by Dana Terrell, LCSW, EMDRIA-Approved Consultant
When a loved one experiences the symptoms of anxiety or panic attacks, it is very hard to know how to help. The panic disordered individual feels helpless and out of control. It becomes easy for friends and loved ones to feel equally helpless. Supporters do not need to provide therapy or cure. (Please see “What a Panic!” article to learn more about how Eye Movement Desensitization and Reprocessing, or EMDR, therapy can help with the trauma of panic disorder.)
There are many ways that you can offer real support, which can make a true difference in the progress of healing.
The key supports include
1) understanding the disorder, the cycle of anxiety and the process of treatment,
2) “being there” in any way that fits for you, and
3) expressing your confidence that sooner or later, your loved one will get past not only each panic experience, but the panic disorder as a whole.
Most people with panic fear that they are dying or have a serious physical illness. Of course it is responsible to have an initial complete physical exam, as well as a second opinion, to rule out physical illness. Once that is ruled out, most physicians will diagnose Panic Disorder. At that point, a licensed therapist can also assess and diagnose the disorder, if the doctor didn’t.
Causes of Panic
In my experience, panic is a result of untreated or incompletely treated stressful experiences, trauma or PTSD (post-traumatic stress disorder). I’ve often observed that panic disorder which has been untreated (or incompletely treated) for a significant period of time can turn into agoraphobia (fear of leaving one’s home or immediate environs). It is usually instigated by a “trigger” event that brings up the old unresolved anxiety or other intense feelings that are actually quite appropriate for the initial trauma(s), though they may not seem appropriate for the trigger. This “inappropriateness” of the intensity of response can make people worry a lot. They wonder, “Am I going crazy?”, or even “Am I dying?”
The answer is emphatically, “No. You simply have a serious, but treatable, anxiety disorder.” It is serious simply because it interferes with life so much, and makes it very hard for a person to enjoy themselves and explore their opportunities for more happiness and success.
Symptoms of Panic
The panic disordered individual experiences anxiety cycles that begin with a perception of threat or danger, followed in quick succession (often so fast that it all seems simultaneous) by adrenalin, causing physical symptoms:
increased heart rate, pounding heartbeat
increased muscle tension/sensation
dizziness or lightheadedness
hotflashes or chills
and breathing changes
These lead to Secondary Symptoms, such as Emotional Symptoms:
and Cognitive Symptoms
ignoring positive facts
perceiving only negative interpretations
which lead to Behavior
Action that are done
Actions that are avoided
If the behavior leads to a positive outcome, the cycle stops. If the behavior leads to a negative outcome, the cycle continues.
As an EMDR therapist, I was eager to help people with panic, but found that the standard EMDR protocol just didn’t work as I hoped it would. Thus, I went to the specialty EMDR workshop taught by Marcia Whisman, LCSW, an internationally recognized expert in anxiety disorders and EMDR. Her presentation at the 2005 EMDRIA Pre-Conference Day was called “Treating the Trauma of Panic and OCD.” She found that in panic disorder, we need to start with the first panic attack, and treat that as a traumatic memory with EMDR. We then proceed to the worst panic attack, and the most recent (sometimes the worst and the last are the same event). After these 3 events are processed with EMDR, the client can understand that the panic is truly related to their anxiety and stress. It is not, as they may have thought, a physical condition such as a heart attack or a prelude to death by some other route. They are then ready for the next stage.
Learning Mastery of Anxiety Symptoms
Stage 2 of EMDR treatment for panic disorder is focused on learning mastery of the physical anxiety symptoms in the present. It is a skill-building stage, easier now because the intense negative cognitions of Stage 1 are calmed. EMDR is used to help “practice” imaginatively the skills, desensitize any insecure practices, and install confident ones. Once the client feels confident and successful in mastering symptoms in the present, they are ready for…
Process Anxiety triggers until they do not arouse anxiety
Stage 3, when the client anticipates all the places, or “trigger” situations in the future that might result in panic symptoms. We process each imagined future experience as if it is a video, with EMDR, until the “video” elicits no more anxiety or distress. Then the client is ready for “in vivo” exposure. The client plans to go to the anticipated location/time with a support person, and confronts the situation directly. This homework then gets processed in the next EMDR session. If necessary, the homework is repeated. This process is repeated until the client has no more anxious anticipation of the future. With past, present and future cleared, the client is free to live life without fear. If unforeseen “triggers” arouse fear in the future, the client is welcome to come back to process that trigger. This usually can be done in just 1 to 3 sessions at this stage in the treatment.
When talking with a therapist friend who experienced panic attacks about 25 years ago, she said that one of the most helpful things to her was to not be alone during the panic attack, to have someone “being there, caringly connecting without taking much responsibility beyond that.”
Support people can also help their friend or loved one in various practical ways. One is to remember to do deep, slow breathing. An excellent breathing exercise is to 1) double inhale – huh HUH — through the nose until the lungs are comfortably full, 2) hold breath for 3 seconds, 3) double exhale – huh HUH — through the mouth. Repeat this 30 times. This works because oxygen is a natural, free tranquilizer. It helps neutralize adrenalin.
Also, bringing a large glass of water to drink may help to dilute the adrenalin in the body and move it out more quickly.
Ask your panic disordered loved one or friend if it may help to have a soothing CD on hand to play. It can help “shift stations” to a rhythm that is calming. CDs by David Grand, at “Biolateral.com” can also be nice to have on hand, and to play for 10-30 minutes. Most panic attacks are over within 30 minutes even if you did nothing to manage it. Doing something positive helps one regain the sense of having control.
My therapist friend who experienced panic disorder 25 years ago added good points to keep in mind, “Panic attacks are an intense fight or flight response that is not under the control of the client . . . at least without treatment! So to have someone be able to empathize rather than judge and distance is helpful. The client often feels intense shame about having panic. An accepting presence and appreciation in the moment can make all the difference for them.”
She contributed a valuable message about enabling: . . . [there] is a fine line between being supportive, and enabling someone to remain helpless in their fear, dependent on the support person. [The goal is to be] supported and empowered by the support person.
The good news is that this therapist now specializes in treating anxiety. She has much compassion for people with anxiety.
To avoid enabling, it is best if the panic disordered individual and the support person work out together a plan that is mutually respectful and mutually agreeable. It need not include all of the suggestions above, and may include some that your creativity inspires. Sometimes it may include financial support, or the offer of a “Safe Place” to live during the work of treatment.
It needs to be ok to sometimes not give support if one does not truly feel “up” to it. If support people do not feel that they have a choice, they won’t get to experience the joy and satisfaction of helping in their own heartfelt way. One positive belief that grows in treatment is this: “I have choices.” We also want the support system people to have choices. This is the reason one needs to expand a support system, so as to not “burn out” one or two key people. For support to be sincere, it needs to be freely given.
Your Vote of Confidence
The importance of this ingredient cannot be overemphasized. A support person who can remember the strengths of their loved one/friend, who reminds them that this will pass, and that this condition is very treatable is being truly encouraging. Think of it. We are dealing with a fear disorder. Courage is the opposite of fear. Powerful encouragement reminds that by following a step-by-step process the fear can be overcome.
Reminders, gently offered, are of great value to a panic disordered individual. When adrenalin is coursing through the blood system, it is hard to access the rational mind. That is what the support person has to offer.
When the support person feels frustrated or powerless
It’s ok to own up to these feelings. It is fine to make it a priority to take care of oneself when needed. To give support, we need to have something of value to give. If we are running on empty, we will have nothing to give. I encourage you to find a gentle way to convey this to your loved one, and to take care of yourself until you do feel some inner abundance. Take a bath, get a massage, connect with a good friend, use any of the self-soothing ways you care for yourself.
If you’ve encouraged your dear one to have an ample support system, it will give you the guilt-free opportunity to take self-care breaks, or to build self-care into your daily routine.
Understanding is so important, that there is a verse in the Old Testament about it: “With all they getting, get understanding.” In reading this article you have already tried to gain some understanding of the disorder, its treatment, and the cycle of anxiety with which your dear one has been struggling. Congratulations! Find simple ways to “be there” and remind about useful self-care techniques for your dear one – AND for yourself! And build hope by expressing confidence in the strengths your dear one has that can help carry her/him through this fear challenge to the other side of courage.
People don’t develop courage in a field of “no fear.” That would take no courage. We gain courage by overcoming its opposite. With EMDR therapy, clients can come out of panic disorder stronger than they have ever been. I’ve seen it again and again. This is why I love treating this disorder. It’s a joy to watch the healing.
Note: Marcia Whisman’s EMDR Protocol for treating the trauma of panic is still considered experimental. Anecdotal reports and my own experience indicate that it is a successful way to treat panic disorder.
©2008, Dana Terrell, LCSW, EMDRIA-Approved Consultant