Fear, Loathing and Panic Attacks

Clinical anxiety is the most prevalent psychiatric issue in society today. And that includes Northern Virginia.

I’d like to apologize to the good people who were on board the 4 p.m. US Airways shuttle from Reagan National Airport to LaGuardia on March 30, 2006. I did not mean to ask the pilot to turn the plane around.
You see, I was nervous about flying without my two kids (it was our first time traveling without them since they were born), and even though my husband was holding my hand, I was already on edge.

Then the plane door closed, we pulled away from the gate, and the pilot announced (heavy sigh into the intercom), Well, folks, it’s a Friday afternoon in the nation’s capital, and it seems like EVERYONE is trying to get out of here at the SAME TIME. There’s quite a long line of planes ahead of us, and we’re not sure how long this whole thing will take. We might be stuck out on this tarmac FOREVER. We may NEVER make it out of here ALIVE.

Okay, maybe he didn’t say that, but that’s pretty much what I heard. And then, in an instant, these things happened:

The walls of the plane closed in on me, and my seat got smaller. My heart started pounding, and I broke into a cold sweat. Then came the bottoming-out feeling in my stomach while the rest of my body went boneless. It felt like I was breathing through a straw, engulfed in a dark storm cloud of doom. I am trapped, I thought. I may never see my children again, and we might all run out of oxygen at any minute. I NEED TO GET OUT NOW.

Taking a deep breath, I turned to my husband and said, “Honey, can you ask the flight attendant to come over? I think I’m having a panic attack.” He might have noticed that I had gone a little pasty.

This was not my first rodeo. I had been having panic attacks at random, unannounced intervals for more than a decade, and carried an old prescription of Xanax at all times, just in case. I quickly popped a 0.25 mg pill while I waited.

Soon, the flight attendant was at my side. “I’m having a panic attack,” I told her, hoping that, given her experience, she would offer the sage reassurance I needed to get through this rough patch. Instead, she simply said, “Oh, do you want us to bring the plane back to the gate?”

Turn the plane around? They would do that for me? “Yes!” I said without thinking. The attendant turned on her heel and disappeared toward the back of the plane.

Suddenly buoyed by the knowledge that I was not trapped and facing imminent death, I felt lighter. My heart rate evened out and I started breathing easier. I asked my husband to summon the flight attendant back so that I could apologize for the false alarm, tell her I was okay and confirm that we were good for takeoff.

But when I did, she just shook her head. “No, it’s too late. I’ve already put in the call,” she said, flatly.

I couldn’t talk my way out of it. And so my fate was sealed. Soon, I was being marched off the plane while a hundred pairs of inconvenienced travelers’ eyes burned into me like daggers.

Later on, I would feel more than a bit silly. Who ever heard of someone getting stuck out on the tarmac forever? But in that moment on the plane, the fear had been real.

Panic is an insidious beast that seeps into your bones, scrambles your guts and clouds your thoughts. There is no reasoning with it. And it’s a monster that no one can see except you.  

I HAVE SINCE come to learn that I am not the only person prone to crippling bouts of angst. In fact, far from it.

An estimated 40 million American adults suffer from clinical anxiety—a category that includes panic attacks as well as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD) and social anxiety, according to the Anxiety and Depression Association of America, an advocacy group based in Silver Spring, Maryland.

While low-grade anxiety is normal (it can even be productive), there’s a threshold above which the mindset becomes disabling. Clinical anxiety is defined by the National Institute of Mental Health (NIMH) as anxiety that goes beyond temporary worry or fear, gets worse over time and interferes with things like job performance, schoolwork and relationships. Nearly one-third of Americans will experience anxiety on this level at some point in their lives. It’s the most prevalent psychiatric issue in society today.

And yet, it’s largely invisible. “Most people with anxiety never tell anyone about it,” says James Ballenger, a Charleston, South Carolina-based psychiatrist who is widely regarded as an authority on the disorder.

(His pioneering research in the 1970s contributed to anxiety’s eventual addition to the DSM, or Diagnostic and Statistical Manual of Mental Disorders, essentially the bible of the American Psychiatric Association, in 1980.) Only a third of people who suffer from anxiety will ever seek treatment for it, according to NIMH.

Men, in particular, tend to keep their silence, viewing an admission of anxiety as a sign of weakness, observes clinical psychologist Rolando Diaz, who practices in Arlington. “People, especially men, feel like they should be able to figure it out on their own,” he says. “Out of context, anxiety is open to a lot of interpretation. People who don’t have anxiety don’t understand why people who do [have it] can’t deal with it. But anxiety disorder has a very emotional component—it’s hard to separate out thoughts that are reasonable from what’s unreasonable.”

 

This was certainly true for Thomas (not his real name), 44, a married father of two in Arlington. “Something changed in me when I had kids,” he says. “My stress levels went through the roof.”

Thomas told no one about the crushing feelings of responsibility and dread that seemed to suffocate him—whether the challenge was keeping his kids entertained for the day or providing for his family and paying the mortgage. “I would be at a work lunch,” he says, “and I’d get this overwhelming sense of discomfort and panic out of nowhere. My heart would start racing, and I would think, I have to get out of here. I’d walk around the block and count to 100 and wonder if this was ever going to go away.”

Rather than seeking help immediately, Thomas turned to alcohol to take the edge off. “I was too macho,” he says. “I wasn’t doing the right things, and I didn’t want to tell anyone about it. Every night was happy hour. My recycling bin was ridiculous. It got really bad for me.”

After a few years, he finally broached the issue with his doctor, resolved to stop drinking and turned to AA for support. Thomas has since relaxed his expectations of himself and focuses on staying present in the moment. He recently began exploring meditation. “Once I owned up to the way I was feeling and allowed for the possibility that not everything was going to get done on time or in the way that I wanted it,” he says, “things started to get better.”

RESEARCH SUGGESTS that anxiety is hereditary and does tend to run in families, but it can also be triggered by environmental circumstances. “There usually needs to be a catalyzing event,” Ballenger says, whether it’s changing jobs, becoming a parent, or “something traumatic like combat, a car accident or the death of a loved one.”

Lyon Village resident Kara McCabe  comes from a long line of worriers (“If it were up to my dad, we’d all be wearing helmets 24/7,” she says). But her family also has been scarred by loss. McCabe was 16 when her older sister was killed by a drunk driver. By the time she reached her early 20s, she was having panic attacks.

“When my sister died at such a young age, it made me realize how easily things can happen,” McCabe says.

In the years that followed, those feelings of vulnerability became mani-fested in phobias that interfered with her everyday life. She began avoiding crowded places. She stressed about seemingly benign scenarios, like being able to find an open seat in a movie theater. And then she had kids.

“I never really understood the loss that my parents went through [with my sister’s death] until I had my first child,” says McCabe, now 45 and a mother of four. “It’s the unthinkable. No matter what you do to keep your kids safe, they’re still vulnerable. You could keep them in a box their whole lives, and then the box could cave in.”

Shortly after Sept. 11, 2001, McCabe developed a crippling fear of flying that persisted, despite assurances from therapists and her husband, an aeronautical engineer, that flying is one of the safest ways to travel.
“I don’t deal with statistics very well,” she explains. “I think I’ll be the one.”

McCabe finally resolved to confront her demons after realizing that her anxiety was stifling her kids—whether it meant vetoing vacations that involved air travel, avoiding water parks and wave pools (fear of drowning), nixing carnivals (potentially faulty rides that hadn’t kept up with inspections), or staying home on the Fourth of July rather than braving the crowds for fireworks.

“When anxiety starts changing your behavior and you don’t do fun things because you’re afraid of what can happen, you need to ask yourself, Am I really not going to do this because of my anxiety?,” McCabe says.

She has since learned to tamp down her negative thinking with cognitive behavioral therapy (more on that later) and medication. This summer, she flew with her family to Cape Cod, Massachusetts, for a vacation.

CULTURALLY, Northern Virginia does tend to feed the beast. “This area is a hotbed for anxiety, with our cultural and intellectual expectations for achievement and social status,” says McLean-based therapist Mimi Weisberg. People feel pressured to carry the big mortgage, pursue the high-powered career, maintain peak fitness, decorate the perfect home, volunteer for every school fundraiser and PTA activity, and raise perfect children, she says.


Kara McCabe has learned to manage her fear of flying for the sake of her kids.

 

Johanna Arenaza, an Arlington mom of two and clinical psychologist with a practice in D.C., says she sees this phenomenon daily: “In this area, we are all so capable. There’s a very high value on achievement and professional and academic success. We think that once we achieve that, we’ll be happy.”

The problem, she says, it that we have a tendency to delay happiness until we reach whatever goal we’ve set for ourselves. And that pattern of delayed gratification becomes an unreachable point on the horizon line.

“We think, I’ll be happy when I get to the next promotion or when I’m done raising my kids,” Arenaza says. “Then, even when we do achieve that goal, we discover we’re still not happy. We think that working more is the solution. It becomes a hamster wheel.”

What’s more, anxiety seldom travels alone. The condition often gives rise to a host of secondary problems, including alcoholism and other forms of substance abuse, obsessive exercising and eating disorders—all of which are flawed coping mechanisms.

“There’s a high degree of perfectionism in this area,” says Ioana Boie, an assistant professor of counseling at Marymount University who specializes in treating eating disorders. “Eating issues … become a way to self-medicate or a means of exerting control.”

Depression also tends to go hand-in-hand with anxiety, given that prolonged episodes of nervousness and unease are physically exhausting, leaving those who suffer from the condition feeling helpless.
Adam (not his real name), a married father in Falls Church, knew that he was supposed to feel proud and fulfilled each time he got a promotion or a new job. But as his family’s primary breadwinner, the

42-year-old says those milestones only compounded the sense that he was living in a pressure cooker. “With each job, my anxiety became harder and harder to control,” he says.
Even worse, his anxious feelings often manifested as anger. Finally, an incident brought everything to a head.

“My wife had given a bracelet to our 9-year-old daughter, and within a few hours, she had already lost it,” Adam recalls. “I started yelling at [my daughter] over this little bracelet, but it wasn’t about the bracelet. It was everything I was feeling: my life, my job and my own anxiety. I didn’t realize how badly I’d reacted until a couple days later when I asked my son to pick up the Legos that were all over his room. He looked up at me and whispered, ‘Sure, Dad,’ like he was afraid. I asked him what was going on, and he said, ‘Sometimes when you yell, I’m scared of you.’ It broke my heart that my own kid was scared of me.”

Now in therapy and taking anti-anxiety medication, Adam says he’s looking for ways to mitigate the stress in his life, starting with his career.

“I need to find something that I can do that doesn’t rob my soul that also allows me to take care of my family,” he says. “The fact that [anxiety] is hereditary makes me want to work on it even harder. I’m scared that my kids are going to go through this. If I can find ways to help my kids process their anxiety, at least I’ll have done something.”

MY INITIATION INTO the world of panic attacks began the morning of my college graduation in 1995. The first episode came at me out of the blue, punching me in the gut and leaving me shaking, clammy and out of breath.

I went to see a doctor, who shrugged and gave me a clean bill of health. But in the years that followed, similar bouts of panic would continue to blindside me—in a low-ceilinged club; on a stalled Metro train; on vacations where I was supposed to be having fun.

My world started closing in on me. I avoided travel and feared new places. I worried about when the next panic attack might strike without warning. I lost joy and found dread lurking around every corner. I had always been adventurous, unafraid and outgoing, but suddenly I had turned into someone I didn’t recognize.

Eventually, in 2001, I found my way to a therapist (and fellow panic-attack sufferer) named Jerilyn Ross, founder of the Ross Center for Anxiety and Related Disorders in Washington, D.C. Ross, who passed away from cancer in 2010, was the first person to identify what I’d been experiencing as panic attacks.

And in one single intake session, she homed in on the traumatic event that had triggered them: The week before my college graduation, a stranger had broken into my apartment in the middle of the night and sexually assaulted my housemate as I slept in the next room. I had never considered myself a victim (after all, the intruder had attacked my roommate, not me), so I never recognized how much the event had upended my world. But the truth was I was still grappling with all of the implications of what had happened—the inability to protect my friend; the survivor’s guilt; the what-ifs; the sense that we’re never really safe, even when we’re tucked into our own beds behind locked doors.

Because my first panic attack happened after the emotional chaos of the break-in had subsided, it had never occurred to me that the two might be connected. But panic attacks are unpredictable in that way, making them difficult to diagnose. The symptoms (which include accelerated heart rate, chest pain, shortness of breath, and nausea, according to the DSM) often mimic those of a heart attack—which may be why 44 percent of people experiencing their first panic attack end up in the emergency room, according to Ballenger.

How can something psychosomatic feel so real? Ballenger explains that panic attacks are a misfiring of the brain circuitry that connects the amygdala (the part of the brain that manages anxiety) to the hippocampus (which is responsible for memory) and the frontal lobe (where we evaluate everything).

“Twenty thousand years of evolution have allowed us to develop this protective system that keeps us safe from predators or dangerous situations,” he explains. But panic attacks hijack this system, creating a false sense of fear.

THE GOOD NEWS? “Panic attacks are uncomfortable, but they’re basically harmless,” says Greta Hirsch, clinical director of the Ross Center (she also happens to be the therapist Ross matched me with when I first visited the center).

 

Furthermore, they’re treatable. Hirsch often uses a type of talk therapy called cognitive behavioral therapy (CBT) to help patients restructure the way they think about and respond to negative thoughts and behaviors.

“The cardinal rule of managing panic attacks is to stay present and stop your thoughts from racing ahead,” she says. “To recognize that in the moment, you are safe. So that when, for example, your heart beats fast, you know that you’re not having a heart attack or that when you start having a hard time breathing, it’s not that you’re really going to run out of oxygen and pass out. You will be okay.

“The goal is not to never have a panic attack again, because then the thought of having a panic attack becomes panic-inducing in itself,” she stipulates. “The goal is to give the patient the tools to handle it once it arises.”

Hirsch also employs exposure therapy, a practice in which a patient physically confronts a fear-inducing experience in manageable increments, essentially re-creating the trigger. “You will find me [taking patients to] all kinds of strange places,” she says, “depending on what your phobia is.”

Afraid of getting trapped in an elevator? Hirsch might break down that fear by first taking you for a ride in a big, clean elevator, then gradually moving you to less comfortable ones, “until we get to the darkest, dingiest, most rattle-y, slow-moving elevator that goes deep underground,” she says.

Experts say behavior modifications can also help ease anxiety flare-ups. Alcohol, smoking and caffeine can exacerbate nervousness, for example, while exercise can help alleviate it.

Though multiple studies suggest that CBT has the longest-lasting benefits of all clinical treatments for anxiety, medication—including antidepressants such as Paxil and Zoloft, and benzodiazepines like Xanax and Ativan—is sometimes prescribed in the interim to get anxiety sufferers to the point where talk therapy can help.

“Medicine can [dial] down an anxiety circuit that’s on hair-trigger so that you get to the level where you can function normally,” Ballenger explains.

BUT NOT EVERYONE who’s dealing with anxiety wants medication. To avoid drug side effects, some anxiety sufferers explore alternative treatments ranging from yoga and meditation to acupuncture.

Recent research spearheaded by McLean resident Ladan Eshkevari, a nurse anesthetist, certified acupuncturist and associate professor at Georgetown University Medical Center, suggests that acupuncture may block the release of cortisol, the stress hormone, in the body. In a controlled study at Georgetown, rats (which are “naturally curious animals,” Eshkevari says) were subjected to stressful conditions and then set free to roam in a divided box. Those that had preemptively received acupuncture for stress reduction were more likely to explore all the quadrants of the box, whereas those that had not stayed in one corner.

Ioana Boie, the counseling professor at Marymount University (who maintains a private practice in Herndon), uses equine therapy to treat anxiety that is manifested in eating and exercise disorders. “Horses require that you stay present in the moment in order to work with them [rather than allowing your mind to race ahead],” she explains, “and they provide nonjudgmental feedback.”

Following my panic attack on the flight to New York, I decided to try a new approach to dealing with my anxiety. I found the Renascence Center, a counseling outfit in Arlington near the intersection of Route 50 and Glebe Road that was close enough to my kids’ preschool that I could sneak in some sessions during my limited free time.

After a few sessions, my therapist, Janice Grose, suggested I try EMDR (Eye Movement Desensitization and Reprocessing), a method of psychotherapy in which alternating sides of the body are stimulated while the therapist walks the patient back through the memory of a traumatic event. Some patients follow a light from side to side with their eyes, but my treatment involved holding an electronic buzzer, about the size of a small stone, in each hand. The idea behind EMDR  (which is often used to treat patients with PTSD) is to help the brain re-categorize the event as a past memory and not as a present threat. Grose says that bilateral stimulation exercises the brain in the same way that REM sleep helps people sort out and process the events of the day.

EMDR has its detractors. Some say it’s essentially just talk therapy. But I found it painless and side-effect-free, and it took only a few sessions for me to work through the origin of my anxiety (the break-in at my apartment) and gain a calmer perspective on that traumatic event. While I am still prone to anxiety, I haven’t had a full-blown panic attack in nearly seven years.

I STILL VISIT NEW YORK frequently, although these days I usually take the train. I recognize that my panic attacks could come back, but I no longer allow them to dictate my life.

I remember one train ride home when, just outside Manhattan, the train stopped dead in a tunnel. Suddenly and mysteriously, the interior lights shut off, and I could hear the systems power down. The dark silence was terrifying.

I got out of my seat, intending to find the conductor and ask what was going on, but instead I found a woman slumped to the ground, her head between her knees, shaking like a leaf. Her daughter and husband stood helplessly above her, but I knew what she was going through.

I sat down next to her, introduced myself and said, “I know what you’re feeling. I have panic attacks, too.” Using my CBT process, I reminded her to breathe and to know that she was safe. This, in turn, helped me remember to breathe and know that I was safe. We talked about what was really happening rather than what we were afraid might happen—which helped me remember to keep my thoughts in the present.

Somehow the simple act of articulating our fears—exposing them to daylight, so to speak, even on that dark train—helped defang the invisible beast. And as we discussed the finer points of our panic attacks, we felt less alone and more okay.

Then, just as suddenly as it had stopped, the train powered back up and started moving forward again, carrying us with it.

Adrienne Wichard-Edds recently visited the top of the tallest building in the U.S. and flew cross-country twice—with no panic attacks. Read her Washington Post article about parenting with anxiety here. You can follow her on Twitter at @WichardEdds. 

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