The Fight, Flight or Freeze Response

The fight or flight response has been around as long as human beings have been around. It’s the body’s hardwired alarm system. If you think of the human body as a computer, the fight-­or-­flight response is an essential part of the operating system. You couldn’t really function (or live that long) without it.

When you encounter a dangerous or threatening situation, this alarm system goes off, and your body goes through a number of changes. For example, during the fight-­or-­flight response, you may experience the following symptoms:

  • An increase in heart rate
  • Perspiration or sweating
  • Narrowing of field of vision (also called “tunnel vision”)
  • Muscle tension
  • Sensitive hearing
  • Racing thoughts
  • Shortness of breath
  • Goose bumps
  • Dry mouth

These experiences aren’t random; they all serve a very important purpose. They prepare you for immediate action. They are preparing you either to flee the situation to avoid any harm or to fight if escape is not possible. In situations where fleeing or fighting is not necessarily a good option, your body may also freeze (kind of like a deer caught in a car’s headlights).

This response is automatic. It occurs without thinking. This is important because it allows you to respond quickly when you are in a dangerous situation. For example, let’s say that you are walking through the woods and come across a bear. Your fight-­or-­flight response will be activated, and you will likely freeze or flee. The sudden and automatic changes that your body goes through will help keep you alive in this dangerous situation. Now, if you had to think about the situation before the fight-­or-­flight response was activated, you would waste precious time. You would have to evaluate the size of the bear and the sharpness of its claws and teeth. And, by the time you figured all of that out, you would probably be supper for the bear! Therefore, the fight-­or-­flight response is incredibly helpful and adaptive. We likely wouldn’t be alive as a species today without it.

Sources: The Dialectical Behavior Therapy Skills Workbook for Anxiety

Anxiety or Panic?

We, as humans, need anxiety. Why? Anxiety is information.

It tells us when we must freeze, flee, or fight and mobilizes our body to respond quickly, without thinking. Without anxiety, we would not be able to avoid real threats to our well-being.

However, we also feel anxiety about imagined threats that may or may not be meaningful or real. In a sense, our minds have evolved to be extra careful about threat detection. They are more likely to evaluate things as threats than not. This way we do not miss anything that might harm us.

Also, our minds do not have an “off button.” This means that sometimes anxiety becomes a problem because it doesn’t give us useful information and contributes to our distress and avoidance.

All humans experience anxiety when they experience stressful events, such as receiving an upsetting medical diagnosis. Public speaking, social events, relationship problems, stress on the job, and financial worries are also common triggers that make people feel anxious. However, sometimes life events can trigger anxiety disorders or panic disorder. So, what’s the difference?

Example 1:

Your social media feed is full of divisive political talk, there are risks of layoffs due to the decimated economy, and there seems to be no clear end in sight.

In the meantime, you have a project deadline tomorrow.

You feel stressed, squeezed, and overwhelmed. You feel tired and worried, unsure about what the future holds, whether you will get done what you need to do, whether you will help your child cope with it all.

Example 2:

It is the middle of the night, and you can’t go to sleep. Your thoughts are racing.

What if …? Your mind can’t stay away from the stream of catastrophic worries that keep circling. Your heart pounds. You’re exhausted. You look at the clock—it’s 3:15am.

Example 3:

You’re out with your friends at a restaurant, laughing at a joke one has just told.

All of a sudden, there’s a sensation of your blood rushing to your ears, and your heart rate accelerates. Your hands are clammy, and you wonder whether you’re having a heart attack.

Intense fear grips you, and you feel the urge to leave, to escape the situation. You get up without excusing yourself and run for the door.

Understanding the differences between naturally occurring anxiety, worry, and panic can help people take steps to address their feelings. Knowledge of these conditions can also help individuals recognize if their condition is serious enough to require treatment.

Example 1: A Normal Level of Anxiety

This describes an individual experiencing very natural, understandable anxiety around a challenging situation. Fear of an uncertain future, memories of a difficult past, threats (both real and perceived), and confusion about the world around us are all triggers for anxiety.

Example 2: A Concerning Level of Anxiety

The second example describes an individual experiencing worry and depending on the level of distress and functional impairment caused, may indicate that treatment for anxiety might be helpful.

Worry is a mental activity that, somewhat counterintuitively, functions as an anxiety avoidance strategy, though it’s one that doesn’t work very well. It’s hard to simply stop worrying.

Typically, when individuals find themselves stuck in a worry cycle, learning acceptance and mindfulness skills from acceptance-based behavior therapy can be useful.

Example 3: Panic

This is an individual experiencing a panic attack. Panic attacks are rarer and more severe than anxiety. They can come out of the blue, without warning or provocation.

People having panic attacks can experience shortness of breath, dizziness, nausea, and numbness. Some shake and sweat. Individuals struggling with panic often are very watchful for the physical sensations that might be harbingers of panic and avoid places where panic attacks may have occurred in the past. Sometimes those struggling with panic avoid leaving their homes at all.

The good news is that panic disorder is highly treatable with exposure therapy.

Sources: McLean Hospital

Dealing With Trauma Triggers

Most of us are aware of the larger trauma triggers. We can recognize some of the people, places, and things that harmed us, and do our best to avoid them all. For example, if our trauma had something to do with the beach we can avoid any area with sand or any sounds of the beach. We can sit down with our therapist and make a list of all of the things that we know trigger our trauma response or bring us back to those frightening events. But what about the unconscious triggers? The ones we don’t recognize, and often find upsetting us, pulling us into flashbacks and causing us to dissociate.

National PTSD (Post Traumatic Stress Disorder) Awareness Day

It’s National PTSD (Post Traumatic Stress Disorder) Awareness Day! Please don’t tell someone just to get over it that it’s in the past or they can’t allow it to define them! Do you honestly think they haven’t tried that? So what does that mean, what are the symptoms…

—> Intrusive memories

~ Recurrent, unwanted distressing memories of the traumatic event
~ Reliving the traumatic event as if it were happening again (flashbacks)
~ Upsetting dreams or nightmares about the traumatic event
~ Severe emotional distress or physical reactions to something that reminds you of the traumatic event

—> Avoidance

~ Trying to avoid thinking or talking about the traumatic event
~ Avoiding places, activities or people that remind you of the traumatic event

—> Negative changes in thinking and mood

~ Negative thoughts about yourself, other people or the world
~ Hopelessness about the future
~ Memory problems, including not remembering important aspects of the traumatic event
~ Difficulty maintaining close relationships
~ Feeling detached from family and friends
~ Lack of interest in activities you once enjoyed
~ Difficulty experiencing positive emotions
~ Feeling emotionally numb

—> Changes in physical and emotional reactions

~ Being easily startled or frightened
~ Always being on guard for danger
~ Self-destructive behavior, such as drinking too much or driving too fast
~ Trouble sleeping
~ Trouble concentrating
~ Irritability, angry outbursts or aggressive behavior
~ Overwhelming guilt or shame

Grounding

What is grounding?

Grounding is a set of simple strategies to detach from emotional pain (for example, drug cravings, self-harm Impulses, anger, sadness). Distraction works by focusing outward on the external world– rather than Inward toward the self. You can also think of it as “distraction,” “centering,” “a safe place,” “looking outward,” or “healthy detachment.”

Why do grounding?

When you are overwhelmed with emotional pain, you need a way to detach so that you can gain control over your feelings and stay safe. As long as you are grounding, you cannot possibly use substances or hurt yourself! Grounding “anchors” you to the present and to reality.

Many people with ptsd and substance abuse struggle with either feeling too much (overwhelming emotions and memories) or too little (numbing and dissociation). In grounding, you attain balance between the two– conscious of reality and able to tolerate it.

Guidelines

  • grounding can be done any time, any place, anywhere and no one has to know.
  • use grounding when you are: faced with a trigger, having a flashback, dissociating, having a substance craving, or when your emotional pain goes above 6 (on a 0-10 scale). Grounding puts healthy distance between you and these negative feelings.
  • keep your eyes open, scan the room, and turn the light on to stay in touch with the present.
  • rate your mood before and after to test whether it worked.before grounding, rate your level of emotional pain (0-10, where means “extreme pain”). Then re-rate it afterwards. Has it gone down?
  • no talking about negative feelings or journal writing. You want to distract away from negative feelings, not get in touch with them.
  • stay neutral– no judgments of “good” and “bad”. For example, “the walls are blue; i dislike blue because it reminds me of depression.” Simply say “the walls are blue” and move on.
  • focus on the present, not the past or future.
  • note that grounding is not the same as relaxation training.grounding is much more active, focuses on distraction strategies, and is intended to help extreme negative feelings. It is believed to be more effective for Ptsd than relaxation training.

Mental grounding

  • Describe your environment in detail using all your senses. For example, “the walls are white, there are five pink chairs, there is a wooden bookshelf against the wall…” Describe objects, sounds, textures, colors, smells, shapes, numbers, and temperature. You can do this anywhere. For example, on the subway: “i’m on the subway. I’ll see the river soon. Those are the windows. This is the bench. The metal bar is silver. The subway map has four colors…”
  • play a “categories” game with yourself. Try to think of “types of dogs”, “jazz musicians”, “states that begin with ‘a’”, “cars”, “tv shows”, “writers”, “sports”, “songs”, “european cities.”
  • do an age progression. If you have regressed to a younger age (e.g., 8 years old), you can slowly work your way back up (e.g., “i’m now 9”; “i’m now 10”; “i’m now 11”…) until you are back to your current age.
  • describe an everyday activity in great detail. For example, describe a meal that you cook (e.g., “first i peel the potatoes and cut them into quarters, then i boil the water, i make an herb marinade of oregano, basil, garlic, and olive oil…”).
  • imagine. Use an image: glide along on skates away from your pain; change the tv channel to get to a better show; think of a wall as a buffer between you and your pain.
  • say a safety statement. “my name is ____; i am safe right now. I am in the present, not the past. I am located in _____; the date is _____.”
  • read something, saying each word to yourself. Or read each letter backwards so that you focus on the letters and not on the meaning of words.
  • use humor. Think of something funny to jolt yourself out of your mood.
  • count to 10 or say the alphabet, very s..l..o..w..l..y.
  • repeat a favorite saying to yourself over and over (e.g., the serenity prayer).

Physical grounding

  • run cool or warm water over your hands.
  • grab tightly onto your chair as hard as you can.
  • touch various objects around you: a pen, keys, your clothing, the table, the walls. Notice textures, colors, materials, weight, temperature. Compare objects you touch: is one colder? Lighter?
  • dig your heels into the floor– literally “grounding” them! Notice the tension centered in your heels as you do this. Remind yourself that you are connected to the ground.
  • carry a grounding object in your pocket– a small object (a small rock, clay, ring, piece of cloth or yarn) that you can touch whenever you feel triggered.
  • jump up and down.
  • notice your body: the weight of your body in the chair; wiggling your toes in your socks; the feel of your back against the chair. You are connected to the world.
  • stretch. Extend your fingers, arms or legs as far as you can; roll your head around.
  • walk slowly, noticing each footstep, saying “left”,”right” with each step.
  • eat something, describing the flavors in detail to yourself.
  • focus on your breathing, noticing each inhale and exhale. Repeat a pleasant word to yourself on each inhale (for example, a favorite color or a soothing word such as “safe,” or “easy”).

Soothing grounding

  • say kind statements, as if you were talking to a small child. E.g., “you are a good person going through a hard time. You’ll get through this.”
  • think of favorites. Think of your favorite color, animal, season, food, time of day, tv show.
  • picture people you care about (e.g., your children; and look at photographs of them).
  • remember the words to an inspiring song, quotation, or poem that makes you feel better (e.g., the serenity prayer).
  • remember a safe place. Describe a place that you find very soothing (perhaps the beach or mountains, or a favorite room); focus on everything about that place– the sounds, colors, shapes, objects, textures.
  • say a coping statement. “i can handle this”, “this feeling will pass.”
  • plan out a safe treat for yourself, such as a piece of candy, a nice dinner, or a warm bath.
  • think of things you are looking forward to in the next week, perhaps time with a friend or going to a movie.

What if grounding does not work?

  • practice as often as possible, even when you don’t “need” it, so that you’ll know it by heart.
  • practice faster. Speeding up the pace gets you focused on the outside world quickly.
  • try grounding for a looooooonnnnngggg time (20-30 minutes).and, repeat, repeat, repeat.
  • try to notice whether you do better with “physical” or “mental” grounding.
  • create your own methods of grounding. Any method you make up may be worth much more than those you read here because it is yours.
  • start grounding early in a negative mood cycle. Start when the substance craving just starts or when you have just started having a flashback.

Benzodiazepines Addiction and Abuse

Benzodiazepines are a class of drugs that are commonly prescribed as a short-term treatment for anxiety disorders, panic attacks, and insomnia.

Although safe and effective when taken as prescribed, benzodiazepine drugs like Xanax or Ativan can be misused for their effects.

Over time, benzodiazepine abuse can lead to severe physical dependendence, addiction, withdrawal symptoms, and other negative health consequences without treatment.

Benzodiazepines are what’s known as central nervous system depressants (CNS). When taken, they depress central nervous system activity, which can affect breathing and physical movement.

Benzodiazepines are known to enhance the effects of the brain chemical GABA. When taken, this can cause calmness, sedation, and reduce anxiety.

Benzodiazepines, also known as “benzos,” can be abused in several ways. What benzo abuse looks like can vary from person to person, and some signs may be less obvious than others.

What benzodiazepine abuse might look like:

  • taking higher doses than prescribed
  • taking doses more often
  • crushing and snorting benzodiazepines
  • injecting benzodiazepines
  • drinking alcohol to enhance drug effects
  • mixing benzos with other drugs to get high
  • taking someone else’s prescription

Chronic benzodiazepine abuse, characterized as a pattern of frequent benzodiazepine misuse, can be dangerous and may harm both physical and mental health.

Misusing benzodiazepines can be dangerous. Both acute and long-term dangers can occur by taking this type of drug in any way other than prescribed by a doctor.

Primary dangers of benzo abuse include:

  • severe dependency
  • drug addiction
  • drug overdose
  • increased risk of polysubstance abuse
  • worsened mental health conditions
  • potential brain damage

Benzodiazepines are rarely dangerous when taken as prescribed. But misusing benzodiazepines carries a risk of serious dangers, including drug overdose.

Benzodiazepine overdose can occur by taking excessively high doses of a benzodiazepine, or by combining the use of benzodiazepines with other drugs, such as opioids, alcohol, or heroin.

People who overdose on benzodiazepines may experience difficulty breathing, breathe very slowly, become unresponsive, or collapse. If this happens, call 911 right away.

Mixing benzodiazepines with other substances such as cocaine, heroin, methadone and alcohol can have serious effects on both short-term and long-term health, with the potential to affect vital organ function and increase the risk of drug overdose.

Common short-acting benzodiazepines include:

  • alprazolam (Xanax)
  • lorazepam (Ativan)
  • triazolam (Halcion)
  • midazolam (Versed)
  • temazepam (Restoril)
  • oxazepam (Serax)

Common long-acting benzodiazepines include:

  • Klonopin (clonazepam)
  • Valium (diazepam)
  • Librium (chlordiazepoxide)
  • flurazepam
  • clorazepate (Tranxene)

Nutrition & Mental Health

Amazingly, people often don’t seem to understand the connection between nutrition and mental health. Time and again people struggling with their mental health don’t eat breakfast, skip lunch, or don’t bother to eat until later in the day. Sometimes people simply forget to eat because they’re busy. Some people lose their appetite because of emotional distress, and others just can’t be bothered to eat properly. Whatever the reason, it’s imperative to understand the connection between poor eating habits and mood and anxiety, as this will underscore the importance of eating properly.

Everybody has heard the cliché you are what you eat, but for some reason many people don’t connect that adage with how they feel mentally and emotionally. What you eat doesn’t affect just physical health; it can also affect general mood on a day-to-day basis. In order for the brain to communicate with the rest of the body, it needs neurotransmitters, such as serotonin, which are made from the nutrients in the foods we eat. Not eating enough, or not eating a well-balanced, nutritious diet, prevents the body from being able to create enough of these chemicals, and depression and anxiety can result.

Skipping meals can make blood sugar levels fall too low, and that eating starchy, sugary foods or simple carbohydrates can cause blood sugar levels to increase too much. These fluctuations in blood sugar levels can make a person irritable, forgetful, or sad. In addition, not eating enough can lead to emotional reactivity, higher stress levels, and an overall sense of reduced well-being. Research in children has shown that skipping breakfast has negative consequences on problem solving, short-term memory, and concentration, and that eating breakfast increases positive mood, contentment, and alertness.

Of course, if a person has anorexia or bulimia, this must be addressed in therapy, either by your therapist or by someone who has experience with eating disorders—and sooner rather than later due to the health risks these disorders present. Besides treating the eating disorder, make sure to see a medical doctor and declared physically healthy enough to do this kind of work.

Sources: DBT Made Easy

Dissociation

Dissociation is when our brain (and rest of our nervous system) feel overwhelmed and unable to deal with what’s going on in the moment and they pull us away. I have always talked about dissociation as our brain pulling the ripcord on reality because it’s just too much! When it comes to the DSM they call any dissociation DPDR or depersonalization/ derealization disorder.

Now depersonalization is when we feel out of our body like we are watching ourselves from above or in a haze and derealization is when we feel separated from our environment and it can feel like we are in a dream or like everything around us isn’t real. These experiences are really common, it’s estimated that half of all adults have had at least one episode of DPDR! 50%! That’s a lot of people, so know that you are not alone!

Anxiety: Can Diet Make a Difference

Anxiety symptoms can make you feel unwell. Coping with anxiety can be a challenge and often requires making lifestyle changes. There aren’t any diet changes that can cure anxiety, but watching what you eat may help.

Try these steps:

Eat a breakfast that includes some protein. Eating protein at breakfast can help you feel fuller longer and help keep your blood sugar steady so that you have more energy as you start your day.

Eat complex carbohydrates. Carbohydrates are thought to increase the amount of serotonin in your brain, which has a calming effect. Eat foods rich in complex carbohydrates, such as whole grains — for example, oatmeal, quinoa, whole-grain breads and whole-grain cereals. Steer clear of foods that contain simple carbohydrates, such as sugary foods and drinks.

Drink plenty of water. Even mild dehydration can affect your mood.

Limit or avoid alcohol. The immediate effect of alcohol may be calming. But as alcohol is processed by your body, it can make you edgy. Alcohol can also interfere with sleep.

• Limit or avoid caffeine. Avoid caffeinated beverages. They can make you feel jittery and nervous and can interfere with sleep.

Pay attention to food sensitivities. In some people, certain foods or food additives can cause unpleasant physical reactions. In certain people, these physical reactions may lead to shifts in mood, including irritability or anxiety.

Try to eat healthy, balanced meals. Healthy eating is important for overall physical and mental health. Eat lots of fresh fruits and vegetables, and don’t overeat. It may also help to eat fish high in omega-3 fatty acids, such as salmon, on a regular basis.

Changes to your diet may make some difference to your general mood or sense of well-being, but they’re not a substitute for treatment. Lifestyle changes, such as improving sleep habits, increasing social support, using stress-reduction techniques and getting regular exercise, also may help. Be patient, as it may take some time before these changes have an effect on your anxiety.

If your anxiety is severe or interferes with your day-to-day activities or enjoyment of life, you may need counseling (psychotherapy), medication or other treatment.

Sources: Mayo Clinic, Craig N. Sawchuk, Ph.D., L.P.