Health - Panic Attacks, Bad Trips, and How to Control Them

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SWIM has noticed that there are a lot of posts on this forum related to panic attacks. A few of these posts include people who describe feeling symptoms of panic attacks and anxiety, but aren’t aware what they are experiencing. SWIM figures that it would be beneficial to the forum community to post a report about panic attacks, bad trips, and how to control them.

What is a Panic Attack?

A panic attack is a period of intense fear or psychological distress, typically of abrupt onset and lasting no more than thirty minutes. Most sufferers of panic attacks report a fear of dying, "going crazy", or losing control of emotions or behavior. These feelings generally provoke a strong urge to escape or flee the place where the attack began ("fight or flight" reaction) and, when associated with chest pain or shortness of breath, a feeling of impending doom and/or tunnel vision, frequently result in the sufferer seeking medical attention.

What are the Symptoms of a Panic Attack?

The symptoms of a panic attack appear suddenly, without any apparent cause. They may include:

• Racing or pounding heartbeat or palpitations
• Sweating
• Chest pain/PVCs
• Dizziness, lightheadedness, nausea
• Difficulty breathing (dyspnea)
• Tingling or numbness in the hands, face, feet or mouth (Paresthesia)
• A sudden feeling that everything around the person represents a threat. This can cause a person to either behave extremely defensively (perhaps even assuming the fetal position), or to become enraged and lash out violently.
• The loss of the ability to react logically to oncoming stimuli, and the loss of cognitive ability in general. One suffering from a panic attack will often only feel the attack and will be unable to assess why they are feeling the attack or what they can do to stop the sensation.
• Flushed face and chest
• Chills
• Dream-like sensation or perceptual distortion (derealization)
• Dissociation, or the perception that one is not connected to the body or is disconnected from space and time (depersonalization)
• Terror, or a sense that something unimaginably horrible is about to occur and one is powerless to prevent it
• Vomiting
• Tunnel vision
• Fear of losing control and doing something embarrassing or going crazy
• Fear of dying
• Feeling of impending doom
• Trembling or "shivering"
• Crying
• Heightened senses
• Loud internal dialogue
• Exhaustion
• Vertigo

The Anatomy of a Panic Attack

A panic attack typically lasts from 2 to 8 minutes. More severe panic attacks may form a series of episodes waxing and waning every few minutes, only to be ended by physical exhaustion and sleep.

The various symptoms of a panic attack can be understood as follows. First, there is the sudden onset of fear with little or no provoking stimulus. This leads to a release of adrenaline (epinephrine) which brings about the so-called fight-or-flight response where the person's body prepares for major physical activity. This leads to an increased heart rate (tachycardia), rapid breathing (hyperventilation), and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood. This leads to shifts in blood pH which can in turn lead to many other symptoms, such as tingling or numbness, dizziness, and lightheadedness. It is also possible for the person experiencing such an attack to feel as though they are unable to catch their breath, and they begin to take deeper breaths, which also acts to decrease carbon dioxide levels in the blood.

Hyperventilation alone can bring about some of the symptoms of a panic attack. However, the person experiencing the panic attack often does not realize this and sees these symptoms as further evidence of how serious their condition is. An ensuing positive feedback loop of adrenaline release fuels worsening physical symptoms and psychological distress.

Can a Panic Attack Harm You?

While the symptoms and the seriousness of panic disorder are very real, the feelings of panic or impending death that accompany many attacks are exaggerated. Many physicians tell panic disorder sufferers that while their body is affected by the attack, they are not in any risk of fatality (except due to auxiliary reactions such as crashing a car, running into traffic, committing suicide, etc). If a sufferer can anticipate an attack and find a safe place to release, there is little immediate risk.

Bad Trips

A bad trip is a profoundly unpleasant experience using a hallucinogenic drug such as LSD, mescaline, DXM, or psilocybin, caused by one or more of the common undesired effects of the drug:

· Panic Reaction
· Amplification of unconscious fears
· Self-aggression
· Suicidal ideation
· Fear of going insane or inability to return to normal
· Perception of rapid aging of self or others
· Profound depression

The effects of hallucinogenic drugs vary widely from one individual to the next. Psychosis is exacerbated in individuals already suffering from this condition. Sometimes individuals under the influence of such drugs have forgotten that they have taken them, and believe that the wildly distorted world they perceive is real and will be with them indefinitely. In extreme cases, hospitalization is required, though the value of this practice is disputed by proponents of recreational use of psychoactive compounds.

Someone who is experiencing a bad trip can often be "talked down" by someone that he or she trusts. One must get a feel for how distorted or disconnected the individual is, and then attempt to remind the individual that they took a drug and that the feelings they are experiencing are a result of the drug, and that these will eventually pass. It is also very important to talk calmly to the individual and not become agitated by their behavior, as this will only make their experience worse as they perceive the most negative aspects of whatever their mind is processing during the bad trip.

Medical treatment consists of supportive therapy and minimization of external stimuli. In some cases, sedation is used when necessary to control self-destructive behavior, or when hyperthermia occurs. Valium is the most frequently used sedative for such treatment, but other benzodiazepines such as Ativan are also effective. It should be noted that such sedatives will only decrease fear and anxiety, but will not subdue hallucinations. In severe cases, antipsychotics such as haloperidol can reduce or stop hallucinations, but this treatment is only effective against the so-called "classical" hallucinogens (LSD, psilocybin and mescaline, among others). Antipsychotics are not effective against dissociatives such as PCP and ketamine, and should not be used if these drugs are involved.

Timothy Leary taught that a bad trip is a result of bad set and setting, and advised that users of hallucinogens be sure that they are comfortable before taking the drugs. Leary claimed that the frequency of bad trips, although highly exaggerated by anecdotes and fabrications in the popular press, was actually about 1 in 1000. He taught that a simple temporary fix to a bad trip is sugar (in the form of candy, oranges, etc.), since bad trips may often be the result of people forgetting to eat and experiencing hyperawareness of low blood sugar.

Alternatively, psychologist R. D. Laing held that bad trips and other such extreme experiences, drug-induced or not, were not necessarily artificial terrors to be suppressed but rather signs of internal conflict and opportunities for self-healing. The greater the pain and pathos of an experience, the greater the urgency to explore and resolve it, rather than attempt to cover it up or dismiss it.
Though Marijuana can lead to panicked states in some cases, it does not cause 'bad trips'. These are merely anxiety attacks which lead the unexperienced user to a confused state. Simply talking them down and possibly having them eat will suffice for these anxiety attacks.

How to Stop a Panic Attack

In SWIM’s experience, the best way to calm yourself down during a panic attack is practice this exercise:

When you sense that a panic attack is coming over you, stop what you’re doing and sit down. Close your eyes, exhale all the air in your lungs and slowly inhale through your nose. While you are inhaling through your nose, visualize your lungs filling up with air. When your lungs are full, hold your breath for a couple seconds. Slightly open the middle of your lips and slowly exhale through your mouth as if you were blowing through a straw. While you are exhaling, visualize your lungs exhaling all the air. Repeat as necessary. By visualizing your lungs inhaling and exhaling, you are able to distract your mind from the panic attack and concentrate on something else. If you are having racing and repetitive thoughts, sternly say “STOP!”, and start to calm yourself down with reassuring comments, such as “This is only a panic attack. It will end soon, and it won’t hurt me.” If your heart is rapidly beating and you fear a heart attack, remind yourself, “This is only a panic attack. My heart is beating fast because I am worrying, and by worrying about it, my heart is only going to beat faster.” Saying “STOP!” to yourself helps to break the cycle of repetitive thoughts and gives you a chance to replace the negative thoughts with reassuring thoughts.
After you have calmed yourself down, you should do something that you find relaxing, such as watching TV, listening to calming music, etc.

How to Help Someone Having a Bad Trip

Crisis situations can manifest themselves in countless ways, anything from belligerent, potentially violent outbursts to complete withdrawal from external stimuli to debilitating paranoia or fear to relatively harmless compulsive or psychotic behaviour. How one deals with the situation depends greatly on the symptoms the person is experiencing.

In most situations you're not trying to force any particular action or reaction on the part of the person experiencing the crisis. The point isn't to "talk them down" since this doesn't work and usually makes things worse. Make sure they know that everything in the outside world is ok...you're with them, watching out for them. Make sure they don't hurt themselves or others, and if things get out of control, call for help. Whatever you choose to do, watch for their reaction. If what you're doing seems to make things worse, move on to something else.

Many guides and counsellors who have experience with this type of acute emotional/spiritual crisis say that the best thing to do is to tell someone to let go and relax into the feelings. The mantra "breathe, relax, let go" was developed in the 1960's and 1970's for psychedelic therapy and it is argued that much of the emotional dissonance and mental stress comes from fighting and resisting potentially uncomfortable internal processes. Guides suggest that it is the fear which is often the dominant force precipitating a crisis and the main role of a crisis-manager is to help create a space where the person can feel safer.

Quick List

• Try to get a sense of 'how far out' they are. Do they think they are in the same place you think you are? Do they know what time of day it is, what their name is? Do they know they ingested a psychoactive?
• Reassure them in a calm, matter-of-fact tone that you are with them and watching out for them.
• Remind them that this is a substance-induced state of mind, which will end.
• Remind them to breathe and relax.
• Let them know that spiritual crises are normal.
• Be as calm as possible while talking to them, and use a normal tone of voice even if you are feeling anxious yourself.
• If possible, bring them some water or a piece of bread. Ask them if they would like a sip or a bite.
• Sit and talk. Pass the time with them.
• If you know their name, use it a couple of times. "Hey John, how are you?
• Introduce yourself, say your name and how you come to be there.
• Look at beautiful things.
• Sing (anything, but especially children's songs such as Row, Row, Row Your Boat).
• Pet or play with an animal.
• Go for a walk.
• Recall good memories (beach, children, etc.).
• Dance.
• Hold hands.

Pitfalls to Avoid

• Don't try too hard to 'get them to come down'. This often makes things worse.
• Don't confuse them by repeatedly asking them questions they can't answer.
• Don't make them feel even more isolated by acting worried and nervous around them.
• Probably avoid any complex physical activities, like trying to zipper a jacket or fixing the stereo or lighting the pilot light on the stove.
• Respect their needs and boundaries.
  • Don't touch them if they don't want to be touched.
  • Give them space if they seem to want it.

What to Do

1. If someone seems to be having a hard time, gently ask them if they would like someone to sit with them. If it seems disturbing to them to have someone sitting with them, have someone nearby keep an eye on them unobtrusively.
2. Relate to them in the space they are in. Oftentimes, the thing which isolates people and creates a sense of paranoia or loss is that they are *so far out* of normal awareness that people are trying hard to ground them. Start off instead by trying to just be there for them. Try to see the world through their eyes.
3. What different ways can you change setting (noise level, temperature, outside vs. inside, etc.)? A party/rave/concert setting can aggravate a person's state of mind. Consider finding the quietest place if it seems like it will help (taking cues from the experiencer), and ask people to not crowd around. Reassure them the situation is under control, noting those who offer help in case help is needed later.
4. How can you minimize risk of emotional or physical harm? Remember your concern for how the person is feeling, not concern for the situation (as in "oh my gawd, we've got to do something.")
5. Paranoia: If the person doesn't want anyone near them, hang back, turn so you aren't staring at them, but keep an eye on them as discretely as possible. Think about what it would feel like to be in a paranoid state, having some stranger (whether you are or not) follow you around and watch you.
6. What objects/activities/distractions might help the person get through a difficult space (toys, animals, music, etc.)?
7. No Pressure: Just be with them. Unless there is risk of bodily injury, just make it clear you are there for them if they need anything.
8. Touch. Touch can be very powerful, but it can also be quite violating. In general, don't touch them unless they say its OK or they touch you first. If it seems like they might need a hug, ask them. If they are beyond verbal communication, try to be very sensitive to any negative reaction to touch. Try to avoid getting pulled into any sexual contact. Often, holding hands is a very effective and non-threatening way to let someone know you are there if they need you.
9. Intensity can come in cycles or waves. It also can work as a system -- a movement through transpersonal spaces which can have a beginning, a middle, and an end. Don't try to push too hard to move it.
10. Not Forever: If they are connected enough to worry about their sanity, assure them that the state is due to a psychoactive and they will return to their 'home' state of mind in time.
11. Normal Drug-Induced: Tell them they are experiencing the acute effects of a psychoactive (if you know what, tell them) and tell them that it is normal (although uncommon) to go through spiritual crises and they (like thousands before them) will be fine if they relax and let the substance run its course.
12. Breathing: breathe with them. If they are connected enough to be present for assistance, get them to join you in deep, long, full breaths. If they're amenable to it, or really far out and freaking, putting a hand on their belly and saying, "breath from down here", "just keep breathing, you 'got it", can help.
13. Relaxing: It can be very very hard to relax in the middle of dying or being pulled apart by demons, but tell them that you are there to make sure nothing happens to their physical body. One of the most important things during really difficult internal processes is to learn to be OK with them happening, to 'relax' one's attempt to stop the experience and just let it happen.
14. Getting Meditative: Gently suggesting they try to close their eyes and focus inward can sometimes change the course of their experience.
15. Barefeet on the ground: One of the most centering and grounding thing to do is to take off shoes and socks and get your feet directly on the hard ground. Be careful of doing this in toe-dangerous surroundings.
16. Eye contact: If the person is not acting paranoid and fearful of you, make sure to include a lot of eye contact.
17. Everything is Fine with Me: Make it clear that the whole world may be falling apart for them, but everything is OK with you.
18. Healthy process: Crises are a normal part of the human psychological process and one way to engage them is as a process of healing, not a 'problem' to be fixed.

It can be very difficult to talk, relate, or even really be fully aware of other people's presence at the peak of intense experiences. If you're sitting with a person who is in this state, listen to what they say and (if it seems appropriate and useful) you can prompt them with very simple questions about their experience...

"What color is it?" -- "Are you sad?" -- "How old are you?"

It seems likely that the answers you will receive will be metaphoric and not concrete. "All the colors" - "I'm as old as the river". Don't expect to carry on a normal conversation.

The most comforting thing some people have reported helped them during acute experiences is a blanket wrapped around them. We cannot recommend enough having a thick, weighty blanket for emergencies.

***Note. SWIM did not write most of this report. With the exception of the section labelled “How to Stop a Panic Attack”, the rest of the report is compiled of articles taken from different sources on the internet. Please see below for a list of the sites that SWIM found the articles on.

Sources

Wikipedia Encyclopedia: http://en.wikipedia.org/wiki/Panic_attackhttp://en.wikipedia.org/wiki/Bad_trip
Erowid: http://www.erowid.org/psychoactives/faqs/psychedelic_crisis_faq.shtml

Reputation Comments on this post:

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