Dr. Marina Angeli is a psychiatrist in private practice in Athens, Greece. Her psychotherapeutic background is in Family Therapy - the Systemic Approach. She is a graduate of the Flower Essence Society Practitioner Training and Certification Program. 

Helping clients who suffer from panic attacks has proven to be one of the easiest and most rewarding health issues for my practice. Prognosis is excellent for all those who go through the healing process that I will review in this article. A 23-year-old girl who was treated for panic attacks about a year ago commented: "Last week I became one year old!!! I have been living only for one year. It was not really life that I was living until a year ago!"

Several years of work with patients suffering from Panic Disorder have convinced me that flower therapy, when combined with psychotherapy, can be very effective. The result is almost immediate relief from symptoms with no need for chemical medication, and profound treatment of the underlying emotional causes of this problem.

Defining Panic Attack Syndrome

Panic Disorder is characterized by feelings of spontaneous, unexpected panic accompanied by acute anxiety. The typical panic attack includes symptoms such as tachycardia, dyspnea, palpitations, and sweating, increasing rapidly during a period of 5-10 minutes. Symptoms may feel life threatening, and great fear arises, resulting in a further worsening of the situation. Panic attacks most typically occur in closed-in places, such as a crowded bus or any place from which the sufferer cannot exit immediately, although these incidents may happen anywhere, at any time. The attack typically endures for 20-30 minutes, up to a maximum of one hour. Soon after the first one or two attacks, considerable fear and apprehension about future episodes develop. Because of this fear, precautionary measures are taken to avoid trigger situations and to ensure a feeling of safety.

More often than not, such persons avoid going out in public unless accompanied by someone they know well. There is considerable fear that a sudden panic attack would expose them publicly. This is known as "agoraphobia," termed Panic Disorder with Agoraphobia. Claustrophobia, a situation in which the person avoids closed-in spaces or vehicles such as tunnels, bridges, elevators, buses, trains, or airplanes, may also develop. If such a person attends an indoor event at a theatre or cinema, for example, an attempt will be made to sit next to the aisle, preferably near the exit, in case panic symptoms erupt.

Treating Panic Attack: Looking Beyond the Symptoms

It took a long time experimenting with different flower essences before a formula that effectively addresses panic attacks became apparent. In the beginning, my attention tended to be "symptom oriented," focusing on the presenting fear and trying to relieve the fear with flower essences. I experimented with all essences concerning fears, such as Mimulus, Aspen, Rock Rose, Rescue Remedy (Five-Flower Formula) , and more. To my surprise, these essences made practically no difference; the emotional situation did not change to any considerable degree, nor did the psychosomatic symptoms. I knew from experience how effective flower essences concerning fears had proven to be. So, why were results lacking? If panic was the real issue, why did it not respond to the essences?

Choosing Essences for the Underlying Emotional Context

The first step is to understand the emotional state of someone with extreme inner tension, resulting in enormous anxiety that explodes in the body. This "explosive" nature of the symptoms points toward Cherry Plum . Such a person is unable to tolerate inner tension any longer. This loss of control is expressed as physical turmoil, a chaotic intensification of body functions amplifying to a state of emergency. Many times the suffering person literally feels that he or she is going crazy. On the other hand, the fact that such crises often occur in closed-in or crowded places, where the person has little or no control, could perhaps be viewed as a lack of control in the person's life. The restricting outer situations may represent an inner state of emotional "suffocation" and despair.

One can also observe heightened feelings of impatience during and between crisis episodes. The patient wants to exit closed-in space immediately. The psychosomatic symptoms of tachycardia, dyspnea, etc. are symptoms of urgent emergency. Moreover, I noticed that panic attack sufferers were constantly in a state of impatience, though not aware of it. Impatience was the natural reaction to an intolerable inner tension and dissatisfaction. Like a volcanic explosion, this tension found dramatic release during a crisis. So the next flower essence to consider was the Impatiens .

The third striking feature of panic attack cases is that the person seems oblivious to the cause of his or her problem. The intense state of emergency predisposes the sufferer to feel that the problem is entirely physical. Therefore, no correlation is made between the acute symptoms and the overall life situation. The idea of attempting a psychological interpretation never seems to occur, not even when prompted by psychological counseling. A lack of inner understanding of the situation only serves to increase the overall feeling of panic and bewilderment. I took this as an indication for Chestnut Bud flower essence.

I also noticed that panic attack sufferers are almost always extroverted personalities. They attempt to avoid personal problems and shift attention to pleasant diversions for as long as possible. When panic attacks erupt, they keep the episodes to themselves or within the family. An intense effort is made to appear normal, even cheerful, to the outside. The fear of exhibiting panic attack symptoms in the presence of others leads to the more extreme condition of agoraphobia. Therefore, I decided to include Agrimony in the formula for panic attack.

These four flower essences elicited many changes for panic attack clients. Cherry Plum promotes emotional differentiation and accelerates contact with the inner feeling life, Chestnut Bud increases awareness about the causes of personal difficulties, Impatiens adds a soothing effect, and Agrimony releases the need to hide negative emotions.

Asking Deeper Soul Questions

With the use of these flower essences, the client acquires the ability to look inside and perceive previously unconscious aspects within the soul life. This new awareness makes it possible to ask questions such as: "Are there circumstances in your life where you feel trapped, or pressed by a situation that causes you to feel about to explode? From what in your life would like to escape, or what do you want to eliminate? Are there instances in your life where you feel dependent, uncomfortable, powerless, or as though you are suffocating?"

By asking these questions, it became apparent that patients had become increasingly dissatisfied with their lives for quite some time before the onset of panic attack symptoms. These clients found life conditions intolerable, but felt unable or unqualified to make changes. These conditions always concerned close relationships, usually with family members. Most often these relationships were with overprotective or over-caring parents, who were at the same time very dependent on the patient, either psychologically or physically.

This complex relationship meant that the panic attack sufferer was over-concerned about the loved one and felt responsible, typically feeling manipulated or burdened by the problems of the loved one. At the same time, the client doubted his or her ability to cope without the help of the loved one. In addition, some patients felt trapped in conditions such as a job they did not like, or even an entire lifestyle that appeared overwhelming and beyond change.

Red Chestnut was the next flower essence choice for excessive worry and entrapment in relationships. Although the negative Red Chestnut state was not apparent in the initial stage, it became obvious when the patient was confronted with the need to take action. A typical feeling is, "This person needs me. How can I ignore her or him and do my own thing?" Red Chestnut has proven to be a strategic choice for breaking free from dysfunctional patterns in relationships and moving towards soul health.

The foundational formula of Agrimony, Cherry Plum, Chestnut Bud, Impatiens, and Red Chestnut provides profound relief from panic attack symptoms within the first few days. When using this combination, panic attacks either decrease dramatically in frequency and intensity or do not appear at all. I also add Gentian to the formula when there is a need to protect from disappointment or discouragement from possible setbacks. Sometimes, particularly sensitive people experience "uneasiness" or anxiety for a few days when beginning of flower therapy. This can be viewed as a "therapeutic crisis" resulting from a major change in awareness. Star of Bethlehem can be used to overcome or minimize this challenge.

Relief from Symptoms and Changes in Consciousness

Relief from symptoms is not the only benefit; more important is the change in consciousness. By the second session, patients shift attention from being symptom-oriented to becoming insight-oriented. They are now able to perceive what is happening from within. Even though they may not yet be able to handle situations in a different way, they are in touch with emotions and understand the psychological issues responsible for the situation. This has a profound calming and liberating effect. Chestnut Bud provides a sense of safety and self-confidence, because the client can now understand what had been wrong, giving control over the situation. The beautiful thing in the use of Chestnut Bud is that symptom interpretation comes directly from the patient, based on internally derived insight, not professional interpretation the patient is asked to adopt.

Cherry Plum catalyzes this process by "melting" the explosive inner tension, educating the language of feelings, and opening the way for inner dialogue. Impatiens calms and gives time to process feelings, rather than causing aimless panic. Agrimony gives freedom to genuinely experience and express thoughts, feelings, and worries that were previously "unacceptable" and to work with these psychological issues in a therapeutic context. Finally, Red Chestnut frees dysfunctional attachments and fears about others, so that the client no longer feels guilty about attempting relationship or lifestyle changes.

As I have become familiar with more flower essences over the years, others have been included in the formulas mentioned above. Dog Rose ( Bauera rubioides ) is used for worry, fear, and Dog Rose of the Wild Forces ( Bauera sessiliflora ) for "somatization of anxiety" (to keep the emotional tensions from affecting body functions), along with Emergency Essence for courage in facing threatening situations. Scarlet Pimpernel ( Anagallis arvensis ) awakens new soul forces that can be released into the personality in an organized fashion; Blackberry ( Rubus villosus ) gives more strength for life conditions, especially fear of death for oneself or a loved one; and Apricot ( Prunus Armeniaca ) brings lightness and cheer for burdened states of mind. With the addition of these essences, panic symptoms usually dissipate during the first week. I have never needed to apply a special treatment for accompanying agoraphobic symptoms — they subside following general treatment.

Therapeutic Strategies for Panic Attack

Although panic attack symptoms may clear immediately, the flower essences are administered for several weeks or months. The length of time depends on how long it takes for the client to resolve the basic underlying causes and make the necessary changes in life in order to feel solid and free. Each person follows his or her own pace.

Clients do amazingly well, with the exception of a few cases. One individual refused to continue the process when she started to realize the impact that a dysfunctional relationship with her spouse was having on her life. Some clients report a dramatic decrease of panic symptoms during the first few days and prematurely discontinue therapy. As these individuals become aware of the real source of their problems, they worry about the threat to primary relationships. However, with the assistance of flower therapy, the majority of panic attack sufferers experience personal transformation and change as an easy, exciting, and enjoyable process.

During the first session, I usually do not talk much with patients. The main issue is to decrease the level of panic and provide access to personal insights. With flower essences, both these goals can be achieved rapidly, while talk is of little help at this stage. I only listen to patients as they describe their physical symptoms and then administer the essences, simply telling them that they are going to feel better very soon. I assure the patient that his or her symptoms, no matter how annoying, are not a direct health threat. I let each client know I will be available in case of any questions or acute complaints.

During this first session, I always avoid scheduling the next appointment. The client still feels an acute sense of emergency and needs assurance they he or she can return whenever necessary. Also, for most clients, this is the first time trying flower essences. The client requires freedom to explore whether the therapy is helpful before committing further. About two weeks later, the client returns with sufficient insight about the situation, and psychological work can begin.

The Possibility of Therapeutic Crisis

A panic attack sufferer can experience a therapeutic crisis during the first days when taking flower essences. By contacting suppressed emotions, one comes face-to-face with realizations that have been avoided. Star of Bethlehem can be helpful for those who react with anxiety at this point.

Informing the patient in advance about the possibility of a therapeutic crisis is important. There have been a few patients who hesitated to take their flower essences after I conveyed this information. But assurance that profound changes can take place helps the client adopt a positive, courageous attitude.

If the client experiences a crisis situation, I recommend cessation of the essences for a day or two, or have the client take the essences less frequently for two or three days. Then I slowly increase the frequency to normal and assure the client that he or she can call me if there are feelings of uneasiness.

While improvement is visible in the first 2-3 days, fears about possible recurrence of panic symptoms take longer to reconcile. However, I have confirmed that no matter what difficulties a person may encounter in the future, follow-up consultations conducted years later confirm that panic symptoms have never reappeared. Clients acquire a much better level of body-mind awareness, as well as functional, conscious strategies for handling their problems.

Helping Clients With Previous Chemical Medication

I have never needed to prescribe chemical medication for panic attacks. In cases in which clients have engaged in drug treatment before coming to flower therapy, I do not suggest stopping medication immediately. This can make the client feel anxious or insecure. Furthermore, most drugs produce their own adverse chemical symptoms when discontinued abruptly.

I inform the client that there will soon be no need for the drug. I recommend a method of gradually taking less of the medicine, to the point that feels comfortable. With these measures, the client reduces, then finally stops taking the chemical medication, usually during the next few weeks. The exception is for those clients who have been using Lorazepam for panic attacks for many years. A strong dependency is developed with this particular drug, and many clients refuse to give it up completely. Soon, however, these patients are able to reduce the drug quantity to placebo levels of 0.5-0.25 mg. per day.

Write to Dr. Marina Angeli.