CHAPTER 1
AN INTRODUCTION TO THE PROBLEM AND ITS SOLUTION

Panic attacks (also called panic disorder and anxiety attacks) are among the most common of psychological problems affecting our modern world. Literally millions of people suffer from them in the U.S. alone and many more millions throughout the world have become afflicted. It seems that the more advanced the society, the more frequent this problem becomes.

This book is designed to help people who have suffered from this condition as well as their friends and loved ones who are also affected by it. Our intent is to first help you understand what causes the problem and then provide a simple, straightforward and effective means of stopping it from happening.

The following are true stories of people who have been temporarily overwhelmed by this problem. Only the names and some details have been changed in order to protect the identity of the persons involved.

Ron and his wife Lynn were taking a leisurely drive down New Jersey's Garden State Parkway one sunny autumn afternoon about ten years ago. It was a weekday, but both were free from work. The children were in school and the traffic was uncharacteristically light.

In the distance Ron spotted a strange configuration to the right side, which he could not immediately make out. As they approached, he saw that it was a man beyond middle age laboriously pushing a car off the roadway. When closer, Ron and Lynn could see an older woman, presumably the man's wife, steering the vehicle while he pushed.

Ron immediately said to Lynn "Lets stop and I'll give him a hand", to which she replied, "No, just go on. He's just about got it off the road already." So, Ron drove on.

Not more than ten minutes later and a few miles down the road, Ron suddenly felt a severe tightness in his chest and his heart began pounding. He broke into a cold sweat, experienced extreme weakness and had to pull off to the shoulder of the road. He was sure he was having a heart attack. He gaspingly told his wife he needed medical assistance and thought he was dying. Terrified, his wife got out of the car and frantically tried to wave down a passing motorist.

Fortunately, a patrolling State Trooper soon came along. When informed of the situation, he radioed for emergency medical assistance. An ambulance transported Ron, with Lynn beside him, to a nearby hospital where a cardiologist was called.

After much probing and testing, the specialist told Ron he could find no cardiac problems, or anything similar and that he seemed otherwise O.K., from a medical standpoint. After a couple of hours in the hospital, he was told he could go home but he was not given any explanation for his sudden, and seemingly life threatening, symptoms. As he was shakily leaving, one of the emergency room doctors commented that it might just be 'nerves.'

That explanation did not seem to fit Ron at all and, in fact, annoyed him. He was an outgoing salesman who was active in his community, seemed to have a good marriage and two healthy, well adjusted kids. No recent problems that he was aware of had been troubling him, and no one ever regarded him as the nervous type. In fact, he was known for his ability to stay calm in situations when others became irritable or upset.

Nevertheless, though he did not know it at the time, Ron had experienced his first panic attack. It was to be one of many which finally brought him into treatment and ended with a new understanding of himself, and how to deal with the attacks he was having.

In so doing, he was ultimately able to avoid ever having panic attacks in the future, so far as we know. As we will see below, that first attack was the result of a lifetime of experiences coupled with certain triggering events in the present.

Ron was like most otherwise perfectly normal people who are suddenly, and from their standpoint, inexplicably, hit by panic attacks. He had no clue as to why this was happening to him. When the mystery of that attack was solved, the road to freedom from further attacks became open to him, as will be the case for yourself, if you are a victim of this condition. Understanding of the hidden facts behind the attacks provides the tools for dealing with them.

Ed was a large, imposing man who normally exuded an aura of self-assurance, competence and authority. But, when first seen, he was a troubled, confused and frightened person, whose life had come to be dominated by a fear of going over bridges. He was a high level executive with a major corporation. He lived in an affluent suburban area. In order to get into the large nearby city where his company's headquarters were located, he normally had to drive over several bridges.

The little ones were somewhat frightening, but he could usually manage them without too much trouble. Sometimes he tricked his mind into ignoring their presence. But, when it came to the big ones, he was terrified. Furthermore, his work regularly required him to be in Washington D.C. While he could sometimes fly there or take the train, it was occasionally necessary to drive, as for example, when he had to accompany the CEO in a limo. He could not get there by car without going over some major bridges. The enormity of this problem began to dominate his every waking hour.

No matter what he did he would think of his problem with bridges. Sometimes when he was trying not to think of it, the thoughts would invade his consciousness and he would go into a panic attack.

When at his home base, he ultimately began to drive ten or twelve miles out of his way every workday so that he could take a tunnel to get to his office. This, despite the hour or more of extra rush hour traffic he had to endure, so he could avoid the big bridge. He also went through a variety of machinations to avoid driving in a car to Washington, D.C. Inevitably, and far more frequently than he could tolerate, he could not avoid the need to do so. On these occasions he experienced such severe fright that he believed he would die.

This anxiety was compounded by the fear that anyone in a car with him would observe his condition and question him about it. As is true of most people with panic disorder and the commonly associated phobic problems, fear of embarrassment or of being observed, only intensified the problem.

When he first came into our office, he said what most people suffering from panic (or, as in his case, panic and paralyzing phobia) usually say. He was embarrassed and felt stupid about this problem, but was helpless to do anything about it.

Ed had tried a variety of remedies, including tranquilizers prescribed by the family physician. They really did not help. He learned to breathe deeply when approaching a bridge. It didn’t help. He had tried meditation and had also consulted with his minister. It was only in desperation that he finally had decided to consult a mental health professional.

He reported that, strangely, the visit to the minister made him feel even worse. He certainly could not figure out what was wrong with him. The rather unique circumstances that actually triggered the problem are described later on in this book. Though they were unusual, the essential root problem was the one most persons with panic disorder suffer from.

Robert was an Australian living and working in the U.S. He was employed by a large, multi-national corporation that had recognized his talents since hiring him about five years earlier. He was a young man of about 32 and highly successful at what he did, which was to sell big ticket medical devices to hospitals. Unfortunately, he had begun to experience progressively more debilitating panic attacks in the very settings where he had to be most effective; that is, in hospitals. He had experienced something similar when he was a young teenager and once again few years later, while in the army. But he had had none for over ten years.

For quite a while he had not even thought of the attacks, and believed they were gone forever. They were not. When his situation was brought to our attention, he was just about to give up. He had tried medications, prescribed by a psychiatrist. They only helped slightly. He had spoken with friends (which is somewhat unusual since most persons with the problem keep it secret). That relieved the anxiety somewhat but it did not have any lasting effects. As time went on the attacks became worse and he felt he would have to give up his promising career. He felt, as do most sufferers, as if some mysterious affliction had taken hold of him and as if he would never get out of its grasp.

In a few sessions, based upon the same principals embodied in this book and the StopPanic.com web site, he was able to resume his regular work. When seen two years later on a courtesy visit, he was symptom free. He had long before stopped taking medication, with his doctor's concurrence But this time, he also knew he was not going to have the attacks ever again, because he now fully understood them. The reasons for his problem and those of others mentioned here are explained later in this book.

Joanne was a warm hearted, skilled hairdresser who was also the mother of three children and a leader in her church. She was used to dealing with difficult and demanding clients in her upscale suburban salon. She was never considered a nervous or ‘high strung’ person. One day she asked her boss to leave early because one of her children had an after school soccer game which Joanne wanted to attend.

The boss was generally accommodating and understanding. In this instance, however, she told Joanne that it would be difficult for her to leave early because one of the other women had called in sick that day and the client list was long. Being a highly responsible worker, and feeling she had to pitch in, she stayed and kept on working.

About an hour before close, she told her boss she felt dizzy, had trouble with her vision, and thought she was going to pass out. The boss had her sit down and called a local doctor. Joanne was taken to the doctor's office. On the way Joanne felt she might be having some sort of seizure, a condition she had never experienced. The doctor took her blood pressure, which was found to be somewhat high but he could not, otherwise, find anything physically wrong with her. Joanne had had her first panic attack.

The experience of panic attack is not theoretical to the authors of this book and its companion web site. We have had personal experience with the problem.

My own turn came on the day that I took the oral boards in the defense of my dissertation. This was the final phase of a doctoral program at a major Eastern university The process was grueling, as it was long rumored to be. For over two and one half hours a group of professors grilled me about all manner of technical and arcane things. Some were, and others were not, related to my dissertation research. In fact, some seemed to come out of the blue.

The orals were known to be the 'do or die' determiner of whether one was awarded the Ph.D. or was: a) thrown out of the program or b) required to go through an additional year or more of misery to get it right. As can be well imagined, it was harrowing. To add to my stress, my wife was a several days overdue with our first son, and I had already informed the committee that I might get an emergency call at any moment.

Traditionally, after the questions had been asked and the answers given, the candidate was sent out of the room briefly, while the committee discussed its decision. ‘Briefly’ usually meant about five minutes. The place where this all took place was an imposing paneled conference room in the university library and you were sent out into the hall to cool your heels until the verdict was in.

Pacing up and down I waited impatiently for the door to open and be told the news, good or bad. After five minutes I started to get even more nervous. When fifteen minutes passed, I was beside myself. This surely meant disaster, I thought. Finally after twenty five minutes, the door opened. I was invited in by a smiling senior professor (Dr. David Wechsler, of I.Q. testing fame) who was a member of the committee. I was greeted with "Congratulations Dr. Guller, you did very well. Sorry to have kept you waiting, but we got involved in telling some jokes."

To have been addressed as "Dr." was an amazing relief, but somehow, I didn't feel any elation. I just thanked everybody and quickly took my leave. As I walked to the bus stop and waited in the rather bright, sunny afternoon for my ride back uptown, I was numb. Suddenly out of nowhere, I began to feel as if my chest was being constricted., my heart started racing, I broke out into a cold sweat and felt weak all over. In short, I felt like I was going to die.

My father had died of a heart attack at a rather young age and I remember thinking "Oh no! Just when I get through all of this I am going to die before I have any chance to benefit from it." I missed the next bus that came along, but managed to get onto the one after that. I felt as if I would never be able to get off. I thought of telling someone to call and ambulance but slowly, as time passed on the ride uptown, the tightness in my chest eased. I only later realized I had had my first (and up to now, thankfully, last) panic attack. In succeeding years, that episode taught me a lot and that is part of what we hope to offer you, here.

For the several million people each year who experience something like what hit Ron, Ed, Robert, Joanne or myself, panic can become a plague. The feeling is terrible. It is frightening, and seems to come directly out of the blue with no forewarning. It often mimics a heart attack, even in a person with no history of any cardiac problems. The person may feel paralyzed, and as if trapped in a life threatening situation.

After the first episode, which the person may ascribe to any number of causes including food poisoning, heat stroke, low blood sugar, etc., he or she is invariably on guard against another. When the second episode occurs (often soon after the first) the person feels confused and terribly frightened. As the episodes persist, the victim feels more and more helpless, inadequate and thoroughly bewildered by the situation. Neither the victim, nor most medical specialists, can see any reason for the problem. It just doesn't seem to make any sense.

Then, the person may begin to restrict his or her daily activities, out of fear of recurrence. They may not go to stores, movies or restaurants, won't ride in any public conveyance or will not ride at all. They may retreat to their own home, their own bedroom and, ultimately, to their own bed where they sometimes will remain as prisoners. The restriction of one’s movements outside of the home, generally coupled with avoidance of any crowded place, is called agoraphobia and is discussed in more detail later on. The condition is well recognized and had been described in the literature for over a hundred years. As will be seen, however, the principal cause of panic attacks, which frequently give rise to agoraphobia, has never, to our knowledge, been clearly identified before. Indeed, the concept, or any alternative version of it, does not even exist in the indexes of most books on the subject.

Panic attacks can strike at any age, but seem especially prevalent in early to middle adulthood. Often they have previously occurred in the person's childhood but have not persisted. They may appear more frequently in women but this is not certain. Many men have them but will not seek professional help, hoping, instead, to 'beat the problem' on their own. This almost never works.

Panic attacks and phobias, as well as some related conditions, may occur in the well educated as well as the illiterate. There seems to be a greater likelihood that they will strike those who are socially stable, solidly conformist and the pillars of our society, rather than sociopathic or generally unstable individuals. On the other hand, they do afflict persons prone to alcohol abuse quite frequently.

The experiences of the four persons described above are used here because they illustrate several of the main issues involved in panic disorder. The principles of this book can help a very large percentage of those who suffer from, or have experienced panic disorder in the past, to understand where it is coming from, and dispel some myths about it. For many, it will enable them to rid themselves of the problem for the rest of their lives.

This is not an idle claim. The process described here has been remarkably successful with many individuals from all walks of life and all ages. Success is generally achieved without any medication. In some instances, medication is helpful on a temporary basis, but medication has never cured this condition. It has only reduced symptoms and the accompanying dread of recurrence. But recurrences do take place, even in persons receiving carefully monitored medication. The methods described here are simple and can be used by anyone. They require no more than a desire to get better and a willingness to look at oneself honestly and in a kinder and less self-critical manner.

All persons suffering from panic disorder have a desperate wish to get rid of it. They just don't know what to do. They may have become convinced that for them, there is no rational answer. This is almost never the case. Panic attacks are caused by an understandable sequence of events. One needs to, and can, find out what causes them. That is the principal objective of this book and web site. They will help in a non-technical and easy to apply way.

In nearly forty years of working with persons suffering from panic disorders, we have distilled certain simple truths about overcoming them. It has become clear that simply helping individuals who find their way to therapist’s offices is not enough. The problem affects so many and there is so much confusion as to how to deal with it, that we felt we had to make this knowledge available to more people. The medium of the Internet is so well suited to that task, that StopPanic.com was born. This book is a summary and extension of it. Through both, we hope to help far more than can be reached by individual treatment.

We recognize that not every person with this disorder will be helped completely by this system. But, it can give even those with very resistant problems a concrete starting point. It is also recommended that if, as expected, this system works for you, and you are now in treatment with a mental health professional, that you do not simply leave treatment. But, openly and freely discuss what you have learned here with that person.

CHAPTER 1 AN INTRODUCTION TO THE PROBLEM AND ITS SOLUTION

CHAPTER 1
AN INTRODUCTION TO THE PROBLEM AND ITS SOLUTION