by Jennifer Lee
In one of his late novels, The Winter of Our Discontent, the Nobel Prize-winning author John Steinbeck offers a very different approach to managing panic and rumination. Like the soldier in Sassoon’s poem, the speaker here is someone who is struggling with feelings of “shell shock” – a psychological reaction to war that we would now consider to be a form of post-traumatic stress disorder. The speaker is a former commanding officer of the narrator of the novel, back when he was in the army, and he offers interesting words of advice about how to prevent oneself from being overwhelmed by “ugly thoughts” of wartime experience:
Trouble is, he says, a guy tries to shove it out of his head. That don’t work. What you got to do is kind of welcome it. […] Take it’s something kind of long – you start at the beginning and remember everything you can, right to the end. Every time it comes back, you do that, from the first right through to the finish. Pretty soon it’ll get tired and pieces of it will go, and before long the whole thing will go.
Even though he was writing in the early 1960s, long before modern clinical therapeutic practice, Steinbeck had stumbled by intuition onto one of the most important insights of modern psychotherapy. Paradoxical as it may seem, the best way to halt rumination or panic is to “welcome” both mental states, just as the character quoted above advises us. Allow them both to happen, remember that they are not actually dangerous, and see what happens.
For psychotherapists working with depression, this method has come to be known as acceptance therapy. In essence, it simply means that when one notices that one is ruminating, one should not try to stop ruminating. Instead, simply notice that one is ruminating and tell oneself that it is okay. Tell oneself that rumination does not have the power to harm you and that you will, therefore, simply let yourself ruminate for as long as it takes. In other words, accept the rumination.
Applying the method of Steinbeck’s commanding officer is an interesting way to reach this state of acceptance. Rather than trying to prevent oneself from ruminating on a frightening or upsetting topic that is trying to force itself onto one’s awareness, actively try to think the whole topic out from start to finish.
While everyone’s experience is different, chances are you will find that your rumination has nothing to proceed on, as soon as you are no longer blocking it, but actually encouraging it. It is as if rumination feeds on resistance, and as soon as you relax and welcome it, it disappears.
A very similar method has been shown to be remarkably effective in managing panic attacks – including in the author’s own personal experience.
Very often, feelings of panic are associated with a frantic effort to escape, as we have seen. One feels that one must make an instantaneous decision in order to protect oneself. This is the essence of the basic “fight or flight response” that all animals enter when they are in a position of perceived threat or danger.
Just remind yourself once again that panic attacks are not actually dangerous, and that it is safe to allow the panic attack to take place. Remember as well that panic attacks are nearly always quite short. A panic attack does not exceed ten to fifteen minutes in duration, and they are nearly always shorter events than that. Even if the panic attack is an unpleasant and uncomfortable experience, you are not putting yourself in any danger by simply allowing the attack to unfold.
You will eventually find that the panic will subside, and you are still perfectly safe and sound. Moreover, you may even find that the panic never comes. You may discover that the tense process of trying to avoid the panic attack, in reality, was the panic attack, and by opening oneself to the possibility of panic, one has actually robbed it of its power.
In psychotherapy circles, this approach is known as “riding the wave.” It is essentially exactly what it sounds like. Instead of trying to swim against the current by halting one’s anxiety, you can simply ride it where it takes you. It will not ever take you to a dangerous place.
In short, 1) try to accept and not oppose the panic attack; 2) remember that you will not die from a panic attack; and 3) remind yourself that it will all be over soon – at most in ten minutes from now, but probably sooner.
When “Riding the Wave” is not Enough…
Simply “riding the wave” of a panic attack can sound like a tall order. For most of us, it feels like an unnatural response to simply sit and allow something scary to happen inside us. Indeed, trying to tell oneself to accept and not oppose a panic attack can itself become another form of trying to “control” one’s emotions, instead of welcoming them.
This can lead back to the same kinds of anxious thought patterns we have been discussing throughout this book: Why can’t I accept this panic attack? Why is this panic attack still happening even though I tried to accept it? The usual methods must not work on me. I’m not like other people. I’m doomed to suffer from this problem forever.
Here, the insights of people who practice meditation, as mentioned in the previous chapter, can be very helpful. Many meditation guides – including those associated with the Buddhist religion – encourage the person meditating to assume a non-interventionist posture to their own thoughts. This means that instead of trying to empty their minds by brute force – which is what some people assume meditation must involve – the person meditating should simply allow thoughts to enter their minds and notice them without trying to change them.
People who are new to meditation, however, often misapply this advice. They may find themselves thinking things like “I wish I wasn’t thinking about that.” They then realize this thought violates the instructions, and they start to reproach themselves for not being perfectly open to new thoughts. What they forget is that the thought “I wish I wasn’t thinking about that,” is also just a thought. If they follow the instructions, they will remember to welcome this thought along with the others, instead of trying to fight it.
Something similar applies to people experiencing panic. We have seen that trying to “control” your emotions often backfire. You cannot simply “force yourself” to calm down in the hopes that the panic attack will “disappear.” Most of us know this from our personal experience. If you have ever been angry, you know that it does no good for someone to tell you to “just calm down.”
Nevertheless, because people often struggle to understand or empathize with anxiety if they have not experienced it themselves, you may have often received unhelpful advice of this sort from people around you when you are in the midst of a panic attack. How many times, while panicking (or ruminating, if you struggle with depression), have you been told to “just let it go” or to “think about something else”? People with anxiety know that this is easier said than done.
All of that is true; however, it is also true that there are simple methods you can apply in the moment of a panic attack that will help mitigate and manage the intense emotions you are feeling. Again, it is important to note that these are not devices to “control” your emotions or to “force” yourself to stop panicking, but quite the opposite – they are ways to help you retain an open and accepting attitude toward yourself and what you are feeling.
So, while you are reminding yourself that it is okay to “ride the wave,” and that you are not in any danger no matter what happens with your emotions, you can also apply the following remedies and solutions during a panic attack:
Engage in simple behaviors or actions that are countervailing to your anxiety and that “cut against the grain” of your panic. Remember above, when we discussed the essay by William James called “What is an Emotion?” James, a famous American philosopher who is best known for helping to invent the philosophy of pragmatism, argued in this short essay that an emotion is really a physical response, rather than a purely mental “internal” state. Applying this insight, we can see that by altering our physical responses, we can also change what we “feel” is happening to us emotionally. In the case of a panic or anxiety response, this means deliberately doing the opposite with your body of what your panic is telling
you to do. Perhaps you are thinking anxious thoughts, and you notice that you have tensed your muscles, balled up your firsts, and squared your shoulders. Try simply letting your hand fall open and resting it palm up on your lap instead. Perhaps you notice that you are chewing your fingernails or running your hands through your hair. Try just leaning back in your seat, leaving your hands open on your legs, and staring out a window. You will be surprised by how much calmer you feel within minutes – or even moments – of doing something with your body that is different from what your anxiety normally dictates. You may not be able to “control” your emotions internally, but you can control your outward bodily actions in response to your emotions, and these actions, in turn, influence what you are feeling. This is one of the core insights of cognitive behavioral therapy. At the moment – and almost immediately – you can change your emotional response by changing what you are doing with your body.
Monitor and alter your breathing. As we saw above, hyperventilation is a major physical cause of panic attacks. Because they are breathing so quickly, people who are hyperventilating are expelling carbon dioxide through respiration faster than they can replenish it. This, in turn, causes them to feel as if they can’t get enough air, which causes them to breathe even faster, making the problem worse. The good news is that by simple practices of breath control, you can quickly lower your anxiety levels, bring down your panic, and eliminate hyperventilation. Remind yourself to simply try breathing slowly and deeply (not through shallow chest breaths, however, but through deep, belly breaths – discussed above – known as diaphragmatic breathing). Ideally, you should aim for about six breathing cycles a minute. If you have reached this rate of slow breathing, your panic and anxiety levels have probably also been significantly lowered as well. You can try taking out a stopwatch (either a physical one or one on your smartphone) and counting the number of times you breathe each minute until you get down to only six respiratory cycles (inhale and exhale) per minute.
Distract yourself, talk to someone near you, call someone on the phone, play a game, or something else to take your mind off the attack. You may be thinking in response to this – “how could I possibly talk to anyone else or do anything else? – I’m panicking!” Just remember though what we said above. Your panic is not visible to others, even though inside you, it may be the most important thing that’s happening. Moreover, you are more in control of your behavior than you think you are. Even in the midst of a panic attack, you are actually still consciously controlling your external actions. Therefore, try a few simple activities to distract yourself from your feelings of panic. The purpose of doing so, it is important to note, is not to “shut down” your anxiety. As we have seen time and again, forcing yourself not to panic goes nowhere. The purpose, rather, is to find a way to stay grounded in the present. Panic preys on the inescapable truth that the future is unknowable. While we can predict certain things fairly well, there is always an element of chance in human life, and we cannot know everything that is going to happen to us in advance. This is why the future can be scary. The way to halt or mitigate a panic attack, therefore, is to return one’s focus to the present and to realize that nothing scary or dangerous is actually happening in the here and now.
Other specific ways to stay focused on the present. Let me offer an example that I use to help manage my fear of airborne turbulence during a bumpy plane ride. It used to be the case that I felt very helpless and frightened when a plane entered a patch of turbulence. Each time the plane would go over a bump, my thoughts kept leaping toward the unknowable future. “What if the next bump is even bigger?” I would think. “What if they just keep getting bigger and bigger and never stop? What if it’s just like this for the whole rest of the flight?” A helpful technique I learned through cognitive behavior methods is to focus on each bump as it happens, not on hypothetical future bumps. When a bump goes by, try to rate it on a scale of 1 to 10, with 1 being a minor bump, and 10 being the most frightening bump you can imagine. You will quickly see that the worst bumps you imagine never come, and a surprising number of the bumps you used to find so scary in the past are actually now in the 1 to 2 range. I have been playing this game for years now, and have flown all over the world on numerous plane rides, and I don’t think I’ve ever ranked a bump higher than 4.
A very similar method applies to manage all forms of panic. Instead of focusing on anxious thoughts of “how bad might my panic attack get in the future” – which you can’t know because this question has no knowable answer – focus instead of ranking the level of fear you are actually feeling in the present. You might even try the 1 to 10 “scoring” game, trying to rank each wave of panic as it comes to see how bad it actually is. Chances are, you will find that you never rate anything very highly, because you have already trained yourself not to focus on the key driver of panic – the unknowable future – but to stay with the present, where you realize you are in fact perfectly safe. This 1 to 10 “scoring” technique was invented by Dr. Martin Seif – a psychotherapist who specializes in treating fear of flying through cognitive behavioral methods – and he recommends it as a simple way to stay anchored in the present.
The Author’s Experience, Part II
If you are struggling with panic and anxiety, it may be difficult to believe that the path to ridding oneself of these conditions can really be as simple as some of the methods described in this book. Given how much pain and discomfort these conditions cause, is the path to freedom really that easy and direct?
Every individual’s experience is different, of course, but it might be helpful at this stage to return to the author’s experience. In the first chapter, I explained how, over a period of several years, I gradually came to feel more and more hemmed in by my feelings of anxiety. At the age of twenty-five, I found it “impossible” to set foot on an airplane, and the prospect of even taking a subway filled me with a certain degree of dread.
At around this time, however, two things happened that made me want to change this situation. A job opportunity opened up that I was very excited about, but I knew that taking it would eventually require me to travel by plane. Secondly, my family wanted to take a trip together to Iceland, and I did not want to be left out.
I suddenly became very tired of being limited by my anxiety. I wanted to do the kinds of things I had done in the past without a second thought – things like traveling and taking up exciting offers. I wanted to do things that other people found it easy to do. In short, I wanted my life back. I wanted to lead my full life again.
I started researching online about methods people had found to overcome anxiety, and I discovered the writings of Dr. Martin Seif, mentioned above. His work introduced me to the basic concepts of cognitive behavioral therapy, and the methods he prescribes worked wonders in enabling me to gradually regain my ability to travel and see the world.
The first important insight I gleaned was one we have already discussed above, in treating the methods of cognitive behavioral therapy. I realized, in short, that I did not have to start by tackling the one thing I dreaded most. I didn’t have to just “suck it up” and get on board an airplane. Instead, in the months leading up to the Iceland trip, I could work my way up to this challenge through stages I found less intimidating.
I was mildly uncomfortable with taking the train on my own, for instance, but I did not find this “impossible,” so I experimented for a few days with simply taking the subway long distances. I visited the art museum. I went to the tallest building in the city and rode on an elevator to the highest floor.
I realized as I did so, that I actually felt empowered by allowing myself to do something I had been afraid of before. This was surprising to me because all that time, I had been afraid of losing power, afraid of losing control. I was worried that if I put myself in a situation, I found “scary,” then I would panic and lose control of my emotions.
What I found instead, however, was that as soon as I started putting myself into situations that I fo
und mildly scary, I felt more empowered, and more in control, than I had in years. I had proved to myself that I could still choose to do things, even though I found them frightening. My panic was not in control of my actions and my life. I was in control.
Pretty soon, I started to look forward to these moments when I was placing myself in a situation that I had previously associated with panic. They became opportunities to prove myself and reclaim power over my life.
My next step was to sign up for a helicopter ride. My sister kindly agreed to go with me. We lifted off and were airborne for only a few minutes. While I had been very afraid just before the trip, however, I realized as soon as we were aloft that I felt great. I had done the one thing I feared the most – I was in the air.
After that, it was a simple step to taking the plane ride to Iceland. And more importantly, once I had realized that I could fly on airplanes and nothing bad would happen and that I would not panic while doing so, I realized that I was capable of surviving a panic attack anywhere. If it did not trouble me in the one place, I was most afraid of. I could handle it anywhere else as well.