This site caters specifically to bipolar audiences and so the discussion of anxiety disorders and panic attacks will take a purely slanted stance towards bipolar interests concerning these subjects.  While this section will touch briefly on descriptions and some discussion of anxiety disorders, the information provided will not be an extensive study of disorders but primarily focusing on bipolar disorder itself.

As bipolar sufferers, many people find themselves not only struggling with the exhaustive battle of maintaining mental/emotional stability, but they also sadly discover their fragile psychological existence is further compromised by the crippling grip of anxiety.  Tragically, anxiety disorders and bipolar disorder can marry together to create a truly painful and difficult predicament for a bipolar sufferer.  To tell the honest truth, I am not sure whether bipolar disorder in itself is the sole contributor to a sufferer’s heightened sensitization to anxiety, or if the disorder is actually divorced from the symptoms and instead partnered with an anxiety disorder that is actually the root cause of these disturbing sensations. There is a similar biological dysfunction of the brain that has been singled out for one of the possible causes of anxiety disorders, not unlike the one known to be responsible for bipolar disorder, an imbalance in the afflicted sufferer’s brain chemistry.  The two forms of disorders are treated with SSRI (Anti-depressant) medications that seem to target similar chemicals in the brain.  So, it is logical that one could quite possibly coexist with the other, or, that bipolar disorder has similar symptoms in common with anxiety disorders that can present in a sufferer, but the two do not exist partnered with one another.  I am at present unsure as to what form of relationship bipolar disorder has to anxiety disorders. 

Whatever the case may be, the end result is stultifying and overwhelming sensations of fear and anxiety that cause the sufferer intense discomfort resulting in his/her dependence on an ever increasing need for avoidance/coping measures that further alienate him/her from the world around him/her.  This further complicates his/her personal growth and mental health progress in relation to his/her therapy.  It can cripple the sufferer psychologically to the point that he/she is unable to think or reason through life situations with any sound logic or understanding as to what is happening to him/her.  A person can literally become trapped in its iron grip rendering him/her unable to discover how to set him/herself free.  The anxiety can grow ever more daunting the more unstable a sufferer may become. 

 In my personal experience, most of the bipolar sufferers I have had personal contact with in hospital and outside of psychiatric institutions have commiserated with me on the subject of chronic anxiety problems.  These sufferers have come to the resignation that anxiety is as much a part of their disorder as depression or mania.  It seems to plague a bipolar sufferer during both phases of the disorder, both mania and depression, without prejudice.  These fellow bipolar sufferers have all described an assortment of anxiety conditions, some could be straight out of a text book definition of a specific anxiety disorders, yet some are a combination, and some are just that sufferer’s special cocktail of psychological goodies all mixed into one.  I myself could lay claim to experiencing symptoms of several anxiety disorders during periods of my illness, such as; Panic Disorder, Social Anxiety Disorder, Obsessive Compulsive Disorder, and Generalized Anxiety Disorder.  Now, whether I truly have these conditions or am just bipolar I do not know.  I do know that after reading about these disorders for this section I discovered they described my symptoms and dilemmas quite accurately when I do experience chronic anxiety.  At present I have found that most of my more apparent symptoms of anxiety seem to have been suppressed by the medications I am taking for my bipolar disorder (One or two of these medications are prescribed to treat anxiety disorders as well).  I do, however, still suffer a deep seated anxiety in my soul that aches with a constant angst, never ceasing, always reminding me of its presence.

Let me explain some of the anxiety disorders for you:

·        Excessive and prolonged anxiety for six months or more

·        Worries over events that may or may not occur, as well as undue concerns over issues that are not posing a threat at present or in the future.

·        Inability to relax or find relief from tension

·        Insomnia

·        Severe muscle tension

·        Trembling, twitching

·        Headaches, migraines

·        Irritability, startle easily, nervous or fragile

·        Sweating, hot flashes

·        Difficulty concentrating or keeping a job

·        Friendships and relationships are a struggle

·        May abuse drugs or alcohol to deal with disorder

·        Some sufferers may experience panic attacks

When faced with social interaction do you experience?

• Blushing
• Sweating
• Hot Flashes
• Racing Heartbeats
• Panic Attacks
• Stammering
• Nausea or Stomach Upset
• Dry Mouth
• Trembling, Shaking, Twitching
• Difficulty With Speech

Other Symptoms:

·        Find it extremely difficult to understand or accept criticism in a constructive manner

·        Avoid any and all situations that may cause interaction with people, even friends and family members at times

·        Experience enormous anxiety when faced with approaching social or performance events, the anxiety does not dissipate during or even after the situation has ended.

·        Feel an overwhelming fear that you will be judged or seen as stupid or foolish by people you come into contact with. 

·        Suffer from a low self esteem and feel inadequate about your abilities in the world.

There is actually two parts to this disorder, obsessive thought patterns and the compulsive behavior resulting from them.  A person suffering from this disorder is tormented by excessive anxiety about spontaneous thoughts which causes them a great deal of distress, to the point that they become an obsession.  It will start with a spontaneous disturbing idea or urge and grow into a desperate need to act on that impulsive thought to make the anxiety go away.  This is when they exhibit compulsive behaviors such as repetitively checking if the door is locked or continuously washing hands to clean off perceived contamination of germs.  Many of the people who suffer from this disorder have rituals or routines which they have enforced as a strict discipline on themselves in their daily lives to ensure that everything is done exactly right so as not to throw them off and cause them great discomfort.  They are compelled to check and recheck things continually throughout their daily routines.  These people are aware that their behavior is not normal and most likely unhealthy, but they are compelled to continue to practice these rituals to relieve their intense anxiety. 

• Experience spontaneous thoughts or urges to do things or believe things that compel you to act out compulsive behavior, these are disturbing and unwanted impulses that seem to pop into your head unsolicited.
• Do you find yourself compelled to have things done just right, placed in the exact order or done in the proper sequence, or else you feel great anxiety?
• Are you deeply concerned about contamination of germs to the point of obsession, do you clean your hands or body to the point of injury?  Do you find you will not touch other peoples’ hands for fear of germs without scrubbing with antibacterial wipes after till your skin is raw, or use public washrooms only if necessary and then go to extremes to disinfect yourself afterwards because of a plaguing anxiety that you have been infected with some sort of disease?
• Do you often check and recheck work you have done or other things in your daily routine like whether you locked your door or if you shut the coffee maker off? (I am often haunted during the day to check if I turned the coffee maker off because I believe my house will burn down, I will sometimes check it five times in the morning alone.  That means driving all the way home each time)
• Do these behaviors interfere with daily activities and relationships?
• Are you deeply bothered by the obsessive compulsive behavior you are controlled by?

This crippling disorder is extremely vicious in its debilitating affect on the sufferer.  The sufferer has to endure the terrifying intensity of reoccurring panic attacks that can cause them to fear any situation that may trigger another attack, which in the end can cause them to shut themselves off from the world completely.  Panic Disorder is described as a condition when a sufferer experiences intense and repeated panic attacks that are unexpected and spontaneous.  The sufferer then begins to develop a persistent and foreboding fear of experiencing future attacks. The panic attack is described as an episode of extreme fear and dread that overwhelms the sufferer to the point that they may feel they are experiencing a heart attack, going insane or are dying. The episodes usually peak within 10 minutes and the sufferer may still feel intense anxiety after the panic dissipates.  They do, however, have a distinct beginning and end. The sufferer lives in constant fear of triggering another panic attack.  He/She may even go to the extreme of becoming housebound and unable to deal with the outside world.  This is a condition called Agoraphobia.  Agoraphobia is a very serious deterioration in a person’s mental health.  A person suffering from Agoraphobia begins to avoid situations and places where they fear panic attacks may strike, where escape may not be handily accessible or help may not be within close proximity.  In the end they are unable to venture no farther than their doorstep for fear of another attack. 

Have you ever experienced an episode where you have felt intense and overwhelming symptoms, such as: (singularly or in combination)

• Paralyzing terror
• A constriction of your chest, like it is being squeezed or pressure is being exerted on it
• A racing of your heart beat, or a missed heartbeat, or a irregular heartbeat
• You cannot breath deep enough, hyperventilate
• Hot or Cold Flashes
• Excessive sweating
• Light headedness or dizziness
• You feel like your throat is closing up
• Tingling or numbness
• Shaking or trembling
• Feeling an out of body experience or like you are somehow detached from the events that are happening around you
• Fear of dying or going crazy or of doing something out of control
• Nausea or stomach upset

These episodes may build up during a time of 10 minutes, peak, and then subside somewhat.

• Do you experience these panic attacks frequently, once in a month or more?
• Do these panic attacks affect you daily routines, work performance and relationships?
• Have you developed an extensive system of avoidance techniques to alleviate your potential for panic attacks and in the process shut out many opportunities and experiences from your life?
• Do you feel you are missing out on life because of your anxiety disorder?
• Are you afraid to leave the safety of your home for fear of triggering an attack?
• Have you ever been hospitalized because of symptoms of a Panic Attack?

“Like a speeding train it comes at you, hits you full force, and then before you know it it leaves you in the dust with train tracks all over you.”  Lisa, 21

“I feel like I am losing my mind, I sweat, my heart races, it’s terrifying”  Jamie, 35

“I can’t seem to breath and I start to panic that I am going to pass out, the whole world starts to spin around like crazy.  I get dizzy and weak, I can’t talk or anything and usually I start to cry.” Dorothy, 28

“You start to feel a tightening in the back of your throat and in your chest.  Your breathing becomes shortened causing you to begin to hyper-ventilate.  You feel as if all the oxygen in the room has suddenly been sucked out and you can’t seem to get enough air into your lungs to breath. Your thought processes begin to shut down like doors slamming shut in the hallways of your mind, one after the other.  At that point, your mind is  a garbled mess preventing you from accurately describing what is going on inside of you.  A sense of dizzying vertigo usually grips you, and if you don’t pass out at this point you certainly must sit down.  You believe your heart has been beating at an accelerated rate this whole time, and you think it might burst.  Overwhelming anxiety has been flooding through your body rattling every bone it passes.  Then you start to shake.  It is very difficult to speak coherently and to be able to decipher what people around you are trying to say.  It is similar to being shouted at by people speaking in foreign languages.  Your senses are on overload and your emotions  seem to trumpet through your mind.  It feels like you have been in anguish for an eternity, but really it may have only been a matter of moments. Usually when you recover from a panic attack your whole body and mind feels spent, almost withered by the ordeal.”  Tatty, 33

These are a few impressions of how panic attack experiences feel for different sufferers.  These quotes come directly from bipolar sufferers that I have known to be afflicted with panic attacks. Each sufferer will experience a panic attack in their own personal way.  There are some sufferers who may only have certain sensations, like irregular heartbeats, racing heartbeats or “skipped heartbeats”- extrasystoles (these sensations often will wake the person from their sleep).  These sensations can be very frightening to an overly sensitized personality causing them to fear for their life, thinking they are about to die due heart failure or that they have a dire heart condition.  Some experience Vertigo or extreme dizziness to the extent that they feel they will lose consciousness, or gut wrenching nausea every time some trigger in their brain is set off causing a serge of adrenaline to trip off alarm bells clanging through their nervous system.  A panic attack is an event in a person’s day that is both deeply disturbing and emotionally jarring.  It shakes the very essence of one’s foundation of his/her own personal well being and sense of inner strength.  It makes one truly question whether he/she is broken, whether he/she is capable to withstand such forceful blows to his/her soul. 

The one fact about panic attacks is that they are typically spontaneous and for the most part occur unexpectedly to the sufferer.  Although, the sufferer may have established situations and factors that he/she can effectively link to the of the probability of having panic attacks when in association with them, for the most part they are not an event the individual can summon on command.  I guess a person could make him/herself so frantic and hysterical about a concern or issue that he/she could eventually induce the onslaught of a panic attack.  A panic attack, is however, mostly described by medical sources as an involuntary and unbidden episode of fear and dread.  They can surface at any time and any place, this leaves the sufferer rather vulnerable to the nagging dread that one will rear its ugly head at any moment in his/her daily activities.  This factor, added to the sensations directly related to an episode of a panic attack, can make a sufferer feel trapped in a suffocating cage of anxiety that seems to have no means with which to escape.  A person with such an extreme sensitization to anxiety feels continually bombarded by their nervous system.  A sufferer may finally build enough strength up to face his/her fears and bravely venture out into the big wide world, only to have it blown to smithereens once again by a hidden psychological mine buried deep in their subconscious.  It is not as if a sufferer does not try to break free of his/her anxiety, it is a constant battle, one that is won day by day.    

These symptoms are sensations one may experience during a panic attack.  A person may suffer multiple symptoms or only a combination of just a few. 

Hyperventilation

Racing Heart Beat           

Choking Sensation

 Missed/Irregular Heartbeat           

Constricting of Chest/Chest Pain

Sweating         

Giddiness/Dizziness          

Hot/Cold Flashes

Shaking/Trembling      

Feeling Out Of Control/Going Crazy

Fear Of Dying      

Feels Like Having A Heart attack

Looking Through A Mist         

Feeling Detached/Unreal/Out Of Body

 Tingling/Prickly Feeling In Limbs        

Nausea/Vomiting/Diarrhea

Night Sweats    

Overwhelming Foreboding/Terror/Panic

Need To Flee      

Frozen To The Spot/Paralyzed          

The attack occurs spontaneously and unexpectedly, “out of the blue”, without any possible means for the person to alleviate the symptoms.  The dread/foreboding/panic/fear that the person suffers is completely out of proportion to the environment or situation at hand.  The attack usually passes in a few moments, from start to finish it usually peaks in 10 minutes.  The body typically cannot sustain the “fight or flight” response for an extended period of time.  The sufferer may, however, be susceptible to reoccurring attacks continuing for an undetermined period of time.  

There are several different possible causes for a person to develop an anxiety disorder/state (I say “state” in order to refer to the condition a bipolar sufferer may present that may produce panic attacks) that can lead to the condition of chronic panic attacks.  Medical researchers have pointed to a definite possibility that there may be a genetic predisposition to anxiety disorders and bipolar disorder.  There have been studies into the genetic family histories of sufferers to determine the hereditary inheritance of these disorders.  Many people who are diagnosed with these disorders report a history of mental illness or anxiety disorders in their immediate or extended family group.  It has been displayed through studies of mental health histories of various family genealogies that descendents/relations of those diagnosed with anxiety disorders/bipolar disorder have a greater risk of suffering a mental illness in their lifetime.

I, myself, have researched my own mental illness history of my family on both sides, my mother’s and father’s, and discovered predispositions from both genetic sources.  On my father’s side there are three known cases of bipolar disorder that are currently formally diagnosed and being treated at this time.  There have been reported cases of depression    in earlier generations of my father’s family, but this was during a time when mental illness was a disease that was not treated as such, rather as a source of shame and stigma.  So, the exact mental illness these earlier generations suffered is shrouded in family folklore and we cannot gain too much insight into what they truly passed on to future generations.  My mother’s side is not a picture of mental stability either.  Let’s just say, genetically I received a double whammy from both sides when it came to inheriting any form of predisposition concerning mental illness.  The same could be said for a person with a family history of anxiety disorders in their family mental health history.

Now, whether or not a person actually becomes bipolar, or a victim of an anxiety disorder, is up to a multiple of possible biological, psychological, and environmental factors.  Just because there is a history of mental illness in one’s family does not necessarily curse one to a lifetime of mental instability and emotional turmoil. 

One possible factor is if the person should develop a biological dysfunction in the brain.  When a person develops bipolar disorder he/she suffers from an imbalance in his/her brain chemistry, his/her brain produces adverse levels of serotonin.  It is interesting to note that medical practitioners have discovered that anxiety disorders have a possible similar root cause for their source, a chemical imbalance.  I must, however, refrain from being so glib as to tout that these two disorders are the result of the exact same chemical imbalance.  Researchers believe that panic attacks may stem from a chemical imbalance (neural transmitter imbalance) in the area of the brain responsible for one’s ability to respond to perceived dangers, the area involved with inducing the “fight or flight” response. 

The Amygdala (corpus amygdaloideum) is a small almond shaped structure found in the brain’s medial temporal lobe.  Tt is responsible for the body’s instinctual reaction to danger; it creates the “fight or flight” response.  This little structure has been avidly studied by neuroscientists and it has been discovered to have quite a powerful influence on human behavior, especially when one is considering anxiety disorders.  It works on the brain without the effort of conscious thought causing the body to react in automatic and rapid reactions to its stimuli.  The purpose of the “fight or flight” response generated by the Amygdala evolved as a protective mechanism to deal with danger in a hostile environment.  Humans needed an instantaneous reaction to an imminent physical danger and the “fight or flight” response provided them this much needed bodily reaction. 

You see, what neuroscientists have managed to decipher from their studies of the brain is that human bodies react to danger with two sets of signals that course through two completely different parts of their brains.  One set of signals takes a very circuitous route that travels through the cerebral cortex relaying information throughout.  This is the cognitive part of the brain that expresses conscious thought and formulates scenarios, concepts in your mind like a large grisly bear is licking his chops as he notices you have just finished hiking into his clearing just in time for his lunch.  You visualize the bear, the thought processes begin to click into place that you are too close to a large dangerous animal.  The other set of signals are not as conscious, they are rapid and set off alarm bells throughout your sympathetic nervous system, flooding your body with adrenaline.  This set of signals head straight for your Amygdala and set it in motion.  This little structure gets to work immediately.  It automatically triggers the “fight or flight” response in the body which prepares you for quick action before the conscious part of the brain can put two and two together.  In other words, before you can actually think “bear!”.  The Amygdala gets the heart pumping hard and diverts the blood from the digestive system to the muscles so you can run.  Adrenaline and other stress hormones, glucose as well, flood your system so you feel a boost of energy to fight or run like the wind if you have too.  Your immune system and pain threshold are suppressed to stop swelling and discomfort so you will fight/run as hard as you can.  In order to prevent future like episodes from ever happening again a fear response is burned into the Amygdala. 

Now, the aforementioned scenario was a realistic fear episode.  Meeting a hungry grisly in a desolate forested area with no help in sight can be a truly dangerous and terrifying situation.  What about unrealistic fear scenarios?  How does the Amygdala affect a person suffering from anxiety disorders/panic attacks?  Well, from what I can surmise the Amygdala is a very important factor in fear related disorders.  Even though it is a very small structure in the brain, it plays a very potent role in the realm of fear response.  This could be detrimental to a person who may be suffering from a chemical imbalance of neurotransmitters in the Amygdala.  This imbalance could cause the Amygdala to fire off unrealistic fear responses to unrelated life situations causing panic attacks to strike the victim at a terrifying force.  These episodes of fear will then be permanently recorded onto the Amygdala.  Sadly scientists have discovered that terrifying experiences are indelibly etched into the Amydala and are impossible to erase.  This fear conditioning will cause the sufferer future panic attacks when the Amygdala is triggered by subtle and unconscious danger signs conjured up by the deeply imbedded imprints of past fear episodes (earlier panic attacks).  The sufferer may not even be aware of what those triggers may be at a conscious level, causing them even more anxiety and creating a vicious circle of perpetuating their panic attacks by generating an even deeper fear of them.  And, our little friend the Amygdala does not allow our brains to forget these deep seeded fear episodes and reacts instinctually at any sign of these fears whether they be realistic or unrealistic.  This is what I have come to understand through my research about this positively amazing structure of the brain. It may be diminutive in size, but it packs a powerful punch. 

• Not all anxiety disorders are the direct result of the dominating influence of a dysfunctional Amygdala on the sufferer, some may stem from other possible causes. 

Another possible factor that may lead to a person to develop chronic panic attacks is if such a strenuous life situation should develop to such an emotional pitch as to cause extreme psychological distress.  There are several traumatic situations in a bipolar sufferer’s life that can cause them to develop the condition of chronic panic attacks.  Bipolar sufferers are prone to being a tad paranoid and have a tendency to lean toward conspiracy theories about people around them plotting against them. At times Bipolar sufferers tend to shut themselves off from those around them; loved ones that only want to protect them, believing that their relatives/friends are only out the ruin them.  These conditions are ripe for panic attacks.  They dislike public situations, feeling it is a terrifying and soul rending experience to be open to so many sentient beings in one place.  Other more taxing situations that befall bipolar sufferers/anxiety disorder sufferers that may cause a downward spiral into the tumultuous world of panic attacks are traumatic life events.  A sufferer may be faced with a sudden death of a beloved and much depended on care giver and family member.  This may not only serve as an immense emotional blow, but also as an extremely troubling turn of events for their life situation and care.  They may also have to face the misfortune of having to be dealt the heart wrenching blow of divorce proceedings and have to go through the process of child custody arrangements.  There are other turmoil’s sufferers may face such as having to relocate to another city/job, or endure a long term illness, nervous breakdown, a strenuous and difficult relationship with teenage children, financial turmoil, loss of employment and birth of a child.     

I also think there is one more dynamic that needs to be discussed here that factors into the development of panic attacks and anxiety disorders and that is environmental influences.  I believe if a person is brought up in an environment where his/her inner self worth is continually buffeted by an atmosphere of abuse and/or emotional persecution and mental warfare, then he/she could be a prime candidate for anxiety disorders in the future.  If he/she is not given the emotional skills to deal with excruciating and uncomfortable emotional situations, how can he/she learn to cope with stress?  He/She will most likely possess an extremely low self esteem and feel inadequate in most areas of their life.  It is highly probable that a personality of this type will suffer some sort of anxiety disorder, including panic attacks, to some degree or another.  I have discovered in my experiences with bipolar sufferers that I have met, many have lived quite colorful and sadly unfortunate lives.  There have been quite a few who have related stories of abusive home lives and many years on the streets.  I believe from listening to their stories and getting to know them that they would not be in the dire shape they were in had they not been exposed to the environments they were thrust into.  Quite a few had symptoms of anxiety disorders that were extreme and caused them great difficulties in their daily lives.  I may be wrong in my summation of this opinion, but this is how I have come to feel.  

It is a sensitized person’s out of context and excessive “fight or flight” reaction to known or unknown triggers in their inner self or surrounding environment.  These triggers could be such things as a disturbing sensation he/she might feel, an emotion he/she feels uncomfortable with, or a heartbeat he/she mistakes for a missed or irregular one, some irregular event in his/her daily routine, a situation he/she can not deal with, a memory that comes to mind out of the blue, etc.  It is usually not an actual fear of the particular person, place, situation, or thing itself that the person dreads, but rather the fear that these things will trigger another attack.  The sufferer lives in dread of reoccurring panic attacks and the anxiety from this can in turn help to set off more if the conditions are right. 

• Sensitized Person - is a person whose nerves are conditioned to react to stress in an exaggerated way.

Some Sources Of Triggers:

-          Caffeine

-          Some forms of medications (always check with your doctor before taking any form of medications if you suffer from anxiety disorders)

-          Exercise can cause heartbeats to speed up and may make a sufferer misinterpret it as a panic attack

-          Enclosed places

-          Troubling or traumatic memories

-          Social situations where the sufferer feels out of control

-          Stressful life situations

-          Unusual sensations/emotions

Each sufferer has his/her own personal triggers that stimulate his/her own panic attacks.  The aforementioned examples are only suggestions of triggers that could cause attacks in some sufferers.  It is up to the sufferer him/herself to actively seek therapeutic aid in discovering how to conquer his/her own struggles with panic attacks and the root causes or triggers of them. 

This attack occurs without any warning at any time of the day or night.  The person may be awake or sleeping, relaxing or working.  The attack is not associated with any particular thing, place, or situation.  These have even startled people awake at night.

These are associated with situations in which the sufferer is directly exposed to situations, places, or things that can (or will most likely) set off a panic attack.  A specific panic attack would most likely occur if one was to expose a person suffering from extreme social phobia to a standing room only rock concert and expect them to enjoy the show.  Okay, that is a bit extreme, who wouldn’t freak out in that situation? (Okay, maybe not if you’re a raving manic at the time.)  Or, if let’s say a compulsive obsessive sufferer has their daily rituals completely disturbed and disarrayed by an insensitive person who introduces germs into his/her environment.  You can basically guarantee that he/she will start to wheeze and grab his/her chest as if they were about to keel over. 

These forms of panic attacks are occurrences in which the sufferer may be predisposed to having panic attacks in specific situations and places, but they are not necessarily guaranteed that these episodes will occur.  Some people may have panic attacks while driving in their car.  Sometimes they will experience a panic attack and sometimes they will be able to successfully complete their trip without an incident.  They are predisposed to having attacks in their cars while driving, but the attacks are not a predictable event related to the activity and they are not a response to a desperate fear of driving.  The attack may or may not occur during that activity or while the sufferer is in that specific place, it is not a probable event.  

There are various ways one can deal with panic attacks and anxiety as a whole.  Most psychiatric specialist’s writings on this subject that I have researched and those that I have spoken too have suggested a combination of therapies of medications along with psychotherapy techniques/sessions.  Both these treatments take time to take effect and are long term methods of dealing with one’s anxiety.  They do not take the problem away immediately.  But, when they do eventually work, they are extremely effective and many people find at long last a great release from their torment.  Actually, to be quite honest and frank there is no method of release that will take anxiety away from a sufferer in a swift and permanent manner without some form of therapeutic treatment.  And, this sadly, takes a bit of time.  There are no short cuts when dealing with panic attacks.  Panic attacks are a symptom of anxiety disorder/issues that need to be addressed and treated before there will be any improvement in one’s mental health.   

Some of these medications will be familiar to bipolar sufferers and some will be new.  Choosing to use medications to aid one in dealing with one’s anxiety is not a sign of weakness or a negative turn of events in one’s mental health.  In fact, I believe it could possibly be a step in the right direction.  If one needs medication to properly deal with one’s anxiety and keep it under control, than I believe it to be a positive alternative to the agony of panic attacks.  Medications can help one control one’s anxiety levels while one endeavors to work through the bare bones of what may be causing the anxiety in the first place.  If it is a chemical imbalance that is causing one to experience panic attacks medications may be a necessity.  There are some conditions that simple therapy and relaxation exercises cannot rid a person these attacks and one of them is a chemical imbalance. 

Medication can be a life saver for people who still have to continue with their lives; they have to go to work and act normal despite the fact that they are suffering from excruciating anxiety.  It is important however, in relation to benzodiazepines, that one uses them in proper dosages and with great care to make sure one does not become dependent upon them.  Medications are typically only the first step.  They address the chemical imbalance of the brain and other biochemical matters concerning the body, but that is not the complete sum of the issues causing the dilemma.  A person also needs to address the psychological issues involved in their anxiety disorder/state as well with further therapies such as psychotherapy.   

·        As a bipolar sufferer one may discover that one may already be taking a number of medications that serve the dual purpose of treating bipolar disorder and anxiety disorders/panic attacks.

·        Remember some medications take a few weeks to have a therapeutic affect on a sufferer.  You must give the medication at least a few weeks, in some cases six weeks to start to take full effect. 

·        There are ongoing studies in which new medications are being tested in the treatment of anxiety disorders that affect other neurotransmitters and brain chemicals like GABA (gamma-aminobutyric acid and Substance P).  A new diagnostic tool will help to measure brain levels of GABA and other substances in order to track their effectiveness in test subjects.

·        There is also research underway to discover whether an antidepressant that affects the neurotransmitter Serotonin works more efficiently when taken with the new anti-anxiety drug Buspirone.

There are many forms of Psychotherapy offered to those who sufferer from anxiety disorders/states of mind.  It may seem like a confusing array of choices as to which one to choose that will bring relief to one’s own personal anguish.  One of the most important things a bipolar sufferer can do in his/her attempt to overcome his/her anxiety issues is to seek out as much research and information on the therapies offered and decide for themselves which will offer them the best results.  Before a person forges on into the world of psychotherapy it is important that he/she has the educational guidance of a professional medical health provider helping them through the decision making process which he/she will need to make when choosing a therapy. The next most important step in discovering the right form of therapy for one’s needs is to consult a psychiatrist, as well as a psychologist, who are willing to work together in developing one’s chosen treatment.  It is, however, vital that one fully discuss this chosen treatment with one’s health care professionals to be sure it is actually right for one’s emotional/mental disorder.  They may suggest other forms of treatment that may be new or alternative to the one a person has chosen, but from their experience they may feel will work more efficiently for that person’s condition.

·        Seek out a psychiatrist who is willing to prescribe medications if they are needed.

·        If one is seeing a mental health care provider for anxiety/bipolar issues make a concerted effort to be sure he/she is willing to work with a medical doctor, preferably a psychiatrist, just in case medications should need to be prescribed.

·        Look for a medical professional who specializes in bipolar disorder and anxiety disorders.

·        Some of these Therapies will be in a group setting and some will be individual one on one with a therapist.  Be sure to inquire as to what type of sessions they are, either group or individual.

Cognitive Behavioral Therapy and Behavioral Therapy is focused mainly on helping the sufferer achieve a more positive and constructive perspective on what makes him/her anxious or fearful, and endeavors to change his/her reactions to situations that create these highly charged emotions.  The therapist works with the sufferer to change his/her thought patterns concerning his/her anxiety issues and teaches replacement behaviors to combat the onset of panic attacks.  The sufferer quickly learns to recognize negative thought processes, mind-sets, and behaviors that can cause them to become vulnerable to potential high anxiety situations.  These forms of therapies try to focus on building up a sufferer’s self confidence in order to face the difficult struggle of overcoming anxiety, as well as shoring up self esteem and teaching the sufferer the facts concerning his/her disorder.  When a person learns about the facts of his/her disorder, the symptoms and how it works, what to expect from it, and that he/she is not alone in the world of anxiety, he/she is much better prepared to fight for his/her betterment, then if he/she is left in ignorance.  A person is much more invigorated to strive for his/her recovery if he/she knows there is a light at the end of the tunnel and others just like them have overcome the seemingly insurmountable battle against anxiety.

Many sufferers actually believe that they are going to have a heart attack or go crazy when they suffer a panic attack.  Cognitive Therapy works on changing those ideas and fears by replacing them with more reasonable and probable ways of perceiving what is happening to them during an attack.  This is sometimes called “cognitive restructuring”.  The sufferer’s therapist slowly reprograms his/her impressions of the panic attack experience into a more controlled and less frightening event.  Along with striving to teach the sufferer to perceive his/her panic attacks as an avoidable and controllable event, the therapist also endeavors to show the sufferer how to discover and identify possible triggers that may cause him/her to lapse into an attack.  When the sufferer learns that it is not actually the trigger that is the direct cause of his/her panic attacks, rather the fear of having the panic attack itself, the trigger gradually loses its power to bring on an attack.

This form of therapy is sometimes used to help a sufferer conquer the fear he/she faces during a panic attack.  The sufferer is exposed to the slow introduction of triggers or sensations that may normally trigger the onset of a panic attack; this is all done in a controlled environment.  He/she is allowed to experience the symptoms of an average panic attack in order to teach him/her that they need not necessarily develop into a full blown attack.  This technique also proves useful in dealing with situational avoidance associated with panic attacks.  Another effective treatment for dealing with panic attacks is breaking an anxiety filled situation down into small manageable steps and overcoming them one at a time until the most scariest point is mastered. 

·        Relaxation techniques and learning breathing exercises are also a very useful means of helping one through a panic situation.  The use of positive visualization and the mastery of shutting off some of one’s senses to the environment about can also assist in calming one’s rising anxiety. 

·        New approaches in research are focusing on developing therapies for anxiety disorders that increase cognitive control over the Amygdala so that the “flight or fight” response can be interrupted.

 This form of therapy focuses on the interpersonal dynamics the sufferer experiences with others.  It looks at their relationships and social skills/attitudes in an attempt to improve interpersonal difficulties that may be causing the sufferer panic attacks/anxiety.  The therapist strives to teach the sufferer to evaluate his/her interactions with people, and to be aware of agoraphobia/self-isolating behavior, difficulties getting along with others, relating or understanding social situations and others.  The therapist discusses ways for the sufferer to deal with social interactions, impressions/attitudes attached to social interactions, and gives him/her advice on distressing ongoing interpersonal dilemmas.  This therapy can be somewhat like Social Skills Therapy which allows the sufferer to learn how to face feared social situations like receiving criticism or praise and meeting new people, as well as how to manage their fears and anxiety in other high stress social situations.

Individual Psychotherapy is a form a therapy that involves the sufferer and a therapist (either a psychiatrist, psychologist, psychiatric social worker, or a psychiatric nurse) It is not a group form of therapy and only involves the sufferer and the acting mental health practitioner.  In this therapy the focus is on helping the sufferer understand the behavior and thought patterns that are negative and dangerous to their mental health.  The therapist works toward guiding the sufferer toward a realization that they have control over their self destructive behaviors and can actually develop skills to control them. 

Talk-therapy can guide a patient through the many layers of his/her anxiety issues.  Peeling back layer after layer, exposing issues that with the help of an experienced therapist that can be dealt with in a positive and healthy manner; each one can be healed to the point that the sufferer can lay them to rest.  Then these issues can be resolved in a safe and protected environment.  The sufferer can bring up past and current issues, obsessive thoughts, painful feelings, or detrimental relationships.  Under the guidance of a trained and knowledgeable therapist the sufferer can begin to understand more about his/her illness, how it affects their lives, and their problems.

Psychoeducation is a form of therapy that endeavors to teach sufferers about their illnesses.  It details how to treat their illness and recognize signs of relapse so that they can seek treatment before another episode should reoccur.  There is also family psychoeducation which teaches coping methods and problem solving skills to family/friends of sufferers to help them deal with the sufferer during difficult times. 

Family psychoeducation is a vital and very important development in therapy because it helps to reduce misunderstandings in the family environment of the sufferer, clears the confusion in a crisis of how to deal with an episode of emotional distress, helps the family deal with their own anxieties, and furthers the recovery of the sufferer.  The therapy teaches the immediate family/friends/caregivers the important facts of the sufferer’s disorder and how it they can help him/her deal with it.  The family/friends/caregivers are given advice on how to treat the sufferer and how to aid in his/her recovery/care.  They are given advice such as, how to keep track of the sufferer’s medications to ensure they are being taken properly.  They are also given a safe environment to voice their frustrations to the sufferer about his/her behavior and work with him/her in trying to improve relations.  

These groups are great for sufferers to get together and share their experiences with others who share their pain.  They are offered to several different types of people, those who suffer from disorders, those who are spouses of sufferers, and even children of sufferers.  There are also groups that encourage the whole family to join in the experience.  These groups are not often led by psychiatric professionals like psychiatrists or psychologists; more than likely they will be led by a social worker or a community volunteer with some social work experience.  But, don’t let that discourage you from participating.  There is a lot to be gained by joining a support group. A sufferer can find great solace in sharing his/her pain and experiences with a group of people who have been there and done that, and know where he/she is coming from.  It can truly feel validating to feel a room full of people say “I hear you; I know exactly where you are coming from”.   A support group can share one’s pain like no one else can and offer advice from people who have been there and done that.  A sufferer walks into a world in which they no longer feel like they are a lonely freak of nature; they discover that they are one of many who are just like them.  They can receive ongoing support, friendship, and even find humor in their illness. 

What a support group can share:

-          Support Network

-          Referrals To Medical Practitioners/Specialists

-          Ongoing Support

-          Friendship

-          Hope

-          Access To Community Resources/Programs

-          Information On Recovery Techniques

-          Advocates For Needed Research

-          Information On Better Hospital Programs

-          Drawing Public Attention To Abuses Such As Discrimination

These groups, however, should never take the place of real therapy with a mental health practitioner.  They should be used as a form of additional support, not a main source of mental health care.

It is hard to say exactly how long treatments can last.  It is truly up to the individual sufferer and his/her dedication to his/her recovery that can determine the time it will take for the different therapies to begin to improve their mental state.  In some therapies, like Cognitive Behavioral Therapy it has been suggested that it could take up to 10-20 weeks, or perhaps longer.  It may even take a year for the full impact of the treatments to be felt.  In other therapies it is all relative to how well a sufferer responds to his/her sessions and is able to work through his/her issues.  Some of these therapies will be conducted in a group setting and others as a one to one interactive experience with one’s therapist.

Now, there are a lot of long term treatments for anxiety and panic attacks, some of which have already been mentioned.  This is all fine and dandy one might say, but what about now, this moment, when I am already incessantly gripped by panic attacks?  What do I do until the long term benefits of these therapies begin to take effect and start to relieve these symptoms?  Do I just dangle in the wind of the storms my anxiety rages at me?  The answer is no, one doesn’t have to be left vulnerable to one’s panic attacks while waiting for some magical moment when one will be released from them.  That is not how it works.  In the meanwhile, while one is attending therapy and taking one’s medications, one can begin practicing a few coping mechanisms to help ease them through the painful healing process.  Typically the therapist or mental health practitioner involved in the process of one’s rehabilitation will teach coping skills and techniques to assist one in handling the day to day struggles with one’s anxiety.  These techniques vary widely and some of them may not even appear on the list below.  These techniques are designed to focus the sufferer on discovering ways within themselves to find peace instead of panic, relax the body so it does not further progress into an increasingly agitated state, and discover that they do not have to give into the fear of anxiety that washes over them during a panic attack. 

I have read through a number of self-help books on anxiety and all of them mention relaxation/breathing techniques as a positive means of avoiding reoccurring panic attacks.  Apparently they allow the body the ability to lapse into a deeper state of relaxation than any other form of exercise.  This is important because it allows the body and mind to release built up stress accumulated during the day.  Deep relaxation allows the sufferer to shed pent up anxieties and upsets by melting them away.  And, deep relaxation stays with you during the day, if you practice it routinely.  It has been noted that a person who practices deep relaxation methods on a daily basis is better equipped to withstand the emotional and mental battering that day to day stress can cause.  A more relaxed body and mind is less likely to be vulnerable to triggers in his/her environment that may set off a panic attack. 

Any form of deep relaxation and practiced breathing exercises can create a positive effect on a sufferer’s mental state.  I have read many different versions of deep relaxation exercises.  They all have their own descriptions of a deep relaxation experience, but they are all very similar as well.  The majority of these versions have some form of muscular stretching and relaxation techniques, regulated and practiced breathing, positive visualizations and image associations, and meditation.  Sounds a bit like Yoga, doesn’t it.  Well, I think one could probably use some Yoga exercises to get the same results.  I would be careful which Yoga exercises I would choose for the purpose of deep relaxation because some of the maneuvers can be quite stimulating and in the end cause the opposite effect.    

For the purposes of this section I will describe a course of actions/maneuvers that are extremely similar to those that I have learned from my research of deep relaxation techniques for anxiety sufferers.  I will use relaxation techniques that I was taught during my training as an actress.  These exercises proved very practical and worked well to help me deal with high stress situations.  They are almost exactly the same as the ones described in the books, articles, and classes I have studied that teach techniques to deal with anxiety.  I know the exercises so well I could recite them to you backwards.  I encourage those who suffer from anxiety, especially social anxiety/stage fright, to practice these maneuvers.  These exercises are very effective if a sufferer has to engage in an activity that causes him/her high stress.  If he/she practices the course of exercises twenty minutes before he/she must engage in the feared activity, he/she will discover he/she has a more relaxed and enabled mental state that is better prepared to deal with the situation at hand.  He/She will find his/her body is more fluid and the physical symptoms that often hamper social interactions will be somewhat decreased (shaking, trembling, heavy or rapid breathing, tense muscles, twitching, difficulty with speech).  People used to ask me how I could stand up before hundreds of people and perform without any signs of discomfort/stage fright.  It was interesting because when I was not performing and was interacting on a one to one level with others I would often shake quite noticeably.  I would never give away my secret, the deep relaxation techniques, I would rather say it was just a knack I had.  And so, here’s the secret.  There are hundreds of theatres everywhere on this planet, at this moment, where actors are lying prone on the stage floor running through their deep relaxation exercises before they must perform.

It is important that before you start your relaxation exercises you find a quiet (soft lighting is always a bonus) room with enough floor space for you to spread out on.  You can use a mat if you want too.  I never do; I like to feel the floor beneath me;  it grounds me better to the space.  Soft music is fine, but make sure it is not stimulating or distracting in any way.  Try to find orchestral music rather than songs with words that can interfere with your thought processes.  Make sure the room is at an appropriate temperature; not too warm or cold.  Sometimes people experience a warming sensation during these exercises and a hot room can make it uncomfortable and distracting.  Do not use a pillow for your head, your body must lie at the same level at all points.  Take the phone off the hook and ask your family not to disturb you while you are practicing deep relaxation.  I am not going to use all of the deep relaxation exercises that I have learnt; then we would be here all day, but I will highlight the ones I think will help to relax and center you.

Start in a standing position.  Shake your body out, including your head, and relax into it.  Do this a few times until you feel loosened up.  Now image you are a marionette and you have strings attached to your head, arms, and body.  The puppeteer that controls you will slowly slacken the strings and you will droop down so that your hands drag on the floor.  Feel the tension of the strings release you from the top of your head, then your neck, then your torso, and your arms will eventually hang down to the floor.  Make sure you bend your knees slightly when you do this exercise.  It should feel like you are rolling your head and body down your spine and hanging limply from your pelvis.  Feel each vertebra as you go.  It should feel like a single string is holding you up from your pelvis as you slump over completely relaxed.  You want to very gently bounce your body two or three times in this position.  Each time you bounce you want to release even more resistance in your spine and neck.  Your head will feel the heaviest, try to relax to the point that it hangs from your neck.  Very gently and slowly sway your head from side to side.  Now, just as you bent over begin to straighten.  Do this slowly and feel each bone in your spine building on top of each other like you are building a wooden block tower.  Remember to always keep your knees bent slightly.  When your head finally sits on top of your neck and you are in a standing position try to straighten your body to its full height.  Repeat two times.

While you are standing place your hands on your lower tummy.  Monitor your breathing for a second or two.  Where is it concentrated?  Are you breathing high up in your throat? Do you feel a restrictive claustrophobic pull in the back of your throat?  Or, do you breathe from your chest?  Do you feel as if you can never truly fill your lungs with the proper amount of air?  Now, with your hands still on your lower tummy exhale forcibly from the pit of your stomach, do this a few times.  You will feel with your hands the thrust of your lower abdomen muscles as you exhale.  Your exhalation should sound like a bark, a “huh” sound.  Focus on the spot on your lower abdomen that thrusts violently when you exhale.  When you inhale try to fill your body with enough air to expand that area of your stomach.  You will feel it with your hands as your tummy moves in and out.  You are trying to focus your breathing into the most appropriate place in your body.  Your breathing should always center in your lower abdomen.  Practice the sensation of breathing from your lower abdomen, filling your lungs with as much air as you can and then expelling it to the point of gasping.  Do this until you feel certain you have focused your breathing in your lower abdomen.  This is important because when a person’s breathing is properly centered it can reduce the amount of tension in their body and the effort it takes to take a breath.  It can give you a calming sensation and gives your body/brain a greater amount of oxygen to work with.  I find when I properly center my breathing my concentration improves remarkably and I am able to focus not on my anxiety, but on other more constructive thoughts.

Now that you have established how to center your breathing start to relax your throat and chest. Often when your throat is tight a person tends to breathe in short gasps and the body tenses, it gives a sensation that breeds anxiety.  When the throat is loosened up and not as constricted the feeling of panic is lessened.  Stand with your feet a shoulder’s width apart, knees slightly bent, and body relaxed.  Gently let your head fall backwards until it rests with your face pointing to the ceiling.  As your head naturally falls backwards, open your mouth and let it hang open.  It will open wider and wider as your head goes further back.  When your head is completely back and your mouth open, open your mouth further, stretching it to the widest it can go.  Stick your tongue out and stretch it as long as you can; say “ah” loudly letting the air in your body flow out of you.  When your breath has been completely expelled close your mouth, feeling a stretch in the front of your throat, and take a deep breath in through your nose.  Keep your head tilted back throughout. Do this at least four or five times.  When you are finished with this exercise keep your head tilted back, with your mouth closed, gently stroke your neck from your chin down to your upper chest.  Try to stretch your neck further each time you stroke your neck.  Do this a few times.

Okay, now in a standing position again you want to start to hum deeply from the middle of your chest.  You want to be able to feel the vibration in your throat and chest as you hum.  Focus your humming and its vibrations deep within your rib cage.  As you hum, start to pummel your chest with your fists, not too hard, you are not trying to hurt yourself.  When you reach the half way point for the amount of air you need to exhale open your mouth and saying “ah” expel the rest while you continue to pummel your chest.  Every time you inhale close your mouth and breathe in through your nose; don’t stop beating on your chest.  Do this for two or three breaths.  When you are done reach your arms backwards and behind your back lace your fingers together.  Then slowly raise your linked hands upwards toward the ceiling. You will be forced to bend over in order to feel the full stretch.  When you are done this stretch let your arms drop at your sides and shake yourself out.  What you are working towards here with the humming is warming up and loosening your chest cavity.  Often people experience a constriction in their chests from anxiety and this can help to counteract that sensation.

At this point you want to check your breathing and make sure you are still centered in your abdomen.  It is good at this time to start to make really goofy and bizarre facial expressions that cause you to stretch your face.  Open your mouth really wide, frown really hard, move your lips side to side, etc.  The more extreme the better.  You want to loosen up your facial muscles to help ease such symptoms like twitching and difficulty with speech.  Massage your cheeks/jaw vigorously, stick out your tongue, move your jaw back and forth and up and down.  Start to enunciate tongue twisters with exaggeration speaking in a loud voice that bellows up from your breathing center, your abdomen.  These exercises are used to help keep your jaw from clenching and allowing your speech to flow freer when you speak.  You may wish to walk around shaking your body out as you go.  Do this for a few minutes or until you feel you are ready to move on to the next step.

All right, you have “ahe’d” and pummeled yourself into a fairly warmed up physical state.  You have worked the major areas of breathing and hopefully loosened them up to the point that you do not feel any constriction of any kind.  I like to do these preliminary breathing exercises in a standing position because it is easier to feel air movement throughout the body that way.  This is important to the control and awareness of a person’s own breathing rhythms.  How you breathe in a high stress situation is very influential on the sensations you feel and how you react.  Learning to control your breathing and centering it in the right place in your body can make a huge difference in how you react to panic sensations and stress in general.  When you are breathing right you do not feel the constriction sensation in your throat and chest, you are more relaxed and are more enabled to deal with stress.

Lie down on the floor on your back.  Your arms should be resting down by your sides.  Your legs should be stretched out straight but relaxed, your feet will fall to either side.  Let your body go limp all over, close your eyes and just relax.  Now, focus on your breathing, in and out.  In your mind close all the doors to your thoughts one by one. Don’t slam them shut, just close them purposely.  Go through the rooms in your mind and as you close the doors leading out of them shut off all the lights as you leave.  As you walk through your mind notice how quiet it is, how peaceful a place your mind is when all those thoughts are shut out.  When you are done shutting out your thoughts it will be dark in your mind, a cool, calming dark.  There is nothing left in it to scare you or bother you now that everything has been locked behind all those doors.  Lie there in the dark and feel cocooned in its safety.  It flows around you, wraps around you protecting you, comforting you. 

Allow your body to sink into the darkness as if it were a pool of water enveloping you in its warm depths.  You discover to your pleasure that you can breathe in it without difficulty.  Focus on the rhythm of your breath as you breathe it in and as the darkness ebbs and flows from your body.  When you breathe in the darkness it brings a calming sensation that fills you up inside.  Now, start to clench and relax each muscle group in your body starting from your head to your toes.  Screw up your face really hard, as hard as you can, hold this for thirty seconds, and then release.  Feel the pleasing sensation as your facial muscles relax, relax for thirty seconds and then move on to the next muscle group.  Your arms are next, then after that your hands.  Move through every part of your body until you reach your toes; at that point relax all your muscle groups together.  Lie motionless on the floor, don’t allow yourself to lose that feeling of deep relaxation, imagine you are very heavy now.  The darkness is even deeper, more luxurious, feel yourself melting into the floor underneath you.  Remember your breathing is important. 

Now, rest in the caress of the darkness.  After a few moments open your eyes and begin to slowly move your limbs around.  Remember the peacefulness of the experience you just had and take a piece of it with you when you face the day.  The tranquility you felt can easily be summoned up at a moment’s notice if you learn to center yourself and your breathing.  Always remind yourself that tranquility is a part of you; it exists inside of you, you just have to learn how to access it.  Knowing it is there is already a huge leap in the right direction.  When panic attacks you it is a great solace to know that you possess the ability to tap into that inner peace that does and will exist within you.  You are now done with this relaxation exercise.  Slowly roll onto your side, pulling your knees up to your waist, and push yourself up into a sitting position.  After a few seconds you can stand up without any danger of losing your balance. 

Practice your breathing throughout the day, monitor its rhythm and how it changes during different situations.  Try to regulate and center it while preparing for stressful situations.

Fear diving is kind of like when you are faced with having to dive into a pool of cold water.  You stand there in your swim suit half naked feeling awkward and uncomfortable knowing that you have to jump in to get to the other side.  You brace yourself for the extremely uncomfortable sensation of the cold water against your skin, close your eyes, and reluctantly dive in head first.  At first, as the water envelopes you there is a sting and your flesh will instinctively recoil from its icy touch.  But it is too late, you are in the deep end and there is no other option than to swim through to the far side.  You start to splash and kick as you swim toward the other side.  Surprisingly, what seemed exceedingly frigid before soon becomes lukewarm, even relatively comfortable.  By the time you have reached the other side you find there is no lingering reason for you to leap from the water.  You can actually stand in it without a shudder. 

When you are fear diving you can either sink or swim.  Many a time I have sank miserably, but then there are times when I have swam magnificently through to the other side.  And, I have surfaced from the flood of my panic with the triumphant knowledge that, yes, I can overcome.  What is fear diving you ask?  Well, it is exactly as it sounds, exactly as the little scenario I first described suggests.  What I am describing is an aggressive form of confrontation/exposure behavior in which you deal with your panic issues head on.  First, you start small, working on little anxieties until you have developed the coping skills to deal with bigger issues.  The more fears you conquer, the stronger you feel, the more confident you become.

I started with the attitude that I knew how to swim (regulate my breathing and find a place of peacefulness inside myself) so I knew I could make it to the other side.  I had come to the point in my illness where I could recognize specific triggers and fears that would cause me to fly into a fit of panic.  Then, all I had to do was dive into it when it came crashing down on me like a tidal wave, swim through it like it was water, and come out the other side a stronger person for it.  Instead of running away from my fears I have forced myself to face them head on.  Preparation is the key.  You can’t go fear diving unless you are prepared for the shock of the cold water.  I don’t recommend this for those of you who have not experienced any form of therapy to help them identify possible triggers or have no coping skills to aid them with their panic attacks.  It is a radical method of dealing with fears.  It doesn’t necessarily do away with panic attacks, it does however, give a person the confidence that they can be overcome. 

• When you feel the wash of panic flood over you try to cut off some of your senses that tend to become overwhelmed when suffering an attack.  Close your eyes to the visual stimulation of your surroundings.  Try to focus your thoughts, awareness, inside of your mind, shutting out loud or disturbing noises.  You could even go so far as to plug your ears with your fingers. 
• Distract your thought processes and decrease the constriction of your throat or chest by humming deeply in your chest.  The vibration of the humming sometimes has a calming effect. 
• If you are in a large crowd of people and you suffer from social phobias with personal space issues hug yourself tightly with your arms, keep your eyes focused upwards above shoulder level.  There have even been times when my panic attacks have been so bad that I have squatted or sat right down where I am and waited for the crowd to disperse.  It seems when you get down that low there is more space between the people and they will move around you (you have to let people know you are there).  If you start to shove and push to struggle your way out chances are people will only become aggressive in response and you may not get anywhere in your attempt to get out of the crowd.  You may have to wait a long time and you will not get home until much later than expected, but the public transit system and the streets will be less congested if you wait for the crowds to disperse before heading home.  You will not have to deal with packed buses and people congested streets if you wait an extra half hour for the crowd to disperse.
• When you begin to feel a panic attack coming on close your eyes and focus on a color that calms you like robin’s egg blue, imagine it surrounding you like an aura and protecting you from the panic.  Remember your breathing and center yourself within a place that cannot be touched by fear, color everything in your mind that calming blue. 
• Remember your breathing
• Try to find an out of the way spot where you can sit down and calm yourself.
• Remind yourself even though it feels like you are dying or going crazy that will not happen.  You are just having a panic attack, it can not hurt you.
• Let the panic crash over you and through you, it can not last forever.  Your body cannot sustain it for longer than a few minutes.  If you can hang on for a few minutes it will go away. 
• If you are prone to reoccurring panic attacks throughout the day do not drink caffeinated drinks.
• Keep a picture in your purse of a place, person, pet, or object that makes you happy when you look at it, when you feel the panic overwhelming you take the picture out and concentrate on it.  Focus your thoughts on the picture, not on your attack.

You may wish to keep a form letter of this nature in your purse or wallet in case you suffer a panic attack in public and need assistance from a stranger.  It also aids emergency response workers in understanding the nature of your dilemma if they have a form such as this to refer too in case they are called to the scene by an onlooker.