Anxiety Disorders, Panic, Phobias and Fear Part 8 Panic Disorder
This stock photo above reminds me of several things about my first panic attack: 1.I was in a long tunnel. 2. I felt like the pavement was moving beneath me; like I was on a conveyer belt. 3.The lights overhead had a stroboscopic effect that felt oppressive. 4.There was actually an 18-wheeler like this one that was right on my tail and trying to pass me.
This is a ten-part series about anxiety: How to identify the different forms of anxiety and what you can do to lessen its effects.
As I mentioned in the previous installment, about 20 years ago, I had a panic attack. As I learned at a recent conference I attended on treating Anxiety Disorders, panic attacks are quite common. According to Psychologist Dr. Mark Schneider, who presented the program, “80% of people will have a panic attack at least once in their lifetime. The only medical problems more common than panic attacks are cavities and muscle-tension headaches.” So, he assured us, one panic attack, or even several panic attacks during a short period of time, doesn’t mean you have panic disorder.
The symptoms of a panic attack are so intense, you start to worry about having another one. And that can trigger MORE panic attacks as it did in my case. My biggest fear was that I would lose control of my car while driving. I remember telling my wife after driving through a tunnel on the Pennsylvania Turnpike (and seeing that we were about to drive through yet another tunnel): “I don’t know what just happened to me but I’m not driving through that next tunnel.” I pulled over and she got in the driver’s seat, and I moved to the passenger seat.
We were heading to a wedding in Pittsburgh and arrived there less than an hour later. I worried about what had happened to me the entire time we were in Pittsburgh. When we headed back on the same road the next day I made a point of driving. I figured I had to get back on the horse and ride it. However, as we approached that series of tunnels (there were about 5 in all) I had another panic attack, and this time I was in the left lane of a three lane highway, so it was much more difficult pulling over. I was convinced that we were going to have an accident and die. (BTW, I had NEVER had a problem driving through tunnels before.) My wife took over driving for the entire 7-hour trip back to Connecticut while I wondered the whole time if I would ever drive again.
The Diagnostic and Statistical Manual (The DSM-5) - which is a handbook used by counselors and psychologists to diagnose various mental health disorders - says that someone who has Panic Disorder has:
Recurrent, unexpected panic attacks
Persistent worry about additional attacks or their consequences such as losing control
Maladaptive behavior as the result of the attacks, as in my case, avoidance of
tunnels and bridges.
For many patients panic disorder can lead to agoraphobia. For some reason, and apparently this is quite common, my fear of driving through tunnels morphed into a fear of driving over long highway bridges. But it did not lead to agoraphobia. Still, it’s easy to see that if I had had my first panic attack in a store, or simply while driving on a local road, for example, that would have severely limited my mobility and possibly could have led to agoraphobia. As it was for me, I didn’t mind driving anywhere as long as I could avoid really long bridges and tunnels like the ones under and over The Hudson River.
One thing Dr. Schneider made clear right from the get-go is that having a single panic attack does not mean you have panic disorder. The main features of a panic attack include intolerance of the physical symptoms of anxiety. (In my case I really believed I was going to lose control of the car. And by so doing I might die.) And that the attacks are recurrent and a mixture of present fear and future oriented worry. At the wedding in Pittsburgh, for example, I worried the entire time about going back through those tunnels again.
Luckily for me, as part of my research for blogs like this on stress, I just happened to have read a book called The Anxiety Cure and had learned how to rate anxiety levels on a scale from 0-10. (see my previous blog) Since my biggest fear was losing control of the car and literally driving off the bridge or smashing into the wall of a tunnel, to hear the author of this book – who had gotten over her own panic attacks -confidently say that NO you will NEVER lose control of the car, no matter how bad symptoms of panic are gave me just enough courage to try to conquer this problem without help.
Also, as part of my work, I had studied many relaxation techniques and other ways to lower tension in the body, some of which, like deep breathing, I could actually use while driving. As I wrote in the previous installment of this series, I discovered that exercising vigorously and consuming less sugary foods and caffeine prior to driving over these long highway bridges - seemed to (on a scale from 0-10) lower my anxiety as I approached any long bridge.
But the one thing that helped me most to cross the super long bridges over The Hudson River was a technique called In-vivo desensitization. In other words, doing what you are most afraid of doing. And crossing the Hudson River was what I was most afraid of. This incessant worry was keeping me from my favorite vacation spot in upstate NY. After the first panic attacks outside of Pittsburgh, I spent no small amount of time worrying about HOW I was going to EVER return to this favorite mountain retreat.
The first time crossing the Hudson I just barely made it across. I drove way below the speed limit and just stared down at the pavement trying to keep my eyes averted from the vast distance between the bridge itself and the water below. But now that I was on the opposite side of the river, I worried about whether I would have the courage to drive back home. Even though it made no sense, it occurred to me that I might be stuck on this far side forever.
Luckily for me, while visiting this vacation spot, I was doing a lot of things that were altering my nervous system for the better: I was exercising, I was relaxing, I wasn’t working or thinking about deadlines. So, one morning, after a good night’s sleep, a vigorous run and a relaxing breakfast, I decided to head down to the Hudson River and cross it over The Rip Van Winkle Bridge.
It was one of the shorter crossings and my plan was to keep driving back and forth until I knew I could withstand these symptoms of panic. That was the essence of in-vivo desensitization. On a scale from zero to ten the first trip across was definitely a ten. It felt like a full-blown panic attack. Coming back the other way felt almost the same. But I was committed to keep making U-turns (which was easy to do on this narrow two-lane bridge over The Hudson.) The next trip across was about an eight. The next trip back was a six. The next trip across was maybe a five. But on the next trip across something magical happened: The fear completely went away. I remember shouting “Whoopee!” as I looked out in both directions up and down the river, thrilled at the fact that I was driving across it again worry-free.
In-vivo desensitization worked, and I have never had a panic attack since.
As I review the DSM-5 criteria for Panic Disorder, it seems like it definitely would have included me: The attacks were recurrent and lasted well more than one month. I had persistent worry about crossing ANY long highway bridge. I avoided driving over these bridges to the degree that I could although not entirely. (Before making this diagnosis, a psychologist might have taken into account the fact that I didn’t stop driving over bridges entirely. A good psychologist will often say the DSM is just supposed to ASSIST him or her in making a diagnosis and NOT meant to be the last word.) And while I have never had a panic attack since, there are times when I can feel my anxiety building as I cross a long high bridge, particularly, if certain adverse conditions are present, like I’m already stressed about something else, or I’m in a hurry, or I haven’t exercised in a while.
There are two more installments left in this ten-part series. One on Post Traumatic Stress Disorder and the other on Obsessive Compulsive Disorder.
James Porter
Author