Confronting Anxiety

by Louise A. Sommer, M.S.W., A.C.S.W.

I can't breathe. I'm choking. What's happening to me?
Is this a heart attack? Am I dying? Should I go to the emergency room?

Sue wakes up in the middle of the night out of a sound sleep. She has a terrible pain in her chest. Sweating and shaky, she's scared about what is happening to her. She feels as though she is going to choke or lose her breath. She debates going to the emergency room and wonders if she could be having a heart attack and dying.

After about 20 minutes, the sensations disappear. She is afraid, alone, and confused.

These sensations happen again and again, only in different settings. First the grocery store. Then in her car as she drives on the freeway. And then in church where she feels she can't escape. Sue can't figure out why she feels so panicked. These places had always been familiar and comfortable to her. They never caused any fear or discomfort before.

Becoming increasingly scared and not knowing what to do, Sue calls her doctor to arrange for a complete physical. After running a series of tests, the physician reassures her there is nothing medically wrong with her. Still, Sue is puzzled. She tries to understand why these attacks hit her with no warning.

The doctor suggests that she may need to seek treatment for stress with a mental health professional. Then the doctor writes a prescription for an antianxiety medication that will help calm Sue when the attacks occur.

Sue contacts a therapist who specializes in treating anxiety disorders. She learns these episodes are "panic attacks" and many individuals have them. In fact, panic attacks are more common than most people think-with two to three million Americans suffering from severe anxiety.

The therapist explains that our bodies protect us when we're threatened by becoming ready for "fight" or "flight." Danger activates the body's alarm system. For example, you're taking a walk and suddenly a dog jumps out of the bushes and growls at you. Your heart starts beating faster and the adrenaline starts pumping to prepare you to face the dog (fight) or run from it (flight). This mechanism protects us from danger.

However, with panic attacks, the body's warning symptoms happen though there is no actual immediate danger. People experience panic attacks for many reasons. Some individuals experience this as a reaction to stress such as divorce, death, or job changes. In others, their brains release chemicals that trigger a panic response. A troublesome childhood experience such as the death of a parent or trauma such as physical abuse may promote a high level of anxiety, which can lead to panic. People also have personality factors-such as perfectionism-that cause an increased level of anxiety.

Other personality traits typical of those with anxiety include conscientiousness, dedication to work and family, sensitivity to criticism, and caring and concern for others. Sue admitted that she has always been a worrier even when there may have been nothing to worry about. In their discussion, Sue and the therapist discovered that some of Sue's family members have been highly nervous people. For Sue and some other panic sufferers, these hereditary factors may play a role in developing panic.

Because she was afraid of experiencing a panic attack, Sue had avoided driving on the freeway and instead took the side streets to work. The therapist recommended that she not become used to this pattern because it reinforced her fear. Together they developed a plan to help Sue face the freeway again in small steps, each step building on the next.

For example, the first step would be to sit next to the freeway for a while. The second would be to travel on the road next to the freeway. Then she would get on the freeway with a friend and go one exit. Then she would drive alone. Slowly, she'd build up to the distance she drove.

The therapist called this "Behavioral Exposure Treatment." Just recalling the panic that she experienced made her heart pound. It became her challenge not to avoid driving on the freeway. Gradually, she could face freeway driving again with less fear.

Over several years, when people avoid something they fear, they may develop a severe condition called "agoraphobia." Agoraphobia is the fear of not being able to escape a situation or not having help available if a panic attack occurs. People with agoraphobia have a restricted lifestyle. In extreme instances, some confine themselves to their homes. Others resort to using alcohol to help them face anxiety-producing situations. This does not solve the problem, but can add another dimension to an already difficult condition.

The therapist suggested Sue look at her negative thinking patterns that kept her depressed and afraid. She often gave herself "what if" thoughts and negative messages like, "I'll never get better." These contributed to "anticipatory anxiety," which is living in fear of having another anxiety attack.

In fighting these negative thought patterns-or "cognitive distortions"-Sue could think about her life more positively. She replaced negative thoughts with more positive ones. Instead of "I'll never be able to drive on the expressway again," she thought, "I have driven for years; I can do it again."

Her therapist taught her about other techniques. People can use positive imagery to visualize those tasks they can accomplish. Seeing themselves in a positive way becomes a rehearsal for real life events. This helps significantly in the recovery process. For Sue, this means visualizing herself driving on the expressway with no fear.

The therapist also taught Sue to do relaxation techniques such as deep breathing and muscle relaxation each day. Sue started exercising consistently because she learned exercise also can deactivate body tension and release stress. By using these techniques, she reduced the anxiety before it escalated.

She learned that when she found herself in a stressful situation and felt panicky, there were some simple coping mechanisms she could use to combat the rising tension. Distraction is one common technique. She focuses on something else to take her mind off the anxiety. For example, when she stands in a crowded line, she diverts her attention by reading a novel she carries in her purse. She learned to concentrate on events outside of herself such as watching others. She uses positive self-talk in assuring herself that she is, in fact, safe and this panicky feeling will pass soon.

The medications the family doctor had given Sue helped calm her anxiety. However, she found that with the therapy, support, and newly-learned techniques, she could take them less frequently and actually manage the tension on her own.

Sue's experience is a fairly common example of how anxiety starts and spreads. There are many other ways that it can surface such as with being severely depressed, during a life crisis, in response to a specific phobia, or even during times of positive stress like the birth of a baby.

All of us have some level of anxiety that protects us. We can experience many different symptoms that are unique to each individual. It is only when the anxiety becomes too great and takes over our lives that we need to confront it. Remember, it is not necessary for anyone to be immobilized as a result of panic and anxiety. For those who are willing to face their fear, anxiety is a very treatable condition.

Books on Anxiety

Barlow, David & Michelle Craske. Mastery of Your Anxiety and Panic.  

Burns, David. The Feeling Good Handbook: How to Overcome Depression, Conquer Anxiety & Enjoy Greater Intimacy.  

Goldstein, Alan & Barry Stainback. Overcoming Agoraphobia: Conquering Fear of The Outside World.  

Griest, John, James Jefferson & Isaac Marks. Anxiety and Its Treatment.  

Marks, Isaac. Living with Fear: Understanding and Coping with Anxiety.  

Sheenan, David. The Anxiety Disease: New Hope for Millions Who Suffer from Anxiety.

Weekes, Claire.

• Hope & Help for Your Nerves.
• More Help For Your Nerves: The Remarkable Technique for Overcoming Fear and Anxiety.
• Peace From Nervous Suffering: The Proven Successful Approach to Overcoming Tension & Anxiety.  

Wilson, Reid.

• Don't Panic: Taking Control of Anxiety Attacks.
• Breaking the Panic Cycle: Self-Help for People with Phobias.