A Few Charms (Banner)

A Few Charms (Banner)

Friday, 24 March 2017

Prescription for panic: ice, ice baby

Have you ever wondered why people splash water on their face? Actually, I myself have never really thought about it before, but they do it all the time on TV and in the movies. Turns out there is a really good reason for this - and the more extreme version called "ice diving" - and it helps if you are upset, angry, worried, or embarrassed, even if you practice forms of self-harm, like cutting.

"Ice diving" is one of the best ways to get out of 911, whether you're feeling anxious or having a panic attack, you're frustrated or angry, or you're feeling disgusted with yourself or feeling full of shame and speaking harshly to yourself.

The Frozen snowflake (and polar bear) charms on my
"Beat the Winter Blues" bracelet
Maybe the reason I've never tried splashing water on my face is because I am a girl and I wouldn't want to "ruin my makeup." But last Wednesday was a make-up free day (as are most days, if I'm being perfectly honest) so I gave it a try. Even better, I went ice diving. And it rescued me!

(Since I've already assigned a meaning to the polar bear charm, I use the snowflake charm from the Disney movie "Frozen" to represent this effective strategy.)

The reason I needed this rescue strategy last week was because my "threat system" (aka the fight-or-flight response) had kicked in. As I explained in an earlier post, "there are only three emotions when you are in 911: anger, fear, and shame." and I was feeling them all.

When I opened the mail last week there was a letter to my husband from the Canadian Revenue Agency (CRA) saying that he owed over $2000 in taxes and I started to panic. I have this memory of the RCMP (Royal Canadian Mounted Police) coming to our home when I was a child and arresting my father for not paying his taxes. Or... maybe it was for not paying for parking tickets. Or... maybe they just came to yell at him and didn't cart him away! Or... maybe it never happened at all. But it sure feels real! Arguments about money were frequent and explosive issues in our home, so they trigger very strong reactions in me. This letter also triggered some shame. Although we have overcome some major financial hurtles and are debt-free, I am not contributing much to our financial situation at the moment.

Shame (here in polar bear style) is one of the 911 emotions.
I knew that there had been some issues with my husband's taxes and he had recently filed some paperwork, so he had asked me to open the mail if anything came from CRA, expecting to find out what his tax refund would be. What a surprise to find out that it was NOT a refund after all! (I have come to see that surprise frequently pushes me into panic.) So, trying not to over-react, I splashed some cold water on my face, and called my husband at work. In the past, my fight-or-flight response would have me fighting with my husband or I would be so overcome with emotions I'd be crying hysterically, but we actually had a reasonable conversation. Sure enough, when he called the CRA the next day he discovered that his new paperwork had not been processed yet - crisis averted. And my urge to respond to those intense emotions, and potentially cause harm to our relationship, also averted.

As soon as I hung up the phone it rang (another surprise!). It was a call from a woman from Desjardin Financial, the company that had looked after my mother's retirement income. Apparently there was a life insurance policy that I hadn't been aware of (surprise!) and they would be sending a cheque to both my brother and I - nine years after she died! Now most people would be happy to hear news of a sudden windfall (a happy surprise!), but I was suddenly flooded with a sense of shame and instantly felt my face get flushed. I started asking the woman questions about how this happened and why were they just finding out now. I also asked myself questions: How had I missed this? What did I do wrong? I was saying things to myself like, "I was a terrible daughter." You know, beating myself up and should-ing all over myself. And I had a VERY strong urge to binge. Ice diving to the rescue!

Both self-harm and problematic eating, like bingeing and purging, can be ways of managing distressing emotions. Intense emotions frequently lead to these urges, behaviour urges that are hard to resist. One of the most important things I have learned about dealing with intense emotions like panic, anger, and shame is "Distress Tolerance." The goal of distress tolerance is to figure out how to tolerate the distress of intense emotions without doing something that is harmful to ourselves or others, or doing something to harm our relationships. In other words the goal is to not make the situation worse. Ice diving can provide instant results and stop you from doing something that is harmful to yourself or others.

The Most Important T.I.P.

When I first met with Dr. Mercer, the psychiatrist at the Shared Care Mental Health Team, back in the Spring of 2014, she gave me this tip for managing my panic attacks - and the way to remember it is the acronym T.I.P. We discussed this in the Day Hospital program I attended in the Fall of 2014, but I learned even more about it in the "Working with Emotions" program I completed just over a year ago in the Fall of 2015.

Although the "Frozen" snowflake charm is perfect for my "Beat the Winter Blues" bracelet, I actually wear it all year round, in different bracelet combinations, because this strategy is, for me, one of the most effective rescue techniques whenever I get into 911.

The Frozen snowflake in the centre of  my bangle.
The T in T.I.P. stands for "temperature change," in other words, change the temperature of your body. Some people find a warm bath, a hot shower, or even putting their feet in warm or very hot water, can help ease the discomfort of anxiety or panic, but most people get their best results from the cold, in particular, "ice diving" (instructions and explanations to follow).

The I represents "intense exercise." This is an effective way to calm a body that is revved up by stress and intense emotions. It allows you to relieve muscle tension and burn off the "stress hormones" adrenaline and cortisol, as well as producing a release of endorphins, the "feel-good" hormones. Do some push-ups, do jumping jacks, run up and down the stairs, or put on some music and dance.

The P represents "paced breathing" and/or "progressive relaxation." Learning how to control your breath, by doing diaphragmatic breathing or counting the length of your breaths, can help reverse the symptoms of fight-or-flight, slowing down your heart rate and racing thoughts. Learning meditation teaches you how to use your breath to calm you down. Learning progressive muscle relaxation also changes the bodily sensations of the stress response.

The Stress Response

To understand how this T.I.P. works, you need to understand the stress response, what happens physiologically when your body responds to a perceived threat, which we can refer to as being in 911.

The reality is we have not really evolved very much from our caveman days, at least physiologically. If you were a caveman (or woman) who sees a threat, like a scary animal, let's just call it a sabre-tooth tiger, you would need to either fight or flee. Your body will immediately kick into fight-or-flight. Regardless of whether you fight or flee, your body needs to prepare for that physical exertion. All of these changes in our bodies can be evident when we have a panic attack; see if you recognise some of them.

If you were going to run from, or battle, that sabre-tooth tiger (I'm still undecided as to which would be best), then your body needs to increase your breathing rate to ensure you get enough oxygen to your working heart and muscles. For me this is the most obvious bodily sensation during a panic attack. I'm breathing really fast, taking shallow breaths, can't get any air into my lungs, can't catch my breath, and feel like I'm being suffocated. Of course being short of breath makes me panic and worsens the panic attack.

Look how much the Pandora charm resembles the snowflake from the Disney movie.
When the fight-or-flight response kicks in, your heart rate also increases in order to make sure that you are getting enough blood flow to your heart and muscles, which will be working extra hard to fight, or flee. Some people with anxiety or panic attacks have racing heart rates, tightness in their chest, and even feel like - and fear - that they are having a heart attack.

Making sure that you have enough blood flow to your heart, brain and muscles also leads to a redistribution of your blood supply. Your blood is diverted away from the non-essential body functions like digestion, which may lead to nausea. Your body may even want to empty the digestive system or the bladder. My mother always had to go to the bathroom when she was nervous; it was particularly annoying when she had Alzheimer's and couldn't remember that she'd just gone! But, as always, I digress.

The blood is diverted to more essential functions like the brain and heart as well as the muscles you will use to fight or flee. Your working muscles will create a lot of heat, a by-product of making energy. In order to dissipate that heat, blood is diverted closer to your skin to make sure you can cool yourself off, which means you may feel flushed and you may sweat.

Any of this sound familiar? Fear is something you can feel and many people with anxiety or panic report symptoms like shortness of breath, muscle tension, chest pain, racing heart or heart palpitations, excessive sweating, sweaty palms, and nausea.

Elsa and her signature snowflake from "Frozen"
If you, the brave caveman or daring cavewoman, while in the process of fleeing from the sabre-tooth tiger, fall into a frozen lake, everything changes; your body changes priorities. The threat to your life now is to keep you from dying of hypothermia. Forget about the sabre-tooth tiger. You need to survive being immersed in freezing water. Your body will stop the stress response. You can trick your body into thinking you have fallen into a frozen lake and reverse those uncomfortable physiological responses of the fight-or-flight system by ice diving.

Instructions for Ice Diving:

Fill a sink (or a bowl large enough for your whole face) with ice cubes and water. When the water is really cold, lean forward, hold your breath, and plunge your face into the ice water. Hold it there for as long as you can, up to 30 seconds (or at least 5-10 seconds). Come up for a breath and repeat. Repeat as often as needed until your intense urges have passed and the intense emotions have settled.

Since there are usually dirty dishes in our kitchen sink, and the ice cubes and freezer are not near our upstairs bathroom sink, I grab a large plastic bowl from the kitchen cupboard, empty a tray of ice cubes into it and then fill it with cold water. And dive in.

If you're not in a place where you can literally dive face-first into cold water, or don't want to wear the Speedo as in the photo above, you can trick your body into eliciting the "mammalian dive reflex."

Mammalian Dive Reflex

This is a physiological response to diving into cold water. The body's "prime directive" (to quote Star Trek) is to keep the brain functioning, ensuring that it is getting sufficient fuel and oxygen. When aquatic mammals, like seals, otters and muskrats, dive under cold water their bodies adjust to allow them to hold their breath longer under water without coming up for a breath, essentially helping them tolerate low oxygen levels. To conserve oxygen, the heart rate slows significantly (called bradycardia) and the blood vessels in the limbs constrict (called peripheral vasoconstriction). The blood shifts from the limbs (and less vital organs) to the chest, concentrating the blood flow between the lungs, heart and brain. It is similar to the slowing down of the metabolism during hibernation or protective hypothermia (the response to falling in that frozen lake).

This reflex is very effective for aquatic mammals but this primitive neural reflex still exists in humans and can provide instant and powerful results just by holding your breath and chilling your face.

Anxiety and Panic Attacks

The stress responses, those physiological changes in our bodies when we are in the fight-or-flight system, are all a result of the sympathetic nervous system. The sympathetic nervous system is one of our autonomic nervous systems, the ones that are (surprise surprise!) automatic and act without our conscious control. We have another autonomic system called the parasympathetic nervous system. It is the one that calms you down and it often referred to as "rest and digest." When we are trying to manage intense emotions the trick is to switch off the sympathetic nervous system and switch on the parasympathetic system, and the most effective way to do this is by controlling the vagus nerve. We don't have direct control over this system but we can stimulate the vagus nerve with the diving reflex.

The diving reflex is the most powerful autonomic reflex known. It instantly slows your heart rate and changes the distribution of your blood. It can get you out of an anxiety attack or panic attack in seconds.

You can also stimulate the vagus nerve through something called the Valsalva maneuver. "Bearing down," as one does when trying to empty the bowel or push out a baby, creates an increase in blood pressure in the chest. There are receptors in the heart which respond by stimulating the vagus nerve, lowering the heart rate to counter the high blood pressure.

I was surprised when I saw these tricks being used on the American TV show "Code Black," set in an emergency room in Los Angeles. The Emergency Room doctor resorted to the dive reflex when he couldn't lower his patient's racing heart rate. He put an ice pack over her eyes and told her to hold her breath and "bear down." Not that you should believe everything you see on television, but if it rescues this patient it can rescue you too.
Screenshot from the emergency room on "Code Black"

Do not use the dive reflex or Valsalva maneuver if you have a heart condition or anorexia!

So when you're having an anxiety or panic attack, channel your inner dolphin (or polar bear) by "diving" into cold. Hold your breath and submerge your face in ice water or hold cold packs on your face, or even a cold wet towel. Make sure to get the forehead and the area around the nose, as well as the eye socket and under the eye. These are the areas that will stimulate that vagus nerve.

In addition to putting ice on your face there are a few other tricks that can help.

Do you know why first aid responders at races like marathons will put ice in the groin and arm pits of people with heat stroke? It's because large blood vessels lie close to the skin surface (that's why we sweat there) and ice in those areas is an efficient way to cool off the body. Take a cold shower and aim the stream of cold water at your arm pits and groin.

Remember your physical education teacher (or your mom) telling you that you lose most of your heat through your head? That's why you pour water on your head if you're running a race and why you need a hat when winter camping (yes, we do that in Canada). In a cold shower I find letting the cold water hit my head makes a big difference.

Why do you think we have physical symptoms like the flush of embarrassment or shame? Or have a red face in the heat of anger? Or have sweaty palms when we're nervous? It is because there is efficient heat transfer there - they help cool us off when the fight-or-flight response kicks in. Recent research indicates that the blood vessels in the cheeks, palms of the hands, and soles of the feet do not contract when they come in contact with cold. You can take advantage of this and continue to cool the blood by applying cold water or ice to these areas - like using your hands to splash cold water on your face!

Have you ever thought about why you put perfume on your neck, behind your ears and at your wrists? It's because the blood vessels are near the surface in these areas, which means they are warmer, which evaporates the alcohol in perfume and amplifies the aroma. Those superficial blood vessels also allow you to take your pulse at the wrist and neck (called "pulse points"). You can calm yourself down by cooling yourself off in these places. I find that if my hands are cold it helps calm me to simply place my fingers behind my ears, or use my cold fingers to massage my eye area and forehead.

I made these felt snowflake Christmas tree ornaments for a Christmas gift exchange last year.
We have discussed the application of acute (short-term) cold as a rescue technique, but on a regular (long-term) basis you can also stimulate your parasympathetic nervous system (the vagus nerve) through singing, yoga, tai chi, meditation, prayer (particularly the repetitive recitation of the rosary), deep slow breathing, positive social interactions, laughter, exercise, and massage (including foot rubs). The best way to strengthen the parasympathetic nervous system is by controlling your breath.

I'm thinking that singing (breath control) and dancing (intense exercise) to "Ice, Ice Baby" might be the best way to remember this TIP:

To rescue yourself from panic or other intense emotions or behaviour urges, use ice, ice baby.

You Tube video of "Ice, Ice Baby" (by Vanilla Ice), performed on the TV show "Glee"

"Ice, Ice Baby:" putting it into practice
  1. Freeze an almost-full bottle of water and carry it with you. Freeze it with the top off so it won't burst in the freezer.
  2. Fill a water bottle with ice cubes and carry it with you. I always have a water bottle or two with me and I have an extra bottle with just ice. Ice cubes will melt quickly if they are in water but will stay frozen quite a long time in a bottle by themselves. I can then add ice cubes to my water bottle to make it colder and roll it on my face.
  3. Carry in your purse or knapsack a soft first aid ice pack from the freezer; wrap it in tea towels to help it stay cold longer.
  4. Carry an "instant ice pack," the kind you squeeze to activate; they are surprisingly inexpensive.
  5. In winter, carry a zipper-top plastic bag that you can fill with snow; it shapes nicely to the contours of your face.
  6. Bring a face cloth and pour cold water onto it. Even better put an ice cube IN the wet cloth and then rub it on your face, neck, behind your ears and on your wrists.
The centrepiece on my bangle is the Frozen snowflake
worn with my chalcedony "Serenity" bracelet
and blue chalcedony Mii bracelets

Millions of people in North America and around the world practice self-harm, including cutting, burning, hair-pulling, or hitting, as well as bingeing and purging, or abusing alcohol or pain killers. It seems that there are some people who specifically associate pain with the feeling of euphoria we get when the pain is relieved. This can become a way of relieving emotional pain or intense emotions. Cutting and other forms of self-mutilation can cause the body to release natural painkillers called endorphins. These painkillers can make a person feel better physically and emotionally, at least for a short amount of time. The reward provided by the relief reinforces the behaviour, making it difficult to stop the very strong urges. The goal is to find another way to relieve the pain without causing physical harm.

"Ice, Ice Baby:" putting it into practice
  1. Ice diving will release endorphins and will give you the same high as cutting or other forms of self-harm, minus the harm.
  2. Jump in a cold shower - with your clothes on if you need to! Not only will it elicit the diving reflex, especially when you let the cold water hit your face, but it will also distract you and delay acting on your urge long enough that the urge to cut or self-harm may pass.
  3. Squeeze ice cubes in your hands as long as you can. The cold causes pain in your hands, and then the subsequent desired pain relief, but is not dangerous or harmful.
  4. Put ice directly on your skin, where you would normally cut or burn yourself. It can give you a strong painful sensation, and may even leave a red mark afterwards, but not a permanent mark.

Next time you are anxious about a presentation, get an upsetting phone call, or panic about your taxes, use ice, ice baby. You could also wash your hands and let the cold water run on your hands and wrists. At the very least, splash cold water on your face. Make-up be damned!

How I stack my "Beat the Winter Blues" bracelet

Related Posts:

Advice on managing anxiety - from a turtle! - a story about my very first charm, on the very first day of my recovery from my eating disorder, and one of the most important reminders when I'm in fight-or-flight and have the urge to binge. You can also learn how to correctly do diaphragmatic breathing - it is probably the opposite of what you always thought it was!

The turtle part two: advice for anxious parents - a story about how heart-breaking it is when you see your children struggle, with strategies we used for helping our son with intense emotions like anger and anxiety. You can also read one of the best pieces of parenting advice I've come across - it's from a turtle!

When your brain and body scream 911 - a story about my introduction to the idea of "wise mind"  and the "threat system" (or 911) and the reason for my intense emotions. You'll also see an overview of the types of therapy that have made a huge difference for my mental health.

Will he always love me? My explanation of panic attacks - a story about the origins of schema-focused therapy. A rather long post but my explanation of panic attacks and my behaviour urges when I'm having a panic attack.

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