David M. Callahan, Ph.D.
Providing Psychological Services to
Cape Cod and Southeastern Massachusetts
Eliminating Panic Attacks with the Amplification Technique
The intervention I am describe below is one that I developed in the early 1990’s to assist patients suffering from panic attacks. It had been my experience that interventions that directed toward understanding the cause of the panic attacks were often quite ineffective, at times even increasing the frequency and intensity of the panic attacks due to the phenomenon of stimulus generalization, in which more triggers seem to become associated with the panic as possible causes are explored. Due to that experience, it was clear to me that an alternative approach needed to be found.
The typical pattern observed in persons with panic attacks is that they will have a single panic attack, frequently but not always triggered by some type of stressful situation or unusual experience. Most persons who have such an experience seem to rebound from that without difficulty, with no recurrence of the panic attacks. However, a significant percentage of people will, often after a period of several weeks or months, experience a second panic attack. Thereafter, there is often a significant increase in the frequency of the panic attacks, with panic occurring more frequently and intensively. It is often only after several such events have occurred that clients would enter treatment.
The cause of the panic attacks, in this psychologist’s opinion, is somewhat complex. I believe that the best explanation for the initial panic attack is that “stuff happens.” A large percentage of people experience a panic attack at some point in their lives, with the triggers often fairly vague and not atypical experiences for the person. For whatever reason, the proverbial planets align in such a way that a panic attack occurs. This is probably best seen as a momentary and transient event that is not likely reflective of any severe pathology, but instead is the result of multiple factors creating what is essentially a “perfect storm” that triggers the panic.
It is during the second cluster of panic attacks that the amplification technique becomes useful. The cause of the second cluster of panic attacks is, again in my clinical opinion, the result of having had the first one. The recurrence of panic attacks creates a tremendous amount of anxiety for individuals, as panic attacks are indeed extremely uncomfortable and perceived as rather dangerous. In a panic attack, a person experiences a rapid heart rate, shallow breathing and significant global discomfort. Persons often fear that they will die of a heart attack or that they are “going crazy,” as the intensity of the response is quite uncomfortable and anxiety-provoking. The fortunate reality is that panic attacks are generally not perceived as particularly dangerous. The lingering long-term negative effect of panic attacks is virtually absent. Even the immediate dangers are actually far less than the discomfort would tend to predict. Generally speaking, at the worst, an individual may lose consciousness and essentially pass out during a panic attack. However, this is a fairly infrequent event, as I have met only one patient in my entire career who has actually lost consciousness during a panic attack, among the thousands of persons whom I have met who have experienced them. Generally speaking, panic attacks are periods of extreme discomfort that are very disconcerting, but are truly not particularly dangerous. Elevated heart rate is very comfortably tolerated by the body in most individuals with reasonably intact cardiac health. There is no association between panic attacks and loss of sanity. Thus, while panic attacks can feel terrible, they generally are not considered particularly dangerous.
However, the extent of discomfort and arousal in our central nervous system that panic attacks create is extremely fear-inducing. We are wired to perceive elevated heart rate and sweating and rapid breathing as signs of response to danger. It is our nature to become fearful in the moments when our body is responding this way, as these are all clear triggers of fear. Unfortunately, it is that very fear that likely perpetuates the experience of having panic attacks. It is learning to relinquish that fear that is ultimately the solution to the panic attacks themselves.
The typical person who has experienced more than one panic attack begins to be hypervigilant and overly aware of their level of anxiety. Once you have had several panic attacks, it becomes very important that you do not have another, as they are a source of a combination of terror and embarrassment that people find quite aversive. As a result, even small amounts of anxiety begin to be noticed, at a level that was unlikely to have been perceived as problematic previously. As a result, normal levels of anxiety begin to become somewhat anxiety-provoking. A person who is experiencing normal fluctuation in daily anxiety begins to become very aware of moments of even mild to moderate anxiety. That awareness creates concern that this moderate anxiety will escalate into more intensive anxiety. As a result, people start to become “nervous about getting nervous.” The typical response to such concern is to attempt to “fight off” the anxiety attack. Unfortunately, fighting anxiety essentially increases the level of the anxiety, as very active fighting anxiety becomes the source of increasing tension and arousal, which therefore triggers a heightened level of anxiety. In essence, the more anxious a person becomes about being anxious, the more likely his or her anxiety will increase. This tends to spiral into increasing levels of anxiety that ultimately triggers panic once more. In essence, the more you fight, the more likely you are to lose.
The Amplification Technique reworks that process by discontinuing the attempt to fight off anxiety. In essence, the Amplification Technique recommends that a person who feels as though he or she is about to have an anxiety attack attempt to create one as rapidly as possible. In order to do so, a simple technique is employed. The client is encouraged to take a 10-second pulse at the carotid artery in their neck and then to wait one minute. During that minute, they are asked to try and increase their heart rate and make their anxiety level higher. As individuals discontinue the tendency to ward off anxiety, as these clients stop fighting anxiety and essentially learn to “go with it,” the level of tension associated with the fighting off the anxiety reduces. Typically, not only is the client unable to increase their heart rate during that one minute period, but the heart rate begins to reduce. As the heart rate reduces, subjective experience of anxiety reduces and concern about the impending panic attack dissipates.
For those interested in understanding the physiology, this approach essentially shifts the client out of a sympathetic response in the autonomic nervous system into mor extensive cortical involvement, allowing the vagal brake to reduce heart rate and arousal levels.
I have taught this technique to hundreds of clients through the years, with a very high success rate. The technique takes advantage of our physiological responding in a way that talk therapy tends not to. This approach works much more quickly than relaxation techniques such as deep breathing, although certainly employing those is encouraged as well.
As a short anecdote to demonstrate the effect of this technique, I recently performed a neuropsychological evaluation on an adolescent female who had been experiencing panic attacks for several months. In my feedback session with the client and her mother, I explained the Amplification Technique. Coincidently, the mother was scheduled to meet with me several weeks later. During that later appointment, she informed me that her daughter was doing quite well, even that morning making a comment that “I thought I was going to panic, but I just went with it and it went away.” More impressively, the mother reported that her own history of decades of panic attacks had been successfully interrupted by her own use of the technique, which had been one of the reasons for her seeking out an evaluation with me in the first place. Thus, we see a very brief training session resulting in very rapid acquisition of a skill that is very effective for a person with recent onset of panic attacks and another with many years of panic.
I would caution that this technique has not been subjected to a controlled clinical study, as I am a private practitioner without the resources necessary to perform such a study. This approach is offered as a noninvasive, benign intervention that requires no pharmacology to be effective. It has been my experience that the use of this technique can be quite dramatically impactful in improving quality of life and reducing risks for panic.
If you use this technique, please contact me as to whether you have found it beneficial. My email address is dcalphd@myway.com. Thank you.
