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Obese individuals frequently experience panic attack problems, and unfortunately, patients with panic attacks before bariatric surgery are very anxious; for this reason, some relaxation exercises are performed during pre-operative consultations. However, this is an instantaneous intervention. In fact, patients need to continue panic disorder treatment after surgery as well. Because the state of being in panic during the weight loss process can negatively affect the person’s progress through behaviors such as constantly weighing oneself and worrying when unable to lose weight.
In addition to these, let’s talk about how to cope with panic attacks in general, why panic attacks occur, and what needs to be done. First of all, we need to know this about panic attacks: A panic attack is not a psychiatric diagnosis on its own. It generally accompanies depression or anxiety disorder and occurs in episodes. It appears suddenly, and the person feels an intense sense of fear at that moment.
Sometimes this can be a fear of death, sometimes a feeling of having a heart attack, sometimes a fear of going crazy. And when this attack occurs, some physical symptoms are usually experienced. The most common of these are shortness of breath, a feeling of suffocating, palpitations, numbness in the body, trembling, sweating… And the person catastrophizes these physical symptoms. Meaning, they turn them into a disaster. When they have palpitations, they wonder, “Am I having a heart attack?” When they experience shortness of breath, they wonder, “Am I suffocating?” When their body goes numb, when their legs go numb, they overly exaggerate physical symptoms like, “Am I going to be paralyzed?” So why do these physical symptoms actually occur?
- a general level of tension,
- stressful life,
- family problems,
- marital problems,
- the person’s individual psychological distress,
- work life,
- educational life
When a person does not cope with these, suppresses them, and does not receive support, the body gives an alarm, and it gives this alarm through physical symptoms. For that reason, a panic attack occurs.
So what needs to be done to cope with panic attacks? First of all, when a panic attack client arrives, they should be asked about their first attack. When did they have their first attack, what physical symptoms did they experience, what thoughts were going through their mind? What emotions were they feeling? Then, it is necessary to learn about the latest attack they experienced and, by asking these same detailed questions, to also learn about the most intense attack they experienced.
These should be detailed, and then a panic diary should be started. In this panic diary, the person should record the moments they experience an attack and what physical symptoms they felt while experiencing this attack, what psychological symptoms they felt, what thought was going through their mind, what emotion they were feeling? Was there a fear of dying, was there a thought of losing their mind? They must record these one by one. Then, it should be examined whether there is a common point between these attacks.
Someone may realize that they sometimes only experience an attack at the workplace, someone else only when getting on the subway, someone in a closed space, someone during a period when they are experiencing a problem related to their family. These are the tactics we use to learn the problem. Triggers are found. Afterwards, the really important thing the person actually needs to do is this: they must go through medical tests.
After going through all medical tests and having their physical examination, once doctors tell them “there is nothing wrong with you,” we as Psychologists look at the psychological factors. These psychological factors are the family problems, marital problems, and general stressful life I mentioned earlier. In addition to these, a person can sometimes be weaker in coping with problems.
They can be weaker in expressing their emotions, and for this reason, an attack can occur. And while coping, after creating this panic diary and finding the common causes, we apply some cognitive and behavioral methods on what they can do against these triggers. But what clients want more is to learn how to cope at the moment of that attack. Because talking about the problem at that moment might bore them a little more. Therefore, they want more solution-oriented techniques. For this reason, let’s talk about slightly more solution-oriented techniques:
Breath Control
The moment you experience an attack, you breathe in and out rapidly. We call this hyperventilation, and because you cannot control your breath, you panic more. Therefore, during the session, we rehearse this rapid breathing and then teach how to take the breath under control. So how? Some call it the 3-second, some the 5-second, some the 8-second rule. Let’s say 5 seconds on average. We take a deep breath through our nose. We take this breath in 5 seconds. Then we hold this breath for a long time, again for about 5-6 seconds. Then we exhale that breath through our mouth, like blowing on soup, for twice the seconds we took it in, and when we repeat this 5-6 times, we take your breath under control at the moment of that attack.
Imagination Technique
You need to create an imagination in your mind. Think of the moment you were happiest, most peaceful, and you need to imagine that moment in such detail that it will be your safe place at the moment of the attack, and you will go to that safe place. For example, imagine you are by the seaside. Let this be your happy moment.
While at that seaside, you need to establish in detail in your mind where you are sitting, from what angle you are looking at the view, the sound of the waves, the color of the sea, and when the attack comes, we will ask you to take yourself to a corner, sit there, close your eyes, and go to this safe place. When you go to this safe place, we will also ask you to do breath control at the same time. This will relax you even more.
Relaxation Exercises
Relaxation exercises should be done not only during the attack but throughout that week. We give this as homework, and in applied relaxation exercises, we teach the client to relax their muscles, and we teach this on all organs. For example, first their right leg, then their left leg, first their right arm, then their left arm. Because when a person is tense, panicked, or anxious, their body tenses up, and teaching them how to relax this tension is another technique that comforts them.
Grounding Techniques
At the moment of the attack, we focus on our body and tend to misinterpret the symptoms in our body. Therefore, to prevent this misinterpretation, it is necessary to distance the person from their body. Their focus needs to be drawn elsewhere. To do this, one must focus on the surroundings. For example, find 5 objects and count these five objects you can see.
Perhaps you can also code this by colors. Like, I will find 5 red objects. Then select 4 smells you can perceive. Then select 3 sounds you can hear. What sounds do you hear? And select 2 things you can touch. Armchair, table, car seat, it doesn’t matter. While doing this, you are stepping away from your body.
This is the important point. Because we focus excessively on the body. And we listen to the symptoms in the body more attentively, and this causes us to exaggerate. Relaxation exercises, breathing exercises, shifting the focus are the most frequently used techniques, and doing this with our senses works much better.
In addition to these, if the person’s attack does not pass despite doing these, or if they have an anxiety that the attack will come again, this is called anticipatory anxiety. In other words, the person is now free from their attacks, they are not experiencing attacks. Maybe they haven’t experienced one for a few months, but they live with the fear of “what if an attack comes.” Then, to get rid of this anticipatory anxiety, it is necessary to look for evidence. What is the evidence that they will experience it again? Or they think they will have a heart attack; what is the evidence that they will have a heart attack? The downward arrow technique should be applied.
For example, they are afraid of having an attack in traffic; what happens if you have an attack in traffic? “I would be stuck there. I would feel very helpless.” What do you do if you feel helpless, what happens then? “I call an ambulance.” Well, what happens when you call an ambulance? “The ambulance comes, but what if it can’t come in traffic?” Well, have you ever seen an ambulance unable to enter traffic? Way is made for ambulances in traffic. In this way, by looking for evidence, essentially performing Socratic questioning, it is shown that there is actually a logic-based foundation beneath their thought and anxiety.
These are solution-oriented techniques. There are also points that the person avoids due to panic attacks. There are places where they fear the attack will come. These can be traffic, public transportation vehicles, elevators. These places should be determined, a list of the situations they avoid and fear should be made, and this list should be ordered from easy to difficult. Then they should be exposed to them one by one. But this exposure should not be directly like “go, get on the subway alone,” but should be done with in-session exposures.
In other words, while in the session room, the client should be taken there by imagining, and when they feel their attack starting, they should practically learn how to cope with that attack at that moment. If this is not done beforehand in the session, it is called flooding. It is a wrong method; therefore, you should be exposed in such a gradual way, first within the session, then outside the session, first while someone is with you, then when no one is with you.
Returning to obese individuals again, panic disorder, panic attacks, anxiety disorder, depression; these are seen very much in individuals experiencing obesity problems, and generally, the person does not receive support on this issue until they reach the final stage. You can try solution-oriented techniques. You can try the techniques mentioned earlier, but if at the root of the problem there are, for example, marital problems, and your problems with your spouse are not resolved in any way.
Then, even if you extinguish the panic attack at that moment with those techniques, it may recur in the future, and at this point, for example, it has been observed that drug treatments for panic attacks, no matter how effective the drug treatment is, cause the attack to recur at a rate of 95 percent in the future. For that reason, after discovering the problem, after discovering the triggers, support should be obtained from a specialist.
A panic attack is very difficult; feeling like you are going to die while experiencing that attack at that moment, not being able to control your breath, all of these are very difficult, but coping is also very easy. You should learn these from a specialist, and without your life becoming a misery, by using a very simple coping method, you don’t have to stay in this difficult moment, and you can get away from this attack caused by the general tension in your life. And the most important point is you must know that the body is giving you an alarm. It means you are neglecting something about yourself. For that reason, your body is saying, “think about me now, look after me.” For this reason, listen to your body’s alarm!
