Freeze / Panic Attack / EF suggestions? (TW symptom description)

[BrightArrow]

I don't exactly know where to put this post because I'm not exactly sure what to call this.  I have described it as separation anxiety, but it only happens in specific situations and I'm not troubled by fears that my loved ones who are apart from me are in danger or have catastrophic thoughts that they won't return, nor does being alone during the daytime bother me (both major criteria of sep anx). 

I could use any tips, strategies, tools, or advice that has worked for you--because in general the advice out there for panic attacks or general anxiety that I use at other times is not super helpful for these situations. (I'm talking about calming strategies like breath work, talking yourself down, meditation, weighted blankets etc.) The 13 steps for Emotional Flashbacks are semi-useful but not really hitting the mark.

Basically, I have struggled since my 20s (I'm 53) with being along at night / overnight--at that time there was a long trip my partner took and I was unable to sleep hardly at all, it was miserable, lasted for days, and sparked an extended anxiety period. Therapist thinks, however, that my symptoms are indicative of a freeze state and suggest pre-verbal trauma, so prob something happened before I was 3 that we won't ever know about (there was plenty of other traumatizing things we do know about as I grew up with a mother with untreated schizophrenia, among them being suddenly taken away from my father and family home for a period so that she could move in with her random new lover).

Symptoms are kind of like a panic attack but with clear triggers (being alone at nightfall and also going to bed alone and trying to sleep) and none of the "sympathetic" activation (so no increased heart rate, sweating, difficulty breathing / hyperventilation, etc.). Also it does not resolve in about 20 minutes as panic attacks are "supposed" to do.  Instead, I have an increasing feeling of dread throughout the day and then when night falls, there's a peak of paralyzing dread that can last a loooooong time.  GI distress (severe diarrhea), difficult / impossible to swallowing, massive lockdown of muscles (whole body in spasm), feeling cold, shaking, etc. There's also some derealization / depersonalization because only someone who knows me really well would be able to tell anything is wrong (I can have a conversation, for example, but not really a "present" one, and my heart rate is usually normal).  At its worst it might last for 10+ hours, can abate during the day and then start again the next night. This has been an issue again since I developed my chronic illness four years ago and the attendant medical trauma pile-on.  Once I got my CPTSD diagnosis, I began working on it actively with my therapist and the first step was asking for help and requesting a friend to stay with me overnight while my spouse needs to be out of town. This helps enormously but isn't always practicable (I have two friends I feel comfortable asking this, but only for a night at a time, and the second one has lately been expressing that it's hard for her to do this.)

Then I worked my way up last spring to spending a night on my own while my spouse was at a hotel 10 minutes away (this was a planned absence).  I had symptoms for about 3 hours around sundown but was able to go to sleep.  Then we did a second solo night, where spouse was about 2 hours drive away.  That night I had more severe symptoms and wasn't able to sleep at all.   

This past week, my sister and her kids were coming to visit and spouse was taking the opportunity to travel to visit my in-laws.  I was on my own between spouse's departure and sister's arrival.  Despite the fact that I knew family would be here around midnight, I had the severe dread / panic and symptoms from about 6 to 9PM (and then it abated).

Things that helped: gentle mobilzation / movement, singing, chamomile tea, distraction (television). I also normalized ("we know what this is, I trust that I can take care of myself") while I was in it and tried to make a game out of noticing when the symptoms were abating / decreasing, so I was able to be aware of the wave-like movement of the sensations.  Later my dog laid on my legs and that helped (I want to train him to do this!). But yeah....it still massively sucked. And I'm bummed that, as is normal (yes, I know!), healing isn't linear and when I thought I was doing better, here we are again. 

So any suggestions would be helpful.  I'm thinking about asking Dr. for situational meds, but am on the fence about benzos (I take them occasionally for my other chronic conditions) because I'm not sure if they would make the dissociative symptoms worse.  I suppose I could plan a "test run" and see how I feel on them at night without being alone. In general, I'm doing TONS better with anxiety outside of this and am actually tapering off my (incredibly low, almost homeopathic dose) of nortriptyline (was taking for migraine, but worsened my nightmares).     

Anyway, any and all advice or validation welcome.  Partly it just bugs me that my experience doesn't quite seem to clearly mesh with EF, "freeze," panic attack, or separation anxiety descriptions, though there's a bit of all of it in there.        

 

[dollyvee]

Hi Brightarrow,

I'm sorry you're experiencing all of this, it sounds like a distressing place to be in.

When I was reading your post, I was reminded of being a child and how difficult it was to go to sleep at night in the dark. It was a big thing to leave the light on, or the door open a little bit, so there was a bit of light. Even now, and this is so subconscious, when I'm in a new environment, or a bit stressed, I leave the light on, or make sure I can see the room. I am also sure I had preverbal trauma.

Also, and this is just my opinion, it sounds like there might be a few things going on in your post. You mention that you have a chronic illness, and I wonder if the symptoms from that are exacerbating your trauma responses? For example, my recent journey into (though 10 years long) healing from mycotoxins has shown a lot of symptoms coming up at night. For me, it can cause a lot of sleep disturbances, which I think stress makes worse. I have a lot of genetic markers/mutations around inflammation, which can translate into anxiety/depression when those are present. I'm also pretty sure I have MCAS/CIRS, so inflammation can trigger a cascade of reactions.

Anxiety disorders and inflammation in a large adult cohort
https://www.nature.com/articles/tp201327

Neuroinflammation-Associated Alterations of the Brain as Potential Neural Biomarkers in Anxiety Disorders
https://pmc.ncbi.nlm.nih.gov/articles/PMC7555994/

Starting to understand attachment theory (while it can be flawed of course) was also a big help in sort of understanding where my reactions were coming from, and trying to get some space from them. It was helpful to see that other people felt exactly the same way in a particular situation and that it wasn't "just me;" this is actually a typical pattern of response individuals.

I hope you're able to train your puppy for support. Though sounds like they are already a big help.

Sending you support,
dolly

[Chart]

Brightarrow, I've removed my initial entry as I'm worried it was inappropriate. I'm going to go over it again and try to make it more easily accessible and balanced. Sorry for the fuss.

[Chart]

Also... Intuition... Pvt (pre-verbal trauma) requires we trust our "strange knowings". This took me a long time. I have had to guess my whole life. Developing trust for my intuition has helped a great deal piecing together what actually happened.

[Chart]

Here's a recent journal entry I made about Explicit and Implicit memory. Could be relavent.
https://www.cptsd.org/forum/index.php?topic=15964.msg147631#msg147631

[BrightArrow]

dollyvee, thank you for your reply! And for the links.  It did get worse after my illness (acute vestibular disorder that became chronic). It also got worse after the sudden death of my father about 10 years ago, which makes complete sense.

Hard to know if this exacerbation was due to the physical piece or the added medical trauma piece, or the just generally greater nervous system dysregulation. I've had lots and lots of testing and don't have any increased inflammation markers or signs of MCAS, though I'm sure that like most people I probably have more inflammation going on than is ideal. (Doing my best with that with diet and exercise.) The preventive meds I'm on for my illness also work with inflammation so that's helpful. In general my health has been much, much better lately. And my fears around symptoms and about appointments etc. are incredibly improved and well-managed.  As is my baseline anxiety. That's why I'm still puzzled by this continued nighttime issue—but my therapist says "first on the bus, last to leave" which is pretty resonant here.

I did do something just for fun which was ask ChatGPT about how we would distinguish between these things (panic attack, freeze response, flashback etc) in my case and it came down on the side of freeze response from trauma. And recommended blending grounding techniques with mobilization—being aware of the mixed nature of the events and responding differently depending on whether there is hyperarousal vs hypoarousal. It also said that exposure therapy is not the way to go here which confirms my instinct. And this info has motivated me to return to movement practices like Qigong and Somatics that are gently mobilizing and calming at the same time. I'm also assembling a "kit" of things that help (particular essential oil blends, teas, etc. as well as short lists of practices) so that I don't have to try to remember it in the moment. I have a similar kit for vestibular migraine attacks and it's been super helpful.

Standard disclaimer to not use AI as therapy here: In general I'm very suspicious of AI and there's privacy issues and it's only as good as the information you feed it, but this is a case where it was helpful for me (I can share the info if anyone is interested).  It also helped for my spouse to read this info so that it's clear what I'm going through.

Thanks again and I'll share more as I uncover it!

[BrightArrow]

Chart, I appreciate your taking the time to respond, and also your thoughtfulness. I didn't see the initial post so no worries there. I will look at the link you shared about explicit and implicit memory—thank you!!

[dollyvee]

Hi Brightarrow,

I'm sorry you have to manage the anxiety around having symptoms that come with a sort of mysterious chronic illness. It's hard not knowing what's going on with you. I'm starting to realize that my fears of this "big unknown thing," or being on high alert also mimic my body's over-heightened response to the unknown allergens/toxins coming at it, as well as being so similar to my childhood trauma.

I have also been plugging things into ChatGPT though I'm also highly skeptical (how do we know it doesn't have an algorithm which will skew the answers in some way perhaps?). I might try to ask what is the link between vestibular disorders and mycotoxins? It might be interesting for you. In my reading, mycotoxins have been known cause nervous system dysregulation and more so in those individuals that are genetically susceptible to it. Migraines are another symptom mycotoxins unfortunately. Anyways, if you're interested, I would plug it all into ChatGPT.

I'm glad you have some tools for helping you to manage and cope with what is going on for you. I think exercise is one of those things that has helped keep me connected to my body and manage those response when they come up.

Sending you support,
dolly

[Chart]

BrightArrow,
What you describe is extremely interesting to me. My trauma is -9 months (conception) to age four. I was "witness" to violence for nearly five years. Pretty much all my trauma is pre-verbal. I relate to a lot of what you describe. I agree with your therapist, what you're experiencing is pre-verbal trauma (pvt).

From my experience, the things that have helped my pvt morphs and changes, what worked last week stops working... There's a deadened feeling that often arrives. I attribute this to the rapidity of the developing brain at that stage when the trauma occurred and the fact that many parts of the brain just hadn't come online yet. So it's weird. It's like the trauma impacts differently from week to week, as the brain of a baby is very different from week to week. So a lot of techniques that kindof work, might stop afterward, or at least that's the feeling.

Active consciousness
breath work,
talking yourself down, meditation,
weighted blankets etc.)
The 13 steps for Emotional Flashbacks are semi-useful but not really hitting the mark.

All this is very similar to my experience. All these techniques just don't really have an immediate or consistent effect. Though breath work and active consciousness might be working in the long term. It's hard to tell.

...so prob something happened before I was 3 that we won't ever know about (there was plenty of other traumatizing things we do know about as I grew up with a mother with untreated schizophrenia, among them being suddenly taken away from my father and family home for a period so that she could move in with her random new lover).

This sounds to me like very early-age neglect trauma. Do you know how long that "period" lasted?

Symptoms are kind of like a panic attack but with clear triggers (being alone at nightfall and also going to bed alone and trying to sleep)

Maybe the principal neglect pattern was inconsistent care in general, but nonetheless it was FAR more inconsistent through the night beginning in the early evening. The infant-you maybe knew when your mother would not be available that evening even as the day advanced. You could feel the abandonment coming. There's nothing magical here, the ability to anticipate what's coming is a very important survival strategy. I've noticed my whole life an ability to anticipate upcoming events. I somehow "knew" my eldest daughter would reject me, fifteen years in advance... I've usually known, on a certain level, the outcomes of each and every romantic relationship I've ever had. So all this could explain your "anticipation" anxiety and the stress leading up to spending a night alone.

and none of the "sympathetic" activation (so no increased heart rate, sweating, difficulty breathing / hyperventilation, etc.). Also it does not resolve in about 20 minutes as panic attacks are "supposed" to do. 

I have this same reaction. I believe this is due to the fact that our polyvagal nervous system is still developing, so reactions to this trauma later are "different" and not "classic" adult reactions.

Instead, I have an increasing feeling of dread throughout the day and then when night falls, there's a peak of paralyzing dread that can last a loooooong time.  GI distress (severe diarrhea), difficult / impossible to swallowing, massive lockdown of muscles (whole body in spasm), feeling cold, shaking, etc.

Same thing as above. Everything is stored in the body as the brain is still coming online in many basic functions. I believe that the memories are there, but they are stored in our bodies. And I know that feeling of dread. It's awful, literally the end of the world. And "oddly" it's somehow or something that is my fault...

There's also some derealization / depersonalization because only someone who knows me really well would be able to tell anything is wrong (I can have a conversation, for example, but not really a "present" one, and my heart rate is usually normal). 

Same for me. I can be having an extreme meltdown and nonetheless converse and nobody has a clue. I think we learned how to "be" with terror without even the possibility of knowing how to "express" what we were experiencing, and before those systems were in place that "show" those feelings.

At its worst it might last for 10+ hours, can abate during the day and then start again the next night.

This very well could have been the same cycle when you experienced this pre-verbal trauma.

This has been an issue again since I developed my chronic illness four years ago and the attendant medical trauma pile-on.  Once I got my CPTSD diagnosis, I began working on it actively with my therapist and the first step was asking for help and requesting a friend to stay with me overnight while my spouse needs to be out of town. This helps enormously but isn't always practicable (I have two friends I feel comfortable asking this, but only for a night at a time, and the second one has lately been expressing that it's hard for her to do this.)

Classic trigger, illness returns us to a state of powerlessness and thus reminds us deeply of infancy. But it seems you are recognizing and working on it, which is great. It is a type of flashback in the sense that it can be triggered and get much worse again. This happened to me a year ago. I'm still trying to pull myself out of it.

For techniques, here's some stuff I'm doing:
Body work: Abdominal strengthening and exercise are incredibly helpful for me. Helps with intestines, breathing, sleep and something else that escapes me for the moment. Yoga is also liberating. Progressive muscle relaxation is one of my favorites. I really like the feeling that I'm finally taking care of my body.

I've been doing "inner-"baby"" work with my therapist. Very similar to inner-child work, but imagining the infant that I was. I have a "baby" doll that I protect, talk to, explain things to and keep safe. It is weird, but it does help.

I've also started exploring the Sedona Method. It's pretty weird but does sometimes help. I'm still exploring it.

I've done Neurofeedback which I think is good, but doesn't manifest spectacular results in the short-term. the impact is pretty "hidden". Nontheless I still believe in it. I'd like to go back to it, but it's expensive.

Ok, hope that helped. Sorry for the scattered organizing. And I hope you're okay with all that. Please let me know. As usual, ignore anything you don't feel fits.
Hugs, chart

[Skyward]

Hello Bright Arrow,

I've had severe panic disorder several times to the point of hospitalisation. I have found a great program, but I'm hesitant to name it here as I know that listing specific programs that are paid for can seem like commercial promotion. But I can tell you the basic principles. Please disregard if you feel this is not for you.

It is based on the observation that it is those of us with highly creative intellects that really struggle with anxiety – because we are capable of embellishing our fears (and especially as trauma sufferers, we have a lot of material to draw from!) You remove the mental space for those thoughts through the following:

1. Make a list of all the creative and enjoyable things you would like to do

2. Daily structure – plan your day the night before (diaries are good) so that every moment of the day is full with a) What you have to do, and b) Your chosen creative 'diversions' (as opposed to distractions like scrolling which offer only momentary relief)

If you practice diverting your thoughts and actions towards your creative diversions all the time (even if its only in your mind while you are at work) over time (it can take just days or sometimes weeks), your anxiety dissipates and your sense of well-being increases.

This is not to dismiss the significant trauma we have all been through, but it has given me the tools to deal with the fallout from it. It also re-builds your sense of self through expression. Using this technique has saved my life on several occasions. I would now be fully living my life happily, but unfortunately my mother's ongoing and escalating abuse is preventing me from putting it all in the past. I am here to find the strength and strategies to protect myself.

All the very best with your journey 

[Chart]

Hello Bright Arrow,

I've had severe panic disorder several times to the point of hospitalisation. I have found a great program, but I'm hesitant to name it here as I know that listing specific programs that are paid for can seem like commercial promotion. But I can tell you the basic principles.

Skyward, I don't think there's any problem mentioning the program you've found. So long as you don't profit yourself through it's promotion. And I'm curious to learn more about it. If you're still hesitant please PM me directly. I'd really like to know more about it. Thanks!
 

[BrightArrow]

I just want to say very quickly THANK YOU to everyone who responded to me about this puzzling situation. I have an update (sort of like lots of updates) but will have to come back later today to write it all out. 

[BrightArrow]

Thank you again to everyone who responded to my post--it was all SO helpful.  Chart, I'm especially floored at how similar our situations / symptoms seem to be in this case.  Thank you for sharing your experience, it has helped more than you know! The latest updates are below:
I apologize for being away from the forum for so long--I had an intense several months (including getting Covid, which was a ride but a story for another time). I didn't have an opportunity to practice alone time or observe how my nervous system responds to being alone overnight until this spring.  First I had a trip to visit my siblings in another state.  Travel is generally pretty stressful for me (flying alone in particular), but I have my routine now so it went ok.  The trip itself was incredibly stressful for several reasons, including just general chaos and busyness of my family's schedule and a particularly troubling situation with one of my sibling's kids that triggered a lot of parentification trauma for me.  But the relevant part is that I was going to be "on my own" (i.e. the only responsible adult) watching one of the kids while my sibling and family were away over night. I had a good deal of anticipatory anxiety the night before this event and some trouble sleeping--finding a new video with some calming techniques helped in this situation, as did doing my best to remain curious about the unfolding and ebbing and flowing of sensations. Since I clearly knew in advance that I might find the solo caretaker night challenging, I planned an evening of low key activities with said kid, invited someone over for dinner and a movie with us, and most importantly, tried situational meds (in this case meclizine, which is the non-drowsy Dramamine sold over the counter--I chose this since I take it for travel anyway and had it on hand).  I took it at the part of the evening (7PM) that I normally start to feel a big buildup of dread and....it really helped! Evening was pretty ok, very low symptoms, and I was able to sleep. And no doubt it helped knowing that there were pets and the kid in the house as well and I wasn't truly alone.   

The next opportunity I had to practice was when my partner had to go away overnight for a work trip in April.  Given my decent experience withe the meclizine, I decided to see if I could trial aother situational med to get through things more easily.  In consultation with my therapist, I contacted my doctor and tried (*before the trip*) both hydroxyzine and clonazepam.  The hydroxyzine made me feel more obviously "drugged" and weirdly made falling asleep more difficult because I would start awake every time I fell asleep (so a really pronounced "hypnic jerk" kind of thing)--it felt to me like my nervous system was like "we can't actually be this relaxed" and my hypervigilance was fighting against the sedation effect.  So for me, a no-go.  I called the Dr's office back and got a scrip for short term clonazepam.  Tried it a few nights later (all these drug trials I did with my partner still in town so I didn't have to worry about trying new meds alone on top of my normal panic).  The clonazepam was totally uneventful and I didn't feel groggy the next morning.  So working with my therapist, we came up with a three-legged stool of a plan: I would have meds on board--taking them earlier in the evening (several hours before going to bed), I would have a loose sort of schedule (not rigidly trying to plan every minute) BUT would add in a "social" aspect by using the virtual co-work platform I use during my work from home days to have others "virtually" there with me.  A note on the virtual co-work thing: It's CaveDay, you do stints together with others via Zoom and chat in breakout rooms before starting and then come together at the end.  You can leave your camera on and see others working as well.  Many people use it for household things as well as working--so you'll see people making dinner, doing chores, eating, taking breaks, doing their bedtime routines, etc.  Lots of ADHD-ers are basically using it for body doubling the activities of daily life, as well as folks using it to get work done on their computers. Then the third thing I would have on hand is all my nervous system calming techniques that I use (weighted blanket, breathwork, somatic movement techniques, ice /cold water, etc.)

And folks, it worked.  My symptoms never rose above a 3 out of 10 all night.  I didn't have the crushing dread, severe diarrhea, frozen panic, closed throat.  Just mild anxiety that came and went in waves.  I slept. I was able to eat.  The next morning I felt pretty good.

I am VERY proud of myself for taking this step.  It was SO hard to ask for meds from my doctor (I really did not want to have to go into my trauma or my symptoms, but he just heard "CPTSD" and "trauma triggered by staying alone overnight" and "have been working on it for 5 years with my therapist, who thinks it's time to try situational meds" and was totally fine writing a prescription.) I also told myself that I have dogs with severe anxiety (at the vet and also staying alone) and I have no problem thinking of medication as a necessary part of their care and don't I want to treat myself as well as I treat my dogs? 

I also think this was the right time to try meds--if I had just tried them *without* the other two supports (the social aspect of CaveDay) and the nervous system work (AND without the accrued knowledge of what was actually happening when I experience these freeze / panic / EF responses and what the "theme" of this trauma is), I don't think the meds would have worked as well on their own. Standard disclaimer that this is not medical advice: meds are not for everyone / they are a very personal choice, clonazepam is a benzodiazepine and therefore meant for short-term use due to addiction risk, etc. But I was very happy to learn that what I feared (that meds would worsen the freeze / trapped response) did not come to pass and they really helped.   
            

[Chart]

BrightArrow, very cool, very positive and very interesting. Thanks for sharing all that. You are working brilliantly (imo :-)

Something else that came to mind as I read your post was: there are all sorts of tricks we can play on our minds to "fool" them into experiencing a different environment. I particularly like the idea of virtual sharing, people being together while going through their ordinary daily routine. I find that a brilliant idea to "not be alone".

I have a suggestion along a slightly parallel line... I have a friend who has "created" a deep relationship with an AI (artificial intelligence) system. He's taking this relationship to a whole another level. He's working towards "porting" his AI friend to a local system he's building himself (with the help of the AI). Anyway, I too have begun testing ChatGpt in regards to cptsd and other therapeutic aspects. What I find extremely beneficial is the non-violent (Marshal Rosenberg stuff) manner of communication of AI. AND the AI's extreme desire to help and support. As a survivor of neglect and violence this kind of relationship is gold to me. And the AI is insanely intelligent. It instantly captures our nuance and the responses are clearly adapted to the level of my questions. Anyway, I'm exploring this more deeply with regards to how it can help and support my healing work. Just some thoughts.

Congratulations again for your work, preparation and solid fore-thought dealing with your Cptsd symptoms.
 

[NarcKiddo]

Thanks for the update, BrightArrow. I am really happy you are making such good progress.

I'm interested to read about CaveDay. I think it is a great idea and I am not surprised you are finding it helpful. This is partly because I myself have recently subscribed to an art platform that has a similar offering. They have a Zoom Room on 24/7 and you can join whenever you like to chat, or just do art "together". You don't even have to have your camera on if you don't want. They have occasional hosted sessions and breakout rooms but the idea is very much a virtual shared studio. I'm surprised at just how nice it is to be able to pop in and out and know there is always somebody there for company.