Panic attacks can consume a person’s life. They are like a virus: they start as tiny invaders that can quickly grow to infiltrate every waking moment of a person’s existence if they are not stopped in their tracks. Unlike a virus, that our body’s defense system fights off and usually conquers, our mind’s most common mechanisms for fighting off panic attacks–avoidance, tends to make things much worse.
This is how it usually begins:
An individual may have a fear or a thought that seems particularly threatening. Often these thoughts are notions that threaten our view of ourselves or how we fear others may perceive us (usually both). Amanda* is a great example. Amanda, an excited college freshman, top of her high school class, received a C on her first college chemistry exam. She suddenly became very fearful that she was not as smart as others have always viewed her. A small fear is planted. Every time she studied, she found herself consumed by the shame of getting a C and suddenly started fearing that she would fail in college and be exposed as a fraud. Fantasies took hold. She imagined the look of disappointment on her parents’ faces, the surprise of her friends, and the glee of her enemies if she flunked out of college. As the next test approached, she became even more frightened as study sessions became hijacked by these thoughts and she couldn’t learn the material. Finally on the day of the exam, Amanda’s fears took over she had a terrifying panic attack. Of course, Amanda didn’t know that is what it was. All she knew is that she had all the symptoms common in panic attacks:
- Shortness of breath or a feeling of not being about to breathe
- Racing heart
- Chest discomfort or chest pain
- Trembling or shaking
- Feeling unreal or detached
- A feeling of impending doom
- Fear of dying, losing control
Amanda, thought she was dying. As soon as she convinced herself she was too sick to take her test, would notify her professor and ask for a retake, and stay in bed, the symptoms mysteriously disappeared. She felt an amazing sense of relief and started feeling herself again.
That was the first big step in avoidance. After that, Amanda found that just thinking about Chemistry brought on feelings of fear. Only now, Amanda was not just afraid of failing, she was afraid she would have another episode of the crippling feelings she had on the day of the test. Anxiety experts call this, “the fear of the fear”. Amanda decided to drop the class. Consumed by shame because the word “Withdraw” now tarnished her transcript, she found she could not share this decision with anyone. Far from resolving the issue, this avoidance and resulting shame, bled into Amanda’s view of herself. Soon, she feared she would fail her other classes despite evidence to the contrary. Her life became a living hell as she started avoiding her other classes and started spending more and more time in her dorm room. Soon, her fears became a self-fulfilling prophecy since she could not do well if she didn’t go to class.
This is a typical story of how a small fear can blossom into a severe anxiety disorder. The lessons are:
- Panic Attacks need immediate attention to stop them in their tracks.
- One has to combat the fear rather than giving in to it.
- Avoidance of feared activities makes panic attacks much worse.
Professionals can help people learn techniques to decrease anxiety and to combat it effectively. There are also medications that can help decrease one’s level of anxiety until management techniques are well ingrained. There are also some books that are very helpful. My personal favorite is The Anxiety and Phobia Workbook by Edmund Bourne.
Amanda’s story did have a happy ending. After telling her parents, she got the psychotherapy she needed to understand her panic attacks. She learned that her fear of failing is a common one among college freshman until they prove themselves in a new setting. She also learned breathing techniques that helped activate her parasympathetic nervous system so that she could return to a state of calm. Most of all, she learned not to avoid things that were scary. She got connected with the college’s disability services so that she could get help in the future if she had continuing problems.
by Cynthia Divino, Ph.D.
*Amanda is not a real name but a compilation of a number of similar client histories.