William ("Dr. Bill") Gaultiere, Ph.D.
Director of New Hope & Psychologist with ChristianSoulCare.com
(714) 971-4213, DrBill@CrystalCathedral.org
May 2005

"My heart won't stop racing. My chest hurts. I can't catch my breath. I feel like I'm going to faint. I've got to get in control!. Why won't God help me?"

That's what a panic attack is like. You've probably talked to someone battling Panic Disorder. Maybe you've suffered it yourself. Certainly, we've all struggled with anxiety, more or less.

What is panic disorder about? Why does it thunder from out of the blue?

How does Jesus bring peace to troubled minds? How can we connect ourselves and others with God's help? That's what we're going to talk about.

Prayer

Intro

A plane was taking off from Kennedy Airport. After it reached a comfortable cruising altitude, the captain made an announcement over the intercom,

"Ladies and gentlemen, this is your captain speaking. Welcome to Flight Number 293, nonstop from New York to Los Angeles. The weather ahead is good and therefore we should have a smooth and uneventful flight. Now sit back and relax - OH NO!"

Silence.

Then, the captain came back on the intercom and said, "Ladies and Gentlemen, I am so sorry if I scared you earlier, but while I was talking, the flight-attendant brought me a cup of coffee and spilled the hot coffee in my lap. You should see the front of my pants!"

A passenger in Coach said, "That's nothing. You should see the back of mine!"

Fear can scare the poop out of us! Literally! I hope I'm not offending you in saying this. But there are some worse words I could've used to get the point across!

What is a Panic Attack like?

It's a sudden outburst of intense fear and physical discomfort. The episode peaks in about ten minutes and includes at least four of these symptoms:

• a feeling of imminent danger or doom;
• the need to escape;
• palpitations;
• sweating;
• trembling;
• shortness of breath or a smothering feeling;
• a feeling of choking;
• chest pain or discomfort;
• nausea or abdominal discomfort;
• dizziness or lightheadedness;
• a sense of things being unreal, depersonalization;
• a fear of losing control or "going crazy";
• a fear of dying;
• tingling sensations;
• chills or hot flushes.

Because of all the physical symptoms in a panic attack - especially the heart palpitations, chest pain, and difficulty breathing - people will page their doctor or go to the emergency room. They'll get an assortment of expensive medical tests. Often the Panic Disorder remains undiagnosed.

When someone suffers at least two attacks like this followed by at least one month of worry over having another attack then a diagnosis of Panic Disorder can be made. According to the National Institute of Mental Health in a given year 2.4 million (or almost 2% of) Americans are likely to be diagnosed with Panic Disorder. It's usually first diagnosed between late adolescence to mid thirties, more often in women then men. It may last a few months or for many years.

Panic Disorder is one of the Anxiety Disorders. The others are Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Phobias, and Generalized Anxiety Disorder. About 13% of Americans have one of these Anxiety Disorders. Anxiety can be debilitating and it is the most common mental illness in America.

Because a panic attack is so frightening and painful the people who struggle with this tend to avoid things that they fear may trigger an attack. They feel like a victim of the panic and never know when they'll be ambushed again. So in order to try to prevent a future attack they may try to stay away from the scenes of previous attacks or the situations that frighten them like grocery stores, malls, crowds, or traveling. This can develop into Agoraphobia in which the person refuses to leave a "safe circle" they've identified, perhaps the route between home and work or home and essential errands. Sufferers may become increasing helpless and even refuse to leave their own house!

Here's one woman's story:

"One day, without any warning or reason, I felt terrified. I was so afraid, I thought I was going to die. My heart was pounding and my head was spinning. I would get these feelings every couple of weeks. I thought I was losing my mind.

"The more attacks I had, the more afraid I got. I was always living in fear. I didn't know when I might have another attack. I became so afraid that I didn't want to leave my house or other safe places.

"My friend saw how afraid I was and told me to call my doctor for help. My doctor told me I have panic disorder and gave me some medicine that helps me feel less afraid. I've also been working with a counselor and learning ways to cope with my fear. I'm slowly starting to feel like myself again."

Many of our New Hope callers suffer from anxiety, including panic attacks. Though I've never had a full blown panic attack I was treated for a Generalized Anxiety Disorder in the psychotherapy I received years ago. Members of my family have suffered from Panic Disorder. I imagine that many of you have had problems of one type of another with anxiety. Have you ever had a panic attack? Do you have a loved one who has suffered from panic attacks? What was it like?

Do you have A-N-X-I-E-T-Y? (Self-assessment)

What Causes Panic Attacks?

Imagine a pot of liquid on a stove. Now turn the heat up. Then put the lid on the pot. What's going to happen? The lid will blow with liquid exploding everywhere.

The liquid is our souls, our interior selves and the pot is our bodies. We're each a different type of liquid; some of are slower to boil over than others. Our bodies are different too; some are more effective than others at insulating our souls from heat.

The heat is the stress in our lives. We all have stressors that put hot pressure on our bodies and souls - some of us endure more than others. Emotional and physical injuries, evil attacks, temptations, expectations of others, responsibilities, changes, opportunities. These are all examples of stressors, some of them are good and others are bad, but they all challenge us.

The lid is our defense mechanisms, the ways that we try to deny our external stress, thereby internalizing it into anxiety. We may repress our feelings, project them onto others, rationalize or spiritualize, get busy helping needy people, try to be ideal, and the like. The more firmly the lid is held down on our feelings the more pressure/anxiety builds because steam is not able to escape!

Eventually, depending on how all these factors combine, the lid will pop off and the liquid will boil over in some way, perhaps in a panic attack.

Let's look at a specific example. Some years ago I helped a man with Panic Disorder who I'll call Jon. Jon's mother was needy, insecure, reactive, and dumped her fears and problems on him. His father who was either detached or critical. As an adult Jon tried to avoid his parents and strived to please his wife and his God, neither of which seemed to be pleased with him. He had three young children and worked about 50 hours a week at a demanding job that didn't enable his family to keep up with the Joneses next door.

Jon would go into a panic attack when he got congested. He became terribly frightened that he wouldn't be able to breathe. This bothered him the most when he was quiet and still in his bed. He tried to be tough and was frustrated with himself for being afraid and for getting sick. He didn't talk to anyone about his feelings. He just became more and more anxious, which kept him awake. He'd become afraid that he'd be up all night or that he'd have a panic attack. Sometimes he in fact did have a panic attack while in bed and other times it came days later seemingly for no reason at all.

The liquid in Jon's soul was quick to boil, hot as it was from all the fear he absorbed from his mother and had stirred up by his father's anger.

His body was a "hot pot" since he'd been internalizing stress since the time he was a small boy. It conducted heat readily!

There was a lot of heat for Jon coming from the stove's burners. Pressures at work, the demands of a young family, criticism from his wife and others were the kind of things that turned the stove's heat up for him.

The way he tried so hard to be strong and confident and put together was the lid he pushed down on the boiling liquid. His denial and self-pressuring prevented him from being able to release much steam from his boiling pot!

Eventually his lid blew with a panic attack. That became a vicious circle because the attack itself was so horrible that he developed a fear of having another one. Fear of fear is a good definition of panic. Someone who panics is afraid to be afraid.

Getting in the Mind of the one in Panic

People who suffer from anxiety are seeped in negative thinking, even catastrophic thinking. Here's what would happen in Jon's mind:

• "I'm getting congested from this cold" becomes "I'm going to suffocate."
• "I'm too upset to sleep" becomes "I'm going to be awake all night and exhausted tomorrow."
• "My wife is angry at me for being late" becomes "My wife doesn't think I do anything right."
• I'm anxious" becomes "I'm a mess. I can't handle life."

The way that anxious people tend to respond to the fears that are triggered by stressors in the first place and bodily symptoms of anxiety in the second place only makes them worse, just pushes the lid more tightly down on the boiling pot. For instance, Jon thought things like:

• "What's the matter with me? I shouldn't feel this way."
• "I have to be strong."
• "Get a grip. Get control of yourself."
• "Don't let anyone see how upset you are."
• "I have to make sure this goes well."
• "If she isn't pleased with me I'll feel horrible."

Is God with us in our Anxiety?

Fear and its generalized form of anxiety or worry are very damaging to our souls and the life of faith. In the Parable of the Soils Jesus said that worrying and being anxious are like thorns that choke the wheat and make it unfruitful (Matthew 13:1-9, 18-23). Jesus, in his beautiful way, told us not to worry about what we need because our Father, who provides for the birds and dresses the wildflowers, cares for us (Matthew 625-34). He said we don't need to be afraid of what's going to happen to us because our Father counts each of our hairs and watches over even the little sparrows (Luke 12:4-7). Instead of being anxious about how things are going to go for us Jesus calls us trust him as our King and to serve him in his kingdom (Matthew 6:33-34).

Of course, Jesus was tested. He knows firsthand that life on earth is difficult and we're vulnerable to live in fear and anxiety. He spoke to us as one who endured many trials and temptations which were frightening experiences and anxious times, culminating in his giving himself for us to be tortured and sacrificed on the cross. He sweat drops of blood in anticipation of this and he prayed to the Father, "Not my will be done, but yours." He found such peace in the midst of his horrifying suffering on the cross he was able to offer salvation to a thief, comfort his mother and disciple John, and forgive the very people who were abusing him and killing him.

The Apostle Paul had the same message for us. He said: "Do not be anxious about anything, but in everything by prayer and petition present your requests to God and the peace of God which transcends all understanding will guard your hearts and minds in Christ Jesus" (Philippians 4:6-7, NIV). He said this while he was on death row in jail being guarded by a warden. God's peace was his real guard then and through many beatings, shipwrecks, conflicts, and persecutions.

Peter, in the midst of his trials persecutions, also learned to find God's peace and he encouraged us in the same way: "Cast all your anxiety on him because he cares for you" (1 Peter 5:7, NIV).

These examples and teachings from Jesus, Paul and Peter highlight a path of trusting God. The Bible is full of hope, comfort, insight, and encouragement for us as we deal with fear and anxiety. It's been said that there are 365 "Fear Nots" in the Bible, one for each day of the year! Well, I counted them and there's actually more than that! I selected 31 of these passages for my New Hope article "Fear Not: 31 Days to Freedom from Fear." The idea here is that if instead of living in fear and anxiety we immerse ourselves in God's way of helping us for 31 days, trusting him and people in the Body of Christ with the things that scare or worry us one day at a time, then "Fear Not" can become our habitual way of thinking, desiring, and acting. (See handout.)

Help for Anxiety and Panic

I'd like to suggest a few things that help to treat Panic Disorder and tie this into New Hope Counseling.

1. Psychiatry. Anti-anxiety medication can calm down symptoms quickly.
2. Psychotherapy. Cognitive behavioral therapy has been proven to be an effective treatment for anxiety. Clients can feel supported, learn to change their destructive ways of thinking, and "take courage" to overcome their fears gradually and grow their confidence with each step.
3. Support groups and self-help organizations. Meeting other people who are struggling with anxiety and being a part of organizations that educate people on the disorder and it's treatment can make a difference. Our New Hope Referral list on our website and in the reference books in our phone room lists a number of these organizations under the heading "Anxiety":

· Anxiety Disorders Association of America

· TERRAP

· Emotions Anonymous and other support groups

1. Empathy. Feeling understood and receiving compassion releases negative emotion, inspires well-being, and empowers positive action. Don't say what people tend to say to anxious people trying to be strong, "You can do it!" That's cheerleading, not caring, and it can exacerbate their anxiety!
2. Limit Setting. Learning that you can say no to needy people, expectations. Anxiety occurs when there's more hot pressure (stress) coming in then there is steam being released. Some external pressures can be minimized by setting better boundaries.
3. God's Word. God's Word is true and wholesome. Anxiety is based on a lot of unreality: misperception, catastrophic thinking, untruths about God, self, and others. As an example of the power of God's Word consider how these six, soothing Biblical truths counter the six sample negative responses that Jon had to his fears (especially when they are made incarnational through the Christ's Ambassadors:
• "Even Jesus felt anxious under pressure."
• "God's grace is sufficient for me. When I am weak then I am strong."
• "Lord, you are in control. Help me learn to trust you."
• "There are people in the Body of Christ who accept me when I'm upset."
• "I'm not going to try to control outcomes. If this situation doesn't go as I want then I'll look to God's love and guidance."
• "Even if she's displeased with me I can remember and thank God that nothing can separate me from his love and I am a new creation in Christ."
4. Relaxation Exercises. There are many proven ways to de-stress your body and mind, to release anxiety and come into calm and peace. They include things like deep breathing (anxious people breathe rapidly and shallowly from their chest rather than slowly and deeply from their gut), meditation (Psalm 23), muscle relaxation, visualization, using a mantra or breath prayer, worship (if you praise God from your heart you won't remain anxious), journaling, physical rest, calming foods (to help with my anxiety I avoid caffeine, spice, chocolate, sugar, excess carbs) - these are a few the 26 antidotes presented in my article "Antidotes to Anxiety."

Crisis Intervention

Before I respond to your questions let me offer just a few brief thoughts on responding to someone who is in the midst of a panic attack or overwhelmed with intense fear.

1. Stay calm. Talk slowly and in a calm voice. Your peaceful demeaner and nonverbals will go a long ways to bring the needed comfort.
2. Listen. Ask the person to describe his or her experience right now. Your open, receptive heart and active listening skills may calm the crisis.
3. Breathing. Then you might ask, "Would you like help relaxing right now?" If so then you can invite the person to breathe slow and deep from their gut (rather than the fast, shallow, from the chest breathing that is associated with anxiety). Go ahead and breathe deep a few times with the caller/chatter right then.
4. Floating. Sometimes what helps people to get through a panic attack is, paradoxically, to accept the fact that they can't stop it, they can't control it and to instead "float" above of it or ride the wave.
5. 1 thing. Anxious people often need help focusing on one thing at a time.
6. Distraction. If nothing seems to help the anxious person can always resort to distraction, talking about something else. This is a way to get through it. Later, when the person is calmed down he or she can deal with the issues.

Q & A

Relaxation Exercise