KEN STRONG - Part 2: Information for Support People, Family and Friends : DRIVING

People subject to panic attacks can find driving difficult. It is frequently one of the last problems to be overcome as they make progress in their recovery. The usual reason given is the person is afraid of a panic attack while driving. This is true but the more immediate fear is they will encounter some situation which triggers a panic attack.  
 
There are some people who find their car the safe place but they are in the minority.  
 
Triggers of Panic Attacks  
 
When anyone first starts driving it seems as though there are a hundred things which must all done at the same time. Watch the traffic; watch the road; watch for stoplights; don't hit that pothole; go back and apologize to that nice motorcycle policeman you just forced into the ditch; use the break; change gears; find the wiper switch - oops that was the hood release. And on top of all that you have to learn to ignore the thousands of other unimportant pieces of data which are flooding your brain. Most of us did it successfully.  
 
Remember a person with high anxiety is hypervigilant which means much of the data registered by the senses is not filtered out. It is sent on to the higher thinking parts of the brain to be processed, identified and evaluated. A situation like that can rapidly lead to sensory overload.  
 
Sensory overload even on its own can be serious. During the Cold War years 'research', if you can call it that, was done on people to see if some method of breaking down prisoners of war using sensory overload would be practical.  
 
Sounds can be enough to trigger a panic attack. The whooshing of traffic in other lanes, horns, the sound of tires from many vehicles on the highway, etc.  
 
Visual stimuli are also a villain. Many cars going in different directions, headlights from moving vehicles, the flashing by of utility poles, white lines which are not clearly visible, the multitude of road signs and direction signs, all play a role.  
 
A while ago I was talking with two women who were having trouble driving. One was a musician, the other an artist. The musician was troubled primarily by the noises while the artist was having a greater problem with the overload of visual information. Makes sense.  
 
Not being in control of the situation is another trigger. Being forced into the wrong lane, not being able to change lanes when required, missing a turn, becoming lost, being tapped at a stoplight, forced to take an unfamiliar route, not able to follow the planned route, all raise the level of anxiety to the point a panic attack may occur.  
 
Getting Started Driving Again  
 
There are a number of ways a person can start driving again. Here are some which have been successfully used. Not all work for everyone and a combination may be the best way. Whichever method you are going to help the person utilize, remember not to push too much. They do not need a support person raising their anxiety level beyond a small touch. Also, be aware it can be very disheartening for someone to have to fight in order to drive over a familiar stretch of road which they have been driving over for years without a second thought.  
 
Don't let the person feel like a failure because a particular method is not working for her. I hear of very few people who find that instantaneous cure. It takes times and practice. Practice by using the baby steps we talked about in an earlier chapter. Even taking a break for a few days may be preferable if a high level of anxiety is being reached. Make sure that short break, does not turn into a long time.  
 
Remember to include a bit humour if possible and if it is welcomed. Some people find the humour helpful others don't. Also, give genuine praise where it is due. Even a very small step, like having the willpower to try, is worthy of praise. But don't be surprized if the person responds with something like, "So what? I was doing that for years." Such can be the life of a support person.  
 
Methods:  
 
These don't have to be done in any particular order or in any time frame. Let the person be the guide.  
 
The first step could be to have the person feel comfortable in the car. Maybe just sitting in it by themselves for a while, then starting it up, moving a bit in the driveway or in a deserted parking lot are all methods of desensitization.  
 
Take her for a ride along a quiet familiar route. She is going to be worried about becoming trapped and having a panic attack so look for places on the road where she can pull off and not feel threatened. Also, find places where she can turn around if she feels she has gone far enough.  
 
Next, let her drive the section with you sitting beside her. Just having you there can give confidence from knowing she will not be stuck if she can't continue. Without the fear of no help during a possible panic attack, she may be able to do the whole route on her own with just a few anxious moments.  
 
Follow along behind her in a second car. Keep up with her and don't drop back out of site. Just the knowledge that help is available may, again, be enough to see her through.  
 
Use a cell phone if you have one. Staying back out of sight or remaining at home but available at the push of a button will also give some confidence. Preprogram one button to call home. During a panic attack she may forget the number or how to dial it. Oh, yes, and stay off the line..she doesn't need to find her lifeline busy.  
 
Suggestions for Driving on Her Own  
 
The cell phone connection I have already mentioned. Other things which have been successfully tried are given below. Again, remember, they may take time and not all will be useful to each individual.  
 
Place some stuffed toy such as a teddy bear on the passenger seat.  
 
Play quiet relaxing music in the car.  
 
Listen to the "little girl inside" as she says it is OK to stop now, OK to go on.  
 
If sound bothers her, suggest the window and sunroof be closed.  
 
Sneak up on stoplights. Crawling slowly towards them ensures the car will not to come to a complete halt before the green light. This way she does not feel trapped or stuck.  
 
Use a road map to plan a route which will avoid trouble spots such as left hand turns, center lanes, overpasses, underpasses, tunnels, multi-lane highways, etc. This will prevent a trapped feeling from when being stopped on an inside lane and avoids the overpowering visual signals from high sides such and underpasses and bridges.  
 
Perhaps three people with trouble driving may wish to go together. With 3 in the car there is, maybe, not so great a chance of an uncontrollable panic attack occurring. Or, when comfortable, these people may all wish to drive together in separate cars.  
 
A novel idea was used with mixed success by a group of people who had no one to drive with them. They had met over the internet and decided they would each go for a drive at exactly the same time and pretend they were together. It worked for two of the three of them.  
 
Prior to a drive, visualizing the route has worked for some. This is rather similar to an athlete visualizing the sports event before doing it.  
 
If they do have problems suggest they pull over and wait the panic attack out. For safely reasons it is possibly better to wait it out rather than trying to continue to drive. If the anxiety level is not too high, then the person may want to continue on without stopping. That is a judgment call.  
 
Ensure there is enough gas in the car and a road map in case a wrong turn is made.  
 
Where possible going from one safe place to another is helpful. For instance going from the house to a friend's place seems to help.  
 
Having the support person wait at a particular location also seems to help.  
 
Other Points  
 
It takes longer for some than for others to be able to drive virtually panic free. For some it is weeks. For others it is much longer but, as with all progress, each baby step is victory.  
 
A "new" car can cause some back sliding or, at least, a higher level of discomfort. The car feels different plus the controls and switches are in different places.  
 
It may take awhile to conquer a particular stretch of road. One woman I was working with took over a year to be able to drive the last 1/4 mile (.4 km) through a park as this section had no places to pull over. She could do both ends of this section but not the middle. Rather than just keep pounding her head against a wall she won back other routes and returned to this one from time to time.  
 
As with other situations, there will probably be back sliding. This is normal and the lost ground will usually be recovered quickly.  
 
Here is an example of a woman who did not give up despite events which would have upset a lot of us. She wanted to drive down a particular 5 mile stretch of road. After several days she felt she was ready to do it on her own . I remained at her house in case she had to use her cell phone. If she did phone I would talk her through her attack, remind her of her relaxation techniques, etc. I was really hoping I did not have to go get her.  
 
The first evening she went on her own I received a phone call, "Come and get me I have just hit a dog". Ouch! She didn't need that and she was so upset I did go down to escort her back. The second evening she was ready to try again. "Come and get me I have just run over a chicken". I talked her down from that one and she returned home a bit shaken. On the third evening she was full of confidence. "Come and get me I have just hit a deer". I went to get her and to ensure she and her car were unhurt. She was shaken up but OK and somewhat nervous of doing the route again.  
 
At this point I thought it might help if I followed her and if she did it in the opposite direction. It was starting to grow dark when I saw her car weaving over both sides of the road. As I got closer I saw about 8 deer running across the road in front of her and behind her. GADS! Next time we will not use this road..use one going the other way. The next evening she started off in the direction she had decided on relieved she would not to worry about dogs, chickens or deer. "Come and get me. I have just hit another deer and it is down on the road."  
 
I really have to give her an "A" for persevering. After that week of disasters she has not so much as scared a rabbit but it certainly was a stressful week.  
 
Giving Yourself Permission  
 
Below is a letter from a woman who responded to my request for stories about learning to drive again.
A letter from Anne
Dear Ken:  
 
After a number of years of not being able to drive (I really had tried), I came up with an approach which worked for me.  
 
Basically, it was a change in my thinking. The thought process is - I'm going out, I'm going to have fun, I'm not setting myself goals, I'm going to do what I want to do and check with myself as to what I can, want or not want to do.  
 
Why did I try this? First, because I had had enough failures - I didn't want more and I was not going to set myself up for them anymore. Second, the joy and fun had gone from life. Third, I was tired of being dependent on others. Fourth, I was worn out from panic attacks.  
 
To drive was my big thing so at first I just drove around a small area near the house. If I became uncomfortable, I'd pull over and ask not why I was uncomfortable but if I should do more, go home or go somewhere else. I listened to the little voice inside (was it me or the inner child - I don't know), but I quickly found the voice was correct. If it was me then I was simply telling myself - yes, go on; no, go somewhere else; try another road; time to go home. I even got lost a few times which previously was a guarantee of an attack, but now it wasn't - I found new places instead. This checking with myself was in essence giving myself permission to do what I wanted to do. It gave me choices and gave me back some control.  
 
What if I panicked? If I felt it coming or it came, I went home. Avoidance - yes. But it usually only happened when I didn't listen to or check with myself. After all those years, I was driving - going to appointments, the bank, shopping centres and malls and able to buy things on my own. I even found myself going over overpasses and 'managing' left hand lanes. I guess it was a lightening up, not taking driving so seriously and letting recovery happen at its own pace. It happened relatively quickly and with a minimum of panic and, in addition to driving, it is spreading into other areas of my life. Do I still have panic attacks? Yes, but rarely when I am driving.  
 
This approach has helped another person with agoraphobia and I hope it is useful to others. It is not a 100% answer to everything, I'm still on medications, but it got me out of the house. I felt like framing the first gas bill I got in years.  
 
Anne
Anne had come to realize her previous thinking process was setting her up for failure and she made changes.  
 
There is a world of difference between, "I am going for a drive", and "I am going to try to go to the store. " In the first, the aim is to go for a drive. It may be to the end of the block or 12 blocks and back. Anne did what she felt comfortable doing. In the second case, Anne would have had to make it to the store or she would have failed to achieve her goal.  
 
The same is true of any event whether it be a walk off the property or a drive. Why make a big thing out of trying to drive to the store when she can have a much more relaxed attitude just going for a drive and doing whatever she feels comfortable doing? Turn right. Turn left. Come home. Keep going. It doesn't matter. Allowing herself to have a freedom of choice without feeling guilty or under pressure is, to her, the key.  
 
After a few weeks of this Anne found she was driving greater distances and, eventually, could set off for a specific location knowing she had been there before while on her "no pressure" drives. She can now drive virtually anywhere. Stoplights and inner lanes are still a bit of a problem but not enough to force her to use alternate routes.  
 
Main Points  
 
* Driving is one of the more difficult tasks to relearn.
* Hypervigilance causes the brain to become overloaded.
* The overload and stress can lead to panic attacks.
* Many find it helpful to pick out a non stressful route.
* There are several ways of keeping stress to a minimum while driving.  
 
© Oakminster Publishing 2001

Ken Strong lives in Victoria, B.C. Canada. His internet site for carers has won numerous mental health awards - http://www.pacificcoast.net/~kstrong/

Ken Strong is also the author of the highly recommended book,

ANXIETY, PANIC ATTACKS AND AGORAPHOBIA - Information For Support People, Family and Friends, which is now in its second edition. ISBN 0929028104

In Australia the book may be purchased through Bronwyn Fox by ringing (08) 8555-5012 or email her on hub@paems.com.au