Fears, Phobias and Panic

Self-help Guide to Agoraphobia

Maureen J. Sheehan

• Publisher: David Fulton Publishers
• Year: 2013
• ISBN:
  9781134081851
• Edition: 1
• Topic: Education
• Subtopic: Education General

First Published in 1988. This book is for people who experience the type of fear that prevents them from doing what most of us take for granted. It is for the person who is frightened to leave the house or go very far from the house, who cannot go into shops or pubs, wait in a queue, travel on a bus or train, go to a cinema or theatre, or have a meal in a restaurant. It is for those of you who feel panic-stricken if you are left alone in the house or if you have to enter a small-enclosed space such as a lift or bus. From time to time some of you may have experienced the very unpleasant sensation that you were not real or that things around you were not real. Others may have experienced the terror of a panic attack.

Chapter 1
Understanding What is Going On

What is happening to you

A patient recovering from a phobia and who had just joined an evening class said to me the following morning: ‘I felt very hot and sweaty during the first part of the class and I didn’t take in very much of what was being said. Then we had a break for a cup of coffee and during that time I thought about what had been going on and understood it. Just understanding what was happening to me helped me to cope with the second part of the class.’

The patient was able to cope because he knew what was happening to him. He was able to interpret the unnerving sensations he had experienced and, armed with his understanding, was able to combat his anxiety.

More often than not, unfamiliar bodily sensations and high arousal levels are misinterpreted, and this can make them worse. If you interpret correctly what is happening to you, you can begin to manage your fear, panic or phobia. This chapter describes many distressing symptoms that you may have experienced and have no wish to be reminded of, but please try to read it. It will help you to understand what causes the symptoms, and this in itself will reduce your anxiety. Once you understand them, you may no longer have to dread such experiences in future.

Fear

We have all experienced fear. It is the emotion of pain or un-easiness we feel when we are faced with a threatening situation or danger. At its extreme, it is a state of alarm or dread. All types of fear can cause bodily changes such as your heart beating faster. In general when we are frightened we are likely to react with one of the three F’s – freezing (silently rooted to the spot), flight, or fight. The difference between extreme fear and panic attacks is in the situations that trigger them.

Phobia

A phobia is a specific kind of fear that can develop in various ways. The word comes from the Greek word phobos which means ‘flight’ and is used to describe an exaggerated and often disabling fear. The characteristics of a phobia are an intense desire to avoid the feared situation. Phobias are emotional/physiological reactions which have become deeply ingrained habits. High levels of anxiety are experienced by the phobic person if he or she is exposed to situations that are feared.

Panic attacks

At the beginning of the book I described how many people experience a panic attack whilst away from home, in a shop, pub, hairdresser’s, bus or train. Usually these experiences take place when the person is alone and away from home but they can also occur at home and even in the presence of someone familiar.

Panic attacks can be terrifying and may lead sufferers to think themselves seriously ill, mad or on the point of dying. This is not surprising if you consider the symptoms. When you have a panic attack your body behaves as if it is responding to a really perilous situation.

In conditions of real danger, such as reacting to a car out of control or facing a violent attacker, the part of the body that is responsible for how you respond is the sympathetic nervous system (which is part of the autonomic nervous system). This system acts quite automatically and prepares the body to take defensive action such as steering your car out of the path of an oncoming car, frightening off an attacker or taking to your heels. The body is in a heightened state of arousal. Among other changes, your heart rate increases, extra blood is pumped to the muscles, pupils dilate and your breathing becomes shallow. This last change often leads to over-breathing (or hyperventilation), which itself is often the cause of strange and worrying symptoms.

If you are subject to panic attacks, your autonomic nervous system has become over-reactive and is being triggered by quite harmless, everyday situations such as travelling on a bus. The physical changes that occur are the same as in conditions of real danger.

As well as physical symptoms, you will also experience changes in your thinking. You may find that you are very confused, unable to recall important facts, unable to concentrate and have difficulty in reasoning. At the core of these panic attacks may be fears of physical disasters, mental disorder or social disgrace. The combination of physical symptoms and thinking difficulties may lead to fears such as:

‘I am losing control’
‘I am not able to cope’
‘I am going to collapse’
‘I am about to have a heart attack’
‘I am going mad’
‘I am about to die’

The thoughts may be accompanied by visual images of hospitals, operating theatres, men in white coats, ambulances and coffins. The frightening physical symptoms, terrifying thoughts and images increase the anxiety and lead to an increase in symptoms and so the cycle goes on.

The next time you contemplate going to the shops, travelling by bus or underground train, your thoughts turn to what happened the last time that you were in that situation. Worrying about what might happen even before you are in the feared situation will almost certainly increase your anxiety. You may attempt to go back to the same or a similar place whilst feeling highly anxious and so increase the probability that you will again begin to feel panicky. You may have a full-blown panic attack. Thereafter, just thinking about the feared situation will produce some of the symptoms you experienced in the actual situation. You may become quite overwhelmed with panic and decide that you cannot go out or enter a shop or pub. The longer you avoid these situations, the stronger the fear will become, and you will develop a phobia.

All these symptoms are particularly frightening if you do not know what is going on. Understanding what is happening to your body and in your mind will help to dispel your fears. Let us look at some of the symptoms of panic attack and in particular those that are produced by hyperventilation.

Symptoms of a panic attack

Hyperventilation

Hyperventilation means overbreathing. We breathe in oxygen and breathe out carbon dioxide. If we overbreathe, we breathe out much more carbon dioxide than usual. This leads to a reduction in carbon dioxide pressure and provokes a marked constriction of the cerebral blood vessels. The result is a feeling of wobbliness. Like a balloon that has begun to deflate, you no longer feel firm and bouncy. All manner of physiological changes result from over breathing and the body has to work hard to restore the balance in the various systems which have been affected. When overbreathing is habitual, you may suffer from chronic symptoms. Here are some of them.

Neurological:

Central:	dizziness, disturbance of consciousness, disturbance of vision
Peripheral:	tingling sensations in hands and/or feet (parathe-siae)

Cardio-vascular:
Palpitations, abnormally rapid heart action (tachycardia)

Respiratory:
Shortness of breath, chest pain

Gastro-intestinal:
Pain in the region of the abdomen (epigastric pain)
Feeling that you cannot swallow because of a lump in the throat (globus hystericus)
Difficulty in swallowing (dysphagia)

Muscuio-skeletal:
Tremors, muscle pains

Psychic:
Tension, anxiety, irritability, inability to concentrate

General:
Weakness, fatigue, disturbed sleep.

As you can see, the symptoms can be quite alarming. Anyone of these symptoms may have led you to believe that you were physically or mentally ill. If you are unaware that your breathing is faulty, what else are you to think? In Chapter 3, I will describe how to improve the quality of your breathing. Slow, relaxed breathing is a crucial element in your fight to reduce tension and anxiety. You cannot be relaxed if your breathing is rapid and shallow.

Poor breathing is not of course the whole story. Two other very distressing symptoms are commonly experienced – not feeling real and feeling that your surroundings are unreal.

Not feeling real

One of the most dreaded symptoms that patients report is the sudden feeling that they are not real. Often they assume that this must be the start of a serious mental illness. The medical term for this symptom is depersonalisation. It is an extremely unpleasant and frightening state to be in and is described by patients in various ways. Some people describe it as a feeling of actually being detached from their bodies almost as if they were watching themselves from a distance. Others talk of feeling as if they have no sensation in their bodies and feel as if they are dying or disappearing. One woman described an occasion when she was sitting in a taxi and felt that the lower part of her body had disappeared. She was not aware of feeling particularly anxious and had had no warning that this might happen.

Feeling that everything around you is unreal

The medical term for the feeling that everything around you is unreal is derealisation. Again, descriptions vary from person to person: objects in a room may appear to be distorted or the whole room may look as if it is a stage-set. Although these feelings are very upsetting and possibly frightening, they serve a purpose. They are a defence against being overwhelmed with anxiety. Like an overloaded electrical circuit, the fuse cuts out.

Both these states may last for minutes or hours but eventually they pass.

Panic disorder and post-traumatic stress disorder

If you live in America, you will have heard the term panic disorder and may well have had it applied to your own problems. In the United States the term is used to coyer anxiety, agoraphobia and depression which are seen as complications of this primary disorder – the cause of which is regarded by some as physical, although it is often associated with problems in relationships, bereavements and other stressful so-called ‘life events’. In Britain and Europe panic attacks are regarded as part of a general anxiety state. Regardless of the name it’s given, you will know the nature of the problem from which you suffer!

After any trauma such as a bereavement, an accident or assault, a bomb scare or fire, wartime imprisonment or torture, people may suffer what is called post-traumatic stress disorder. Recurrent intrusive images of the event trouble them for perhaps years afterwards and they are unable to rid themselves of the fears that surrounded the event. Other sufferers avoid thinking about the disaster and shrink from any situation that will remind them of it. This type of avoidance behaviour can be treated with systematic desensitisation, which is explained in Chapter 4.

How fears and phobias develop

Individual differences

In order to understand how fears, phobias and panic attacks develop, it is useful to know how individuals differ in terms of nature (what they are born with) and nurture (what happens to them during their life).

Taking nature first, people are born with a variety of constitutional differences. There is evidence that individuals are also born with differences in the way in which the autonomic nervous system and the central nervous system react. These systems may influence the development of a disorder so it helps to know the difference between them.

Autonomic nervous system

The bodily reactions that accompany fear, such as an increase in heart rate, dry mouth, shallow breathing, etc., are governed by the autonomic nervous system. According to your particular constitution, these bodily reactions may differ in the following ways:

• – the reactions may be triggered more easily;
• – the extent of the reactions may be greater;
• – th...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Dedication
• Introduction The Problem of Fear and Panic
• 1 Understanding What is Going on
• 2 Getting in Touch with Your Feelings and Thoughts
• 3 Changing Your Behaviour
• 4 Your Family and Friends
• 5 Professional Help
• Index