I find myself taking numerous sick days due to pain from my chronic conditions (fibromyalgia, lupus, thyroid disorders, bipolar)

It’s hard to address them all at once. I’ll just mention that your issue with panic attacks is probably both psychological as well as physiological. From your wording, it sounds as though you experienced anticipatory anxiety about having a panic attack which then operates in a self-fulfilling prophecy fashion to trigger a panic attack.

So there’s an initial cognitive element, which then produces a physiological result. That’s pretty common but also points to the fact that at the very least, you’ll need to use a two-pronged approach to resolving your issues with panic: your psychological tendency to talk to yourself in catastrophic terms (i.e. “it would be awful, terrible and unbearable for me to have a panic attack this morning.

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The fact that I have them must mean there’s something seriously wrong with me; I must be defective and so not measure up to the other people out there who don’t have my problem”) and also the physiological effects of tensing up in reaction to what you’re telling yourself and so beginning to hyperventilate as well as release adrenalin into your system.

As far as dealing with the cognitive or psychological side of your problem, you would be best serving yourself if you can begin to challenge your catastrophic thinking: i.e. “where’s the evidence that having a panic attack this morning is truly awful and horrible and not simply an uncomfortable, inconvenient pain in the ass? Where’s the evidence I can’t bear to have another panic attack?

I’ve had them multiple times before and I’m still here. While there’s evidence I don’t like panic attacks, there’s no evidence I can’t bear them. I can, even if I’m strongly uncomfortable having them. Where’s the evidence there’s something truly wrong with me compared to other people? Do I fully know the lives of other people to be able to make that kind of comparison?

Am I saying I’m the only person to have this problem or that others who share this problem with me are somehow inferior to other people who don’t have this problem? Where’s the proof for this assertion? And if other people, say my best friend, isn’t inferior because of her problems, why do I claim I am?”

Things like this.

Challenging your catastrophic thinking, whatever it is, will begin to help you calm down, decrease your physiological reactions and begin to move you out of the fight-or-flight response which is a trigger for many panic attacks.

In going about this cognitive house cleaning, I’d recommend you find a local therapist skilled in rational-emotive-behavioral therapy, otherwise known as REBT. You can also begin to work on this yourself, with the help of books such as “Overcoming Destructive Beliefs, Feelings and Behaviors” by Albert Ellis, the founder of REBT, or another of his many books, such as “How to Stubbornly Refuse to Make Yourself Miserable About Anything. Yes, Anything!”

On the physiological side of things, apart from your thyroid condition (Hashimoto’s or hypothyroidism?), much of what you’re describing you’re going through is made significantly worse by chronic muscle tension and breathing faster than your body actually requires. This is a common problem with most people in our hectic, stress-filled society (and depending on your students, with being a high school teacher).

Here’s a copy of what I wrote in an earlier post. For more details, I recommend the books “Breathe to Heal,” by Sasha Yakoleva as well as the “Buteyko Breathing Course Manual” by Dr. Eduard Reuvers.

Before I retired as a psychotherapist and counselor in various hospital and university settings, I treated hundreds of people with panic disorder, with I’d say roughly a 90%+ success rate among those who actually followed my suggestions.

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On the physiological side: panic attacks are the “little brother” or the “little sister” of asthma attacks. They’re caused by what’s called “subclinical hyperventilation,” which is a fancy way of saying they’re caused by the person unconsciously breathing faster than what his or her body requires.

Here’s how you tell where you’re at in this: breathe normally for a while as you always do and when you’re ready, exhale normally (don’t try to “empty your lungs”) and as soon as you’re done exhaling, hold your breath exhaled while timing yourself.

You’ll feel an initial bump of discomfort and then that discomfort will plateau for a while, then all of a sudden your discomfort will start to rise very quickly. As soon as you feel your discomfort starting to take off after that plateau period, inhale normally and note how long you were comfortably able to hold your breath exhaled.

Here’s how you can rate yourself:

  • 3–5 seconds = asthmatic
  • 6–12 seconds = panic disorder
  • 12–18 seconds = typical stressed-out individual
  • 18–25 seconds = normal person for our society
  • 25–35 seconds = typically either a swimmer or an endurance athlete
  • 60 seconds = optimally healthy

To put your Diagnostic Pause in context, let’s say you ended up with a Diagnostic Pause of 15 seconds. That’s 1/4 the optimal time. That tells you that you’re unconsciously breathing four times faster than what your body requires; more than that when you’re stressed. Can you now understand why your body is sensitized towards panic attacks?

This is normal in our stressed society. As we live our stressful lives day after day, the inner part of our brain adjusts its resting breath setting, if you will, to accommodate that more stressful lifestyle. It’s similar to setting the idle speed on a car’s engine to a much higher RPM than what the default factory setting is.

Your job, once you find this out, is to now recalibrate your body’s breathing rate back down to its original default setting. Over time, as you slow down your breathing, your brain will reset itself back to its original breath rate.

Now that you know what I like to call your Diagnostic Pause (and others call the Control Pause), to begin to resolve the physiological side of your panic attacks, begin to now practice holding your breath exhaled for about two seconds longer than your Diagnostic Pause.

So if your diagnostic pause was ten seconds, for instance, now practice holding your breath for twelve seconds, slightly uncomfortable but not too much. This is now your Training Pause.

Do this three to five times a session, three to five sessions a day.

When you’re completely comfortable holding your breath for twelve seconds, increase your Training Pause to fourteen seconds, then sixteen, and so on. Make sure you don’t push yourself here.

Pushing yourself beyond a mild discomfort can result in reactively hyperventilating when you stop and might even precipitate a panic attack.

Not good.

Typically, it takes a person two to three weeks to go from their initial Diagnostic Pause up to being able to comfortably hold their breath exhaled for 30 seconds. At the 30 second point you’ll be functionally “immune” to panic attacks except for times when you’re overly stressed, over-tired or on the verge of getting sick.

It takes the average person about a year to progress from being able to comfortably hold his or her breath exhaled for thirty seconds to being able to comfortably hold his or her breath exhaled for sixty seconds, the optimal time. Some people work to hold their breath exhaled for as long as a minute twenty seconds but this is not really necessary.

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While holding your breath exhaled, you’ll probably notice strands of muscle tension in the sides of your chest and in your cheeks. If you can consciously relax those muscles, you’ll speed up your progress while also learning how you’ve unconsciously held muscle tension in your body all these years.

Going back to the psychological side of the equation, a person suffering from panic attacks also has to learn how not to make everyday problems into catastrophes. Catastrophic thinking forms a direct link to subclinical hyperventilation and panic attacks.

One thing most people suffering from panic attacks do is engage in what I call Negative Possibility Thinking. The reason to themselves in 1,001 different ways “It’s possible I could die of a heart attack at 5PM today”; “It’s entirely possible I could be horribly injured and then die in a car crash this afternoon”;

“If I do badly on this upcoming test, it’s possible that might mean I’ll do badly on all my future tests, fail my class, get kicked out of school, not be able to get a job, and end up cold and hungry, shaking a tin cup in an alley for change”; “It’s possible that right now, Putin could be drunk, staggering around in the Kremlin and push the button today, killing us all in a nuclear blast by dinnertime.”

The problem with Negative Possibility Thinking is that you can’t disprove any of these thoughts outright: all of these things are indeed possible. You can’t say to yourself that they’re impossible.

What you can do to deal with your version of negative possibility thinking is to confront it with what I call Probability Thinking: “While it’s possible I could die of a heart attack at 5 PM today, probably I won’t”; “While it’s entirely possible I could be horribly injured and then die in a car crash today, probably I’ll be just fine”; “while it’s possible I could do poorly on this upcoming test, get kicked out of college, fail to ever get a job and end up on the poor side of town begging for money to keep myself alive.

Probably I’ll do all right on this test (although maybe not perfectly), stay in school, end up with a reasonably good job and not end up unemployable and poor—especially if I continue to study diligently and work to correct whatever errors I make”; “while it’s possible Putin is drunk right now and about to hit the button, probably he’s not.”

Keep in mind that only trying to resolve your issues with panic attacks by working on the psychological side of it alone won’t be as effective as also working on resolving your tendency to over-breathe—and working on your breath alone generally won’t resolve your tendency to think catastrophically about events or engage in negative probability thinking. The two approaches work the best hand in hand.”

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