News

I have been anxious my entire life. In kindergarten, my fingerpainting skills were poor; my lines were wiggly because my hands were so trembly.

In Grade 5, I was repeatedly convulsed by nervous stomach aches. A barium enema turned up nothing except for a resolution to keep any future nervous stomach aches to myself, thanks awfully, and a life-long aversion to St-Hubert chicken, which we stopped for as a treat on the way home from the hospital.

Then, in my last year of high school, panic kicked in, leaving me pale, shaky and breathless in the mornings before exams. (My super-cool doctor at the time, when told of my symptoms, calmly asked if I had been doing coke.)

In my late 20s, panic attacks crashed over me like violent waves, leaving me too scared to leave my apartment, so I simply didn't for several months. I quit my restaurant job and sat in my tiny apartment, watching TV and hating myself.

Eventually, I found a psychiatrist and dragged myself, twitching, cramping and panting, up to his office twice a week. I don't know whether it was the simple act of leaving my house, the dreary therapy (punctuated by his habit of nodding off several times a session) or the fact that twentysomethings are just wonderfully resilient creatures, but eventually I got better.

Still, twinges and whiffs of the period plagued me for years. A flash of dizziness or nausea would immediately make me think, "Oh God, is this it? Is it happening again?"

I wasn't afraid of being a shut-in again because, if you can swing it, being one is actually quite lovely. It's the getting out that's the tricky part.

And then, last year, it happened again. The panic came back, leaving me a shut-in for three long months.

Panic is to anxiety what vomiting is to nausea - while anxiety can be a persistent and ongoing sensation, a panic attack is a violent, shorter-lived explosion. The symptoms include terror, a racing heart, dizziness, chest pains, nausea and an overwhelming sense of a loss of control.

Many people will experience a panic attack in their lifetime. Most studies have found that between 1 and 2 per cent of people suffer from panic disorder. The Public Health Agency of Canada says 0.7 per cent of Canadians aged 15 to 64 suffer from panic.

While many people who have panic attacks are able to dust themselves off afterward, others live in perpetual fear it will happen again.

Picture a Fort Knox-grade alarm system manned by a pack of shivering, meth-addicted Chihuahuas. The slightest whisper of danger, and those alarms are going to blare. Maybe you turned your head too quickly and felt a little dizzy, or had a little heartburn after eating a spicy lunch - that symptom that you associate with panic sends a message to your brain that, oh shit, it's happening again. Alarm wire tripped. Panic induced.

It's not uncommon for sufferers of panic disorder to also start experiencing agoraphobia, an intense fear of public places brought on by worrying about being unable to escape to safety during a panic attack.

"You start to avoid situations, foods, whatever you think might have triggered the panic attack," says Eilenna Denisoff, a psychologist at the Centre for Addiction and Mental Health in Toronto.

"People don't recognize that it's their own physical symptoms that trigger the anxiety," Dr. Denisoff says.

Instead, we start finger pointing and scapegoating - and instantly the place you were when it hit is to blame, slashed with a big, bright red X. Had a panic attack in Loblaws? Guess you can't go there again. In an elevator? Better learn to take the stairs. Pretty soon your old, normal life is a dizzying display of red X's. Your world gets smaller and smaller and smaller, and so do you.

I was at work last fall, feeling overwhelmingly dizzy, woozy and unable to draw a deep breath, which rather convinced me that I just might be dying. I had been feeling off for two weeks, since being hit by a 12-hour, inner-ear abnormality.

I knew I was hyperventilating, so I tried breathing into a tiny Tim Hortons bag proffered by a worried co-worker, inhaling cookie crumbs and feeling worse than before. I stayed at my desk, afraid that if I moved I would faint, vomit, die.

A friend carefully drove me home, where we were met by my worried husband and our rapturous dog, who twirled madly through our legs, ecstatic that we were both home. For her, it was an excellent day.

I resolved to go back to the office the next day, but the morning brought more of the same dizziness, seeing as now the office was slashed with an ugly red X. Thanks to an incredibly supportive boss, I was able to work from home.

At home, I felt safe. Not safe from panic attacks, unfortunately - those kept coming non-stop. I had them in the morning while drinking my tea. I had bolt-upright ones in the middle of the night. One day I had one in the shower, so I started keeping my showers as short as possible: I stopped shaving my legs and switched to a 2-in-1 shampoo and conditioner. At least at home I was safe from the threat of the embarrassment of experiencing a panic attack in public.

By the time Ben got home from work, the house would be sparkling, the dinner was roasting, the dog was exhausted (it's really not so bad to be married to an agoraphobe, in some ways). Ben would walk me around the block after dinner, like a little old dog, and I'd be protesting and crying and trembling the entire time. I felt both tiny and lumbering at the same time. Turning the corner onto our street would fill me with pride that I had done it, enormous gratitude that it was over, and immense disgust that it was even an issue in the first place.

I watched the leaves turn and then I watched them fall.

The great escape

What did agoraphobes do before the Internet? I researched cognitive behavioural therapy (CBT), considered by researchers to be the hands-down best way to treat panic disorder. CBT works on a few different levels: by encouraging safe exposure exercises, using introception exercises (which recreate the physical symptoms of a panic attack in an attempt to make them less scary) and by teaching you to deal with your thoughts and behaviour during a panic attack. I found a private clinic and called, hoping for home visits, or maybe a few nice sessions over the phone.

When the woman on the other end suggested I come in for an assessment, I burst out laughing. "If I could come in for an assessment, I wouldn't need to come in for an assessment," I explained. She then assured me that having a panic attack in front of the therapist would simply create a "rich working environment." I laughed again.

In the days leading up to the appointment, I was tempted to cancel dozens of times. I pictured Ben trying to put me into a cab, a feral cat being forced into a carrier, limbs outstretched and unyielding. I pictured failing.

But, by breaking the seemingly enormous journey into tiny steps, I managed: Put on my coat. Walk to the corner. Get into a cab...

In my first session, we talked about my fears. What was I most afraid would happen during an attack? That I would faint in a crowd? Vomit?

Imagine that the worst did happen, the therapist suggested. So I did, panicking at the mere thought, creating a nice, rich working environment. "Then what?" she asked. "What would you do?"

I would survive, I realized. I would be momentarily uncomfortable, yes, but it would pass. People would help me. The more I pictured the worst happening, the smaller it became.

The simplicity of CBT is almost embarrassing: Afraid of flying? Then fly lots. Afraid to leave your house? Then leave your house. Lots.

When I went back to the clinic a few days later, I rode my bike. The next week, I felt well enough to ride the streetcar there, and walk the whole way home. Still, there were bad days when even the idea of leaving the house left me hysterical, which frustrated me incredibly, making the preceding good day feel like a farce.

For some reason (based on nothing in my life experience), I believed that progress looked like a 45-degree upward slope, like the yodelling game on The Price is Right. But I did get better, if not in a 45-degree slope, then in a series of hills and valleys, in a growing ratio of good days to bad.

Soon I was shopping at Loblaws, and riding the subway and walking outside without even thinking about it. And then, one day, three months after I had left, I was sitting gingerly back at my desk.

I still get dizzy. I still feel panicked. But I breathe and, politely, I thank myself for the concern. Instead of calling myself a useless idiot, I talk to myself as I would to a friend: It's okay, I whisper, you're going to be fine. The calmer and kinder I am to myself, the quicker the attack subsides.

Recently, I started running in an attempt to get into better shape and to keep the winter blues at bay. Sometimes my pounding heart, my cold sweats and my fast breathing terrify me, achingly reminiscent of panic. But three times a week I tie up my new blue shoes, marvelling that one year ago I was forcing my quivering, nauseated, petrified self to take shaky little walks around the block. And every time I find myself running away from my house, not toward it, it feels strange and wonderful and strong.

Getting help

Cognitive behavioural

therapy

Research shows that an average of 73 per cent of patients treated with cognitive behavioural therapy (CBT) were panic-free at three to four months. Finding a program that's covered by provincial health care may be tricky, though. Most have long waiting lists. For those who can't wait and who can afford it, there are private CBT clinics across Canada. The rates generally range from $100 to $200 an hour, and treatment usually requires about 10 to 14 sessions.

Online treatment

Paniccentre.net offers a free, online treatment course (complete with progress tracking forms and support forums). The 12-session, Canadian CBT course is monitored by professionals and recommended by Eilenna Denisoff, a psychologist at Toronto's Centre for Addiction and Mental Health.

Medication

Others opt for medication. "SSRIs [that] are generally used with depression can be helpful with anxiety," says Dr. Denisoff. What's not helpful, she says, is to take short-term solutions such as Ativan, a benzodiazepine with sedative, amnesic and anticonvulsive effects. "You don't want to take a pill every time you feel the panic symptom - that will lead to taking more and more." Learning to deal with the attacks and understanding them better may be more daunting in the moment, but much more beneficial in the long run.

Support services

The Centre for Addiction and Mental Health's mood and anxiety program: http://www.camh.net. The centre has community offices throughout Ontario (though clinical services are not offered at these offices). To find the closest CAMH office, call 1-800-463-6273 or visit www.camhprovincial

services.ca

Anxiety Disorders Association of Canada: http://www.anxietycanada.ca or 1-888-223-2252

The Panic Centre: http://www.paniccentre.net

Canadian Mental Health Association: http://www.cmha.ca, by phone at 613-745-7750 or e-mail the association at mdabc@telus.net

Kate Rae