A full-blown panic attack is as different from anxiety as a cup of water is from the ocean. Adrenaline surges through one's body, readying it for a flight-or-fight response, producing a cascade of physical effects: sweating, palpitations, dizziness, and tremulousness. An impending sense of doom makes concentration and even rational thought nearly impossible. In fact, people who suffer from panic attacks on a regular basis will often say that having them makes them feel as if they're about to die. That's how the only panic attack I ever experienced felt, too.
Despite its various causes, panic is always seeded by a thought (though one often not remembered). It may be the thought that the chest pain we're feeling is now radiating down our left arm, or that airplanes sometimes crash, or that we can't answer any of the questions on a biochemistry exam.
But when such thoughts lead to the belief that we've become trapped in an acutely dangerous situation from which we have no escape, they begin to trigger many of the physical symptoms characteristic of panic. These symptoms then often lead to a belief that something is seriously wrong with us, something that might actually kill us. This fear serves only to intensify the physical symptoms, which in turn reinforces and intensifies our fear and conviction that we're in grave danger, which then cycles into full-blown panic.
Alternatively, we might find ourselves focusing not on the physical symptoms but on the life consequences that we think will follow from our inability to extricate ourselves from a panic-inducing predicament. I wasn't worried that I was in physical danger when I panicked during my biochemistry exam. Rather, I was thinking that if I failed the test, I'd fail the course, and that if I failed the course, I'd fail out of medical school, and that if I failed out of medical school, I wouldn't become a doctor, and that if I failed to become a doctor — then what would I do with my life?
Irrational as it was, that last thought — the abrupt belief that I had no future — immediately tethered itself to the high probability that I was about to fail a test and held me in its grip without mercy. It engulfed my entire thought process, filled me with dread, and ignited my panic.
Several nonpharmacologic techniques can be useful in situations that provoke acute anxiety. First, patients who suffer from recurrent panic attacks often report that simply carrying antianxiety medication with them often obviates their need to use it. Though they know a pill won't remove them from a situation that induces them to panic, they also know it will relieve the awful feelings that such situations stir up.
Knowing they have the power to exercise control over their feelings then becomes the thing that helps them control their feelings.
A second technique to quell acute anxiety involves rating the severity of the anxiety as we feel it moment by moment. Few things bounce us out of an experience more quickly than pausing to examine our own reactions to it, which takes us from having an experience to watching ourselves have an experience. (Think of the effect of being asked by your partner in the middle of making love, "So, on a scale of one to ten, how's this going for you?")
Also, we're likely to recognize we're feeling anxious earlier in the course of escalating anxiety when self-monitoring for it, which then positions us to react to it before it becomes unmanageable.
A third technique involves looking for and correcting thought errors that cause us to panic. If we've recently heard a story of an airplane crash in the news, we'll believe the likelihood that the airplane in which we're flying might crash to be greater than it actually is. Or if a friend tells us about a complication he suffered following surgery, we'll believe the likelihood of that complication happening after our surgery to be greater than statistics suggest.
In learning how to use statistical thinking to more accurately estimate the true likelihood of a disaster occurring — in learning to believe in the power of statistical thinking — we're far more likely to be able to prevent ourselves from panicking over things whose likelihood is actually low.
Finally, we can habituate ourselves to the things we fear by deliberately and repeatedly exposing ourselves to them. If we're afraid of riding in elevators, for example, we might begin by looking at pictures of an elevator until doing so ceases to induce anxiety. Then we might stand several feet away from a closed elevator. Then we might stand directly in front of one. Then we might stand directly in front of one with the doors open. Then we might stand inside one with the doors open with a companion. Then we might take a short ride in one with a companion. Then a longer ride. Then a ride alone.
In fact, this kind of desensitization works to control not only simple phobias, but also more complex fears like social anxiety (which is why forcing ourselves to ask people out on dates, for example, gradually reduces our fear of doing so).
In the end, I did fail my biochemistry test. But I didn't flunk out of medical school. I applied myself, retook the test, and scored well, ultimately passing the class by a comfortable margin. The experience taught me several valuable lessons, though, the most important one being this: our minds cannot be trusted. With little justification, they begin to worry about the worst possible outcome when we're confronted with even minor threats.
Copyright 2012 Alex Lickerman. All Rights Reserved.
Reprinted with permission of the publisher,
Health Communications, Inc. ©2012. http://www.hcibooks.com
The Undefeated Mind: On the Science of Constructing an Indestructible Self
by Alex Lickerman MD.
Through stories of patients who have used nine core principles to overcome suffering caused by unemployment, unwanted weight gain, addiction, rejection, chronic pain, retirement, illness, loss, and even death, Dr. Lickerman shows how we too can make these principles function within our own lives, enabling us to develop for ourselves the resilience we need to achieve indestructible happiness. At its core, The Undefeated Mind urges us to stop hoping for easy lives and focus instead on cultivating the inner strength we need to enjoy the difficult lives we all have.
Alex Lickerman, MD, is a physician and former director of primary care at the University of Chicago. He is also a practicing Nichiren Buddhist and leader in the Nichiren Buddhist lay organization, the Soka Gakkai International, USA (SGI-USA). Dr. Lickerman is a prolific writer, having written for medical textbooks, national trade publications, and even for Hollywood with an adaptation of Milton's Paradise Lost. Dr. Lickerman's blog "Happiness in this World" is syndicated on the website of Psychology Today, and receives over one hundred thousand unique visitors per month. Please visit his website at www.alexlickerman.com.