It’s hard to understand anxiety unless you have experienced it yourself. Most of us have a degree of anxiety about our mortgage, our appearance, our future and our loved ones.
But full-blown panic where your muscles freeze, your throat goes dry and your mind is irrationally telling your brain that you are about to die is a whole different ball game.
Anxiety is an inbuilt alarm system that is telling us we are in danger and we should freeze, fight or flight. Blood is pumped away form the gut and to muscles, heart rate increases, respiration goes ballistic which results in us
This results in calcium and potassium ions rushing through gates in the muscle and nerve cells, your fingers start tingling and more messages are sent to your hyperactive brain that impending doom approaches. Your muscles and jaw clench, chest pain kicks in at about the time the ambulance is called, or your plane is diverted as you, the cabin crew and pilots are worried about a suspected heart attack.
Last week I had such an attack while standing on top of steep chute on my snowboard in the Southern Alps. My guide managed to coach me down like a frightened rabbit and I obviously survived. The irrational part is that I have snowboarded steeper and harder before, but my brain could not see where I was going so was flooding my consciousness with error messages. I froze as cold as the snow I was clinging to for dear life. I have had similar experiences surfing big waves and being hit by a tsunami in Java at 2am in 1994 that killed around 500 people.
So, when seeing patients presenting with full blown panic I imagine them being faced with a tsunami of thoughts, chemical reactions and physical side effects to what to the rest of us seems just a normal day. We as clinicians, husbands, wives, parents and workmates know that they are not going to die, but the anxiety sufferer feels like they are despite all the reassurance in the universe.
Empathy, patience and reassurance are key ingredients in managing someone else’s panic. As many of the unpleasant side effects of tingling in fingers and muscle cramps are caused by a biochemical imbalance in the blood slowing the rate of shallow breathing is important. Breathing in and out of a paper bag (not plastic) can restore carbon dioxide levels in the blood, symptoms recede, thereby reducing anxiety. Many people fear the symptoms of anxiety rather than what makes them anxious in the first place, like air travel.
Anxiety can be the enemy of progress, so it can be useful to try and determine if the anxiety is healthy or unhealthy. If anxiety about workplace safety causes you to put in safe practices then it is healthy anxiety, if it keeps you awake at night or paralyses you, then it’s probably unhealthy anxiety.
To control my anxiety about taking risks or the future I use two letters to manage and preface the flood of thoughts. Instead of thinking “what if my boat sinks on my impending circumnavigation of New Zealand”, I change my thought (not in a flippant way) to “SO what if my boat sinks, I will get in my life raft which has just been serviced, use my EPIRB and safety equipment and get rescued by the coastguard of which I am lifetime member”. It will certainly give me something to write home about.