Dr Harry Barry shares cognitive behavioural therapy techniques to overcome panic attacks, social anxiety and phobias.
Do you suffer from panic attacks? Are you dreading that awful moment when the physical sensations sweep over you like a tsunami and your body feels completely out of control? Are they taking over your life?
Do you suffer from social anxiety? Are you dreading the next social occasion where you will have to expose yourself to the perceived scrutiny of others? Are you dreading the feelings of anxiety and shame that this occasion will bring? Are you terrified to be asked to speak in public situations?
Do you suffer from general anxiety? Do you find yourself constantly worrying, in a constant state of dread as to what might happen next? Are you constantly tired as a result?
Do you suffer from a phobia? Are you terrified of getting on a plane, going on the motorway, entering lifts, being exposed to blood or simply of spiders?
Do you suffer from post-traumatic stress disorder? Are you in a state of hyper–vigilance, always seeking out danger?
Are you a parent of an adolescent who is struggling with anxiety or panic and don’t know how to assist them? Are you a young person who lacks the skills to deal with them? Have you a loved one whose life is plagued by these conditions, and want to know more?
Hundreds of thousands of Irish people including many reading this article live in the shadowy world of anxiety. And yet despite the countless people affected by anxiety and panic in all of its forms — many struggle to access any meaningful help for these conditions.
This was made very clear to the author when he was asked a year ago to put up a video on YouTube on panic attacks. To date this has been viewed by over a quarter of a million people. And yet many of the conditions above can be overcome by simple cognitive behavioural therapy (CBT) exercises and some hard work by those involved.
The dilemma is that there is a dearth of CBT therapists within the compass of many people with anxiety.
To try and improve this situation — namely both an absence of real information and a lack of easily accessible CBT therapists for so many in difficulties — Flagging Anxiety and Panic was born.
The first key understanding was that the anxiety pathways in our brain can be reshaped by our mind — a process called neuroplasticity. This is best done with the harnessed use of our mind. This sets up the incredible capacity of using key CBT exercises to reshape our anxious mind and as a result to reshape the very anxiety pathways that are causing the problem.
The second key understanding was that anxiety is not only a cognitive condition where we worry and catastrophise all the time — but also a strongly physical condition involving parts of our emotional brain and our internal stress system. The physical symptoms we experience in all forms of anxiety and panic are created by the firing of our internal stress system by a little organ in our emotional brain called the amygdala which is increasingly been seen as a key player.
The amygdala is an ancient little organ — there in the dinosaur — whose job it is to see or sense danger and ‘fire’. It keeps us alive when faced with danger by firing our stress system to pump out, for example, our fear hormone, adrenaline. It is this hormone that makes us feel our stomach in knots, our heart going quicker, our breathing faster, our mouth dry, muscles feeling tense and general feelings of dread. Everybody who suffers from anxiety and panic can relate to these symptoms.
But it is also the gunslinger of the stress system — it shoots from the hip often without thinking and does not really worry about the consequences. The gunslinger is not particularly smart, has a long memory, does not respond to normal talk therapies, and regularly disregards instructions from head office (our logical brain). So one of the objectives of Flagging Anxiety and Panic was to highlight new techniques to put him back in his box.
The third key understanding related to the fact that the worrying side of anxiety comes from the left prefrontal cortex part of our brain and the catastrophising comes from the right prefrontal cortex part of our brain.
With simple CBT techniques and a lot of hard work by the person with the various forms of anxiety (whether it be panic attacks, phobias, general anxiety or social anxiety) — one can retrain one’s mind to deal with the worrying and catastrophising; and also learn how to manage the physical symptoms which are often dominating one’s lives.
With these simple concepts I decided to use simple clinical cases which it was felt that people suffering from panic attacks, social anxiety, general anxiety or phobias could easily relate to. In each case, we would show how the person — from the second they sat down to open up to their distress — could learn the simple CBT techniques necessary to learn how to manage their anxiety or panic. As an example, a panic attack is where, out of nowhere, a person suddenly finds themselves short of breath, heart pounding, mouth dry, dizzy, stomach in knots, muscles tensed up, shaking, sweating and feeling as if they are going to die.
They can strike suddenly, for no obvious reason and terrify the sufferer. Many think they are going to die, go mad or run amok. Sufferers live in a state of constant fear as to when the next one is going to strike. At the heart of panic attacks is the understanding that the attack is simply due to an adrenaline rush created by the gunslinger firing inadvertently and seemingly without warning. We now know that the amygdala or gunslinger only responds in panic attacks to a concept called flooding. This involves learning how to go with the physical symptoms caused by the adrenaline rush. This in turn resets the amygdala and the gunslinger settles down.
What is quite extraordinary is how once the person understands what is going on and how the amygdala works, panic attacks can rapidly become a thing of the past.
Another example is general anxiety where we live in a world of constant worrying about what might happen in our lives. This is associated with a stream of physical symptoms such as fatigue, difficulties with concentration, irritable bowel, tension headaches, teeth grinding, sighing constantly, sleep difficulties and being constantly on edge. It can also be associated with procrastination, avoidance of tasks; trying to do everything perfectly and trying to self-manage the physical symptoms with alcohol or tranquilisers.
One of the most common issues is the presence of physical symptoms even when one is not actively worrying about something, and this is due again to our gunslinger amygdala ending up firing our stress system to produce high levels of our stress hormone glucocortisol.
It is the worrier, or our left prefrontal cortex, and the catastrophiser in our right prefrontal cortex, that drives the amygdala to produce all the physical symptoms as well as the constant anxious thoughts in our mind. Classical CBT concepts and exercises can show us how to challenge the worrier and in particular the catastrophiser; and different approaches to deal with the amygdala gunslinger-driven physical symptoms.
Another example is social anxiety where we are anxious and embarrassed in case people will pick up some signs that we are anxious and end up judging us as inferior as a result. Once again it is associated with very distressing catastrophic visualisations in our mind, and associated physical symptoms which are very uncomfortable. It is also associated with a lot of avoidant and safety behaviours which are described in detail in the book. Once again the two main players are the gunslinger amygdala which is misreading danger in other people’s faces which is not actually there; and the catastrophiser. They give rise to most of the cognitive and physical symptoms we experience.
Once again a real understanding of this condition with some targeted CBT exercises and a lot of hard work can help us to challenge the thinking and behaviours driving this condition. Let’s take anxiety out of the shadows and reshape our anxious minds and brains.
Dr Harry Barry is the author of ‘Flagging Anxiety and Panic’ (Liberties Press)
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