Anxiety Disorders, Panic Attacks, and Positive Feedback Loops in the Body

Introduction

The topic of my today's narrative breaks away from the usual pattern. But I consider it very important to talk about this, as this information has public significance and could make someone's life easier.

Deciding to speak on psychological topics is not easy, because many people treat them with justified distrust. Under the camouflage of "psychology," all sorts of charlatans, freaks, and even outright cultists operate. And the amount of nonsense they've infiltrated the internet with is hard to overestimate. I'll try to build my story in a concrete, understandable way, without overloading it with terminology.

All the recommendations I'll give will not contain calls to take medications and are unlikely to harm anyone. My main goal is educational.

How It All Began

I don't have a psychology degree, but I do have a higher medical education that included courses in psychology and psychiatry. During my student years, I befriended psychology students and became fascinated with how our brain works and how it can be influenced. Getting ahead of the narrative, I'll say right away: Freudianism and its offshoots were already considered hopelessly outdated unscientific garbage, whose place is in the dustbin of history. I was lucky to end up in an environment where a scientific approach was well-developed, where psychology was inseparably linked to physiology, and this saved me from various forms of esoteric thinking.

Sometimes I attended group sessions organized by students. Sometimes I secretly attended their lectures, which was easy back in the days when universities didn't yet look like high-security facilities with passes, bars, and turnstiles.

The Peak Moment When the Advice Worked

I remember well the day I found out my girlfriend had cheated on me (you can imagine the intensity of the emotions raging inside me), and by some miraculous providence the thought came to mind: "Come on, dude, apply to yourself what you've been advising others!" And I started observing the emotions and thoughts boiling in my head. I swear, as great as my surprise was, for less than a minute I simply stood in the park and watched what was happening as if it were a movie or a literary description of events. As if I were watching from a couch. Not engaging, not resisting, not fighting the emotions. They simply happened.

And miracle! The avalanche of raging emotions began to subside, and I unexpectedly started rationally thinking through a plan of action. Never in my life would I have believed that such quick self-help was possible. And from that point on, I became a firm believer in the power of knowledge and the effectiveness of psychological methods of help.

Relevance

I have a friend who during his school years experienced an episode of obsessive-compulsive disorder that drove him to such despair that he even had to seek medical help. We discussed the details of this condition extensively, and he also came for consultations with psychology students.

I'll try to briefly convey the essence of what happened. During 9th-10th grade, he started encountering frightening and intrusive thoughts related to the death of his parents (so-called obsessions). At first they came episodically, and initially he managed to distract himself. But the condition worsened, the thoughts became increasingly intrusive, constant, and agonizing. The moment he woke up, they would appear like dementors, tormenting him for days on end. It became difficult to study and perform daily routines. And then he invented something that initially helped him — rituals.

Rituals (compulsions) are these strange sets of actions that a person discovers to somehow cope with intrusive thoughts. They can be completely absurd, and some people realize this. For example, someone might find it helpful during their walk to work or school to make sure they don't step on any boundary along their path. Such people might carefully ensure they step over all cracks, curbs, and crosswalk stripes, never allowing their foot to land on a boundary.

The insidiousness of rituals is that if a person tries to use them to suppress anxiety, they tend to constantly grow more complex. For example, if not stepping on stripes helps now, in a month the ritual will become complicated with the condition that you must enter all doorways backwards, and six months later — with an even more absurd set of actions. Because of this, a simple trip to the store can be burdened by half an hour of magical actions. All these rituals themselves become energy-consuming due to their complexity, and on top of that, a fear of violating them appears — thereby triggering the dreaded event.

It's hard to say precisely why the brain tends to solidify behavior into rituals; perhaps it has to do with so-called displacement activity. When some activity temporarily redirects attention, distracting from anxious thoughts, engaging in performing pseudo-useful activity where control is possible. And through the mechanism of learning, the ritual-like activity simply becomes reinforced as a skill. The only problem is that it doesn't solve the issue — it merely temporarily manages it...

Fear of Fear

I experienced panic attacks several times, but at that time I wasn't aware of their mechanisms and how I should have behaved. Once it hit me on the street. My legs were buckling, it was very frightening, and I even had to lie down and rest on a bench at a bus stop. The second time it hit at home. In my joy (and foolishness), when I returned from a long trip home, I drank several full glasses of wine and several cups of strong coffee in company. Then, when I returned home and lay down to sleep, I started focusing my attention on my tachycardia. And the more I thought about it, the faster my heart pounded. On top of that, my hangovers set in faster than usual, and the effects compounded. I fell into a vicious circle of a positive feedback loop: by worrying about tachycardia, I frightened myself even more, the symptoms became more vivid, and I got even more scared. Thoughts started appearing about an "imminent heart attack" and that I was definitely going to die that night. I was literally saying goodbye to life. Now, of course, I recall that episode with a smile, but back then it was no laughing matter, and I experienced firsthand how these states feel from the inside.

If you ever get "hit" by a state of uncontrollable, escalating panic, remember the most important thing: It is very frightening, but almost completely safe. Your heart is pounding wildly not because death is approaching, but because you are scared and continue to be frightened by a perfectly natural physiological response to fear. Imagine that you just sprinted a hundred meters and are standing there breathless, with blood pulsing in your ears and tachycardia. Would you lose your mind and call an ambulance? No, you'd just wait, and everything would pass. Imagine you've hit a zone of turbulence on a modern, super-safe airliner and you know for certain that it'll shake a bit and then pass. Don't fight the symptoms, don't resist the state — just observe.

Ruminations

This term describes the exhausting and largely automatic activity of the brain in "chewing over" the same thoughts, typically related to negative situations and relationships with people. You're surely familiar with the experience of your brain seeming to spontaneously recall unpleasant situations before sleep — when you should have responded differently or, conversely, stayed silent. Embarrassing incidents. Misunderstood hints.

Studying this topic led me to a revelation. Spiritual teachings with centuries-long histories assign a key role to practices of observing the automatisms of the mind. They reveal to a person a certain hidden "roboticness" of thinking, which seems to live its own life and is barely controllable. Buddhists call this process a wall of thoughts that supposedly distances us from reality, covering it with a transparent layer of verbal thinking.

And indeed, if you observe how various thoughts arise within you in the form of inner speech, you'll discover that they are very often formulaic and looping, and on top of that, they are very poorly formulated slogans.

How to Cope with Ruminations?

1) Develop the skill of mindfulness. I know this recommendation will more likely cause irritation and associations with advice from flashy info-gurus. But the ability to notice in time that you've gotten stuck in chewing mental gum — this is an important skill that allows you to exit this state.

Although thinking is in some sense automated and acts like an LLM, returning text descriptions based on incoming information, we have control over attention. This is the loophole for the expression of free will that is available to us by nature. The more you observe yourself, the more you'll notice the dual nature of the psyche, consisting of silent attention and the verbal "talker."

2) An effective strategy for silencing automatic thoughts is to think each one through to its end, formulate a brief and satisfying conclusion. Write it down or remember it, and then refer to it when the thought arises. You recall the conclusion, and the thought shuts up.

Fear of One's Own Bad Thoughts

Once my friend, who at the time was working as a certified psychologist, told me about a case from his practice (it's important to note that everything was anonymized and without deanonymizing details). A man came to him with severe experiences that he couldn't endure and had even started drinking alcohol because of them. He came from a religious family, and one day, while in a church, he caught himself thinking that he imagined loudly and profanely swearing during a service. (I ask you to refrain from dismissing and smirking — psychologists generally follow the rule that if something matters to the client, it is accepted as an axiom and considered important in their psychic reality.) So, he was very frightened that such a sinful and foul thought arose in his mind. Everything would have been fine, but on the next visit to the church, a pathological cycle began forming. His anxiety was already elevated, fearing these thoughts would arise again and he would lose control and be terribly humiliated.

You're surely familiar with the "white bear" effect, when subjects are asked to spend several minutes trying not to think about a white bear, which leads to exactly the opposite effect — the person cannot detach from the image. (Amusingly, LLMs suffer from something similar — when asked to depict a room absolutely not containing an image of an elephant, they'll inevitably draw that elephant somewhere.)

Attempting to prevent certain thoughts leads to the directly opposite effect — the human brain begins to focus on precisely those thoughts. And if the person is also afraid of them or considers them very dangerous, the effect only intensifies. And this provides an understanding of the key mechanism behind the development of obsessive-compulsive disorder.

But first, let's talk about why people in general tend to think "bad thoughts" and envision bad scenarios.

Why Are We All Anxious?

The reason is fundamental and goes back millions of years of evolution. Through the process of natural selection, the most cautious individuals survived. Literally, evolution itself selected for individuals with heightened anxiety. Those who flinched at every rustle and preserved their lives. After all, in the case of a false alarm, we lost only a tiny fraction of energy to hide or run. But if an actual predator was rustling in the bushes, the human individual got the chance to survive and pass on their genes.

The second reason is that in highly developed beings, evolution produced the ability to predict how events will unfold. This function of the psyche is called "anticipatory reflection of reality" (a term introduced by Soviet physiologist and brain researcher P. K. Anokhin). The brain automatically constructs multiple scenarios for how the current situation might develop. Due to sensitivity to threats, negative scenarios receive special priority.

For example, when I pick up a sharp knife at a cutting board, I almost always vividly and in detail imagine my fingers lying in a pool of blood (considering I saw up close how my grandfather lost parts of his fingers while working on a planing machine). When I board an airplane, I see a mountain of smoking, mangled metal and body fragments. And so on. I'll spare you the savoring of bloody details. But if I weren't aware of the mechanisms described above, imagine what my life would be like.

Related to this feature of how thinking works is another common cause of intrusive thoughts — the fear of losing control and harming loved ones. For example, a woman is cutting food with a knife, and her child enters her field of vision. She gets a frightening thought that she might stab him with the knife. It's easy to imagine the terror of a person who is shocked that such a terrible thought could even be born in their head. She starts fixating on it, believing that if she's capable of thinking such a thing, it must be a sign of some hidden mental illness. Although, as we already know, anticipating the most disturbing scenarios is the standard operation of the psyche.

Thoughts Are Not Equal to Behavior!

For people with anxiety disorders related to their own frightening thoughts, understanding a simple rule becomes significant relief. Thoughts inside the head, no matter how base, cruel, or frightening they may be, are not a problem if they are not acted upon. Visualizing negative scenarios is normal for a human being — it poses absolutely no threat to anyone!

As an example, I want to show a notebook with drawings that I and several of my friends created in school. It's nothing but bloody horror with dismemberment and torture. But none of us grew up to be a sadist. I personally left medicine because of high empathy — it was extremely difficult for me to cause people pain even for a good purpose. For example, injecting anesthetics before preparing teeth. I don't like cruelty, I don't hunt animals, and I don't fish.

Imagine if our drawings had fallen into the hands of some school psychologist — they'd have immediately committed us to a mental institution.

How to Cope with Anxiety?

0) Normalize your sleep, for crying out loud! This is the best thing you can do for your health, and it's free. Seriously, never sacrifice sleep.

1) If things are hard and you don't believe in the effectiveness of self-help, see a specialist. Perhaps you're in a situation where your central nervous system is severely depleted from chronic stress, and you'll need pharmacological support. This is the most reliable and correct way to solve the problem.

2) Acceptance of your own anxiety as an individual feature of your brain. That is, you come to terms with the thought that you are who you are, and you have the ability not to follow the lead of anxious thoughts, letting them resolve on their own.

From my life: since childhood I've noticed a peculiarity — I can fall into very vivid, detail-rich fantasies with sharply anxious storylines. For example, I can be walking down the street, wandering in thought, and hear a car somewhere abruptly braking at an intersection and honking at a pedestrian. My brain immediately paints a picture in full detail about "what would I do if I were the only witness to a traffic accident where the driver fled the scene? Would I memorize the license plate, how would I record it in a moment of stress (for instance, scratch it in the dirt with a stick — I'm bad at remembering numbers), how would I call an ambulance, how would I be a witness in court," and so on. Meanwhile, I continue walking down the street like a zombie, completely immersed in the imagined situation I've plunged headlong into. I practically have to slap myself across the face to snap out of it. What to do? Nothing — accept it and move on. Accept it as a feature.

3) Changing your attitude toward your anxious thoughts. This is the foundation of psychotherapy, and a competent psychologist will work on this with you. But if you have no practical way to see one, you can try performing what's called a cognitive reappraisal. Moreover, you now know that anxious thoughts are a product of the psyche's functioning, and they are inherently safe. This realization alone will noticeably ease life for many people.

I can also recommend a technique borrowed from cognitive behavioral therapy that could be called "putting a thought on trial." You need to try to briefly formulate the thought that troubles you and write it down. Then come up with at least five rational arguments for it and against it. It's important to do this work fully. I know how easy it is to dismiss any such practice and devalue methods simply because a person has no experience of truly effective application. With a psychologist, of course, it's easier. They serve as a coach to guide and monitor.

4) Paradoxically, ordinary swings can help — just regularly swing on them. It has been statistically proven that they reduce the overall level of anxiety.

5) Here's a playlist with recommendations from a good certified psychologist, Pavel Zygmantovich.

6) A program about the causes of obsessive-compulsive disorder and its treatment.

I wish everyone mental health and harmony with yourself!