Relaxation Therapy Triggers More Panic Attacks
From 1981-1983, when I was on the Faculty in the Department of Family Practice at Upstate Medical Center in Syracuse, NY, I quickly evolved the fundamental components of panicLINK. Intuitively, I felt relaxation training would NOT be a critical component in the treatment of panic disorder. Wolpe (1976) introduced Deep Muscle Relaxation (DMR) Training as a counter conditioning agent in his systematic desensitization procedure for Simple Phobias (heights, snakes). In these phobias, the fearful stimuli are external. In panic disorder, the fearful stimuli are internal physical sensations, like heart pounding and lightheadedness.
Live Observation of Relaxation-Induced Panic
While practicing at St. Joseph’s Hospital in Syracuse NY, I had the opportunity to witness the effect of relaxation therapy on panic first hand. In one of my early treatment session with Henry, a 35-year old business executive, I guided him through a tape-assisted relaxation protocol. The protocol was developed by Joseph Wolpe. Wolpe had abbreviated a procedure created by Edmund Jacobson’s (1964) in a now classic work, “Self-Operations Control, A Manual of Tension Control”.
I asked Henry to close his eyes and I began guiding him through the relaxation exercises. All of a sudden, he became very apprehensive, opened his eyes and with a terrifying look on his face, he said “I feel like I am going to faint!” I asked him, “Right this second, what are your actual physical feelings?” He described lightheadedness and floating sensations, feelings that are often associated with the positive effects of DMR.
I then realized that Henry had misinterpreted the relaxation feelings of floating as a sign of a fainting spell, and that set off the alarm in his brain, creating the vicious cycle of panic! I have observed this finding on several occasions, which has naturally change my approach to relaxation training for panic patients.
Panic Patients are Locked In to Monitoring Their Bodily Sensations
Later in my career, I discovered research by Barsky and his associate (1994) at Massachusetts General Hospital in Boston, which demonstrated that panic patients have an “Information-Processing Bias.” They experience somatic hypervigilance. In other words, they show increased awareness of physical sensations of arousal. It is almost like you have an amplifier in your ears locked in on monitoring bodily sensations. According to Barsky’s research, panic patients are better able to detect particular sensations like increased heart rate relative to comparison groups. Because of the catastrophic thinking associated with panic, patients tend to misinterpret these sensations as a sign of imminent disaster.
Hypersensitivity to the Physical and Mental Effects of Medication and Alcohol
This finding made perfect sense to me. I also think panic patients may have an increased fear of losing mental control, and value alertness and feeling focused. This finding explains why many of my panic patients worry about taking any medications for fear of how it might make them feel. Minor side effects of medications can often trigger panic attacks. Many of my patients also fear the effects of alcohol because the concern over loosening of mental control.
Swinson (2000) reported a study by Schmidt (2000) that actually showed the addition of Breathing ReTraining (BRT) to a Cognitive Behavioral Treatment (CBT) Protocol for panic disorder led to a poorer outcome on some measures.
Needless to say, relaxation training is not a critical element in panicLINK!
*References to real persons, places and events are made in a fictional context, and are not intended to be in any way libelous, defamatory or in any way factual.