THE FEAR FAC­TOR

One woman’s jour­ney back from panic at­tacks.

Reader's Digest Asia Pacific - - Contents - BON­NIE MUN­DAY

It was 6pm, Sep­tem­ber 2001, and I was driv­ing our van on an ­in­ter­city high­way. I was 36 and head­ing to din­ner at my par­ents’ house. My hus­band was in ­Ber­muda where he’d just landed a two-year con­tract and was look­ing for an apart­ment so I can join him. So it was just me mak­ing the half-hour drive I’d made hun­dreds of times.

The news on the ra­dio was the ­re­cent Sep­tem­ber 11 ter­ror­ist at­tacks. It seemed I couldn’t get away from the shock­ing news and im­ages; I hadn’t been sleep­ing well. As I ­ap­proached a bridge my heart sud­denly started beat­ing rapidly. Then my legs turned to jelly. You’re go­ing to drive off the bridge, a voice in my head warned. Then my arms went numb. You’re about to lose con­trol and die. I was ter­ri­fied. My hands gripped the wheel; I just wanted to make it over the bridge and to the exit. I did, then I pulled

over and started to cry. What was hap­pen­ing to me?

This turned out to be the first of my many panic at­tacks. I had panic dis­or­der – a type of anx­i­ety in which at­tacks take place out of the blue – for the next 12 years. I didn’t know what was go­ing on at first, but I’ve learnt a lot since.

Un­like fear, a re­ac­tion to an ac­tual threat, panic is in­tense fear in the ab­sence of real dan­ger. Ac­cord­ing to fig­ures from Be­yond Blue, ap­prox­i­mately five per cent of peo­ple will ex­pe­ri­ence a panic dis­or­der in their life­time, with 2.6 per cent of peo­ple ex­pe­ri­enc­ing panic dis­or­der over a 12-month pe­riod.

The first episode usu­ally be­gins when peo­ple are in their early to mid20s or in mid-life and is more fre­quent in fe­males. The rea­son is ­un­likely to be bi­o­log­i­cal, says psy­chol­ogy pro­fes­sor Martin Antony, who thinks men ­sim­ply don’t want to ad­mit ex­pe­ri­enc­ing panic to re­searchers.

Suf­fer­ers of­ten re­port re­cent stresses such as get­ting mar­ried or di­vorced, mov­ing, get­ting or los­ing a job, fi­nan­cial or health prob­lems. In stress­ful times, sleep­ing poorly can make us more sen­si­tive to anx­i­ety- re­lated events, like rapid heart­beat. Panic ­at­tacks oc­cur when the brain iden­ti­fies this heart­beat as a dan­ger sig­nal.

“Hu­mans are hard-wired to sur­vive,” says clin­i­cal psy­chol­o­gist ­Eilenna Denisoff. “The fight-or-flight re­sponse al­lows us to run faster and jump higher if we’re be­ing chased. Phys­i­o­log­i­cally, the brain’s re­ac­tion to the rapid heart­beat ‘dan­ger sig­nal’ is to move blood from the limbs to pro­tect the core.” (This ex­plains the feel­ing of limbs turn­ing to jelly.) The per­son isn’t ac­tu­ally in dan­ger but the brain mis­reads the signs as need­ing to flee.

For me, the stres­sor was my up­com­ing move. Plus, I’d not been sleep­ing well, so hear­ing more news about Sep­tem­ber 11 likely in­creased my heart rate.

The first at­tack of­ten leads to panic dis­or­der. Be­cause the symp­toms make you feel you’ll lose con­trol and die, the next time they oc­cur it leads to an­other panic at­tack, says Denisoff. “Your brain starts to look for sit­u­a­tions when you should be fear­ful or feel trapped.” Ba­si­cally, you be­gin to fear the fear.

I TRIED DRIV­ING

on the high­way a week later and, again, panic drove me to the first exit. Af­ter that I took smaller, slower roads. Weeks later, I moved to Ber­muda where there were no high­ways. We also didn’t have a car. I was so re­lieved. I hadn’t told my hus­band about the two episodes; I knew he loved my in­de­pen­dence and strength and I felt ashamed of be­ing so weak.

To get around, I rode on the back of our mo­tor scooter, or I took the bus. I did this of­ten, but one day, out of the blue, as I took the bus into town my heart started rac­ing. Sure enough,

next came the sweat­ing, legs turn­ing to jelly, and the feel­ing that some­how I’d lose con­trol or ‘go crazy’.

I rang the bell to stop the bus and, in tears, walked home, where I felt safer. A few days later I tried the bus again – and the same thing hap­pened. The thing that had forced me to avoid driv­ing on high­ways was now forc­ing me to avoid tak­ing pub­lic trans­port.

It was time to come clean. That even­ing, I told my hus­band what had been go­ing on. He was so sym­pa­thetic; I shouldn’t have kept it bot­tled up be­cause it felt good to let it out. But he was as mys­ti­fied as I was. We searched ­on­line for ‘fear of high­ways’ and ‘fear of pub­lic trans­port’ and got lots of hits, which is when we learnt that many peo­ple ex­pe­ri­ence episodes called panic at­tacks.

What a re­lief to know I wasn’t alone. But my heart sank when I learned that what hap­pened on the bus meant I also had ago­ra­pho­bia [fear of open spa­ces], which of­ten goes hand in hand with panic dis­or­der. You fear that if you have panic symp­toms, you won’t be able to es­cape. In ex­treme cases, your world shrinks un­til you fear leav­ing your home.

Now it was time to tackle this; I’d be damned if I was go­ing to let some­thing in my mind con­trol my life. I’d read that it helps to talk about it with loved ones. So, a few days later, when I flew back home for a visit, I had din­ner with my best friend and her hus­band and told them about the panic at­tacks. Lind­say looked at Todd with wide eyes then back to me and said, “Todd went through that a few years ago!”

He said sheep­ishly, “When I was 28, I had panic at­tacks.” He had sev­eral episodes over a few months. It was a very stress­ful time as he’d just taken over the fam­ily busi­ness. One even­ing at a restau­rant with Lind­say, his heart started pound­ing fast; he thought he was hav­ing a heart at­tack and felt the need to flee. They left mid-meal and the pound­ing stopped. The next morn­ing he went to his doc­tor. “It sounds like you had a panic at­tack,” he said. He re­ferred Todd to a men­tal health spe­cial­ist, who gave him a pre­scrip­tion for an anti-anx­i­ety drug. Todd took the med­i­ca­tion and avoided restau­rants, but then a panic at­tack hit when he was in an air­port lounge. Ago­ra­pho­bia had kicked in.

He dealt with it on his own by

FEAR IS A RE­AC­TION TO AN AC­TUAL THREAT. PANIC IS IN­TENSE FEAR IN AB­SENCE OF REAL DAN­GER

learn­ing re­lax­ation tech­niques and was able to cut back on the pre­scrip­tion drugs. Even­tu­ally, the fre­quency of at­tacks less­ened, then dis­ap­peared, so he stopped tak­ing the med­i­ca­tion. “The drug was key,” Todd told me. “And read­ing up on panic at­tacks – know­ing it’s not un­com­mon – re­ally helped.”

Back in Ber­muda, I dared to get back on the bus – with a book on cop­ing with anx­i­ety as an an­ti­dote in case panic be­gan. When my heart started rac­ing a few min­utes into the jour­ney, I pulled open the book to the ear­marked pages ad­vis­ing that panic wouldn’t kill me, I wouldn’t ‘ lose con­trol’, and I wouldn’t ‘go crazy’. It calmed me.

THER­APY WAS THE ONLY WAY I’D GET PAST THIS. BUT THAT WOULD MEAN FAC­ING THE FEAR – AND I WAS TOO FRIGHT­ENED

FOR THE NEXT TWO YEARS

I kept panic at bay in this way; I didn’t con­sider ther­apy or med­i­ca­tion. But it was in­evitable that one day I’d be back liv­ing in a city with lots of high­ways, and I’d need more than a book to get me be­hind the wheel.

For nine years af­ter mov­ing back home, I avoided panic at­tacks by re­ly­ing on my hus­band to drive on the high­ways. I told only peo­ple close to me about my ‘weak­ness’. I knew ther­apy was the only way I’d be able to get past this for good. But that would mean fac­ing the fear – and I was too fright­ened to con­tem­plate get­ting back on the high­way.

Then we bought a cabin in the coun­try which needed fix­ing up. My hus­band worked on it for weeks at a time while I worked in the city. It was a three­hour drive away on the high­way and it wasn’t on a bus route, so if I wanted to go up on week­ends, I’d need to find a psy­chol­o­gist.

Panic dis­or­der can be treated with an­tide­pres­sants for a long- term dis­or­der and beta block­ers for im­me­di­ate re­lief of symp­toms. But ex­perts recog­nise cog­ni­tive be­havioural ther­apy (CBT) as the best treat­ment. It re­solves anx­i­ety by chang­ing the ­un­der­ly­ing be­hav­iours and cog­ni­tions that tell you the symp­toms are dan­ger­ous. “Chang­ing your re­ac­tions to the symp­toms is key,” says Pro­fes­sor ­Antony. “When you’re will­ing to let your panic at­tacks hap­pen with­out try­ing to con­trol them, they of­ten stop.”

Ex­po­sure ther­apy plays a big role. The goal is to feel the same sen­sa­tions as dur­ing a panic at­tack and dis­cover you don’t need to fear those

sen­sa­tions. In my first ther­apy ses­sion I learnt deep breath­ing – a long slow in­hale through the nose, a long slow ex­hale through the lips.

“This will be your tool to calm your­self when you feel pan­icky,” the psy­chol­o­gist ex­plained.

A week later, we started imag­i­nal ex­po­sure ther­apy. She asked me to tell her the high­way routes near home that were no-go zones. Then she asked me to close my eyes and imag­ine driv­ing the least scary route, to de­scribe each step and rate my anx­i­ety lev­els from one to ten.

“One,” I said, men­tally back­ing out of the drive, then “two,” as I turned onto the next street. It jumped to “eight” when I reached the road lead­ing to the on-ramp. My heart was pound­ing; I was start­ing to sweat. “Do your breath­ing,” she told me.

She asked if I’d ever kept some­thing in my purse for when I felt un­well. In fact, I had chew­ing gum for stom­ach upsets. “Good,” she said. “Imag­ine you’re chew­ing a piece of gum.”

Now, the mo­ment of truth: in my imag­i­na­tion I ac­cel­er­ated and merged into high­way traf­fic. “Ten.”

My legs turned to jelly and I had that aw­ful feel­ing I’d lose con­trol. “It’s OK, keep breath­ing,” she said. “It’s less than a kilo­me­tre to the first exit.” In my mind, mo­ments later I saw the exit ramp and be­gan to calm down.

My re­lief turned to fear when she said, “Your home­work is to do that for real this week. Re­mem­ber your breath­ing, bring your gum. It won’t be much dif­fer­ent from do­ing it in your mind.”

So, one Tues­day af­ter din­ner, I took a deep breath and grabbed the keys. Just like in ther­apy, my heart pounded as I got on the high­way. But, us­ing my new tools, I made it to the exit with­out my phys­i­cal symp­toms es­ca­lat­ing. I was over­joyed.

Over four more ther­apy ses­sions we did imag­i­nal ther­apy, each time tak­ing a tougher route or adding dis­tance. My home­work matched what we imag­ined, and each week I could do it for real, though I al­ways re­turned home on reg­u­lar roads.

On a home­work ses­sion that in­volved the scari­est route yet, I ex­ited the high­way panic-free. I said to my­self, What the hell, let’s give it an­other go. I looped around and got back on the high­way to­wards home. It was a feel­ing of pure vic­tory, and I haven’t had a panic at­tack since.

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