This is an edited version of chapter 17 of When Panic Attacks by Dr Aine Tubridy. The book is
accompanied by a CD which includes all the exercises mentioned
here
Keynote : Emergency
Drill
This is a summary of the core concepts to hand when
you get an attack, to remind you of what most efficiently brings the
sensations under control.
1 Be still: resist escaping
When you perceive the initial whispers in your body
telling you that an attack is on the way, making attempts to escape
or planning to run is the equivalent of telling yourself that you're
going to be overwhelmed, that you are helpless in the face of what
is coming, and that you'd better ‘get to safety'. This
misinformation generates more adrenaline and makes matters
worse. By deciding to remain, you are giving yourself a powerful
message, which is that:
I will still be safe if I don't
run.
This also prevents your muscles responding with a
further increase in tension, which happens if you are physically
running, pacing around or restlessly
fidgeting.
2 Go with your body's reaction: don't fight
it
Although you obviously didn't want to get an attack,
if it has been triggered, acceptance is the stance which holds the
least fear. Resisting only increases and prolongs the adrenaline
surge, and makes you more tense and afraid, whereas flowing with it
allows it to spend itself in the quickest time. Trying to deny it's
begun (“Oh no, not here! I don't believe it, it can't be happening
again! Please, please not now in front of all these people!”) is
like closing the stable door after the horse has bolted, a waste of
energy.
Once panic has begun it won't finish until the
molecules of the chemical have left your bloodstream. This obviously
takes time, just like an alcohol hangover takes time to clear out of
your system. You cannot just ‘wish' it gone, it has to run its
course, so you might as well adjust to allowing that time to elapse
and the concentration of molecules to eventually dissipate.
Floating with the ‘wave of molecules' as it washes
over you, going with whatever physical reactions your body is
having, allows it to spend itself more quickly because you're not
creating any more. Make a statement of acceptance such as
All the sensations I am
feeling now will pass.
I can allow this to wash over
me.
3 Stay in the present: don't 'futurise'
Although every fibre of your being may be thinking of
how to prevent the ‘disaster' about to occur, try to stay with
what's happening right now. By allowing your thoughts and actions to
prepare for the worst, you are again sending powerful messages of
helplessness to yourself, not safety. By keeping your attention only on what's happening now,
rather than what could happen in the future, you reduce your mind's
field of observation to:
l your racing heart: a highly unpleasant sensation (rather
than a predicted heart attack and presumed
death).
l your
uncomfortable tight chest (rather than imminent
suffocation).
l the confused, dizzy feelings in
your head, (as opposed to future admission to a mental hospital, or
an operation for a brain tumour).
4 Deflate the danger: tell yourself the
facts
This means reminding yourself of what you know about
what the sensations mean and why you get them. For
example:“Boy it's hot in here. I've suddenly begun sweating -
but then there are a lot of people dancing, and alcohol always makes
me a bit sticky, so it's nothing to worry about.”
“My heart has
begun to race; no wonder, I suppose, since I've been fighting
against the clock all day. I'll try to slow down and that'll
help.”
“My fingers are tingling and that dizziness is here a bit
- I've obviously let my breathing get too fast again.”
“I feel
shaky and peculiar, my adrenaline is obviously higher today than I
thought.”
“I feel faint and a bit nauseous - I must be more
careful not to let myself get so wound up, I'd better calm down the
reaction now by easing up on myself.”Always
remember:
All the
sensations of panic are harmless, no matter how intense - the
response is protective in nature.
You will never stop breathing
because of panic.
Your heart is not at risk during a panic
attack.
Nobody has ever gone mad, died or lost control as a
result of a panic attack.
All panic attacks end: they are time
limited.
5 Dampen down the reaction
Put into action the strategies you've
learned:
l Breathe slowly and abdominally, counting from one to
ten.
l Let
your muscles go slack and quiet.
l Stabilise your energy. Behaviours that would be consistent with these might
include relaxing in a hot bath, placing a cold towel over your face
if you're sweaty, listening to calming music, or taking a walk or in
some way using your limbs as a method of ‘grounding' your energy if
you're feeling spaced out.
6 Be consistent: don't resort to bad habits
The
overall objective in this programme is to decrease the intensity of
your reaction to the uncomfortable sensations, and in time persuade
yourself that they won't harm you. It's important to be consistent
in holding that intention, so that all your strategies are pulling
in the one direction. So, for example, it undermines the overall
premise of the programme if you've been having success with teaching
your muscles to relax and your breathing to slow down, but then try
to use them while rushing round frantically looking for an exit. The
overall intention isn't clear - if you are you feeling safe enough
to stay then why are you planning your escape?
Most panickers have their own individual methods of
calming themselves, but many of these are with the intention of
staving off an attack so that ‘dire consequences' won't result. It's
contradictory to be too urgently forcing your body to relax, or slowing your breaths ‘so you won't die of suffocation'. Both of
these stances are motivated by fear, although on the surface it
looks like you're trying to decrease arousal levels.
Some find that distraction or keeping busy prevents
them thinking too much, and then they forget to worry. This may work
in the short term, but in the long term it's perpetuating the
incorrect belief that ‘I had better get my mind off the subject
quick, or it will escalate out of control'.
The
ultimate goal is that you learn to select (and have confidence in)
safe truisms to replace scary lies which take over your thoughts,
rather than dodge them through distraction.
And
finally, to recapitulate:
- Be still: resist escaping.
- Go with your body's reaction: don't fight it.
- Stay in the present: don't futurise.
- Deflate
the danger: tell yourself the facts.
- Dampen down
the reaction:
- Breathe slowly into your belly
- Relax your muscles
- Stabilise your energy
- Be consistent: don't
resort to bad habits.
