Palpitation, rapid heartbeat, sweating, trembling or shaking, feeling short of breath or choking, chest pain or tightness in the chest, nausea or abdominal pain, dizziness, inability to stand, light-headedness or fainting sensation of being cold, shivering or hot, numbness (apathy or tingling sensations), derealization (perceiving the environment as different from what it is) or depersonalization (perceiving oneself as being different from what one's body is), fear of losing control or going crazy, death Fear is the subject of panic attacks.
Before answering the question of how a panic attack begins and how it continues, I need to explain what classical conditioning and operant conditioning are, because panic attacks begin with classical conditioning and continue with operant conditioning.
Classical conditioning is based on research conducted by Russian physiologist Ivan Pavlov. With the "connection" method introduced by Pavlov, connections are established between events and objects. Pavlov conducted experiments on dogs. In his experiment, he gives meat to the dog with one hand and rings a bell with the other. The dog cannot understand this at first, because he is not interested in anything other than eating the meat. But after a few tries, the dog starts to salivate even if he hears only the sound of the bell, as the meat comes after him when the bell rings. Because waste has established a connection between the ringing sound and meat. The bell, which at first had no meaning for the dog, later turned into something meaningful for the dog. When you give cat food to your cat more than a few times, your cat will make a connection between your arrival and the food and will run towards you as soon as it sees you. To give a different example, if your child does not want to eat yoghurt, making a yoghurt salad with his favorite fruits can help him develop a positive attitude towards yoghurt. Or, if you are afraid of dogs and you see a friend of yours with his dog every time, you can now react to your friend the same way you react to the dog, since you have established a bond between the dog and your friend. While you normally do not get startled or scared when you see your friend, now that you have had a dog, you startle when you see your friend as if you saw his dog. Panic attacks also begin with classical conditioning. Your heart beats faster While the sound of light is not normally a frightening stimulus and your heartbeat accelerates (for example, if you run, your heartbeat accelerates), you may start to feel afraid after classical conditioning. Anxiety ends in our minds as the heartbeat accelerates. In this case, we may start to feel anxious when our heartbeat increases. Panic attacks begin with classical conditioning but continue with operant conditioning.
What does operant conditioning mean? The consequences of our actions govern our actions. If a behavior brings us a reward, our tendency to continue that behavior increases, or if we get rid of something we do not want as a result of our behavior, we feel the desire to continue that behavior. So how do panic attacks continue with operant conditioning? Let's say your heart beats faster or you feel tingling or you start sweating and the thought of dying comes to your mind and naturally you panic, that is, you feel anxiety, you throw yourself into the hospital to reduce your anxiety. Here, when you go to the hospital, the anxiety decreases, that is, you get rid of something you do not want. This part is operant conditioning. In other words, the behavior you do (the behavior of going to the hospital) reduces your anxiety, you get rid of the unwanted feeling that disturbs you, so now every time you feel anxious, you run to the hospital to avoid worrying and to make sure that you are not about to die. Every time you go to the hospital, you feel relieved for a short time (anxiety decreases), but the next day the same anxiety comes back and sticks to your neck. We call this part operant conditioning.
Panic disorder begins with the catastrophizing of body sensations. In a panic attack that occurs as a result of catastrophizing, thoughts such as heart attack, brain hemorrhage, and loss of control are present. When working with individuals who have problems with thoughts of death, we ask whether these individuals have had a medical examination beforehand. In fact, clients decide to see a psychologist after seeing a doctor many times. Clients visit doctor after doctor and come to see us after receiving feedback that there is no physical or biological problem. The focus is on their depressing beliefs. When bodily sensations are interpreted as dangerous, the person begins to feel anxiety. In other words, a behavior interpreted here affects a person's emotions. What physical sensations the person feels during a panic attack, what thoughts pass through his mind, what emotions he feels and what behaviors he does, that is, how he tries to cope with the panic attack, are tried to be determined together with the client. In other words, what are the precautions he takes to prevent panic attacks, and what does he do when panic attacks occur? What was he doing before the panic attack occurred? And in addition, it should be learned how their interpersonal relationships are.
When the problem arose, it should be looked at, what kind of course it followed should be learned. We may have experienced a life event that triggered a panic attack. This needs to be discovered. We should look at what changes are happening in our lives when the panic attacks begin. It should be checked whether there are life events such as a change of city, a death, starting a new job or school graduation. Panic attacks are often observed after a life event.
How did a panic attack affect the person's life? This should be emphasized in the interviews, because it is not the panic attack that brings the client to the meeting, but the restrictions imposed by it.
What the client thinks about the problem he is experiencing is very important, so it is necessary to learn what is the reason for this experience and how the solution will be.
The primary goal of the interviews is: 1. The client's ability to define his own thoughts, 2. The client's ability to replace his own thoughts with alternative thoughts. If the client can develop alternative thoughts, his feelings and behaviors can also change. Thoughts are that the sensations indicate disaster. It should be studied what it could indicate other than disaster. The focus should be on the relationship between body sensation-thought-emotion-behavior.
Clients who have a panic attack check whether there is any pain in their body or an acceleration in their heartbeat, they check it because they have a chance to prevent something bad that may happen. When they act like this, they focus more on their bodies and how they feel. They increase their control over what they believe in. When a panic attack occurs, clients engage in avoidance behaviors (going to the hospital, etc.), and these behaviors prevent people from confronting their negative thoughts. The person begins to believe that he or she does not experience an unpleasant situation because he or she goes to the hospital. He or she misses the opportunity to see what will happen if he or she does not go to the hospital, and begins to believe his or her negative thoughts. continues. In fact, the negative thought becomes a self-fulfilling prophecy.
The client may be asked to imitate or visualize the panic attack he/she is having, so that it may be easier to notice the feelings and thoughts.
The client's mind may be asked at the time of the panic attack. Thoughts (e.g., I may be having a heart attack, I will be paralyzed, I will be blind, I will drown, I will not be able to breathe) are evaluated together with the client. Thoughts can be examined using the evidence and counter-evidence method. In other words, what kind of data supports the ideas and what data does not support them are examined. This part is the work done in the cognitive techniques section.
In the behavioral part, the relationship between the symptoms and thoughts caused by increasing sensations is studied. What do the symptoms caused by increased sensations mean? For example, let's consider a person who associates an increased heart rate with having a heart attack. This person is asked to increase their heart rate. The desired sensation is increased by the acceleration of heartbeat. The person may interpret this sensation as "I may die" or "I may have a heart attack". After experiencing this sensation and interpreting it as "I may die", the person will naturally take precautions to avoid dying in accordance with his own interpretation, that is, he will exhibit escape and avoidance behaviors. For example, he will go to the hospital or silently recite a prayer. In summary, the individual will try to relax. We call the behaviors he/she does to relax escape, avoidance and security-seeking behaviors.
What happens if the person does not do these escape-avoidance behaviors, for example if he does not go to the hospital? Imagine that you don't go to the hospital even though you think you are going to die. Sounds very strange and scary, right? You think you are in danger of death and you do not want to go to the hospital. You prefer it. Your anxiety will increase even more. In other words, when you do not perform your avoidance behavior, you will not relax and your anxiety will increase. If you do not go to the hospital or do other avoidance behaviors, your anxiety will increase, but anxiety, like other emotions, will not last forever. It will rise for a while, reach its peak, and then gradually decline. So anxiety has a lifespan. Its intensity does not always remain the same. If the individual does not engage in escape, avoidance and security-seeking behaviors, he will become desensitized to anxiety as he comes face to face with anxiety and will be able to begin to manage his anxiety. An attempt is made to make clients experience this during the session. In other words, efforts are made to confront anxiety. If the client allows, an attempt can be made to create an artificial panic attack with the client during the session. Symptom augmentation method can be used. For example, you may be asked to breathe quickly, increasing your heart rate yourself, and then slowing down your breathing to decrease your heart rate. Or let's imagine an individual who thinks that he will be paralyzed after feeling a tingling sensation in his hands. The individual is asked to create the tingling sensation in his hands by squeezing his hands to himself. Clients are taught relaxation, controlled breathing (diaphragmatic breathing) and paper bag breathing techniques to manage panic attacks.
After the artificial panic attack is created, the client has an opportunity to learn how to manage this panic attack. After a panic attack occurs, the client is asked to end the panic attack by using relaxation, controlled breathing (diaphragmatic breathing), paper bag breathing techniques, so that the client understands how to control anxiety. In this case, the client sees that he can start and end a panic attack. In other words, the client experiences that he can increase his heart rate and then decrease it again. The client can be asked about the differences between artificial panic attacks and real panic attacks.
During these practices, thoughts such as "I may die, I may faint, I may be paralyzed" arise, and after the application, a study is carried out on what happens to these thoughts, that is, what the client feels in his body is reinterpreted. . Thus, panic attacks become a vicious circle
Read: 0
