Calming Down Panic Disorder

Your chest gets tight and you are having trouble breathing. “This is strange,” you think, but you try to compensate by taking in a deeper breath. You tell yourself, “Don’t panic, I’m sure its not a heart attack.” Unfortunately, that deeper breath only serves to make your chest tighter. This starts to increase your concern.

Now you find yourself starting to get dizzy and your fingers and toes are tingling. Something is definitely wrong. You are now becoming panicked with catastrophic thoughts.

“I’m either dying or going crazy. OMG what do I do now?”

Does this sequence of events sound familiar to you or someone you know?

Thank goodness that what you experienced wasn’t deadly like a heart attack. But you did have a real physical event happen to you. You had a panic attack.

 

Panic attacks are more common than people believe, and are really quite misunderstood. There are some physiological facts that when you understand them, will make this syndrome much more understandable, and relatively harmless.

These occurrences are due to over breathing in the first place. This doesn’t mean that your breathing changes will be noticeable. Usually they aren’t. But what happens when you over breath is that instead of our bodies using oxygen for survival, something else happens.

There is a part of our red blood cell called hemoglobin. When we breathe in, oxygen is transferred to the hemoglobin in our red blood cells. The hemoglobin then takes the oxygen around the body so that the vital organs and muscles can use the oxygen for energy reactions.

 

Once the oxygen is used in this energy reaction, it turns to carbon dioxide (CO2), which the blood then carries back to the lungs for elimination.

 

Now where does the trouble start? Over breathing causes a number of changes in the body. The first and most important change being that there is a drop in CO2 levels. The reason why this is important is quite simple. Not enough C02 causes the blood to become more alkaline. Hang in there with me. We’re at the central part.

 

Once your blood is alkaline (a completely temporary condition) the hemoglobin in your blood cells becomes sticky. Then what happens is that the oxygen does not get released by the blood, and your muscles and organs become temporarily constricted.

 

THIS IS A TEMPORARY, NOT HARMFUL CONDITION.

 

It changes back to a balance of acid/alkaline as soon as your breathing comes back to a normal pace and your ph balance (between acid and alkaline) is achieved.

 

If you are ever unsure of whether you are having a heart attack, or a panic attack, get an immediate medical evaluation. If after you do and if the doctors cannot find any other reason for your symptoms, it may be prudent to consider whether what you may have may be anxiety related:

 

In the last month, have you suffered from these common physical symptoms: (put a 0= not at all; 1=mild; 2=moderate; 3=severe):

 

1 – Tension or pressure in your chest ___

2 – Difficulty breathing ___

3 – Tingling or numbing in your extremities (fingers, toes) ___

4 – Trembling ____

5 – Shaking ___

6 – Feeling unsteady ____

7– Discomfort in your stomach ___

8 – Heat Rushes ____

9 – Weakness _____

10 – Exhaustion ___

11 – Sweating when you are not hot or exerting yourself ___

12 – Rubbery feeling in the legs ___

13 – Cold chills ____

14 – Headaches ___

15 – Pain in the back of the neck ___

16 – Heart pounding, or skipping beats ___

 

Common Panicky Thoughts:

 

17 – There’s something terribly wrong with me ____

18 – No one believes that there is anything wrong with me.

19 – I feel like I’m going crazy ___

20 – I’m going to die ___

21 – I’m losing control ___

22 – I’m terrified that I’m going to faint ___

23 – I must look so foolish ___

24 – I’m all alone ___

25 – I can’t concentrate

26 – I’m going to lose my job ___

27 – I can’t stop my mind from racing from one thing to the next ___

28 – I feel detached from my body

30 – I’m so tense I can’t stand it ___

31 – Things around me are so strange and unreal ___

32 – I am always apprehensive; doom is right around the corner ___

33 – I can’t shake this nervous feeling ___

34 – I’m must be having a nervous breakdown ___

 

These symptoms are found quite often in people with panic attacks. While this questionnaire can give you a good sense of how much you are suffering, it is only for information and education purposes. If you believe that there is something physically wrong, then ask for medical assistance. If there are no physical findings be glad.

 

Then take a look at the suggestions I give you for self help. They may be of assistance. If after practicing these suggestions for a few weeks you should start to feel better, but you have to practice. If after practicing and you still feel pretty badly, contact me and I’ll find the right help for you.

 

Information and Educational Strategies (summary)

 

1 – We have already covered the first and most important strategy – Get the right information. You have this in this article.

2 – Keep a daily record of your moods and panic attacks. Can you find a pattern or trigger to them?

3 – How did you cope with each episode?

4 – Which one was the worst?

5 – Have you practiced your two part breathing everyday??

6 – Have you been practicing Progressive Muscle Relaxation everyday?

7 – Have you written down a number of positive self statements to help you calm down?

8 – Have you written down the negative statements that make you distressed?

9 – How many things that you have worried about have happened like you predicted?

10 – What characteristics do you need to strengthen in order to cope and overcome?

 

Information and Educational Strategies – Elaborated

 

1 – Get the right information (see the top of this article).

 

2 – Daily Mood and Panic Attack Record

• For each day of the week (and weekends) write down your mood periodically during the day. Start with 9 am; 3 pm; 8 pm.
  
• Write your mood down, what is on your mind, and why do you think you feel this way?
  
• Always write down times you had, or were afraid you were going to have a panic attack.
  
• Can you find any connections to your mood and times you have attacks?
  

3 – For every panic episode write down how it started; how it got worse; what you did to cope with it; and most importantly, what did you learn from this episode? What could you do differently next time another attack comes (if it does).

 

4 – Remembering the worst panic attack may give you some comfort. You survived it. Remember that. How did it amplify; how were you affected. What could you do differently next time another attack comes (if it does).

 

5 – Two part breathing exercise – Take gentle breaths (it drives me crazy when people tell you to take a deep breath. If you are having a panic attack, don’t take a deep breath, please!) So where was I?

• Take a gentle breath into your abdomen. Imaging that you are blowing up a balloon and your stomach is the balloon.
  
• Hold for a microsecond and then continue breathing into your chest.
  
• Hold for a microsecond and then release the breath in your chest.
  
• Hold for a microsecond and then release the air in your stomach.
  
• If you have trouble practicing this lay on your bed; feet on the bed with your knees up. Let nothing be under your head. This will make practicing this breathing pattern much easier.
  
• Practice this exercise at least 3x a day; please start practicing when you are not stressed. Make this an automatic part of your behavior. Practiced sufficiently, some of my patients have reported considerable relief.

 

6 – Progressive Muscle Relaxation (PMR):

The goal is to teach yourself to shift from states of tension to states of calm.

With each body part mentioned, just create a mild to moderate tension and hold for 5 seconds. Then release for 10 seconds and receive the release. There is no benefit from seeing how tense you can make parts of your body. Actually you can do more harm then good, so please be gentle with yourself.

 

• Curl toes down
  
• Curl Toes up
  
• Flex feet with heels on the floor.
  
• Flex legs with feet and legs extended; pull your toes back for a little extra tension
  
• Tighten your buttocks
  
• Tighten your abdominal cavity
  
• Tighten your chest cavity
  
• Make a fist and tighten your hands and arms
  
• Pull your shoulders up to your ears (or as far as they go)
  
• Stick your tongue out while opening your mouth very wide (many of my patients tell me that they can only do this when they are alone in their bathrooms).
  
• Close your eyes as though you were watching a movie and it got scary
  
• Wiggle your eyebrows.
  

Practice PMR twice a day; practice when you are not stressed.

 

7 – Write down those positive self-statements and put them on a 3×5 index card and put it in your pocket. Or if you are part of the “Internet Generation” type those positive statements into your smart phone.

 

Then whenever you feel anxious, worried, self-doubting, take out that list and reassure yourself of the strengths and abilities that you have to overcome this problem. If you don’t, then reframe your anxiety as an opportunity to continue learning and growing.

 

8 – Write down your negative beliefs about yourself.

• When are they not true?
• If you are not perfect (and who is?) What do you do when you do not live up to your expectations when you tried your best?
• Are you kind or cruel to yourself.
• If you are cruel, what’s that about? How did you learn to be so harsh?

9 – How many things that you have worried about have happened like you predicted? How often do you worry? What have you learned from your experience of worrying when something bad didn’t happen? OK, how many times do you say it doesn’t matter, something bad will happen next time. (Does this sound like you?)

 

10 – What characteristics do you need to strengthen in order to cope and overcome a difficult situation?

 

Remember, we all need our resources.

 

Have you had a parent, coach, mentor, teacher, priest, who you could go to for advice? If you have, consider yourself lucky. Have you ever known anyone from books, movies, the music world, even cartoons (think how powerful “Stuie” in the Family Guy might be).

 

What about any spiritual icons. What if Jesus could be my ally?

 

Sometimes we need a little help from others who “live” in our imagination in order to cope with a difficult situation. Sometimes these are real people we have met, or known well; sometimes they are strictly from our imagination.

 

Take out a pad, pen, colored pencils etc. First write out everything that describes this person or spiritual icon (you can have as many as you need). Then write down your feelings when you bring them to your imagination.

 

Next, have a “device” like pressing your knuckle or stretching your arms; you might even move your eyes back and forth a few times.

 

Notice how you feel after each time you “amplify” your “resource.”

 

My favorite resources are Humphrey Bogart and Jerry Garcia. When I was a young man in college my heart got broken. After a while I wanted to ask a girl out but I was too afraid of rejection. I had just seen the movie Casablanca 3x in a row with my new best friend at Boston University. I imagined Humphrey on my left shoulder saying, if I can survive so can you. Ask her out.”

 

Now I had my share of rejections, but I had my share of girls who said yes, and I recovered. Now this wasn’t due to panic disorder, but if you think, “What qualities and characteristics do I need to cope with my fears of a panic attack I’m sure that you will be able to strengthen your abilities to overcome.

 

If these suggestions do not help sufficiently, contact me @ mdworkin@optonline.net and I’ll try to find the right help for you.