Panicked? 8 tips to wage your own war on terror

More than a quarter of all people will experience a panic attack in their life



One night seven years ago, I completely lost it. I was lying in bed,
staring at the ceiling, trying to fall asleep. Suddenly, my nerves
seemed to catch on fire, my muscles became as stiff as steel rods, and
my heart felt like it would explode. I clutched the mattress to steady
the spinning room. I had three thoughts: I'm going crazy. I'm going to do something crazy. I'm dying.
I was overcome by the urge to get the hell out of there — to jump out
of bed and run out the door or crash through the window. But I couldn't
move. I was paralyzed with fear — the same feeling you get when you
step off a curb and realize a car is heading straight toward you. Only
there was no car. The danger was all in my head.

Forty-five
minutes later, it was over. At the time, I was convinced I'd gone
temporarily insane, but a little research revealed a more probable
diagnosis: panic attack. A panic attack is clinically defined as a
powerful, inexplicable sense of terror that comes on without warning,
peaks within 10 minutes and is marked by at least four of the following
symptoms: racing heart; sweating; shaking; shortness of breath; chest
pain; a sensation of choking, nausea, dizziness or numbness; chills or
hot flashes; fear you're going nuts, losing control or dying; and the
feeling that the world isn't real or that you're detached from your
body. I had experienced at least half a dozen of these feelings. No
wonder I was ready to check myself into a psych ward.

Bring out the dread

Panic
attacks aren't as rare as you might think — experts estimate that more
than a quarter of all people will experience at least one in their
lifetime. They often come on suddenly and without warning, though
studies have shown that attacks are sometimes precipitated by highly
stressful events. "In patients who have panic disorder, six to eight
months before the first attack we tend to see not merely stress but
stress caused by loss, whether it's due to a job change, a move, a
divorce, or even marriage or pregnancy, which is a loss of your former
life," says Reid Wilson, Ph.D., a clinical psychologist in Chapel Hill,
N.C., and the author of Don't Panic: Taking Control of Anxiety Attacks.

"When
you experience a loss or too many changes too fast, it's easy to lose
your grounding," says Pauline Boss, Ph.D., a stress researcher and
therapist and the author of Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss.
"You can't fix the problem, you feel out of control, and at some
primitive level you can become panicked." If you're prone to panic
attacks, your internal distress may continue to build as you go about
your normal life until finally it overflows, sending your mind and body
into a tailspin.

Given that, my own freak-out wasn't as random
as it seemed. The seeds of my attack had been planted six months
earlier, when I moved to Spain to study abroad, then later returned to
the States only to transfer to a new university. Add an on-again,
off-again relationship to the mix and I was a panic attack waiting to
happen.

But everyone gets stressed and experiences loss. Why
do some of us end up hyperventilating into a paper bag while others can
decompress with a few Mike's Hard Lemonades and a round of PlayStation
3? Experts still don't know exactly why or how stress sets off an
attack, but some believe it's a result of faulty neural wiring. "One
theory is that in some people the brain circuitry responsible for
processing emotion and fear is in a state of hyperexcitability," Wilson
says. "This may cause the brain to mislabel nonthreatening, everyday
stress as highly dangerous and set off a false alarm that sends your
body into Defcon 1 status." Sometimes this irrational response is
genetic. Call it an inherited proclivity toward panicking.
Brain scans show that many of the same stress
hormones that are activated during the body's instinctive
fight-or-flight response are triggered during a panic attack. Two
possible culprits: adrenaline and noradrenaline. "Evolutionarily
speaking, these hormones would be released when you're faced with a
lion or a bear," says Lindsay Kiriakos, M.D., a clinical instructor in
psychiatry at the UCLA Neuropsychiatric Institute and the author of Panic Disorder: How to Fight Back and Win.
Both hormones shift your respiratory and circulatory systems into
overdrive to prepare you for action. With massive amounts of oxygen
pumping into your muscles and brain, you can react quickly to a killer
grizzly. "The problem is that, during a panic attack, this extreme
response occurs without the presence of any real outside threat,"
Kiriakos says. Without a real enemy to respond to, whether it's the
snarling beast our ancestors had to contend with or a modern-day
carjacker, the rapid breathing and muscle tension that would otherwise
help us can translate into hyperventilation and trembling. "Sufferers
can't figure out what's happening to them, and the confusion can be
terrifying," Kiriakos says.

Some
scientists theorize that noradrenaline may be to blame for much of that
confusion. When this hormone hits the frontal lobe, which is associated
with judgment and reasoning, among other things, your ability to think
clearly may get jammed up. Unable to comprehend the ensuing cyclone of
negative sensations, people assume the worst: that they're dying or
having a heart attack. In fact, according to a 2003 study in the
Canadian Journal of Emergency Medicine, people with panic disorder are
significantly more likely than people without the disorder to head for
the E.R. due to chest pain.

Other than being convinced that I had boarded
a one-way train to Reaperville, what scared me most about my panic
attack was that I wasn't doing anything strenuous or out of the
ordinary when it hit. There was no obvious trigger — I was just lying
in bed. That's common during what's called a spontaneous panic attack —
one that isn't clearly connected to any fear­inducing situation, says
Jordan W. Smoller, M.D., Sc.D., associate professor of psychiatry at
Harvard Medical School. Though it's true I had been under a fair amount
of pressure in the months leading up to the attack, because it didn't
arise as an immediate reaction to my stress, I didn't make the link
until later on.

In
other cases, it's easier to connect the dots. A panic attack may strike
when a person encounters something that trips a specific phobia, as
when a claustrophobe enters a confined space. Asthmatics — who,
researchers have found, are about twice as likely as people without
asthma to have panic attacks — may experience one at the first sign of
shortness of breath. Or a chemical trip could shove you over the edge:
Substances such as caffiene,
nicotine and other drugs can spark a panic attack because they induce
arousing symptoms (like the jitters you get after a few rounds of
espresso) that people who are vulnerable to attacks interpret as
dangerous. "About a third to half of my patients report that their
first panic attack occurred while they were taking a drug like
marijuana," Kiriakos says.


Your panic plan

If
stress usually precedes a panic attack, then the obvious prescription,
you'd think, would be to double up on yoga classes or try some
head-calming meditation. Unfortunately, more "om" isn't the answer.
There's no scientific proof that stress-reducing techniques will stifle
future panic attacks. Because there's often no predicting when or
whether another attack will strike, doctors usually don't recommend
therapy or taking meds regularly unless your attacks are frequent and
debilitating. But if a panic attack does occur, how you respond can
steer you clear of uncontrollable hysterics. Here's how to wage your
own war on terror:

Before it happens know that a panic attack will not harm you

"In
therapy, we teach patients that although panic attacks are
uncomfortable, there's nothing physically dangerous about them," says
Kimberly Wilson, Ph.D., a cognitive-behavioral therapist in the San
Francisco Bay area and a psychiatry instructor at Stanford University.



Open up about your attacks


If
you know you're susceptible to panic attacks, let friends, family, or
even a trusted co-worker know the symptoms, so they can recognize one
when it's happening and reassure you that you'll get through it,
Kiriakos says.



Pack a pill

If
you've had a panic attack before, you can talk to your doc about
getting a prescription for a small amount of a benzodiazepine, such as
Xanax or Valium, to have on hand in case another one strikes. A
benzodiazepine takes only a few minutes to increase the activity of a
neurotransmitter called gamma-aminobutyric acid (GABA), which has a
calming effect in the brain. "They're not recommended for chronic panic
sufferers [because they can be addictive], but they can be effective
against isolated attacks," says Alexander Neumeister, M.D., an
associate professor of psychiatry at Yale University. "Sometimes just
having the pill in her purse can prevent a patient from having an
attack in the first place," he says.


During an attack, sit tight

If
you're afraid you're going to faint, tense the muscles in your legs,
arms and gut until your face feels flush, about 30 seconds. This forces
the blood up to your head, which can prevent you from passing out.


Distract yourself

"Counteract
the flood of negative thoughts by doing something familiar and
comforting," Kiriakos says. "I've had patients sit in total silence or
watch TV; one even tuned in to Howard Stern." Or, ridiculous as it
might seem, start organizing. "Find some little piece of your
environment that you can control," Boss says. "Even something as simple
as straightening up the hangers in your closet or organizing your desk
can help keep you grounded."



As a last resort, go to the E.R.

It's
unlikely that you're having a heart attack or stroke, but if you
absolutely can't shake the belief that something's terribly wrong, ask
someone to take you to the hospital, where a doctor can reassure you
and treat you with anti-anxiety meds if he or she thinks they'll help.


Don't be a trouper when it’s over


"The
goal is to keep yourself from becoming preoccupied by the attack and to
return to your usual activities as soon as possible," Kiriakos says.
That said, it's OK to take some time before you jump back into work or
whatever situation you were in when the attack occurred. "It's normal
for mild anxiety to linger for a day or two," Kiriakos says. But if
you're still upset after three days, ask your doctor whether you could
benefit from seeing a therapist.


See your doctor

Always
check in with your regular physician after an attack and describe your
symptoms precisely. He or she will quiz you on your medical history and
current health to determine whether the attack was triggered by a health problem.