Front Row Seat to a Panic Attack

In the US, a poll just came out showing nearly half of Americans are already reporting mental health impacts from Coronavirus, with around 20% reporting severe impacts. I was lucky (?) enough to have already had a year or so under my belt of living with anxiety, so I went into these COVID times pretty well armed with coping techniques. Official diagnoses were GAD (Generalized Anxiety Disorder) and PTSD, though at some point I had had a few legit panic attacks. I work in a hospital, and semi-joked with my therapist that lately, my potential COVID symptom (shortness of breath) was more likely attributable to passing waves of mini-panic attacks. It was a weird thing to be thankful for.

If you’ve never had a panic attack, I hope you never do. I didn’t have my first until about six months ago, and that was before this hot mess. I wish I had known a bit more about it so I would have recognized it in the moment. Below are some tips not only on recognition, but also on prevention and some things you can do in the moment. From a neuro-physiologic perspective, a panic attack starts in the amygdala, the brain’s most primitive section, and the one which houses both fear and the flight or flight response. When the amygdala is triggered, it can set forth a cascade of stress hormones (such as cortisol and adrenaline) which alter your breathing and heart rate, among other things. While the reason for panic may or may not be an actual mortal threat, the biological effects are objectively measurable.

Only a fraction of people with anxiety will experience full-blown panic attack, so it’s worth talking a bit about anxiety disorders in general first. The major categories of anxiety disorders are Generalized Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), Panic Disorder, Obsessive Compulsive Disorder (OCD), and Phobic Disorders. Of these, GAD is the most common. A good instrument to assess your current risk for GAD is here. At the height of my burnout, I scored near the top of the chart. These days, even with a pandemic afoot, I (so far) manage to only register on the very mild side.

Western Medicine treats anxiety disorders often with the same treatments as depression (often SSRIs). These drugs triggered bipolar disorder in my mother, so I decided to seek out a treatment team that respected my wishes not to use drugs (they may work wonders for many people, so I’m not advising anyone not to take them here). Instead, my team and I worked in the holistic space of bodywork, somatic psychotherapy, meditation, etc. This approach was long and slow, but ultimately very rewarding in terms of helping me learn to cope and thrive.

In terms of my own experience with panic attacks along the way: I had some minor vibes before, seemingly always related to feeling trapped (a PTSD trigger for me). I remember once when sitting in stand-still traffic in a tunnel under the Chesapeake Bay in Baltimore. I had visions of the aging infrastructure crumbling and the walls collapsing under the weight of the tons of water above us. But I kept it together.

The first attack was the most memorable. Last summer, I was on a flight to visit the ol’ bestie in Boston. Under normal circumstances, I enjoy flying. But I wasn’t in a great place mentally in general then, and for whatever reason, when they closed the plane doors that day, I had this overwhelming fear. I felt like I was going to panic in the closed space of the locked cabin and be one of those lunatics who gets arrested trying to open a plane door mid-flight. Or, worse still, actually succeed in opening the door and killing us all. It was like this one little passing idea that would normally be dismissed was suddenly something I wasn’t sure I had any control over, and would perhaps become a fait accompli.

I sat there in my seat, my breath missing, my chest tightening, my head spinning. Wondering if I should just make a scene now to protect everyone from my impulse (there are actually several stories of passengers having this impulse, and some have carried through with it). Somehow, I was able to just sit there internally spiraling and the wave eventually passed. In the post-mortem, it was the same trigger as that traffic jam in a tunnel – a sense of being trapped.

As this was my first panic attack, I didn’t know what it was. I just had this overwhelming sense I was going to die. I told my therapist about it in our next session and asked if it was in fact a panic attack. She told me the symptoms, and we checked off several of them and confirmed that it was. Shortness of breath, racing heart, a sense of disembodiment, fear of dying or losing control. It was good to give it a name and it helped me recognize future episodes, so I could (generally) put on the brakes before they became overwhelming.

In terms of prevention, knowing and naming your triggers is crucial. The quicker you can associate your spiraling with a cause, the more you can realize what’s going on. I asked how one could remedy a panic attack in process and my therapist said perhaps the best thing is a technique called 5-4-3-2-1. Basically, you try to pay attention to your breath and then look for a set number of things/objects to recognize with your senses.

The purpose of doing these things is that it grounds you through sensory focus. A panic attack is largely a product of the brain run amok. Sure, the heart and lungs play a role; but they’re taking their cues from above. When you use each of your senses, you are coming back into your body.

You can also do 5-4-3-2-1 in other contexts to improve grounding and mindfulness even when not in the throes of a panic attack. I enjoy doing it when I’m in nature and doing outdoor qi gong. I go to a little creek by my house and walk barefoot on the sand and in the shallow water. There are so many things to connect with. It’s like nature on steroids when you interact with it so palpably.

These times are difficult. People without any previous mental health concerns may be facing economic insecurity, isolation, worry, and loss. Mental health professionals were already in short supply and their services have been poorly covered by insurance. Even those lucky enough to have an established therapy relationship may not be able to venture out to check in right now.

When the dust on all of this has settled, there will be deaths directly attributable to COVID, and then there will be the secondary ones, often diseases of despair like suicide and drug/alcohol overdose. These disorders were already contributing to increased mortality rates for the young and middle aged. How many more people will succumb to overwhelming grief or self-medicate their (very legitimate) worries away now?

As this is an integrative medicine blog, I’d be remiss if I didn’t mention how Chinese Medicine frames up not only anxiety, but all mental concerns. Chinese Medicine has a concept of the three treasures which we are all born with: jing, qi, and shen. We’ve covered a lot about qi (the vital energy of life) before, but have yet to discuss the other two concepts. Jing is your nutritive essence and comes into play often for fertility issues. Shen, which is most relevant for mental health, is your spirit, soul, conscious mind, or perhaps the spark in you that came from god. A block quote from my future school (class starts this month!), Maryland University of Integrative Health is below:

“From a Chinese medicine perspective, depression and anxiety can be understood as a disturbance to the shen, roughly translated as our spirit. When the shen is disturbed, manifestations might include a feeling of lack of meaning in one’s life, an inability to connect to other people, feelings of worthlessness and self-loathing, lack of energy, and feeling inauthentic, among other things. Also, if qi/energy is stuck in the body, not moving smoothly, the emotions may also get stuck, in fear, or anger, or grief for instance. Chinese medicine treats these conditions by reconnecting the spirit with the deepest sense of our self, and with something larger than ourselves. And it can guide the qi to move more smoothly, alleviating feelings of being stuck emotionally or spiritually.”

Chinese medicine in ordinary times would call for a mix of acupuncture, herbs, nutritional guidance, and movement therapies. All well and good academically, but I’m not sure many states are deeming acupuncture essential and herbs are in very short supply. So what can you do? The movement therapies of qi gong and tai chi are available via endless YouTube options. There are many flavors, but here’s one focused on stress/anxiety.

In general, learning to listen to your body, calm your mind, and learning to self-soothe have never been more important techniques. Moreover, overcoming your fear of stigma and daring to share your struggles with others (if virtually) to find support and help are crucial. I put my own dirty laundry out there hoping it will help others take the courageous leap of asking for support when needed. Giving voice to your fears and worry, weather through sharing with others or writing them down can be a huge help. Wishing you all health and peace.

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