What would a Psychotherapist do if you had a panic attack in front of them?
When Panic attacks, it is a horrible episode to experience and to witness.
As a therapist, I have seen clients in full-on "panic attacks" and have witnessed the effects attacks have on their minds and bodies in how they react.
Imagine the scene…
I am visiting a client I will call Nick at his home where I have agreed to treat him.
As I sit reading my notes, waiting for him, I see him walk into the room so badly affected that he is soaked in sweat, hyperventilating, his eyes darting everywhere, he is agitated and unable to talk as he begins vomiting repeatedly.
He was experiencing a full-blown "panic attack" during the start of a 90-minute consultation. I had to act quickly and decisively to help him.
People like Nick are no longer in conscious control of their life at that moment, their mind and body have been hijacked by the body’s stress response to fear, and their anxiety has turned into what is labeled a full-on panic attack.
What is actually happening is that they are experiencing a four-pronged attack that is overwhelming them.
During these distressing episodes it is not uncommon for clients to suffer through the following symptoms: Hyperventilation, Heart palpitations, Trembling/shaking, Sweating, Choking, Nausea, Numbness, Dizziness, and sometimes many at the same time.
This is because of their perception of what is about to unfold, a stimulus in their environment, has been identified as life-threatening by their amygdala, the part of the brain that manages our emotional responses. It is like the brains security guard, and it is sounding every alarm possible to energise the body for fight or flight, evasive action.
They are actually under attack in four ways...
Psychological attack, their executive brain function, the Pre-Frontal Cortex, (put the palm of your hand above your eyebrows and across over your forehead) everything in the area immediately behind your forehead is the PFC the rational brain which is hijacked and held hostage by their emotional brain. They can no longer think rationally.
Chemical attack (the emotional brain floods the body with stress hormones, glucocorticoids, adrenaline and cortisol)
Biological attack (as the stress hormones affect the organs, heart, lungs, muscles, spleen, stomach, digestive system, bowel) and finally
Physiological attack as the tension increases in their body as the pressure builds.
The first thing I do in these circumstances as a highly trained and experienced Clinical Hypnotherapist and Psychotherapist and what any good therapist should do is to distract the client’s attention away from what it is locked on by drawing it to a different focus.
The therapist should reassure them, I do this by explaining I am going to help them regain control.
I do not tell them that “It’s alright… and that everything is going to be ok!” they cannot relate to that in the height of panic. They do not feel like this is alright, and their mind is not telling them that everything is going to be ok!
I explain we will work together to help them feel better and ask them to help me by taking a breath and then naming and saying out loud five things they can see in the immediate environment.
I praise them and encourage them, asking for four things they can hear, paise again and then ask for three things they can feel, more praise and encouragement, two things they can smell, and finally one thing they can taste.
This serves to focus their attention on what their senses are actually sensing right now in the environment we are both sharing. Whilst they comply, I praise and encourage them at each step to breathe and in doing so start to calm their nervous system down.
Once a panicked client starts to regain control of their breathing through techniques any good therapist should teach, their nervous system starts to unwind and relax, then their attention can be brought back into focus and their brain's executive functioning PFC comes back online and a therapy conversation can take place.
Bringing the mind back to a sense of equilibrium (no pressure) and body back to homeostasis (a sense of balance) allows the person to regain a sense of calm and feel more at ease. It is here that good deconstructive and reconstructive therapy should start from.