The Panic Trap

I must be dying... or, could it be a panic attack? It happens...

  • You are driving your car, and as you approach the bridge that you've crossed a million times with ease, your heart begins to race,  your hands tremble, and as you gasp for air, you notice that there is no place to pull over or stop the car. You feel trapped in the center lane, so you move to an outer lane, and you're not sure why, but you think it helps. A sense of impending doom overwhelms you as you will yourself to focus through the dizziness and weird sensations. You grip the wheel and attempt to distract yourself. Just drive you tell yourself. You turn the radio up very loud. You sing, perhaps scream. The episode begins to subside as you move closer to the exit of the bridge. What just happened?
  • As you stroll towards your office on a seemingly ordinary day, out of the blue, you experience this strange feeling -- disconnected and unreal -- you no longer feel in control. Familiar things around you begin to blur, the buildings sway, fingers tingle, you think something serious is going on inside your body. No, you're quite sure of it! You notice your heart skipping and pounding as you feel for your pulse. You begin to wonder if you're having a heart attack. It begins to subside, but maybe if it happens again you've go to the ER. You feel trapped by aspects of your life -- maybe...okay, you definitely hate your job! Why is it all coming out in this way?

Hopefully the episodes above read like a bad dream to you, but if it sounds all too familiar, then you may have experienced a panic attack. Panic disorder is a complicated condition. These attacks often show up out of the blue and can be described as an "uncontrollable panic response to an ordinary, non-threatening situation." People who develop panic disorder often report that they know exactly where the highway exits are and make frequent visits to the local emergency room, fearing a major event such as a heart attack or stroke. Doctors, out of an abundance of caution, take these symptoms seriously and rule out disorders, diseases or other possible causes for the symptoms before diagnosing panic disorder. To be diagnosed as having panic disorder, a person must experience some of the following symptoms during a panic attack: sweating; hot or cold flashes; choking or smothering sensations; racing heart; labored breathing; trembling; chest pains; faintness; numbness; nausea; disorientation; or feelings of impending death, losing control, or losing one's mind.  Panic attacks typically last only minutes, but feel like a forever thing.  During the attack, the physical and emotional symptoms increase quickly, building to a peak, then descend and finally subside. It is very much like riding a wave that crests and then falls. It always subsides and follows a predictable pattern. Knowing about the pattern is often helpful for sufferers as they learn to ride the wave. Some find that counting breaths or the old brown paper bag trick really does stop a panic attack (you've seen this in films and on TV, people briefly breathing into a bag while covering their mouth and nose, it quickly changes the ratio of oxygen to carbon dioxide which happens because of hyperventilation). While many of the more disturbing symptoms may subside following an episode, often the dissociation and out-of-body sensations may linger.  A person may also feel anxious and jittery for many hours after experiencing a panic attack. This wikiHow article can help you if you're in a situation with someone who is having a panic attack.

What is panic disorder?A person who experiences recurrent panic attacks, at least one of which leads to at least a month of increased anxiety or avoidant behavior, is said to have panic disorder. Panic disorder may also be indicated if a person experiences fewer than four panic episodes, but has recurrent or constant fears of having another panic attack. Panic attacks can occur in anyone. It is believed that chemical or hormonal imbalances, drugs or alcohol, stress, generalized anxiety or other situational events can trigger panic attacks.

Are you in a pattern of fearing fear?The fear of more panic attacks can cause some to lead a very limited, restricted life. People who have experienced one or subsequent panic attacks can often go on to develop agoraphobia, a serious condition where individuals avoid the things they think triggered the original panic episode and modify their lives or avoid altogether the previously, non-threatening, enjoyable aspects of their lives.

Am I the only one who suffers with this?No, you are not alone. It is estimated that 2 percent to 5 percent of Americans have panic disorder, usually making a first appearance in one's early twenties (not always), and often follows a traumatic or stressful event, such as the death of a loved one or a major life transition.

What causes panic disorder?Panic disorder seems to run in families, which suggests that it has at least some genetic basis. Theories also suggest that those with generalized anxiety are prone to panic disorder and that severe separation anxiety can develop into panic disorder and agoraphobia.  My experience has been that many psychotherapy patients report feeling "trapped" in some aspect of their lives. Those on the biological front point to autonomic nervous system instability. General hypersensitivity in the nervous system, increased arousal, or a sudden chemical imbalance can trigger panic attacks. We also know that chronic stress, caffeine, alcohol, stimulants and several other agents can also trigger these symptoms. Conditions such as adrenal and thyroid problems, are often overlooked in mainstream medicine, but should always be investigated. Women who experience a rise and fall in sex hormones (PMS, perimenopause, menopause) also report an increase, or experience for the first time panic, anxiety and depression symptoms. In easy language, the body automatically goes into "fight or flight" response, when there is no actual threat.

Is panic disorder treatable?Yes, there is evidence that the combination of therapy and medications such as SSRI's may offer some benefits over either one alone. What kind of therapy works best? You may not need to be on medication indefinitely, but a trial may help you get back into your life and interrupt the experience of avoidance and dread. In my experience working with patients who suffer from panic attacks, de-briefing after personal or environmental stressors, expressing emotions, affirmations, positive thoughts, mantras, mindfulness, EMDR therapy and relaxation techniques are helpful. For example, if you practice mindfulness and have panic you may be able to notice and observe that panic rises much like a wave that reaches it crest and then it falls -- it always subsides. You ride the wave down so to speak.

Many would say that panic is a learned behavior, and as such, it can be unlearned. Recovery from panic disorder can be achieved using CBT therapy and EMDR therapy, which is a form of systematic desensitization and exposure treatment done in the office. The process involves imagining various triggering situations with the goal of returning the nervous system to a place of regulation, safety and mastery (think driving over a bridge, with the resolution being the fact that one was always safe and can now de-link the experience of terrifying somatic or body experiences with driving).

What else helps with panic disorder. Some find lifestyle modifications and enhancements such as a proper diet, specific nutritional supplements, exercise, reduced caffeine and alcohol, increased emotional connections and positive emotions, stress reduction and restorative yoga. Meditation and learning specific breathing techniques such as diaphragmatic breathing (to replace the shallow breaths that result in chronic hyperventilation) can be very helpful. (yes, there's even an iPhone app, or several, for that as well!) Peer support, individual expressive therapy and even group therapy can be a vital part of overcoming panic disorder. Many sufferers have found it helpful to reach out to trusted individuals in their family and workplace about this struggle so they feel less alone. It's no longer a secret that you're trying to manage. No need to suffer in silence and no shame ever in having this symptom. Mind and body are always dynamically connected!  Always, always check with your trusted healthcare provider if you experience any of the symptoms listed in this post to rule out serious medical concerns. Visiting your doctor just in case might be better than the ER, but emergency rooms are an option and equipped to help with this because they see it often.

Practice acceptance, try compassion and change what you can. Take care, KS

Kim Seelbrede is a former Miss USA and a New York City psychotherapist, coach, consultant and EMDR therapist who specializes in a holistic approach to therapy and coaching, working with adults, adolescents and couples. Kimberly is trained to collaborate with you in developing the insight and coping skills to address many concerns including: relationships, anxiety, depression, panic disorder, self-esteem, self-harm, ADD, ADHD, social difficulties, adolescent challenges, family issues, underachievement, perfectionism, identity and sexuality concerns, addictions, compulsions, OCD, binge eating, PTSD, trauma, transitions, life purpose, spirituality, health concerns, weight management, stress management, performance problems, life balance, meditation and mindfulness support.  Please email her to arrange a consultation in her Manhattan office or online via Skype. 

Kim completed her graduate studies at New York University and has advanced post-graduate psychotherapy training and also holds an advanced certificate to practice EMDR therapy as well as specialized training in Cognitive-Behavioral Therapy (CBT), DBT skills, Non-Violent Communication (NVC), and applies the work of Emotionally Focused Therapy (EFT) and her training with The Gottman Institute in her work with couples. She Is a registered yoga therapist (200 + 500 RYT) trained with the Urban Zen Foundation.

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