perceived; and it’s highly influenced by genetics, life-experience, and learning. According to the cognitivists, one of the foundations of guilt is negative self-thought. That said, the guilt-ridden individual generally turns blame for unfortunate circumstances inward. Yes, though the behavior presentations associated with guilt hold the potential to be significantly outwardly harmful, it seems most of the harm is inflicted upon self. Any harm inflicted upon others is less directly aggressive, and more resentment or passive-aggressive based.

Well, for panic and anxiety sufferers, here’s the bottom-line. No matter what kind of personality your superego may happen to have, your first step in whipping guilt is to become proactive in making things right with yourself. Only then is it time to make things right with others. If, indeed, the task at hand involves another party, approach him/her and offer a sincere apology. If some sort of debt has been incurred, suggest and work out a settlement; and make sure you hold up your end of the deal. Then, move on with your life in an enlightened and recovery-driven manner. True friends and true loved and loving ones will gladly accept the sincerity of your thoughts and words, and the action backing them.

But, please, don’t ever forget to settle accounts with yourself. And now that you have insight into how absolutely cruel we can be to ourselves, and why; you may want to consider taking your circumstances to a therapist for resolution if you’re having a tough time pulling things together.

There's no reason to accept domination by guilt. Except, of course, if you elect to do nothing about your situation.

Panic Attacks, Anxiety, and Somatic Experiencing: Part II

In Part I of this two-article series we discussed Somatic Experiencing (SE), Dr. Peter A. Levine’s anxiety and trauma healing philosophy, within the context of a contributor to panic attacks and anxiety. Well, now we’re going to have a look at SE from a treatment perspective. As with the first article, I believe you’ll find the information fascinating and relevant. Let’s get to work.

In review, SE came to life as Dr. Levine made the observation that though wild animals of prey are under constant threat and siege, they’re rarely traumatized. Levine’s explanation is that these animals possess an innate mechanism that very efficiently manages and discharges the energy that accumulates in their bodies as a result of self-preservation behaviors. Levine went on to observe that when an animal of prey survives a potentially deadly chase, it actually takes time to physically shake-off unused survival energy before moving on with the herd.

Now, according to Dr. Levine, humans are equipped with essentially the same mechanism; however, ours is greatly inhibited by our more advanced cognitive capabilities. As a result, we brain our way out of a complete purging of survival energies, which, in turn, prohibits the nervous system from regaining equilibrium, or homeostasis. And that, in yet another turn, leads to trauma because the body now has to try to manage huge quantities of high-voltage unused survival energy, residual from an incomplete biological response to a threat. This is a highly toxic force, locked within, that tears our minds and bodies apart.

As he approaches treatment for anxiety and trauma, Dr. Levine believes the foundation must be set in what we feel in our bodies, as all of the distress we’re tolerating is as a result of thwarted physical attempts to escape disaster. To Levine, relief is about the removal of learned and dysfunctional freezing and immobility responses as we face anxiety-generating situations. And this is accomplished by reconnecting with the very natural defense and orientation responses that were interrupted as our previous escapes from threatening situations were foiled.

Okay, so how might one do that? Well, I believe you have to consider the issue within two distinctly different contexts. I mean, are we dealing with the fallout from past trauma or is the focus to be strictly upon coping skills in the present? If the matter is trauma from the past, it seems to me a good portion of insight-oriented therapy may be the first order of business. Now, if reestablishment of pre-traumatic defense and orienting responses is required to uncouple scene-of-the-crime, fear-induced freezing responses in an effort to process all of this unused survival energy, that would mean we have to take a trip back in time to the scene of the trauma. Yes, the very event from which escape from deep peril was interrupted. And while there, we must relive the event and implement the previously thwarted physical, psychological, and emotional responses that would have facilitated escape.

Certainly, this is no small task, as the actual traumatic event causing all the problems may be buried very deeply in the unconscious, making its identification close to impossible. However, assuming it’s uncovered over time, the goal of therapy would be to find oneself at the very moment in time when escape from the ensuing horror was aborted, and establish some means of physical, mental, and emotional escape. This would allow unused survival energies to flow forth.

I believe after insight-oriented therapy and, perhaps, bioenergetic analysis (BA) is incorporated to identify and process the trauma; the informational, cognitive, and exposure foundations of cognitive behavioral therapy (CBT) could come in quite handy. Indeed, CBT strategies and techniques could be used to address coping skills in the present. One final comment here. Dealing with buried trauma from the past is a very delicate and dicey bit of therapy and should only be facilitated by someone who really knows what they’re doing. Keep that in mind, okay?

Well, between the two articles in the series you ought to have at least a solid Somatic Experiencing knowledge base. It’s incredibly fascinating stuff and I encourage you to take the time to research Dr. Levine’s work. It will be well worth your time.

Panic Attacks, Anxiety, and Somatic Experiencing: Part 1

In my ongoing quest for knowledge pertaining to the contributors to panic attacks and anxiety, as well as treatment strategies and techniques, I came upon some very cool stuff several years ago. It’s called Somatic Experiencing (SE) and it’s the amazing work of Peter A. Levine, Ph.D. This will be the first in a series of two articles. Here we’ll have a look at SE within the context of a contributor to panic and anxiety. The article that follows will approach SE from a treatment perspective. Well, tune-in because I know you’re going to find the information fascinating, hopeful, and helpful.

SE came to life as Dr. Levine observed that though wild animals of prey are under constant threat and siege, they’re rarely traumatized. Well, I never really gave that much thought, but I suppose it’s true. So, just how in the heck do they pull that off? Well, credit is given to an innate regulating mechanism that very efficiently manages and discharges the energy that accumulates in their bodies as a result of self-preservation behaviors. Levine observed that when an animal of prey survives a potentially deadly chase, it actually takes time to physically shake-off unused energy before moving on with the herd. Well, Levine posits we humans are equipped with essentially the same mechanism; however, ours is greatly inhibited by our more advanced cognitive capabilities. Man, how many times does thinking mess things up for us? By the way, isn’t it interesting that we so often use the phrase, “Just shake it off,” when someone takes a relatively minor hit of some kind.

Now, as we consider the notion that humans have an innate ability to manage and discharge unused survival energy, let’s take a look at a large structure in the midbrain known as the periaqueductal gray (PG). The PG is thought to be involved with physically defensive reactions such as freezing, jumping, running, rapid heartbeat, blood pressure fluctuation, and increases in muscle tone. It’s believed that when sufficiently stimulated, the amygdala, our fear alarm control panel, rings-up the PG and on come one or more of the physical phenomena just mentioned.

Interestingly enough, the PG is also responsible for something known as quiescence, a state of being at ease and immobile, yet highly alert. Many scientists believe this is a natural recovery response after a tussle with a real or perceived threat. Did you ever feel like you were frozen or immobile during a time of intense fear or anxiety? Come on, you know you have. In humans, indeed all mammals and reptiles, freezing usually occurs right before the real or perceived attack. It’s one of three primary responses called upon when we’re faced with a perceived overwhelming threat, the others being fight and flight. Well, this altered state of consciousness is designed to provide a last ditch shot at escape and to spare the body pain through a natural analgesic process should a brutal death occur. And guess what? The PG is responsible for this onboard pain relief, as well.

Now, this inability to “shake-off” causes big problems because it prohibits a complete purging, if you will, of excess survival energy. And this, in turn, impedes the nervous system’s efforts to regain a sense of internal balance or homeostasis. And that, in yet another turn, leads to trauma because the body now has to try to accommodate an excess of unused survival energy. And this “has-been” mass of energy remains bound in our bodies where it rips us up mentally, emotionally, and physically. Again, we humans have the ability to shake-off this toxic mess; however, we generally find a way to think our way out of it.

Well, it sure doesn’t seem like much of a stretch to me that this storehouse of poisonous unused survival energy would have the potential to generate all sorts of panic and anxiety. And that’s what makes this material so relevant. So, keep this information in your back pocket as you read the next article discussing SE from a treatment perspective.

Panic Attacks and Kindling: Building a Different Fire

First of all, this isn’t going to be a discussion of how to build a fire. Uh no, this is a review of a fascinating physiological phenomenon that I consider a physical contributor to panic attacks and anxiety. And that’s because the limbic system, particularly the amygdala, is highly susceptible to the effects of kindling. Now, before we get to work I want to make sure you know that I’m going to be cramming thirty pounds of information into a five pound bag. Okay? Well, let’s get busy.

In the strictest sense, kindling is the term used for the generation of brain seizures by electrical stimulation. The pioneer of kindling, Canadian scientist Dr. Graham V. Goddard, believed kindling is a process of “message formulation” induced by repeated natural electrical stimulation of small and selected groups of brain cells. Now, scientists can also trigger these epileptic seizures in animals through repeated mild electrical stimulation of deep-brain structures. Curiously, as this electrical stimulation commences the effects are barely noticeable. However, sensitivity to the stimulation intensifies with repeated administration, ultimately leading to the animals seizing spontaneously. Yet, in spite of all this electrical zapping and seizure activity, physical damage to the brain is undetectable.

In the real-life world of brain physiology, chronic life-stress can generate kindling-like stimulation with accompanying mental, emotional, and physical manifestations. Drug abuse and withdrawal, particularly involving alcohol and cocaine, can as well. This expression of kindling is of great significance to depression and bipolar sufferers, as it appears to stimulate and exacerbate mood cycling both in the immediate and down the road. Indeed, a specific life-stressor may initiate the kindling process with no symptoms in the present, only to have expressions of mood cycling pop-up later in life without the influence of a specific stressor. Now, it’s important to note that research isn’t suggesting this is a matter of having actual epileptic seizures, as we traditionally know them. It’s more an issue of a similarity to the strictest definition of seizure-generating kindling we reviewed in the second paragraph.

Okay, let’s bring this kindling business to the panic and anxiety section of the stadium. Kindling can play a mean tune on our limbic system, in particular the amygdala. And this results in the generation of a whole lot of fear and anxiety. At the beginning of this discussion we talked about how electrical stimulation of the brains of laboratory animals generated barely noticeable seizures in the immediate. But, we also learned that the sensitivity to this electrical stimulation intensified with repeated applications, and the animals ultimately begin to seize without any stimulation whatsoever. Well, chronic over-stimulation of the amygdala, or any number of our forged neural highways, may lead to a hypersensitivity to fear-generating stimuli and a propensity toward hyperarousal. Doesn’t that make sense? I mean, consider the scientifically confirmed dynamics of neuroplasticity, the notion that neurons that frequently connect tend to establish long-term working relationships. Well, I believe kindling and neuroplasticity sit in the same section of the ballpark.

So, let’s consider a real-life example of kindling to bring the point home. I’ve written about our HPA axis and noradrenergic (having to do with the neurotransmitter and hormone norepinephrine) system in previous articles. As it applies here, let’s just say the end result of their work is the activation of our fight/flight response; and we become rough and ready to deal with the threat at hand. Well, research has noted that early life trauma may have something to say about how all of this works, and it’s thought to go like this. Someone who’s been exposed to such trauma develops a hypersensitive HPA axis and noradrenergic system due to their overuse so soon in life. It seems our bodies just weren’t designed to deal with excessive amounts of their secretions so early on. These secretions include cortisol, norepinephrine, and epinephrine.

So, as a result of being chronically overworked, these systems become super-sensitive and super-reactive to stress. And as the years go by, any exposure to stress, even in what would seem to be tolerable measures, only serves to agitate and exacerbate this already hypersensitive and exhausted stress response. Ultimately, one ends up attempting to live life as an adult with out-of-control biochemistry. And this goofiness well exceeds design tolerances, resulting in any number of physical, mental, and emotional outcomes; including panic and anxiety. Yes, in this case, early life trauma, and its snowballing biochemical fallout, actually alters neurophysiology in the immediate, as well as stimulating psychopathology in the future. That said, kindling must be considered a significant biological contributor to panic attacks and anxiety.

My Mother Died Yesterday

In Memory of Lily Marie Bloodworth White...

My mother died yesterday. She was 85 years old. A ruptured 6+ centimeter aortic aneurysm took her life subsequent to breaking a hip during a fall at her assisted living facility two days ago. I might also add that my mother suffered a stroke two and a half years ago, and was diagnosed with Parkinson’s Disease several years prior. Given her medical history and our knowledge of two aortic aneurysms, her passing still took us by surprise.

My mother was an extraordinary woman. She was a highly intelligent accounting professional who was always socially active and appreciated. Well, at least until the onset of Parkinson’s, as her social anxiety spiked and her social confidence plummeted. She was born in Macon, Georgia in 1923, and moved to Columbia, South Carolina with my grandparents, uncles, and aunts when she was in high school. She married my father shortly after the end of World War II and they remained husband and wife for a remarkable 62 years.

Maybe you’ve experienced this phenomenon. When I received the call from my brother yesterday morning announcing our mother’s death, I wasn’t overcome by emotion. Nor was I moved to tears. Since then I’ve spent a great deal of time ruminating over why the loss of my mother didn’t rock my world; but, frankly, I suspected all along my reaction would be as it was. Actually, I’ve asked myself numerous times since my mother’s Parkinson’s diagnosis why her declining health hasn’t caused me significant distress. I mean, this is my mother we’re talking about. Damn, I’ve known so many people over the years that were so very close to their mothers, driven to tremendous emotional upset upon news of a serious health issue or her death. So, what’s up with me?

Well, I believe a number of things come into play here. My parents built a home in suburban Columbia, South Carolina just before retiring and took residence some 20 years ago. They’d lived in a suburb of Detroit. I’ve lived in suburban Chicago for the past 23 years; and, of course, it’s very difficult to maintain a personal and thriving relationship over 850 miles. And though we enjoyed many visits together, they just weren’t sufficient to overcome the distance.

But, I believe my relationship with my mother was limited by more than just 20 years of logistic inconvenience. As great a mother as she was, she and I just never got close. Make no mistake about it, she was there for me every step of the way; however, whether it was something within me or her – both - that bond I so often envied in other mother/child relationships simply wasn’t there.

My mother was a mystery to me. Indeed, if someone were to ask me who my mother really was, I’d only be able to detail that which I, and others, observed of her on the surface. In terms of the foundation of my mother’s personality - what excited, hurt, and worried her - I really wouldn’t know. Isn’t that something? Still, I believe my mother was emotionally tormented throughout our years together.

Now, if you’ve followed my articles and blogs you know I’ve recovered from decades of panic disorder and alcoholism. I know for a fact that anxiety and mood disorders are prevalent in my mother’s family. I also know both of her brothers were substance dependent; indeed, substances led to both of their deaths. So, it seems as though, like me, my mother may have come by her demons honestly. Yet, to my knowledge my mother was never diagnosed with a psychiatric disorder and has no history of abusing substances.

Of course, one’s behavior isn’t always indicative of what’s going on deep within. And let’s forget my mother grew up prior to, and during, World War II. So you can be sure if a psychiatric situation existed, it sure wasn’t going to be openly discussed. Regardless, as I indicated earlier, I’ve known for years my mother suffered from a diagnosable anxiety disorder and situational depression. But, of no great surprise, when I’d try to discuss her emotional pathology with her, even within the context of my own woes, there was very little of substance to be learned.

Well, then. My mother was a great woman in all ways. Her intelligence, compassion, and grace were truly remarkable. Yes, she was very much the “genteel and refined” woman her southern parents raised her to be.

I don’t know that I’ll ever be moved to tears with her loss, or feel any sort of deep aching within because she’s no longer here. But, that doesn’t really matter, does it? Her’s was a great life and her legacy will live on for generations.

Panic Attacks From a Psychoanalytic and Cognitive Perspective

Sigmund Freud, the father of psychoanalysis, on the left; and Aaron Beck, the father of cognitive therapy.

Sometimes people ask me why I spend so much time on what generates panic attacks. My usual response is, beyond my natural curiosity, I simply don’t see how one can manage something if one doesn’t fully understand just what that something is. And, at least to me, a complete understanding has to include insight into genesis. I mean, if you were experiencing chronic chest pain, wouldn’t you want to know what was causing it? And let’s no forget that knowing why something happens leads to more efficacious management strategies and techniques.

I have always placed emphasis on both the psychological and physical contributors to panic attacks. But, in this article I’d like to stick with the psychological and address two theories of treatment. Needless to say, there are many floating about; however, I’d like to briefly discuss the psychoanalytic and cognitive points of view with regard to the generation of panic attacks.

Psychoanalytic
A psychoanalyst would likely submit the generation of panic attacks goes back to infancy and childhood. They would, however, acknowledge that panic attacks may also occur as a result of assorted cues in the present, such as the fear of having a panic attack in a situation where one recently occurred. For the record, an attack occurring within this context could either be situationally-bound or situationally-predisposed. The psychoanalysts consider both conscious and unconscious panic triggers as representations of intense early life wishes and fears. So, panic attacks, in large part, occur in response to cues associated with long past psychological and biological threats to one’s existence. By the way, these cues are based in retained themes of intensely feared eventualities such as castration, separation, and parental disapproval.

Cognitive
A cognitivist would likely submit that a panic attack is a manifestation of an intense feeling of helplessness in the face of intense danger. The vicious cycle of panic, which we know all too well, is generated and sustained by combining the very real terror of vulnerability with one’s traditional distorted thought and feeling responses. Within the context of human genetic predisposition, which from a phylogenetic perspective leans toward the anxious for purposes of survival, it naturally flows that these thought and feeling responses appear to be designed to produce the belief that out-of-control internal distress can lead to grave danger, even disaster. Doesn’t it make sense that it’s this dynamic that so often generates the intense need to seek a caregiver for immediate assistance? I mean, at this point all bets on reason and logic are absolutely off as our primal instincts take over. And then all sorts of physical symptoms arrive on the scene because our mind really believes we’re in imminent danger, and it’s getting us ready to fight the good fight. And the snowball just rolls on down the hill from there.

Finally, the cognitivists would likely submit that though panic attacks are often thought of as spontaneous, some sort of event had to have tripped the trigger. Who knows, the culprit may have been a sudden physiological change; say, feeling faint upon standing, sensing a rapid or palpitating heart beat, or detecting a shortened breath. The thought is that events such as these, in the absence of reason, are interpreted as indicators of immediate physiological danger. And, boom, off to the races we go.

It’s my belief that, individually, both the psychoanalytic and cognitive angles hold great merit. But, for my money a combination of the two is truly the ticket. I mean, so okay, according to the cognitivists a physiological change, such as a shortened breath, may trip the panic trigger. Well that’s great; however, I’d like to know what existed unconsciously that led to the perception that that shortened breath was a signal of coming catastrophe. Hmmm.

As always, the more we understand about our circumstances, the better we become at managing them.

The Insular Cortex: A Budding Anxiety Star

I finally hit the research trail wanting to learn more about a bundle of grey matter in the brain known as the insular cortex. I was stunned as to its operation and just how much influence it exerts on our emotions. This is great reading for anyone, especially anxiety sufferers.

I wrote an article just yesterday summarizing a bit of research by Dr. Jack Nitschke at the University of Wisconsin-Madison. Dr. Nitschke’s work focused upon the role of the element of uncertainty in intensifying reactions to disturbing events, as well as increasing overall levels of anxiety. Along with the amygdala’s involvement in these presentations, Dr. Nitschke noted a brain structure known as the insular cortex. Until reviewing his research I didn’t know much about the insular cortex, so my curiosity was piqued and I did some digging. This powerful and mysterious body of cerebral cortex (grey matter), a significant player in anxiety, has traditionally flown under the radar. And the very good news is that’s changing. Well, perhaps this article will attract your curiosity and provide a tad of education along the way.

The insular cortex (a.k.a. insula, insulary cortex) is a mass of neurons that lie in the midst of the temporal, parietal, and frontal lobes. Even though there are actually two insula, as they’re contained in both brain hemispheres, I’ll be using the term “insula,” in the singular. Incidentally, the word “insula” comes from the Latin for island. Now, some authorities view the insula as a lobe of its own, and others see it as part of the temporal lobe. Yet others, who assign it to the limbic system, consider the insula and the other components of the limbic system, a separate limbic lobe. The insula is divided into two parts, an anterior and smaller posterior section. As you read this article, always remember the insula is all about subjective human experience. Indeed, it’s been said the insula is responsible for what it feels like to be human, as opposed to just another mammal.

To say the very least, the insula is very well connected. It receives input from the brain’s great sensory hub, the thalamus; as well as from the very headquarters of our fear and emotion circuitry, the amygdala. And the communication with the amygdala is actually two-way. There’s also a bilateral line of communication with the primary sensory cortex. Given these landmarks it’s obvious the insula is deeply involved with a wide variety of functioning linked to emotion and the maintenance of homeostasis, our body’s ability to maintain a relatively stable state of internal regulation and equilibrium. And, yes, it’s a frequent contributor to assorted psychopathology, particularly anxiety. Hey, I find it terribly interesting that scans have shown the right anterior insula is significantly thicker in people who meditate.

Well, since the insula is involved in such a wide variety of sensation and functioning, we’re going to take a look at things categorically. And though the information is certainly available, I’m going to consider the insula’s functioning as a whole, rather than specifying the anterior and posterior sections. One last note. The insula is very much in the mix with regard to motor control and, as I cited, homeostatis. However, I won’t be going into detail on either.

Interoception
Interoception is the sensing of stimuli arising from within our bodies, especially from the major organs of the trunk. A great example is the ability to time your own heartbeat. The insula is also activated upon physical exertion and becomes involved with blood pressure control, especially after exercise. Other interoceptive dynamics involving the insula are: perceived intensity of pain, how we imagine pain would feel in our own bodies when we observe images of painful events involving others, the degree of the skin’s non-painful warmth or coldness, sensations of a distended stomach and full bladder, loss of balance, vertigo, and the sensations involved with passive listening to music, laughter, crying, and language.

Emotion
The insula is receiving more and more attention as it applies to its role in body representation and subjective emotional experience (e.g.: feelings). The insula is thought to process a convergence of stimuli, formulating an emotionally relevant context for all the hub-bub. It’s also very much involved in sensing feelings of anger, fear, disgust, happiness, and sadness. And let’s not forget about conscious desires such as food and drug craving. Absolutely, the insula is a player in addiction and addictive behavior. Just one example is the insula’s ability to read body states like hunger and craving; ultimately pushing people to reach for that second sandwich, cigarette, or line of cocaine.

Believe me, giving the insula its due would require a book. And that’s why I had to make this particular presentation short and to the point. But, go ahead, do some research. No doubt, the insula is a fascinating and still mysterious accumulation of neurons. However, as I said earlier, it’s receiving more and more attention. I liken it to the development of interest in the amygdala. It actually began in earnest in the 1930’s, and with the invention and development of imaging instruments and techniques, the research continued. Of course, now we know the amygdala as the epicenter of our emotions and fears. And having this knowledge at hand opens all sorts of doors for creative and effective relief and curative measures for, as it applies to us, panic and anxiety.

So here’s to tomorrow and the insular cortex. I’m thinking bunches of great news is just around the corner.

Panic Attacks, Anxiety, and Uncertainty

You’d certainly get no argument from most anyone that we’re living in very uncertain times. Though I suppose that’s been the case since humans graced the planet, it sure appears to be a lead-pipe-cinch these days. I mean, you name it, the economy, unemployment, political unrest, terrorism; the list of uncertainty goes on and on. Now, for many, this business of uncertainty isn’t much of an issue; however, it sure is for an anxiety sufferer. And the good news is there’s a reason.

Research conducted by Dr. Jack Nitschke, a professor of psychiatry and psychology at the University of Wisconsin-Madison, revealed the element of uncertainty can be so powerful that it holds the potential to make an already distressful experience all the more intense and difficult to manage. And this, of course, can have profound negative impact upon social functioning, as well as overall mental, emotional, and physical health. It’s all about emotional response, and as always, it’s driven by the activity of neurons.

So how did Dr. Nitschke make such a discovery? Well, it’s pretty cool, actually. Functional magnetic resonance imaging (fMRI), an imaging technique that’s augmented by its ability to follow blood flow, allowing it to gain a functional perspective, was incorporated to monitor the workings of the brain’s amygdala and insular cortex. The amygdala, located within the temporal lobe, is the very headquarters of our emotion and fear circuitry. The insular cortex, located at the junction of the temporal, parietal, and frontal lobes, is involved with a variety of functions linked to emotion and the maintenance of homeostasis, our body’s sense of internal regulation and equilibrium. Significant among these functions are perception, motor control, self-awareness, cognitive functioning, and overall interpersonal experience. To the point, it’s been said the insular cortex is responsible for what it feels like to be human, as opposed to just another mammal. Interestingly enough, the highly mysterious insular cortex doesn’t traditionally receive much press, but that’s changing as it seems it’s getting a lot of attention within the realm of addiction.

Okay, let’s hit the lab. Dr. Nitschke’s subjects wore goggles that presented a series of images that either symbolized neutrality, like a bed; or symbolized something highly disturbing, say, a seriously injured person. But, before the introduction of each image the subjects were presented with an image that signaled one of three things about the image that would follow. Sort of a tipoff you could say. One such cue was a circle that indicated the coming image would be neutral. Another was an “X” that tipped off the subject the image to come would be disturbing. Finally, a “?” cued what was to come was uncertain.

Well, what do you know? The results showed a much stronger neural response to the disturbing images when they were preceded by the “?,” indicating uncertainty. This, of course, means the amygdala and the insular cortex both responded more vigorously when the element of uncertainty was introduced. Yes, this reaction was much more prolific than when an “X” warned of a coming disturbing image.

After the testing, the subjects were asked how often the “?” was followed by a disturbing image. In spite of reporting they viewed equal numbers of neutral and disturbing images, 75% of them overestimated the frequency of disturbing images that followed the cues of uncertainty. And it makes perfect sense that these overestimations were explained by the brain's increased response to uncertainty. It seems all the uproar definitely made an impression.

So, this is all well and good, but how can the research be brought alive? Well, to someone who suffers from anxiety the research suggests this whole concept of uncertainty merits much more attention and emphasis within the context of everyday life and therapy. And that’s because if the element of uncertainty can be reduced, overall levels of anxiety and over-the-top reactions to distressful experiences will be reduced in kind.

Here's a link to his laboratory's website.

An Elevator, Misinterpretation, and Overreaction...

If you’ve followed my writing you’ll know I believe misinterpretation and overreaction are the number one psychological contributors to panic attacks. I believe so deeply in this truth that I coined the term, “interpreaction,” to underscore the power of the relationship between interpretation and reaction. Well, let’s take a look at this concept within the context of a very real life scenario.

A few days ago I summoned an elevator to the 11th floor of a building. As I waited, a massive floor to ceiling window caught my attention and I very comfortably gazed outside absorbing the landscape. And suddenly I said to myself, “You know, this is really very fascinating. Here I stand within 24 inches of a 110 foot fall to a very messy death, the only thing standing in the way being a one-quarter-inch thick piece of glass (and my desire to stay alive), and it doesn’t bother me!” And, then, the realization hit home that if that piece of glass wasn’t there I’d be frozen solid in fear. So, on one set I’m fine and on the other I’m terrified and immobile. And the only difference is a one-quarter-inch thick glass prop.

As I’ve ruminated over the matter I’ve been terribly annoyed by the injustice and indignation of a one-quarter-inch thick piece of glass holding such power over my emotions, thought, and behavior. And it’s this kind of spunk and drive, along with the incredible power of reason, that hold the very keys to overcoming panic attacks, simple phobias, and any number of anxiety’s manifestations. No doubt, the very bottom-line fact is, logically my potential for catastrophe was virtually non-existent whether or not the glass was there. And if I truly receive and digest that message I must believe I possess what it takes to overcome my compromised reasoning, leading to absolutely no fear should I choose to stand unshielded within two feet of the edge of a building’s 11th floor. Doesn’t that make sense?

Well, back to that 11th floor. Let’s take a look at an edited script. There I was enjoying a beautiful view through this massive floor to ceiling window as I waited for the elevator. All was well with the world until out of nowhere the window was gone, leaving nothing but open air. And there I stood within two feet of that very messy catastrophe I’d considered when I knew I was safe and sound. Reading the new script, here are the biochemical events that would be going down in my mind.

My brain’s sensation receiving hub, the thalamus, is soaking up signals from my sense of sight that the glass is gone. It’s receiving the word from my sense of hearing that the wind’s blowing and there’s road noise below. And it’s receiving a signal from my sense of touch that the wind’s blowing against my skin. Well, after receiving these messages my thalamus begins to send information to other components of my brain. One message is headed toward my amygdala and the other is on the way to my prefrontal cortex. But, it’s important to note the message to my amygdala is the more expedient of the two.

When my amygdala receives its message it sounds the alarm because it’s not interested in interpretation. Its job is to fire and entertain questions later. As a result, my HPA axis gets cranked up, and that leads to the secretion of cortisol, norepinephrine, and epinephrine. So now my fight/flight response is chugging along like a locomotive. Oh, and my amygdala is also sending a message to my brainstem to facilitate additional adjustments to heart rate and respiration.

Well, the slower message finally arrives at my prefrontal cortex and it’s time for some reasoned interpretation and decision making. And after a lightening quick analysis it sends a message back to the amygdala to continue firing because this is definitely a life threatening event. And with that, my fight/flight locomotive chugs on and if I can manage to thaw from my full body freeze, I’m out of there!

But, wait, a true danger didn’t exist. Remember? We’ve already established I was safe whether or not the glass was in place. That being the case, my prefrontal cortex misinterpreted the signals from my amygdala, resulting in a perceived threat. Within this context, the events could have gone down very differently. Had my amygdala received a message from my prefrontal cortex that, indeed, no true danger existed it would have turned off the alarms and in short order calm would have been restored. And I’d have stood there facing the breeze from 110 feet up without batting an eye.

To me, what I’m presenting is very logical and theoretically correct. And I believe striving for this kind of reason is foundational in resolving our irrational fears. However, thought alone isn’t going to get the job done. No, facilitating management over our myth-generating reasoning takes practice. And with sufficient amounts of motivation and effort we can make great strides toward holding our fears, anxiety, and panic in check.

As you consider these dynamics, go back to my 11th floor scenario and remind yourself that with the exception of a silly one-quarter-inch thick piece of glass, nothing on the two sets was different. And that includes a poorly disciplined prefrontal cortex that allowed misinterpretation to run wild.

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Check it out. Bill

Panic Attacks, Temperament, and Uncle Hans: A Matter of Engineering?

Well, he may not have been one of the better known personality theorists, but Hans Eysenck was one of the finest. Eysenck believed temperament, a pre-wired characteristic mode of emotional response, had everything to do with having panic attacks. Here's a snippet from an article I just published...

Neuroticism
People that fall into this dimension are generally fairly calm to very nervous. According to Eysenck, these folks are prone to what he called “neurotic” problems, issues of a mental or emotional nature that result in stress. Interestingly enough, Uncle Hans focused upon the sympathetic nervous system. Well, panic sufferers know this system well, as under the direction of our fear and emotion circuitry, the sympathetic nervous system launches our physical fight/flight response. According to Eysenck, neuroticism involves, shall we say, a “hyperactive” sympathetic nervous system.

The most noteworthy expression of neuroticism, so says Eysenck, is a panic attack. And here’s the pathological progression. One becomes mildly frightened by something, which most often causes the amygdala to sound the alarm. Well, answering the bell is the sympathetic nervous system, and the physical sensations it generates make one even more on-edge, upset, and hyper-reactive to any form of stimulation. Well, that just eggs-on the amygdala and sympathetic nervous system all the more, and now everything’s cycling very quickly out of control. And before you know it, in the midst of this viciously cycling mess comes a panic attack. Very curiously, when it’s all said and done, one is actually reacting more to one’s stimulus-overload than the original mildly frightening hiccup. Does that sound at all familiar? I’m thinking so.

Please have a look at the full article. Bill

I'll Be Back Soon...

Wanted to touch base and let you know I'll be posting something of substance very soon. Seems the psych emergency biz has gone through the roof. Spending tons of time with cases, but have some free time coming very soon. Hang in there. Bill

Panic Attacks and Other Mind Variances: Blood Tests on the Way?

Wouldn't it be great if you could get a simple blood test to diagnose panic disorder, depression, bipolar disorder, schizophrenia, etc.? Well, it just might be a possibility in a couple of years. Here's a snippet of an article I just published...

"I find it incredibly exciting that research is now being conducted on objective lab-based mind variance diagnosis. And from everything I’ve read it appears as though the work is about to produce some dramatic breakthroughs. The research is focusing upon the prevalence and pattern of gene expression in mind variance sufferers. It’s all about genetic biomarkers, very unique chemical signatures. And extraordinarily fascinating is the fact that scientists have found ten genes that can be detected in the blood, which will soon provide the information necessary to generate accurate mind variance diagnoses."

"Now, as wonderful as this news is, one has to play devil’s advocate and consider some ethical issues. I mean, it’s one thing for, say, insurance companies, employers, college admissions staff, the military, and the government to know about one’s hyperthyroidism. But having knowledge of one’s panic disorder, bipolar disorder, or schizophrenia is another matter altogether. Obviously, the combination of stigma and financial agendas could lead to some serious problems."

Here's a link to the full article. Bill

Panic Attacks and Fear Learning...

Well, I promised a posting today and here it is. Back to the anatomy/physiology thing. Guess I become fixated on it at times, but it's so very pivotal in what we experience. Here are a couple of blurbs...

"Well, it seems as though neuroscientists have now located the very neurons that are responsible for fear learning in mammals. Using a highly sophisticated imaging technique called Arc catFISH (FISH is an acronym for fluorescence in situ hybridization) researchers at the University of Washington have traced all sorts of neural activation in the brains of rats. And they’ve pinpointed the basolateral nucleus of the amygdala as central in the dynamics of fear encoding."

"Now, it’s really of no great surprise that the amygdala has been found to be so deeply involved in the presentation of fear, as it, and its limbic system mate, the dorsal hippocampus, have been considered for quite some time to be the playing field of cue synthesis, leading to the formation of fear memories. But, this new work reveals the role of the hippocampus as one of stimuli processing and transmission to the amygdala. So the bottom-line is the dynamics of fear learning can be exclusively attributed to the action of neurons located in the amygala. And, by the way, processing, transmission, and reaction occurs very quickly, as learned responses are crucial to survival; especially if you’re a rat or lived as a human in a cave thousands of years ago."

You guessed it! Here's a link to the full article...

Bill