Do You Suffer Panic Attacks?

There's a surprisingly playful way in which it can be treated Do You Suffer Panic Attacks? By Dr Dayal Mirchandani On her way home from a party, 28-year-old Smita* suddenly found it difficult to breathe. Her heart was pounding and she felt she would die that very moment. Her friend immediately drove to the nearest hospital. The emergency room doctor administered a tranquillizer and insisted that she stay overnight in the hospital to rule out a heart attack.

Smita lay awake all night listening to the beep of the cardiac monitor attached to her. In the morning all her tests were clear. Yet, overnight her world turned upside down and her sense of safety was fractured-the doctor had also told her that she'd suffered a panic, or anxiety, attack.

Over the next couple of months, Smita had three similar episodes quite unexpectedly. Her GP diagnosed them as anxiety attacks. Yet she resolutely refused to see a psychiatrist or take any anti-panic medication. Instead she embarked on a blitz of alternative therapies: Reiki, Pranic healing, yoga and meditation. The yoga and meditation helped reduce the intensity of her attacks, but Smita continued to be preoccupied with irrational fears of a serious undetected illness. She had also become vigilant, constantly monitoring her body for anything out of the ordinary: any twinge or strange sensation would trigger catastrophic thoughts, leading to more panic. Soon she quit her job and became a recluse, restricting her outings to a minimum.

In a year's time, her boyfriend gave her an ultimatum: "See a psychiatrist or break up with me."

On hearing her story, the psychiatrist told her that an energy drink she'd had at the party probably triggered the initial attack. Smita's initial panic attack frightened her so much that her problem now stemmed from a fear of another attack. The doctor told her that panic attacks could be triggered by physical illnesses, hormonal imbalances, stress and psychological disorders. An experience of intense anxiety scares the person to the point that panic takes on a life of its own.

The psychiatrist gave Smita two options-medication or a new approach, developed by Reid Wilson, PhD, author of the book Don't Panic: Taking Control of Anxiety Attacks, which promised rapid results. He told her that as she'd already tried relaxation with little improvement, behavioural techniques would take a long time to help. Medication focuses on reducing symptoms and discomfort.

In Dr Wilson's approach, it's the opposite. Here one seeks to increase the discomfort in order to allow the mind to 'habituate.' The more frequently you allow yourself to experience anxiety, the sooner you get used to it. He explains this with the example of wearing new shoes. When you first wear them, you are very aware of them but soon you are quite comfortable with them.

TO PROVOKE AN ANXIETY ATTACK Smita's psychiatrist asked her to breathe rapidly. Within a few breaths some distressing symptoms including tightness and tingling in the chest started and these sensations triggered upsetting thoughts. At this point he asked her to personify the panic disorder (PD) and talk to the PD as though it were another person and to continually ask it to "bring on more anxiety." It scared her at first, but after doing this a few times she found she was no longer as frightened by the sensations she experienced.

As homework, using her imagination and her breathing, Smita was given the task of trying her best to bring on the anxiety as many times as possible every day. The aim was to learn how to mentally change her attitude to the distress from "dangerous" to "this is a game," and seek out every opportunity to do this. In addition he asked her to download the free Playing with Anxiety storybook, which explains this approach.

By her next session Smita was already much calmer and feeling more in control and willing to experiment further. Over the next few sessions both she and the psychiatrist worked out a number of increasingly difficult weekly tasks and each week she found her distress tolerance increasing. In time, she even agreed to travel in a crowded commuter train during rush hour-something that a month earlier would have been impossible.

WHILE SMITA MADE rapid progress, possibly due to her high motivation fuelled by the fear of losing her boyfriend, I have found that the most difficult part of this approach is persuading sufferers to face their fears. Rather than the severity and duration of the problem, a willingness to "play" with this anxiety determines the success of this approach. I have even seen patients who have succeeded in using the approach after reading Don't Panic. Slightly modified versions of this approach have also been found to be useful in helping people get over other anxiety disorders, including obsessive-compulsive disorder (OCD). Those too scared to use this approach can still be helped with medication or traditional behavioural methods such as cognitive therapy, hypnotherapy and relaxation hypnotherapy but they take much longer to get over the problem.

Dr Dayal Mirchandani, MD, is a Mumbai-based consulting psychiatrist and author.