Jerry is a 31-year-old stockbroker. Today has been his most stressful day in the office to date.
The stock market is crashing, his clients are screaming obscenities over the phone, and threatening to take their money elsewhere.
Jerry fears that his career is over!
He tells himself that he is being punished for cheating on his girlfriend.
Jerry loosens his shirt collar as he struggles to breathe.
He breaks out into a cold sweat, feels nauseous, and is experiencing a tingling in his arms and legs.
He gasps for air and worries that he is losing his mind.
Jerry’s chest feels tighter by the second and begins to cramp.
“$#@!, I’m dying!” he yells out to his co-workers in a desperate plea for help.Jarr
What is happening here?
No, Jerry is not being punished for cheating on his girlfriend, losing his mind, or suffering a heart attack.
He is experiencing a panic attack.
Should Jerry realize this and seek help from a clinical psychologist, he will need to access something called “psychological mindedness” in order to get the most out of his treatment for panic disorder.
Psychological mindedness refers to your capacity:
- to interpret your experience of the world as psychological (occurring “in your mind” rather than cold, hard fact) (Beitel, 2010), and
- to consider that there is psychological (i.e. mental and emotional (Oxford Advanced Learner’s Dictionary)) meaning behind the way you experience or make sense of your life (Beitel, 2010).
For example, the psychologically minded individual may attribute a violent outburst to their anger (an emotion) rather than saying, “The devil made me do it,” (a religious attribution) or “I had a chemical imbalance” (a purely physical attribution) (Beitel, 2010).
In Jerry’s case, he initially attributes his physical symptoms to karma, or more specifically being punished for cheating on his girlfriend. This is religious attribution.
He doesn’t yet know that what he is actually experiencing are the classic symptoms of a panic attack. This includes the thoughts that he is “going crazy” and dying.
In its simplest form, a panic attack is when our body’s responds to something scary. However, this response keeps escalating beyond the level of appropriate anxiety suitable to the situation at hand.
One can compare the body’s response to turning the volume up on a recording of a soothing symphony – but so high up that it hurts your ears.
Part of therapy is working out what “is in your head” or psychological, and therefore potentially open to change.
Not only the kind of change that others can effect to make your life easier (like magically controlling the stock markets), but changes that you can make to make your life easier (such as following the recommended treatment for panic disorder).
Naming the problem to jumpstart recovery
For Jerry, the vital first steps in his treatment would be to understand that he was having a panic attack and that there is a predictable pattern and science underlying all panic attacks.
This knowledge will allow Jerry to define the limits of the experience he went through in the office and to rule out a host of confusing beliefs about why he was experiencing what he was.
Wouldn’t you feel reassured to know that you are not losing your mind, and even worse, dying? To know that you are one of many who experience exactly the same set of symptoms and that therapy can help you understand, manage and limit the severity of future panic attacks?
Valuing what you think and feel
An important part of psychological mindedness is a willingness to perceive a link between our thoughts, feelings, and behaviours (Silver, 1983).
Hence the reason why therapists ask about our thoughts and feelings when we describe a significant experience or behaviour in our weekly therapy session.
Jerry’s initial thoughts following events in the office were something like:
- “My career is over.”
- “I will lose my job and be destitute.”
These fearful thoughts (not validated by any evidence) lead him to him feeling anxious and hopeless.
His physical body responded to the perceived danger by trying to help him survive in situation that his brain computed as similar to having to escape from a predator in the wild (Nathan, Correia, & Lim, 2004). The following physiological changes took place:
- sweating in order to be difficult to grasp by a predator and to prevent his body overheating,
- his blood running away from his arms and stomach to parts of his vital organs which could help him fight or flee the perceived danger (resulting in his tingling sensations and nausea)
- his heart beating faster to circulate blood and much-needed oxygen through his body (making him aware of his pounding chest), and
- increased depth of breathing to supply more oxygen to the body (causing difficulty getting enough air as the carbon-dioxide and oxygen ratio in his blood changed and he experienced a tightness in his chest that he thought was a heart attack).
According to psychology, everything happens for a reason when it comes to human behaviour and physiological changes (as above).
Thoughts and feelings about a specific event are also not random.
Every mind has a history: Know your history
Thoughts and feelings have a history and can almost always be traced back to earlier life experiences which form a person’s mental blueprint of the world.
While tension was high in the office for all of Jerry’s co-workers, Jerry was particularly vulnerable to catastrophic thoughts about losing his job and being destitute. His parents had both been retrenched when he was in primary school and it took some months before they found new employment.
During the months of unemployment his parents were open with Jerry and his siblings about their financial constraints. His parents hoped that doing this would allow their children to understand why there were no luxuries in the home, that the situation was temporary and that cutting back had nothing to do with not loving their children.
In one way this was helpful to Jerry and his siblings but as an 8-year-old boy he worried that his parents would remain unemployed indefinitely and that his family was destined for the streets.
Key to psychological change is being open to the belief that ways of viewing the present are based on a person’s previous experiences.
In therapy, one explores the assumptions about the world that cause one distress and discomfort, and look at alternative and more balanced ways of seeing the world.
If Jerry is unable to recognize that his symptoms were not the result of karma, of him losing his mind or pending death by heart attack, psychotherapy will not be able to assist him.
Developing a psychological understanding of emotional turmoil
One aspect of the therapist’s work is to help the client develop a curiosity about the psychological (i.e. mental and emotional) aspects of their difficult experiences.
In the case of panic attacks (or panic disorder), part of the initial treatment is about helping the client see that there is predictable pattern to their panic attacks. This is achieved by reflecting on the sequence of events in previous attacks and also reviewing the client’s personal records of current attacks.
This is the beginning of treatment for a highly treatable disorder – provided the client is able to accept the psychological diagnosis assigned to his/her problem.
More on psychological mindedness
Understanding painful physical and emotional experiences as psychological is one important aspect of psychological mindedness relevant to panic and other emotional crises such as depression, generalized anxiety, post-traumatic stress disorder and obsessive-compulsive disorder.
Other aspects of psychological mindedness include (Conte, Ratto, & Karasu,1996):
- an openness to understanding oneself and others better (rather than holding onto purely nonpsychological reasons for Jerry’s panic attack),
- an openness to new ideas (such as Jerry accepting his psychological diagnosis) and a capacity for change as a result,
- having access to one’s feelings,
- a belief in the benefits of discussing one’s problems with others, and
- an interest in the meaning and motivation of the behaviour of oneself and others (such as why a stock market crash and job insecurity would impact Jerry in the way it did).
But what about nonpsychological factors?
Nothing happens in a vacuum, and of course there will be extraneous circumstances that do contribute to frightening experiences such as panic attacks.
An experienced therapist will always attempt to rule out the influence of medical conditions that may look like psychological concerns.
External factors are not necessarily the cause of the psychological reaction but these may be the straw that breaks the camel’s back psychologically
Let us consider a metaphor from the world of physical medicine.
Scientist Louis Pasteur (famous for developing the pasteurization process and his work in immunology and vaccination) said on his deathbed, “It is not the germ, it is the culture medium upon which it falls.”
In other words, germs are more likely to effect the bodies of those people whose immune systems (i.e. the culture mediums) are already compromised, less so than those individuals’ whose immune systems are functioning optimally (Shealy & Myss, 2010).
As in Jerry’s case, all his colleagues were exposed to the same events in the office on the day that he had his panic attack. However, Jerry was more prone to the unhelpful thoughts that felt like reality and lead to a collection of physiological responses known as a panic attack.
In the course of this blog post we have delved into some of the psychological science behind panic attacks.
Key to successfully treating panic disorder is the client’s ability to recognize that their symptoms are psychological in nature. That is, that there is a strong mental and emotion basis to the disorder.
There will always be external stressors in our lives.
Psychological mindedness enables us to explore why these stressors impact on us in the specific ways they do.
Therapy for panic attacks, like any other psychological concern, is about:
- learning how to understand your unique responses,
- where they come from,
- to evaluate if these responses serve you well,
- to develop ways of better coping with external stressors, and ultimately
- to enable you to live your best life.
Wishing you well in all your endeavours. – F.W.
Beitel, M. (2010). Psychological mindedness. In The Corsini Encyclopedia of Psychology. John Wiley & Sons, Inc. Available at: http://dx.doi.org/10.1002/9780470479216.corpsy0729 . Last accessed: 11 February 2016.
Conte, H.R., Ratto, R., & Karasu, T. B. (1996). The Psychological Mindedness Scale : factor structure and relationship to outcome of psychotherapy. The Journal of Psychotherapy Practice and Research, 5(3), 250–259.
Nathan, P., Correia, H., & Lim, L. (2004). Panic Stations! Coping with panic attacks. Perth: Centre for Clinical Interventions.
Oxford Advanced Learner’s Dictionary (n.d.). Psychological. In Oxford Advanced Learner’s Dictionary. Available at: http://www.oxforddictionaries.com/definition/english/psychological . Last accessed: 11 February 2016.
Shealy, N., & Myss, C. (2010). The creation of health: The emotional, psychological, and spiritual responses that promote health and healing. Random House.
Silver, D. (1983). Psychotherapy of the characterologically difficult patient. The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 28(7), 513-521.