A show that easily captivates an audience “This Is Us” is an American television show that depicts an extraordinary family of 5, with parents Jack and Rebecca raising twins and a trans-racially adopted son, who all happen to share the same exact birthday.
One protagonist, Randall Pearson, who happens to be the adopted boy, is a devoted husband and father to two beautiful girls. He also made the decision to become a foster father to older kids facing adversity and hardship. This way, he would be able to uplift and empower the kids as opposed to molding them from infancy. With a stable job in weather-derivative trading providing a secure income, wealth seemed to be prevalent. With the perfect wife, perfect kids and perfect house, Randall’s life is the epitome of the ideal American dream. Although Randall’s existence may appear exemplary, he is not immune to the perils of mental ailment – he struggles with panic disorder.
Randall’s intellectual capacity and being a black man raised by a white family has led to his diagnosis of panic disorder. His anxiety is evident in episode 15 of season one, which portrayed a flashback to when the now 36-year-old was in high school and, in a hysterical state, began panicking over his homework.
This sudden onset escalated, with his rapid speech, uncontrolled breathing and excessive worry that his essay wouldn’t be good enough despite his academic talents. His father had to implement breathing techniques to calm young Randall. Even after this initial panic attack, Randall is seen crying due to the anxiety that manifested within him (Fogelman, 2016). This panic attack disclosed the presence of anxiety in Randall, and is the first incident that demonstrated symptoms associated with panic disorder.
Another depiction of Randall’s panic disorder is seen in the same episode, but in present time. He was overwhelmed with the stress of finding his biological father, William, who happened to be dying of stage 4 stomach cancer. He was also distressed to discover that his adopted mother knew about William all along and chose to keep that a secret.
With the tension from his job on top of maintaining a happy home, Randall experienced another panic attack. His symptoms included trembling hands, obscured vision, and a disconnect from reality. When in full-blown panic mode, he also struggled with his breathing and experienced body perspiration (Fogelman, 2016).
Upon this second panic attack, Randall officially met the DSM-5 criteria for panic disorder, fitting the symptoms of unexpected onset, repeated panic attacks, and anxiety that follows these panic attacks (Oltmanns & Emery, 2015). His panic attacks are cued, meaning there are triggers that induce these nervous breakdowns. For Randall, this includes the stress of maintaining his definition of the perfect life, and the loss of control felt when his circumstances became too overwhelming. His attacks also reveal a different side of panic disorder, one that isn’t overt with hysterics. Regardless of expression, panic disorder is debilitating and requires psychological intervention.
Luckily for Randall, various forms of therapy exist. He would benefit mostly from cognitive-behavioral therapy. Cognitive treatment allows therapist to identify errors in the thought processes of those with panic disorder.
Therapists recognize the pessimistic interpretations of life events, and aim to help patients develop alternative perspectives in hopes of reducing distress.
One method known as decatastrophization asks patients to imagine a worst-case scenario, and then use their flawed logic against them. They ask “what if?” questions that encourage patients to think beyond initial negativity and suggest other possible turn outs. They also assign homework, asking patients to record the worst possible outcome for something compared to the actual end result (Oltmanns & Emery, 2015).
Randall’s anxiety stems from the struggle to control his perfect life when things fail to go his way. From this cognitive therapy, he can learn to associate unexpected outcomes with normal experience, and slowly but surely let go of his need to control everything that goes on in his life.
Exposure to relaxation techniques may be paired with cognitive therapy, resulting in behavioral adaptions.
Randall’s adopted father Jack was on the right track when he encouraged young Randall to change his breathing. Breathing retaining, although not fully understood, has proved to be effective in reducing anxiety by halting hyperventilation with breathing from the diaphragm opposed to the chest (Oltmanns & Emery, 2015). This way, he would be able to deal with the sensations of anxiety resulting from stress.
With much practice, Randall would be able to calm his autonomic nervous system in the face of stressors. Therapy focusing on cognitive revamping and relaxation procedures would allow Randall to experience significantly reduced anxiety, and ways to cope with his anxiety if it arises.
