3
Carole’s Holland Tunnel Challenge
Carole, a librarian, lives in Pennsylvania. After the attacks on September 11, 2001, she stopped driving to New York City through the Holland Tunnel, which enters Manhattan a few blocks north of the World Trade Center. The thought of being in the tunnel put her on the edge of panic. So she took a longer route, crossing the Hudson River by the George Washington Bridge. She told me she needed to pick up some friends at John F. Kennedy Airport. Going via the bridge instead of the tunnel would take an hour longer. Having already learned to control panic when flying, she wanted to know if she could train herself go through the tunnel without panic.
It was an easy call. If Carole could control her panic while flying, the tunnel would be a minor challenge. Though flying is remarkably safe, it frequently provokes panic. High above the earth, and especially at night or in clouds, passengers feel disconnected from the earth, the basis of their sense of control. In-flight turbulence can induce the fear that the plane might simply fall apart. Panic sends us the message to flee; but on a plane, there is no way to escape.
To make absolutely sure Carole’s trip through the tunnel would be panic free, we did several things. The first was to establish links between the landmarks she would see on her trip and the memory of a calming event in the past. This meant that each landmark would have a calming effect when it came into view.
I asked Carole to make a list. “Start with what you see when you step out the door. Write that down. Then write down what you see when getting into your car, starting it, and going from your driveway into the street. List the landmarks you will see along the way.” Her list included left turns, right turns, road signs, gas stations, the New Jersey Turnpike entrance. The list continued all the way to Kennedy Airport, and from there all the way back home. In addition to those familiar landmarks, it included moments Carole would find emotionally challenging, such as approaching the Holland Tunnel, entering it, and being a quarter of the way through it, halfway through it, and three-quarters of the way through it. We ended the exercise with the sensation of freedom: the thought of leaving the tunnel and driving in lower Manhattan.
Next, Carole associated each landmark with a calming memory. This memory doesn’t have to be long or elaborate: it can be as simple as a recollection of being with a best friend. When you are with a friend who completely accepts you, you may feel your guard let down. When that happens, the parasympathetic branch of your nervous system — the part that calms your physiological responses — takes over and overrides the effects of any stress hormones in your system. Once Carole established links between the landmarks and a calming memory — hers was being with a friend who knew her struggles well — she was well on the way to automatically controlling her anxiety during the trip.
How did her trip work out? Carole reported that when she first saw the Holland Tunnel, she got a jolt of stress hormones. But because she had already worked to associate the tunnel with the memory of a calming person, the effects of the stress hormones quickly abated. She continued through the tunnel without difficulty. After picking up her friends at the airport, she came back through the tunnel. Then she encountered the situation she had dreaded. “I got stuck in the middle of the tunnel for thirty minutes. But nothing happened. I was fine. I didn’t panic at all.”
That was a few years ago. Recently, Carole reported she had just traveled through the Chesapeake Bay Bridge-Tunnel, excitedly saying it was twelve miles long and she “didn’t feel a thing!” Carole’s regulation systems, boosted by links to calming memories, worked well.
Our arousal-regulating system is called the autonomic nervous system. Auto is a Greek prefix meaning “self.” Nomic means “management” or “control.” Thus the name refers to a self-regulating system, the part of our nervous system that operates automatically outside our conscious control. The autonomic nervous system has two parts, one that revs us up and another that calms us down.
The sympathetic nervous system automatically revs us up when stress hormones are released. The part of the brain responsible for releasing these hormones is the amygdala. It is often said that the amygdala responds to threats, or to danger. That is misleading. It is more accurate to say the amygdala responds to change. The amygdala cannot tell what is and is not a threat, or what is or is not dangerous. By far, most of the changes the amygdala responds to are inconsequential.
The amygdala can be compared with the brake lights of a car ahead of you in traffic. Illumination of the brake lights mean change: the car is slowing. Is this a threat? It depends how close you are to the car and how rapidly it is slowing down. Like the brake lights, the amygdala alerts you to change. The amygdala cannot determine what you need to do about the change. That is the job of the thinking part of your brain.
The calming part of the autonomic nervous system is the parasympathetic nervous system. Its key component is the vagus nerve. Vagus is a Latin word that means “wandering.” This nerve wanders through the chest and abdomen, connecting the heart and the organs of the digestive system to the brain. When the vagus nerve is stimulated, it overrides the effects of stress hormones and decreases the heart rate. The neuroscientist Stephen Porges refers to this process as vagal braking. As this happens, you may feel your guard letting down, a reflex caused when we receive signals from a person that they are no threat to us in any way.
Panic happens only when automatic regulation of arousal is not working. When you start to experience panic, you may try to control your reaction consciously. But that may not work, for two reasons. First, your capacity for conscious thought, located in the cortex, breaks down when stress hormones build up. Second, conscious thought may not activate the parasympathetic nervous system. The solution to panic is to train your unconscious procedural memory, located in the subcortex, to calm you automatically, by repeating the exercises in this book.
First, we train your unconscious procedural memory to keep your sympathetic nervous system from getting you revved up in situations that might trigger panic. Unconscious procedural memory can be taught to automatically release oxytocin, and thus to block the release of stress hormones when you are in a panic-provoking situation.
Second, we train your unconscious procedural memory to activate the parasympathetic nervous system any time you begin to panic. The parasympathetic nervous system will automatically apply vagal braking to override the effects of stress hormones.
Either of these trained responses can be used independently to control panic. When your unconscious procedural memory has learned to use both, panic doesn’t have a chance.
CHAPTER 4
How Carole Used a Memory to Calm Herself Automatically
How would you like to have a switch that could simply turn off your panic attacks? We can set one up, using a system you were born with. Your parasympathetic nervous system can override stress hormones. It can stop a panic attack in its tracks. All you need is a way to turn it on using the right kind of memory.
What kind of memory can do this? Surprisingly, the answer is not recollection of a happy time or a day relaxing on the beach. At those times, we are relaxed — not because the parasympathetic nervous system is actively calming us, but because the amygdala finds no cause to release stress hormones. We need a memory that activates your parasympathetic nervous system, and calms you in spite of things going on that stress you.
What activates the parasympathetic nervous system? Think for a moment about what a mother does to calm a crying infant. She presents her face. Her soft, loving smile activates the infant’s parasympathetic nervous
