Naari-Magazine aug edition

She turned towards her husband and revealed
she had to leave right away as she had a pounding
heart and was in desperate need of fresh air.
Soon after, she found herself at A&E. An ECG was
conducted on her and results came back normal.
Kim was at her wits end as the experience was
frightening. She felt her heart racing as a sense
of doom descended on her. She felt the urge to
scream out loud. Her stomach, legs and hands just
‘gave out’ as she put it.
Over the next few weeks, Kim found herself
frequently checking her pulse and avoiding
crowded places. She felt very anxious that she
would experience a panic attack out of the blue
again and started curtailing her outdoor activities.
The first thing I started off with Kim was
emotional stabilization before we embarked on
symptomatic management. Thereafter, I proceeded
to tackle her cognitive and behavioural issues with
regards to her panic attacks.
Kim had overactivated her sympathetic system,
which is a part of the autonomic nervous system.
Its function is to regulate the body’s unconscious
actions. When the sympathetic system is in a
hyper-aroused state as in Kim’s case, it becomes
hypervigilant – on constant lookout for any signs
of potential threat. Moreover, the heart begins
racing and priming the body to flee or fight.
In preparation for the fight or flight, the
sympathetic system will activate sweat secretion,
dilate the pupils, increase the rate and force of the
heart contractions, constrict the gastrointestinal
muscles and more. Hence leading to the symptoms
we explained earlier. In effect, the sympathetic
system has gone on autopilot. The aim of therapy
is to turn off this autopilot that triggers all these
deeply uncomfortable symptoms.
Kim’s panic attacks impacted her in many ways.
Soon she started to avoid driving, visiting malls and
found herself quick tempered as she was constantly
anxious about the next unpredictable attack.
Treatment of her panic attacks involved ‘resetting’
her sympathetic button. In order to do this, I needed
to help shift her stress threshold as she was in a
constant hyper-aroused anxious state.
Kim was taught various bio-feedback techniques
and breathing re-training to induce deep relaxation.
Once she mastered these, we moved on to
management of her disturbing symptoms.
During therapy, I induced her panic attacks
using two methods. Firstly by spinning her until
she started experiencing rapid heartbeats and
secondly, by exposing her to triggering situations.
She was then taught how to stabilize her rapid
heartbeats using a number of techniques,
namely the Valsalva modified as well as other
techniques that would quickly bring down her
rapid heart rate, normalize her breathing and
return her to a calm position.
Step by step, she was taught how to deal
with her vertigo, tingling of the extremities,
feelings of unreality through a combination of
cognitive behavioural therapy as well as body
scanning techniques.
Once Kim gained a fair level of control over
her symptoms and in turn confidence, we
embarked on psychological therapy to unravel
her unconscious triggers.
We began EMDR (Eye movement desensitization
and reprocessing) therapy to address her
subconscious fears about her children’s safety
while she travelled to work.
Although we do not understand the
neurobiological underpinnings of how EMDR works,
it was originally devised to help earthquake and
tsunami victims. The technique was later further
developed to help individuals facing traumas
such as loss of a loved one or the memories of a
crippling accident. Ultimately, EMDR decouples
memories or thoughts from pain.
Finally, I commenced exposure desensitization
work with Kim where she was taught coping
skills to face her fears of going outdoors and her
anticipatory anxiety of the next panic attack.
Kim’s panic attacks were completely resolved by
the 7th session. However, some individuals require
longer time to resolve and reset their condition.
This article may not be produced in part or
whole without Nivedita Ramanujam’s express
written consent.
Nivedita Ramanujam
Nivedita is a clinical psychotherapist,
hypnotherapist, founder and CEO of Inner
Compass and has over 22 years of clinical
experience with anxiety, panic attacks,
couples issues, behavioural change issues,
critical incident and helps use beliefs to
shift biology through PNI techniques.
www.zen-compass.com
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