(Faure - "Pavane")
The Avoidance – Panic Connection
If you have ever experienced a panic attack, the sudden shortness, of breath, severe chest pain or feeling that your head was expanding may have led you to wonder if you had a serious illness or were going mad. The feelings are so dreadful that immediately you begin to worry about this happening to you again and as a result you are 'on the look-out’ for the slightest signs of increasing nervousness within yourself In order to reduce the chances of a recurrence, you might begin to avoid situations, places, and activities that you think are likely to make you feel uncomfortable or uneasy, and bring on a panic attack. The cycle of anxiety leading to avoidance leading to the anticipation of more anxiety leading to more avoidance has begun.
Francis Charlton, a trauma therapist, states in his (i992) pamphlet, 'Coping With Panics', that '...the -greatest part of what makes up a panic is that you thoughts get out of hand and run away with you!'. He goes on to say, "No one can die of fright and panic attacks cannot send you mad, although temporarily you feel unlike yourself. Though panic feelings are unpleasant they cannot in any way harm you, or damage vital organs. The feelings themselves are quite normal. It is just that they are happening in an ordinary situation rather than in a dangerous or frightening one.'.
Often these 'ordinary situations' are more public like shopping, or using public transportation, riving could become a problem as well, if you start to fear that you will have a panic attack while in traffic or on the motorway. You may no longer trust yourself to stay in control, and feel you cannot predict when the anxiety will arise. Thus, you avoid more things, and life becomes more limited.
In order to cope with these panic feelings, and to reduce your fears in anticipation of them, try to tell yourself that you are overreacting in an ordinary situation. As a result of the trauma that you have been through, your body and mind have been conditioned to perceive danger even in situations seemingly unrelated to the traumatic event.
Rather than trying to figure out the cause of the anxiety try to gain confidence in managing those panic reactions. Focus on controlling your breathing, count down slowly from l0 to 1 and congratulate yourself on small successes ('I was able to stay out shopping for half an hour before I began to mind the crowds'). Once you are no longer frightened by them, and give them less attention, the panic attacks will usually disappear on their own.
1. Remind yourself that you understand what is happening to you now, and that there is no real need to be frightened. Remember these symptoms are uncomfortable but not dangerous!
2. Begin to concentrate on your breathing. Blow out first, as slowly as you can. The next breath in will be deeper. Try to breathe out to the count of 1 0, then in again to the count of 10, breathing from your diaphragm (belly) and not from the top of your chest.
3. Repeat a coping statement to yourself -'] can get through this' or 'This feeling will pass in a few seconds if only 1 stay with it!'.
4. Slow down a bit and continue what you were doing, as calmly as possible. Try not to rush home.
5. If the feelings continue, try singing! If you are alone in the car, while driving, sing out loud and if you are with others, hum a tune or sing softly under your breath. Try to pick a song that makes you feel good, strong, or cheerful!
6. Congratulate yourself on your progress in continuing your trauma recovery program. It is hard work and you are not giving up!
7. When you are in a comfortable place again, practise the Relaxed Breathing Method, and try to let go of the built-up tension.
It will also help if you keep a record in your notebook for a two week period, noting when you feel panicky or anxious and what
was happening at that time. For example, were you in a particular place, or with certain people, or especially tired or upset?
At the same time, make a list of the things you have been avoiding because of the panic attacks and select one to work on first. Then decide what gradual steps you could take towards resuming that activity. Order them from easiest to hardest, and start work on an easy step first. This should make you feel just a little uncomfortable, but not overwhelmingly so.
1. Keep a record of your panic attacks in your notebook. Rate them in terms of their strength (using a scale between 0 = none and 8 = absolutely overwhelming) and monitor them on a daily basis.
2. Next, look at the notes in your panic diary and decide on an activity that you have been avoiding, but would now like to try to master again. Choose an activity that won't be too easy but also not completely overwhelming. State precisely what it is that you would be able to achieve if you were to master this target activity.
3. Then list the steps (from easiest to hardest) that you
have to take to be able to achieve your target activity.
The same technique of setting one target at a time, and identifying a series of small, very gradual steps towards a goal will work for any number of feared activities or situations. It is very successful, for example, with driving phobias, which are very common after road traffic accidents.
It would be helpful for you to monitor and record your level of anxiety or panic each time you practise these steps. You should also write down:
* What you used that helped you achieve this practice,
* What was not so helpful about the things you did and
* What, if anything, you would like to do differently during your next practice.
Make sure that you congratulate yourself on the progress you have achieved each time and don't be despondent if progress is slow. Confidence comes through a series of small, but increasing successes.
If you have been feeling emotionally closed off and empty inside, you should begin to ask yourself (gently): 'What am 1 trying not to face?'. Often this type of reaction indicates that your mind is trying to protect you from an emotion that you are afraid of, for exam le: 'I am afraid to love again', 'I am afraid to trust again', or 'I never want to feel that bad again'. In effect, you are hiding from your emotions, for fear they will overtake and destroy you.
It is important for you to take things slowly and not be overwhelmed, as that is likely to cause a setback. Be wary of highly charged emotional situations for this reason. Working slowly and privately - by yourself or with the help of a health care professional - you must begin to acknowledge the parts of your experience that you are trying not to face:
* What has been the meaning of this trauma for you?
* Are you drawing conclusions from it that are inclined to be bitter or cynical and that are keeping you emotionally closed off?
* Have you been trying to justify this behaviour to yourself?
Whether you are managing avoidance behaviour or other avoidance responses, like emotional numbness, the same technique of gradual exposure - taking things bit by bit, one step at a time - should be applied. In all situations, your goal is to achieve containment of your reactions. You have already had your coping abilities overwhelmed by the traumatic experience(s) you have been through. This book aims to help you develop strategies to enable you to deal with your reactions without feeling wiped out' and experiencing setbacks to your recovery.
If you begin to feel overwhelmed by the work you are doing with this book, it may be a sign that you are trying to do too much too fast or that it is time to talk to a professional. The key is not to be impatient with yourself! Healing rarely occurs in a straight line.
Emotional numbness does not usually go away on its own. You have to challenge it and be willing to examine its origins. Often it is connected to a significant loss that you have experience, perhaps even a sense that you have your identity n, i994). You may have lost your your place in a professional group
(such as a military unit, or fire fighters'team); part of your identity may have been wraped up in your plans for the future. Losing the possibility of achieving hopes and dreams or not being able to be the person you hoped to become may have caused you to shut down emotionally.
(Faure - "Pavane")