Ask the Equishrink: Got Panic? Part II

Seana Adamson Ph.D, USDF Gold Medalist and equestrian sport psychologist, continues her series on panic attacks: what they are, what triggers them, and how to deal.

Illustration by Morgane Schmidt of The Idea of Order. Check out a new comic by Morgane each Wednesday here on Horse Nation!

In Part I of “Got Panic?” a reader wrote in with a question about how to manage instantaneous panic attacks in the saddle. If you missed it, catch up here!

Part II:

“I feel like my life is ruled by the possibility of panic.”  Too often I hear this sentiment from riders who are torn between their love of horses and riding, and their extreme anxiety brought on by the very activity that they love so much. Anxiety and panic are like an evil twin and then a really nasty awful, truly evil twin. Though you may want some intensity when riding to be effective, intensity is not the same as anxiety. Intensity is appropriate when you are pulling a four-horse trailer on a busy L.A. freeway, or flying an airplane, or riding a horse that could choose to squash you at any moment. Some activities in life require intense focus. Anxiety on the other hand is a pit of the stomach feeling of impending doom. Where intensity can have a feeling of quiet confidence, anxiety often involves a brain that won’t stop ruminating on disastrous thoughts.

In my last installment I talked about the anxiety pail. When that pail fills to overflowing, it turns into panic. Panic is an intense physical experience and can include a racing heart rate, tingling and numbness, dizziness, nausea and confusion. Panic, the really truly evil twin, has some special considerations that I’ll try to cover below. In the future installments over the next few weeks I’ll pass on some additional ideas and tools for those who suffer from anxiety, but not panic.

First of all, panic may have a fairly strong genetic basis. We all recognize that a young, hot-blooded thoroughbred has a very different nervous system than an old plough horse. The same may be true with humans. A reactive nervous system could be of benefit to survival. If you notice the saber tooth tiger before your paleo pal Gork, he’ll end up getting eaten instead of you. So remember, you come from a long line of survivors!

Panic can also occur after an injury or traumatic experience. In my experience, head or spinal injuries tend to create more anxiety than an arm or leg injury. But we can get traumatized but all sorts of awful things, even if we never have an actual injury. Many riders have sought consultation after witnessing an accident, or even just hearing about it. Others may have had a very frightening experience (such as being flat out run away with by a horse) with no actual injury, but still a lot of residual fear and anxiety.

A panic attack is a physically painful state. The sympathetic nervous system triggers a racing heart, shortness of breath, dizziness and tingling that can seem to come on for no good reason. These symptoms are extremely disruptive and accompanied by an emotional sense of impending doom. There is always a mental search for what may be causing such an intense physical reaction. The conversation goes something like this:

Sympathetic Nervous System (SNS): “I’m going to freak out because I want to.”

Logical Brain: “OMG! What’s wrong?”

SNS: “There’s scary stuff out there.”

Logical Brain: “Oh no! Where is all the scary stuff?? Geez. I didn’t realize we were in such danger but now I see the potted tree that might blow over and the neighbor’s car that looks sketchy, and I hate the blue on that jump. It reminds me of the blue jump where I crashed three years ago.”

SNS: “We crashed?!!! Did we crash now or are we remembering a crash? I better get that heart feeling faster and divert a little more blood from the extremities….”

There is a wide rift in the therapy community on the best way to help people process past trauma and panic attacks. Some therapists think you have to talk about the trauma to make it better, but a growing number of therapists are finding talk therapy to be of little use and possibly even adds to the trauma by forcing clients to relive it. Fortunately there are many roads to Rome. Just as there are many approaches to training horses, there are many approaches to dealing with panic. Here are four basic approaches:

Approach 1. Talk therapy: Try to get a word of mouth recommendation. Look for a psychologist, a mental health counselor, or a marriage and family therapist.

Approach 2. Alternative therapies such as EMDR (Eye Movement Desensitization Reprocessing), Hypnosis, and Energy Therapy: These therapists will have special training and certification in their area of training. EMDR therapists can be found all over the nation, and this form of therapy has become extremely popular for processing traumatic experiences. EMDR has been shown to be especially effective with trauma when there is a strong visual or flashback component.

Approach 3. Medication: Some people find medication to be extremely helpful. See a psychiatrist, or talk to your family doctor. There are a wide variety of medications available.

Approach 4. Practical Self-Monitoring Techniques: Finally! Here’s where I step in. These are techniques you can do on your own or with the help of your therapist. Here are three ways to begin to manage your panic.

Technique #1

• Take care of your physical body. Look for patterns in your self-care that might be triggering your physiology. Keep a diary tracking your diet, exercise and sleep, as well as overall stress level. Here are some things that are notorious for contributing to panic attacks:
• Caffeine, alcohol (or hangover), nicotine
• Poor diet, high sugar, high processed food, allergens such as wheat (in sensitive people)
• Sleep disruption, chronic insomnia
• Lack of exercise
• Accumulated stress in all areas of your life whether it is horse related or not. Stress at work, in relationships or with family members can all add to your anxiety bucket.

It may take weeks, or even months to begin to unravel your panic patterns. Stick with it. You must become a master of your own physiology.

Technique #2

Track your internal voice, and look for habitual patterns of thought that might contribute to your anxiety.

• Do you begin to worry hours before you get to the barn?
• Are you hyper vigilant about any of your bodily sensations? Does the slightest flutter in your chest fill you with fear of an imminent panic attack?
• Do you fixate on the jump you fear the most, or the corner of the arena you hate the most?

Look for patterns of thought that are contributing to your panic. Does your panic take you completely by surprise (go to an EMDR therapist), or did you drink too much last night, eat poorly, add several doses of caffeine combined with obsessing about how crappy you feel and how it would be so easy to fall off in this condition… you get the picture.

Technique #3

Practice a simple deep breathing exercise. In my last installment I introduced the Amygdala, the personal alarm system that lives in your head. Our breath is the first way to begin to speak Amygdalese. During a panic attack the breath becomes short and shallow. By slowing and deepening our breath we can signal to the nervous system that it is in a place of safety. Here is the basic exercise:

• Take a long slow deep breath. Put your hand on your lower belly. As you inhale breathe deeply into your belly, pushing your hand away from you spine, then fill your lungs all the way expanding up into your ribs and chest. Imagine pouring milk into a glass, or in this case maybe you’d rather imagine whisky or wine! Fill your lungs from the bottom up as you inhale, then empty your lungs from the top down, like pouring milk out of your glass. Exhale all the way until your belly pulls in and your hand moves toward your spine.
• Take a complete slow breath, and notice any sensations inside your body.  As you exhale relax at least one set of muscles. The shoulders or jaw is usually a good place to start.
• Take another long slow deep breath and notice everything outside your body, the air temperature, the sights and sounds.
• You do not have to practice breathing for 10 or 20 minutes at a time. Try to focus on your breath any time you find yourself waiting for something throughout your day. Maybe you’re in the line at Starbucks or sitting at a stoplight. There are probably 10 or 20 times throughout your day that you can spend a minute or two focusing on your breath. Remember to relax at least one set of muscles each time you exhale. It’s amazing how much tension we hold habitually in our muscles.

So much of anxiety comes from worrying about the past or stressing out about the future. This simple mindfulness exercise pulls your attention back into the current moment. It teaches you to move your attention fluidly between your body and your environment.

These three techniques are the beginning of learning to unravel your own panic patterns. If you are plagued by panic you must become an expert in managing your physiology. This involves long hours of self-monitoring. Consider exploring some of the modalities discussed above. EMDR seems to hold particular promise, although some people do not find it effective. Look for more anxiety management techniques in my next installment. And as usual, feel free to email me directly at [email protected] with any additional questions.

Contact Seana at [email protected] or visit www.seanaadamson.com

Seana Adamson Ph.D, is a psychologist specializing in Sport Psychology for equestrians. She is a United States Dressage Federation Gold Medalist, has been training dressage horses and riders for over 30 years, and is the author of “Memorize That Dressage Test: A workbook of mental games to improve focus and flow.” Learn more by visiting seanaadamson.com.