She did try to get out. She first took a job at an agency that kept track of credit reports. The first day she sat for about a half hour at her computer nearly paralyzed--then ran out and frantically drove home, where she pretty much stayed for the next several years.
To find some relief from the daily attacks, Joni tried drugs and alcohol, often more than once a day. Nothing worked, not even the numerous medications designed specifically for anxiety. She has been to emergency rooms more than once. She experienced so much dizziness that her doctors gave her a CT Scan to check for inner ear problems. When medical tests revealed nothing, she began to believe she had a tumor of the adrenal glands.
When Joni tried to go to work again, she again found herself in front of a computer taking care of the billing in an office. She wouldn't admit that anything was wrong, but at times the mere act of staying at work must have been real agony. This time, however, Joni was working for me, and at a time when I was serendipitously introduced to the idea of Hyperventilation Syndrome and treatment for panic attack victims.
Over the next few months Joni and I found some people who were looking for help, and we
started a group.
A few months before I started writing this, I asked Joni how she was doing. She wrote me back:
I DO NOT have panic attacks anymore...for almost a year now. A solution to this problem was and is a Godsend. Miracles can really happen in the most unusual ways!!
I don't think Joni used the word miracle lightly. If you have been looking for the miracle that Joni is talking about, the one which brought her the knowledge of what to do, look no further.
Panic attacks are so powerful they seem to be completely beyond your control. Joni thought so. But as easy as it is to believe that panic attacks are an inevitable part of your life, I can assure you that just the opposite is true. Panic attacks are not inevitable. They can be controlled. For a few of the people who read the first few chapters of this book and do the exercises, success (meaning no longer having panic attacks) will be almost immediate. Success will take a little longer for most people, but it will come.
People with Panic Disorder suffer from periods of intense fear or anxiety. The fear is a result of great physical distress that indicates something has gone seriously wrong. For some people attacks come "out of the blue" and for no discernible reason. Others report experiencing warning signs that an attack is coming on. An afflicted person must cope with the possibility of an attack occurring while shopping, driving, attending church, or being with other people socially. For some, the worst fear is that they will be alone when an attack occurs.
If you have panic attacks, you know that you may be out of breath, experience a racing heart, or have pronounced chest pain. Trembling hands, blurred vision, pressure or a knot in your throat, tingling or numbness in your face, fingers, and arm, and profuse sweating are among the dozens of symptoms reported by panic attack sufferers. Being left confused, weak, and exhausted can be a part of your attacks.
What Is the Explanation for Panic Attacks?
In the past, and even today, there is no universal agreement among professionals about the causes of the panic attacks experienced by Joni and millions of others. Many will say that the cause is not really known. Stress or anxiety is often blamed, because attacks often start after periods of unusual stress.
Only in the last few decades has there emerged an explanation for panic attacks that accounts for all the various symptoms. When this explanation is understood and applied to treatment, control is regained and panic attacks are stopped.
Panic attack sufferers have one thing in common: they don't breathe properly. People who suffer from panic attacks breathe shallowly and rapidly. They breathe mostly using the muscles of the chest, neck, and shoulders and make little or no use of the diaphragm. This type of breathing results in a disruption of the exchange of oxygen and carbon dioxide in the bloodstream and body, leading to a condition know as Hyperventilation Syndrome.
Hyperventilation occurs any time a person breathes in such a way that the amount of carbon dioxide breathed out exceeds the amount the body is manufacturing. This results in a condition known as "hypocapnia" in the medical field. When the blood's level of carbon dioxide falls below a critical point, the person begins experiencing apprehension and physical symptoms such as dizziness, shortness of breath, and rapid heartbeat.
If the person doesn't know what to do at this point, the symptoms become more severe and a panic attack results as the condition becomes more pronounced. A few people will experience partial paralysis or faint as a result of hyperventilation.
The symptoms experienced during panic attacks are not "imagined"; they are quite real. The sensation of dying that many people experience during a panic attack has a physiological basis. If too much carbon dioxide were lost from the body, life could not continue. Fortunately, the body has several ways to prevent that from happening.
What we call a panic attack is one of the ways the body protects us. The feeling of not being able to get enough air during an attack arises because the part of the brain that regulates breathing temporarily "shuts down" and allows the rebuild-up of carbon dioxide. This shutting down of the ability to breathe in the normal way can be extremely frightening.
One final point to be made before going on: Panic attacks happen to normal, healthy people who, for whatever reason, are breathing improperly. When panic occurs, the nervous system is doing exactly what it is designed to do: protect the body from death. Mostly, the mental states associated with panic disorder are the result of hyperventilating and the fear of having attacks in the future. Obviously, the place to begin treatment is learning how to breathe without hyperventilating.
Susan
Susan is one of those people who succeeded right away. Susan was never in formal treatment with me for her panic attacks; she only heard me talk in a group of people one time about hyperventilation syndrome and what could be done to remedy the condition. (She was unable to come to the rest of the scheduled meetings because of vacation plans with her husband.)
A few months after she returned from her vacation, Susan wrote the following letter so it could be used to help others who suffer from attacks:
I am so happy with the results of learning how to breathe
diaphragmatically. I wanted to share my experience. It has
changed my life for the better.
I have been a sufferer of panic attacks for over three years.
I have tried everything. I have been to doctors, had all
kinds of tests, even been into urgent care a few times. All
they would tell me is that it was stress. I finally got so
that I could go through life as long as I had my
tranquilizers. But I would still experience panic, feel
dizzy, sick, out of control, and worst of all a feeling like I was
losing my mind. The only thing that sort of worked for me
was to take Ativan and not do all the things in life that I
really wanted to do.
It was while I was at a meeting in Redlands that I met Dr.
Anderson. I was very interested in what he was telling us
about diaphragmatic breathing. It made so much sense, I
decided to give it a GOOD try.
I first started by diaphragmatic breathing before I got out of
bed in the morning. I noticed that I seemed to feel less
shaky and more calm right away. At the time I was on the
highest dosage of Ativan that I had ever taken.
My family was planning a vacation, so I took my [volumetric exerciser] to
practice my breathing. Every time I could I would practice.
By the end of my vacation I had cut my medication down by two-
thirds. I kept breathing diaphragmatically every time I would
think about myself and how I was feeling, which is pretty
often when you suffer from panic disorder.
When I returned to work, the stress returned too. But
breathing really helped. It really works! I did not want to
go back on medication.
I have had a few panic attacks since. But I try to catch it
early. I know this is hard. But there are signs of stress
coming. I also know that after breathing diaphragmatically at
least three times I could feel the panic lift. And the best
feeling of all is the feeling that I am in control again.
I have been totally off medication now for one month. I am
thrilled. I have even been tested pretty good--a trip to
the dentist. I just kept up the diaphragmatic breathing. I
really believe in diaphragmatic breathing. It has changed my
life for the better.
Sincerely,
Susan H________
The wonderful thing about Susan's letter is that she mentions several steps which helped in her
recovery. She began by deciding to give it a good try. She then:
- Practiced diaphragmatic breathing before getting out of bed in the morning.
- Practiced several times during the day, using a volumetric exerciser.
- Used inner cues to remind herself to practice.
- Began cutting back on her tranquilizing medication as soon as she made progress.
- Stayed off medication even when the stress intensified; she relied on diaphragmatic breathing to deal with symptoms.
- Became aware of the early signs and learned how to breathe to get rid of symptoms.
Keeping Panic Away
Several months later Susan wrote to me that she has the same ability to control attacks as when "treatment ended" and that she doesn't have panic attacks now. Thinking of others, she wrote as follows:
A person needs to stop and think at the first sign of panic
what might be triggering the attack and breathe to slow down
the increasing panic.
Since your tendency to have panic attacks may remain for some time after you've learned the skills of controlling them, it is important, as Susan found, to stay aware of early signs and breathe diaphragmatically to stop the symptoms.
All the former patients who responded to my questionnaire about their success noted that they
continued to practice breathing diaphragmatically as a way of controlling their tendency to have attacks.
Hyperventilation Syndrome is a complicated interaction of many things. This means you have to accomplish several things in order to gain control and live without attacks.
You don't have to learn "perfect" diaphragmatic breathing, but mostly you should be able to do it when you think about it. Give yourself some time to change your habitual breathing pattern.
Reward yourself for making a little progress at a time.
Practice at those times you feel best. If that's not very good, then accept it as your best time and do what you can. Go slowly. If you're in this situation, you probably haven't felt anything close to normal in a very long time.
Tranquilizing medications allow you to function, at least somewhat. But they can get in the way of recovery, because they impair learning and memory and tend to be addictive. When you have gained some skill in recognizing and controlling attacks, you can taper off your medications with the help of your doctor. For now, the medications provide you a window of opportunity that's helpful.
When Joni and I would talk about the struggles she went through and how panic attacks became the focus in her life, we both recognized that after one has mastered diaphragmatic breathing, one needs continuing support to keep on succeeding.
Functional breathing will stop panic attacks, just as stopping drinking will lead to sobriety for a person who has become addicted to alcohol. Relapse is possible, so more than functional breathing is needed. After suffering over years, many panic attack victims have become fearful of life, dependent on others, feel isolated, and have learned to manipulate others in order to protect themselves. Working with a therapist, self-help groups, and your religious faith can help you with these attendant problems.
It would be easy, in the short term, to play it safe. To stay at home. To do nothing. You must be willing to work in order to succeed. And you will succeed if you carefully follow the instructions outlined ahead. All you have to look forward to, after all, is freedom. Freedom from panic attacks and all the limitations they have placed on your life for so long.
-- Bert A., M.Div., Ph.D.
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