Anxiety and Panic

Condition & context

Anxiety does not always announce itself first as a thought or a feeling. Very often, the body registers it before the mind has fully understood what is happening. It may begin as tightness in the chest, the sense that a satisfying breath remains just out of reach, or a heart that starts racing when the day is finally quiet. It may appear in the digestive system as nausea, loss of appetite, reflux, or a stomach that seems permanently unsettled. For others, it is held in the muscles: a jaw that is rarely unclenched, shoulders that remain lifted, headaches that gather at the end of the day, or the persistent sense that the body has forgotten how to let go.

Because these symptoms can appear unrelated, they are often investigated one at a time. A racing heart may lead to a cardiology workup; persistent nausea to a gastroenterologist; jaw pain to a dentist and a night guard. Those evaluations are important, particularly when symptoms are new or unexplained. But once medical causes have been appropriately assessed, it is equally important to ask whether the symptoms belong to a larger pattern. The chest tightness, unsettled stomach, disturbed sleep, and muscular tension may not be four separate problems. They may be different expressions of the same prolonged state of physiological arousal.

How Chinese medicine interprets it

Chinese medicine has never drawn a rigid boundary between emotional distress and its physical consequences. The two continually affect one another, and treatment is shaped by the particular way anxiety presents in each person: insomnia and a racing mind, digestive disturbance, palpitations and chest tension, persistent muscle guarding, exhaustion, or some combination of these.

Acupuncture is used to help reduce that state of physical vigilance and give the body an opportunity to settle. For many patients, the first changes are quite concrete: sleep comes more easily, waking becomes less frequent, breathing feels less restricted, digestion settles, or the jaw and shoulders are no longer permanently braced. These changes matter in themselves, but they also change the conditions in which anxiety is being experienced. As the body becomes less insistent in its signals of alarm, the mind often becomes quieter as well.

This is why we do not treat anxiety as something that exists only “in your head,” nor do we treat its physical symptoms as a collection of unrelated complaints. We look at the pattern as a whole: sleep, digestion, energy, menstrual or hormonal changes where relevant, muscle tension, breathing, and the circumstances in which symptoms worsen or improve. The aim is not simply to make you feel calmer for an hour after treatment. It is to help restore a more stable baseline in which the body can rest, recover, and respond to ordinary stress without remaining perpetually on alert.

What we treat

• Generalized anxiety — the constant low-grade hum and unshakable feeling that something is wrong
• Panic attacks and the anticipatory fear of the next one
• Physical symptoms associated with anxiety — palpitations, chest tightness, breathlessness, dizziness, nausea, sweating, and trembling
• Anxiety that lives in the gut — the nervous stomach, reflux, or IBS that flares with stress
• Anxiety and insomnia together, one of the most common pairings we see
• Health anxiety, particularly after a frightening investigation or diagnosis
• Anxiety during medication changes — we stay in touch with whoever is prescribing
• Perimenopausal anxiety — including new or worsening anxiety in the forties and fifties, when hormonal changes may be an important and sometimes overlooked contributor
• Jaw clenching, teeth grinding, and tension headaches that accompany anxiety

What treatment involves

We generally begin with weekly acupuncture. Sleep and the physical symptoms of anxiety are often among the first things patients notice changing. Over the first several treatments, we look not only at whether you feel less anxious, but whether you are sleeping more soundly, breathing more freely, digesting more comfortably, carrying less muscular tension, and recovering more readily after periods of stress.

The treatment itself is part of the effect. An hour spent lying still with the needles in, in a quiet room with nothing required of you, gives a nervous system that has been continually vigilant an opportunity to experience a different state. For some patients, it is the first occasion in months on which they become aware that their jaw has unclenched, their breathing has deepened, or their body has stopped bracing. That is not incidental to the treatment; in anxiety, it is an important part of what we are trying to achieve.

Herbs are sometimes added after the first visit, at your practitioner’s discretion and yours, most often to address sleep or prominent physical symptoms. Dietary work may also be part of the plan, shaped by how anxiety is showing up for you — eating rhythm and blood-sugar stability can be as relevant as digestion itself.

For an established pattern, eight to twelve sessions is a common initial course, after which we reassess. Some patients finish treatment at that point or return only when symptoms recur; others find that periodic maintenance helps them sustain the changes they have made and choose to continue monthly or as needed.

At the 1997 NIH Consensus Conference on Acupuncture, which Adele attended, Kevin Ergil, then dean of her acupuncture school, noted that “a feeling of well-being” had turned up among acupuncture’s reported side effects — because, he joked, there was no column for unexpected good outcomes. It was received in the room with some amusement. Nearly thirty years later, that sense of settling and well-being remains one of the things patients most consistently report back to us.

When anxiety is held in the body

All too often, the physical symptoms are not merely expressions of anxiety; over time, they become sources of anxiety in their own right. A chest that repeatedly feels tight can make every change in breathing seem significant. A jaw that aches from constant clenching, shoulders that never quite relax, or a stomach that remains unsettled despite every effort to calm it can keep the body’s attention fixed on the very sensations that are causing concern. What began as one part of an anxious state can gradually become a self-reinforcing cycle.

We also frequently see changes in the way people breathe. When the body has spent a long time in a guarded state, breathing may become shallow and predominantly upper-chest, with reduced diaphragmatic movement and persistent tension through the rib cage, neck, and accessory breathing muscles. Because breathing and muscular tension continually influence one another, this can become another part of the physical pattern we address rather than simply something a patient is told to “relax” or breathe their way out of.

When that pattern has been present for months or years, treatment is often deliberately gentle at first. We may use fewer points and leave them in for a shorter duration, combine acupuncture with delicate hands-on work, and pay particular attention to breathing and the diaphragm. The purpose is not to force the body to relax, but to reduce the amount of effort it is continually making to protect itself and allow a less guarded state to emerge.

When past trauma appears to have contributed to a persistent pattern of physiological guarding or hyperarousal, we may also incorporate our Emotional Release Treatment. This is always approached gently and does not require you to recount or relive the circumstances surrounding the trauma.

Therapy and medication

We treat the physical side while leaving psychotherapy and medication management to the clinicians who specialize in them. We’ve built relationships with therapists and physicians across the city over many years and regularly refer to — and receive referrals from — them.

Our approach is emphatically integrative. Talk therapy, EMDR, and medication can be very effective, and we recommend them when appropriate. Whether you want to avoid medication, eventually come off it under your physician’s supervision, or stay on it indefinitely and simply feel better, you’re treated here on the same terms — none of those choices is second best.

Tell us everything you take, prescription and otherwise. If herbs come into the plan, they can interact with medication, so we need the full list. We are glad to speak with your physician or specialist when appropriate, and any decision to begin, stop, or change a prescription medication belongs with your prescriber.

Common questions

How quickly will I feel a difference?

Sleep and the physical symptoms are often the first things patients notice changing. Some notice a difference within the first few treatments, while longer-standing patterns generally take more time.

Do I have to stop my medication?

No. Treatment can continue alongside medication. Any decision to change your medication belongs to you and your prescriber.

Can I have treatment while in therapy?

Absolutely. Many of our patients receive acupuncture alongside psychotherapy, and referrals between therapists and our practice are common.

Do I have to talk about what’s causing it?

Only as much as you want to. We need enough information to understand the clinical picture; you do not need to tell us the whole story.

Will the needles make me more anxious?

Being afraid of needles is common, and it is not a reason to stay away. Tell us. We can use fewer, finer needles, explain what we’re doing, and go slowly. Most people find that their apprehension diminishes as treatment becomes familiar.

Can you treat panic attacks specifically?

Yes. We work with patients who experience panic attacks, with particular attention to the physical symptoms and the state of heightened arousal that can persist between attacks. We can also teach you simple acupressure points to use when you feel an attack beginning.

My heart races at night and my cardiologist found nothing.

We see this presentation frequently. Once cardiac and other medical causes have been appropriately evaluated, we can look at the racing heart in the context of sleep, anxiety, breathing, hormonal changes, and the broader pattern of symptoms rather than treating it as an isolated complaint.