Panic Attacks While Driving
Symptoms, Causes & Treatment of Panic Attacks Behind the Wheel:
How to Get Over the Fear of Driving
By Steve B. Reed, LPC, LMSW, LMFT
It is estimated that 4.7 percent of adults will experience panic disorder, the recurrence of regular panic attacks, at some point during their lifetime. (1) When people experience the symptoms of panic attacks while driving, it can cause a traumatic imprint deep in the midbrain. This conditioning then causes an activation of the fight-or-flight response when exposed to any reminder of the earlier panic attack.
Panic attacks while driving often leads to avoiding driving in the same type of situations where previous panic attacks took place. When exposed to a painful reminder of a past panic attack, a new panic attack begins. This can happen when you remember:
- Panic attacks while driving on freeways
- Panic attacks while driving on bridges
- Severe driving anxiety when stuck in traffic
- Anxiety attacks driving on an overpass
- Panic attacks while driving at night
These are a few of the common driving conditions that can become linked to panic episodes. They become the source of severe driving anxiety, fear, and dread. The avoidance that follows impairs functional driving and causes a terrible inconvenience. This is in an attempt to elude overwhelming and debilitating driving anxiety symptoms.
Symptoms of a Panic Attack
There are many distressing symptoms of panic attacks while driving. When your midbrain alarm center activates, those symptoms are what you feel. This leads to the sympathetic branch of your nervous system mobilizing you to run for your life or fight for your life. This is the fight-or-flight reflex. When this happens, your body will experience rapid changes. This can include the:
- Release of endorphins and adrenalin
- Release of cortisol and epinephrine (stress hormones)
- Dilation of the pupils
- Activation of the sweat glands
- Increase in heart rate
- Constriction of the blood vessels (these last two raise blood pressure)
When a person experiences anxiety attacks while driving, the changes noted above are present. However, you may not notice all of them. Some of these changes, such as dilation of the pupils are too subtle. What you will notice are several strong physical and emotional symptoms. These are the symptoms of going into the fight-or-flight reflex.
These panic attacks/panic disorder symptoms are described in the Diagnostic and Statistical Manual of Mental Disorders – DSM-5 (2). The symptoms of a panic attack include:
- Trembling or shaking
- A feeling of choking
- Chest pain or discomfort
- Heart palpitations or racing heart
- Sensations of shortness of breath (like smothering) or hyperventilation
- Feeling dizzy, unsteady, light-headed, or faint
- Nausea or abdominal distress
- Fear of dying
- Feelings of unreality (derealization) or being detached from oneself (depersonalization)
- Fear of losing control or going crazy
- Chills or hot flushes
- Numbness or tingling sensations (paresthesias)
Having four or more of these symptoms will meet the clinical criteria of a panic attack. This is according to DSM-5 criteria.
How Long Do Symptoms Last?
These fight-or-flight symptoms can show up suddenly. They usually last between a few minutes and 30 minutes. The intensity often hits its peak within 10 minutes or so. Only rarely will the symptoms last more than an hour. However, when a person experiences going into the fight-or-flight reflex, it may feel like it will last forever. This is especially true if you are experiencing panic attacks while driving.
Many people have been through this. They suffer overwhelming and acute anxiety. It destroys the quality of life. When they learn that their symptoms qualify as a disorder, they are not surprised. However, they are often perplexed by what causes their symptoms or why they started to begin with.
What Causes a Panic Attack?
The answer to this question is at the intersection between genetics and life experiences. It involves two different types of stressful experiences:
- Acute stress and
- Cumulative stress
Our genetic predisposition and psychological vulnerabilities influence our experience of stress. Ultimately, this determines how the midbrain encodes it. Is it just another bad day? Or does it cross the line and go beyond a breaking point? If it’s just another bad day, then in time, we forget about it. But if it goes beyond a breaking point, the result is a panic attack. That is a brain-changing event. Let’s take a closer look at each of these components.
Interesting research is emerging from the Academy of Finland. This is where scientists have isolated some important genes. Those specific genes may link to our genetic predisposition and psychological vulnerability to different types of anxiety disorders. (3)
According to Finish scientist, Dr. Iiris Hovatta, different genes are related to different disorders including:
- Panic disorder (panic attacks)
- Social phobias or
- Generalized anxiety disorder
Research conducted in Germany with firefighters drew a similar conclusion. In that study, the subjects were newly hired firefighters. At the start of employment, they were each given an anxiety inventory to complete. This inventory was known as the State-Trait Anxiety Inventory. The trait version measures whether one has a predisposition or trait toward anxiety.
Those with a high score on the anxiety inventor were found to be much more likely to develop Post Traumatic Stress Disorder (PTSD). Those with a low score were less likely to be traumatized from their work as a firefighter.
Having a genetic predisposition for anxiety is like having a smaller capacity for coping with stress. When that small capacity meets a large inflow of stress, it's easy to lose containment. Those who have a lesser coping capacity must be mindful of their stress load.
2 Types of Stress: Acute Stress and Cumulative Stress
Most people would assume that having panic attacks while driving is due to having experienced a traumatic auto accident. And it is true that such experiences can be the basis for both anxiety and panic disorder. Below is an example of how acute stress contributes to causing panic attacks.
Acute Stress Case Example:
Injury Auto Accident
George was driving along a three-lane boulevard on a sunny afternoon. All was right in his world until he routinely went through the intersection. That's when a fellow motorist ran a red light and crashed directly into the side of George's car. Both cars were severely damaged. George suffered several injuries. An ambulance ride to the hospital put him on the path to his body recovering. Six months later he was physically OK.
The problem is that he developed a panic disorder. He now experiences a panic attack every time he passes the accident scene. When he goes through other stoplights he feels anxiety too. Sometimes, his anxiety also became panic.
This is one cause of people having panic attacks while driving. But it is not the most common. What I mainly see in my practice is the second cause. That is cumulative stress build-up.
Two Cumulative Stress Case Examples:
1. Fight-or-Flight on the Side of a Freeway
Alice is experiencing a difficult time in her life. Her husband has just divorced her. She lives in an expensive part of town with her two teenage sons. Alice is in her 40s and has not worked since she got married. She has no earned income. The court-ordered child support is not enough. She is financially dependent on her ex-husband to make up the difference. If he’s in a good mood, he may give her what she needs. She can’t control her teenagers. She can’t control her finances. Alice has no control over her ex-husband. She braces herself for the next disaster.
This paints a picture of her background stress. It’s quite a load. Her psychological coping container is nearly full. She is almost at her breaking point. The only thing needed to push her over the edge is one more high-stress moment. This is where a Dallas highway comes in.
She is driving on the freeway. Her boys are fighting in the back seat. A large black pickup truck speeds up from behind. The truck begins to tailgate her. The pressure is building. Finally, she can’t take it anymore. She puts on her blinker and pulls over to the side of the highway. Feeling like she is in a trap, she has to get out. She opens the car door, stands beside the highway, and starts to go into fight-or-flight. As the cars speed by at over 70 mph and only a few feet away, she has a panic attack.
It takes every bit of strength she has to get back in the car and get to the next exit. Her brain has now associated highways and that feeling of fight-or-flight panic. Thinking about driving on the freeway now evokes the same anxious sensations.
2. Panic Attack on a Mountain Road
Jack and his wife Tina are moving from Colorado to North Carolina. They are getting a late start. The only U-Hall moving truck left looks beat up. They choose to rent it anyway since they are on a deadline.
After half a day of loading the truck, they are both physically and mentally exhausted. They are also sleep-deprived. Jack got four hours of sleep. Tina only slept for 6 hours. They start their drive in less than optimal shape.
Jack notices that with the truck fully loaded, and going down steep mountain roads, the brakes don't work as well. He tries to make the best of it. Yet the longer they drive, the worse the brakes feel. At times, he uses the emergency brake as a backup. The longer this goes on the higher his stress level becomes.
As he is finally about to leave the Colorado Mountains, a car suddenly stops ahead. He barely has time to hit the brake and narrowly misses the car. For him, this is his breaking point. His coping container spills over. He goes into fight-or-flight. He experiences a panic attack. His brain is now conditioned to associate mountain roads with panic. Tina has to drive through the Appalachian Mountains for him on their way to North Carolina.
Hopefully, this explains how our genetic predisposition combines with stressful life events to cause panic attacks to develop. Once your brain has been imprinted, how to overcome driving anxiety becomes the next question.
Unfortunately, panic attacks do not go away permanently without therapy. It requires help from a licensed mental health professional to retrain the alarm center of your emotional midbrain. The good news is that with the right treatment, you can find freedom from panic and anxiety. But what is the right treatment?
If you have read this far, you are not just curious about the symptoms and causes of panic attacks while driving. You are ready to do something about it. Whether it's driving anxiety treatment, therapy, counseling, or help then you are all in. You want to know how to stop panic attacks while driving. You no longer want to go into fight-or-flight when you get in the car. It's time to overcome the fear of driving. The problem is there are different approaches to treatment. How do you know what's best?
Here is the list of treatment methods that I both recommend and use in my therapy practice. This is what I have found effective during the last 25 years of treating anxiety, phobias, and panic while driving.
- Eye Movement Desensitization and Reprocessing (EMDR)
- Quick REMAP (a type of Systematic Desensitization)
- Cognitive-Behavioral Therapy (CBT)
- Exposure Therapy
In my experience, the best treatment involves combining these methods. Let's take a look at each and how they can help you.
EMDR (4) for panic disorder uses patterns of bilateral eye movements to calm your emotional midbrain and ease the fight-or-flight reflex. It is also useful in accessing stressful memories. As you review those memories, the eye movements contribute to calming the nervous system. It teaches the midbrain to break the association between panicky memories and emotional pain. Then EMDR helps link the old memory to a new experience of comfort and relaxation. This makes it possible to remember a panic attack without feeling upset.
Quick REMAP accomplishes the same thing as EMDR. However, it does it differently. Instead of using eye movements as the mechanism to calm the midbrain, Quick REMAP uses acupressure. Studies at Harvard Medical School have shown certain acupoints to rapidly calm the midbrain (5,6). This allows the sympathetic nervous system to soothe the fight-or-flight reflex. We can use both Quick REMAP and EMDR to treat traumatic memories of panic attacks while driving. This is the first step in therapy. The video below will introduce you to some of the Quick REAMP interventions.
While EMDR and Quick REMAP both focus treatment on the midbrain, CBT targets the thinking brain. CBT is a useful tool in treating panic disorder (7). Cognitive therapy helps you catch and switch automatic negative thoughts. It enables you to change catastrophic worry about driving into better and more believable thoughts. Worry is the fuel that anxiety runs on. Without worry, the mind can relax and the body can follow.
Exposure Therapy (8) is the part of treatment where you get back on the road. Starting with small steps, you gradually get comfortable with different driving conditions. Little by little you grow your comfort zone. After multiple repetitions of driving on freeways, over bridges, or mountain roads, you then become comfortable. There are no fight-or-flight symptoms, no panic attacks, no anxiety, and no stress. Eventually, driving becomes pleasantly boring again.
Treatment is available by phone or video appointments for individuals anywhere in the U.S.A.
Including Albuquerque, Atlanta, Austin, Boston, Charlotte, Chicago, Cleveland, Columbus, Dallas, Denver, Fort Worth, Houston, Indianapolis, Jacksonville, Kansas City, Las Vegas, Los Angeles, Oklahoma City, Phoenix, Philadelphia, Portland, New Orleans, New York, San Antonio, San Diego, San Jose, San Francisco, Seattle, Tampa, and Washington DC.
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- Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 1: Lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013.
- Donner et al. An Association Analysis of Murine Anxiety Genes in Humans Implicates Novel Candidate Genes for Anxiety Disorders. Biological Psychiatry, 2008; DOI: 10.1016/j.biopsych.2008.06.002
- Goldstein, A. & Feske, U. (1994). Eye movement desensitization and reprocessing for panic disorder: A case series. Journal of Anxiety Disorders, 8, 351-362.
- Wu MT, Hsieh JC, Xiong J, Yang CF, Pan HB, Chen YC, et al. Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain—preliminary experiences Radiology 1999; 212:133-41.
- Hui K, Liu J, Makris N, et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Human Brain Mapping. 2000; 9:13-25.
- Manjula, M., Kumariah, V., Prasadarao, P. S., & Raguram, R. (2009). Cognitive behavior therapy in the treatment of panic disorder. Indian journal of psychiatry, 51(2), 108–116. https://doi.org/10.4103/0019-5545.49450
- Ito, L., De Araujo, L., Tess, V., De Barros-Neto, T., Asbahr, F., & Marks, I. (2001). Self-exposure therapy for panic disorder with agoraphobia: Randomised controlled study of external v. interoceptive self-exposure. British Journal of Psychiatry, 178(4), 331-336. doi:10.1192/bjp.178.4.331