Staunching a potential anxiety attack?

November 9, 2009 4:01 PM

How do I prevent an anxiety attack in a specific situation that is likely to trigger one?

I am interviewing for professional school in January. I have not had problems with basic job interviews before, and I don't fear presentation or public speaking in general. I have done those things in the past completely without panic or anxiety, even with enjoyment (I did competitive speech in high school).
However, I get anxious just thinking about being questioned about my knowledge, general intelligence, and potential for success by people who hold advanced degrees and know more than I do. I can manage the interviews, but only if I am able to focus on the conversation above those fears. I'm very concerned someone will ask me a pointed question and I'll just start crying or go silent, even if objectively I know I could give a reasonable answer- this has happened once or twice to me before, and once the fear of being judged takes hold, it's hard to stop the physical reaction of panic.

Do I need a full course of CBT in preparation for interviews? Will a one-time use of benzodiazepines be appropriate, or will it make me so loopy that I'll perform poorly anyway? I don't think the usual hacks like deep breathing, stopping for a sip of water, etc. will be enough if I start feeling anxious. I have to go in knowing I am well-armed against that happening. What's the best way to do that?

posted by anonymous to human relations (18 comments total)

As someone with a (diagnosed, if that makes a difference) anxiety disorder, in your position I'd likely use a benzo. If you go that route, I suggest you get a prescription now and do a test run. Take one and then do a mock interview with a friend. That way you'll find out exactly how you react.

Good luck!
posted by sugarfish at 4:12 PM on November 9, 2009

I would go for an instant-action benzodiazapene in case you need it (sublingual xanax?) which will make you feel more secure and probably not too loopy if you use a small dose, practice asking for a break if you need one, and think about what the worst thing that could happen would be like--you don't answer a question--what then?

If it's an almost purely physical panic attack situation and you can't see yourself doing anything mental to stop it, a preventative benzo is probably the way to go. Maybe try one and see how it affects you? A good psychiatrist's advice would be helpful, I am just a layperson who has had a lot of panic attacks.
posted by kathrineg at 4:12 PM on November 9, 2009

I think benzodiazepines are inordinately helpful in this sort of situation, but you would want to make sure that the dose was low enough that it didn't slow your mind down too much. At reasonable doses, the cognitive deficits are pretty minimal (though still present), and probably wouldn't hamper you from interviewing effectively. However, I personally would want to do a 'practice run' first just to see how the drug would affect me.
posted by solipsophistocracy at 4:13 PM on November 9, 2009

The reason I suggest having an emergency benzodiazapene on you is that it often makes me feel better even if I don't use it, just because it's there, allowing me to be more confident in anxiety-producing situations. You might not get the same effect.
posted by kathrineg at 4:14 PM on November 9, 2009

I got a benzo prescription way back when, when my tinnitus was making me insanely anxious and I realized I was in a vicious circle and it needed to stop. Now I tell people that I think they can be lifesavers for situational anxiety that needs to not ruin your life. My experience is

- I've pretty much taken them once in a blue moon [when I haven't been able to sleep decently for days and I have something important to do] so a prescription for 15 lasts me half a year or more
- they do not make me loopy, they make me a little sleepy but not "I can't drive" sleepy
- I make a deal with myself that I won't take more than one in a week [I'm concerned about their addictive properties, though haven't had a problem]
- I sometimes get a low-level crash the next day, little more anxious, little more GRAR

I really recommend it. Most of the time now, my bottle full of a few pills is like Dumbo's magic feather. Knowing it's an option makes me realistically evaluate whether I think i really need it. I think it would solve this particular problem and not cause any other long term ones and allow you to concentrate on doing a good job at this interview.
posted by jessamyn at 4:16 PM on November 9, 2009 [1 favorite]

There is this sweet story about Artur Rubinstein the pianist who had to play in a large concert hall and a lot of his colleagues were in the audience to listen. Someone asked him 'aren't you especially nervous today'? and he answered 'no, those guys know how difficult it is to play a concert'. Or something similar.
I would always fear those who know and/or care less about my work than myself. Those are the people whose questions can make others cry or dry up.

Assemble more positive thoughts like this and, yes, breathe.
posted by Namlit at 4:20 PM on November 9, 2009 [4 favorites]

Is xanax the recommended benzo or are there other options?
posted by infinityjinx at 4:32 PM on November 9, 2009

Nthing the benzo route. I prefer Ativan (lorazepam) over Xanax (alprazolam). 0.5 mg is enough for me to feel calm and centered but not sleepy or loopy. No matter how small a dosage of Xanax I take I always feel not quite present, I'm not sure why.
posted by hapax_legomenon at 4:50 PM on November 9, 2009

Yeah my vote is also for Ativan/lorazepam.
posted by jessamyn at 4:55 PM on November 9, 2009

0.5 mg is enough for me to feel calm and centered but not sleepy or loopy.

This is just to say, definitely do a test run, because I took 0.5 mg of Ativan once and pretty much fell asleep with my glasses on. I am a lightweight, though.
posted by palliser at 5:28 PM on November 9, 2009

I'm actually not a huge fan of xanax but my understanding of it is that it is the go-to of choice for fast acting symptom relief. But that's where a shrink comes in, who can go over the benefits and drawbacks of each kind and determine what's right for you in this particular situation.
posted by kathrineg at 7:49 PM on November 9, 2009

this may not work for you, but when i am super anxious about something i have to do the next day, i take .5 mg of lorazapem the night before, i sleep and wake up feeling relaxed and calm and that feeling pretty much lasts at least through half the day. so i avoid drowsiness but still feel calmer and more centered.
posted by dmbfan93 at 8:45 PM on November 9, 2009

What about a little exposure therapy?

The idea is- say you're afraid of being trapped in a small space. Well, if you spend enough hours locking yourself in a trunk, and the world doesn't come to an end, eventually you'll go from abject terror to total boredom.

In your case, maybe you can also expose yourself enough to the experience that makes you panic that it doesn't phase you anymore.

Even if you aren't personal friends with someone in your field, surely just about all your friends know more than you about some random subject or another.

You can talk about that subject with them, and have them play the role of your worst nightmare- I'm assuming some kind of brilliant, snobby, no-nonsense person with high standards who will see you as some kind of fraud?

Or just have them pretend-judge you in other ways. You can start with really really mild judging if you need to and just increase it slightly as you go along.
posted by Ashley801 at 9:43 PM on November 9, 2009

Agree with what others before have said. I have a prescription for klonipin but I've needed it less and less over the last few years. Just knowing I have one in my wallet has a security blanket effect. I only take maybe 3 a year now and a 1 month prescription will last me well over a year.
posted by white_devil at 12:51 AM on November 10, 2009

Nthing getting something like Ativan. I took half of a (I think .5 mg) pill this morning for exactly this reason. It's amazing how much it helps!
posted by rosethorn at 1:40 AM on November 10, 2009

Xanax does it for me.
posted by WeekendJen at 11:58 AM on November 10, 2009

I agree with all of the suggestions for benzodiazepenes (I use Klonopin, personally). I also agree with the recommendations of a "test run." It might make you very sleepy. Seriously, do not drink when you take it (not that you would before an interview, but...).

In the longer run, what's helped me is giving myself permission to fail. I imagine the worst-case scenario - in your case, you don't get into this particular school; surely there must be others. The scenario might suck, but you won't be dead or dying, and there are other far worse fates. It sounds grim, but it's really helped me to put things in perspective and it calms me down to the point where I perform much better than I'd anticipated.

Good luck!
posted by desjardins at 12:20 PM on November 10, 2009

If you do go the benzo route, and want more input (even though you've got an awful lot):

I'm a fan of the classics, personally. Valium (diezepam) all the way. Xanax (alprazolam) is my preference if Valium's not an option, but Klonopin makes me dumb as hell. I know this is probably just a personal thing, but I swear it seems like there are stronger cognitive deficits with ole clonazepam...
posted by solipsophistocracy at 5:17 PM on November 10, 2009