Having to give any sort of performance to a group of people can be threatening. It is a very variable thing depending on such things as basic genetic personality factors, acquired factors, such as damaged external appearance, being, for one reason or another outside your peer group [vide Albert Camus 'The Outsider’ or ‘L’Etranger’], carrying a history which you are conscious of but unsure how much others know or believe,and so on.
There are huge differences, one from another, in terms of how these things play out in practice. There are those who welcome public performance and only feel they come to life in these circumstances, the challenge and the performance they find thrilling and pleasurable, unfortunately some can find ordinary life a boring thing. Here we are interested in those who find public performance to be threatening to the point of pain.
Panic attacks and the problem of nervous over breathing are often treated as synonymous, it is not so in truth, ‘panic attacks’ is a general term indicating incapacitating disability relating to particular life demands, over breathing is one symptom of panic attacks which is common and disabling so we will deal with that.
Over breathing is an extension of the common reflex reaction to difficult circumstances; ‘the sigh’. We all sigh at times, it is natural. Over breathing or ‘air hunger’, is a situation where the person feels very short of breath and cannot ‘get enough air’ even though they have no disorder of the cardiorespiratory system or have exercised enough to explain the problem. It is often linked to ‘adrenaline rush’ situations which,biologically prepare the body for ‘fight or flight’.
A commonly suggested remedy is to breathe in and out of a brown paper bag applied to the mouth and nose. The idea behind this is carbon dioxide loss which can cause muscular twitching and spasms [‘tetany’] which can be disabling, this is a result of the over breathing but soon becomes a cause of further panic because of the symptoms caused. When I practiced as a GP I advised people to throw away their paper bag because this management, in the long term augments rather than solves the problem. the first step is to explain to the patient the underlying causation and physiology of the problem including the effects of CO2 loss from the bloodstream via the lungs, and next to explain a rational way out of the difficulty such that the patient is in control of their own difficulties. I never needed to refer on to specialists with this system. It is necessary to teach the patient systems of muscular and mind relaxation which they can put into operation immediately, controlling their rate of breathing whilst realising that this was a stress reaction and not a physical illness.
Once over breathing as a problem is under control then one can turn to things that cause panic; there are two basic approaches, either can be valid depending on cicumstances. the first is to avoid the threatening situations, we all do this, often unconsciously,and there is nothing wrong with it if it does not disrupt normal life. If this is not practicable or unwanted then the next approach can be understood by the phrase ‘gradual familiarisation’, this can be done by oneself or with the aid of a psychologist or some other trained person. It entails doing the thing that is threatening in a very graduated manner with’ if necessary very tiny moves forward but for this to work it must be applied on a daily basis; give a speech on your own, give one to one trusted friend, two trusted friends etc etc until, like Winston Churchill you come down the steps of some important building in Washington after talks with president Truman just after the end of WWll and address the waiting world press with the following words: ‘I wonder if you could spare a few moments of your valuable time to hear about the results of the discussions between myself and President Truman?’ It turned out that ’Yes’, the pressmen could spare a few moments of their valuable time for that purpose. Speech making is to some extent a gift but the more one shows warmth and concern for others then the easier it is.
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