Therapist: Tell me a little about yourself:
Client: I’m a 32–year-old male, software engineer, living in Los Angeles. I’ve never been to therapy before, this is my first time.
Therapist: Why did you decide to seek therapy now?
Client: I need to fix the issue of having panic attacks while driving to work. I drive back and forth to work every day, and I have to drive at least 40 miles each day. Obviously, I’m worried, sometimes I feel helpless, like I won’t be able to drive to work, and this concerns me greatly.
Therapist: Describe your experience of having these attacks.
Client: Well, it starts off as a shortness of breath. Then I start to feel numbness of the arms and hands, then some dizziness. Then all that creates a type of fear that I am going to lose control of the car and crash. Usually I drive 65 miles an hour and have the radio on. Between the speed and loud volume of the radio, and my own thoughts, I start to feel out of control.
Therapist: I could understand you being concerned about this. What have you done to help your situation?
Client: Well, I try to get to the farthest right lane, in case I have to pull over. I turn off the radio and turn on the AC, and try to take deep breaths. I try to prevent having a panic attack. When I actually have a full blown panic attack, I pull over and put the chair back and put my knees to my chest. I breathe in a controlled fashion until the dizziness goes away. Usually I have to put my knees to my chest a few times and breath before the anxiety attack passes.
Whenever I get an attack I try to figure out what I was thinking about the moment I got anxious, and I try to find out the causes. If I’m stressed at work, I spend just 10 minutes before driving to relax and stretch, listen to the news or a song and then drive home, not just get in the car and drive immediately. I would lower the volume of the radio to a comfortable volume. If I have the volume high it seems to trigger anxiety. I also turn on the air conditioner low or crack a window just to make sure I have enough air.
Therapist: Have you noticed any patterns in your thinking right before a panic attack?
Client: I never found a pattern but I think that stress is a big factor. Stress, traffic, it is all too much for me.
Therapist: So it sounds like you become stressed, and this leads to some anxiety which causes shortness of breath and perhaps some tingling or numbing sensations in your hands, which you then interpreted as more than normal anxiety. Is that right?
Client: Yes. It is a sign of a panic attack coming.
Therapist: Let me comfort you by saying: perhaps not. Actually, this is a common misconception that perpetuates panic attacks. What you experienced was stress and anxiety, not necessarily a prelude to a panic attack.
Client: I think, yes, you’re right; these feelings of anxiety lead me to believe that I’m going to have a panic attack. In most cases I don’t have a panic attack, but sometimes I do.
Therapist: Why don’t we talk about the very first panic attack you ever had. Was it while you were driving?
Client: The very first time was at work. I got dizzy and anxious during a meeting, and I thought I was going to faint. I walked outside and had a panic attack. I felt like I would faint or pass out, hit my head, and make a spectacle of myself.
Therapist: So you had a bodily sensation brought on by anxiety during your meeting, dizziness, and misinterpreted this sign of anxiety as being dangerous, like you were going to faint at work in front of your coworkers, and this led to an intense fear reaction: a panic attack, a fear of losing control over your body.
Client: Yes. I had a fear of losing control over my body, and that seems to cause my panic attacks. I think I’m beginning to understand. My normal physical responses to anxiety are being blown out of proportion. I guess I just freak out when I have these sensations in situations where if I lost control, it would be totally catastrophic, like during a meeting or driving. Now I’m always worried that I’ll have a panic attack in front of people or while driving, and THAT is what’s going to cause me to lose control.
Therapist: Actually you’re having the attacks because you’re AFRAID to lose control. Losing control would be what is catastrophic. Many people become traumatized by their first panic attack because it seems as if it comes out of the blue, for no reason. But there is always a reason, the misinterpretation of your physical sensations as a sign that you are going to die, lose control, or faint.
Three Steps for Dealing with Panic Attacks
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