There are always many postings about DID and other PTSD patients being overwhelmed by panic attacks. I have discussed this in both volumes of Engaging Multiple Personalities in some detail but I want to emphasize that there is a path to dealing with panic attacks.
The essence of any panic attack is the complete loss of control. First, one must engage in preparation – learning what you need to do to avoid that loss of control. For anyone, DID or otherwise, panic attacks are terrifying. They appear to come out of the blue, they arise with immediacy and always involve the sensation of a loss of control. It is very helpful to practice how to work with your mind and body at a time when you are not in the midst of a panic attack.
For all human beings, there is a completely intimate connection between mind and body. If your mind panics, your body will follow. If your body panics, your mind will follow. Triggers, therefore, can come in many ways – events that trigger either one’s mind or body. While this can be confusing to some patients and therapists, it is quite straightforward.
The mind following the body and the body following the mind is actually quite good news. If the mind starts to panic, by calming the body the mind will settle down. If the body panics, by calming the mind the body will settle down. While it is sometimes too hard to settle a panicking mind with thought, you can often settle the body with exercise. Get the body in exertion mode (such as a brisk walk, push-ups or even dancing), exerting just a bit more than the bodily arousal produced by the panic. Then, as soon as you stop the exercise, the body will automatically settle down. As the body slows down, the mind goes along with it.
Alternatively, sometimes it is the body initiating the panicking. While it may be too hard to settle it down with exertion, by settling the mind through mindful breathing, the body will often follow.
Some patients ask what mindful breathing is. It is simply paying attention to a specific aspect of your breathing. There are many techniques, but the simplest is to count each outbreath up to 10 – and then repeat. You can also pay attention to the feeling of the air moving out through your nose on the outbreath and in through your nose on the inbreath.
You can be mindful of when the shift from outbreath to inbreath happens, and vice versa, just as you can be mindful of when you are holding your breath. When you see that you are tensely holding your breath, you can then control its release by intentionally breathing out. When you release the breath, the air goes out along with the tension that subtly caused you to hold your breath.
Whatever method you use, understand that using a method rather than simply being carried along by the panic is an indication that you are re-asserting control. This is very positive.
Practice is what is called for, usually a lot of it done regularly. In a quiet safe space, you can intentionally allow a very small slightly negative thought to arise – something that is an ordinary everyday irritant and not a deep trauma. This is something which you are controlling, that is key. Remember, starting with baby steps is extremely important.
As your heartbeat increases, choose to do some exercise or some mindful breathing. Then, after a few minutes when you choose to stop the exercise or mindful breathing, you will see that your mind and/or body has settled. Making a choice about the technique and trying it is a second indication/assertion that you are in control.
The point of the exercises is to re-empowerment. It is to create new habits in both your mind and body so that when you actually are hit by a panic attack, you have already created new pathways to react to it – all of which are marked by being in control.
Do not try to generate thoughts of trauma and try to work them out this way. That is dangerous and will not be helpful. Please work directly with a therapist on the trauma material.
When in the midst of a panic attack, first try to remember what you have practiced, and second, try to do it. Don’t worry if you cannot quell the panic right now. Do not be angry with yourself if you remain terrified and panicked. That is not an indication of failure, it is simply an indication that you need to practice more in a safe place. Remember, this is a path that needs to be trod step-by-step. Even remembering that you are panicking more than you had hoped you would is an indication that you have retained some level of control in the midst of the attack.
While medication can support you in working with panic attacks, genuine healing occurs only when the disempowerment experience of the trauma is overcome. Re-empowerment is the goal. It is much more important than simply wrestling the agitated mind into submission again and again by a chemical which will have limited ongoing impact on the panic.
You have that power for re-empowerment in the present moment. Practicing before a panic attack, again and again, enables you to access that present moment power when you need it.
