"Anxiety isn’t a feeling, it’s a physiological response. "

       Anxiety isn’t a feeling, it’s a physiological response. We’ve all felt and seen the unmistakable signs of the mobilized fear response: sweaty palms, rapid heart rate, fidgeting movement, muscle tension, eyebrows expressing concern, and the “deer in the headlights” look. It’s hard to mask these overt signs of anxiety. But intense anxiety has another appearance, it can look quiet and still. This is its hidden face that is easy to miss. Some patients may look extremely calm when their anxiety is intense. Consider your compliant patient, the one who doesn’t interfere with your treatment, the “easy patient”. This person may be the one who really needs your extra emotional support. 

       The mobilizing Fight/Flight response is good for overwhelming escapable stress. We run away or get angry and fight, and the body returns to “rest and digest”. But what about overwhelming inescapable stress, like financial problems, the Covi-19 pandemic, or having to sit through a procedure that scares us? If we can’t mobilize and don’t have the resources to increase our sense of safety, the autonomic nervous system engages the response of “freezy business” by way of the dorsal vagus nerve ^[4]. This is a shutting down of systems. Think of an electrical grid overwhelmed by power demands during a heatwave. Controlled “rolling blackouts” are a way to manage the demand and prevent the entire system from crashing. This is what “freezy business” is all about- non-essential systems shut down, such as higher reasoning, digestion, the senses dull, blood pressure lowers, and saliva production ceases. This is a high-intensity stressful event in the body and an undesirable state for your patient to be in as it is paired with feelings of helplessness and being invisible, impaired ability to engage higher reasoning centers in the brain to understand information and instructions, slack muscle tone, difficulty relating socially, and restricted capacity to register information in the environment. Here are some of the tells:

 There are active things one can do to signal body “safety” and improve their resources to cope. Some simple exercises can help with freeze recovery. These involve low-intensity movement, activation of cranial nerves, and signals of safety from social connections like the relaxed friendly face of a hygienist. Explaining and giving information isn’t very helpful, remember that higher cognitive processes are in “rolling blackout” mode. Reducing stimulation helps. Think about dimming the lights, lowering the music volume, and backing up your chair to give more personal space. 

I write about a specific technique that can be helpful in my article “Dorsal Vagal Freeze: It’s Role in Dental Anxiety” (https://www.rdhmag.com/patient-care/article/14223194/dorsal-vagal-freeze-and-dental-anxiety). Check it out and give it a try on yourself when you are feeling stressed or anxious, it will take you less than a minute. I find in my therapy office that when I suggest something to a patient that is a bit outside their “box”, my own example of it helping me in a personal situation is just the thing my patient needs to be willing to give it a try.  

Reference:

[4] Dana, D. Polyvagal Exercises for Safety and Connection. New York, W.W. Norton & Co. 2020.