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panic

Another panicky post

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I would say about 99% of my panic (today) is caused by worrying that I might have a panic attack.

This is not uncommon.

People with anxiety and panic typically have a lot of panic about panic, almost as if it’s a PTSD response.

My heart skips a beat, because sometimes hearts skip beats, and that triggers a thought: Ohmygod. What was that? Was that panic? AM I GOING TO HAVE ANOTHER PANIC ATTACK? What do I do if that happens?! And THAT makes me anxious, so my heart races faster, which solidifies my belief that it is indeed a panic attack, and before I know it it’s a full attack all because of a stupid trigger. Not because of anything even legitimate! (Not that panic is legitimate – but you know what I mean.)

There are people I have had panic attacks in front of before – even a full decade ago – and I still get anxious when I am with them. Not because of THEM, but because deep in my brain, there is still an association there. Every time I go to Whole Foods I get on the verge of a panic attack because that happened one time last summer. Today I wore a sweater that I once wore during a panic attack and that brief memory put me on edge.

It’s annoying and exhausting.

But I think it’s important in distinguishing that difference between a true isolated panic attack and one that’s really just a traumatic response because panic attacks are freaking traumatic. For me at least it helps me understand that it’s my brain responding in faulty, stuck ways (just like with PTSD) and not because I am designed to panic in response to everything. I don’t know – it makes sense to me.

It also motivates me to find ways to break that faulty cycle.

Exercise is a huge one. There’s a lot of research that says that exercise helps panic and anxiety but I didn’t care about that until I understood why. And a big reason (aside from that the neurotransmitters that get released and bind to receptors, causing calming the same way medication would) is because your brain makes new associations. You learn to associate a pounding heart and sweating palms with the feeling of a good workout, instead of panic that’s going to leave you vomiting and passed out on the ground. And it works, for sure. Following an immensely panic-filled summer and fall, I made it a priority to make sure I got even 15 minutes of a good workout multiple times a week, and I saw a difference when I did.

Sometimes I face the panic head on. I know it’s likely to happen, given where I’m going or who I’m going to be with, and I do things to counteract it. Holding onto my cold water bottle is grounding. I choose where I sit and ensure I have an exit. I rub my oils on my wrists before I enter that situation. I remind myself that I can just get up and leave if I need to and it doesn’t matter what people think. (Although as an aside, having people know about my panic is immensely helpful because then the fear of what they would think is eliminated). I try to do something to get my heart moving before a potentially hard situation, even if it’s just walking up a flight of stairs or three jumping jacks.

I try ,and lately I’ve been succeeding. Sometimes I don’t, and I hate when I don’t, but that’s the journey, right? Also, sometimes when I get annoyed about it, I remember myself from 3, 5, 10 years ago and I am comforted by how much more I understand now, how much more control I’m in now. So while my brain can sometimes take hold and spin me out of control, the magnitude and frequency is negligible compared to what it used to be – and that, my friends, is freaking wonderful.

Lessons learned. Again.

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You know how when there’s a leak in your house you usually fix it right away, but sometimes you just ignore it? Because it’s really not doing that much damage and it’s probably only leaking because it’s raining and it’s going to stop raining eventually.

Right. Except.

The thing is, you don’t know when it’s going to stop raining. Or when it’s going to start raining again. And how hard. Because despite your best efforts, and the best predictions and forecasts, sometimes storms just come. And sometimes they come out of nowhere, and you haven’t fixed the leak, and it makes an even bigger mess.

And then you have to figure out how to fix the damage from the leak. There’s no point in wasting time wishing you had fixed it earlier. Hindsight is 20-20 and all you can do is deal with what you have in front of you.

So you get mad at yourself, and you complain, and maybe you cry, but then you do the Next Right Thing. You call the repairman, and tell them that even if their schedule is crazy, you need to be fit in. And you don’t, you can’t, feel bad about it, because that’s their job. And you have to fix the damage to your house. No amount of avoidance or wishing is going to make it go away.

And you remind yourself: next time, for the love of all things holy, don’t ignore the leak. No matter how tempting avoidance is, remember that the likelihood of the leak just stopping is slim to none. Patch it. Fix it. Face it. Call the repairman. Well before the damage occurs.

The intimacy of a panic attack

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There was a recent episode of “This is Us” that had people talking (this is not a spoiler, not to worry). It involved Randall coping with anxiety that quickly increased in severity, and eventually showed him in the midst of a full-blown panic/anxiety attack.

It hurt my heart. It was gut-wrenching and painful and beautiful, too, because during his panic attack, his brother came and sat on the floor with him and just held him.

There are few things so vulnerable, so intimate.

I can count on one hand the number of people who I have wanted to see me in the middle of a panic attack. Some people have witnessed it just because it happened when they were around. But usually? I prefer to ride it out on my own, touching base after the wave has passed.

I don’t think there’s a right or wrong way to do it. You get through the hard times however you get through them. Some people want to be physically hugged through a panic attack – others push loved ones away. You do what you need to do.

There have been very, VERY few times in my life that during a panic attack that I have actively sought out someone. It is hard to be that vulnerable. It’s hard to be that intimate. It’s hard to let someone bear witness to your struggle.

What I CAN tell you, is that the times I have sat in front of someone, allowing them to see me at my most vulnerable, as I shook and sweat and gasped and hyperventilated and felt the color draining from my face – those times ended, interestingly, with me feeling more empowered after. I think it’s similar to how being upfront and telling it like it is in a medical setting has a positive result. There’s something very empowering about thinking, I could not be more vulnerable right now – and yet I’m going to let someone bear witness to my struggle. I’m going to trust them to love me through it and I’m not going to tell them what to do or what to say. I’m going to ride out what’s happening right now, and they will figure out how to help or what to do. It’s empowering because it’s allowing me to be me, and not feeling shame or embarrassment about it.

Like I said – it’s rare. I much prefer to handle it on my own. But from time to time, there’s something special about it. There’s something beautifully intimate about experiencing a hard time with someone else, and something powerful about embracing the struggle, and letting it float out there freely, letting it move through you, and not feeling like you need to hide.

You be you. You do you. You embrace you. And the right ones, the loved ones, those special ones that are in your tribe for a reason, will love you for it, and love you through it.

Advertising Anxiety

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When working with a client who stutters, we often talk to them about “advertising”. By that, we mean being open about their stutter. Sometimes we’ll have a client go into another therapist’s office and tell them, “I was hoping to talk to you today about stuttering. What do you know about it?” Or they might ask to borrow a stapler, but stutter while they’re doing it (on purpose). Other times they’ll be ready to tell a new adult, “I stutter, and this is what I’m working on.” The idea being that the more they are open about stuttering, the more their own internal stigmas are broken down. Additionally, the more open they are, the less likely they are to have avoidance behaviors (avoiding people, places, and words, because of their stutter).

This is the type of advertising I have learned to do about my anxiety when I’m in a medical setting.

I don’t do well in a doctor’s office of any capacity, and I have recognized that I likely never will be able to be present in those settings without any anxiety. But for many years, this knowledge, this belief of I have panic attacks in medical settings directed my behavior. I was completely out of control – or rather, my anxiety was completely in control.

[Apologies in advance – the next part is gross but hey, it’s all about being real, right?]

For years I passed out every single time that I had blood drawn, or a TB test. But passing out wasn’t the worst part. I knew people who fainted from things like that, and let me tell you, I would’ve paid money to only have fainting be the issue. What would happen to me is that a heavy, hot, feeling of unreal-ness would pass over me. I’d start to get tunnel vision. And then instantly, nausea and an urgent stomachache would follow. My body would go directly into flight-or-fight mode, and shut down, trying to empty. And this meant maybe by vomiting and maybe from my bowels. Well, you can’t really do both at once, or else it’s going to be messy and disgusting. And it’s even messier and more disgusting if it happens in an exam room. So in this split second, I’d realize I needed to bolt to the bathroom before any or all of these things happened. Usually I’d make it to the bathroom, my system would empty in one way or another, and I would pass out on the toilet seat.

Lovely, right?

The memories of these unpleasant panic attacks combined with my pre-existing fear and anxiety about a doctor’s office in general led me into a cycle for years: knowing it would happen, therefore it would, therefore confirming that it happened, therefore knowing it would happen next time, etc. I’d sit in the chair, and wait for the needle, hoping I could fake it this time around, never succeeding.

Until one day about 5 years ago I realized that I didn’t have to be helpless.

I began to advertise.

“I need to lie down when you take my blood,” I started telling the techs. “I am a fainter and do better reclined.”

“I’m going to listen to my ipod while you do that procedure,” I told a dentist.

“I appreciate you telling me exactly what you’re doing while you’re doing it, but can you actually talk to me about anything else instead?” I’d ask the doctor.

“I am about to pass out,” I told a doctor once. “I need to recline and I need something cold for my head.”

“I know you’re not doing an exam today, but I just need to let you know that I tend to get very anxious in medical settings. So if I step out into the hall or something, I’m fine, I just need a minute.” I told a new specialist I was seeing.

“So do you think it’ll snow tomorrow?” I’d ask a technician, not caring about the weather and not knowing if she did, but knowing I needed to distract myself from what was happening.

And it began to work. I had a TB test where I didn’t faint. I had blood drawn where I didn’t pass out. I sat on an exam table without the white-hot unreal fog coming over me. Breaking the cycle, making me believe I could be in control of this.

My expectation was never – and is not today – that I will never have these episodes again. But more that in being up front about it, the fear is out of me and into the world. They know what to expect so there are no surprises if I rush off to the bathroom or suddenly dart out of the room. One lab technician thanked me, saying, “I’m glad you said something. We’d always rather know, just in case.”

I used to not speak up out of – you guessed it – shame. Feeling that I should be able to handle this and it shouldn’t be such a big deal and what was my problem, anyway. But guess where that got me? Correct. Nowhere.

So now, I advertise.

Dispelling a piece of that shame, each time I speak up.

Toolkit

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I  said this the other day:

I don’t know about you, but in the moment, tools are really hard to remember to use. Also sometimes hard to believe that they’re going to do anything. So I find that practicing strategies and tools during calm moments, and semi-stressful moments, make them much more automatic to use during the super hard times. I think I could probably write a whole post on tools, and I think I will.

And I did.

Here are the three main tools in my toolkit lately that always help:

1. Move
Sometimes this means moving locations. Walking out of my apartment to go sit by the reservoir. Going to a coffee shop. Usually a change of location and scenery makes a huge difference and abates some of the heaviness I had been feeling.

Sometime this means physical movement, like going for a walk, going to the gym, or going to yoga. During this type of movement, I usually feel “it” moving through me. As I move my body, however vigorously or gently suits that moment, I’m moving it out. Moving the heaviness around, dislodging it from where it had taken root. More often than not, the tears or panic stop once I move – and this is something I have to re-learn each time. This morning I kept trying to wait it out. I said to myself, I’ll leave the apartment once I feel calmer, I’ll go to the gym once I’m not teary. But after a while I decided to just go – and by the time I got downstairs and into my car I was already a bit calmer. Just move. Now.

2. Visualize
I used to hate the idea of visualization, and that’s because I thought visualization was only “imagine yourself on the beach listening to the waves.” And while that type of visualization certainly has its time and place for me, it doesn’t do it all, and I needed more than that. I have since learned way more about this idea, and visualization has quickly become a go-to.

I usually visualize “it” moving. “It” can be panic, anxiety, memories, fear, whatever it is for you, or for me. Lately “it” has been a general heaviness that holds itself in my chest, in my throat, or in my head. It feels like a dark murky thick smoggy cloud. I like to envision a white, sparkly light coming in as I breathe in, swirling around, and clearing out the murky darkness as I breathe out. To those of you reading this and rolling your eyes: This works.

The other visualization I’ve done stems from something I read in an amazing neuroscience book [this is an affiliate link]. This chapter of the book discussed chronic pain and how visualization can help decrease the pain. And, I’ve used those ideas before, when I get a headache – I imagine the pain center in my brain, and I imagine a barrier around it, so that any pain signals my head tries to send are blocked and don’t reach the pain center. This works. I have practiced it so much that it now decreases the pain of a headache fairly quickly.

Anyway, I decided I could probably use the same principle around my heart, for those times that I’m feeling too much of my own feelings and all of everyone else’s feelings. So I imagine a barrier around my heart – not shutting myself off from the world, but protecting my heart when it needs a break.

3. Grounding
I could give you a zillion grounding tools (i.e. tools that help you stay present, focused on the moment), and there are another zillion out there on the internet. The ones that work for me best lately:

Mantras. I like mantras a lot, and I don’t like affirmations a lot. Mantras seem to be more relevant to me in the moment, whereas affirmations just…don’t work for me. [Side note: does anyone else feel like there’s a difference between the two?] For me, a mantra is a grounding statement, often what someone else would tell me in that moment, or what I would tell someone else, and ultimately, what I am aiming to trust and believe in that moment.

Sometimes my mantras are on post-it notes (there’s about 8 of them in my moleskin notebook right now) or in my pocket (the day of my wedding I texted my dear friend a picture of the post-it note in my purse that read, I am worthy) or just in my head. One that works in a moment of hypersensitivity: “Those are not my feelings. I don’t have to feel them.” Another one that works in a moment of panic: “I am breathing through this moment. I am breathing through this feeling.” They have become comforting statements that bring me focus and relief.

I also find narrating what I’m doing to be very calming. If I find myself starting to get spinny in my brain while I’m driving, I focus on what’s going on: I am in the car. I am driving home.

The one specific visualization that I do love, seems to fit better into this “grounding” category for me. It was an exercise I once learned in a therapy session, and the idea was to find a calming, safe place that could be thought about in such great detail that it would eventually be neurologically strengthened in my brain as calming, the minute that I pictured it. The place that has been consistently safe and calming for me is a specific location at my summer job. So after formally talking about the place in great detail (5 senses), it has been so strengthened in my brain that in a moment of overwhelm or panic or heaviness, I fairly automatically start thinking, I am on the back porch. I am rocking in the chair. I see the sunlight, streaming through the trees. I see the green grass, I see the blue skies. I hear the crickets, I hear the birds.

Calm.

For all of these mantras and narrations, I find pairing it with my breath crucial. I don’t really know how to explain this in writing, but basically, I breathe in for one piece of it, and breathe out for the other part, so it has some sort of rhythm to it. For example: Inhale for the entire length of I am breathing through this moment and then exhale for the length of I am breathing through this feeling. Does that make sense?

And there you have it. My current set of tools. As I’ve said, I really find that in a hard moment, it’s equally hard to remember to use these tools. Generally because I initially think, That’s not going to work. That’s not going to make this feeling better. But they always do. Not always right away, and not always fully, but they always help. And the more I practice them during less intense moments, the more automatic they become during hard moments.

I would really, really, love to know: do any of these tools work for you? What are your go-to tools and strategies these days? Please share with us – anonymous is always an option.

Accepting the storm

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When a wave of anxiety hits me, be it for a moment or a day or a week, my first thought is always panic. Why am I anxious, what am I anxious about, why is this happening, what can I do to feel better, why are none of my coping mechanisms making me feel better, why is it a day later and my heart is still pounding? Then is a little bit of, What do I do what do I do what do I do??? And then I breathe. And I remember. I have a choice.

I could fight it. I could wish it away. But that doesn’t work.

I could allow helplessness to consume me. I could decide that there’s nothing I can do, so I will drown.

Or I can accept it.

Because I know how to tread water.

Accepting it isn’t the same thing as submitting to it. Acceptance is peace. It’s mindfulness. It’s riding whatever wave is carrying me, whatever weather the universe is bringing. I don’t fight it. I don’t curse the storm. Nor do I submit to it. I don’t go outside barefoot and in a thin t-shirt and allow myself to be soaked. Accepting it means putting a raincoat on when I go outside into the storm because no, I can’t stop the storm, but I can protect myself.

The power of coping with anxiety is that balance. There is power in acceptance. In knowing, this is where I am. This is what’s happening. I might know why it’s happening, I might not. I might be able to see the way out of it, I might not. But in this moment, I can protect myself. I don’t have to fight it. And I don’t have to submit to it. Just as I can’t fight a riptide, nor do I need to let it pull me away. I know how to tread water. I know how to breathe. I know how to keep myself safe – while being in it – until the waters subside. I don’t need to know why the riptide is happening. I don’t need to understand why the storm hit. I can just be.

And in the meantime? I tread water. I rest. I write. I read. I stretch. I light a scented candle. I color. I drink tea. I breathe. I reach out. I look at the sky. I accept hugs.

And eventually, the storm subsides.