Photo: Nick Wong
It’s 6 p.m. on a September evening in 2001, and I’m driving our green minivan on a Toronto highway. I’m 36, and heading to dinner at my parents’ house. My husband has been in Bermuda for three weeks, where he’s just landed a two-year contract and is looking for an apartment so I can join him and continue my work as an editor remotely. So it’s just me and my little black poodle, who is curled up on the passenger seat, making the half-hour drive I’ve done hundreds of times.
The news is on the radio—top story, the recent 9-11 terrorist attack. It seems I can’t get away from the shocking news and images; I haven’t been sleeping well. As I approach a bridge, my heart suddenly starts beating rapidly. Then, my legs turn to jelly. You’re going to drive off the bridge, a voice in my head warns. Now my arms are numb. You’re about to lose control and die. I’m terrified. My hands grip the wheel; I just want to make it over the bridge and to the exit. I do, then I pull into a parking lot and start to cry. What’s happening to me?
This turns out to be my first of many panic attacks. I’ll have panic disorder, a type of anxiety in which the attacks continue and always out of the blue, for the next 12 years. I didn’t know what was going on at first, but I’ve learned lots since then.
Unlike fear, a reaction to an actual threat, panic is intense fear in the absence of real danger. According to a study published in Prescriber, a U.K. journal for health professionals, about 7 percent of Europeans develop “panic syndrome,” while 2 percent suffer from the more narrowly defined “panic disorder.” It’s most common at ages 45 to 59, though typically the first attack is in the 20s and 30s.
Women are twice as likely to experience panic disorder. The reason for that is unlikely to be biological, says Martin Antony, a psychology professor at Ryerson University in Toronto and author. He says that perhaps men simply don’t want to admit experiencing panic to researchers.
Sufferers often report recent stresses such as getting married or divorced, moving, getting or losing a job, financial or health problems. Eilenna Denisoff, a clinical psychologist and director of CBT Associates in Toronto, explains: “They are different from everyday hassles like getting a parking ticket.” In stressful times, sleeping poorly can make us more sensitive to anxiety-related events like rapid heartbeat. Panic attacks occur when the brain identifies this heartbeat as a danger signal.
“Humans are hard-wired to survive,” explains Denisoff. “The fight-or-flight response allows us to run faster, jump higher, if we’re being chased. Physiologically, then, the brain’s reaction to the rapid heartbeat ‘danger signal’ is to move blood from the limbs to protect the core.” (This explains the feeling of limbs turning to jelly.) The person isn’t actually in danger but the brain misreads the signs as needing to flee.
For me, the stressor was my upcoming move. Plus, I’d not been sleeping well, so hearing more news about 9-11 likely increased my heart rate.
The first attack often leads to panic disorder. Because the symptoms make you feel you’ll lose control and die, the next time they occur, it leads to another panic attack, says Denisoff. “Your brain starts to look for situations when you should be fearful or feel trapped.” Basically, you begin to fear the fear.
I tried driving on the highway a week later—and again, panic drove me to the first exit. After that, I took only smaller, slower roads. Weeks later, I moved to Bermuda, where we did not have a car—and where there were no highways. I was so relieved. I hadn’t told my husband about the two frightening episodes; I knew he loved my independence and strength, and I felt ashamed of being so weak. I reasoned it was just a blip and pushed it aside.
To get around, we had a motor scooter that I rode on the back of, and I took the bus when I went somewhere on my own. I did this often over the first couple of months, but one day as I rode the bus into town to do some Christmas shopping, out of the blue my heart started racing. Sure enough, next came the sweating, legs turning to jelly, and the feeling that somehow I’d lose control or “go crazy.”
I hadn’t reached my destination but rang the bell and, in tears, walked home, where I felt safer. A few days later I tried the bus again—and the same thing happened. The thing that had forced me to avoid highway driving was now forcing me to avoid public transit.
It was time to come clean. That evening, I told my husband what had been going on. He was so sympathetic; I shouldn’t have kept it bottled up, because it felt good to let it out. But he was as mystified as I was. We searched online for “fear of highways” and “fear of public transportation” and got lots of hits, which is when we learned that many people experience episodes called panic attacks.
What a relief to know I wasn’t alone. But my heart sank when I learned that what happened on the bus meant I also had agoraphobia, which often goes hand in hand with panic disorder. You fear that if you have panic symptoms, you won’t be able to escape. In extreme cases, your world shrinks until you fear leaving your home.
Now It was time to tackle this; damned if I’d let something in my mind control my life. I’d read that it helps to talk about it with loved ones. So, a few days later, when I was back in Toronto for a visit, I had dinner with my best friend and her husband and told them about the panic attacks. Lindsay looked at Todd with wide eyes then back to me and said, “Todd went through that a few years ago!”
He said sheepishly, “When I was 28, I had panic attacks.” He had several episodes over a few months.
He’d just taken over the family business and was feeling very stressed. One evening at a restaurant with Lindsay, his heart started pounding fast; he thought he was having a heart attack and felt the need to flee. They left mid-meal and the pounding stopped, but next morning Todd went to his doctor. “I think I had heart palpitations last night.”
The doctor checked him and said: “It sounds like you had a panic attack.” He referred Todd to a psychiatrist, who gave him a prescription for Ativan (an anti-anxiety drug you take when panic symptoms start). Todd took the medication and avoided restaurants, but then a panic attack hit when he was in an airport lounge. Agoraphobia had kicked in.
He dealt with it on his own, by learning relaxation techniques, including deep breathing, and was able to cut back on the Ativan. Eventually, the frequency of attacks lessened, then disappeared, so he stopped taking the medication. Todd told me, “The drug was key, and reading up on panic attacks—just knowing it’s not uncommon—really helped.” He gave me his copy of Living With Fear: Understanding and Coping with Anxiety, by Dr. Isaac M. Marks.
Back in Bermuda, I dared to get back on the bus—with the book in my handbag as an antidote in case panic began. When my heart started racing a few minutes into the journey, I pulled out the book and opened it to the earmarked pages advising that panic wouldn’t kill me, I wouldn’t “lose control,” and I wouldn’t “go crazy.” It calmed me.
For the next two years in Bermuda, I kept panic at bay in this way; I didn’t consider therapy or medication. But it was inevitable that one day I’d be back in the land of highways, and I’d need more than a book to get me behind the wheel.
For nine years after moving home, I avoided panic attacks by relying on my husband for highway driving. I told only people close to me about my “weakness.” I knew therapy was the only way I’d be able to get past this for good. But that would mean facing the fear—and I was too frightened to contemplate getting back on the highway.
Then we bought a cabin. It needed fixing up, and my husband would be working on it for weeks at a time while I worked in the city. It was a three-hour highway drive, and it wasn’t on a bus route, so if I wanted to go on weekends, we’d have to get a second car. Finally, it was time to find a psychologist.
Panic disorder can be treated with antidepressants for long-term disorder and beta blockers for immediate relief of symptoms. But experts recognize cognitive behavioral therapy, or CBT, as the best treatment. It resolves anxiety by changing the underlying behaviors and cognitions that tell you the symptoms are dangerous. “Changing your reactions to the symptoms is key,” says Martin Antony. “When you’re willing to let your panic attacks happen without trying to control them, they often stop.”
Exposure therapy plays a big role. The goal is to feel the same sensations as during a panic attack and discover you don’t need to fear those sensations.
In my first therapy session, I learned deep breathing—a long slow inhale through the nose, a long slow exhale through the lips. “This will be your tool to calm yourself when you feel panicky,” the psychologist explained.
A week later, we started “imaginal therapy,” a form of exposure therapy. She asked me to tell her the highway routes near my home that were no-go zones. Then she asked me to close my eyes and imagine driving the least scary route, to describe each step and to rate my anxiety level from one to 10.
“One,” I said, mentally backing out of the drive, then “two,” as I turned onto the next street.
It jumped to “eight” when I reached the road leading to the on-ramp. My heart was pounding; I was starting to sweat. “Do your breathing,” she told me.
She asked if I’d ever kept something in my purse for when I felt unwell. In fact, I had peppermint gum for stomach upsets. “Good,” she said. “Imagine you’re chewing a piece of gum.”
Now, the moment of truth: in my imagination, I accelerated and merged into highway traffic. “Ten.”
My legs turned to jelly, and I had that awful feeling I’d lose control. “It’s okay, keep breathing,” my therapist advised. “It’s less than a kilometer to the first exit.” In my mind, moments later I saw the exit ramp and began to calm down when I reached it and decelerated.
My relief turned to fear when my therapist said, “Your homework is to do that for real this week. Remember your breathing, bring your gum. It won’t be much different than doing it in your mind.”
So, one Tuesday after dinner, I took a deep breath and grabbed the keys. Just like in therapy, my heart pounded as I got on the highway. But, using my new tools, I made it to the exit without my physical symptoms escalating. I was overjoyed.
Over four more therapy sessions we did imaginal therapy, each time taking a tougher route, or adding distance. My homework matched what we imagined, and each week I could do it for real, though I’d always return home on regular roads.
But finally, on a homework session that involved the scariest route yet, I exited the highway panic-free—then said to myself, “What the hell, let’s give it a go.” I looped around and got back on the highway toward home. It was a feeling of victory, and I haven’t had a panic attack since.