What You Can Change _. And What You Can't - Martin E. Seligman [33]
Next, Clark and his colleagues asked if activating this habit with words would induce panic. All the subjects read a series of word pairs aloud. When panic patients got to “breathlessness-suffocation” and “palpitations-dying,” 75 percent suffered a full-blown panic attack—right there in the laboratory. No normal people had panic attacks, no recovered panic patients (I’ll tell you more in a moment about how they got better) had attacks, and only 17 percent of other anxious patients had attacks.
The final thing Clark told us was the “breakthrough” that Rachman had promised.
“We have developed and tested a rather novel therapy for panic,” Clark continued in his understated, disarming way. He explained that if catastrophic misinterpretations of bodily sensation are the cause of a panic attack, then changing the tendency to misinterpret should cure the disorder. His new therapy, as he described it, was straightforward and brief:
Patients are told that panic results when they mistake normal symptoms of mounting anxiety for symptoms of heart attack, going crazy, or dying. Anxiety itself, they are informed, produces shortness of breath, chest pain, and sweating. Once they misinterpret these normal bodily sensations as an imminent heart attack, their symptoms become even more pronounced because the misinterpretation changes their anxiety into terror. A vicious circle culminates in a full-blown panic attack.
Patients are taught to reinterpret the symptoms realistically, as mere anxiety symptoms. Then they are given practice right in the office, breathing rapidly into a paper bag. This causes a buildup of carbon dioxide and shortness of breath, mimicking the sensations that provoke a panic attack. The therapist points out that the symptoms the patient is experiencing—shortness of breath and heart racing—are harmless, simply the result of overbreathing, not a sign of a heart attack. The patient learns to interpret the symptoms correctly.
One patient, when he felt somewhat faint, would have a panic attack. He became afraid that he would actually faint and collapse, and interpreted his anxiety as a further symptom of imminent fainting. This escalated to panic in a few seconds.
“Why,” Clark asked him, “have you never actually fainted?”
“I always managed to avoid collapsing just in time by holding on to something,” replied the patient.
“That’s one possibility. An alternative explanation is that the feeling of faintness you get in a panic attack will never lead you to collapse, even if you don’t control it. In order to decide which possibility is correct, we need to know what has to happen to your body for you actually to faint. Do you know?”
“No.”
“Your blood pressure needs to drop,” said Clark. “Do you know what happens to your blood pressure during a panic attack?”
“Well, my pulse is racing. I guess my blood pressure must be up,” the patient responded.
“That’s right. In anxiety, heart rate and blood pressure tend to go together. So you are actually less likely to faint when you are anxious than when you are not,” said Clark.
“But why do I feel so faint?”
“Your feeling of faintness is a sign that your body is reacting in a normal way to the perception of danger. When you perceive danger, more blood is sent to your muscles and less to your brain. This means there is a small drop in oxygen to the brain. That is why you feel faint. However, this feeling is misleading because you will not actually faint since your blood pressure is up, not down.”
The patient concluded, “That’s very clear. So next time I feel faint, I can check out whether I am going to faint by taking my pulse. If it’s normal or quicker than normal, I know I won’t faint.”9
“This simple therapy appears to be a cure,” Clark told us. “Ninety to one hundred percent of the patients are panic free at the end of therapy. One year later, only one person had had another panic attack.”
At this point in the meeting, Aaron Beck, the