For many survivors, panic attacks and their triggers can lead to agoraphobia - a fear of the unfamiliar. Leaving your bed, your house, leaving anywhere familiar can be very difficult and require a lot of work.
Panic attack symptoms can include: increased heart rate, hot flashes, sweating, trembling, difficulty breathing, nausea, choking, inability to speak, feelings of unreality, feelings of paranoia, fears of losing control, fears of being sick, and even fears of dying. For some survivors, panic attacks can also trigger flashbacks and dissociative episodes, and in severe cases can even cause temporary hallucinations.
Since so many panic attacks occur when we are out in public, it can be very difficult to address a panic attack without feeling like everyone's looking at us. So this week, we'll focus on what usually triggers your panic attacks, what symptoms you have, and how you usually cope with panic attacks. Talking about the triggers can sometimes give us a good idea of things to work towards - for example, one of my major panic-triggers is the grocery store. So I have begun doing "intentional desensitization" exercises to lower the effect it has on me.
Intentional desensitization is when you allow yourself to be triggered, but not to the point where your emotions overwhelm you - to a point where it is tough, but tolerable. Then, through focusing on coping skills, you allow yourself to calm down a bit more. Doing this repeatedly over time will re-wire your associations, and can help make your triggers a lot harder to set off. The important key is allowing yourself to be triggered to only a 5 or 6 on a 1 to 10 scale (1 being "you're fine" and 10 being "it feels like the world's ending") - as if you are overwhelmed to the point that you need to avoid the trigger altogether, it can reinforce that trigger causing panic attacks.
So this week's questions are:
- What usually triggers panic attacks for you? Or are most of your panic attacks un-triggered?
- What symptoms are usually present in a panic attack for you?
- How do you usually deal with panic attacks?
- Can you think of any ways to practice intentional desensitization to try to lower your specific triggers?
I am *definitely* agoraphobic, so leaving familiar territory can be difficult. Even walking from my car to a familiar place (like a doctor's office or friend's house) can set off a panic attack. And without fail, every single time I go to a grocery store, I'm guaranteed to have a panic attack at least once. Specific triggers can be: lots of people, fluorescent lights (too unnatural feeling), beeping, strangers standing close to me, needing to make a decision while stressed, confrontation, not having a place to escape to, and any constant noise.
My panic attacks usually include my heart pounding, hot flashes, nausea, sweating, and trembling. On the *really* bad panic attacks, I have auditory hallucinations - usually of my mother or father yelling for me in the "you're in trouble" tone of voice. Also, with all of my various stomach issues, it's not uncommon for me to get physically ill from a panic attack. Oh, those poor grocery store clean-up guys.
I usually try to focus on one object - sometimes it's a book, or my shoe - anything really that I can see and touch. I will focus entirely on that object and describe it to myself (silently usually): what color it is, what it feels like, what's in it. Usually focusing on one thing can divert the panic energy into focus, which helps. I also carry tissues with me, which are both soft to the touch and something I can really squeeze when I'm nervous. Another trick of mine is just focused breathing in and out. While I'm focusing on my breath, I'll usually think "I'm okay. I'm a badass and can handle everything. I'm not alone in my fear. Everything's okay" It's a combination of being soothing and really funny. Saying "I'm a badass" to myself usually makes me laugh, which eases up the panic a bit, or at least reminds me that if something horrible does happen, I can handle it.
For desensitizing, I use a combination of coping-skill based exercises (using focused breathing, support network, etc. to calm me down) and occasionally, with some "as-needed" or PRN medication. If I take a tiny dose of that medication (Xanax), I can usually tolerate the trigger enough to work on desensitization. I've found only a few triggers that are strong enough that I can't find a middle ground to work from emotionally, so I use medication to help desensitize pretty rarely.
So feel free to discuss things, sometimes we can learn new coping skills or figure out some of our triggers when we all put our heads together :)