Panic. Again there are two approaches. First, allow panic and agitation to develop fully while protecting the person against injury. Second, 'steady' the person and bring them back into contact and subsequent comfort. This is a matter of timing, since the second option is in fact a way of protecting the person against injury. It is probably a good thing to give the panicking person some elbow room so that accumulated tension can be discharged through motor activity. The second phase, steadying, should ideally only apply when the person is already on the way back to contact and is calming down, a process that you can encourage once it is underway. However, in practice, it may be necessary for safety's sake to steady a person somewhat earlier than is biologically good for them. It is important to accept panic as a necessary functional discharge. Too often onlookers rush to restrain a panicking person because the extreme mobility of panic provokes great anxiety in those who normally keep their own panic 'frozen.' A literal or chemical strait jacket is normally applied not to protect the panicking person but to protect other people from all that emotion.

It is best here to start with a few don'ts:

—Do not stop a person from screaming, whether after an accident or in a personal crisis. Screaming is probably the best thing 'energetically' for the person, and if allowed to run its course, is almost a guarantee that the main content of the terror will not return in waking or sleeping nightmares. Too often people are restrained from screaming and left to deal with waking up in the middle of the night wanting to scream. If in reading this you find the idea of screaming makes you anxious, take a safe time and place and practice screaming for yourself; open your mouth wide in a big 'square' shape with the muscles of your neck contracted, close your eyes tightly, and scream with a high pitched 'AAAA' sound (as in the word 'man') which feels as if it is vibrating out of your head. (From your chest it is more likely to be an angry yell.)

—On the other hand, do not induce screaming in a person who is not already screaming. The previous instruction (contact 1) to 'make a sound' may induce screaming, but do not try any further measures. (Some measures, which you may have heard of from therapy, involve manipulations of the neck and jaw that are best left to experts and even then must be used carefully.)

—Do not restrain the person from trembling or fidgeting or moving about, unless the movement will cause them physical harm.

Some EFA measures:

—For hyperventilation, i.e. uncontrolled panicky pumping and panting of the chest accompanied by an increasing lack of contact, proceed as outlined in Emergency.

—Constantly urge the person to get the breathing down from the chest mainly into the abdomen, to 'Breathe low and slow. '

—Deal with violent panicky attacks on you or anyone else by restraining the person and at the same time insisting loudly and repetitively that they look at your eyes.

—If possible, deal with self-destructive behavior, such as head banging, by putting padding between the head and any hard surface. If this is not possible, restrain the person in your arms but leave them room to struggle and discharge tension.

—If the person is calming down from motor activity, but the eyes are still rolling around in panic and distress is severe, take them firmly by the shoulders, give them a firm jolt, and encourage them to look at you. Ask them to open their eyes and look at your eyes. This may induce sobbing and consequent relief.

Switching

Switching from an expression of fear is normally into anger or grief. (Hysterical laughter is obviously far from being an excape into joy, and can be treated like panic, by steadying and focusing contact.) As with all switching, once a tendency toward a new emotion is strongly established, this should be accepted. EFA is not concerned with making judgements as to whether an expression is appropriate.

Some minor signs of anger building up are tearing and twisting at clothes or objects, grinding the teeth, and holding the breath in an inflated position. Watch for an explosion. Remember that anger is most dangerous when mingled with fear. Unfortunately, you have little option but to allow the anger to emerge and then attempt to deal with it as outlined in Chapter 5. The opposite route, of trying to pressure the person further into their fear to cover the anger, is a dangerous maneuver since it will be experienced as an attack.

Some signs of grief are wringing of the hands, clutching at the head or face, and rocking movements of the body. The person needs to be held. If your level of intimacy permits this, it will channel the fear into a softer expression of crying, which will in time discharge it. If physical contact would be too invasive, proceed as outlined in Chapter 4. A deep discharge of grief at whatever has happened, and contact with a source of reassurance, which tends to produce crying with relief and gratitude, is a natural and perhaps essential phase in the resolution of fear.

Panic may contain switching as a main element, and when a person is alternating rapidly between outbursts of sobbing, spasms of terror, and lunges of anger and aggression, Emotional First Aid is not easy. But contact, if gently insistent, should steady the person into whichever of these emotions needs most powerfully to be expressed, or at least slow down the process of switching to a manageable rate.

Resolution

If in extreme fear the person is reduced by feelings of panic and vulnerability to a state of being like a baby, resolution consists of a beginning to emerge from this state after the period of support and comfort that the EFA should have provided. So, once the person has calmed down, it is as well to encourage movements toward reestablishing a more adult position, such as a wish to stand up and move around, or to discuss the fearful situation rationally. Even jokes about it help reestablish confidence: if the person makes a joke after having fully experienced fear or grief, this cannot be called an attempt at escape from the feeling.

The problem in resolution after fear is similar to that after grief, a question of timing—when to accept the person's struggles to return to a 'normal' attitude and behavior, and when to discourage them for the time being so as to make sure the emotional discharge really is complete. Fear adds the problem that, more than in all but the most severe cases of grief, the organism has been severely shaken and the tendency to relapse into a need for help is strong. Even physiologically it takes time for the body to adjust. You can help the adjustment by remaining calm, steady, and supportive. This will enable the person's autonomic nervous system to reestablish a balance after being flooded with chemicals associated with emergency.

As with severe grief, the person who has experienced severe terror needs to be assured of a support system afterwards. This need may lead to a clinging to the source of help for some while after this is really necessary. In general, the suggestions made in the section on resolution after grief apply equally after fear.