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Paris Attacks – anxiety and uncertainty

Dealing with uncertainty and the unknown

The Paris attacks which took place on 13/11/2015 left 129 people dead and hundreds injured.  It also left many traumatised witnesses and many people around the world fearing for their safety and fearing what may happen in the future.  With 24/7 media coverage and social media posts, few of us will be unaware or unaffected by the events that unfolded.

For all of those witnessing the events first hand or via media outlets, fear about the future and worry about the uncertainty of whether more attacks will occur and where they may take place. can lead to increased anxiety and a sense of powerlessness.  Events such as these can lead some to overestimate the dangers that exist ie ‘the world is so dangerous now that being attacked, injured or killed is now more likely than not’.  Some may also begin to underestimate their ability to cope and therefore engage in unhelpful behaviours such as avoidance ie ‘Since the risk of injury or death is so high, I cannot go to work/school/bars/shops etc anymore’

Whilst there is no doubt that we are living in an unsettled time and tragic events are occuring all around the world. Overestimating or exaggerating the actual threat and underestimating or minimising our ability to cope can lead to a series of unhelpful thoughts:

” I’m in danger right now”

” The worst possible scenario is going to happen”

“I won’t be able to cope with it”

These thoughts can lead to a lot of emotional distress and Physical Sensations produced by the Adrenaline Response. When there is real or a perceived threat or danger, our bodies’ automatic survival mechanism kicks in very quickly. This helps energise us to fight or run away (‘fight or flight response’). Lots of physical sensations are produced including:

  • Heart racing –  taking the blood to where it is most needed – the legs so that we can run faster (flight); the arms so that we can hit out (FIGHT); the lungs to increase our stamina. At the same time blood is taken from the places it is not needed for example fingers, toes and skin. These changes cause tingling coldness and numbness.
  •  Breathing gets faster –  helping the bloodstream to carry oxygen to the arms, legs and lungs. This will give us more power. The side effects may include chest pain, breathlessness and a choking feeling. As there is a slight drop in the blood and oxygen being sent to the brain so that we may feel dizzy or light headed, and may experience blurred vision.
  • Muscles tense and prepare – The large skeletal muscles tense and create power, this may cause pain, aching and shaking.
  •  Sweating – Sweating helps to cool the muscles and the body. It helps to stop them from overheating. Sweating can also make us more slippery to our enemies!
  •  Pupils dilate – This lets more light into our eyes so our overall vision improves. Side effects may include sensitivity to light or spots before the eyes.
  •  Digestive system slows down – These are not important while in danger and so are slowed down then the saved energy goes to where it is most needed. Side effects may include nausea, butterflies and a dry mouth.
  •  More alert – We will be concentrating on looking for danger, much less able to concentrate on anything else. We’re waiting for something to happen. Behaviours might include:
  •  Avoiding people or places
  •  Not going out
  •  Going to certain places at certain times, e.g. shopping at smaller shops, at less busy times
  •  Only going with someone else
  •  Escape, leave early

Whilst avoiding people or situations might help you feel better at that time and make you feel safer about possible dangers, it doesn’t make your anxiety any better over a longer period.  If you’re frightened that you or a loved one could be harmed if you leave your house, then staying at home becomes a solution and leads to a temporary reduction in your anxiety.  However by staying at home or avoiding going out, the belief that something bad will happen is maintained and sometimes strengthened, along with the anxiety.

Doing things differently

If you are avoiding situations its important to recognise that this maintains our anxiety over the long-term.  It also then makes sense that learning to confront fears might be uncomfortable in the short-term, but it will help us take control and feel better over time.

  • Make a plan to gradually do the things you normally avoid.
  • Pause, take a breath, don’t react automatically
  • Ask yourself: What am I reacting to?  What is it that I think is going to happen here? What’s the worst (and best) that could happen? What’s most likely to happen?  Am I getting things out of proportion? How important is this really? How important will it be in 6 months time?  Am I overestimating the danger? Am I underestimating my ability to cope?   Am I believing I can predict the future?  Is there another way of looking at this?  What advice would I give someone else in this situation?  Am I putting more pressure on myself?  Just because I feel bad, doesn’t mean things really are bad.   Is there another way of dealing with this? What would be the most helpful and effective action to take? (for me, for the situation, for others)  Visualise yourself coping in the situation you feel anxious about. See the situation to a successful completion.

And remember awful things do happen but wonderful things happen to.  All too often we can neither predict or prepare for either.  All we can do is live each day in the moment, dealing with everything situation as it arises and continuing to live our lives without fear and avoidance.

Managing Panic Attacks

What are Panic Attacks

A panic attack is an experience of sudden and intense anxiety that can occur as a result of a specific trigger or sometimes occur out of the blue and with no apparent trigger. Panic attacks can have physical symptoms, including muscle tension, headaches, nausea, shaking, feeling confused or disorientated, rapid heartbeats, dry mouth, sweating, dizziness and chest pain.

The symptoms of a panic attack normally peak within 10 minutes. Most episodes (attacks) will last for between five minutes and half an hour.

 

Symptoms of panic attacks

During a panic attack you experience a whole range of frightening symptoms, and worrying thoughts may go through your mind.  You may think something bad is going to happen, that you are going to have heart attack or faint or that you are going to lose control.  The symptoms you experience can feel very real and can mimic many symptoms of physical disorders eg. tightness and pains in the chest can mimic cardiac issues, constant feelings of nausea, stomach cramps or a need to run to the toilet can mimic gastrointestinal problems.

Its always best to have any physical symptoms checked out by your GP but once you have been given the all clear for any physical disorders, you need to tell yourself that you are not in danger and the symptoms you’re experiencing are caused by anxiety.

When you experience a a panic attack its best not to look for distractions. Ride out the attack. Try to keep doing things and if possible, don’t leave the situation until the anxiety has subsided.

Confront your fears is difficult and distressing in the short term but if you don’t run away from it, you’re giving yourself a chance to discover that nothing’s going to happen.  As the anxiety begins to pass, start to focus on your surroundings and continue to do what you were doing before.

 

How to manage panic attacks

If you have panic disorder, you may frequently feel stressed and anxious and worry about when your next panic attack may be.  Learning to relax, which isn’t as easy as it sounds, can help to relieve some of this stress and tension, and may also help you to deal more effectively with your panic attacks when they occur.

 

CBT aims to identify and change the negative thought patterns and misinterpretations that are feeding your panic attacks and can be extremely effective.  Find a CBT therapist with experience in treating panic disorder.  In the meantime follow some of the steps below:

Understand Your Body

A panic attack is often a reaction to fear (either conscious or unconscious), and some of the strange physical reactions you experience during one are the result of your body reacting to this fear. Common catalysts of panic attacks include:

Anticipatory anxiety. You become mentally anxious over a past, traumatic event, and your body responds as if it will happen again right away. Catalysts can include photographs, conversations, or anything that triggers the bad memory.

Your body goes on alert. Your brain sends a message to your body to protect it against the perceived danger, and your body prepares for the perceived emergency. For instance, the eyes may dilate to improve vision, your heart rate quickens to circulate blood faster to vital organs, breathing increases to get more oxygen to the circulating blood, and your muscles tense in case you have to move quickly.

Your mind remains stuck on fearful thoughts. Instead of reacting to either solve the problem or remove yourself from the situation (which you’d likely do in a real emergency), you get stuck on the perceived threat and remain unable to let go of the fear.

Your breathing becomes more rapid. Inhaled oxygen reacts with your cells to produce carbon dioxide, which is then exhaled. During a panic attack, breathing rates increase so your body can absorb oxygen more quickly in preparation for any necessary action. During rapid, heavy breathing (also called hyperventilation), your lungs exhale more carbon dioxide than your cells produce, causing the level of carbon dioxide in your blood and brain to fall. The results (which may include dizziness and heart palpitations) can cause some people to panic further, thereby increasing breathing even more.

Relax Your Breathing and Muscles

If you feel an attack coming on, simple breathing and relaxation techniques can help you feel more in control. But don’t wait until you’re having a panic attack to perfect the techniques. Practicing them twice a day for just 10 minutes at a time may make your panic attacks less frequent and easier to conquer.

Relax your breathing. Put one hand on your upper-chest, and the other over your diaphragm (where your rib cage meets your stomach).

Take in a slow, deep breath through your nose while counting to five. The hand on the chest should stay still, while the one over your diaphragm should raise with your breath. This is how you know the breath is deep enough.

When you reach the count of five, let the breath out slowly (through your nose) at the same rate. Concentrating on your hands and the counting will help focus you and calm you down. Continue these breaths until you feel relaxed.

Relax your muscles. Find a comfortable position to sit in (or lie down).

Close your eyes and begin to focus solely on your toes. Curl them under tightly for a count of five, squeezing the muscles together as hard as you can, then relax.

Next, concentrate on your feet. Contract all of their muscles tightly for a count of five, then relax.

Continue up your body, isolating each muscle group (calves, thighs, buttocks, stomach, chest, shoulders, neck, fingers, hands, and arms) all the way up to your face.

By the time you contract and relax your face muscles, you should feel much more calm.

Confront Your Fear

The more you understand your fear, the better you’ll be able to control it. Try writing in a journal before, during, and after a panic attack; record your thoughts, ailments, and worries. When you’re feeling better, go back and reread the entry. This can prepare you for another attack (as you’ll know what to expect) and can help you look for patterns between attacks.

 

World Mental Health Day

Mental Health problems can affect anyone at any time in their lives and thankfully the stigma associated with mental illness is reducing and more people are asking for and receiving help.

This year Word Mental Health Day was marked by the Duke and Duchess of Cambridge when they met with young people with experiences of mental health problems at an event held by the charity Mind in London.  It was their first joint engagement on mental health issue and I hope will be the first of many.

Young people face many challenges and pressure today and educating young people and their families about emotional health and resilience is vital.  It is hugely important that all of us change our attitudes about mental health problems.  Asking for help is not a sign of weakness!  In United States of America where mental health has long been recognised as important, asking for help and engaging in a counselling process is viewed as a sign that someone is on the road to recovery rather than a sign that they are unwell.  Roll on he day when we recognise asking for help in the same way!