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How You Can Tame a Raging Fight-or-Flight Response: How to manage a fight-or-flight cascade

KEY POINTS

  • Fight-or-flight is a normal response and has evolutionary advantages.

  • Exaggerated fight-or-flight responses can contribute to physical and mental disorders.

  • We can learn strategies that can help reestablish calm and restore homeostasis.





The experience of anxiety is normal and a part of all human life. It provides useful information that helps prepare us for and protect us from harm or threat. Stress, fear, and danger trigger a cascade of physiologic changes, known as the "fight-or-flight" response, where the brain alerts the autonomic nervous system (ANS) to release adrenaline and cortisol and thereby puts the body on high alert. Our heart beats faster, which increases oxygen flow to major muscle groups. Our hearing sharpens, pain perception reduces, pupils dilate, and blood thickens, simultaneously narrowing perception and attention so that our focus tightens and remains acutely on the threat. This mind–body cascade has evolutionary advantages in that it prepares us to either confront a threat directly or retreat from it, as quickly as possible.


The fight-or-flight response is reflexive—that is, it is involuntary. Its initiation happens automatically and without our direct control. However, fight-or-flight can become a response that gets "stuck on" chronically; occurs too intensely, in non–life-or-death situations; or generalizes and is activated at inappropriate times. Fight-or-flight is a survival response, but, in our modern world, it can be elicited when we are in stressful situations that are not truly perilous. This can become habitual, as the more frequently the fight-or-flight response is initiated in response to stress, the more likely it will be activated in similar circumstances. When the fight-or-flight response is exaggerated or inappropriately stimulated, it puts us at risk for chronic pain, heart attack and stroke, metabolic disorders, insomnia, gut inflammation, and a host of anxiety disorders such as panic disorder, generalized anxiety disorder, phobias, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).


For myriad reasons, our bodies can develop an exaggerated stress response where fight-or-flight is triggered in nonthreatening situations. Chronic stress, trauma, or illness may all impact the response, as can environmental factors and "social" threats such as job interviews or public speaking. In such cases, we may feel exaggerated worry, disproportionate to the actual concern. We might experience agitation and fear as if things are spiraling out of control, or find ourselves obsessing and stuck in a negative thought loop. Finally, certain medications and illness, such as arrhythmias, hypothyroidism, diabetes, irritable bowel syndrome, and respiratory disorders can induce the fight-or-flight response in the absence of any true psychological event (Chu et al., 2022).


It is important to rule out or be aware of medical conditions that might be contributing to an overactive fight-or-flight response. Since the onset of the COVID-19 pandemic, the incidence of anxiety disorders in the United States has surged more than a quarter, rising from 8.1 percent in 2019 to 27.3 percent in 2023 (CDC, 2023). Further, the incidence of dysautonomia, an umbrella term for medical disorders that dysregulate the ANS, has increased as a common immune-mediated disruption among patients with long COVID (Dani et al. 2021).


In learning how to manage a faulty fight-or-flight response, the goal is not to try to control the reflexive onset but rather to become aware of triggers and ANS patterns, recognize the early signs of a faulty fight-or-flight cascade, learn proactive strategies that may preclude full-blown events, and understand how to shorten the symptoms once they come into play. A foundational understanding of the ANS can be useful for building strategies for skillfully coping.


Understanding the Autonomic Nervous System

The ANS consists of two main branches: the sympathetic and parasympathetic nervous system. The sympathetic nervous system is the driver of the fight-or-flight response. Conversely, the parasympathetic nervous system regulates our "rest-and-digest" functions, which promote a conservation of energy, relaxation, and a return to homeostasis. There are 12 cranial nerves connected directly to the brain. Four of the cranial nerves are used by the parasympathetic nervous system. One of these cranial nerves, the vagus nerve, accounts for 75 percent of all parasympathetic nervous system. The vagus nerve is actually a pair of nerves that act reciprocally, as a counterbalance to fight-or-flight, communicating between the organs of our body and our brains and assisting in the control of involuntary processes like heart rate, breathing, immune response, and digestion.


When the fight-or-flight response is initiated, we are alerted to danger, so we do not feel safe. It can be tough to intellectually think our way out of this. But that does not mean we are helpless. We can learn strategies that can help calm our ANS and restore homeostasis and a sense of safety. To become aware of your specific triggers and patterns, you must first pay attention to your own fight-or-flight response. Perhaps your muscles tense up or your heart rate accelerates when you are presented with a particular stimuli or situation. When you are able to notice nascent signs of activation, you are able to intervene early in the regulation of your system and return more efficiently to a place of safety. Similarly, it is important to recognize the symptoms associated with your own, individual flight-or-flight cascade. For some people, the response feels most located in their thoughts, like an endless and accelerating doom loop. For others, physical symptoms are more dominant. For example, the shallow breathing of fight-or-flight may feel like choking or suffocation. Perhaps gastrointestinal distress, such as nausea or stomach pain, is more pronounced; you feel a sharp pain in your chest; or you feel a sense of derealization, as if you have left your body. Greater awareness of your own sensations can help you identify what is happening in order to develop individualized strategies to target these symptoms. Calming the Fight-or-Flight Response There are many techniques for calming the fight-or-flight response. Generally, you are prompting your nervous system to reverse the triggered cascade. Deep, diaphragmatic breathing is an effective way of slowing down your heart rate, reducing the flow of adrenaline, and helping to shift your focus to the rhythm of your breath. Grounding is the process of using your five senses to anchor yourself in the present moment and refocus your attention to a safe space (i.e., name 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste). These practices can be augmented with visualization, systematic desensitization, and other methods of relaxation. The more breath work and relaxation techniques are practiced, the faster and more reliably they will become to your natural response to a fight-or-flight cascade. Further, slowing your breath is a way of stimulating the vagus nerve, to prompt your body to return to a state of rest-and-digest. Because the vagus nerve directly signals the brain, vagus nerve stimulation is increasingly being recognized as a method for hacking your nervous system (Pappas, 2023). New research is exploring direct stimulation of the brain with implants, but there are manual, less-intrusive methods. Slow, deep breathing with a long exhalation, stimulates the vagus nerves, as does yoga and cold-water immersion of the face or neck (Gerritsen & Band, 2018). Other methods of stimulation have been suggested, including humming, gargling, and certain eye movements, but, to date, these lack rigorous research. Finally, there are a host of proactive mechanisms that can be incorporated as lifestyle choices to help achieve a calmer nervous system and manage stress. Eating a healthy diet and getting high-quality sleep are essential. Regular exercise will reduce stress hormones and increase endorphins. Establishing a strong social support network promotes well-being and provides outlets for sharing feelings and learning coping mechanisms from others. Finally, practicing mindfulness, meditation, yoga, and other relaxation techniques will go a long way toward managing your fight-or-flight response. By understanding the fight-or-flight response, becoming aware of your own personal cascade, and incorporating deliberate techniques to calm the nervous system, you can learn to more effectively restore calm and a sense of safety and, moreover, promote mental and physical well-being.

References Centers for Disease Control and Prevention (2023). Household Pulse Survey: Anxiety and Depression. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm

Chu B., Marwaha K., Sanvictores T., et al. (2022). Physiology, Stress Reaction. StatPearls, Treasure Island (FL): StatPearls Publishing; Available from: https://www.ncbi.nlm.nih.gov/books/NBK541120

Dani M., Dirksen A., Taraborrelli P., Torocastro M., Panagopoulos D., Sutton R., & Lim P. B. (2020). Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies. Clin Med (Lond), 1, e63–e67. doi: 10.7861/clinmed.2020-0896. PMID: 33243837; PMCID: PMC7850225.


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