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| Face your fear |
Phobias affect some 10 million people, with sufferers of all ages and from all walks of life. Professor Kevin Gournay explains how to cope with the panic attacks they can cause.
I probably use the words “fear is normal” every time I see a new client who comes to me with phobic anxiety or panic.
The problem with fear is that, as with many normal phenomena, it can simply get out of hand. Fear can grow into a phobia so that the presence of a particular object or situation leads to a level of fear that is overwhelming and makes you want to escape from it at the earliest possible opportunity.
Fear is an essential part of our lives, it has a survival function and protects us from making unwise choices. It also protects us in the physical sense. The hormone of fear (adrenaline), prepares our bodies for the “fight or flight” response.
Phobias and panic may develop when fear gets out of hand and I deal with these two together as they are often inextricably linked. The majority of people I see in outpatient clinics experience panic attacks and the pattern of their panic can become as much of a problem as the phobia.
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| Dealing with hyperventilation |
Panic is a very difficult concept to define. One of the problems is that everyone is different and what is experienced by a panic attack by one person may simply be a high level of anxiety for someone else.
Perhaps the best definition is a condition where, in the mind of the person concerned, the anxiety has become uncontrollable. Symptoms of panic attacks include:
– Palpitations, pounding heart or accelerated heart rate
– Sweating
– Trembling or shaking
– Sensations of shortness of breath or smothering
– Feelings of choking
– Chest pain or discomfort
– Nausea or abdominal distress
– Feeling dizzy, unsteady, light-headed or faint
– Fear of losing control
– Fear of dying
– Numbing or tingling sensations
– Chills or hot flushes
Those who experience panic attacks will know that it is a combination of symptoms, such as those listed above, that makes them feel something dreadful is about to happen. The feeling of a loss of control is perhaps the most central preoccupation.
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| Dealing with your fears |
Panic attacks can be such a distressing problem that lives become dominated not by the panic itself but by an anticipation of panic – fear of fear. Managing a panic attack comprises three approaches:
Maintain exposure
This means you should prevent yourself from “escaping” from the situation. To remove phobic fears from your life you need to face them. Exposure to phobias and panic needs to be carried out in steps, with you gradually increasing your efforts.
Exposure should be at a level you find difficult but manageable. If you try to push yourself too far you will suffer setbacks.
Dealing with hyperventilation
When we become anxious our bodies prepare for “fight or flight”.
One element of this reaction is that we breathe more rapidly to provide the body with additional oxygen. However in a state of anxiety and panic we breathe more than what the body needs.
Over time this hyperventilation will lead to an imbalance in body chemistry which can result in pins and needles, feeling light-headed, yawning and in extreme cases, muscle spasms. Hyperventilation usually leads to rapid shallow breathing that is restricted to the upper part of the chest.
Simple breathing exercises, consisting of taking slow but not too deep breaths, can be extremely helpful. Ensuring that your breathing comes from the top of your chest is very important.
You can check you are achieving this by placing your hand on your abdomen, slightly below your rib cage. Your tummy should move in and out to ensure that as much of the chest as possible is used.
Practise this slow diaphragmatic breathing once or twice a day combined with a period of relaxation. You should also try to undertake some form of daily physical exercise such as running, cycling, swimming or walking.
Dealing with catastrophic thoughts
If you keep a record of your panic attacks, perhaps using a diary, you will find that the thoughts accompanying such attacks will be much the same each time. For most sufferers, the central theme tends to be some sort of loss of control.
For example, you may fear that you will faint, have a stroke or a heart attack, vomit, go mad or die. You can deal with catastrophic thoughts by examining the evidence.
For example, you may have panicked on numerous occasions but when did this lead to anything other than anxiety about what could happen? Did you have a heart attack? Did you faint?
Here is a range of strategies you could use to keep your thinking balanced:
– Write down a list of pros and cons, points for and against the catastrophic outcome occurring.
– Keep these somewhere handy to read when you feel panicky.
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| Dealing with claustrophobia |
– Deliberately bring the thoughts on. This may sound perverse but give it a try, it often works. This is called paradoxical intention. Research has shown that facing these thoughts gives people a feeling that they are in control, rather than the thoughts controlling them.
What should I do if I have a panic attack?
Hyperventilation can sometimes lead to an acute panic attack. If possible, try to find somewhere quiet to either sit or lie down and attempt to take slow, deep breaths from the diaphragm. Loosen your clothing and relax your posture.
Although this can be very difficult, try to concentrate on relaxing your muscles and at the same time remember that panic can do no real harm. One very rapid and effective way to deal with the hyperventilation associated with panic is the old tried-and-tested method of rebreathing exhaled air, inset left.
Exhaled air contains more carbon dioxide than the air around us, so rebreathing it replenishes the carbon dioxide in your body, reversing the chemical changes that follow from hyperventilation.
You can do this by breathing in and out of a paper bag, the top gathered at one end and placed over your mouth. If this is not possible, a simple alternative is to cup your hands over your nose and mouth and rebreathe your exhaled air that way.
Doing this for two or three minutes is usually enough to restore the correct chemical balance in the body. If you are with someone who is hyperventilating, one of the key principles is to remain calm yourself.
It is important to remember that hyperventilation, although it can look quite dramatic, is usually self-limiting and very rarely has any serious medical consequences. Occasionally it can lead to muscle spasm but this is also harmless.
Extracted from The Sheldon Short Guide To Phobias And Panic by Professor Kevin Gournay, published by Sheldon Press (£4.99).
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