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HOW A PANIC ATTACK "WORKS" |
4
KINDS OF SYMPTOMS | A
FIRST PANIC ATTACK | NOTE: This is a particularly long and important section. Don't try to read it all on the screen. Scan it first if you like, but then print it out for more comfortable reading. I want to talk to you about the different parts of a panic attack, and how it "works". You may well feel that you've already thought about it too much, that you're all too familiar with panic, and that the last thing you want to do is to think about it more. I understand that. But in order to master panic, you'll probably need to develop a new understanding of how it "works". And you'll need to know how to use this understanding to develop a game plan that will help you foster your recovery. So take your time with this information, and go at your own pace. As with all of our Self Help articles, I suggest you print or download it so that you can read it, and reread it, comfortably and on your own schedule. THE
4 KINDS OF SYMPTOMS Let's start by dividing the symptoms into categories, based on what kind of symptoms they are. For instance, it's common for people to experience symptoms such as rapid heartbeat, labored and shallow breathing, lightheadedness, chest pain, sweating, stomach and intestinal distress, and tingling or numbness in the toes and fingers, among others. See what these have in common? They're PHYSICAL SENSATIONS. Physical sensations are a big part of a panic attack, but by no means are they the whole story. What else do you experience during an attack? Maybe you're remembering from your last attack that you had an urge to flee, or that you were confused and couldn't focus, or that you thought you were having a heart attack. Psychologist have a fancy word for this kind of symptom. We call them "cognitions". I went to school for many years and spent lots of money so I could use this word! But all it means is THOUGHTS. This is a second major category of symptoms during a panic attack, thoughts. People often don't think of thoughts as symptoms. As a culture, we value our intellect and thoughts so much that we find it hard to think of thoughts as symptoms, but it's true. And the characteristic thoughts during a panic attacks include these: "I'm dying"; "I'm going crazy"; "I'm going to faint"; and "I'm going to lose control and humiliate myself in a very public way and no one will ever respect or like me ever again". You might think that's enough, that a panic attack consists of just physical sensations and thoughts, but no! There's more. It includes EMOTIONS. Mostly fear, but also anger, disgust, embarrassment,shame, and depression as the attack fades. And finally...one more category. When I give lectures about panic attacks, I always ask the audience to guess what this last category is, and nobody ever does. It's BEHAVIORS. Nobody ever thinks of it because nobody thinks an attack involves any of their own behaviors. They feel victimized by something "out of the blue" and feel like they've literally been attacked by something. But a panic attack comes from within you, and there are certain behaviors that people engage in, even as the attack begins, that play a big role in starting and building a panic attack. For instance, many people hold their breathe during an attack, and many more (the great majority of people) breath poorly before and during an attack. By this, I mean they breathe shallowly, from their chest, rather than breathing from their diaphragm. This causes or increases many of the physical symptoms mentioned above, including lightheadedness, tingling, labored breathing, and rapid heartbeat. When you have a first panic attack, you experience all or most of these symptoms, without any warning or apparent cause. No wonder you got so frightened! HOW
IT WORKS: A FIRST PANIC ATTACK You're going along, minding your own business. Maybe you're shopping in a busy grocery store; or driving on a highway; or sitting at a red light on a hot day; or sitting in church trying to follow along with the sermon, but your mind keeps wandering. Maybe you're on vacation somewhere nice, but far from home. The next thing you know, you feel attacked by all these terrible symptoms, for no apparent reason. And because people generally want explanations for what happens to them, you look around and try to figure it out. But you see no explanation in your immediate surroundings. If you had just had a close call with a runaway truck, or a wild animal, you would understand why you felt so afraid, and simply let it pass. But here, you don't see any explanation. People don't like to have no explanation. So what do you do? You guess. That's right, you make something up. And do you know what? People always make the same kind of guess: "I'm either dying, going crazy, losing control of myself, or all of the above." That's the kind of guess you make, and you make it based on the symptoms you're feeling. And it's a reasonable guess, under the circumstances. It's a very understandable guess. It's just wrong. A panic attack doesn't do any of those things, as I explained in "The Panic Trick". What's more, people will tend to continue to believe that a panic attack will kill them, or make them crazy, even after they've had many panic attacks which did neither. They're usually not reassured by the fact that the attacks haven't killed them or made them crazy. In fact, they often think they survived only because they were "lucky", and worry even more because they figure their luck is running out! We need
to break this process down even further to help you understand how it
works, and what you can do to change it. Here is a diagram I use with
my clients which depicts the stages of a panic attack.
One of the first things to notice, even before we consider the individual parts, is that the panic attack is cyclical. This is a big advantage! Why? Because it always follows the same, predictable pattern. That will make it easier to manage than a problem that always follows changing, unpredictable patterns. I know that many people feel there isn't a pattern. They'll say things like "It doesn't make any sense...it's irrational" and feel discouraged, because if I can't understand something, how can I change it? But, while it's true that the fears of a panic attack are illogical (meaning that they aren't really going to happen), the pattern a panic attack takes is predictable and regular. The symptoms often change over time, but the pattern remains the same. A panic attack starts with what I labelled The Event. By this, I mean an internal event: specifically, one of the symptoms of a panic attack that I discussed in the previous section. So, this event could be any of the following: a physical symptom (say, labored breathing, or feeling lightheaded; a scary thought ("what if I have a panic attack at the party this weekend?"); an emotion; or a behavior, like holding your breath. The event, then, is simply a panic symptom. Next comes the Reflex Reaction. By this, I mean that you experience more of the initial symptom, and perhaps some other symptoms as well. In the lingo of the old potato chip ad, "bet you can't have just one". If you feel lightheaded, you'll probably tense up in ways that make that feeling continue, and often produce other symptoms as well. How does this happen? It occurs in response to the interaction between the Reflex Reaction and the Interpretive Reaction. What I mean by Interpretive Reaction is simply that you tell yourself what these symptoms mean; this is the "guess" that I referred to earlier. In some way, consciously or unconsciously, you decide what the symptoms of the event and reflex reaction mean, that is, you make an interpretation of those symptoms. Before I go any further, let me explain what I mean by "unconscious", because that term means many different things to different people. I use it to describe thoughts, feelings and sensations of which I am unaware, or that I don't notice when they occur. For instance, as you read this now, you have probably not been consciously aware of the sensation in the soles of your feet... ...but now you are! My clients often tell me, in describing a panic attack, that they weren't thinking anything, and that the attack just came "out of the blue." I know that's how it seems. If I had asked you earlier what sensations you had in your feet when you first looked at this site, you would probably have said "none". But they were there - you just had no reason to pay attention to them, or remember them. I think very few attacks happen without some thought or other trigger. Very often these thoughts are unconscious, and the person experiencing the panic attack didn't notice them in a conscious manner. So, part of learning to handle a panic attack involves becoming a better observer of your own thoughts and feelings, and making what has been unconscious, more conscious. Let's get back to the panic cycle. The interpretive reaction is usually some anticipation of doom - of dying, going crazy, and/or losing control of oneself. A person driving down the street might see a traffic signal ahead, think of it turning red, and anticipate "freaking out" while waiting for the light to change. That's an interpretive reaction. And, that interpretive reaction produces more of the reflex reaction (maybe a more rapid heartbeat, or more lightheadedness) which in turn leads to an even more catastrophic interpretive reaction ("Oh NO! It's happening again!"). These two reactions escalate and fuel each other, and lead to the Panic Attack itself. What do you think happens next, at the question mark? Stop and think about this for a moment. Remember that part of recovery from panic is retraining your thinking about it. In a small way, that's what you're doing with this exercise. When you're ready to move on, click the button.
This is another one of those questions I always ask when I lecture, and nobody ever offers the answer. The answer is: It Ends. What makes that such a big deal? Well, how many times have you had a panic attack and had this thought: "Will this ever end?" or "What if it never ends?" These are the kind of thoughts that make the panic attack feel worse if you don't have the right answer. And the right answer is that... This panic attack will end because they all end. It's not up to me to end the attack. That will happen regardless of what I do. Whether I do all the best things to calm me down, or all the worst things to get me agitated, the attack will end. It is not my job to end the attack. My only job is to make myself as comfortable as possible while waiting for the attack to end. I can do that by practicing coping skills while waiting for it to end. So it ends, because they all end. And continuing with the cycle, you'll feel Relief. And other feelings, too...maybe tired, depressed, and other emotions. But at some point - maybe the next hour, maybe the next day, maybe the next week, it's bound to happen that you'll experience some "what if..." thinking, and enter into the Anticipation part of the cycle. And, once you've started anticipating, it's easy to produce another Event, and you're off again, into the vicious, repetitive cycle of panic. THE
ROLE OF SELF TALK Have you ever tried to get out of a panic attack by thinking of something else, by distracting yourself? Or, have you ever been starting to panic when you were interrupted by an unexpected visit from a good friend, or a child falling down and getting hurt, and later realized that the panic attack simply ended? Have you ever pulled out a bottle of xanax when you were feeling panicky and felt better just by looking at it? Or gotten instant relief as soon as you took one, even before it could actually be working? If you've done any of these things (and most people with panic have), you've noticed that distraction from the thoughts can help you get out of a panic attack. Have you ever tried to avoid, or end, a panic attack by distracting yourself? Most people with panic have. This leads them to think along this line: "If I don't think about it, I won't panic". And so they try to distract themselves from panic by avoiding the subject entirely. And yet, while that can help sometimes, it's clearly not the answer. If simply thinking about panic were enough to cause a panic attack, who would read a Claire Weekes book? watch Oprah? or visit this site? Yet many people find all of these things helpful. In my work with clients, I ask them to fill out a questionnaire whenever they have a panic attack. Many of them think it's a crazy idea at first. Yet most of my clients report that they start to feel calmer as soon as they start answering the questions, even though the questionnaire asks them to think about, and describe, the panic. They're thinking about the panic, rather than being distracted by it, and yet they feel better. What does that mean? I think it means that they're not thinking about the panic in a particular kind of way. Their viewpoint, or editorial stance, has changed. They're describing the panic more from an observer's point of view, rather than a victim's point of view. When they look at that bottle of xanax, or complete the diary, they are no longer engaging in Phobic Self Talk. WHAT
IS SELF TALK? When you were a child, you learned to talk, slowly and gradually. You learned a few nouns, for the important people and objects around you. Then you learned some verbs, and eventually other words so that you could put your thoughts into sentences. And you talked to yourself. Out loud. You'd talk yourself through walking, eating, and playing. I watched my four year old son do this last night. "I pick up the ball and THROW IT! I"m BIG! I'm STRONG!!" And this talking comes to include a lot of commentary about you, and how you're doing. As you got older, you noticed that the adults and older kids didn't talk to themselves that way. So you began to internalize it, and didn't say it out loud, but you kept thinking this way. Sometimes I can see my son's lips move when he's not talking, just thinking! And as he gets older, this thinking will become so automatic that he won't notice it much anymore (and he'll stop moving his lips, too!) But he'll keep thinking this way, all the rest of his life. That's self talk. And one of the most important characteristics of self talk is that it's subliminal. In other words, you hear it as a background sound, without paying a lot of attention to it; and because you don't pay much attention to it, it has more influence with you, because you don't notice what you're telling yourself, and therefore don't have a chance to challenge or analyze it. But when you're not paying close attention to your self talk, your body will still "hear it", and respond as if it were true, even when it isn't. This is okay when your self talk is reasonably positive, or realistic; but can cause you lots of trouble when your self talk is negative and unrealistic. And phobic self talk, the kind of self talk that precedes and accompanies a panic attack, has three characteristics.It's
Imagine what we would hear if we could listen in to your self talk when you were having a panic attack. If you're like some of my clients, we'd hear things like
Imagine how your body will respond to hearing these dire thoughts. It's going to trigger its emergency responses and flood you with adrenaline, speed up your heart, and make you feel like fleeing. That would be great if there really was an emergency, because it would give you the energy and motivation you need to protect yourself. But since there's really no danger to run from, it's going to make you feel worse. Self Talk is a powerful influence in the production of panic attacks, but people usually don't recognize it. They tend to think it's something that panic is something that "just happens", or something that's a purely physical event. Barely a week goes by without someone asking me if attacks are due to a "chemical imbalance". Certainly there are chemical aspects to a panic attack, because we are literally made of chemicals; and the use of certain chemicals in medications can help some, though not all, people. But, in my opinion, panic attacks are not simply the product of a "chemical imbalance". Here's an exercise to help you see why not. On a piece of paper, write down five situations in which you feel almost sure you would have a panic attack. Maybe this would include highway driving; flying; a crowded grocery store where the air conditioning has failed; and so on. Now write down five situations in which it would be practically impossible for you to have one. Pause here and make your lists. When you're ready to continue, click the button.
Did you make your lists? One with situations practically guaranteed to produce a panic attack, and one with situations that probably can't lead to panic at all? Okay. My question for you is this. How do the chemicals find out where you are? That's right! EXITING
THE PANIC CYCLE So, you don't always automatically follow through with a full attack. Depending on what you do, how you play your hand, you might go on to have a full attack, or you might skip it entirely. So, what I've called the Event really deserves a different name. It's an Invitation, not a command!
It isn't something that automatically forces you into a panic. It's a cue, just like a yellow traffic light. Depending on your situation, you might respond to a yellow light by slowing down and stopping; or speeding up and going through the intersection; or even maybe turning down a side street to avoid it entirely! It's an invitation to which you can respond in a variety of ways. And what happens later - panic or no panic - depends on how you play your role. You have a role to play. Let's consider what we've got so far. When you don't talk to yourself in a negative, scary, and unrealistic way, you generally don't panic. Instead of panicking, you cope. No one does it for you . They may provide the cue that reminds you to cope, but you cope. But, when you talk to yourself in a negative, scary, unrealistic way - when you fall for the trick - you panic. This is how it works, that your body responds to your self talk as if it were true. Regardless of how true or false it is. So, there is an essential ingredient to panic attacks. That essential ingredient is the unrealistic, scary, misinterpretation of what's going on around you, and especially within you. When you get distracted from this scary self talk, you don't panic. But you can't always count on distraction. When you're with your safe person you talk to yourself differently. But you don't want to always have to rely on your "safe person". So, if you could find some other way to change the scary self talk, that would be a better, more reliable way of preventing panic. That's all you have to do to get over panic disorder. Pretty good, huh? But, there's a catch. You knew that. You can't just say something to yourself and expect it to have an effect. You have to really know it's true. Hoping it's true, or trying to believe it just because you want to, won't be convincing enough to dispel the fear. You have to know it's true, from your own personal experience. So, you need practice coping with panic symptoms. A little bit at a time. That's the catch. Practice in which you respond to the panic in different ways than you used to, as you practice new ways of coping with the scary sensations. Enough gradual, progressive practice that you can determine for yourself that you are safe. Not because someone else tells you, but because you demonstrate it to yourself over time. And as you come to believe you can cope, from your own practice, you begin to talk yourself through, and out of, the attacks. And, as you gradually lose your fear of the attacks, they fade away. Just like any other bully. ©
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