Making Life Work – Anxiety: A Heart Attack To The Soul?

“Suddenly, right after I learned that I might be fired, I got these sharp pains in my chest. My heart was beating a mile a minute and I couldn’t get my breath. So I called Anne and asked her to find me a cardiologist on the spot. As you know, she called you to help us find someone and was so lucky to reach you. Thank you for jumping in and immediately calling Penn for me. The recommendation you got – that I should go to the 24 x 7 emergency services – was right on. The docs there were great.
They did a physical and sent me for an EEG. Then they sat me down and told me I had not had a heart attack at all. I couldn’t believe it. I mean, I felt so weak and sick on the train from DC that I honestly thought I would die before I could even say goodbye to Anne. I was barely able to drive home after it was all over. It is the most terrifying thing that has ever happened to me in my life. I did not know I could feel so sick.”
“What did they say was causing the heart palpitations, and the sweating?” I assumed the culprit was anxiety, but wanted to hear what Brad had learned from the well-trained cardiac emergency crew.
“I was really surprised. They said that the source of the physical symptoms was actually one panic attack after another. But, man, did it feel like a heart attack…I never guessed my mind could play tricks on me like that.”
“Your mind was not playing tricks. The symptoms are real. Anxiety can be really crippling. You felt sick because the anxiety was making you sick.” Since he did not seem to grasp the importance of what I was saying, I decided it wise to tell Brad a bit about how anxiety can mask as physical illness.
The American Psychiatric Association’s criteria for the diagnosis of panic disorder or anxiety state that four or more of the following 10 physical symptoms of anxiety must be intensely and suddenly present, and reach their peak within 10 minutes :
1. Palpitations – Heart Beating Hard and/or Fast Pounding
2. Sweating – Perspiration
3. Trembling – Shaking
4. Shortness of Breath – Breathlessness – Difficulty Breathing
5. Difficulty swallowing
6. Sharp Pains in the Chest – Chest Discomfort
7. Nausea and/or Vomiting
8. Dizziness – Lightheadedness – Faintness
9. Hot or Cold Flashes
10. Fears of Losing Control, Dying, or “Going Crazy”
Given the severity of the symptoms Brad experienced, one might expect that he was highly motivated to learn the breathing and behavioral techniques that could definitely help him successfully manage his crippling anxiety. Nope! Although the emergency room team advised him to get cognitive therapy to teach him to manage his own anxiety, and although Brad was panicked beyond belief about the anxiety that he mistakenly diagnosed as a terminal heart attack, he began to relax the day after the crisis.
By the time Brad reached my office, he was feeling better, thanks to an anxiety reducing medication. He wanted only to forget all about the horrible time he had had.
I knew he could spiral out of control again. “Brad, we can do some quick work. You need to learn to breathe more deeply and to work with your automatic thoughts which keep you scared and worried.”
“No,” Brad broke in, “that breathing stuff seems boring. Doesn’t interest me. I’m feeling better now that I know that I am not going to die, and taking a pill is an easier than learning how to change the way I think about the stuff that worries me.”
Accustomed to working with clients who give more credence to physical illness than to emotionally traumatic events, I was not surprised that Brad was minimizing the need for therapy. “Brad, we need to get you back in balance and off the habit-forming meds. The panic can strike again the next time you worry about being fired. Let’s meet a few times and see how far we get.”
I guessed that my tenacity would move him towards constructive decision formation and, sure enough, Brad agreed to three meetings about how to control his severely disabling anxiety. Can he do the needed work in three meetings? Time will tell.
To Consider: How well do I understand the impact that fear and anxiety can have on my health? How might I benefit from honoring the power of emotions as much as the power of physical illness?
To Read: When Panic Attacks: The New, Drug-Free Anxiety Therapy That Can Change Your Life. David D. Burns M.D. 2007. Broadway Books.