How to reduce the risk of panic attacks.
Ideally, of course, we don't want to have to cope with panic attacks but to reduce the risk of their happening altogether. The best way to overcome them is to start with the rewind technique, so as to neutralise the high emotion attached to the panic situations you have experienced in the past, and thus stop inappropriate pattern matching in the future. How therapists do this will be described in the next section. Then you will need to take the following steps, to help you recover a normal life. If rewind treatment is not available to you, you can still learn to overcome your fear of panic attacks by taking the following steps.
Practise 7/11 breathing every day
Draw up a list of 10 feared situations
In this list, 1 is one that induces mild panic (perhaps posting a letter in the box at the end of the street or meeting a friend for a coffee) and 10 is one that almost induces a panic attack at the very thought of it (shopping in a major supermarket on a crowded Saturday morning, for instance, or going to a wedding). Decide what would be a 5. Perhaps a drink with your partner in the pub on a quiet Thursday evening or eating in the canteen. Then fill in 2, 3 and 4 and 6, 7, 8 and 9 accordingly.
Relax yourself as deeply as you can, perhaps going in your mind to your I special place' for a while. Then, in your imagination, see yourself calmly leaving the house and walking down to the post box with your letter (or having the coffee with your friend without spilling it or choking). Do this on a few occasions. Then go to the post box/ cafe for real. (If your situation doesn't naturally involve another person, you can take someone with you the first time and then go another time on your own.) All the time, concentrate on remaining calm in the ways we have shown you. When you feel comfortable about doing the first activity, move on to number 2 on your list. Imagine yourself doing what needs to be done to accomplish it successfully. Then do it for real. And so you progress up your hierarchy of fears at a steady pace, with each last success bolstering you for the next one.
Don't just imagine perfectly straightforward situations. Imagine the worst that might happen (something possible, not far-fetched and over-dramatic) and then see yourself coping successfully with the crisis. For instance, perhaps you might imagine someone jogging your arm in the pub, making you spill your drink on a stranger's coat. You see yourself apologising profusely but calmly, offering to pay for dry-cleaning, if necessary, and so on. If the imagined person refuses to be mollified, hear yourself saying firmly, "I am truly sorry for spoiling your evening and I am happy to give you the money for dry-cleaning" and then moving away. And see yourself calmly repeating this, if the person keeps making a point of complaining.
It is unlikely that you will progress right through your list without a glitch. But don't think you have to go right back to number 1, if you balk at no 6. Think instead about why you might have had difficulty (perhaps you had just had some bad news; perhaps you hadn't slept well the previous night), so you were already more stressed than usual when you went into a situation that, by its very inclusion on your list, could be expected to be somewhat stressful. Use the knowledge that the circumstances were unusual or else explicable in some way to help you try again.
Feeling helpless and at the mercy of a feared situation is part of what makes panic escalate. Remember, it is a human need to feel in control, so have some coping tactics ready for particular situations. If you are going to the theatre or cinema or somewhere similar, ensure you know where the exits are and how to reach them. If you are going to give a presentation, have a few questions in mind that you could ask your audience, momentarily to take the attention away from you if your anxiety starts to rise. Or tell the audience that you feel a little nervous - nothing is better guaranteed to get them on your side! We like other people to admit being 'human', just like us. And if you take control of your situation in such ways, by creating the means of temporary escape, you are less likely to need them.
For sufferers from social phobia, the cause of blushing or shaking or clamming up is often an over-focus on oneself. In effect, the person is thinking, "What is he/she going to think about me/my behaviour/my performance? Will they think I am stupid, overdressed, underdressed, etc.?" It is most salutary to realise that they probably aren't thinking about you in those ways at all. They might well be more interested in the impact they are making! So, a highly effective way to take some control and feel more relaxed is to ask questions of other people. Get them talking about themselves, what they do, what they like, what they think about certain things. All people like to be asked about themselves or their opinions, and will probably think warmly of you for doing so.
Write out on a card a reminder of what you need to do. This is a cognitive technique known by the acronym: AWARE
- Accept - don't fight the panic because you will make it worse. Breathe calmly;
- Watch - try to stand outside what is happening and observe it. Scale it for severity from 1 to 10;
- Act - normally. Try not to do anything to escape, as that will bring only short-term relief;
- Repeat - go back over the first three steps and check that you are still doing them, instead of tensing up and getting more frightened .
- Expect - the best. Don't catastrophise, as that exacerbates symptoms. Be confident that this will pass in moments, if you allow it to.
Put aside fear of embarrassment
For many people, the single reason most likely to cause their panic to escalate is the fear that their behaviour will be uncontrollable and so out of place and unacceptable that other people will think they are crazy. If we realised just how common panic attacks are, we would stop being so embarrassed about what other people might think of them! A large number of the people you corne across will have had one at some time too.
Remember: a panic attack is not a sign of mental illness. It is a statement about the stress levels in your life.
Eleanor rides out a relapse
Eleanor was a 50-year-old woman who had suffered from agoraphobia for some years. With a psychologist's help, she had advanced very successfully up her hierarchy of fears and had actually reached '9' - which, for her, was visiting the supermarket on a moderately busy day. But the day after achieving that, she rang her psychologist in a total panic. She couldn't now even go outside the door, she said. What had happened in the interim was that she had found out that her husband's firm was to be relocated from just around the comer to a town 30 miles away. It had always helped her to know that she could call on him if she suffered a terrible panic and he would be able to get to her to help her. First, she begged him to leave the firm. Then, she begged him to stay with it, because they had four children to support. Then again she -begged him to give up the job, and then once more she changed her mind. She was in a terrible state.
Her psychologist asked her to have someone drive her to his office, where he calmed her down. He then told her that it was absolutely normal to want there to be someone she could calIon if she was frightened. Was there anyone else she could rely on, instead of her husband? As Eleanor could now think straight, she was able to realise that her husband wasn't the only possible source of support. One of her neighbours knew about her panic attacks and had always been very sympathetic. She could call on her. And her sister lived quite close too. It probably wouldn't be an onerous responsibility for either of them because, as she could now acknowledge, she never actually had to call on her husband at all. What was important for her was knowing that he was there.
"Do I have to go all the way back down to 1 and start over again, now? Have I ruined all I achieved so far?" she said to her psychologist.
"The very fact that you ask the question in that way tells you the answer is no," her psychologist told her.
"Once you have learned a skill, you have it available to you if you choose to use it - just like riding a bike."
Matthew changes perspective
Matthew was 18 when he came to see his psychologist because of a terror of eating in public. He was going away to university, where he would stay in a hall of residence that offered subsidised meals in its canteen. He didn't know how he could possibly cope. In fact, he was so distraught that he felt life wasn't worth living anymore. "It is pointless going on. My whole life is ruined," he said. He rated his distress at a 10, top of the scale. Matthew found it difficult to imagine himself, while relaxed, having a different emotional response. So his psychologist tried another tack. He asked him about his interests.
"Well," he said, when Matthew had told him how he enjoyed spending his time, "you say your life is ruined. Yet you still enjoy playing football. And driving. And music. And you enjoy your studies."
"Yes, I do."
"How much time do you spend eating, in a day?"
Matthew shrugged. "About an hour."
"About an hour? So that is one twenty-fourth of a day? Because you feel uncomfortable for one twenty-fourth of a day, you think your life is ruined and you are prepared to kill yourself?"
"Well, that feels different, looking at it that way," marvelled Matthew. "I thought my whole life was ruined but it is only one twenty-fourth of it."
"So," said his psychologist. "You scaled your anxiety at a 10 when you arrived. What is it now?"
"It's a 2," said Matthew. "And a 2 is something I can handle."
He completed his university education without further problem.
How to use imagination to control blushing
Relax yourself, then, imagine a situation in which you tend to blush and let the blush happen. Then imagine a thin, flexible film of cooling ice, pleasantly covering the skin of your face and neck. Really concentrate on the sensation of cold ice. Just as we can bring saliva into our mouths by imagining the tart taste of a lemon, so we can direct blood away from the face and neck if we create for ourselves the sensation of cold. Try this in your imagination until you can achieve the effect reliably without closing your eyes. (Check it out in the mirror.) Then apply it whenever you are in a situation in which you feel a blush rising.
Another approach is to imagine a situation that makes you blush with embarrassment or anxiety and then 'instruct' your brain to signal for even more blood to come rushing to your face and neck. Get yourself blushing redder than you have ever blushed before. (If you dare do it in public once or twice, even better.) What happens if you do this is that, when the thinking part of your brain instructs the brainstem to make you as red as a pillar box (when usually, at the first flush, you would turn and flee), it cottons on to the fact that the situation can't be so dangerous after all. So gradually it turns off the blushing response altogether.