Keep It Together, KIT, Keep It Together
“…And all of a sudden, I have a panic attack.” Unimaginable, even if it is not your first. Terrifying, whether in your home or on a plane. Expensive, energetically and especially emotionally. And then you must recover…and dread the wait for the next one. Whether you have experience with anxiety or panic or not, we have all be terrified at some point so everyone can relate in some regard. Anxiety and panic disorders are significant diagnoses that, like depression, have unfortunately become mainstream terms. Too many people throw around these words, depression, anxiety, and panic, without truly understanding the severity some people suffer. That being said, every person alive has had the experience of depression, anxiety, and panic so the use of the terms can make sense. An attack is a bit different experience, though. The speed of the symptoms and the lack of control magnify the terror from the psychological stress, creating a terrible event. Getting help is vital and makes an enormous difference so if you have been wondering if you should get help, that is your cue to do it. This article is NOT a substitute for help but perhaps a different way to think about the all of a sudden part of the problem.
Tragically, anxiety is experienced by 19 million American adults, with the data reporting between 31-33% of the population seeking treatment (and this data is over a decade old on the NIMH website). Panic Disorder affects between 3 and 6 million people, mostly women. Quite the range. One out of every three people have anxiety bad enough to seek treatment, making me wonder what that number would be if there were no social stigma around mental health and seeking treatment. But that is not the topic here. I want to talk about the timeline of an attack with the intention of empowering people with anxiety. And by “people with anxiety,” I mean everyone, because everyone experiences anxiety, some worse than others, but everyone can get better at dealing with it.
I have done a decade of sport psychology in the equestrian world, working with riders that run the gamut from the Olympic Team to the “backyard barn” rider who has no desire to compete. There are two issues when working with equestrians: performance or fear. The performance stuff is similar to other sports except the necessary accounting for a live animal as your competitive partner. No tennis racket will ever wake up sore or tired or find a loose plastic bag in the wind a death threat. So, working with riders and horses has that as a difference. And then there is fear. More women than I can possibly count are afraid of their horses and call me to get some help, exposing me to a plethora of stories over the years. It is truly fascinating to have someone terrified to death of the very thing they love so deeply. But that is another topic, too.
Do you know the difference between fear and anxiety? Most people cannot answer this question. Not only are people surprised they don’t know the difference, but even more are surprised that there IS a difference. Fear is a response to an actual threat and anxiety is a response to a perceived threat (sport psych 101). The problem with fear vs. anxiety is that the Sympathetic Nervous System (SNS) is engaged in both and thus, the physical symptoms are exactly the same, making it hard to tell the difference at times. So, an actual threat is a car on the wrong side of the road headed towards you, in which case you want your SNS to take over and save you with the immediate increase in blood flow to the muscles and increase in respiratory rate so that blood is super oxygenated and your body’s chemical response of adrenaline and cortisol give you that super-human strength and reaction time you just might need to fight or flight. A perceived threat is your child’s school showing up on your caller ID and the immediate assumption that something bad has happened, or just thinking about an upcoming event and how it might go wrong. Again, same physical symptoms of fight or flight, even though the school was calling to tell you your child is back safely from a field trip and not that they are maimed or injured. The best place to intervene is before the symptoms appear, which means before the anxious thought is thought. You can train that, believe it or not, and decrease competitive, performance, or simply being alive anxiety significantly.
A few years ago, I was working with a woman on her riding anxiety, which admittedly had spilled over from her being alive anxiety. (Let’s call her “Lisa” which is not her real name, of course and because I was not there, I cannot accurately diagnose this as a “panic attack” so I am using her language and description. Please read this from perspective that what she felt was intense and fit many of the descriptions of a panic attack, but the point here is not the diagnosis but the post-event reflection that created a powerful change for her.) The gift of working with Lisa was her incredibly high level of insight and personal awareness; I guess that would be the blessing side of the curse of anxiety which had led her to years of counseling and personal growth work. Her descriptions of her thoughts and resulting tensions were detailed and full of great observations. As she told me the story of her latest and most harrowing anxiety event, she used the phrase, “…and then all of a sudden, I had a panic attack.” Because of the depth of description, that sentence just did not make sense to me, even though it is what everyone who has ever had a panic attack says. I asked her to go through the few days leading up to and then the morning of the event again but this time, telling me about her physical symptoms and not just her mental state. She felt a worsening for days and then terrible all day, from the moment she got out of bed until the evening when the panic attack happened. She described herself as twitchy and irritated, and not hungry because of low-level nausea all day. She had low energy and a slightly elevated heart rate all day, for some reason. When I asked her to pair her physical to her mental and emotional, it really got interesting. After a long pause and few easily identifiable deep breaths, she said, “looking back, I spent the whole day fighting it and trying to keep it together.” So, was it really all of a sudden…it didn’t seem so when she looked deeper.
In 1999, Steve Martin wrote and starred in a film called “Bowfinger.” Eddie Murphy plays two look-alike characters, one a famous action-movie star named Kit Ramsey. Kit is famous but neurotic and paranoid, and a member of an organization called MindHead (represented as your typical movie brainwashing cult). The leader of the organization counsels Kit, whose name really stands for Keep It Together. Eddie Murphy has a scene where the stress is really getting to Kit and he walks along mumbling, “K-I-T, keep it together. K-I-T, keep it together, keep it together, keep it together.” This scene always comes to mind when I am talking with someone battling anxiety as it is a constant fight to keep it together and is difficult and exhausting. This scene really came to mind as this woman described her day, actually many days, of keeping it together and as she spoke, the pattern became more and more visible. There was a stressor (isn’t there always) and then the panic attack…with seemingly no in between. But that is where I saw the disconnect. What there was in truth were a thousand moments of increasing impact from the stressor, with no awareness of it nor successful strategy for relief from that stressor. This forced her to “kept it together” for as long as she could until she “tipped,” and the inability to suppress both the mental and physical elements of the stressor caused a rush of anxiety and created panic in the form of an attack. It sounded like holding flood gates for as long as you can and then not being able to hold it off and being swallowed by the water as the gates burst open.
The physiology of anxiety and panic are often mentioned but I don’t think they are given enough credit…for both the contribution to the event and the untapped alert system it could provide. When I work with athletes, talking about how performance anxiety impacts physiology makes perfect sense because an athlete needs their body to respond exactly how they expect it to for great performance. So, the advantage of being much more tuned into the body creates an automatic opening for intervention. Non-athletes may not have the level of sensitivity to their bodies, making this conversation more difficult or even foreign at times. For Lisa, as she continued to answer questions about how she physically felt that day, it became clear that her physiology was a major contributing factor to her panic attack. The other thing she realized as we talked was how she completely ignored her physical symptoms for days, and especially that day. This is the keep it together part of the problem. Not only are we naturally wired to stave off any sign of weakness, but it basically makes us ignore these early warning signs that begin as subtle and then increase in intensity. When Lisa connected with the idea that she could use her physical symptoms as a warning sign, she said she felt a glacial shift.
The all of a sudden part of an attack is what leaves people disempowered, confused, and with no access to preventing the next one. When Lisa could look back on it, she could see the physical warning signs and how she could have used them to address some of that anxiety. Undoubtedly, anxiety sucks so why would we want to address it at all? But ignoring it or trying to pretend it isn’t there is a terribly strategy because at some point, it will come to the surface, no matter how strong you think your flood gates are! Self-awareness is a skill set that takes time, effort, and tenacity to develop. And, it is not static, so you have to keep working on it, dammit. Next time you feel mentally stressed, check in with your physical self and see what it tells you. Are your symptoms worsening? Do they spike when the mental stress spikes? If you can calm your physiology does that help you regain some mental capacity? It should so give it a try. Even a small decrease in physical symptoms of 5% can have an incredible impact on your mental or psychological state. It doesn’t take much to start to feel better…just like it doesn’t take much to start to feel worse. Knowing this is power. Stressors will always be there waiting to catch us off guard and mess up our balance. Be ready for it before the “all of a sudden” sweeps you away with the flood waters.