When Panic Attacks

How to Take Control of Anxiety and Panic

Áine Tubridy

• Publisher: Gill Books
• Year: 2018
• ISBN:
  9780717181353
• Topic: Psychology
• Subtopic: Emotions in Psychology
• Index: Psychology

Hundreds of thousands of people inIrelandsuffer from panic attacks and anxiety; but many struggle to access any meaningful help for these conditions.

Prompted by years of working with patients suffering from panic attacks and struck by just how common and debilitating they were, medical doctor and psychotherapist Dr Áine Tubridy first published When Panic Attacks in 2003. Grounded in years of clinical experience and research, it has been a bestseller ever since – because her methods work.

A true visionary in the crusade for mental health, Dr Tubridy uses pioneering mind–body medicine methods to alleviate panic and anxiety, encouraging patients to understand the root cause of their symptoms and to make tangible and fundamental changes at every level of life – physical, emotional, mental and spiritual – opening up the possibility of extensive and permanent healing.

In an increasingly fear-driven society, this book is more relevant than ever.

PART ONE

HOW PANIC WORKS

1

WHAT IS A PANIC ATTACK?

KEYNOTE: RED ALERT!

Has this ever happened to you?

You’re doing the weekly shopping, when suddenly everything changes. A hot, sweaty feeling creeps over you as a wave of nausea grips your stomach. ‘Oh God, I think I’m going to pass out!’ Your head begins to spin, your surroundings become a blur. ‘What’s going on? Why has the place got so hot!’ you wonder, peeling off your jacket.

‘Are you OK?’ asks the assistant behind the counter, adding to your mounting suspicion that something is seriously wrong. By now your heart has begun to thump violently in your chest. ‘Why can’t I breathe? What’s wrong with me? I’ve got to get out of here!’ Tightly gripping your trolley, you try to calculate whether you’d make it to the exit in time. The voice intrudes again. ‘Can I do anything? Maybe you should sit down.’ You notice with concern how tight and uncomfortable your chest feels and how difficult it seems to take in enough air. ‘Something awful’s going to happen to me!’ you suddenly think, and the next minute you find yourself bolting for the door and heading for the bathrooms.

The person staring back at you from the mirror is pale, sweaty and terrified. You splash your face with water, thinking ‘I need to get to a doctor before it’s too late!’ After a few attempts your trembling hands manage to punch the numbers into your mobile phone. ‘John! Thank God! Something’s wrong, I feel really ill, can you come and get me in the supermarket right now? Hurry, will you, I’m really not well!’ Confused and disoriented, your mind races with questions, as you lean immobilised against the wall. The minutes tick by in a haze of fear, but gradually you notice that your breathing is getting slightly easier, and your heart isn’t racing quite so fast. You realise that ‘whatever it was’ seems to have passed, leaving you utterly drained, as though a fog had descended on you.

Mythology tells us that the Greek god Pan, who was the god of nature, was an ugly, short character with goat’s legs. He lived in the countryside and was known to jump out and terrify many a passer-by by uttering a blood-curdling scream that was so horrific it caused most to run for their lives and some to die of fright on the spot. This sudden, unexpected and all-consuming terror that they experienced became known as ‘panic’. In contemporary times thousands experience this daily, usually in association with some sense of impending danger or threat. Experiences of such an internal attack vary:

Tony – ‘It was a day I was due to give a presentation at work, not something I’d done often. As I stood up to begin, I froze. A chilly ‘pins-and-needles’ feeling crept over me, starting in my hands, making it difficult to feel the pages I was holding. Time seemed to stand still as I struggled to start speaking, and I felt a pressure around my throat, as though my voice was trapped and couldn’t come out. My feet didn’t feel connected to the ground, and a wave of nausea was building in my stomach. Gazing around at the blur of faces I realised they were all waiting for me to begin, but by now I knew I couldn’t continue. In fact I doubted I’d make it to the door without passing out. It was certainly the weirdest and most frightening thing I’d ever experienced, not to mention humiliating.’

Marie – ‘It happened first at my daughter’s wedding, during the service. Such a happy occasion, she looked so beautiful, and I so wanted it to be her perfect day. Suddenly I could feel my heart ‘turn over’ and I put it down to excitement. But it kept on thumping and I noticed a loud ringing in my ears. Feeling dizzy, I sat down and closed my eyes, telling myself that my urge to run out of the church was out of the question. The rest of the service, which seemed to last forever, passed by as though it was a dream, as though it wasn’t real at all.’

Len – ‘I woke up gasping for air and drenched in sweat. My heart was pounding, my chest was tight and I was terrified. I shook my wife awake and told her to get the doctor quickly, that I was having a heart attack. Throwing open the windows I leaned out and gasped for air. As I paced up and down I wondered what the hell was taking him so long. I splashed my face with water and when I saw myself in the bathroom mirror I knew this was it, the big one, I was going to die. By the time he arrived I was a gibbering, blubbering wreck, and became worse when he gave me a sedative instead of something for my heart. Did he not get it? Who was this fool? Gradually a blessed grogginess took over. Drained and exhausted, all I wanted to do was sleep.’

How is Panic Diagnosed?

If you have experienced something like this, but didn’t know what it was, it will help if you answer the following questions in order to be absolutely clear that it is panic attacks you are getting. They are based on the DSM-4, the classification used by the medical profession to diagnose panic disorder. A positive answer to any four of them confirms that you are experiencing panic attacks.

Do you sometimes feel short of breath, like you can’t get enough air in, making you take short panting breaths, or big deep sighs, or want to throw open the window?

Yes

No

Does your heart race at times, so that you are uncomfortably aware of it thumping in your chest, maybe even making you afraid you could have heart disease, or need to call a doctor?

Yes

No

Do you ever feel discomfort or pains in your chest, a tight or aching feeling?

Yes

No

Have you occasionally felt sensations of choking or smothering, where every breath feels like it could be your last, and getting outside where you can breathe becomes a matter of survival?

Yes

No

Did you ever feel wobbly or unsteady on your feet, with a dizzy feeling or a pressure in your head, as though you might faint, and wonder if your ‘jelly legs’ will support you as far as the nearest exit?

Yes

No

Have you experienced sensations of tingling, numbness or ‘pins-and-needles’, usually in the arms or legs? Or blurring and double vision making it hard to focus normally?

Yes

No

Do you ever get a queasy ‘knot’ in your stomach, and a feeling that you might vomit, or have a sudden urge to empty your bowels?

Yes

No

Do you ever tremble or shake, so that it could be hard to write a cheque or hold a cup steady?

Yes

No

Do you feel waves of heat or cold chills pass over you, or sweat profusely at times, so that you might need to rapidly undo buttons and peel off clothes? Does it ever make you want to splash cold water on your face or plunge your hands into the freezer? Have you woken up at night with the sheets soaked in sweat?

Yes

No

Does your perception of your surroundings change so that you feel out of touch with your body or detached from things around you?

Yes

No

Have you feared that you were going to die while experiencing any of these symptoms, say from a heart attack, ceasing to breathe or some other medical emergency?

Yes

No

At any time did you fear losing control, or that you were going crazy?

Yes

No

What Exactly Is Panic?

Broadly speaking, a panic attack is an extreme fear response which occurs when a person is convinced they are in extreme danger, although no real danger exists.

Physiologically panic is a sudden surge of adrenaline into the bloodstream. Once set in motion, the surge of adrenaline molecules, known as the fight or flight response, rises to a crescendo and slowly dissipates. This primitive survival reflex is vital for dealing with danger, equipping us to fight like a gladiator or run like an Olympic sprinter. Heaving lungs, pounding heart, tense muscles, and hairs standing up on the back of the neck warn us that our life is on the line. This emergency response is essential for life in the jungle, fighting off an assailant, or reflexly responding to threats such as crashes, fires and other potential catastrophes. Whether we live or die may depend on our ability to run for it, scream for help, hide, jump aside, slam on the brakes, head for the nearest exit, or stand and fight.

Psychologically panic is a disorder of perception. Internal sensations of the fight or flight response are being misread as life-threatening and dangerous. This misinterpretation triggers panic in supposedly safe environments such as the supermarket, cinema, one’s home or one’s bed. With no obvious external threat, all the impulses to run, scream or attack are curtailed or censored, and confusion reigns. The sole task now is surviving the sensations themselves. Advancing into the depths of the supermarket can become synonymous with shark-infested waters, the distance from the door as critical as the distance from the shore. The degree of advance warning and the availability of an escape route define the level of danger.

What Course Does It Take?

The symptoms of a full-blown panic attack are similar for everyone, but vary in their combination and intensity. It is rare for anyone to experience all of the symptoms listed above. Some only get two or three of them, others more. The commonest are:

• intense fear or apprehension

• palpitations

• trembling

• breathing difficulty

• dizziness

• sweating

After a time one main symptom may begin to predominate, and the others may seem to be less to the fore. Or the panic attacks may cease as long as the person avoids certain situations, such as lifts or shops. All that seems to be left is an anxiety about going into certain situations.

The situations in which a first attack occurs are endlessly varied. It can be while doing something quite ordinary, such as watching a football game on TV, having a meal out in a restaurant, or getting on the bus home after work. On the other hand, it can be during a peak period of stress, such as going into an exam, or during a period of financial or personal insecurity, such as company downsizing or relationship breakdown. It is equally common to experience panic attacks only at night, where you’re woken from sleep, gasping for breath. For most people it first occurs without warning, leaving them incredulous, shocked, shaken and utterly mystified as to what has just happened. After the attack, most people feel completely drained and exhausted.

The frequency of attacks varies. Many in the general population have one or two and no more. Others go on to have them several times a day, every other week or month, or for several years. They may disappear as mysteriously as they came, without treatment, or they may need medical intervention, as most do, before they are managed.

On average attacks tend to last between five and twenty minutes. Although you may remain ‘on the verge’ for days in the period before and after one, this is a state of anxious apprehension rather than panic itself, and will be discussed in the next chapter.

Panic attacks are exceedingly common. They occur equally in both sexes, and no particular type of personality is susceptible to them. Every age, occupation and socio-economic group experiences panic, as does every culture.

2

WAITING FOR THE NEXT ATTACK

KEYNOTE: WALKING ON EGGSHELLS

Tony – ‘I don’t know how I didn’t eventually lose my job, because at least 70 per cent of my thoughts at work were about how to avoid that first “thump” inside my chest, when my heart would begin to race and the whole nightmare would begin. It seemed safer to out-think it and stay alive, rather than risk a possible heart attack. I reckon I deserved the Nobel Prize for ingenuity and dedication to a cause, because strategies to keep down the next one never left my mind. I would mentally scan my schedule each day looking for the “danger zones” – situations which I knew from experience might bring one on. This meant anywhere I felt trapped and unable to leave, like meetings, lifts, lunches or conference calls. I had all sorts of little side-routines in case this happened, and excuses which the boss seemed to buy most of the time. By the end of the day I would feel a pressure in my brain simply from the effort of trying to be one step ahead of things, to head off an attack. I was on tenterhooks all the time.

‘I’m certain it held me back from getting on in the job. I’d always have to cry off joining my colleagues for a drink after work, or in-house training days where you’d be likely to be stuck in the one room for hours. Of course I knew that some people wrote me off as anti-social or painfully shy. I didn’t care; it was the lesser of two evils. No way was I going to panic in front of people!’

Marie – ‘The trouble really started when the attacks began to affect our social life. Up until then I was able to fob my husband off with excuses about feeling tired or hatching a cold or something. But then he realised that it was because I was afraid! “Afraid of what?” he’d bellow. His job involved going to a few social events each year, and it seemed so lame to be saying to him “I know it’s important to you but I just can’t.” It caused so many rows over the years. He used to say that the person he married was a different woman, extroverted, adventurous and on for anything, that he’d somehow lost her along the way. I think it was when it began to extend to the mundane places like the kids’ school, supermarkets or restaurants that he began to get angry with me for “giving in”. It wasn’t that I didn’t love them enough to push myself – I just couldn’t.

‘What I could never explain was the dread I felt at the very first sign that we would have to go out socially and feeling that wave of apprehension inside me starting up. Even the phone ringing used to make me tense up, in case it meant I had to go somewhere. I felt safe at home, at least there I was more in control and could fight it off with some success. But outside my own surroundings all I could think of was “exits, how far away are the exits!” I dreaded that trapped feeling in queues or places where the doors were closed, anything that would prevent me leaving instantly if I had to. I always felt there wasn’t enough air in places like trains or cinemas. If I could get outside, it usually eased, but it was a living hell if I couldn’t! Enjoying things would have been a luxury; it was enduring and surviving them that I found hard. For years, events like family weddings or christenings became a blur of watching for exits! And then of course there was the clock: “How long more till it’s over and I can go home and feel human again?” It was all about “keeping the feeling down”, whatever that took. If anyone could have read my thoughts I’d have been taken away by the white coats for sure.’

CONSTANT VIGILANCE

That first panic attack is a terrifying event, a life-and-death experience, and as such it leaves a deep imprint. Like an earthquake, it is not easily forgotten. It is difficult to write it off and go on as if it hadn’t happened. After the first few you can feel as if a ferocious beast has taken up residence inside you, who always has the potential to rise up and run amok, and each subsequent attack is like waking it up again. Once aroused it rips and roars through you, unstoppable and outside of your control. When it’s over you feel shocked, exhausted, disillusioned and beaten up. In between attacks the monster sleeps, and you tiptoe around it. Your only ho...