TAKE CHARGE OF YOUR MENTAL HEALTH

from Healthy Living February 2015

TURN SETBACKS INTO A W.I.N.

WRITER: RICHARD T. BOSSHARDT, M.D., FACS

My ﬁrst and only real panic attack blindsided me, awakening me from a sound sleep.

It had been a full day. My wife and I were on an anniversary trip to Paris, had ﬂown through the night, stayed awake all day and retired at our usual time locally to reset our internal clocks.

We had a lovely apartment, but tiny by U.S. standards.

When I awoke, I felt like the walls were closing in on me and I had a feeling of impending doom. It was beyond terrifying; I had never experienced anything like it. I knew I was having a panic attack. The episode lasted perhaps 10 minutes, then passed.

I think I know why the attack occurred. The ﬂight from the U.S. was crowded and the seats were terribly uncomfortable for such a long trip. I had left behind some loose ends and the sense of disconnect and distance from home was extreme. During the attack I couldn’t see how I would ever get back to the U.S. I actually thought that I might be stuck in Europe for life, as crazy as that may seem.

I did get home without any further incidents but the experience left me shaken and very hesitant to board an airplane again.

A panic attack can do this to you and as a physician, I knew I needed correct it.

I made an appointment with a psychologist and related the experience. His insights were interesting.

“Anxiety and panic disorder are both due, in large part, to a perceived loss of control,” he said. “Most of the time we feel we are in control of our lives and when we lose that sense, anxiety creeps in. A panic attack is just an extreme expression of that.”

It made sense: Each time I felt the rising panic was when I was in a situation I felt I could not control or from which I could not escape.

“Remember,” he went on, “you have been in similar situations before and everything turned out ﬁne.”

Again, it was true: I’d ﬂown hundreds of times, been on countless elevators and never had a single instance of a real threat.

“A panic attack won’t kill you and really can’t even hurt you, terrible as it may seem,” he said. “It won’t last but a few minutes.”

While panic attacks occur in our minds, our bodies react to the perceived threat as they would to any threat. Our adrenal glands produce a surge of adrenaline in our blood, which leads to physical manifestations: rapid heartbeat, palpitations, difﬁculty breathing, shakiness, sweating and tingling. Our bodies cannot sustain such a response for long and the reaction soon shuts down.

The psychologist recommended behavior modiﬁcation, mentally simulating a situation likely to trigger an attack and thinking through it. He suggested relaxation techniques such as slow, deep breathing; imagery to mentally remove the situation; and focusing on the goal or destination.

Finally, he suggested a “lifeboat.”

It isn’t possible to avert every attack, and he said it was reasonable to have some medication on hand. I got a prescription for a half-dozen Xanax (a mild anti-anxiety medication), which I keep with me “just in case” when I travel. My “lifeboat.”

I have yet to take a single pill. I have traveled on everything from wide-body jets to Caribbean “puddle hoppers” without a hitch. That’s not to say I’ve never welled up with anxiety in a close situation, but I’ve been able to avert escalation of the feeling.

No one is immune to anxiety or panic attacks because we cannot control every situation we encounter. Stress is endemic to modern life and that isn’t likely to change. The trick is to not let these situations control us. Problems arise when our ability to cope is surpassed.

It helps to recognize what triggers your anxiety and or panic. In my case, it is situations where I am in a tight space surrounded by people or places such as airplanes, elevators and even the backseat of cars — any place I feel hemmed in.

— Thomas à Kempis German medieval Christian monk and author

THESE COPING MECHANISMS HELP ME. THEY CAN HELP YOU, TOO:

DISTRACTION. I always have some interesting reading material with me, or I actively engage someone next to me in conversation, focusing on someone else other than me.

MEDITATION. I close my eyes, focus on my breathing and consciously relax my muscles.

VISUALIZATION. I imagine where I’m going, what I will do there, how much I will enjoy it, etc. In the ﬁve years since my episode in France, I have never had to reach for medication.

BE PROACTIVE. Avoid overcommitment. Accept that life is uncertain and you are never truly in control. Get enough rest, exercise regularly and eat a healthy diet. They all play an important role in our overall well-being, including our mental well-being.

If anxiety and panic attacks, or the threat of them, is affecting your quality of life, don’t hesitate to see a mental health professional.

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