HELP FOR PANIC ATTACKS
Anyone can have a panic attack. Panicking is part of being human. If stressors become great enough and create a feeling of being overwhelmed, an alarm goes off in the brain. The surge of anxiety that follows is not mild or moderate. It’s full blown, with a sense of impending doom. Even though panic is human and normal, very few people have learned the basic skills for managing a panic attack.
Some people suffer from panic attacks frequently and live in fear of panic. In some cases, these people cannot identify a reason for the attack, and describe it as “coming out of the blue.”
Living in fear of panic causes intense anguish and suffering that can only be appreciated by those who have experienced it.
Some people who suffer with panic have “agoraphobia.” People with agoraphobia fear situations in which they feel trapped and unable to escape. These situations include driving in traffic, crowds, elevators and shopping malls where there is no easy exit.
People with agoraphobia often have a “safe place,” where they feel secure and unlikely to panic. They become anxious if they travel too far from the safe place. Many people with agoraphobia carry “safe objects.” These objects make them feel secure and less likely to panic. Lastly, “the safe person” completes the agoraphobic protective arsenal. People with agoraphobia can often travel farther and face their fears more easily when accompanied by a particular individual they consider safe.
People with agoraphobia are afraid of the crowd, the elevator and the shopping mall because they are afraid of having a panic attack in these environments. More than anything, people with agoraphobia are afraid of bodily sensations. They are afraid of palpitations, dizziness, shortness of breath, etc. and are often afraid to even talk or think about these sensations.
What Can You Do About Panic and Agoraphobia?
The research is clear and definitive about what works. Talk therapy is no more effective than placebo. Therapists who help people with panic attacks and agoraphobia are called “behavior therapists” or “cognitive-behavior therapists.”
Cognitive Therapy
People suffering from panic attacks and agoraphobia need to learn how to change the anxiety producing thought process with “cognitive therapy.” Cognitive therapy involves learning to appreciate the profound impact thoughts have in creating anxiety and panic. Cognitive therapy will teach you how to challenge your distorted thoughts and bring your anxiety under control.
Exposure Therapy
Even Freud admitted that you cannot master a fear unless you learn to get up and practice facing it. If you are struggling with panic attacks or agoraphobia, therapy will involve identifying the source of your fear and helping you to face that fear gradually in small steps.
If you are agoraphobic and afraid of driving in traffic, exposure could start with a therapist sitting next to you in the car. Once you’ve mastered that, the therapist might crouch down in the back seat. When you are ready, the therapist might drive in a car immediately behind you, able to speak with you on a cell phone, if necessary. If you are afraid of malls, exposure might start in a store that has no crowds and that has easily accessible exits. With practice, you would gradually work toward more crowded stores where exits are not as accessible.
Because exposure can be anxiety provoking, a skilled therapist should make efforts to minimize your discomfort. First, the therapist should make sure you are in charge of the exposure process. You should not feel under any pressure from the therapist, and you should feel free to stop an exposure exercise at any time. Second, the therapist should train you in a set of anxiety reduction techniques so you can bring your anxiety under control during the exposure exercises. And finally, the therapist should be highly skilled in creating an anxiety ladder (i.e., the written plan for facing your fear in small steps). A well-designed anxiety ladder will prevent unnecessary anxiety as you master your fears.
Exposure can be difficult, but the process is very rewarding. If you practice the exposure exercises repeatedly, the fear will loosen its grip, and before you know it, a problem that once ruled your life starts to melt away. The experience according to many who have been through the process is exhilarating.
What If You Have Panic Attacks Without Agoraphobia?
Exposure to panic attacks works differently from exposure to phobias. If you suffer panic attacks, you’re afraid of bodily sensations. You need to be exposed to these sensations in the same way the driving phobic needs to be exposed to driving. If you’re afraid to feel short of breath, exposure might involve breathing through a narrow straw. If you’re afraid of feeling dizzy, therapy might involve spinning in a chair. These exercises are performed in the therapist’s office with professional guidance. And they are done with you in control and in charge of the process. Exposure to bodily sensations is called “interoceptive cue exposure” by experts in the field. An easier term to remember might be “sensation exposure.”
If you suffer from panic attacks, you may be afraid of normal-life activities that produce the feared sensations. Physical exercise, arguments, exciting movies or talking about sensations are just a few examples of activities you may need to practice as part of your exposure therapy program.
As with the agoraphobia exposure exercises described above, exposure to panic sensations should involve training in anxiety reduction techniques that you can use during exposure to bring your anxiety under control.
Training in anxiety reduction techniques, cognitive therapy and exposure therapy provide a highly effective combination approach to resolving panic attacks. According to multi-site research studies, 85% to 90% of people completing cognitive-behavior therapy for panic attacks are panic-free.
Although success rates with agoraphobia are not as high as they are for panic attacks, cognitive-behavior therapy is still effective in the majority of cases, and it is more effective than any known alternative. People suffering from agoraphobia may need to practice exposure to feared bodily sensations (described above) in the therapist’s office and, eventually, in the fear-producing environment, such as the mall or crowded store.
Finding A Qualified Therapist
Only therapists who have been specifically trained in anxiety management and exposure therapy know how to help people with panic attacks and agoraphobia. To find a qualified specialist in your area, visit
http://adaa.org. Do not assume therapists who claim to be qualified have had the appropriate training. When interviewing a therapist on the phone, ask the following questions:
1) Can you describe how you help people with panic attacks and agoraphobia? Can you explain exposure therapy to me? (If the therapist does not give an accurate description, call another therapist. And if your primary problem is panic attacks, make sure the therapist can explain exposure to bodily sensations.)
2) Could you describe how you were trained to help people with panic attacks and agoraphobia?
3) Approximately how many people suffering from panic attacks or agoraphobia have you worked with?
4) What is your success rate?