It’s 6 p.m. on a September evening in 2001 and I’m driving our minivan on a Toronto highway, heading to dinner at my parents’ house. My husband has been in Bermuda for three weeks, where he has landed a two-year contract, and he’s looking for an apartment so I can join him. Now it’s just me and my little black poodle, making the half-hour drive I’ve done hundreds of times.
The top story is on the radio: the 9/11 terrorist attack. It seems like I can’t get away from the shocking news. As I approach a bridge, my heart suddenly starts beating rapidly and my legs turn to jelly. You’re going to drive off the bridge, a voice in my head warns. Now, my arms are numb. You’re about to lose control and die. I’m terrified. My hands grip the wheel — I just want to make it over the bridge and to an exit. I do, and then pull into a parking lot and start to cry.
What is happening to me?
I tried driving on the highway a week later and, again, panic drove me to the first exit. After that, I took only smaller, slower roads. Weeks later, I moved to Bermuda, where we didn’t have a car. I was so relieved. I hadn’t told my husband about the episodes — I knew he loved my independence and strength, and I felt ashamed of being so weak.
To get around, I rode on the back of our motor scooter or took the bus when I went somewhere on my own. I did this often over the first couple of months, but one day, when I rode the bus into town to do some Christmas shopping, my heart started racing. Sure enough, next came the sweating, the jelly legs and the feeling that somehow I’d lose control or “go crazy.”
I hadn’t reached my destination, but I rang the bell and, in tears, walked home, where I felt safer. A few days later, I tried the bus again and the same thing happened. The thing that had forced me to avoid highway driving was now forcing me to avoid public transit.
Panic attack symptoms
It was time to come clean. That evening, I told my husband what had been going on. He was sympathetic. I shouldn’t have kept it bottled up because it felt good to let it out, but he was as mystified as I was. We searched online for “fear of highways” and “fear of public transportation” and got lots of hits, which is when we learned that the episodes were classic panic attacks.
Unlike fear, which is a reaction to an actual threat, panic is intense fear in the absence of real danger. Those who suffer from panic attacks often report recent stresses, such as getting married or divorced, moving, getting or losing a job, financial difficulties and health problems. For me, the stressor was my upcoming move. Plus, I hadn’t been sleeping well — sleeping poorly can make us more sensitive to anxiety-related events, such as a rapid heartbeat. Panic attacks occur when the brain identifies those events as signals of extreme peril.
“Humans are hardwired to survive,” explains Dr. Eilenna Denisoff, a clinical psychologist and director of CBT Associates in Toronto. “The fight-or-flight response allows us to run faster and jump higher if we’re being chased. Physiologically, then, the brain’s reaction to the rapid heartbeat ‘danger signal’ is to move blood from the limbs to protect the core.” (This explains the feeling of your limbs turning to jelly.) The person isn’t actually in danger, but the brain misreads those signs as a need to flee.
Because the symptoms make you feel like you’ll die, the first attack can lead to panic disorder, says Dr. Denisoff. “Your brain looks for situations where you should be fearful or feel trapped.” You begin to fear fear itself.
It was time to tackle this — I wasn’t about to let something terrorize my life without fighting back. I’d read that it helps to talk about it, so when I was back in Toronto for a visit, I told my best friend Lindsay and her husband, Todd, about the attacks. Lindsay looked at Todd with wide eyes and then said to me, “Todd went through that a few years ago!” When Todd was 28, he’d just taken over the family business and was feeling very stressed. One evening, when he was at a restaurant, his heart started pounding fast — he thought he was having a heart attack and went to his doctor.
The doctor said, “It sounds like you had a panic attack.” He referred Todd to a psychiatrist, who gave him a prescription for Ativan, an anti-anxiety drug that you take when panic symptoms start. Todd took the medication and avoided restaurants, but then a panic attack hit when he was in an airport lounge.
He learned relaxation techniques, including deep breathing. Eventually, the frequency of attacks lessened and then disappeared, so he stopped taking the medication. “The drug was key, and reading up on panic attacks really helped,” he says. He gave me his copy of Living with Fear: Understanding and Coping with Anxiety by Dr. Isaac M. Marks.
Back in Bermuda, I dared to get back on the bus, with the book in my handbag. When my heart started racing a few minutes into the journey, I opened the book to the dog-eared pages that reminded me that panic wouldn’t kill me — that really did calm me.
For the next two years, I kept the panic at bay
Even after we moved back to Canada, the land of highways, I treated myself by altering my behaviour instead of resorting to therapy or medication.
For nine years after moving home, I relied on my husband to do all the highway driving. Then we bought a cabin. My husband would fix it up for weeks at a time while I worked in the city. The house was three hours away, and it wasn’t on a bus route. If I wanted to go on weekends, I would need to drive. Finally, it was time to find a psychologist.
Panic disorder can be treated with antidepressants in the long term and with beta blockers for immediate relief of symptoms, but experts recognize cognitive behavioural therapy (CBT) as the best treatment. It resolves anxiety by changing the underlying beliefs that tell you that the panicky feeling itself is dangerous.
In my first therapy session, I learned deep breathing — a long, slow inhale through the nose, and a long, slow exhale through the lips. “This will be your tool to calm yourself when you feel panicky,” the psychologist explained.
A week later, we started a form of exposure therapy called imaginal exposure. The doctor asked me to imagine driving the least scary highway route near my home, and to rate my anxiety level from one to 10 during each step of the trip.
“One,” I said, mentally backing out of the drive, then “two” as I turned onto the next street. It jumped to eight when I reached the road leading to the on-ramp. My heart was pounding, and I was starting to sweat. “Do your breathing,” she said.
She asked if I’d ever kept something in my purse for when I felt unwell. In fact, I had peppermint gum for stomach upsets. “Good,” she said. “Imagine that you’re chewing a piece of gum.”
The moment of truth
In my imagination, I accelerated and merged into highway traffic. “Ten.” My legs turned to jelly, and I had that awful feeling that I’d lose control. “Just keep breathing,” my therapist advised. “It’s less than a kilometre to the first exit.” In my mind, I saw the exit ramp moments later and began to calm down when I reached it.
My relief turned to fear when my therapist said, “Your homework is to do that for real this week. Remember your breathing, and bring your gum. It won’t be much different than when you were doing it in your mind.”
So, one Tuesday after dinner, I took a deep breath and grabbed the keys. Just like in therapy, my heart pounded as I got on the highway. But using my new tools, I made it to the exit without my physical symptoms escalating. I was overjoyed.
We did imaginal exposure over four more sessions, each time taking a tougher or longer route. Each week, I was able to do it for real, though I’d always return home on regular roads.
Finally, on a homework session that involved the scariest route yet, I exited the highway panic-free and said to myself, “What the hell, let’s give it a go.” I looped around and got back on the highway toward home. I haven’t had a panic attack since.