Robert Davies © 2018
Ms. Kim had explained the situation to Bob-the-counsellor:
“Well, one morning it was Charlie’s (Charlene) turn to tell us about her family. She suddenly got nervous, and I had to put her in my office until she calmed down. Then again just yesterday, I was away and the substitute teacher said Charlie got nervous at some point, then anxious and started to breath very hard and get emotional.”
That afternoon, Mr. Jenkins met with Charlie.
“Well, Charlie, how can I help?
“Mr. Jenkins, I got feeling nervous this week and then I got really nervous and my heart was really beating fast. It was scary.”
“Yes, that would be scary. It sounds like a panic attack. It’s quite normal. It’s no fun, mind you, but it doesn’t hurt you or anything. Still, it’s very unpleasant. Do you want some help to stop them?”
“Yes, please.”
“Okay, Charlie. Let me explain what it is. It is basically anxiety. Do you know what anxiety is?”
“Kind of, but not really.”
“Well, Charlie. Anxiety is worrying. You think you feel as if something bad is going to happen. You have all sorts of negative thoughts about it. You feel really threatened, so your body sort of tries to run away. Your heart starts beating faster and faster like it’s going to jump out of your chest. You breathe very rapidly as if you have just run a race. Plus you mind is so full of terrible thoughts such as: I am going to die or my heart is going to burst out of my chest and other thoughts like that. It is no fun.”
“But why Mr. Jenkins, why am I having them?”
“Well, it is your thoughts that start them. You are frightened by something. You start to panic. Then your body has natural things in it called adrenaline. It is powerful stuff that gets you ready to fight or run away. The adrenaline makes your chest tighten so it’s hard to breath and your heart starts to go really fast.”
“I am frightened about something?”
“Charlie, I am thinking that when you get nervous that that is the trigger. I’m going to ask you to close your eyes for a while to think back to when the substitute teacher walked in. Can you do it? Does it bother you?
“No, I can do it.”
“Thanks, Charlie. That will help us. Now, close your eyes for a minute and go back to that morning of the new substitute teacher.”
Charlie closed her eyes.
“Are you doing okay with your eyes closed, Charlie.” She nodded yes.
“Okay, pretend you saw the substitute teacher again for the first time. Suddenly, you realize that Ms. Kim won’t be with you today. All that day you will have someone different. You won’t know exactly what comes next because the substitute teacher will do things differently from Ms. Kim. Now pay attention to how your body is reacting, is feeling. Where is your body telling you that it is feeling nervous?”
“My stomach is feeling funny.”
“What do you mean by ‘funny’?”
“Like I might get sick?”
“Do you mean like sick to the stomach?”
“Yes.”
“What are you thinking about it?”
“I think I will get sick and make a mess in class in front of everyone.”
“Then what happens? Everyone laughs and no one wants to be my friend after.”
“Thanks, Charlie, open your eyes. Well, it makes sense that you might get a panic attack thinking about maybe getting sick and losing friends. Do you want to start with that as a way of helping you with your panic attacks?”
“Yes,” said Charlene.
(Mr. Jenkins uses paradoxical agenda setting to get rid of any resistance Charlie might have. He wants Charlie to express a real willingness to change and to do the work necessary to create that change. )
“But, I am thinking, Charlie, that you might have to feel nervous for a while longer especially if we are facing an anxiety problem. You will have to be strong to look at your problem square in the face without running away. That is a lot to ask of a grade one student. Maybe, I shouldn’t help you. I will have to make you feel nervous again in order to stop the nervousness all together.”
“But I want to stop those panic attacks, Mr. Jenkins.”
“I know but I don’t want to force you to feel nervous again. I will probably have to,”
“That’s all right. I can do it. I can do it!”
“Are you sure?”
“Yes, okay, but I warned you. You can’t back out on me now.”
“I won’t.”
“Tell me more about feeling nauseous. Did you throw up at school before?”
“When I was about 4 years old, I suddenly got very sick and threw up. I didn’t know what was happening. It was really scary. I thought I was dying. Mommy wasn’t there. I was at Daddy’s house.”
“Thank you for sharing that. I bet it was hard. You know, Charlie, when you are small and you suddenly vomit for the very first time. It can be traumatic. It can leave you feeling very vulnerable, unsafe, nervous especially about anytime you might get nauseous. So when you feel nervous in the stomach, it might feel similar to the first time you vomited and you would return, in your mind, to the same feelings, to that experience you had when you were 4 years old.”
“I think I understand, Mr. Jenkins.”
“Charlene, we are going to have to talk about it in detail in order to take the scariness away, okay?”
“But I think I said enough.”
“Charlene, in order to get rid of a panic attack you have to confront your fears. First of all, you have to confront the first time you vomited. We call it ‘exposure therapy’ confronting what you fear the most. It is the only way to stop the panic attacks. Remember our deal.”
“Okay.”
Let’s talk about vomiting. Why do people vomit? Usually, it is because whatever the person ate did not agree with them. If the stomach decides, it is bad food such as meat that is too old or cheese that has gone bad, it will force it back up and out your mouth.”
“Is that a good thing, Charlene?”
“No!”
“Everyone’s body in the world when they eat something that is ‘off’, gone bad, the stomach will reject it and push it out of the stomach. If the stomach didn’t do that, what would happen?”
“Charlene shrugged her shoulders.”
“Well, lets do a survey. Come with me.”
Mr. Jenkins and Charlene headed down the corridor and took a walk about the school. In no time at all, they were both back. They had talked to the gym teacher, the principal, the secretary, the librarian, three grade 9 students, the janitor and two workmen fixing the back door. Everyone agreed that throwing up was no fun. However, everyone agreed that it was a good thing or the person would stay sick longer or get worse. Everybody agreed how great it felt when it was over.
“Okay, Charlene, throwing up is a good thing.”
Suddenly, Charlene raised her voice, “Don’t say that word anymore. What word? Vomiting or throwing up.”
“Don’t say that word, please, Mr. Jenkins?”
Charlene was suddenly getting agitated. Her eyes were getting larger and she was squirming in her chair and pleading for Mr. Jenkins to stop.”
“What word? Vomiting? What’s wrong with vomiting? We just learned that throwing up, barfing, chucking, vomiting – it’s all the same thing – is a good thing, not a bad thing!”
Charlie waved her hands at Mr. Jenkins, “Stop! Stop! Stop!”
“Charlene, take some deep breaths. Nothing is going to happen. You are not sick. You won’t throw up or vomit or barf. Tell yourself. It’s okay, and it happens when you eat something bad. You haven’t eaten anything bad. You are just feeling nervous about the word. You are safe. It is okay. I can say ‘vomit, vomit, vomit, vomit’. “
“Stop! Stop! Mr. Jenkins, Stop!”
“Charlene, remember our deal. Take deep breaths now.”
Mr. Jenkins imitated the deep breathing, using his hands to indicate breathing in and breathing out.
“Charlene, tell yourself that every thing is okay, that you are safe. The words can’t hurt you. Vomit can’t hurt you. Throwing up can’t hurt you. Barfing can’t hurt you. Keep breathing, Charlene. Keep breathing. Keep telling yourself that you are not nauseous.”
“I can say barf-barf, vomit-vomit, womit-vomit. They are only words. You are only nervous about the word 'vomit'. You had a bad experience when you were 4 years old, but you are a big girl now. You have just turned 7. You won’t let the words bother you because to vomit is a messy thing, a stinky thing - but a good thing when you are sick. You are not sick. You are nervous and excited but not sick. Keep breathing. Keep breathing. Nice and easy. You can do this.”
The scenario continued for a while with Charlene jumping out and threatening to return to class. Eventually, things subsided and Charlene returned to class but not as calmly as Mr. Jenkins had hoped.”
Mr. Jenkins believed he had hit the nail on the head. Exposure was the only thing that would work. Still, he quietly said a short prayer for Charlene and then one for himself. Mr. Jenkins was of two minds. Should I have pushed her into exposure or shouldn’t I have pushed her? Deep down, Bob-the-counsellor knew the answer: exposure is the only way to fight anxiety.
Charlene came to see him the very next day. She seemed calm, and she was back! “Yes!” Bob-the-counsellor said to himself.
THE END
Panic Attack! A young person dealing with past trauma Part 2
Most people like stories, and therapy is all about stories. Telling stories about powerful techniques used in TEAM CBT therapy demystify this therapy one story at a time.
Yet, confidentiality is a cornerstone of all counselling. Without confidentiality, clients wouldn’t feel safe going to therapy to divulge the most painful areas of their lives. To safeguard clients while illustrating TEAM CBT techniques, confidentiality is kept by either having the client’s consent or by distorting the facts, making the client unrecognizable .
Robert Davies
Counselling Therapist