From the author: Abstract of Gianni Francesetti's seminar on working with panic attacks. Each person experiences PA in his own unique way. PA usually appears suddenly in a person who does not have any particular disorders. At the initial stage of PA, a person does not go to a psychologist, but goes to a doctor or an ambulance, because... he has the feeling that he is dying. Usually such a person feels quite well, he does not have any special disorders, until the moment of PA “life is fine.” Panic disorder and Panic. Panic is a physiological situation that is described by Perls and Goodman as a defensive reaction at the border of contact. This defensive reaction is born when a danger appears that cannot be dealt with. An incident occurs, panic occurs and we run away. Or we lose our senses and faint. It is a physiological reaction to escape from danger. Panic is a physiological reaction that occurs when there is real danger. This reaction also happens in animals: running away or freezing. Freezing is an evolutionary acquisition. The eyes of a predator see movement better; if one animal is frozen and the other is running, the predator will react to the running animal. This is the reason why we take a sharp breath and hold our breath out of fear. Panic attack. PA is a symptom (it is not a diagnosis). What happens with PA? It occurs suddenly for no apparent reason. Feeling of fear, horror. The fear of death or the fear of going crazy is here at this moment, and something needs to be done right away. Palpitations, sweating, changes in breathing, weakness in the legs, etc. abdominal pain, severe nausea. The senses perceive the internal state in a strange way. Panic disorder. This is a diagnosis. When a diagnosis of PR is made, PAs, at least at the beginning, are unexpected. (PA for phobias is not considered as PR). With PR, the first attack occurs suddenly. Everything is as usual, and “lightning on a clear sky” happens. And if I survive, then the terrible fear of “walking on the road with a clear sky” takes hold. I start to avoid the situation where this happened, I try to control it. And these situations can happen somewhere else... Doctors say that everything is fine with my body... So, surprise + prohibition (avoidance of situations) where this happened. I can only survive this if I am accompanied. The person does not know why this happened to him. This is a strong symptom that is divorced from life. It is important to give (expand, redefine, recreate) background to make an obscure symptom understandable. Phenomenology of PA. Gestalt point of view. In most cases, PA in PR occurs unexpectedly. And the patient’s story about his attack is typical: “I did this and that that I always do, for example, I went shopping. I was getting milk at the supermarket and suddenly my heart started beating and I thought I was having a heart attack.”… There is a discontinuity, a break in the continuum of experience. When I have anxiety, it can decrease or increase. And here something happens that is a completely different experience. It's such a different experience that I think I'm dying or going crazy. In terms of figure-ground dynamics, the following happens. In the Gestal approach it is known that the Figure is born based on the Background. Example. I am now making contact with you. I see you, I choose my words, but this is possible because I have functions that I should not think about, but that support me. For example, physicality. I believe that my heart will beat, I will breathe, my brain will find words. This faith allows me to be here with you without a panic attack. This is not confidence, but faith. The second part that I rely on is my clinical experience, the cases when I taught this topic in groups. The fact that you recognize me as a teacher. This is my personality function. Every moment we rely on a background that we consider obvious and this background consists of id and personality. What happens during PA? The figure that develops disappears because the background that supported me collapses. This is PA in figure-ground terms. My heart is dyingit doesn't beat as usual, I can't recognize myself in the mirror, what was implied suddenly becomes problematic. This collapse of the support immediately indicates the possibility of therapeutic intervention. Because the work should be aimed at maintaining support. Support the ID function, support personality. Since this is a symptom in which the ego function is lost, one must be careful not to put pressure on this function, because there is a risk of retraumatizing the person. An example about a girl with a history of PA. While working, she found herself on her feet in front of me, very frightened, she did not know what to do, she doubted whether to stay where she stood in her fear, or take my support. An intervention like “You must take responsibility and decide what to do” can be re-traumatizing, it has nothing to rely on. The ego function must be supported by the id and personality. I could say: look at me, what changes in the body when you look at me?.. This is background support. At the beginning of PA there are physiological symptoms: my heart is pounding, I’m having a heart attack... Over time, it becomes clear that this is a fear of a heart attack, and not a heart attack. Fear appears. And this is a big step that the patient can say not that I have a heart attack, but that I am afraid of a heart attack. But the transition that gradually manifests itself in therapy is a special type of fear, it is a fear associated with the feeling, with the experience of loneliness. The word loneliness is prohibited for a person suffering from PD. This is a special loneliness. It is different from loneliness in depression. This is the loneliness of someone who suddenly finds himself too visible in front of a huge world. This is the loneliness of someone who suddenly feels very small in front of a huge world. And this type of experience is prohibited for a person, otherwise there would be no PA. In most cases, PA is associated with problems of fear, and is not associated with loneliness. This is a merger with the field of suffering, the patient is not aware of his loneliness, and the therapist is also forced not to notice it... With PA, the fear of death and the fear of madness arise - these are fears in which we fall out of the community. And then it is necessary for the patient to be accompanied by someone. This suffering becomes weaker when I am close to someone I trust...(It looks like shame, but shame is one of the possible feelings when we are too exposed. And with PA there can be a lot of shame. But besides shame there can be many other experiences). A specific experience - I am too visible without feeling the ground under my feet. So, with PA, some thing is discovered with which our personality (idea of ​​ourselves) was not in contact, this is deep loneliness, feeling which a person feels too visible in the face of the world PA occurs at the moment when the patient cannot protect himself from being seen by the world in the usual way of interrupting contact. Interruption of contact is a restriction from encountering novelty. At the moment of PA we go through an experience where we cannot use the usual methods of breaking contact. PA is a sharp breakthrough of unconscious loneliness... It is contact with something that a person did not know he had. This is the loneliness of a small child thrown into the world, aggravated by the fact that he did not have such experience, otherwise he would not have gone there... What is important for us to understand? Two questions. 1. What happened 2 minutes before the panic attack - in most cases the patient does not remember this. Perhaps neurophysiology is working (forgotten) + if unconscious loneliness is working, until the work is done, it will not be realized (Typical answer: “No, everything is fine”). We conduct a microanalysis: we remember what happened (second by second) in order to restore the unconscious experience (unconscious loneliness). What happens two minutes before is very important, but it can only be restored through long-term therapy. Microanalysis is not necessary but may be helpful, especially with a very controlling patient. There is always something before, but it is so traumatic that it is lost. And there's something that I can't get over in the usual waysinterruption of contact. 2. Why at this particular moment in life? There are often two backgrounds of life. These two backgrounds are in contact with loneliness, which we deny and are not aware of. The first background is the transition from oikos to polis. Oikos – from Greek – house. Polis is a world, a city. Oikos is a place where there are few people, intimacy, they already know us, there are walls that protect us. When a child is born, we already think about what his room will be like, prepare his crib, name him... and this is oikos. The psychotherapy training group is the strongest place of the oikos, there is a supportive affiliation, a place where we are rooted. Language, smells, grandparents - this is oikos. Polis is a place of many. This is a place where I still have no roots, no belonging, a place where I am a stranger. In order to be recognized there, I have to do something. In the oikos, belonging is guaranteed, the polis is a place where our belonging may or may not exist. The transition from oikos to polis is a risky transition, in which we are alone. When might this happen? For example, when I have to go to study in another city. Or when I finish school and go to university. There are many PAs during these periods. Either when I move to another city, or when I get married, on honeymoons, when a child is born, because I myself stop being a daughter and become a mother, or if I have never left the oikos in my life. If you are still in oikos, the death of a parent is painful and disheartening. If you are in the policy, the death of a parent is painful, but not disheartening. If PAs occur in this transition from oikos to polis, then it depends either on the oikos (personal biolgaphy) or on the polis (social context). The more fluid and changeable the policy, the more narcissistic it is, the more PA, because you are alone and cannot feel the need for another, because otherwise you will lose. In postmodernism, relationships become unstable, there are no social connections that support. There is loneliness and it cannot be expressed, since in a narcissistic context one must be strong and alone. Through PA, I regain the figure of need for another. The most typical time for PA is the age of 15-35 years - this is the age at which the transition occurs. Thus, PA is a growth disorder. A person grows faster than his need for belonging that he has. He is not aware of his loneliness. Therefore, there is a movement towards autonomy, the greater it is, the greater the need for belonging. This is the reason why in therapy, very independent individuals are afraid of the loss of autonomy and the fact that they are forced to have an accompaniment, asking to remove the symptom in order to quickly return to autonomy. And you don’t need to pay attention to this. As a therapist, I know that your autonomy will increase if I bring you back to belonging. From this point of view, especially during the first PA in young people, it is necessary to look at growing pain points. Autonomy grows faster than belongingness, which is needed. Instead of seeing them as fragile, we see them as growing, with a point of loneliness where we can support them. What happens in a person's life before PA is what puts the person into unconscious loneliness. A person has no support in experiencing this loneliness. This can happen during the transition from oikos to polis. Or the loss of a loved one, which is not fully experienced. This unexperienced grief develops the risk of panic attacks. This loss leaves a drop of loneliness that we are not aware of. When grieving, you don’t just need to gain strength and move forward. Anyone who suffers from PA does it too well. We must work through the other part so that what was lost becomes assimilated, becomes my blood and meat. Otherwise, the loss has an unassimilated piece and leaves the person alone in the world. A person comes and he is not aware of any of the above. The person will say: “I want to be autonomous, I have a symptom that prevents me from living. And he comes with a certain type of physicality where he feels.