People with Panic Disorder suffer from periods of intense fear or anxiety. Physical distress such as not being able to get their breath, racing heart and feeling weak and exhausted, are usually part of "panic attacks."
Panic attacks start without warning and last for minutes or hours. An afflicted person must cope with the possibility of an attack occurring while shopping, driving, attending church, or being with other people socially.
There has been no agreement among professionals about what causes them. Even today, most professionals who treat panic disorder patients will say that the cause is not really known. Many state that stress or anxiety is a factor.
Most people who have attacks believe that there is something physically or mentally wrong with them, that they are ill. It is a common misbelief that something has happened during the person's lifetime which was quite fearful, and this deep psychological fear reasserts itself during an "attack."
It is important to seperate conditions of a psychological nature, such as early life trauma or lack of assertiveness, from the physical manifiestation of panic attacks. Both in clinical practice and in correspondence with many people who have sought help by downloading "How to Treat Your Own Panic Disorder," there has been no evidence of an underlying psychological condition worthy of a diagnosis.
WHAT IS THE NEW EXPLANATION FOR PANIC ATTACKS?
Only in the last decade has an explanation for panic attacks appeared which explains all the various symptoms. When this explanation is understood by the panic attack sufferer and applied to treatment, control is regained and panic attacks can be stopped.
This explanation is based on evidence that panic attacks result from what has been called "Hyperventilation Syndrome." Panic attack sufferers all have one thing in common. They don't breathe properly. There is much to know about faulty breathing and having panic attacks.
People who suffer from panic attacks:
- Breathe shallowly and rapidly.
- Breathe using the muscles of the chest, neck and shoulders.
- Make little or no use of the diaphragm in breathing.
Day in and day out, people who suffer from panic attacks breathe
about twice a fast as normal breathers. Every person who has
sought help in my office for panic attacks has been tested for
these dysfunctional breathing habits using sensitive biofeedback
sensors. Without exception, all have been found to breathe
improperly. Their shallow, rapid breathing causes them to
Hyperventilation occurs any time a person breathes in such a way
that they breathe out more carbon dioxide than their body is
manufacturing. Medically, this results in a condition known as
"hypocapnia." When the blood's level of carbon dioxide gets
below a critical point, the person begins experiencing
apprehension and physical symptoms such as tingling arms and
hands and rapid heart beat. If they don't know what to do at that
point, the symptoms become more severe and a panic attack
WHAT ARE THE SYMPTOMS OF HYPERVENTILATION?
The symptoms of hyperventilation are said to mimic the
symptoms of organic disease. People who suffer from panic
attacks are often put through a series of expensive medical tests
only to find that there is no physical cause for their symptoms.
The symptoms experienced during panic attacks are not
"imagined," they are real. Hypocapnia (abnormally low level of
carbon dioxide in the blood) upsets the normal chemical balance of
the body. Changes in the regulation of the heart and breathing
result. Blood flow to the brain has been shown to decrease by
30% to 40% in laboratory studies of hyperventilation. Oxygen
transfer from the red blood cells to the tissues is inhibited, known
as the "Bohr effect." The nervous system is over-stimulated at
first, then under-stimulated as the condition worsens.
Fortunately, the body has numerous ways of protecting itself from
death due to a complete loss of carbon dioxide, but the sensation
of dying which many people experience during a panic attack has
a physiological basis in actual fact.
WHAT ABOUT PANIC ATTACKS ASSOCIATED WITH PHOBIAS?
Researchers now believe that the fearful symptoms of panic
attacks are responsible for the development of phobias. It is not
unusual for many people who suffer from panic attacks to take
precautions about being too far from home, medical help or those
who they trust. But phobias and rituals can become a disabling
complication for people who have suffered panic attacks over a
long time. They lose the confidence to carry on life in a normal
way. They rarely leave the safety of their homes.
When phobias and avoiding any situation which might trigger an
attack have become a way of life, they become the most serious
obstacles to recovery. Even treatment which offers the promise of
recovery is rarely carried through because of these fears. When
treatment is sought, the patient, their family, doctor or
psychiatrist, and therapist need to make careful plans to keep the
treatment going until the patient feels strong enough to do it on
her or his own.
COMMON SYMPTOMS OF HYPERVENTILATION AND PANIC DISORDER
- Light headed, giddy, dizzy, vertigo
- Blurred vision
- Tremors, twitching
- Numb, tingling, prickly feelings, especially in the face and arms
- Chest pain or pressure
- Nausea or vomiting
- Abdominal pain or upset
- Gas and abdominal extension
- Lump in the throat
- Dry mouth
- Difficulty breathing
- Weak, exhausted, fatigued
- Apprehensive, nervous
- Feelings of unreality
- Fearful during an attack of dying
- Going crazy
- Doing something uncontrolled
These symptoms are essentially the same as those
listed for Panic Disorder in the Diagnostic and
Statistical Manual (DSM-IV) of the American
HOW ARE PANIC ATTACKS TREATED?
Although behavioral approaches such as desensitization are
currently popular, panic attacks are best treated by teaching
victims of this disorder to control their tendency to breathe
shallowly and rapidly. Nearly all persons who learn to change
their habitual and unconscious breathing pattern will experience
considerable control over their attacks in the first few days, or at
most, weeks of practice.
The anxieties, phobias or other disorders which may be
preconditions or a complications of panic attacks should be
treated as soon as the person has gained some control of the
attacks. The help of a competent therapist may be needed but
much can be accomplished through self-help publications listed in
the Bibliography. Many people who use these materials,
especially those whose onset of panic attacks has been recent and
has interrupted an otherwise normal life, will need no further
assistance. They should, however, continue breathing practice for
some time after they have stopped having panic attacks.
Those who have had panic attacks for many years and have
become fearful of going places should not discount the possibility
that these materials will give them the help in controlling their
attacks. More patience and practice may be needed and help
getting over the phobic part may also needed. Phobias should be
discussed frankly with a therapist so treatment can be planned
WHAT ABOUT MEDICATIONS?
Medications can be both a help and a hinderance to overcoming
panic attacks. A medical doctor should always manage a person's
medications. In the beginning, medications can provide a level of
comfort which makes practice easier.
Because many anti-anxiety medications interfere with learning
and memory, it is necessary to withdraw from them as soon as
some control has been regained over the attacks. Those who have
participated in this program have expressed a desire to be off
medications as soon as possible. Only minor relapses have been
reported by persons who no longer take anti-anxiety medications.
By continuing breathing practice, the possibility of relapse is
minimized. Paradoxically, failures to achieve recovery have been
among those who stayed on even low doses of benzodiazapine
HOW TO TREAT YOUR OWN ANXIETY AND PANIC
We live in a fortunate time for those who suffer from anxiety, panic attacks
and agoraphobia. The decade of the 1980's saw advances in research and
treatment in two major areas.
The first was in the devlopment of high-potency tranquilizers, notably alprazolam
(Xanax), which is powerful enough to ward off panic attacks, but does not cure
them. They are the most frequently prescribed drugs in this country.
In spite of the widespread use of drug therapy, it has been shown by
well-conducted surveys that the public and agoraphobic patients don't like drug
treatments and would like to find some other way to deal with mental and
emotional problems. The relapse rate is close to 100% for those who want to
get off drug therapy.
The second development has come from the research into which non- drug
treatments are effective and which are ineffective. Several effective
interventions have resulted, and, in combination, are the core of treatment
programs around the country. Finding the right program located near enough to
home to be practical, however, can be almost impossible.
So, what is the good news? It is this. All the most effective treatment
procedures can be learned and practiced at home. One of the things which was
sorted out by researchers studying clinic programs was that those which
encouraged home practice were the most effective.
The idea behind this book is that it brings what you would learn in a clinic into
"the safety and comfort of your own home." Especially for those who have
developed substantial fears of going out, this can be quite important.
RECOVERY FROM PANIC ATTACKS IS ESSENTIAL
Over the years experimental evidence indicates that what is known as
exposure based treatment for panic disorder, avoidance and agoraphobias is
only successful when it is accompanied by an actual reduction in panic attacks.
Leading researchers now believe that panic is the central feature of
agoraphobia (and panic disorder) and that avoidance is a resulting complication
of panic attacks.
Whereas many programs concentrate on helping patients with their avoidance
behaviors or catastrophic thinking, but ignore or downplay panic, this book
targets panic directly.
How it helps the sufferer to rid him or herself of panic attacks is the unique part
of the treatment or training detailed in this book. It is by fully embracing the
evidence that panic attacks are caused by improper breathing habits which
brings on a condition, for some people, known as Hyperventilation Syndrome.
The proposition is simple: "If panic is the root cause of phobias, agoraphobia
and panic disorder itself, and breathing is the root cause of panic, then the best
place to start is with breathing." Studies have shown that when breathing
retraining is added to conventional treatment, the individuals receiving such
training were significantlly better after six months than those who had not.
When dozens of patients who suffered from panic attacks were tested in my
office for breathing problems, all fit the criteria which could lead to having
Better yet, those who stayed for breathing retraining overcame their panic
There were some who did not completely overcome panic attacks, and from
them I learned some important lessons. The most important lesson, was that
drug treatment, particularly with alprazolam (Xanax), prevents recovery. The
reasons for this and the best way to withdraw from drug treatment are
contained in the chapter on drug therapy.
Note: The Chapter on the usefulness of medications in treatment is not yet
available on these pages.
This book begins with breathing but is not only about breathing. It contains all
of the breathing awareness, reinforcing, early sign recognition, and exposure
exercises which have been proven so effective in helping people who have
suffered from panic attacks. It therefore presents a complete treatment plan for
the agoraphobic and panic disorder patient.
I have tried to write this book from the patient's point of view. The most help to
my understanding was my association with Joni. Joni was a true victim of panic
and agoraphobia, who in spite of her fears, ventured out and found the answer
to her seven year quest. In the process, she taught me most of what I know of
the real suffering and agony the victims of panic go through.
For this reason, I dedicate this book to Joni.
HOW YOU CAN SUCCEED
Take a minute and think about it. What do you believe, indeed, what have you
been forced to believe about Panic Attacks? If there is anything in the world
which effects you so powerfully, and seems to be completely beyond your
control, it is Panic Attacks. One of the things people feel who have Panic
Attacks is that they are out of control of their own mind and body.
For this reason, a lot of what is in this book is about getting in control. As
reasonable and logical as it seems to believe that Panic Attacks are an
inevitable part of your life, I want to begin by assuring you that just the opposite
is true. Panic Attacks are not inevitable. They can be controlled. For a very few
people who read the first few chapters of this book and do the exercises,
success (meaning they will not longer have panic attacks) will be almost
immediate. For most people it will take a little longer.
This is written for those for whom it will take a little longer.
Joni started having panic attacks when she was 28 years old. She's now 36.
With the help of her husband she's raised a son, but for most of the last eight
years she stayed at home.
Determined to get out, she took a job at an agency which used computers to
keep track of credit reports. The first day, she sat at her work station nearly
paralized -- for about a half hour -- then ran out and frantically drove home were
she stayed for several years.
Joni tried everything, including alcohol, to find some relief from the attacks
which were a daily occurance, often more than once a day. The list of
medications for anxiety is impressive. She has been to emergency rooms more
than once. She experienced so much dizziness that her doctors gave her a CT
Scan to check for inner ear problems. When medical tests revealed nothing she
began to believe she had a tumor of the adrenal glands that was causing the
A few years ago Joni again tried to go to work, and as it happened she was in
front of a computer again taking care of the billing in an office. She wouldn't
admit that anything was wrong, but at times staying at work must have been
real agony. It so happened that Joni was working for me when I was
serendipitously introduced to the idea of Hyperventilation Syndrome and the
treatment which would help panic attack victims.
Together we found some people who were looking for help and started a group
in the next few months.
I asked Joni a few months before this was written how she was doing. She
replied in writing:
"I DO NOT have panic attacks anymore . . .for almost a year now.
A solution to this problem was and is a Godsend. Miracles can
really happen in the most unusual ways!!"
Joni mentions a miracle. If your are looking for the miracle that Joni is talking
about, it is the one which brought her together with the knowledge of what to do.
You too, now have that miracle. It is in the words which are before you at this
The real secret to Joni's success was just plain hard work. Since everything
else had failed to help her, she threw herself into the exercises with a vengence.
Like all the others I asked about their success, Joni still practices, as of this
writing, her breathing as she learned in the group.
Susan is one of those people who succeeded right away. Susan was never in
formal treatment with me for her panic attacks. She only heard me talk in a
group of people ONE TIME about hyperventilation syndrome and was unable
to come to succeeding weeks of the group in a mental health center because of
vacation plans with her husband.
Mostly I'm going to let her tell her own story as it came to me in a letter a few
months after she returned from her vacation and reported her success.
I am so happy with the results of learning how to breath
diaphragmatically. I wanted to share my experience. It has changed
my life for the better.
I have been a sufferer of panic attacks for over three years. I have
tried everything. I have been to doctors, had all kinds of tests, even
been into urgent care a few times. All they would tell me is that it
was stress. I finally got so that I could go through life as long as I
had my tranquilizers. But I would still experience panic, feel dizzy,
sick, out of control and worst of all a feeling like was loosing my
mind. The only thing that sort of worked for me was to take Ativan
and not do all the things in life that I really wanted to do.
It was while I was at a meeting in Redlands that I met Dr.
Anderson. I was very interested in what he was telling us about
diaphragmatic breathing. It made so much sense, I decided to give
it a GOOD try.
I first started by diaphragmatic breathing before I got out of bed in
the morning. I noticed that I seemed to feel less shaky and more
calm right away. At the time I was on the highest dosage of Ativan
that I had ever taken.
My family was planning a vacation so I took [the time] to practice
my breathing. Every time I could I would practice. By the end of my
vacation I had cut my medication down by two- thirds. I kept
breathing diaphragmatically every time I would think about myself
and how I was feeling, which is pretty often when you suffer from
When I returned to work, the stress returned too. But breathing
really helped. It really works! I did not want to go back on
I have had a few panic attacks since. But I try to catch it early. I
know this is hard. But there are signs of stress coming. I also know
after breathing diaphragmatically at least three times I could feel
the panic lift. And the best feeling of all is the feeling that I am in
I have been totally off medication now for one month. I am thrilled.
I have even been tested pretty good -- a trip to the dentist. I just
kept up the diaphragmatic breathing. I really believe in
diaphragmatic breathing. It has changed my life for the better.
The wonderful thing about Susan's letter is that she carefully spells out the
steps everyone who suffers from panic attacks should take. As spelled out in
more detail in the remainder of this book, these steps are:
- Decide to give it a GOOD try.
- Practice diaphragmatic breathing before getting out of bed in the morning.
- Practice several times during the day.
- Begin cutting back on your tranquilizing medication right away. But with the help of your doctor.
- Use inner cues to remind you to practice breathing.
- Stay off medication even when the stress increases. Continue to use diaphragmatic breathing.
- Become aware of the early signs and see how a few breaths will do the trick in turning the symptoms around.
There is a follow up to Susan's letter several months later which came in
response to my inquiry. She notes that she has the same ability to control
attacks as when "treatment ended" and that she doesn't have panic attacks
now. Thinking of others, she wrote as follows:
A person needs to stop and think at the first sign of panic what
might be triggering the attack and breathe to slow down the
Since the TENDENCY to have panic attacks may remain for some time after
the skills of controlling them have been mastered, it is important, as Susan
found on her own, to stay aware of early signs and breath to stop the symptoms.
All of the former patient's who responded to my questionaire about their
success noted that they continued to practice breathing as a way of controlling
their tendency to have attacks.
COMMON SENSE SUGGESTIONS TO HELP YOU SUCCEED
Be Willing To Take One Step At A Time
No, I won't say, "Rome wasn't . . . .", but I will say that like a lot of things, what
might seem simple at the outset turns into something requiring persistence in
the long run. As you've seen, Hyperventilation Syndrome is a complicated
interaction of many things. Several things must be brought together in order to
gain control and live without attacks.
You don't have to learn "perfect" diaphragmatic breathing to be able to go on
to the next step, but you should be able to mostly do it when you are thinking
about it before taking the next step. So give yourself some time and reward
yourself for a little progress at a time.
Learn To Work Within Your Limitations
For many people, having panic attacks and the fears and phobias which go with
them is severly disabling. They have a lot of limitations which have been built
up over the years.
Working within your limitations means that you will practice at those times you
feel best. If that's not very good, then accept it as your best time and do what
you can. Go slowly, if you're in this situation, it's been a very long time since
you felt anything close to normal.
The same applies to medications. What's good about them is that they allow you
to function, at least somewhat. You can taper off the medications that you now
take when you have gained some skills to recognize and control attacks. Right
now, the medications provide a window of opportunity which is helpful.
Don't Ignore The Spiritual Part Of This Problem
When Joni and I would rap about the struggles which she went through and how
panic attacks became the focus on her life, we both recognized the after
breathing, a Twelve Step program such as used by Alcoholic Anonymous would
Breathing will stop panic attacks just like stopping drinking will lead to sobriety.
Like the alcoholic, many panic attack victims suffer the consequences in terms
of personal isolation, having to manipulate others to get their way, and being
fearful of life in general. Don't overlook the self help groups available to you
and the spiritual teachings of your religion to help you with these attendant
"Spirit" and "air" mean the same thing. To inspire means to take in air or
spirit, to expire means to let go of air or spirit. The physical fact that we all live
together in a world filled with air, taking that air into our bodies several times
each minute and giving it back again to the universe has spiritual meaning. No
wonder breathing and being spiritual were seen by ancient people as closely
related. Even today, in some religious traditions, right breathing is understood
as an essential part of the spiritual life.
There is something else which comes to mind when I think of the problems
faced by people who suffer from panic disorder. This comes from my own
religous beliefs. It is "The pearl of great price." To obtain it, the finder has to
go and sell everything that he has in order to obtain the pearl. There was no
way to play it entirely safe. He or she had to take the risk.
How easy it is to play it safe. To stay at home. To do nothing. There must be
some pushing at the boundaries which this problem imposes. But it must be a
right pushing. To push too hard to function at a high level right away is one
error. To not push at all or be willing to persevere will lead to no solution at all.
Carefully follow the instructions outlined ahead. The Pearl of Great Price is
freedom. Freedom from panic attacks and all the limitations which they have
placed on your life for so long.
Chapter II: "Panic and Hyperventilation Syndrome"
What is contained in this book is a new. It will teach you a way to control and overcome panic attacks which is not yet widely known. It is what I teach people who come to me who are overwhelmed by daily, weekly or monthly attacks which are sometimes so terrible they think they are dying, going crazy or will do something horrible.
People who suffer from panic attacks can't come up with enough words to describe to others how out of control they feel when an attack "hits". They feel overcome by some lurking inner madness which periodically reveals itself. They live in fear of the next
attack, but also know that sooner or later they will be overcome just as if someone crept up behind them and put a black sack over their head, drew a tight cord around their neck and left them to struggle for air until they could claw the sack off and, exhausted, be free for awhile until caught once more.
Recently I attended a lecture on Panic Attacks presented by a psychiatrist. When he
began the presentation he asked the people in the audience how many of them had ever experienced a panic attack. A scattering of hands went up. He then admitted that he had also suffered from these attacks. At the end of the lecture, when asked to pin-point the actual cause of the attacks, he did not have a ready answer.
This book does have an answer to the question, "Where do Panic Attacks come from?" Is it the right answer? Researchers don't yet agree. It's a simple question, but the answer, I'm afraid, is far from simple.
There is, however, one very good thing about the answer which is given in this book. The treatment based on that answer works for people who seriously try it. Most are able to completely prevent panic attacks from occuring. All but a small percentage are able to be in control and reduce the intensity of attacks, and prevent most of their attacks altogether.
I have been counseling people with emotional problems for over 25 years. Like 99.9% of my colleagues, I was as confounded by the problems of people who sought out my help for their panic and the numerous fears and other problems which accompany this condition.
Just like many other physical and emotional problems, panic attacks probably are not caused by any one thing, or for that matter cured by any one thing. Also, people who experience panic attacks for any length of time become fearful (phobic), learn to avoid any situation where the attacks might be triggered or where they can't get help. Other reactions to getting safely through life develop to, some of which are very disabling in themselves.
Panic sufferers have to look at a three step process that goes like this:
The conditions or situations which set-up the eventual victim of panic attacks may
be multiple. Being an anxious person? Stress? (Many panic attack victims are told by the emergency room doctor that it's just their reaction to stress.) Diet? Bad breathing habits? Grief? A bad heart? Being a perfectionist? Unique brain chemistry? Tight girdles like women wore in the 1890's, or too- tight designer jeans nowdays?
All of the above have been implicated as possible existing conditions which make the person vulnerable to panic attacks.
There is some "thing" which triggers panic attacks. It might be an anxious thought or an anxiety producing situation. As I was making the notes to write this section I was sitting at the kitchen on a warm summer morning with the back door open, our Golden Retriever laying nose-on-paws looking languidly into the sunshine. Suddenly, without any warning, he was on his feet, rushing out the open doorway, barking loudly. I jumped in my chair in
reaction, saw it was nothing and went back to my notes. For some people with the right preconditions, that might have been more than enough to start a sequence which would sooner or later lead to a panic attack.
Panic attacks are not preconditions or triggers. In the frame of reference of this book,
the panic attack will come to be understood as something which comes about because of preconditions and triggers, but which can be treated by itself. As you will see in a few pages, attacks are undoubtedly physiological reactions, over which, when we know how, we have a lot of control.
FEARS AND COPING REACTIONS
The fears, anxiety, phobias, social isolation, need to control others and even ritualized obsessive-compulsive behaviors are the most destructive part of the panic attack cycle. Increased anxiety is to be expected at the very least. Anxiety, remember is one of the pre-conditions. In this way the cycle of preconditions, triggers, attacks and fears-anxiety are kept going.
People who have experienced attacks for any length of time usually consider themselves to be anxious people. But is anxiety the chicken or the egg? Was it a precondition which existed before the person ever had an attack? Or, is it the result of having been through emotionally wrenching experiences time and again, sometimes for years or decades? As you will see, it may easily be a result rather than a cause.
Now let's begin to look at some examples which makes all the theory understandable.
John was a patient who was referred to me to undergo therapy to help him with intense anxiety. His managerial job forced him to make presentations at meetings and before groups. At these times his panic became so intense, he was ready to quit his job. After John left my office, I reached for a new professional book which had just arrived in the mail. I opened it and began to read to see if there was anything new that would help me understand how to
help my new patient. I was fascinated. The author of one of the chapters, Richard Ley, described John's problem exactly.
Lay's article was titled, "Panic Disorder, a Hyperventilation Explanation." It became
clear that John hyperventilated and that led to his feelings of panic when he was called on to lead a meeting or talk to groups. He had begun to fear these attacks so much, he was willing even to quit his job to avoid being put in this position.
The Pre-existing condition for John was that he was, by now, habitually anxious because he good reason to fear a panic attack. He had developed that fear from the time he had the first attack. The pre-condition of the first attack probably was a faulty breathing pattern and not some underlying psychological condition.
The Trigger was knowing that he had to make a presentation or lead a meeting. John
had come to fear the fear. His anxious breathing pattern was keeping him on the edge of hyperventilation and the Trigger was enough to push him into apprehension and finally Panic-Fear.
John's Coping Reaction was to protect himself from the Trigger. He had decided he
would quit his managerial job and go into another line of work This was an instance when Science had finally caught up with a problem. Good science rarely makes startling discoveries. Ley had not "discovered" hyperventilation. His article contained an extensive bibliography of papers and books.
Many people who write today about panic attacks go back to an original scientific article titled, "Hyperventilation, The Tip of the Iceberg," written by Dr. C. M. Lum in the late 1970's. Over 2,000 patients had been admitted into his program at Papworth and Addenbrook's Hospitals in Cambridge, England, by the mid 1980's. 95% of these patients were not only helped, most were cured.
After thirty years and 2,000 patients, Doctor Lum concluded that "faulty breathing"
perhaps along with being a perfectionist if you were a woman or a "Type A" if were a
man, was the real root cause of hyperventilation and panic. After many years of faulty
breathing ---> anxiety ---> hyperventilation ---> panic, you can hardly be blamed for
thinking of yourself as "anxious". By now "anxious" has gotten to be a habit.
It was late in the day when a frantic mother called about her daughter. She had been
having a panic attack for most of the day. She had gone into convulsions, the mother told me. They were afraid of going one more time to the emergency room of the local
hospital. The doctors were definitely not sympathetic. Traci had been there more than once previously. A few weeks before, she was so agitated that she had been given injections of a powerful tranquilizer before she could calm down. She was told that unless she was able to get control of herself the sheriff would be called and she would be taken to the psych ward of our County Hospital. The tranquilizer affected her speech and she was uncoordinated
from the effect of the medication when I saw her four days later.
When mother and daughter got to my office, Traci was gasping for air, she could hardly walk and the muscles in her face were twitching. Her eyes were glazed over from fear and exhaustion and her pupils were dilated. She was unable to concentrate on anything for more than a few seconds, and that made helping her very difficult. What she needed was to get control of her breathing. Little by little, I helped her slow down and deepen her breathing. After
an hour, she was weak but calm. She had gained moderate control.
The panic had passed.
In the throes of a Panic Attack, people usually experience difficulty breathing. Usually,
the breathlessness is thought to be caused by the attack. It is one of the many recognized symptoms of an attack. What is unrecognized is that actual symptoms of panic attacks are brought on by the way the person normally breathes. The breathlessness and gasping experienced during an attack is an extension of a problem which began very quietly and unawarely.
When Tracy first visited my office to begin her training in controlling the attacks, I could not see her breath at all. When I attached a stretch band around her abdomen and put some sensors on her neck and shoulders, all connected to a computer, I could then see her breathing. Only when I looked at the computer screen and saw the graph that was being made from what was being picked up by the sensors. Her breathing was shallow, rapid, erratic, and
she was using only the muscles in her neck and upper chest. Her abdomen wasn't moving at all. She was breathing at a rate of 22 breaths per minute, about twice as fast as is considered "normal".
Tracy, like other victims of panic attacks, shows all the characteristics of
hyperventilation syndrome which were recognized by C. M. Lum. Here's the list of
They take air into their lungs by using their chest muscles.
They don't use, or only partly use their diaphragm when breathing.
They usually breath rapidly and shallowly, so it is hard to see them breath unless
they sigh or are requested to take a deep breath.
HABITUAL rapid, shallow breathing (something of which the victim is usually not
aware) keeps the important level of carbon dioxide too low all of the time.
Panic Attacks are triggered by anything which results in more rapid breathing and
drops the carbon dioxide level below a critical point, causing increased
apprehension leading to panic-fear symptoms.
A person is said to hyperventilate when the way they are breathing results in them
loosing carbon dioxide from their blood faster than it is being manufactured by the
THE CRITICAL ACID/BASE BALANCE (pH) OF THE BODY
What most people don't know, is that breathing is what regulates the acid/base balance of the body. The amount of air we inhale and exhale is continually adjusting by the needs of the body to maintain a constant point on the scale between acidity and alkalinity. What the amount of carbon-dioxide we exhale has to do with the acid/base balance (base and alkali mean the same thing) is that when carbon dioxide is dissolved in water it makes the water
more acid. Since the blood and the human body is 70% water, the right amount of carbon dioxide is essential to maintaining that balance at just exactly the right level.
Maybe you can see that this discussion is already getting too technical. Unfortunately, for the understanding of the people who have panic attacks, it can get a lot more technical.
Here's a summary of what you should know:
The right amount of carbon dioxide manufactured by the body remains dissolved in
the blood before it is eliminated by breathing.
It is the amount of carbon-dioxide dissolved in the blood which regulates the
The acid/alkali balance of the blood is, normally, very slightly alkaline.
A slight shift either in the direction of the blood becoming too acid or becoming too
alkaline can have serious consequences.
The consequences can be, and too often are, panic attacks.
WHAT HAPPENS DURING PANIC ATTACKS
Panic attack sufferers are most interested in what happens in the body when too much carbon-dioxide is breathed away and the blood becomes too alkaline.
Just to put it as simply as possible, the following are effected as the blood becomes more alkaline, a condition known as "blood alkalosis."
THE BRAIN: Breathing control centers are effected along with the panic
victim's ability to think clearly. As the condition worsens, the brain
processes information from the body too rapidly or not at all. Wrong signals
or none at all are given as the brain shifts into "emergency". Clear thinking
THE SYMPATHETIC AND PARASYMPATHETIC NERVOUS SYSTEM:
Adrenaline is discharged into the system, pupils tend to dilate, hands and
feet get cold, and there is a tendency to sweat.
THE HEART: Reduction of the oxygen supply to the muscles of the heart,
changes in the electrocardiogram, increase in heart rate, and increased
blood output by the heart. Blood pressure may be affected (in either
direction) to the point of causing the person to faint, a condition called
THE OXYGEN TRANSPORT SYSTEM: The red blood corpuscles give up
their oxygen to the muscles and organs of the body, including the brain, less
easily. Starved of oxygen, the person feels weak, confused and, rightly, feels
like they are suffocating.
That's probably more than enough to convince you that when the blood alkalosis gets
serious, you are going to experience that a great deal is wrong. For more information on
any or all of these points, there is a Bibliography of the references mentioned in this
chapter which can be consulted for more complete information.
SUMMARY OF WHAT CAUSES PANIC ATTACKS
Panic attacks and Hyperventilation Syndrome are two terms for the same thing.
Over-breathing creates a shift in the acid/alkaline balance of body in the direction
of being too alkaline.
The physiological and mental consequences of the brain, breathing, heart and
oxygen carrying capacity of the blood and what results from all that are, in reality,
what we call "Panic Attack!"
THE MEDICAL APPROACH TO PANIC ATTACKS
In spite of decades of research and successful treatment programs, your physician
probably doesn't yet know about the promise which the methods discussed in this book hold out for you. A paper published in New England Journal of Medicine which focused on the increased risk of suicide among people who suffer from Panic Disorder did not mention hyperventilation or suggest treatment protocols which utilize this explanation for the symptoms.
Probably the reason that the medical profession is not up to speed when it comes to
treating panic attacks, is that virually all medical practice for this disorder is focused on which drugs will do the job. Books written my medical doctors for people who have panic attacks, enthusiastically focus on the advances in drug therapy. The treatments used by those who have studied Hyperventilation Syndrome have nothing to do with drugs.
There are problems with some medications most used by physicians to treat panic
attacks. They are physically addicting after a very short time. The side effects bother
many people. And they interfere with the ability to learn or recall what you have learned.
THE STEPS TO OVERCOMING PANIC ATTACKS
The methods for overcoming panic attacks which are detailed in coming chapters are not the invention of any one single person, but have evolved over the years. These methods are based on observations, research and clinical practice which has taken place in hospitals, universities and the practices of many disciplines.
Now that you have been introduced to what is causing the symptoms which you
experience and call "panic attacks", it is time to get down to how you breathe now, how
you should breathe to prevent panic attacks, and what to do to train yourself to do
These are the steps as presented in the chapters to come:
CORRECT BREATHING, HOW YOU BREATH NOW, BEGINNING TO CHANGE
While you are practicing the beginning exercises, talk to your doctor about how to
reduce medication particularly if you are using any anti-anxiety medication known as
WARNING: Don't discontinue any medication without your doctor's advice.
Some drugs require supervised withdrawal in order to avoid withdrawal reactions such as seizures.