November 15, 2018, by Ryan Neal

Dealing with panic attacks

Guest post by second year medical student, Issy.

Panic attacks are exactly what their name says – when you feel like you’re being physically attacked by the anxiety – the panic – your body is experiencing. They’re both emotionally and physically draining. Lots of people get panic attacks as a one-off during a stressful period. It’s quite normal, and those who suffer from anxiety attacks can get them a lot when in a heightened state of anxiety. Panic disorder, however, is actually a separate mental health diagnosis that often comes alongside a diagnosis of anxiety, when the panic attacks become so frequent and acute that they become the main symptom of the anxiety itself as opposed to general worry.

I used to have such severe panic disorder that it affected my ability to function in my everyday life. However, through the right therapies and treatment for me, my panic disorder is now largely in remission, although I do get relapses, which I’ve learnt is pretty normal and not something to be ashamed of.

The basic premise of Cognitive Behavioural Therapy (CBT), which I have been receiving for four years now at varying intensities, is to understand why we get the symptoms we do, and using this knowledge to begin to control them. So, here’s a breakdown of what I’ve learnt about my condition, which is increasing in prevalence amongst university communities worldwide as perceived expectations are heightened, and stress levels rise.

Your body will actually tell you when you’re about to have a panic attack. True, sometimes they feel like they’ve come out of nowhere; one minute you’re fine and the next you’re not. However, notice the little things. Personally, in the minutes before I have a panic attack, I’ve begun to notice that everything seems much more intense: lights are brighter, I can feel the clothes on my skin, sounds are much louder. I find it difficult to concentrate on what I’m doing, and intrusive thoughts – even innocent ones like wondering what I’m going to have for dinner – take over and cloud my mind. Sometimes I feel deliriously happy and energetic: this is all due to the adrenaline taking over due to the fight or flight reaction my body has decided to activate for no apparent reason at all.

Then, the adrenaline takes over just that little bit more and you get the more immediate ‘oh no, this is not good at all’ symptoms. Shaking, hyperventilating, an urge to sprint, feeling sick, sweating, the list goes on. Its normally about this point that the major panic starts if you don’t manage to calm yourself down beforehand (more on that later)

Here is a snapshot of what is going through my mind during a panic attack:

‘Oh god, what is going on, am I allowed to be here, where is the bridge, I can’t find the bridge, I can’t breathe, sort yourself out, I look like a fool, I’m going to be sick, I don’t get it, help, where is that bridge, I can’t feel anything, I don’t know what’s happening, I can’t breathe at all, I’m going to die, this is so stupid, what’s going on, what colour is the bridge, why can’t I see properly, get a grip, I don’t want to be here, get me out of here, help me, what is the bridge, I don’t feel alive, what’s happening, where is the book, what does this say, this will never stop, I’m acting stupid, I can’t even think straight, I have no hope, help me, I don’t know what to do.’ 

Make sense? No? Exactly. It’s an irrational, unyielding thought process – I like to think of it as if your mind is a group of five-year-old children surrounding you, all screaming random questions at once, yet you cannot even answer the simplest one. Sometimes illogical thoughts keep returning to the forefront of your mind – represented by the ‘bridge’ I’m obsessing over above. This tends to make you panic even more because you feel like you’ve lost control, and you will probably keep going along this spiral until suddenly the adrenaline shuts off and you are left with complete and utter exhaustion.

I feel numb after a panic attack. Truly and utterly disassociated with my body. It’s difficult to walk and I can’t put coherent sentences together. Normally I will fall asleep for hours after, and still feel pretty rough and weak when I wake up. This is the reality of when all your adrenaline stores are used up at once in such a short time – think of it as the exhaustion after a relentless 2km sprint.

It’s no wonder that people suffering from panic disorder have panic attacks worrying about if they’re going to have a panic attack. It’s a vicious, unrelenting cycle that eats away at you emotionally. The experiences I’ve had with panic disorder have led to the development of other conditions such as social anxiety, where I feel worried I’m going to make a fool out of myself at any given moment as was often the case with my panic attacks. I was also exhausted and lethargic due to the medication I took to suppress the panic – in the end I stopped this medication because I couldn’t cope with the tiredness. Depression sunk in pretty quickly too, when I felt that I couldn’t enjoy myself like everyone else, and was ashamed of the physical marks my panic attacks left, making it all too obvious something was ‘wrong’ with me.

The key to CBT is understanding what causes the panic attacks – for me, it was impulsive thoughts and lack of self-esteem. Targeting where these thoughts stemmed from and trying to build up my self-esteem were key in recovering. If I notice myself slipping back into those old habits, normally I am actively able to stop myself going into a panic situation by putting into place the techniques I have learnt, such as grounding (a form of distraction) or actively building up my self-esteem by writing good things about myself. It’s so counterintuitive when you feel pretty rubbish, but it does actually work. It’s slow and a lot of trial and error – but that’s the key. It doesn’t happen overnight. It’s different for everyone so you may get peaks and troughs in how it’s working at different points. Now, I’m able to calm myself down if I notice myself slipping, meaning that I can regain a sense of control – often this is enough to stop myself panicking.

I also take medications to help me along the way to take the edge off my symptoms as I work out what works for me. At first I was pretty ashamed about it; I felt like I was cheating, but now I know it’s completely okay – just like taking paracetamol to get rid of a headache so you can focus is completely okay.

“Don’t panic” and “don’t worry” are both phrases that frustrate me endlessly – trust me, if I could voluntarily stop the way I was feeling, I would! No-one wants to go through this. However, I am going to contradict myself in saying that if you feel like this, don’t feel worried that you are alone and that help isn’t there: you’re not alone – you’ve got me feeling the same way for starters – and so many people are out there solely to help you. Be it the GP, Student Services, the counselling service or even your friends and families, making that first step in confiding in them and admitting you need some help in controlling the symptoms is the most important step.

I’m not going to say that it gets better – because it definitely does feel that the symptoms will always stay with you. Maybe that is the case, but what is for sure is that it’s possible to control them, with time and effort, and minimise the impact they have on your life. I’m four years into CBT and still not completely recovered – I doubt I ever will be, but what is for sure is that I am suffering less, and beginning to see myself as a person, as more than what I used to think defined me.

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