THE FEAR FACTOR

One woman’s journey back from panic attacks.

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.