“Oh God, I’m shaking, I feel sick!” (the physiology of fight or flight / panic attacks)

Evolution produced us: today’s fabulous human beings. But… there are a few design flaws. And some primitive responses we’ve been saddled with that often do more harm than good these days. But we can learn to understand and control them with CBT…

What is ‘fight or flight’? When we perceive a threat, our bodies go into ‘fight or flight’ mode in an instant – this physical response was developed during evolution to help us survive the sabre-toothed tiger, or that troublemaker that was trying to oust us from the tribe, or indeed anything that threatened our survival.

“Fight or flight is an instant pumping up of our bodies (with a series of physiological changes) that better equips us to fight hard or run fast from ‘danger’ – it prepares us for extreme physical action in an instant.”

Here are a couple of examples that will explain the immediacy and effects of fight or flight:-

• You walk over to your lovely bowl of fruit. Reach in, and… ‘OH! a big SPIDER! EEK’. The natural reaction is to jump back – our bodies instantly revving into fight or flight, our hearts thump, our stomachs tighten into a knot etc. But within a few moments, we (well most of us) realise there is no extreme danger here – and our bodies return to a natural balance very quickly.
• You’re in bed. You’re woken by a crash sound somewhere in your home. A BURGLAR?! You are instantly alert – you spring up, tilt your head back, eyes focussing in the middle distance for danger, ears straining to hear what’s going on, your heart pumping and lungs expanding to take more oxygen, heat rising in your body, ready to take whatever action is required (this can include ‘freezing’ which protected us from notice of predators etc)… then your flatmate shouts in ‘sorry, only me, I dropped a plate’. Deep sigh as your body returns to balance…

Those are examples of real practical problems that would benefit from fight or flight… after all, if you had to deal with a giant tarantula or a violent intruder, you would make good use of your body in its prepped and revved up state. And in both instances, within a very short time, we realise there has been a mistake in processing the event, and our body returns to balance (homeostasis) quickly. But – many of us fight ‘invisible tigers’ constantly – perceiving dangers and threats and sabre toothed tigers everywhere, which brings on flight or flight even when there is no real danger present.

Stress triggers that cause uncomfortable fight or flight symptoms are different for everybody, any number of things can mistakenly appear as a hazard or danger that we feel unable to cope with – general examples?  having to give a presentation, attend an interview, go on a date, drive in bad traffic, cope with your noisy children, sort out the bills, busy social occasions, talking to people you’re attracted to, oh… take your pick, you know who you are!

If you have anxiety (or are a ‘worrier), the chances are that you are fearful of many things, with the flight or flight hormones constantly simmering within, which may cause general fatigue, confusion, and ill health – this would also contribute to self-limiting decisions and behaviours, and would of course reinforce a negative view of the world.

Fight or flight carries a lot of unhelpful and debilitating effects – recognise any of these?

Of course, situations are only a ‘fight or flight’ danger if you perceive them as such – todays danger is often psychological rather than physical. Ideally, we would use CBT to recognise that our thinking causes our ‘upsettness’ and the idea that we are unable to cope – so that we could learn healthy new thinking that would prevent us perceiving hazards where there are none – and so that we could develop new coping skills for a better and more comfortable life experience.

But… for the purpose of this post – let us just look at the physiology of fight or flight here – as it is shown to help people better manage the situation if they understand, scientifically, exactly what is happening and why. Understanding that fight or flight is a natural bodily reaction with a beginning, a middle and an end – and that it is actually a sophisticated elaborate chain developed to help and protect you – can be hugely helpful. This learning and awareness helps us to break down the cycle of fear that can happen otherwise, and can even calm us down – ideally halting the symptoms, or at least decreasing their ferocity and duration – helping us to calm down and ‘right our body balance’ in a shorter time frame.

OK … common Fight or Flight physical symptoms – (the things we don’t realise are happening to cause the symptoms):

• Thoughts racing and disjointed – caused by an adrenaline release.
• Dizzy / lightheaded –due to adrenaline and increased oxygen levels.
• Surroundings seem distant or visual ‘tunnel’ –your pupils dilate to allow you to take in as much visual information as possible. Eyes refocus to the distance to spot danger.
• Heart pounding – The heart starts beating faster to increase circulation, since the body anticipates it will be working harder to service the muscles.
• Difficulty breathing – the lungs throat and nostrils open up to flood the lungs with enough oxygen to keep up with the increased circulation of blood (re-oxygenating it) – this can trigger shallow rapid breathing.
• Neck and shoulder tension – caused by oxygen pumping to muscles, or after effects as the oxygen reduces.
• Blushing – Adrenaline causes your blood vessels to dilate in order to improve blood flow and oxygen delivery. As a result, the veins in your face dilate, allowing more blood to flow through them than usual.
• Sweating – The body heats up because it is working harder to circulate blood. And then sweats so it can cool itself down / regulate temperatures.
• Butterflies/’sick’ feeling – Cortisol shuts down your digestive system, (as it is not needed to fight or run), redirecting blood to essential systems such as the heart, lungs, legs and arms. This can also cause irritable bowel syndrome, nausea and diarrhea
• Dry Mouth – Cortisol shutting down inessential systems reduces saliva in the mouth.
• Need to urinate (and maybe even pass a stool) – The bladder and bowels may open out to reduce the need for inessential internal actions (and faeces & urine may have put off our attackers)
• Trembling, wobbliness, tingling and shaking – an effect of adrenaline stimulus and oxygen overload.
• Tightness in the chest and throat, difficulty breathing – the body is overloading on oxygen – which is dangerous if you do not burn the extra oxygen off. Therefore the body tries to reduce the levels by constricting the chest and the lungs, reducing breath intake…

It is common that some people feel even more anxious and scared when these physical effects of fight or flight kick in (they start out feeling anxious about the situation, then they get the physical symptoms and are freaked out by them as well – which accelerates and amplifies the symptoms up to an actual ‘panic attack’). For some, it becomes the fear of the physiology itself that causes a major and ongoing social fear issue (blushing, sweating, breathlessness). Attempting to ‘fight’ against the physical manifestations of anxiety almost always has the opposite effect and intensifies them. Try instead to simply ‘let them happen’ – try to ‘observe’ outside of yourself… tell yourself what’s happening to your body and why – e.g.:

This sweating is simply my bodies way of regulating it’s temperature as it’s overheated because I’m scared of this situation and I’ve gone into fight or flight – it will stop as soon as I calm down – I’ll breath in and out slowly and deeply… I am ok, I can cope, this is ok…

Summary: what is happening with a person who reacts with anxiety and inappropriate physical symptoms is that their body is reacting to the situation as if were as dangerous as, say, a tiger or lion approaching to tear them apart. A false perception has occurred, triggering a very basic and automatic response. We can learn to challenge our perception of events, and because the fight or flight response occurs only when we perceive danger, it can be avoided or minimized if we can convince ourselves there is nothing to fear.

We can challenge and relearn our behaviour and responses to stress triggers by restructuring our thoughts in a more rational and healthy way with CBT – but we also need to be aware of how and why we are physically feeling the way we are – this can help us to stave off panic and remain reasonably calm.

Quick tips:

Deep breathing: because so many symptoms are caused by the oxygen/rapid breathing physiology – breathing control exercises are hugely helpful in easing them. 

Medication: if your anxiety is extreme and affecting your life, please go to your doctor and discuss the situation, there is no shame – if you had high blood pressure or diabetes you’d accept it and address it pragmatically, right? treat this in the same way.  If necessary, there are several medication options that can relieve your symptoms immediately while you work on your new coping skills (e.g. Betablockers, which suppress the stress hormone involved in the fight-or-flight response. This helps control the physical symptoms of anxiety, or a benzodiazepine/tranquiliser…).

Cardio exercise – when you feel your body go into fight or flight jitters, do 5 minutes of physical exercise if possible in the environment you’re in (run up and down stairs, do sit ups…anything cardiovascular, something that  makes you sweat!). The body has primed itself for something physically dramatic (the fighting the tiger or running away very quickly..) – and if you stay immobile it will be confused and take longer to return to homeostasis – the exercise will restore balance more quickly.

Relaxation – choose deliberately to do something you find relaxing (movie, book, candles and music, a walk in park, whatever) – the body has a ‘relaxation’ physical response, which releases chemicals that reduce stress hormones, this slows your heart rate and lowers blood pressure and relaxes muscles, returning you homeostasis (balance). A good source of relaxation/mindfullness exercises can be found on Beaumont Hospital’s site at www.beaumont.ie/marc

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EXTRA NOTE – BEWARE CORTISOL (the stress hormone, or the ‘death hormone’ as it’s scarily called!) – it gets secreted when we are under physical and/or emotional stress. No matter what the source of stress, cortisol is released into the blood stream to help us cope, aiding our fight and flight response by putting sugar into the blood stream so our muscles and brain have the fuel needed to react.

Cortisol is generally high in the morning, but should subside by evening when our rest and repair system (parasympathetic system) is supposed to take over and return us to metabolic equilibrium (homeostasis).  Or… at least that scenario is the appropriate stress response by the body – BUT, todays lifestyles and challenges mean that more and more of us are in a state of high cortisol most of the time – as our system keeps us in a constant state of ‘readiness’ for the perceived danger/threat of our ‘stressors’.

This is very dangerous to our health as cortisol curbs functions that are not essential for fight or flight, which alters the immune system responses and suppresses the digestive system, the reproductive system and the growth process. Long-term overexposure to cortisol and other stress hormones can disrupt almost all your body’s processes. This puts you at increased risk of numerous health problems, including:

Irritable bowel syndrom – Heart disease – Sleep problems – Digestive problems – Depression – Obesity (particularly depositing fat around our middle section) – Accelerated aging – Memory impairment – Skin problems – susceptibility to illness, etc.

These physical health implications are why it’s so important to learn healthy ways to cope with the stressors in your life to help the body stay at (or return quickly to) hormonal balance/homeostasis

CBT – learning how to view events and situations in a way that is in proportion to their actual effect on you/your life, will help control your emotional response to them… reducing the instances and strength of fight or flight manifestation. You should also explore relaxation and visualisation exercises, and of course a good diet and time set aside for regular physical exercise will play a part. As will maximising satisfactions and benefits in your ‘life areas’ (You like walking by the sea? Do it more! You dislike something? Do it less!)

Task: create a two column chart, in the first column write out a list of physical symptoms you feel when stressed, and in the second write out the scientific explanation for each one. Study & remember.

Some minor edits were made to the original article which can be found in Veronica Walsh’s blog at http://iveronicawalsh.wordpress.com/2012/04/08/oh-god-i%E2%80%99m-shaking-i-feel-sick-the-physiology-of-fight-or-flight/