MY INITIATION INTO the world of panic attacks began the morning of my college graduation in 1995. The first episode came at me out of the blue, punching me in the gut and leaving me shaking, clammy and out of breath.
I went to see a doctor, who shrugged and gave me a clean bill of health. But in the years that followed, similar bouts of panic would continue to blindside me—in a low-ceilinged club; on a stalled Metro train; on vacations where I was supposed to be having fun.
My world started closing in on me. I avoided travel and feared new places. I worried about when the next panic attack might strike without warning. I lost joy and found dread lurking around every corner. I had always been adventurous, unafraid and outgoing, but suddenly I had turned into someone I didn’t recognize.
Eventually, in 2001, I found my way to a therapist (and fellow panic-attack sufferer) named Jerilyn Ross, founder of the Ross Center for Anxiety and Related Disorders in Washington, D.C. Ross, who passed away from cancer in 2010, was the first person to identify what I’d been experiencing as panic attacks.
And in one single intake session, she homed in on the traumatic event that had triggered them: The week before my college graduation, a stranger had broken into my apartment in the middle of the night and sexually assaulted my housemate as I slept in the next room. I had never considered myself a victim (after all, the intruder had attacked my roommate, not me), so I never recognized how much the event had upended my world. But the truth was I was still grappling with all of the implications of what had happened—the inability to protect my friend; the survivor’s guilt; the what-ifs; the sense that we’re never really safe, even when we’re tucked into our own beds behind locked doors.
Because my first panic attack happened after the emotional chaos of the break-in had subsided, it had never occurred to me that the two might be connected. But panic attacks are unpredictable in that way, making them difficult to diagnose. The symptoms (which include accelerated heart rate, chest pain, shortness of breath, and nausea, according to the DSM) often mimic those of a heart attack—which may be why 44 percent of people experiencing their first panic attack end up in the emergency room, according to Ballenger.
How can something psychosomatic feel so real? Ballenger explains that panic attacks are a misfiring of the brain circuitry that connects the amygdala (the part of the brain that manages anxiety) to the hippocampus (which is responsible for memory) and the frontal lobe (where we evaluate everything).
“Twenty thousand years of evolution have allowed us to develop this protective system that keeps us safe from predators or dangerous situations,” he explains. But panic attacks hijack this system, creating a false sense of fear.
The good news? “Panic attacks are uncomfortable, but they’re basically harmless,” says Greta Hirsch, clinical director of the Ross Center (she also happens to be the therapist Ross matched me with when I first visited the center).
Furthermore, they’re treatable. Hirsch often uses a type of talk therapy called cognitive behavioral therapy (CBT) to help patients restructure the way they think about and respond to negative thoughts and behaviors.
“The cardinal rule of managing panic attacks is to stay present and stop your thoughts from racing ahead,” she says. “To recognize that in the moment, you are safe. So that when, for example, your heart beats fast, you know that you’re not having a heart attack or that when you start having a hard time breathing, it’s not that you’re really going to run out of oxygen and pass out. You will be okay.
“The goal is not to never have a panic attack again, because then the thought of having a panic attack becomes panic-inducing in itself,” she stipulates. “The goal is to give the patient the tools to handle it once it arises.”
Hirsch also employs exposure therapy, a practice in which a patient physically confronts a fear-inducing experience in manageable increments, essentially re-creating the trigger. “You will find me [taking patients to] all kinds of strange places,” she says, “depending on what your phobia is.”
Afraid of getting trapped in an elevator? Hirsch might break down that fear by first taking you for a ride in a big, clean elevator, then gradually moving you to less comfortable ones, “until we get to the darkest, dingiest, most rattle-y, slow-moving elevator that goes deep underground,” she says.
Experts say behavior modifications can also help ease anxiety flare-ups. Alcohol, smoking and caffeine can exacerbate nervousness, for example, while exercise can help alleviate it.
Though multiple studies suggest that CBT has the longest-lasting benefits of all clinical treatments for anxiety, medication—including antidepressants such as Paxil and Zoloft, and benzodiazepines like Xanax and Ativan—is sometimes prescribed in the interim to get anxiety sufferers to the point where talk therapy can help.
“Medicine can [dial] down an anxiety circuit that’s on hair-trigger so that you get to the level where you can function normally,” Ballenger explains.