Warning. If you have had panic attacks before, some of the imagery here may trigger you. If you start to feel what I call "the whitewater," stop reading, remind yourself there are no bears, and count out 10 slow steady breaths. We can learn to make panic attacks our friends even though they totally suck. Hopefully this article will help.
If you are reading because someone you love has panic attacks, hopefully the imagery will give you a hint of what it is like. Take that hint and multiply it by a thousand. It can feel that bad; but that's not the end of the story.
It started the moment I began to glide into the tube. The dread. The ugly rush (not the good kind of speeding fast on skis or your bike). The sick feeling came instantly. The MRI was for my chronic hip and as much as I enjoyed the pictures of purple flowers and blue sky on the ceiling panels before I went into the machine, the images didn't stick with me.
I've had panic attacks periodically since college. Most of them at night. Others when I'm in enclosed spaces. I hadn't been in an MRI before. An MRI is a very enclosed space.
I'm a big guy, 6 feet, 4 inches, 225. As I traveled through the tube, my shoulders touching the sides of the machine, I got a small reprieve. I'm so tall my head popped out the end. The adrenaline instantly slowed. And unfortunately, I was about to make the classic mistake when a panic attack is triggered by circumstances.
If you are blissfully unaware of the nuances of a panic attack, you can feel it coming. Everyone's experience is a little different, but whether it is your stomach, chest, or a feeling of awful foreboding that signals the whitewater about to rage through your body, you know what's about to happen.
Full scale panic attacks feel like you are going to die. It could be physical symptoms that manifest like a heart attack or emotional overload that makes general anxiety feel like a vacation. A panic attack makes you think you are going stark raving nuts. 2.7 percent of the American population, that's six million people, struggle with panic disorder. Studies have shown that 5 to 10 percent of people have them during an MRI.
Multiple parts of the brain go into overdrive during a panic attack. The amygdala or alarm responsible for keeping us safe and midbrain regions responsible for pain and defense like running or freezing go into hyperdrive. When they send too many hormones and the parasympathetic nervous system doesn't compensate, it truly feels like your world is coming to an end even though you are completely safe.
What was different for me with this attack is that I knew exactly what was happening. A panic attack often comes without warning, and the extreme symptoms last around ten minutes. The out-of-nowhere quality to many attacks only jacks up the terror. You feel completely out of control. You have no idea why your body is doing this or how to stop it.
My MRI experience was truly controlled. I knew when I recovered from the initial surge as I entered the machine that I could do my mindfulness exercises and be fine. I counted my breathes. I imagined myself in a safe space. I made up techno songs to the loud beat of the machine.
Then, I made my mistake. I started imagining using a machine like this for therapy. As exposure therapy can help some people recover from trauma, why couldn't exposure to small spaces help us make friends with our alarms' hyperactive tendencies. As I write about and coach brain health, I'm always looking for ways to integrate theory with solutions that help us feel better in our own skins.
I had been in the machine for five cycles totally 16 minutes; I was almost done. My thinking caused my alarm to kick in hard.
I remembered a CSI episode when one of the detectives was trapped in a coffin being eaten by ants. I imagined my self being in a coffin. I opened my eyes, trying to fight the rising tightness. I looked at the ceiling (that made it worse). I couldn't move (I felt completely trapped). My feet were taped together (I began to lose it).
Just writing now I can bring up the sick feeling. Then the next cycle of sound kicked in. It was louder, more like bullets. I lost it.
Then I couldn't find the balloon. The balloon is what they give you to squeeze if you melt down. I was melting down. If I could have grabbed the balloon, knowing I could get out if I needed to, maybe I could have breathed back into the moment. Not being able to find it was like losing a child in a crowd at the zoo.
I started screaming, "Help, help." The worst part at first was watching myself cave in. I knew what was happening, but my conscious self couldn't stop my old brain. I waved my hands. It probably took less than ten seconds from the start of the collapse for them to get me out.
It took another three or four minutes for the adrenaline to cascade. I didn't think I could get it back under control at first. As usual, I was sweating. My heart thumped like a jack hammer. I couldn't shake the sick feeling.
That's what the alarm in our brain does in normal circumstances to get us out of trouble, aka away from lions, tigers, and bears. In this case, the alarms signals had no place to go. I couldn't move or leave the situation. So it kept flooding my system until I did get out of there.
And after a few minutes and enough breathing, my frontal lobes began to kick in again. I had to finish the test. It was strange to know I was safe and have my body still reject reason. But once I was breathing normally, I closed my eyes, imagined I was on my grandmother's porch, and finished the session. I have done this exercise enough that it worked, I made it through the last cycle (barely), and I walked away from the experience fascinated.
If I couldn't stop my old brain from kicking in, what do we all need to do when panic attacks and their little brother anxiety keep us on edge all the time.
1. Remind yourself you're not crazy. When we experience panic attacks in places where we are entirely safe, we can feel like we're losing our minds. That unsettling feeling that lingers (I'm still having aftershocks five days later) is still your alarm. There is nothing wrong with you; our brains simply haven't evolved enough yet to prevent this from happening to millions of us. Again, they suck. And, you can learn to recognize their signs, hopefully prevent a full-scale attack, and if not, at least recover quicker.
2. Practice mindfulness exercises when you are well. The secret to brain health is to be mindful all the time. You can't use breathing exercises in an attack if you haven't practiced them regularly when you are well. We have to create the neural pathways before we need them. Whatever mindful practice you do, do it regularly and often.
3. Have a friend to call who understands. We may still have attacks. We may not be able to figure out why; brains are still more mysterious than understood. Find that person who understands, who knows what you need to hear to feel better. Each of us need a different kind of support and there is someone in your life you can call. Let them know how important they are to you before you need them and they will happily listen when you need them.
4. Change your memory of the experience. Studies show our brains are plastic and can be trained. Memory, it turns out, is also pliable. The memory of past attacks is, in part, what causes the deeper fear of the next one. These attacks do not have to be seen as bad things. Again, they are terribly painful, but if we change our memories of the past experience, remembering how the panic helped us live differently, learn more, or appreciate our ordinary times in a new way, maybe it can help prevent future events.
5. Reframe the experience. And if we can't stop them, we have to reframe them. Studies show that we can turn down the alarms in our brains by taking something awful, like a panic attack, and describing it unemotionally or in a helpful way. Hence, the whitewater. The technique is called reattribution. Rafting whitewater is insanely fun. While a panic attack may never be a joy, recovering from it can be something we decide to make meaningful. Name your experience. Own it as something you take control of the moment the adrenaline begins to cascade.
You are not your panic attacks and they can become something we make friends with. And maybe that's what we need for them not to come back again.