From Stress to Terror

Not every screw needs a hammer. Find the right tool for the mental state.

Hey there! I’m glad to see you made it back. How’ve you been? I’ve been doing a lot of thinking and researching since we last spoke. Last week, I told you about my experience in an MRI tube and how I felt. I used words like stress, anxiety, terror, fear, panic. But I used those words in a casual way, interchanging them as if they all meant the same thing. I wasn’t sure if they did, so I did some digging. Turns out I was wrong. At least from a scientific standpoint. Which, it turns out, is kinda important when you’re trying to figure out why you feel a way and how to manage that feeling. Right tool, wrong job. When you have a hammer, everything looks like a screw.

So, what are the words, what do they mean, what do they do and how do I manage them? Stress, anxiety, fear, panic, terror. I’ll break them down one-by-one so we can get on some common terrain.

Stress is your slow clock response. It’s the turtle. Or the follower. It’s the one that acts after another of these on the list, as a follow up. Your HPA (Hypothalamus-pituitary-adrenal) axis gets the signal that there’s a problem, so it releases cortisol to get your body ready to fight. Or flight. Kill or be killed. Run away or be dinner for some sabertooth tiger.

Cortisol and adrenaline are hormones that raise your heart rate, your blood pressure, your energy level, and get you ready for action. Adrenaline burns off pretty quickly, but cortisol. is. slow. It lasts hours, or days, if you don’t burn it off. (spoiler: exercise) And it lasts long enough that if you have another emergency before you fully rid yourself of the last batch, you’ll get a build up. What is bad about cortisol you say? Cortisol is an anti-inflammatory. Inflammation, it turns out, and you’ll see in later essays, and as a thread throughout almost all of my future writings, is a bad, bad thing. Inflammation causes issues with your heart, your brain, your platelets, your gut. The list is long. It’s bad. And the problem with high cortisol levels for an extended period of time is that your body builds up resistance to cortisol, and it loses its ability to anti the inflammation.

How do you deal with this? You need to actually recover. You need time. You need rest. You need Aruba. And exercise, as distasteful as it sounds. Cortisol and adrenaline were put into your system so you could do pushups and run laps, so, the best way to get rid of them is to do pushups and run laps. Or swim. Swimming is good because you don’t look out of place swimming with a Piña Colada like you do running with one. Also, running is hard on your knees. Swimming is a good, gentle, vigorous full body workout. Yoga is good, too.

Anxiety is different. Anxiety is a fear of something that might happen. It’s not about a real, actual threat. So you have this thing called self. Science calls it your DMN (default mode network). DMN, Daemon? Demon? I cast thee out!

This is your brain’s self-referential system. Your “me”. When “you” have anxiety, your “me” is almost always on, which keeps “your” amygdala active and working towards scenarios and not real threats. Your amygdala, however, doesn’t know the difference between a made up “scenario” and a tiger about to pounce. And unlike a real threat, anxiety has no real physical object and no real timeline. Some thing, some time.

So how do we deal with this? You have to get your prefrontal cortex back in charge. You have to think, “what am I afraid of”? And get out and touch grass. Wash the dishes. Do something to get your DMN turned off. When you’re thinking about right now, where you are, what’s around you, you can stop worrying about what may never actually come. So the antidote for anxiety is mindfulness. Meditation. Being in the now so you’re not thinking about next week, or next year. “What is actually threatening me right now?”

Anxiety also has a physiological feedback loop that keeps it going. It’s almost like the panic/fear of fear loop, but at a lower level. Anxiety triggers your HPA to release cortisol, which over time leads to cortisol resistance, which allows more inflammation (pro-inflammatory cytokines), which can cross the brain-blood barrier to reduce your serotonin production, which can lead to more anxiety and depression. Whew! That’s a lot of words to say that anxiety leads to more anxiety.

So you have to break the cycle and get your body to get its groove back (reduce cortisol resistance to lower inflammation). And a quick cheat code is a hug. Go hug someone. Hugging someone will trigger the production of oxytocin, which is anti-inflammatory and dampens your HPA axis activity. Petting your dog works, too, so get out there and hug it out, bitches!

So now I know what you’re asking, what triggers your HPA, right? Well, technically all of them. Stress is actually the long term HPA response. But the others do at different doses for different lengths of time. So we’ll look at them one at a time.

Fear is what your SAM (sympatho-adrenal-medullary) axis responds to. The sympatho in SAM is for your sympathetic nervous system. More on that later.

Fear is an emotion based on an object. Something is about to eat me. This fire is about to burn me. Fear is about things that are going to happen right now if I don’t react. The SAM axis is also, luckily, about the now. It releases adrenaline and noradrenaline that work in seconds and usually clear in minutes to an hour. So you’re pumped up, but it goes away fairly quickly. But, it also triggers your HPA axis, so you will get some long-lasting cortisol, too.

How do you handle fear? Get away from the threat. I mean, literally. Fear is based on real threats, so run away, put out the fire, climb a tree. Do what you have to do to survive and your body will handle its own recovery, once you’re safe.

Unless the object is a social or psychological threat. In that case, you’re probably going to have to handle your recovery yourself.

When you experience fear, your amygdala fires off and your prefrontal cortex kinda stops doing its logical thing. You need to turn that around. How? Your vagal brake. My what-al brake? Vagal, as in your vagus nerve. The Vagus nerve (we’re going to spend a lot more time on this in the future) is the biggest nerve in your body and it runs from your brain, through your eyes, your carotid, your lungs and ends up in your gut region. And your vagus nerve is the trigger from your SAM’s archnemesis, your parasympathetic nervous system. Your PNS (heh, heh) shuts down your sympathetic nervous system. This allows your body to rest, digest, and recover. How do you activate your vagal brake? There are a number of techniques, but you already know the one I’m going to mention, if you’ve been reading along with my other essays. Which I know you have. Ding! Ding! Ding! The double exhale. Breathe in, then breathe out for around twice as long. A slow, mouth exhale. Within a few breathes, your vagus nerve should be actively igniting your PNS.

Now you can name the object of your fear and take its power away from it. You start transferring power back to your prefrontal cortex, which takes control away from your amygdala, and brings balance to the force. Once you’re thinking logically, and you’re not in fear of the object, your body will continue to restore itself from the response. It knows what to do, you just have to give it the chance.

Panic is the next step up from fear. It’s basically a self-amplifying loop. You’re afraid, so your body responds, which increases your heart rate, blood pressure, chest tightness. And now you think you’re having a heart attack. Which leads to more fear, more response, more of all the bad. Which means panic is fear of fear itself. Very Churchill-ish. Actually, it’s the fear of the fear response, but my way sounds cooler. Like t-shirt potential cool.

So, we know what it is, how do we deal with it? First, panic only lasts up to about 10 minutes, so if we do nothing, it goes away on its own. Yay! Easy, peasy. So now that you know, remember that if you ever panic. And oddly enough, that’s really the best way to deal with it. Just acknowledge it and know it’s going to go away. If you fight it, that actually makes it worse. It feeds into the secondary fear and increases the response. But it’s still going to go away. So why fight it? Breathe instead. Take a breath, think about the breath you’re taking. The panic will pass. Like last night’s dinner.

I’ve saved the worst for last. Terror is not higher panic. Terror represents the activation of the dorsal vagal branch of the autonomic nervous system. This is distinct from the sympathetic nervous system, the fight-or-flight response.

Here we get into Polyvagal theory (Stephen Porges in the 1990s), which describes the branches of the autonomic nervous system operating in a hierarchy. The autonomic nervous system includes the sympathetic, the parasympathetic, and your gut system. The Ventral vagal is your safe, social, regulated branch. That’s at the top and where you want to be. Your Sympathetic is your fight or flight branch, below that, and where you don’t want to be. And the Dorsal vagal is the reptilian branch for immobilization, conservation and shutdown, at the bottom, where you really, really don’t want to be.

So with terror, you start out in a really intense fight or flight but with no way out. That’s the difference between fear and terror. Fear, you can fight, you can run. Terror, you’re stuck in that proverbial quicksand all the 80s tv sitcoms were always trying to convince us are such common threats. I’ve only been stuck in quicksand once and it wasn’t so bad.

When you can’t fight or flight, or when things are too intense, or you just can’t leave, the system stops escalating. You drop out of sympathetic into dorsal vagal. Your heart rate drops, your metabolism slows. You start to dissociate. You get the famous thousand yard stare. You look calm, but your nervous system has basically thrown in the towel.

The trigger is intensity and no exit.

This can be chronic, too. Low grade. It’s common and usually underrecognized. You have brain fog, emotional numbness. You feel like you’re just going through the motions. You can live in it for months without realizing it’s a nervous system state.

So how do you get back? Gentle physical movement. Warmth. And being around someone whose nervous system is regulated.

You can move back up the ladder, first to the sympathetic branch, and then back up to ventral vagal. When you hit the sympathetic branch, you’re going to experience those heightened heart rates and blood pressures. You’re awakening back into fight-or-flight. It’s temporary, and necessary, so it’s good to have support for it. But it’s just a step to recovery.

Each of these states has a recovery and they’re different.

The double exhale works for fear and panic. It doesn’t reach dorsal vagal shutdown. Each state needs to be handled differently. Knowing which state you’re experiencing will help you reach for the right tool.

The throughline is the breath. Double exhale is great for quickly activating the vagus nerve to counteract fear and panic. Daily practice with the double exhale will build up your brain’s ability to handle stress and anxiety. Breathing is even good for recovering from dorsal vagal when you use it at the right times. Who would’ve thought the most effective and versatile method would be free, easy and readily available in unlimited supply.

So remember, no matter which state you’re in, or how badly you’re dysregulated, you can recover. And it starts with breathing. Like Mr. Miyagi once said, “Don’t forget to breathe.”

Slow down. Be quiet.

— R