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Panic Attacks

Based on: Panic Attacks and Postmodernity: Gestalt Therapy Between Clinical and Social Perspectives. Gianni Francesetti (Editor)2007

Those suffering panic attacks tend to describe their condition as something unsayable. This unsayability would seem to lie at the very heart of the panic attack experience.

The unsayable is in the very essence of the panic attack; defying the logic of the experience - in every other sense the client 'knows' (mostly) they are not going to stop breathing; not going to have a heart attack; is not going to suffocate.

The unsayable is not a failure or deficit of language, rather is itself in the origin of the panic attack.

The daily life of those who suffer panic attacks is suddenly interrupted, as if they had suffered a severe trauma. In panic attacks, as opposed to a trauma event, there is no phenomenological source for the client's anxiety; a trauma has occurred - its nature, however is unsayable.

As therapists we are dealing with the consequences of a trauma that has not been fully experienced. Our task is to construct a new ground of security. We cannot recreate the previous sense of security; it is no longer here, it is gone; it has past, forever.

The new ground has its origins in a full awareness of the fragility of existence and in a decision to live life to the full, seeking to contrast the fear of losing what one has with the positive aggressive determination to actively give and take what one wishes.

Panic attacks may be defined as a necessarily dramatic way of reaching out for a relationship, helping to reconstruct the belonging, which is a constituent part of any integrated and full identity

From a Gestalt perspective panic is consider as a healthy and normal creative-adjustment. Panic is a phenomenon that serves to protect the individual in situations of extreme environmental danger. A Panic Attack is the experience of panic in a situation where there is no (apparent) extreme danger.

The concept of figure/ground is pertinent to the understanding of panic attacks. In the panic attack the individual's ground disintegrates, gives way, and this both prevents the figure formation to complete and shatters the existence of what was perceived as being taken for granted, i.e., the ground

Gestalt psychotherapy looks at how an individual makes contact with another, or with the self. As such, there is a contact boundary, the 'space' at which the individual will take in, meet, or reject the availability of having contact. It is at the contact boundary that our experiences develop; with the development of experience, i.e., with contact at the contact boundary we will each be met with growing excitement. However should there be an interruption to this contact we instead are met with anxiety. Anxiety is the interruption of excitement. And panic is on a continuum of anxiety, with panic attacks being the panic without cause. Panic attacks are entwined with contact, and the interruption of that contact.

The process of contact is stimulated with the differentiation in the individual's perception of what is in the environment; this differentiation is of figure from ground. This is usually demonstrated with an image such as this:

The picture shows either a vase/chalice figure, or two heads in profile looking at each other. The concept of figure/ground originates in gestalt psychology studies of perception and is that you see one or the other, never both simultaneously.

In Gestalt psychotherapy the view is the individual selects the figure from ground. Whilst it may be easy to image the ground as solid earth underfoot, this is not what is meant by ground. Ground is what you will filter out as you pay attention or concentrate on what you are attending to. So in reading this the figure is the words here in this paragraph, in this line, and the ground is what is not figure, that is, the page itself, the screen, the computer, the room, your appetite, how you are sitting ... and so on. Figure/Ground is not static, in that you will switch your focus and attention: seeing the screen, not the words, noticing perhaps tension in your shoulders, etc.

In respect of panic attacks, these occur when there is a loss of, not the figure, but of the ground. In this respect the ground is the familiar, the taken for granted aspects in the world of the individual that suddenly does not exist. At this point the ability to seek out a new figure, and thus ground, is removed for the individual. There is a loss of imaginational and creative perspective.

Ok, so now, bringing together contact and figure/ground, there is the process of differentiating a figure from ground, and this figure becomes the focus, or object of contact. Within this process panic attacks sit with a loss, or interruption of perception, that effectively removes the backdrop (ground) of what is being attended to (figure).

The other aspect of this process to be examined is the process of contacting. In Gestalt psychotherapy this contact process is usually termed the contact cycle. The process of contact runs through a wave, or cycle, of phases of fore-contact, contact, and post-contact, and continuously repeated with the rising and emerging figure. The image below (Zinker 1978) describes the contacting process.

As with any theory, this is the 'perfect' contact model that is not interrupted or disturbed and whilst this exists and is experienced there many ways in which an individual will limit, distract, avoid, or halt the contact process. An illustration of this is for you to think of someone that you engage in conversation when really you don't want to. How do you act, what do you not say, what do you say, how do you hold yourself, your posture, your expressions; how is this different when you meet a person you enjoy talking with? And we all do this, there is, at a minimum, a social - a cultural - aspect to how we are in contact with others.

How we adjust 'pure' contact is now referred to as Contact Styles (where previously these have been termed interruptions - and still often are)

Panic attacks are best reviewed and worked with in conjunction with recognising and noting the style of contact of the individual.

Styles of Contacting (Interruptions to Contact)

Desensitisation Deflection Introjection Projection Retroflection Egotism Confluence

... more to follow on this, but, for now the renewal of Self from Panic Attacks:

The Self has a number of functions and attributes (seeThe Gestalt Selffor more) and with panic attacks the Id and Personality functions are partly lost. From this perspective the Ground of these functions disappears, or at least in part get hazy and hidden. For now settle for the term Id and Personality as descriptors for addressing what follows because in Gestalt the terms have meanings not in line with other psychotherapeutic approaches - but that is not important right now.

Te Id function refers to the Fore-Contacting phase of the contact model and so considers the nature of sensitisation, awareness and mobilisation. In particular, and this is not limited to Gestalt by any means, the process of breathing is important in terms of sensitisation of the individual to their environment. This is the starting point to explore and bring the individual into contact with their own being, physically; placing it context to the environment.

Especially important is to attending to breathing and particularly to exhalation. The person having a panic attack tends to hold their breath in. This may also lead to hyperventilating and fainting. Breathing exercises are a valuable and necessary tool for the individual to have.

The following text is an extract from this website -www.patient.co.uk

Try the following for 2-3 minutes. Practice this every day until you can do it routinely in any stressful situation.

Breathe slowly and deeply in through your nose, and out through your mouth in a steady rhythm. Try to make your breath out twice as long as your breath in. To do this you may find it helpful to count slowly "one" as you breathe in, and "two, three" as you breathe out.

Mainly use your diaphragm (lower chest muscle) to breathe. Your diaphragm is the big muscle under the lungs. It pulls the lungs downwards which expands the airways to allow air to flow in. When we become anxious we tend to forget to use this muscle and often use the muscles at the top of the chest and our shoulders instead. Each breath is more shallow if you use these upper chest muscles. So, you tend to breathe faster, and feel more breathless and anxious, if you use your upper chest muscles rather than your diaphragm.

You can check if you are using your diaphragm by feeling just below your breastbone (sternum) at the top of your abdomen. If you give a little cough, you can feel the diaphragm push out here. If you hold your hand here you should feel it move in and out as you breathe.

Try to relax your shoulders and upper chest muscles when you breathe. With each breath out, try to consciously relax those muscles until you are mainly using your diaphragm to breathe.

In addition to breathing, and its regulation, there are further exercises that can be used with the emphasis on raising the awareness of the individual to the physicality of their being. The essential ingredient is for the individual to increase their attentiveness to their own physical sensations and feelings. In so doing the person increases their own capacity to be in touch with their emotions. Therapeutic care is necessary, of course, since Gestalt therapy recognises an individual's resistance to being in touch with emotions is a creative-adjustment that has been made for necessary reasons (at the time).