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.

Speaking Services...

Just built and added a page to my website offering mental/emotional health speaking services.
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

Be Back in the A.M.

Sorry for the absence of posts the past few days. Bunch of stuff going on. Loooong day today, as well. This cowboy's chillin'. Will have a nice post tomorrow. Watch for it! Bill

A Great Story About a Great Man...

I read a great story in the Chicago Tribune this morning. One that's of great relevance to anyone who's ever suffered from a mind variance. The article was so good I wrote my own article sharing my feelings about it. It's all about a 72 year old man who's finally found a measure of relief from a lifelong dance with OCD. Here's a link to the Tribune article. And one to mine. Bill

Please Subscribe to Our Newsletter!

Wanted to invite you to subscribe to our email newsletter....

Panic Attacks and Assorted Mind Variances: Pieces of a Greater Whole

It was a beautiful Sunday in Chicago. Wanted to post before the end of the day. Submitted an article a bit ago and wanted to share. Here's a piece...

"The human brain is absolutely amazing. And as much as we’ve learned about it, it remains one incredibly mysterious three-pound mass of tissue and fluid. The brain’s functioning has certainly been a puzzle to me over the many years, as it’s facilitated a long bout with panic disorder, as well as dances with other distressing mental, emotional, and physical phenomena. Lately, I’ve become more and more fascinated with how a panic sufferer’s assorted pathological challenges present and interact."

"Well, to me, our assorted bits of pathology aren’t pieces from different puzzles that happened to have been thrown on the card table. No, they’re pieces from a massive and complicated puzzle that simply take a longer amount of time to piece together. It’s just all the more evidence that mind variances co-occur and interact. And though, in terms of treatment, we traditionally lean toward the myopic, focusing upon the issue that’s causing the most grief in-the-moment; all pieces of the grand puzzle must be considered. Only then can we maximize insight, identity, education, treatment, and hope."

To read the entire article just click here. Bill

The August Newsletter Is Out and About...

hopeandhealingareeverlasting

Yes! The August '09 Hope and Healing Dynamics Newsletter is now floating about cyberspace. Will be writing more in the a.m...

Bill