Advanced Biofeedback Center

Panic Attacks & Generalized Anxiety

Assessment of condition

Overview

There are many terms that you have heard regarding panic and anxiety. Among these are "nervousness," worry, "stressed," "overwhelmed," and many others. There appears to be an underlying physical mechanism associated with all of these descriptions. Physicians and behaviorists may refer to this undesirable mechanism as autonomic arousal or sympathetic activation.

What happens when the autonomic nervous system or sympathetic nervous system becomes activated?  Your skin surface temperature will likely decrease because of a vasoconstriction (meaning your blood vessels --- veins, arteries, capillaries --- start to get smaller in diameter). Cold hands and cold feet are a good example of this stress response known as autonomic arousal. Your heart rate may also increase above your normal baseline. Your blood pressures will likely become elevated. You may experience some sweat gland activity, particularly in your hands, feet, and axillary region ("armpits"). Autonomic arousal is even associated with certain types of prominent brain wave changes (high Beta Wave activity).

Sensors

To educate you about the interaction of your thoughts, behaviors, and physical changes, a multimodal biofeedback approach would be used. A skin temperature sensor (thermistor), muscle tension sensor (EMG sensor), photoplethysmograph, sweat gland sensors (EDR sensor), and possibly EEG sensors to assess brain wave changes consistent with panic and anxiety would be used during different sessions.

Where sensors are placed

The skin temperature sensor is typically affixed to your index finger.  Non-invasive, painless skin surface EMG sensors are usually placed on your forehead. The photoplethysmograph is usually placed on your index finger or thumb. Sweat gland sensors are usually placed on the middle and ring fingers of either hand. EEG (brain wave) sensors are placed on your ears and/or ear lobes and scalp.

Behavioral intervention

Learning and behavioral change

If you think of anxiety or panic as a specific type of physical state --- that is, the state of sympathetic activation or autonomic arousal --- then you may logically, and correctly, conclude that by voluntarily reversing those physical states, you can decrease your panic and anxiety. Famous researchers and clinicians for several decades have confirmed the obvious: You cannot suffer from panic or anxiety if you are relaxed! Therefore, you will learn about the types of physical changes that accompany panic and anxiety. More important, you will learn how to effect the opposite physical changes!

Heart rate variability training and diaphragmatic breathing are relatively easily learned techniques, and they would be first skills for you to learn. You would be taught to coordinate the activity of your heart and lungs --- something called coherence --- with this type of training. Skin temperature (thermal) biofeedback would be taught so that you would learn to increase circulation in your fingertips and toes, a technique that is known to decrease autonomic arousal. Your muscle tension would be assessed with EMG sensors. In addition, one or more sessions may be devoted to the monitoring and training of sweat gland activity, primarily for the purpose of demonstrating how your thoughts can either lower or raise your panic and anxiety. Brain wave biofeedback (neurofeedback) may be used to demonstrate how intrusive thoughts, rumination, and "worry" are reflected in High Beta wave activity. Alpha-Theta neurofeedback training may be used to train you into deep relaxation states --- a feeling of physical and psychological "peace" that you may not have experienced for many years!

Number of sessions

The number of sessions is totally dependent upon your particular issues, and the severity and duration of the problems.

Change in behavior

Goals

An eventual goal would be for you to respond differently to the "triggers" that previously had caused your panic and anxiety. By proving to yourself that you have considerably more control over your physical processes than you had previously thought, the fear of those "triggers" will greatly diminish. Instead of being a "victim" of those "triggers," you will have mastery over them.