Tremendous panic is frightening and overwhelming - but no-one has ever died of a panic attack! It's acute anxiety that creates the frightening symptoms of breathlessness, 'butterflies in the stomach', palpitations, choking or dizziness, not heart disease or some other disease.

All these symptoms are just signs of a hyped up nervous system, but as psychotherapist Martin Jelfs says, "In a panic attack people focus on the physical sensations rather than seeing them as a sign that something is wrong". Attacks seem to come out of the blue - but according to The National Phobics Society they are usually a delayed reaction to major life changes like bereavement, divorce, or having a baby. They can also be the consequence of a long period of stress, when background anxiety and insecurity - really 'fear spread thin' - can suddenly erupt into overwhelming panic.

Anything can act as a trigger - from being in closed spaces or the dark, but it's more often due to the fear of fear itself! The fear that a panic attack could erupt at any moment often stops sufferers venturing far from home - or staying anywhere without an easily accessible exit.

Jelfs sees the constricted breathing typical in a panic attack as a symbol of resistance to the 'unconscious' psychological material threatening to erupt into consciousness. 'Anguish' comes from the Latin for narrowing/choking, and he suggests that feelings of anguish explain the sensation of constriction in the throat. Of course, feeling that you can't breathe properly is guaranteed to bring on panic.

Regardless of which is the chicken or egg, breathing techniques are vitally important in managing panic attacks, since feelings of panic are always aggravated by hyperventilation. Setting up a regular relaxation routine is essential for those who find themselves locked into a spate of panic attacks.

For Mooky, a 58 year old ex-nurse who is now a yoga teacher, it was yoga that helped her the most.

Mooky found herself battling with panic attacks shortly after arriving in London from South Africa, when she was 34.

I've noticed that many women develop panic attacks when their children grow up and get involved in their own lives. Just as Mooky felt her family didn't need her in the same way, many women find the transition from motherhood very difficult. In some ways panic attacks can have unexpected 'secondary gains' - for instance in limiting the choices available. Such gains can keep sufferers locked in a cycle of panic attacks for years. But as psychologist Elaine Sheehan emphasises, the answer is not to avoid stressful situations but to develop more effective strategies at coping with life. At the first sign of avoidance behaviour designed to limit difficult situations or activities in your life, you need to seek help.

For many people, the source of panic attacks can be found in experiences that happened years earlier. In my homeopathic practice, I've noticed they're often related to loss of a parent, or an experience where you face your mortality, such as a car accident. In Mooky's case, her beloved father had a massive heart attack when she was 18. "I was devastated. But I didn't have time to grieve, because suddenly I had to grow up, and support the rest of my family" Such traumatic life experiences can leave traces of shock in the body, which can lead to panic attacks if you experience further shocks in later life.

When I asked her, Mooky recalled "Around that time my husband suddenly collapsed on the bathroom floor. It turned out to be only a blood sugar crisis, but the whole family was thrown into a panic because it reminded us of losing my father. A lot of feelings of grief resurfaced, and I was very upset for a couple of years."

If feelings of shock aren't expressed at the time, we can become stuck in a state of fear, reinforcing it through the fearful reactions we have to normal living. According to Peter Chappell, author of Emotional Healing with Homeopathy, homeopathic remedies help you step outside this closed loop as well as recover from the original trauma.

BOX

Homeopathic remedies for fears and phobias;

Aconite: Use for panic attacks that have started after a shock - being in or witnessing a nasty accident. The shock results in panic attacks at night, on going to sleep. Fear of dark, and great anxiety about being left alone. Claustrophobia. Can't drive any more. During the panic convinced that death is imminent.

Stramonium; Panic attacks after some violent confrontation - a mugging or physical attack. The feeling is one of pure terror. Hate to be alone, especially at night. Usually too afraid to sleep without the light on. Terrifying nightmares as well.

Arsenicum album: Use for panic attacks with hypochondria. Every little twinge is assumed to be a symptom of the disease - regardless of how many times doctors give reassurance that nothing is wrong. Neurotic anxiety that loved ones have been involved in an accident when they're only late home. Hates to be alone.

Argentum nitricum: Panic attacks with agitation. Feel very hurried and anxious, with fears manifesting almost as impulses. For instance in a high place, there's a feeling of being drawn to the edge. Compulsive thoughts that something terrible will happen - for instance, if they stand on a crack in paving stones. The panics become much worse when anticipating a meeting.

Dosage. Take 3 doses of the 200 potency over 24 hours. The tablet should be allowed to dissolve in a clean mouth - don't drink anything, or eat, for at least half and hour before or after taking each of the three doses. Don't take any more than three doses without the guidance of a professional homeopath.

 

Sometimes, dealing with panic attacks can mean major life changes are needed. Stimulants don't help your wound up nervous system. So, stop all caffeine and tobacco, and reduce sweets and alcohol. Eat a varied, well-balanced diet including lots of fresh fruit and vegetables. Daily relaxation, exercise, and fun are all essential.

Robin Monro, director of the Yoga Therapy Centre recommends daily practice of yoga, which includes breathing techniques, postures, and techniques for deep relaxation. "Panic attacks are a habituated response to anxiety, which you can break either by reducing anxiety or muscular tension in your body. Yoga does both." Regular practise of breathing techniques will usually bring about improvement within a month, but to make deeper changes you will need to make wide-ranging changes to your life-style, building in activities that replace a negative, fearful mindset with a positive attitude. Monro believes that creating a life-affirming social or spiritual connection is also vital. "It's important for those with panic attacks to know they're not isolated individuals struggling alone, but to know they're part of the whole pattern of life. We all need a sense of oneness."

Remember, none of these techniques work like magic. According to psychologist Elaine Sheehan, you really have to work at changing your negative frame of mind - often literally reprogramming it with positive thoughts to replace your fears and anxieties. Remember to build on each success, no matter how small it might seem at first. Don't get put off by set-backs. Your goals need to be realistic.

Immediate self-help

• Bach flower remedies. Rescue remedy can be taken at the first sign of panic. Just put 1 or 2 drops on your tongue.

• Abdominal Breathing. Being aware of the movement of your abdomen is very helpful. Rest your hand between your lower ribs and belly button, and be aware of the way your hand moves. If you feel panicky from the pressure of your hand, just be aware of your breath. Counting it will help you focus your attention.

• Getting rid of negative thoughts. As you breath out, imagine you are dispelling all your panicky feelings and anxious thoughts in a black cloud. As you breath in, imagine you are breathing in a cleansing white light.

• Standing with your shoulders still, take a slow, deep breath. As you inhale, imagine that you're drawing the air in through the tips of your fingers, up your arms and into your chest. As you breathe out, imagine you are exhaling down through your trunks, down your legs and out through your toes. As well as slowing down your breathing, this extends the out breath.

Relaxation

• It's important to take time out very day to relax. Even a daily walk in your local park will help. Try yoga, meditation, or anything that appeals to you.

• Regular massage will help ease muscle tension. Aromatherpis Cathy Tabakin suggests adding no more than 5 drops of a calming essential oil to a massage oil base. Try lavender, neroli for acute anxiety, or ylang ylang for palpitations.

• Aromatherapy oils such as Lavender, marjoram, cedar wood, rose, frankincense, neroli, true Melissa, ylang ylang can be sniffed straight from the bottle. You can add a few drops to a bath. Or put a few drops in a little water over a candle burner to scent the room.

Reprogramming negative thoughts.

• Stop technique. Negative thoughts become habitual and self-fulfilling. Notice when they come up, stop them, and replace them with more appropriate or realistic thoughts.

• Self-affirmations. Instead of thinking 'I'm going to die' or 'I'm going to have a heart attack' reassure yourself. 'I know these feelings will pass. They're just physical sensations - there's nothing wrong with my body. I've survived before and I will get through this too.'

• Visualise yourself reacting differently. If you tend to have panics in a lift, visualise yourself calmly getting into a lift and travelling between floors in a serene state. Visualise yourself leaving the lift feeling relaxed and happy.

• You can use self-hypnosis to reprogram your behaviour. In a very relaxed state repeatedly read out to yourself auto-suggestions that 'I will feel calm and constant' in a situation that would normally trigger a panic response.

 

 

Anxiety, Phobias and panic attacks by Elaine Sheehan (The Element Guide, 1996)

Yoga for common ailments. by Dr R Monro, Dr Nagarathna & Dr Nagendra. (Gaia Books 1997)

Emotional Healing with homeopathy by Peter Chappell . Element Books 1994.

The National Phobics Society run a help-line and offer person-centred counselling, as well as hypnosis. They produce a newsletter which keeps members updated on medical research developments and the use of complementary therapies.

Send an SAE to 26 Kensington Road, Chorlton cum Hardy, Manchester, M21 9QJ (can we arrange a link to this organisation)

Yoga Therapy Centre run classes. Provide tapes for deep relaxation, and their book called Yoga for Common Ailments. List of yoga therapy teachers through country. (link???)