January 6, 2011

How I lost it and got it back again -- and how you can, too. Part 4



It's a complex organ, that crazy brain
I've appreciated all the comments and e-mails I've received from readers in the year since I started my panic attack series, and I wanted to give you a final update (at least here on the blog) and share how things are going, now two years past the date of what I affectionately refer to as "my nervous breakdown." (Catch up by reading parts 1, 2, and 3.) For those of you who also experience panic attacks, this may sound familiar to you.

2010 was all about acceptance. Or resignation? Let's go with acceptance.

There was the presentation I gave where, as the conference room doors closed behind me, I was suddenly overcome with panic and the urge to flee. I started to jump out of my chair. For what? Maybe to pop a quick Ativan? Problem was, the host was already introducing me and my bag was directly behind him.

Instead I turned around and quietly asked the person who closed the door if he could open it a little "for some air." I managed to get up -- like I always do -- and knock down the presentation.

There was that time when seven of us crammed ourselves into a minivan for a ride from the hotel to the conference, when I became overwhelmed with fear and had to do everything I could, mentally and physically, to keep from leaping out of the car. I ran down my calming measures:

Bottle of water (my #1 security blanket)? Check. Lean forward so I'm not cramped by the others around me? Check. Tell myself there's plenty of space and it's only a short drive? Check. Distract myself with conversation? Check. Breathe? Check.

There was the time, standing outside on a hot day, waiting for an event to begin, that I thought I would flip out if I didn't get out of the heat and find something to drink. After some respite in a shady spot, I headed to the women's restroom to splash water on my face. On the way, I found a vending machine with bottled water. Saved.

By the way, I totally get how silly this probably sounds to someone who doesn't get panic attacks. Anxiety from being too hot? Believe me, I get it. It seems like a ridiculous amount of overreaction to a minor discomfort. Yep, that's exactly what it is. Completely irrational. And that's why it sucks so much.

There was also the time when I sat at a table in the middle of a hot, noisy, crowded restaurant (the kind of place that first set me off 20 years ago), and I tested myself. "Gee, it's hot in here," I told myself. "It's awfully crowded." Knowing that these are typical triggers for me, I poked and prodded myself mentally. "Are you hot? Are you claustrophobic? Can you stand the noise and the crowd?" And the answer was yes. I felt completely fine and in control.

2010 was all about discovering who I am now, acknowledging myself as a person with panic attacks, and how I deal with that reality and live my life knowing there could be a trigger around every corner -- but also getting on with life and not thinking about it every minute!

There was a period of months in 2010 when I thought I might have licked the attacks. But that just wasn't the case. When I found myself too busy, too stressed, with too little sleep and exercise, it was almost a guarantee that I would, with the right trigger, get punched in the gut with that familiar electric jolt that makes me want to jump out of my skin.

So now I test myself. As in the example above, I check in with myself when I'm in a situation that would be a typical trigger: hot, noisy, claustrophobic, crowded, enclosed. How do I feel? Am I going to be caught off-guard by my circumstances and freak out? What are my options? Can I go outside? Can I drink some water? Can I find a space to clear my head? This has proven to be a successful tactic, and 100% of the time, when I check in with myself this way, I prevent an attack.

But there are still those times when I'm hit with that unexpected body blow. And this is enough of a threat to keep my anxiety quietly revving in the background (sometimes the anticipatory anxiety -- the anxiety about potential anxiety -- is worse than the panic attack).

In a heavy rainstorm, hubby made an offhand comment/joke about our water-damaged ceiling caving in. Something about the idea of the ceiling, water pooled into a small reservoir waiting to burst, sent me flying from the couch into a familiar pattern of agitated pacing, looking for escape. Fear of drowning? The burdensome image of heavy water over my head? I don't know, but once again I was startled by the intensity of the physical reaction, before my brain even had time to think.

This is the lizard brain at work, the part of the brain that processes emotions and controls autonomic (involuntary) responses associated with fear. Here's a little science for you:



"­The brain is a profoundly complex organ. More than 100 billion nerve cells comprise an intricate network of communications that is the starting point of everything we sense, think and do. Some of these communications lead to conscious thought and action, while others produce autonomic responses. The fear response is almost entirely autonomic: We don't consciously trigger it or even know what's going on until it has run its course.

Because cells in the brain are constantly transferring information and triggering responses, there are dozens of areas of the brain at least peripherally involved in fear. But research has discovered that certain parts of the brain play central roles in the process:

Thalamus - decides where to send incoming sensory data (from eyes, ears, mouth, skin)
Sensory cortex - interprets sensory data
Hippocampus - stores and retrieves conscious memories; processes sets of stimuli to establish context
Amygdala - decodes emotions; determines possible threat; stores fear memories
Hypothalamus - activates "fight or flight" response

­T­he process of creating fear begins with a scary stimulus and ends with the fight-or-flight response." ~ Discovery Health

And more:

"According to the Public Health Service, about 50% of mental problems reported in the U.S. (other than those related to substance abuse) are accounted for by the anxiety disorders, including phobias, panic attacks, post-traumatic stress disorder, obsessive compulsive disorder, and generalized anxiety. Research into the brain mechanisms of fear help us understand why these emotional conditions are so hard to control.

Neuroanatomists have shown that the pathways that connect the emotional processing system of fear, the amygdala, with the thinking brain, the neocortex, are not symmetrical -- the connections from the cortex to the amygdala are considerably weaker than those from the amygdala to the cortex.

This may explain why, once an emotion is aroused, it is so hard for us to turn it off at will. The asymmetry of these connections may also help us understand why psychotherapy is often such a difficult and prolonged process -- it relies on imperfect channels of communication between brain systems involved in cognition and emotion." ~ LeDoux Laboratory

Check out this fascinating and easy to understand series of articles about the brain and fear!



As 2010 went on, and I became familiar with this new reality, it finally dawned on me that I'm done trying to fix it. I've done all the work I can do, I've got more tools than ever, I've researched the heck out of this thing, I'm healthier and stronger than I was two years ago, and infinitely more self-aware thanks to the excellent work of my therapist. Maybe my panic attacks will never go away. And you know what? Lots of people have physical and emotional baggage and "issues" -- and this is mine.

I realized then that it was time. Time to stop therapy, time to stop analyzing every instance of anxiety, and time to acknowledge that this is the way it's going to be.

I had my last appointment with my therapist almost two years to the day that I started seeing her.

I don't avoid the places or situations that trigger my attacks (oh, how I wish I could avoid the MRI machine...). Avoidance just makes anxiety more powerful. I keep going back, keep testing myself, keep pushing myself to focus on my tools.

Freaked out in Pirates of the Caribbean in 2009... conquered it in 2010. Avoided elevators in 2009... piece of cake in 2010. I hate crowds, but I immerse myself in them. I'm uncomfortable in hot stuffy rooms, but half of my presentations take place in them!

My prevention tools are plenty of sleep, healthy eating, exercise, positive attitude, and avoiding stress. My in-the-moment tools are water, coolness, space, movement, thought-stopping, distraction, and as a last resort, Ativan. (I wrote in more detail about these tools in Part 2.)

It's been a fascinating learning experience and a window into my own psyche and the brains of so many others who share this disorder (or condition, or whatever you want to call it).

For the first time since December 2008, I'm not in any kind of treatment for panic attacks. It would be heaven to be completely free of them and maybe I will be one day. But for now, I'm happy, I'm healthy, and I'm in control of my life -- and I'm okay with this one minor annoyance that pops up now and again.

Thanks for reading this series and I hope that, whatever your challenge is, you'll face it head-on and gain strength from the fight.

Previous posts in the series:

Part 1 Falling apart
Part 2 Tools and techniques
Part 3 Meds and moving on

4 comments. Please add yours! :

Barb Desmarais said...

Lisa, I admire your candidness about this very personal part of your life. You are human, like the rest of us. I too suffer from anxiety; but fortunately not to the point where I get full blown panic attacks although I've had a few but not for several years. Small challenges in my life get completely blown out of proportion in my head and create anxiety in my body. I can't say enough about the benefits of yoga. It puts me in a complete state of calm and relaxation. Have you ever looked into the hormonal aspect of anxiety?

Lisa Braithwaite said...

Thanks, Barb. Even though my anxiety isn't related to public speaking, I want my readers to know that I have experienced severe anxiety and hopefully my tips will help some of them.

My doctors initially entertained the notion of hormonal issues, but ruled it out.

I still haven't tried yoga for it, but honestly, any exercise that gets me off my butt, the more vigorous the better, makes me feel great. When I was really debilitated by panic attacks at the beginning of 2009, I couldn't wait to get back to working out.

Linda Menesez said...

Lisa, I'm so grateful for the generosity of spirit you've shown in sharing this personal struggle with all of us. Everyone can identify with feelings of fear and anxiety. It happens to all of us from time to time in varying degrees. Thank you for educating and encouraging those who have serious anxiety and don't yet know that they have options.

It sounds like you had a wonderful therapist who traveled with you on a difficult journey, and when you were ready, helped you move forward on your own. I love that you challenge yourself and have a good awareness of the many ways you've grown through all of this. I have so much respect and admiration for you.

With gratitude,
Linda

Lisa Braithwaite said...

Thank you for your lovely and articulate comment, Linda. My therapist and I came to the same conclusion at the same time, which really proved to me that it was time to move on.

I do love to challenge myself, or at least I don't feel that I have a choice! It's what I do. And I'm glad that I can sometimes use what I've learned to help other people. It's a win-win!

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