How I put the fear behind me

When a panic attack left Clare Dwyer Hogg helpless on a supermarket floor, she decided to find out more about her condition. What she discovered has helped her take control again
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Indy Lifestyle Online

I was shopping in Sainsbury's when, without warning, I felt a strange change in my breathing. Each breath was coming faster than it should, and I felt as if the air around me was suddenly thinner. My instinct was to take larger gasps to get more oxygen. Yet doing this only seemed to exacerbate the need to breathe faster, and soon the huge breaths were coming in of their own accord, without giving me any time to breathe out. As my head started to spin, I set down my basket and tried to control my breathing. It was initially calmed, but by this stage it was sufficiently disrupted to affect my oxygen level: I could no longer stand and promptly fell over into my shopping.

I am not a hypochondriac, but the tingling in my hands and feet felt more like the onset of paralysis than pins and needles, and my hands did in fact begin to seize up. I lay on the floor of a supermarket feeling like a dead weight, unable to open my eyes or move. As luck would have it, though, a doctor and his partner were shopping for vanilla essence in the next aisle, and they came to my aid. The doctor commanded me to breathe more slowly ("He's so bossy," his partner whispered to me), and placed a paper bag over my mouth. I lay in this way for about half an hour, during which time my breathing went through little pockets of hyperventilation and finally began to settle down. I was very lucky to meet people who knew what was happening to me, but the whole experience was still mortifying.

This was not the first time that I'd had a panic attack. The previous three had been prompted by specific unfortunate events, but this seemed entirely unconnected with anything. Later I realised that visiting a particular place that day had triggered a subconscious memory, which in turn had set off the attack. There is nothing more frustrating than feeling that there is something lying dormant within you that you cannot control. So what exactly is this condition, and what can be done about it?

Around three per cent of women and one per cent of men suffer from panic disorder. Panic attacks usually begin with palpitations, dizziness and the need to breathe heavily. While these are all symptoms of stress, the real problem, according to medical opinion, seems to occur when the individual becomes more worried about the symptoms of their stress than they need to be. Dr Cosmo Hallstrom, a fellow at the Royal College of Psychiatrists, uses the term "catastrophic misinterpretation" to describe the reaction that can actually perpetuate those bodily reactions that people fear most. "People begin to hope after the first panic attack that it will never happen again. They become fixated on it, and on thinking of ways to avoid it happening again." People can, Hallstrom explains, begin developing avoidance patterns and, in extreme cases, move into more serious conditions, such as agoraphobia.

The medical terminology – misinterpretation – does not undermine the legitimate fear that people can experience when they feel as if their bodies are out of control. "The first panic attack can be terrifying," Hallstrom points out, "but people think that the symptoms have greater significance. They may think they are going to have a stroke and die, that they haven't had time to say goodbye to their families and so on." Information and reassurance may be vital in conquering attacks: understanding that this strange sensation is not the beginning of a heart attack, but excess adrenalin – a sign, in fact, that your body is functioning normally – is psychologically helpful.

The treatment process that uses this idea as its foundation is called cognitive behavioural therapy. This focuses less on the root causes of attacks than on how to deal with the pattern of thoughts that allows an individual to succumb to the symptoms.

Some people may need to take a more psychiatric route, but Hallstrom cautions that this level of treatment could delve into areas that you don't particularly need to reopen, or look for problems that aren't particularly related to the panic attacks, but emerge as issues in themselves. One-to-one counselling is certainly not to be marginalised, but by the time treatment begins (given the current state of NHS waiting lists and levels of funding), your initial disorder could have transformed itself into something chronic. Thought switching (the reversal of the thought processes that occur at times of panic) and relaxation techniques are central to cognitive behavioural therapy, and can be taught over a fairly limited period – six weeks – with the help of a therapist.

Some people may need to use drugs to help their condition. In cases where panic attacks actually stop people from leaving their home or entering certain social situations, taking Prozac or one of the other SSRI (selective serotonin re-uptake inhibitor) antidepressants may be the best remedy. The inherent problem here is that the medication treats the symptoms, not the response to them, and the test comes when patients eventually stop taking the treatment. Prozac can also increase the level of panic attacks in the first couple of days, and so patients should be aware that it is not necessarily a quick fix in itself.

Some of the most radical research into panic attacks is being undertaken by Dr Chris Barker and Dr Mel Slater at UCL. Working on the core ideas of cognitive behavioural therapy, Barker and Slater are using virtual reality as the tool to change the way in which patients react to situations that can prompt an attack. Barker uses the example of a fear of public speaking, saying that virtual reality can be used to pinpoint and reverse the safety mechanisms that people resort to in this situation. "They do things to reduce what they are afraid will happen – they feel that their body will shake, for instance, so they stand rigidly and squeeze their hands. Yet in fact those safety measures only make the situation worse: squeezing your hand makes you more tense, and what you try to avoid actually happens."

The research has not moved beyond the trial stage as yet, but the initial results are very positive. One woman who felt panic resulting from a fear of heights participated in virtual-reality scenarios (the "pit room" where she had to move close to a deep hole in the ground) and ultimately abseiled down a cliff at the Eden Project. At the moment, the equipment is too costly to reproduce on a large scale, but the hope is that this treatment will eventually be available on the NHS. If it were, patients could have two long sessions (each lasting two to three hours) with the equipment, combined with "homework", to treat their condition.

The important thing to remember about panic attacks seems to be – paradoxically – not to panic. They are treatable and, once you begin to understand them, they can be controlled. Try to consider panic attacks as the result of a thought process, as the effect of something that is being dealt with as opposed to the precursor of something bad; and, in time, you will begin to become free of them.

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