resonance imaging) machines.
In parts 1 through 3 of this book, I first explain the physiological and psychological mechanisms that lead to panic. Then, in part 4, I lead you step by step through a ten-day program to establish automatic control of panic. In ten days, you can learn to put behind you the frustration, the worry, and the distress of panic and claustrophobia, in the air and on the ground.
Before You Start
Before embarking on the ten-day program, you must confirm that what you are dealing with really is panic and not an underlying medical condition.
Though symptoms of panic vary from person to person, the following symptoms are common:
• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or suffocation
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed, or faint
• Chills or hot flushes
• Numbness or tingling sensations (paresthesia)
• Feelings of unreality (derealization)
• Feelings of being detached from oneself (depersonalization)
• Fear of losing control or going crazy
• Fear of dying
Some of these symptoms, however, are also associated with other disorders. You need to discuss your symptoms with a physician to rule these out. And even if you have already talked them over with your doctor, it’s a good idea to review your symptoms and any changes at your yearly physical examination.
CHAPTER 2
The Panic-Proof Part of Your Brain
Jan, an emergency room nurse, emailed the following:
In training, I was taught about dozens and dozens of situations. For everything that could happen, there was a plan. My instructor said, “If this happens, you do that, and if you see this going on, you have to fix it this way.” The number of things I had to know how to react to was overwhelming. Even after we practiced responding to each situation again and again, I really doubted I could do the job. But I was surprised. Even the first day in the ER, what I had practiced kicked in.
You would think that a person who can operate as an ER nurse could handle anything. And, in general, I’m fine. But put me in a place where I can’t get out, and I panic. I’ve done therapy to get rid of it, but nothing worked until I did this [the SOAR Fear of Flying Program].
It is said that first responders and emergency medical professionals do not “rise to the occasion” in life-and-death situations: rather, they “descend to the level of their training.” Why? In life-threatening situations, the release of stress hormones can impede their high-level thinking. To function under extreme stress, they depend on a part of the brain that is immune to stress hormones: the unconscious procedural memory in the subcortex. In training, they repeatedly perform the various procedures they will need to carry out when under stress, installing every step of these procedures in this part of the brain so that they can perform them without having to depend on high-level thinking.
Though the concept of unconscious procedural memory may be new to you, if you are an experienced driver, you have been using it for years. You can drive and think of other things at the same time.
How did your unconscious procedural memory learn to drive a car? When you were a new driver, you focused your conscious mind (in the cerebral cortex) on the task. While you were doing this, your unconscious procedural memory (in the subcortex) was memorizing what you were doing. It learned to steer the car and keep the speed steady. Unconscious procedural memory can’t make decisions, though. For example, it can’t decide what freeway exit to take. If your mind is elsewhere as you near your exit, you may go right past it on “mental autopilot.”
When you are alarmed or highly aroused, stress hormones are released, and your conscious mind, in the cortex, is overwhelmed. That is when panic can arise. But unconscious procedural memory, in the subcortex, is not bothered by stress hormones. Not only can it perform well-rehearsed mechanical tasks, but, if it is trained to do so, it can automatically activate your calming system, the parasympathetic nervous system.
In this ten-day program, you’ll train your unconscious procedural memory to serve as your personal panic-controlling first responder. In the high-stress situations that now cause you to panic, it will step in and protect you.
Situational Control of Panic and Claustrophobia
CHAPTER 3
Carole’s Holland Tunnel Challenge
Carole, a librarian, lives in Pennsylvania. After the attacks on September 11, 2001, she stopped driving to New York City through the Holland Tunnel, which enters Manhattan a few blocks north of the World Trade Center. The thought of being in the tunnel put her on the edge of panic. So she took a longer route, crossing the Hudson River by the George Washington Bridge. She told me she needed to pick up some friends at John F. Kennedy Airport. Going via the bridge instead of the tunnel would take an hour longer. Having already learned to control panic when flying, she wanted to know if she could train herself go through the tunnel without panic.
It was an easy call. If Carole could control her panic while flying, the tunnel would be a minor challenge. Though flying is remarkably safe, it frequently provokes panic. High above the earth, and especially at night or in clouds, passengers feel disconnected from the earth, the basis of their sense of control. In-flight turbulence can induce the fear that the plane might simply fall apart. Panic sends us the message to flee; but on a plane, there is no way to escape.
To make absolutely sure Carole’s trip through the tunnel would be panic free, we did several things. The first was to establish links between the landmarks she would see on her trip and the memory of a calming event in the past. This meant that each landmark would have a calming effect when it came into view.
I asked Carole to make a list. “Start with what you see when you step out the door. Write that down. Then write down what you see when getting into your car, starting it, and going from your driveway into the street. List the landmarks you will see along the way.” Her list included left turns, right turns, road signs, gas stations, the New Jersey Turnpike entrance. The list continued all the way to Kennedy Airport, and from there all the way back home. In addition to those familiar landmarks, it included moments Carole would find emotionally challenging, such as approaching the Holland Tunnel, entering it, and being a quarter of the way through it, halfway through it, and three-quarters of the way through it. We ended the exercise with the sensation of freedom: the thought of leaving the tunnel and driving in lower Manhattan.
Next, Carole associated each landmark with a calming memory. This memory doesn’t have to be long or elaborate: it can be as simple as a recollection of being with a best friend. When you are with a friend who completely accepts you, you may feel your guard let down. When that happens, the parasympathetic branch of your nervous system — the part that calms your physiological responses — takes over and overrides