Should a cup of coffee cause panic?

Source: Photo by Liya Zerya Konuş from Pexels

A recent article online said that if we have a panic attack after a cup of coffee, that doesn’t mean we have a problem; the problem is the caffeine.

Not so. Although caffeine can trigger panic, caffeine is not the problem. The problem is that our parasympathetic system is not doing its job. When stress hormones are released due to caffeine or any other stimulus, our parasympathetic nervous system is supposed to limit arousal. Our level of arousal is believed to be regulated by these competing systems:

  • The sympathetic nervous system: This system gets its name from the fact that it works “in sympathy” with stress hormones. When stress hormones increase, the sympathetic system increases heart rate, breathing rate, and sweating. It also redirects blood supplying the digestive system to the muscles. This takes place to prepare the body to flee or fight.
  • The parasympathetic nervous system: This system has the prefix “para” which means against. When the sympathetic begins to excite us, the parasympathetic is believed to repel by slowing heart rate, breathing rate, and reducing sweating. It also restores blood supply to the digestive system.

Hyper excitement

Many of us have not developed the necessary psychological processes to automatically activate our parasympathetic system. If we lack process, when stress hormones are triggered, the sympathetic system has free rein. Depending on the amount of stress hormones released, the sympathetic system can cause hyper-arousal. Hyper-arousal alone does not cause panic. In addition, the person must believe:

  • They are in danger
  • They can’t fight the danger
  • They can’t run away from danger

A person may believe they are in danger for various reasons:

  • They are frightened by the hyper-excitement
  • They don’t know what feelings mean
  • They fear they are having a heart attack
  • They are afraid of going crazy
  • They fear losing control
  • They may have experienced these feelings before when they were in danger or traumatized
  • The hyper-arousal impaired their reality check and allowed memory or imagination of a traumatic event to be experienced as happening

Excitation normalization

If a child is lucky, an emotionally available parent has shared varying levels of excitement with the child. In a workshop on emotional regulation, neuro-psychologist Allan Schore presented a video of a young girl and her mother sharing varying levels of arousal. The girl smiled at her mother. His mother smiled back. The mother’s response made the daughter smile even more, causing the mother to respond with a bigger smile. Seeing her mother’s biggest smile, the girl giggled in delight. This delighted the mother, who then laughed.

In this way, the girl and her mother accelerated to a peak of excitement. And then, as if climbing a ladder to the top, they descended to a level of stillness. By sharing a range of feelings of excitement, the child has learned that all of these levels are safe.

But if a child is unlucky and unable to share the full range of arousal with an attentive caregiver, they may not experience all levels of arousal safely. If so, a high level of arousal can cause fear, which triggers additional stress hormones, which can lead to increased arousal, etc. When a person feels threatened by arousal, they can use a distraction exercise such as The 5-4-3-2-1 exercise to regulate downwards.

Hyper-arousal can alter the sense of reality

Ordinarily, the mind generates a sense of identity, place and time. When overwhelmed, the mind may temporarily stop producing one or more of these senses:

  1. Loss of sense of time: The disappearance of time can allow the memory of a traumatic experience that took place in the past to be experienced as occurring in the present. This is called a flashback. A flashback, if overwhelming, can feel like panic. Or, when time disappears, the imagination of a highly improbable but disastrous event can turn into a terrifying experience that happens. Consider it a flash-forward. For example, faced with an upcoming flight, a fearful airman spoke of a flight that crashed. He said, “When they got on that plane, they didn’t expect it to crash.” He added, “Can you imagine what it’s like to know you’re about to die for ten minutes!” The implication is that the experience would be unbearable. Then he imagined himself as a passenger on a doomed plane. Imagining the terror he would feel would trigger the release of stress hormones. The stress hormones made his sense of time collapse. He experienced what he imagined might happen in the future as a reality in the present. He said, “I just know if I get on that plane it’s going to crash.” Although he did not panic, the same psychological maneuver, if performed in flight, can cause panic. For example, when a passenger on an airplane imagines that the plane might fall from the sky, the stress hormones he releases can cause him to experience panic similar to that if the plane were actually falling from the sky.
  2. Loss of sense of location: As stress hormones defeat reality checks, we lose sight of where we are. This loss places us inside the movie that we invent in our mind. We lose the ability to escape. Now, deep within a movie of our own making, we believe that what we imagine is actually happening and that we are about to die. I once took a friend to a balcony that overlooks Piazza San Marco in Venice. As we walked through the door and onto the balcony, she shouted, “Get me out of here! Get me out of here!” For her, this expansive view was overwhelming. All she needed to be relieved was to turn around and go back through the door she had just left, to regain her sense of where she was.
  3. Loss of sense of identity: Normally, without being aware that we are doing so, we generate a self-image, a sense of who we are. When overwhelmed, the mind’s ability to produce this sense of identity weakens. As our sense of who we are fades, we may be gripped with the terror that our existence will also fade.

Panic

When we have no control over such experiences, and no way to escape them, we can panic and experience the “fight, flight, or freeze” phenomenon. From an evolutionary perspective, the most primitive response to danger is to freeze. This ancient answer is still rooted in us. We cannot deliberately cause or prevent the freeze response. When the Freeze Reaction takes place, it’s usually in a situation where it’s impossible to fight or flee from a threat. Freezing takes us from hyper-arousal to hypo-arousal and renders us unable to function.

Avoid triggers

Although we can try to avoid hyper-arousal by avoiding all triggers, this is considered a disorder called agoraphobia. It is healthier to establish the necessary psychological processes to allow the parasympathetic system to do its job. A properly responding parasympathetic system prevents hyper-arousal. Just as your car’s brakes can override the gas pedal, your parasympathetic system can override the sympathetic system. None of us would drive a car without brakes, but many of us have no choice but to operate without the psychological processes necessary to activate our emotional brakes.

If we have the necessary psychological processes, when stress hormones are released, our parasympathetic system overrules the stress hormones so quickly that there may not be a feeling of stress. If we lack these processes, when the stress hormones are released, a feeling of arousal occurs which continues until the stress hormones burn off, which takes about 90 seconds. This can cause us to avoid situations where stress hormones might be released. The fear that these feelings will lead to panic can make us unable to fly. If the flight is smooth, we may be able to tolerate it. But if there is turbulence, the amygdala interprets the downward movement of the plane as falling. Every time the plane descends, the amygdala of every passenger, not just fearful passengers, releases stress hormones. In a passenger who has good automatic emotional braking, the effects of stress hormones are controlled. In a passenger who does not have automatic parasympathetic activation, every downward movement causes alarm. Since there is one downward movement after another, additional stress hormones are released before the previously released hormones can burn off.

Leading neuroscientist Stephen Porges discovered that when we are with someone who is in no way a threat, signals are transmitted unconsciously through their face, voice, and body language that activate our parasympathetic system. We can use this discovery to establish the psychological processes necessary to automatically activate our parasympathetic system. The following exercise is adapted from Without panic, my book on how to increase the automatic regulation of emotions. Dr. Porges gave an afterword on the application of his finding that therapists may find useful in their work with clients:

  1. First, think of someone you feel physically and emotionally safe with. For this exercise, you need someone who is easy-going, non-critical, and non-judgmental.
  2. As you go through your day, look for the first sensations you feel when stress hormones are released.
  3. Stop what you are doing. Look across the room and pretend to see the door open. Imagine you see your friend come in. As you imagine his face, your parasympathetic system will begin to activate.
  4. Imagine hearing his voice say hello to you. This will help activate your parasympathetic system.
  5. Finally, pretend they’re coming over and giving you a huge, high five, or other physical touch appropriate to your relationship.

It is this intentional activation of your calming parasympathetic system whenever you feel an increase in stress that will allow you to establish the psychological processes necessary to automatically activate your parasympathetic system when stress builds up.


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