Should a Cup of Coffee Cause Panic?

Source: Photo by Liya Zerya Konuş from Pexels

A recent article online said that if we have a panic attack after a cup of coffee, that does not mean we have a problem; the problem is the caffeine.

Not so. Though caffeine may trigger panic, caffeine is not the problem. The problem is our parasympathetic system is not doing its job. When stress hormones are released due to caffeine—or due to any other stimulus—our parasympathetic nervous system is supposed to limit arousal. Our level of arousal is supposed to be regulated by these competing systems:

• The sympathetic nervous system: This system gets its name because it operates “in sympathy” with stress hormones. When stress hormones increase, the sympathetic system increases heart rate, breathing rate, and perspiration. It also re-routes the blood supplying the digestive system to the muscles. This takes place to prepare the body to flee or to fight.
• The parasympathetic nervous system: This system has the prefix “para” which means against. When the sympathetic starts revving us up, the parasympathetic is supposed to push back by slowing the heart rate, breathing rate, and reducing perspiration. It also restores the supply of blood to the digestive system.

Hyper-arousal

Many of us have not developed the psychological processes necessary to automatically activate our parasympathetic system. If we lack the processes, when stress hormones are triggered, the sympathetic system has free rein. Depending on the amount of stress hormones released, the sympathetic system may cause hyper-arousal. Hyper-arousal, alone, does not cause panic. In addition, the person must believe:

• They are in danger
• They cannot fight off the danger
• They cannot flee from the danger

A person may believe they are in danger for various reasons:

• They are frightened by hyper-arousal
• They do not know what the feelings mean
• They fear they are having a heart attack
• They fear they are going crazy
• They fear they will lose control
• They may have had these feelings previously when in danger or when traumatized
• Hyper-arousal has impaired their reality-testing and allowed memory or imagination of a traumatic event to be experienced as though it were taking place

Normalization Of Arousal

If a child is fortunate, an emotionally available parent has shared various levels of arousal with the child. In a workshop on emotional regulation, neuro-psychologist Allan Schore presented a video of a young girl and her mother sharing different levels of arousal. The girl smiled at her mother. Her mother smiled back. The mother's response caused the girl to smile even more, which led the mother to respond with a bigger smile. Seeing her mother's bigger smile, the girl giggled in delight. This delighted the mother, who then laughed.

In this way, the girl and her mother revved each other up to a peak of arousal. And then, as if they had climbed a ladder to its top, they climbed back down to a level of calm. By sharing a range of feelings of arousal, the child learned that all of those levels are safe.

But if a child is not fortunate and not able to share the entire range of arousal with an attuned caregiver, they may not experience all levels of arousal as safe. If that is the case, a high level of arousal can cause fear, which triggers additional stress hormones, which can cause increased arousal, and so forth. When a person feels threatened by arousal, they may use a distraction exercise such as The 5-4-3-2-1 Exercise to down-regulate.

Hyper-Arousal Can Impair the Sense of Reality

Ordinarily, the mind generates a sense of identity, location, and time. When overwhelmed, the mind may temporarily stop producing one or more of these senses:

1. Loss of the sense of time: The disappearance of time may allow the memory of a traumatic experience that took place in the past to be experienced as happening in the present. This is called a flash-back. A flash-back, if overwhelming, may be experienced as panic. Or, when time disappears, the imagination of a highly unlikely but disastrous event can morph into a terrifying experience that is happening. Think of this as a flash-forward. For example, when facing an upcoming flight, a fearful flier spoke of a flight that crashed. He said, "When they got on that plane, they didn't expect it to crash." He added, "Can you imagine what it is like to know you are about to die for ten minutes!" The implication is that experience would be unbearable. Then, he imagined himself as a passenger on a doomed plane. Imagining the terror he would feel triggered the release of stress hormones. The stress hormones caused his sense of time to collapse. He experienced what he imagined might happen in the future as a reality in the present. He said, "I just know that if I get on that plane it will crash." Though he did not panic, the same psychological maneuver, if done on a flight, can produce panic. For example, when a passenger on a plane imagines the plane might fall out of the sky, the stress hormones they release can cause them to experience a panic similar to if the plane were actually falling out of the sky.
2. Loss of the sense of location: As stress hormones defeat reality testing, we lose track of where we are. This loss puts us inside the movie we are making up in our mind. We lose the ability to escape. Now, deep into a movie of our own creation, we believe what we are imagining is actually taking place and that we are about to die. Once, I took a friend up to a balcony that overlooks St. Mark's Square in Venice. As we went through the door and stepped out onto the balcony, she yelled, "Get me out of here! Get me out of here!" To her, this expansive view was overwhelming. All she needed to get relief was to turn around and go back in through the door she had just come out of, to regain her sense of where she was.
3. Loss of the sense of identity: Normally, without being aware we are doing it, we generate a self-image, a sense of who we are. When overwhelmed, the mind's ability to produce this sense of identity weakens. As our sense of who we are fades away, we can be gripped with the terror that our existence is fading away as well.

Panic

When we have no control over such experiences, and no way to escape them, we may panic and experience the "fight, flight, or freeze" phenomenon. Evolutionarily, the most primitive response to danger is to freeze. This ancient response is still built into us. We cannot deliberately cause or prevent the freeze response. When the freeze response takes place, it is usually in a situation where it is impossible to fight off or to flee from a threat. Freeze shifts us from hyper-arousal to hypo-arousal and renders us unable to function.

Avoiding Triggers

Though we could try to avoid hyper-arousal by avoiding all triggers, doing so is considered a disorder called agoraphobia. It is healthier to establish the psychological processes needed to allow the parasympathetic system to do its job. A properly responding parasympathetic system prevents hyper-arousal. Just as the brakes on your car can override the accelerator pedal, your parasympathetic system can override the sympathetic system. None of us would drive a car with no brakes, yet many of us have no choice but to operate without the psychological processes needed to activate our emotional brakes.

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If we have the needed psychological processes, when stress hormones are released, our parasympathetic system overrides the stress hormones so quickly that there may be no sense of being stressed. If we lack these processes, when stress hormones are released, a feeling of arousal takes place that continues until the stress hormones burn off, which takes about 90 seconds. This may lead us to avoid situations where stress hormones could be released. The fear that these feelings may lead to panic can make us unable to fly. If the flight is smooth, we may be able to tolerate it. But if there is turbulence, the amygdala interprets downward movements of the plane as falling. Each time the plane moves downward, the amygdala of every passenger, not just the fearful passengers, releases stress hormones. In a passenger who has good automatic emotional braking, the effects of the stress hormones are controlled. In a passenger who lacks automatic parasympathetic activation, each downward movement causes alarm. Since there is one downward movement after another, additional stress hormones are released before the hormones previously released can burn off.

The distinguished neuroscientist Stephen Porges discovered that when we are with a person who is in no way a threat, signals are transmitted unconsciously by their face, voice, and body language that activate our parasympathetic system. We can use this discovery to establish the psychological processes needed to automatically activate our parasympathetic system. The following exercise is adapted from Panic Free, my book on how to increase automatic regulation of emotion. Dr. Porges provided an afterword about applying his discovery that therapists may find useful in their work with clients:

1. First, think of someone you feel physically and emotionally safe with. For this exercise, you need someone who is easy-going, who doesn't criticize, and who is not judgmental.
2. As you go through your day, look for the first feelings you get when stress hormones are being released.
3. Stop what you are doing. Look across the room and pretend you see the door opening. Imagine you see your friend walk in. As you imagine their face, your parasympathetic system will start to be activated.
4. Imagine you hear their voice saying hello to you. This will help activate your parasympathetic system.
5. Finally, pretend they come over and give you a huge, a high five, or whatever physical touch is appropriate for your relationship.

It is this intentional activation of your calming, parasympathetic system whenever you feel an increase in stress that will allow you to establish the psychological processes needed to activate your parasympathetic system automatically when stress builds up.