Want to Stop Pandemic Claustrophobia, Anxiety, and Panic?

Just inhibit your up-regulating system and activate your down-regulating system.

Posted Sep 23, 2020

When flying, passengers have no control or escape. To fly comfortably, I teach them to  neutralize claustrophobia, anxiety, and panic. In this pandemic, we also have no control or escape. Nevertheless, there is a way to remain composed. We simply need to reduce activation of the system that revs us up (the sympathetic nervous system) and increase activation of the system that calms us down (the parasympathetic nervous system).

We need to stay steadily in touch with reality. A seemingly innocent slide away from reality can result in high anxiety and even panic. For example, we might think, "What if we get the virus?" Though this is conjecture, it is potent conjecture. Thinking about getting the virus releases stress hormones that increase our heart rate, breathing rate, perspiration, and tension. 

If we recognize these feelings are caused by conjecture, no harm is done. Reflective function - our ability to look inward and sense what kind of mental processing is going on - allows that. But if we lack strong reflective function, feelings belonging to the past, cause a sense of danger in the present. A client describes how "feeling is believing" made distress escalate:

Claustrophobia in an elevator, a plane, a subway, or having a CT scan is "the beginning of the end.” My body feels it happening. My mind believes the physical feeling and I feel unsafe. My thoughts progress in seconds....I have to get do I get out....I can’t get out....I have to get out....if I don’t get out I’m going to go crazy....I have to get out....I'm going to die.

In claustrophobia, we are trapped. In anxiety, we are trapped, plus believe there is danger. In panic, we are trapped plus "just know" we are doomed. A client describes sliding from claustrophobia to anxiety to panic.

Before takeoff, a flight attendant remarked about how high the plane was going to fly to get over a storm. As we taxied out for takeoff, I could not get the thought of being high up out of my head. I looked around for a way to get out. I told myself I could run to a door and jump out. Instead, I froze. I imagined - almost hallucinated - the terrible thing that is "going to" happen. I literally saw the plane spiraling down to my death. I was dizzy. I couldn't breathe. I thought I was having a heart attack..

Psychological theorist Peter Fonagy calls this alteration of reality "psychic equivalence." Psyche means the mind. Equivalent means two things are equal. In psychic equivalence, the person is certain that what is in their mind equals reality. Psychic equivalence takes place when reflective function stops critiquing and correcting our "take" on reality.

Freud addressed this phenomenon when he wrote “What characterizes neurotics is that they . . . react just as seriously to thoughts as normal people do to realities.” But it is not just neurotics that have this problem. The problem can develop when stress hormones are released. Unless reflective function is quite strong, stress hormones can cause it to collapse. When it does, psychic equivalence takes place, and imagination takes over.

How does this hijacking of the mind take place? Let's go to the basics. The amygdala monitors what is going on around us. But it also monitors what goes on inside us. When it senses possible danger - whether perceived or imagined - the amygdala releases stress hormones. The stress hormones increase our heart rate, breathing rate, and perspiration. They also cause alarm.

Does the feeling of alarm mean danger? It could be a false alarm. How do we know? The amygdala can't help us. It doesn't know what is safe and what is dangerous. In fact, it doesn't even know what is real and what is imaginary. Hopefully, our high-level thinking, executive function, can separate what is imaginary from what is real, and what is safe from what is unsafe. If there is danger, executive function needs to figure out what to do.

If executive function is focused on something, alarm must overwhelm its ability to focus. Alarm then forces executive function to note what the amygdala is reacting to. Then, alarm needs to be dialed down to restore executive function’s ability to focus on similar situations in the past, use them to project the likely outcome, and determine what - if anything - needs to be done.

How is alarm dialed back? This is our parasympathetic nervous system's job. But mental software is needed to activate the parasympathetic system, cause it to oppose the stress hormones, and replace alarm with curiosity about what is going on.

This is where things can go very wrong. Many of us (research suggests 40%) lack the mental software required to quickly reduce alarm. When alarm continues, executive function goes into a state of psychic equivalence. It cannot separate what is imaginary from what is real. Imaginary calamity is experienced as though it were taking place.

There is a solution. As I mentioned, the answer is to reduce activation of the sympathetic nervous system and increase activation of the parasympathetic nervous system.

  • Stress hormone release is inhibited by oxytocin. To reduce sympathetic nervous system activation, we link an oxytocin-producing memory to the situations and thoughts that release the stress hormones that activate the sympathetic nervous system.
  • The parasympathetic nervous system is activated by the face, voice quality, and touch/body-language of a person who is no threat physically or emotionally. To activate the parasympathetic nervous system, we link the memory of such a person to the situations and thoughts that cause stress hormone release.

My book Panic Free includes detailed instructions for establishing protective links to elevators, bridges, tunnels, high places, and MRIs, as well as social situations and an additional book, Panic Free Pandemic Workbook provides linking instructions for pandemic issues.