I have a severe panic disorder that is linked to emetophobia (fear of throwing up). Basically, I panic in any situation that I cannot get out of quickly because I am afraid I will throw up. I panic in obvious places- like when I am preaching, on planes, in movie theaters, on buses and other forms of public transportation, when I ride in someone else’s car, or when I have other people ride in my car (carpools are NOT my thing), and even when people are visiting at my house. I have had this panic disorder since I was six years old, but only recently found a therapist who knows how to help me recover from it.
It is a common misconception that if you just go on a plane, get trapped in an elevator, or even make yourself throw up, that you will get over your panic because you will see it was not as scary as you thought it was. That might work for actual fear- normal fear of something you have not done before. That does not work for a panic/anxiety disorder.
In addition to figuring our where the panic came from, you also have to slowly work towards what you want to do. If you force someone in a full panic attack on a plane, even if the flight goes fine, you will reinforce the panic disorder and make it worse. Yes, sometimes we have to do things in the middle of extreme panic, and yes, it will set back our recovery immensely. However, we forget that there are many, many times when we can take it slowly and work on our recovery.
For example, the other weekend my husband and I wanted to go to the Pride Parade. This is our first year in San Francisco and my friends told me driving there was impossible, and the train (BART) was the only way to go, but even that would be crowded. Like, sardines packed in a can crowded. My ultimate fear- being packed in on a train and possibly throwing up and not being able to get out or even have enough room to throw up. (Ew. I can’t even write that without panicking.)
My therapist often asks me to assess my anxiety on a scale from 1-10. 1 being very little panic, 10 being full blown panic attack. She said that if I am at a 5 or above, that is not the right time to “face my fear.” At that level, I will only reinforce the panic. So, my husband and I talked about how we might be able to get to the Pride Parade and keep my anxiety manageable enough that 1. We could go to something important to us, and 2. It would be an experience that would aid in recovery rather than be an event that would reinforce the panic. Here is how we handled getting me through the event.
We were not on a time crunch and we tried to travel on the train at times when it might be less crowded. For instance, we started travelling after the parade had already started and we got on and off the train at stops that were not as close to the parade so there were less people when getting off the train.
We did not force me when my panic was over a 5. When the doors opened on a train that was packed and my anxiety immediately spiked to a 9, we waited for a train with less people and we only went in the front cars, which usually have less people.
I used my “anti-anxiety playlist” on my iPhone if my level got above a 2.
We sat as close to the door as possible and had an agreement that I could get off the train at any stop if I needed to.
I used meditative breathing when my anxiety started to get close to a 5 while on the train. I like the typical Zen breathing of counting to ten (breathe in and our with each number and if a thought comes into your mind, start over at 1 again), but some people like 4x4 breathing. Use what works for you. 4x4 breathing (breathe in for 4 seconds, hold for 4 seconds, breathe out for four seconds, hold for four seconds, repeat) done at any count, makes me feel like I am hyperventilating and it is too hard for my brain to concentrate on the pattern of counting and breathing.
My husband took care of navigation so I did not need to know when to get on and off the trains.
At the parade, when crowds were too big, we went down side streets.
Basically, we both had to plan, together, how to keep me under my threshold.
For my whole life, I have just sucked it up and “muscled” my way through things that cause me panic attacks. I had no idea that this reinforced the panic and fed it, until it has become something that now will take a long time to recover from.
I do believe that this method of always keeping my anxiety at a 4 or less will work. One day, a packed train will leave me at a level 3 or less of anxiety. Basically, this is desensitizing you to what makes you panic. We now know, especially through research in animals (my friends who are dog trainers will understand this) that pushing you to do things when you are a level 5 and up increase panic. This site on emetophobia explains it well. Too many “exposure therapy” therapists expose you at too high of an anxiety level and this is why so few people recover from a panic disorder.
Remember to assess your level of panic and if it is at a 5 or higher, slow down and take smaller steps.