28 September 2013
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24 September 2013
by Amanda Williamson - Counselling in Exeter
I would like to share some thoughts on panic attacks, including some of my experiences as a sufferer which may be helpful for you. Althought it is aimed at sufferers it may also help those that know a sufferer. I did lots of research over the years, to try and get a better understanding of what was happening to my body. I see many people with panic and or anxiety issues, so I thought that I would share what I have discovered.
Have you ever suffered with a panic attack? Do you know what it's like?
If you have never had a panic attack you may find it hard to understand just how horrific and debilitating they can be. I asked what people's experience of having a panic attack was like and got the following responses:
"Like your heart's going to explode out of your chest."
"Bloody awful you feel like your gonna die, legs go weak and you feel as though everything is going grey and no sound... very frightening"
"First your thoughts are like marbles rolling around in your head. They bump into each other and you can not think straight. Then the breathing becomes voluntary instead of involuntary. You think you are having a heart attack"
"It is like being really afraid of something, but you don't know what it is. Your heart is racing, and that coupled with not knowing the cause makes it worse. As it seems to have come from nowhere."
"I thought I was having heart problems and went to the doctor. In the waiting room, a howl crept up from somewhere deep inside and released. It didn't feel like it was me. I then went into hyperventilation and the nurse threw a bag over my face...! I'll never forget it because it was all beyond my control..."
"After losing my Mum and sister within a year I suffered massive panic attacks. Mine were not of the chest pain variety but of an inability to breath without trying really hard to concentrate. The breath would be shallow and very fast where I didn't feel I could take enough air in eventually it would pass but could go on for several minutes and several times in any day."
"I had my first adult panic attack whilst 30ft under water training to get my padi open water diving cert in Thailand. It was horrific and felt I was going to die. I had no control over my breathing or body , I said adult life because after suffering this it clicked that when I was a little girl at bed time I would get panic attacks but I didn't know what they were until I had that same feeling in my adulthood. They now manifest themselves when I least expect them. I can't swallow so start to panic then my breathing goes and the fear of this happening in front of people makes the feeling like a wave even worse. I have experienced violent shakes & cold sweats flu like feeling... it's all incredibly emotional , you feel you have no control."
I used to think that I knew what a panic attack must be like. I had friends and acquaintances that suffered with them and thought to myself "That sounds a bit horrible" as well as secretly asking myself "Can't they just use rational thought to calm themselves down?". Well pride comes before a fall and I did end up going through a phase of suffering with panic attacks about 8 or 9 years ago.
The Ride of Doom
The first one happened in one of those "fun" simulator rides which consists of a moving, enclosed box in which you sit in the dark, facing a big screen with some sort of motion based movie of a racing car or rocket ride. The ride started and I immediately felt very sick and wanted to get off straightaway, except there was no way of doing so. The nausea was accompanied by a feeling of intense panic. I groped around in the dark for some kind of emergency stop button but there was nothing. The ride was full of people and I didn't want to let it be known that I was petrified so I panicked in silence. The feelings were incredible, like nothing I'd felt before. I felt like I was going to die of fright. It's hard to explain just how convincing that feeling is, but at the time, the only thing that could explain the intensity of feelings was that I was, in fact, about to die.
I didn't die, and when the ride eventually stopped I disembarked, looking around at the cheerful and excited expressions of my fellow riders. I was obviously alone in my terror. I vowed never to go inside one of those rides again.
The Tent of Doom
Then I had an attack in a tent in the middle of the night, in the middle of a field on Dartmoor, in the pitch black darkness. I couldn't find my torch so the panic rose and it was as intense as the time before. I started to take solar lights camping with me from that point onwards.
The Flight of Doom
After a very early morning (aka middle of the night) start I joined the mightiest check-in queue and nearly missed my flight. Once on board, panic started and by the time we took off, I was having a full blown panic attack, racing to the loo, eyeing up the other passengers to see who might have a Valium (having NEVER touched a tranquilliser before in my life). I considered jumping off the plane. This is after years of flying with no issues whatsoever. The flight was miserable and my holiday was blighted with the knowledge that there was no way I ever wanted to set foot on a plane again. I ended up finding a local doctor who prescribed "Trankimazin" (alprazolam - a benzodiazepine). So I did make it home.
The Caves of Doom
During the above trip, following the flight of doom, I went to visit an extensive network of underground caves. I'd always loved visiting caves and never felt claustrophobic or the slightest bit nervous. However, after the flight, I was in a heightened state of anxiety and wondered whether this would affect my willingness to be stuck underground. After quite a long queue I finally shuffled with the crowd down into the caves. The moment I was in I felt rising panic, felt like being sick, turned white as a sheet (apparently) and very quickly, almost automatically, bolted out as quickly as I could, passing the guards who, through their utterances, made it be known that the Spanish word for claustrophobia is pretty much the same as ours.
I sat in the car for a couple of hours, texting friends, nipping to the loo frequently, and trying to come down from the horrific onslaught of chemicals that my own body was flooding me with.
The Mobile Phone Shop of Doom
Things were really bad by this time - I ended up having to switch mobile phone provider because the Orange shop was too narrow and dingy (and orange). The service desks were at the back of a particularly long and narrow mini-shop. I switched to Vodafone who's shop was wide and light and I could breathe properly in there. I realised that this was nuts.
So why am I telling you all this?
Well, after suffering numerous panic attacks in various situations my lifestyle was being impeded and I felt terrible about it. I saw my GP who suggested relaxation techniques and counselling. I did see a hypnotherapist/counsellor who helped me to feel calmer, although I did continue to suffer in certain situations.
The Coach Trip of Doom
One particularly awful attack happened on a coach trip to London. I was going down with the flu, and had prebooked an early morning coach. This coach was driven by a woman who had to stop the coach once an hour to have a cigarette. To make up time, she was speeding in between breaks, and the coach was hurtling down the road, with her accelerating and braking like, well, like a really bad driver. I felt travel sick and very panicky. Because the ride was so long (over 4 hours) my panic attack just went on and on. I felt like I was in hell. Eventually, I lost all sensation in my right arm and my hands went numb. I was in a right state.
These incidents are just a few of many instances which I would describe as constituting a full-blown panic attack. Eventually I started to notice a few things about my attacks:
- They often happened when I hadn't slept enough and/or eaten properly (certainly true for the ride of doom, flight of doom and coach trip of doom
- The consumption of a strong coffee often preceded daytime attacks (applies to ride, flight, caves, mobile phone shop and coach trip of doom)
- The situations pretty much all involved some kind of change in the air I was breathing (more about this below as there is a theory about an increase in the level of CO2 triggering panic attacks)
- They were worse, and more frequent, in the Winter (ride, flight, caves, mobile phone shop)
Here are some things I've learnt, and which I have applied and which have improved my quality of life considerably:
Why can't we talk ourselves out of panic attacks?
Our survival system is being triggered. The centre of this system is our brain stem which is the oldest part of our brain, often referred to as the reptilian brain because it's all about instincts. Emotions aren't even allowed a look in here (at least not in the immediate moment), and certainly, rational thought has a way to catch up. When it comes to survival we need instant responses, so our efficient systems, when sensing danger, fling us straight into flight-or-flight mode. You can read more about "fight or flight" here. We can apply rational thought afterwards, but by then, with the onslaught of panic feelings, it might be hard to access reason, when our bodies has just been telling us we're about to die. The centre of rational thought is our frontal lobe, the more recently evolved part of our brain. It takes longer to apply rational thought than to instinctively rip our hand away from an open flame. It's quite a good design really. We'd die a lot sooner without it. But if it's triggered unnecessarily, then it's no fun.
Don't be hard on yourself. You aren't weak or feeble. For some reason, you are having an involuntary physiological response to a hard-wired survival system.
Caffeine can make hypersensitive individuals more anxious
I suspected that caffeine was really not helping me at all. Then I read a paragraph on caffeine in the textbook "Abnormal Psychology" where they starkly lay out the facts about caffeine and it's effect on the sympathetic nervous system. As we all know, caffeine is a stimulant and it affects us by increasing our heartrate and brain activity. Our bodies respond by releasing adrenalin, which is the "flight or flight" hormone, which may be enough of a trigger for people who are prone to suffering with panic attacks. I knew that I was very sensitive to caffeine, and too much would make me feel jittery, but I was also very addicted. If I didn't get 2 good strong coffees a day then I would suffer terrible withdrawal headaches. I had a sneaking suspicion that giving up might help me. Most people can consume caffeine without any problems but for hypersensitive individuals, the physiological changes that caffeine induces may contribute to or trigger a panic attack.
It took 3 weeks of making gradually weaker coffee. The headaches were manageable but I did notice that I seemed to need a lot more sleep at first. This did pass and even now, over 4 years later, I do not miss the groggy, caffeine withdrawal feeling of early morning. I also have hardly any panic attacks. In fact, it's close to zero, but I did have one this year, which I go into below.
If you want to read more about caffeine and panic attacks there's a useful article here. There is also a well written article here on the effects of caffeine on our bodies.
Could your panic attacks be caused by or contributed to by caffeine consumption?
Blood sugar highs and lows can impact on susceptibility to having panic attacks
When blood sugar levels are low the body responds by releasing adrenaline, which as we've already established, is the fight or flight hormone. Many people inflict roller coaster blood sugar levels on themselves, by skipping meals or making poor dietary choice when it comes to the energy our food provides us with. Some of my panic attacks have happened on an empty stomach.
Having a strong coffee on an empty stomach is a particularly good way to induce anxiety in me.
You can read more about the link between adrenaline and insulin (the blood sugar regulating hormone) here.
Alcohol and anxiety
I can't really mention blood sugar levels without mentioning alcohol, which sends our blood sugar levels plummeting, especially the morning after. I know of many people who have said that with a hangover comes heightened anxiety. The NHS mention it here in their advice on dealing with anxiety.
Have a think about your diet - it can be very helpful to keep a food and drink diary to see if there are any links between what you are (or aren't) eating and drinking, and the occurence of anxiety or panic attacks.
Carbon dioxide sensitivity
I had wondered whether it was the change of air that sometimes triggered an attack. I did some research at the time but, at the time, there really wasnt that much available on the internet making the link between CO2 levels and panic attacks. There's a lot more out there now, although there are no hard and fast answers. The theory goes, that certain individuals have an increaesed sensitivity to increased CO2 levels in the air. So, looking at my doom list, we can see that to a certain extent, my experiences could involve that:
- The ride (stuck in a small box with several other people)
- The tent (which I was sharing with 4 others)
- The caves ("caves often contain elevated levels of carbon dioxide")
- The flight (read here for info on cabin CO2 levels),
- The stuffy coach..
...even the titchy Orange Shop might have had elevated levels of CO2.
This explains why people feel claustrophobia in elevators AND large, packed shopping centres.
There's an interesting blogpost here on the link between CO2 and panic.
So this seems obvious I suppose, but having stressful occurrences can lead to panic attacks, because the stress has caused the body to go into a state of hyperarousal. This can be a result of Post Traumatic Stress Disorder, or a huge stressful event in your life such as the death of a close family member, divorce, work problems, relationship problems...you get the idea.
Some people end up with depression, others end up with anxiety and/or panic disorder. Unfortunately for some individuals they may have both.
Stress has definitely been a contributing factor in my experience of panic attacks. It can be hard to avoid all stressors; sometimes we are going to have really difficult challenges in life and we need to be able to look after ourselves to navigate those times. You've heard it all before but my GP was right - relaxation tapes, meditation, counselling...these all can help to reduce the physiological responses to stress. I also recommend exercise and mindfulness. Mindfulness is a really good way of learning to listen to your body and stop the racing thoughts that may be plaguing you. You can attend mindfulness classes, or read books, listen to tapes, watch videos on YouTube.
Can panic attacks be "cured"?
I believe that certain lifestyles adjustments can be made to reduce the frequency and intensity of panic attacks. Or at least, these things worked for me:
- Giving up caffeine
- Eating sensibly and not skipping meals
- Making sure I get fresh air where possible
- Counselling - this really helped me, so much so that I trained as a counsellor
- Sorting out my SAD (see my SAD article here)
- Reading about it and understanding the phenomenon (here's a good book)
I did have a panic attack fairly recently, in an underground metro whilst abroad. This was the first one in a very long time. There were, I think, various contributing factors:
- I had been going through a very stressful situation
- I had received a highly stressful phonecall the night before and had had a sleepless night
- The air in the metro was incredibly stuffy and, here is an article stating that CO2 levels are actually 20-50% higher on underground metros)
This was the first in a long time. It hasn't worried me. I have a good understanding of what was behind it. It wasn't very pleasant, but it wasn't anywhere near as bad as when I had no idea what was happening to me.
Maybe there are steps you can take to reduce the frequency of your episodes and/or the impact of them. I sincerely wish you all the best in dealing with your panic.
Amanda Williamson is a professional counsellor working in central Exeter, Devon.