How do I get my panic attacks in a car under control?

May 27, 2008 12:28 PM

How do I get panic attacks, triggered by the threat of a real physiological condition, under control? Warning: Somewhat gross discussion inside.

Obviously this question is a bit embarrassing, and I've been holding off for months asking it in any forum at all. But I have to admit that the situation has gotten beyond my control and I don't know what to do.

I've always had what you could call a nervous stomach or, more clinically, IBS. The short version of the symptoms is that it's difficult for me to remain 'regular', and when I do need to have a bowel movement, it's an immediate thing - I go from feeling a twinge, to a painful ache in my intestines, to needing a bathroom in the space of about ten minutes.

Nervousness has always been a kind of trigger for it, but for a long time I had the situation under pretty good control - With fiber supplements and a careful diet I could manage a pretty normal once-daily cycle, with only the occasional emergency outside my normal time if I was really anxious about something.

At some point, starting about a year ago, I started getting nervous when I was in my car. My commute in the morning and evening is very, very congested - 17 miles takes me about 45 minutes to an hour during rush hour. It may have been because a couple of times I found myself stuck on the highway when my body decided it was time to 'go', but that's happened before, so I don't know if that's what precipitated it. But whatever the reason, I've gone from being a little anxious when stuck in traffic to on the verge of a panic attack ANYTIME I'm in my car at all.

Even if there's no bad traffic, or maybe just the threat of bad traffic, there's this pit of fear in my stomach I can't get rid of. If there IS traffic, or if I'm in a situation where I know I won't be able to quickly get to a bathroom (long bridges for example), I spend the whole drive in what I assume must be a full-on panic attack - I don't know, I've never felt anything like them before, but I figure that's what it is. I'm sweating, terrified, my stomach starts hurting something fierce, and I can't think of anything else. And that triggers at least what feels like my body needing to have a bowel movement, which makes it something of a vicious cycle.

I don't think my physiological condition has changed, this seems to be mental - I don't really have to have a bowel movement until I start panicking and the nervousness makes my intestines clench up. Even right now, writing this post, I'm squirming in my chair and my stomach's making sad noises at me, just because I'm thinking about it.

I don't know what to do. Long car rides are a near-impossibility for me now, I can't go on recreational motorcycle rides like I used to, and in a few months I'm going on a driving tour through Europe that I have no idea how I'm going to cope with. I'm not exaggerating when I say this happens every time I get in the car now, it's become an absolute trigger - I feel fine, I get behind the wheel or in the passenger seat of a friend's car, and that knot forms in my gut. I live in California, so driving a lot is a requirement for my life.

Anyone had this or similar problems they could offer advice on?

posted by wolftrouble to health & fitness (10 answers total)

I don't think my physiological condition has changed, this seems to be mental - I don't really have to have a bowel movement until I start panicking and the nervousness makes my intestines clench up.

This is only somewhat accurate, but understand that physiology and psychology are intricately linked, and IBS is very much associated with psychological triggers.

I have a similar condition to yours (though admittedly a less gross sister of your illness), and I experience heightened symptoms when I'm under stress (notably during exams or periods of intense workloads). I start to develop intolerances to many of the things I normally eat, and have to carefully pick and choose things that make as much a picturesque diet as possible, and my belly often grumbles and cringes at everything I offer it.

Admittedly I am not a doctor, but I think this might offer you some insight as it pertains to my own situation, and I believe many people who have these conditions: What you are describing here is very much like what a psychologist might call "conversion syndrome" where you are quite literally transforming your panic into symptoms. This is a strategy of your mind to translate its stresses into tangible things of the body. The thing is, these tangible things are often your personal weak-spot, which we both share: the gut.

You may be developing a strengthening association between traffic congestion, and IBS-accident, which is an understandable thing to worry about! And paradoxically I'm going to say: don't worry about it. You may want to see a therapist to talk about this, because talking it through with a professional would certainly be your best option.

I think you've done the right thing to post this on a forum and seek help, and I think you have a very good sense of personal insight on the matter, you've worked out most of the causes - it's just the solution that's hard to approach.
posted by tybeet at 12:44 PM on May 27, 2008

I had this problem (the sudden need to find a bathroom immediately, if not sooner) when my colitis was flaring up. One thing that would help was making sure I went to the bathroom just before I was going to be without bathroom access for some amount of time. This is easier said than done, I know, but you said that even thinking about being trapped in the car makes you need to go right now, right? This is going to sound weird, but... What if you do that thinking on purpose before you start your commute? You evoke the anxiety, your stomach cramps up, you run for the bathroom and go. And then... you know that you won't physically have anything that can come out for the next hour or so, so you can feel calm about getting in the car and getting to work. And then, because you're calm, you won't have the in-car panic moments. It sounds weird, but it really works.

Also, if you're drinking any caffeine at all, stop. Caffeine was always a huge trigger for me, both for the "gotta take a crap right now" urge, and the accompanying panic. Good luck, and hang in there! It does get better. In my case it was a matter of finally getting my colitis into remission, but I suspect with your IBS it may mostly be a matter of breaking the cycle of panic.
posted by MsMolly at 12:49 PM on May 27, 2008 [1 favorite]

It sounds almost as if you've developed a phobia of car rides, so a treatment plan for phobias might work in overcoming it. I am not an expert but as far as I know they are usually overcome with controlled exposure.

So maybe start by taking really short rides - "this is just 5 min so I don't have TIME to get an IBS attack", then gradually increase the length. Or go for rides with a friend in the car, having a fun conversation, playing a word game, putting on some music on that you like, etc - anything to get your mind off the anxiety and stomach upset. Or even see a professional and get some anti-anxiety meds, and take one before a car ride - that way you'll KNOW you won't have a panic attack so you can demonstrate to yourself that it's possible to be in a car without one.
posted by Mr Bunnsy at 12:57 PM on May 27, 2008

Oh, and can't believe I forgot this but... Imodium. If you're not taking it already, start, and you probably won't even have to worry.
posted by MsMolly at 12:58 PM on May 27, 2008

Dismiss this if it's crazy - but what about wearing Depends on your European trip? Maybe just knowing they're there will decrease the anxiety. According to the ads, you can't tell people are wearing them. : )
posted by Penelope at 1:12 PM on May 27, 2008

Seconding MsMolly on the caffeine!

Come up with a plan for the worst-case scenario. Keep extra underwear, tp or paper towels, a bottle of water, a couple plastic bags in the car. It'd suck, yeah, but you can handle it. Just convincing yourself of that will help immensely. If it no longer feels like the worst thing in the world, your stress level will go down, and problem solved!
posted by hippugeek at 1:55 PM on May 27, 2008

You've conditioned yourself to have anxiety upon entering the car. It's classic learning theory.

You have to de-condition yourself - this is something a therapist with a behavioral or cognitive-behavioral bent can help you with. This is the kind of thing that hypnotherapy or relaxation therapy could be helpful with as well. But don't worry - this kind of generalization of anxiety leading to panic attack is quite treatable.

You might benefit from some anti-anxiety meds during the de-conditioning process, but they are not a substitute for doing the work in therapy, just a helpful tool during the therapy process.
posted by jasper411 at 2:30 PM on May 27, 2008

I have IBS and I know how painful and stressful it is. I also know what happens, to me at least, once the cramps start, and it's not short lived, easily contained or quickly cleaned up after. So you have my sympathy.

Stress and psychological effects are a very real part of IBS, as both a cause and an effect. What is happening here is physiological as well as mental and unfortunately they feed into each other. It sounds like you've built up a fairly strong connection between being in the car and the anxiety to the point that counselling and possibly anti-anxiety medication would likely really help. You need to break that connection. If you can get a handle on the psychological side then the physical stuff won't be such an issue, and a professional can help you do this.

Also, back when I had attacks pretty often, I used to take an anti-spasmodic (which I do not remember the name of and is probably out dated by now anyway, but there are several). They were awesome, stopped the cramps and bloating, prevented the pain and generally meant things didn't progress to the must go now state that sucks so much. To start with I was really badly affected by stress and my IBS was pretty out of control so I took a fairly high dose every day for a couple of years. Then once I was used to not getting sick at every little thing and stopped anticipating it all the time and winding myself up I was able to just take one whenever an attack was starting. A year or so later I stopped them and I now take no medication at all, just generally watch my diet. Scientific literature I've read about IBS does mention anti-spasmodics and they are a recognised part of treatment but my experience was that a lot of doctors don't know how to deal with this disorder and many of them had never heard of what I was taking.

Obviously I can't say if you should take something similar and you'll need to talk with a doctor but my point is there are a bunch of different types of medications available for IBS, it can take a very good doctor to know about what's out there, and it should be possible for you to treat the acute attacks to lessen or prevent them. If you knew there was something you could take that would help alleviate the immediate pain and pressure should things go wrong during a car trip then that would also help on the psychological side also. Attack from both sides if possible.

And don't take Imodium without at least talking to your doctor about it. I couldn't think of anything worse for my IBD and it's a highly personalised disorder.
posted by shelleycat at 2:20 AM on May 28, 2008

Hi, are you me?

I had to finally pay my membership to respond to your post. I've had the identical symptoms, to varying degrees of severity, since I was 13. I developed the same car phobia issues for the exact same reasons. It's embarrassing, hard to explain, and more than a little ridiculous and undignified. I'm sorry you're going through it! Don't feel alone, though. Lots of people have panic attacks, IBS, and the combination of the two. You may be surprised to find people close to you have similar issues, but of course no one talks about it.

I have found some coping mechanisms over the years that have served me quite well, and hopefully will bring you some relief too. It's exhausting to fight that battle every morning just to go about a normal routine, and you'll never be entirely free of it, but you can reduce it a great deal....and still enjoy Europe.

- First off, panic attacks, whatever their cause, are one of the most responsive conditions to treat in therapy. Cognitive Behavioral Therapy in concert with Prozac did me enormous worlds of good. If your experience is like mine, you will still respond to your triggers, but the tidal wave of inappropriate anxiety is reduced to a...much smaller water metaphor. Squirt with the garden hose? Totally surmountable, and smaller after every victory. It's very much a wonderful feeling, to overcome those fears.

- Do look into getting this treated. Don't wait til you've spent 2 years agoraphobic like I did. Cos you know, this fear of car rides thing can lead to you being too afraid to go ANYwhere. Deal with it before it gets to that point, okay?

- Morning drives are much easier to take if I don't eat beforehand. In my experience, an empty, hungry stomach is incompatible with an IBS attack. Can you bring breakfast with you and eat it once you've arrived at your destination? I have also found that I am much less cranked up on the ride home, and seldom feel anxious or ill if I am headed homewards - even if I've eaten recently. Is it the same for you? Being aware of this can reinforce the awareness that your issues are primarily anxiety-fueled.

- Just for peace of mind, keep some emergency goods in the car. A couple plastic bags, some spare clothes, paper towels, handi-wipes. They're there if you need them, and certainly useful to have in the car under many circumstances.

- Play the "What's the worst that could happen?" game. Explore the scenario in your mind, if you were to have Poopsplosion in your car. Other motorists can't see. Car seats are washable, clothing is washable. If you don't have a garage, you might have the Walk of Shame from your parking area to your door, but if you have the supplies above, that can be minimized as well.

- Distractions are great. Audio books are my favorite. You can be so engrossed in the story, you forget to be anxious. Podcasts work well too, especially This American Life. Ira Glass has no idea.

- You might skip carrying passengers or being a passenger til you've chilled out and feel that you can do so without concern. The act of driving my car - and being able, if I ever needed to, to pull over - is the best thing to keep me relaxed and comfortable. I can give lifts to friends now, but I almost always choose to drive, and will elect to meet someone at a destination rather than take a lift. Knowing I can make a 'getaway' in my own car gives me no end of comfort.

- Look at the clock. Panic attacks seem like they last forever. But they really generally only last around 5 minutes and certainly under 10. If you have to count the second hand ticks on your watch, do. It's temporary!

See if you can identify foods that trigger your gut, and avoid them. Some whole grain is certain to help regulate you (shredded wheat is great.) But IBS is fickle and I can't always figure out what kicked it up. Foods that I can sometimes get away with, will sometimes do me a world of hurt. Menstrual cramps almost always kick it up, and sometimes the whole intestine churn thing just happens for no reason. It sucks. But I try to remind myself, hey, I'd rather have this than a brain tumor.

Best of luck - you're not alone and you can totally deal with this. Try to keep a sense of humor about it, and take the fright out of it. Everyone poops, and if the internet is good for something, it's good for finding other people's accidental poop stories. It's part of life and it is far from the worst thing that could happen to you, really.
posted by Lou Stuells at 12:12 PM on May 28, 2008

Funny, apparently IBS (or IBS-like symptoms, in my case) and panic attacks aren't so uncommon. In my case (as a passenger, I don't drive), I would freak out and insist on getting out as soon as possible, bathroom available or not. After the initial concern, people began simply insisting that I wait it out. So I had to find alternate solutions (:

Something not mentioned here -- I usually take a non-drowsy Dramamine ahead of time. That really helps me, also makes me very hungry without IBS symptoms (even when I eat). Good stuff. That and, you know, deep breathing.

Seconding the empty stomach solution and avoiding caffeine. I found that caffeine usually made my stomach hurt really badly when I had to "go". For long flights in the airplane, I get an aisle seat and snack very lightly.

Also, when I was panicking, I would usually think up an emergency plan. So the emergency pack in the car sounds like a very good idea. It may seem ridiculous, the lengths you have to go towards making yourself comfortable, but from what I know about panic, your comfort is important.

Good luck.
posted by vaguelyweird at 10:57 PM on May 29, 2008