Preventing panic attacks

The last time I flew was over 20 years ago. I was sitting in a window seat, with the curve of the plane's body right over my head. The back of the seat in front of me was right in my face.

Add in so many people jammed right in there, and it started to feel like I couldn’t catch my breath. Before long I was breathing in short bursts, and my anxiety went through the roof. It felt like I was spinning in my seat.

Thankfully, I switched to an aisle seat, and that helped a little. What I experienced was a classic panic attack. I’d never had one before, and because of that truly horrible experience, I haven’t flown since.

Recently, I attended a program at the airport for folks afraid of flying. They said that, before COVID, they would fly you down to Washington, D. C. and back just to prove how safe flying is (statistically, it’s by far the safest way to travel).

These days, they just advise you to take Xanax or other tranquilizer-type drugs to “take the edge off” before air travel. But I don’t like drugs. Never have.

So lately I’ve been researching panic attacks for two main reasons: one, I’d like to be able to fly again someday and, two, as a volunteer firefighter, I can’t afford to panic for any reason.

So what is panic, anyway? It’s a little more complicated than screaming when you open the property-tax bill.

Having a sense of not being in control can cause a panic attack. Clearly, when you board an aircraft, unless you’re the pilot, you are ceding control.

But it even happens when driving. When I had my Nervous Nellie father as a passenger, his right foot would automatically hit his imaginary brake pedal when he thought I should be stopping. He’d also put a death grip on that little handle above the door and not let go.

I’d hear “Ease, ease” — his broken English way of saying, “Easy, easy” — any time he felt I was going more than 5 miles per hour under the speed limit. He was basically having a mini panic attack any time I drove.

But it’s more than a perceived lack of control that can cause a panic response. Turns out that sight provides 70 percent of our sensory input.

Sight is so important that right behind the eyes in the brain is the amygdala, the structure in the brain responsible for managing fear, anxiety, and aggression. When you see something that is potentially dangerous, the amygdala secretes adrenaline, which creates the “fight or flight” response, and cortisol, the “stress hormone.”

This is a vast simplification of a very complex process, but in essence, this is what happens when you sense some kind of panic-inducing situation such as: fear of enclosed spaces (claustrophobia), fear of flying, fear of drowning, etc.

Note: These fears can be real, or they can be imagined. The amygdala doesn’t care; those hormones go out and then the whole panic response sets in. Not fun.

Fortunately, the brain has a way to counteract stress and fear. Endorphins are hormones that can mitigate feelings of pain and generate feelings of well being, thus countering cortisol to some extent.

Produced in the pituitary gland of the brain, endorphins are known to relieve stress. Runners get “runners high” during a really good run from this response.

Isn’t it amazing all the ways our brains work? That’s why I’ve never been a fan of drugs. Reality, in all its day-to-day sameness, is more than enough for me.

So the trick is to find a way to suppress the fight-or-flight response, as initiated with cortisol production, with a feeling of the well-being response, as happens with the release of endorphins. Turns out there are four ways to do this: Combat Breathing, Transference, Positive Self Talk, and Meditation.

Let’s look at them one by one:

— Combat Breathing, also known as Tactical Breathing or Box Breathing

This is a proven technique to reduce stress levels during panic or high-risk situations. What you do is inhale slowly through your nose for a count of four. Then hold your breath for a count of four. Then exhale out of your mouth for a count of four. Then pause for a count of four after exhaling.

This procedure can be repeated three to five times or as needed until you calm down. This technique is used by all kinds of folks with high-stress occupations, even the United States Navy SEALs [sea, air, land]. The more you try it, the better you get at it.

Note: just because it’s simple doesn’t mean it’s not effective. Quite the opposite; it works so well because it is simple and effective;

— Transference

The theory is you associate a favorite or beloved person with a stress-producing situation. Let’s say you’re afraid of getting on an elevator (yes, that is really a thing). As you approach the elevator, you imagine your wife or your grandma is there to comfort you.

When the door opens, you imagine hearing the sound of her voice. Then, as you get in, you imagine her giving you a big hug. Remember, in your mind, it doesn’t matter if the fear is real or imagined, the stress is still there, so the comforting effect can work wonders.

When I read about transference, my first thought was to use my beautiful wife as my object of comfort and reassurance. But she already does so much for me I decided not to saddle her with anything else. Instead, I chose my motorcycle (you don’t have to use a person for this exercise).

So, when I decide to fly again, it might go something like this. As I enter the airport, I imagine rolling my bike out of the garage. Then, as I board the plane, I imagine starting the engine and deciding where to go.

Finally, as the plane accelerates for takeoff, I imagine twisting the throttle on my way to my next adventure. You might not believe this can work, but I’m ready to try it. For me, anything involving motorcycles makes me feel good. I’ll bet you a brewski that it will work just fine;

— Positive Self Talk

I’ve been a big believer in this for a long time. It’s a way to motivate yourself by repeating motivational or inspirational phrases.

For example, I’ve interviewed several long-time firefighters about how they can motivate themselves to literally put their life on the line by running into some really inhospitable situations. They all told me that, once you’ve been trained, it’s just a matter of getting in there and doing it.

No ambiguity. No drama. Remain calm, revert to your training, and just go for it. For example, before entering a burning building, you might say to yourself, “I’ve trained for this, I know how to handle this, and now I’m just going to do it.”

Again, you might think this kind of thing is too simple to work. Clearly, entering a hotter-than-hell raging inferno that may collapse at any moment and is filled with thick, choking smoke is a nightmare scenario if ever there was one. But psyching yourself up with positive self talk is the first step in getting the job done. “Just Do It,” the famous Nike advertising catchphrase, has been so effective because it’s true; and

— Meditation

Meditation has been around in many forms forever. Basically you just sit in a comfortable position and try to clear your mind as a way to relax, focus, and remain calm. It’s often done seated on a pillow with legs crossed.

Sometimes a “mantra” — a simple word or phrase like “ommm” that you repeat — is a part of it. In some cultures, it’s used like prayer. In other cultures, it could be combined with recreational drug usage. But the benefits — focused, clear thinking, and a relaxed state of mind — are no doubt helpful for reducing or eliminating stress and panic.

I actually went to see a mental-health practitioner about panic attacks, and he immediately directed me to guided meditation podcasts, where a skilled practitioner leads you through a calming and relaxing meditation exercise.

Those are good, but every time I’ve tried to meditate on my own — and I’ve tried it many times over the years — I’ve found it’s very difficult to empty my mind of thoughts. I always start out by picturing something blue, like a blue sky or ocean, while repeating some kind of word or phrase, trying very hard to focus on breathing and relaxation and nothing else.

But then I start to remember that my bike needs an oil change, I need to set the DVR to record the game, what am I going to cook for dinner, etc. So to get good at meditation — surprise — you need to practice it, like anything else.

A guy says to his buddy, “Hey, my son just started a meditation program.

“Good,” his buddy says, “at least he’s not sitting around all day doing nothing.” Rim shot, haha.

Real-world example

Let’s put this all together with a real-world example. Magnetic Resonance Imaging scans are often prescribed by doctors. This involves laying down on a conveyor and getting shoved into a narrow tube.

These scans are so difficult for many people to complete, myself included, because it feels like you are being buried alive. In fact, they make open MRI machines now. They provide a little less scanning resolution or definition, but are much easier to complete.

But suppose you need to have a traditional MRI. How would you do it?

First, you’d meditate the night before and the morning of the scan. Then, as you lay down on the conveyor, you’d start your Combat Breathing.

After that, you repeat to yourself, “I’ve got this. It’s nothing. People do this every day. It’s no big deal.”

Then you’d imagine you’re at the beach (the brain doesn’t know that you’re not), on a clear, sunny day, about to lay down for a nice nap on the smooth, warm sand. Before you know it, the scan is over.

The majority of the research I did for this column comes from the 2019 book “Panic Free” by Tom Bunn. If you or someone you know is struggling with controlling any form of panic, this book is a must-read.

We don’t do well in general with problems that are “between the ears.” Broken legs, we understand. Cancer diagnosis, we offer support. Mental health, not so much, due to the negative stigma attached.

But I know firsthand how bad my one and only panic attack was. I wouldn’t wish that on anybody. Hopefully, these techniques will help panic sufferers. Good luck.