Airports are the breeding grounds for panic because they impinge heavily on our basic sense of control and agency. The neuroscience of panic disorder shows us how this takes place in the brain.
I have been sucked in and spat out of airports more times than I care to remember, but they never quite lose their otherworldly status. If gate 501 was the porthole to space, I would take this on good faith, just as I do the finer mechanics of aeronautics. As you relinquish your baggage at the check-in counter, with it goes your sense of control. Tensions run high as you simultaneously wait and hustle your way through endless security checks, hoping that nobody slipped a package of cocaine into your hand luggage while you were looking the other way. Airport anxiety is a real thing. It hasn’t quite earned diagnostic criteria but when the symptoms hit you’ll know it.
The vast majority of airport experiences will be smooth sailing, especially if, like me, you tend to arrive an hour earlier than the standard recommendations. But it only takes one cluster-fuck to leave the lasting impression that airports are places of trepidation.
In 2010 on route to Colombia from Ezeiza Airport in Buenos Aires, we were refused boarding because we did not have an out-bound ticket from Colombia. Although our South African passports afforded us entry without visa, somewhere in the fine print of Colombia’s immigration policy was a clause about an onward flight. We were extreme budget backpackers at the time and the check-in attendant’s casual suggestion that we simply buy a return ticket sent my heart into palpitation. Mention of a possible refund at a later stage was cast into doubt by our very tentative grasp of the Spanish language. By the time we’d committed to buying the return tickets, the gate was already closing. There was a phone call, could they please hold the plane? We would need more time because the printer was jammed.
The blood, pumping rapidly through my arteries began to pool in my cheeks, radiating heat. And I myself, turning to jelly, felt like I was pooling into the ground, removed from any capacity to act. There was a stifling sensation of smothering, a weight pressing down on my ribcage as if my body was retreating back into itself through my chest cavity. Our fate was hanging in the air and we could do nothing about it.
We eventually made it on to the plane. Two dishevelled young gringos looking worse for wear and probably smelling the part too. It took most of the flight to regain a sense of composure.
Recounting it now, it all seems rather dramatic, but once panic has set in, it tends to spiral out of control, each recognition of your degrading state spurring you on to further fright. In retrospect, as upsetting as it would have been, the profound emotional upheaval seems disproportionate to the prospect of missing the flight.
But airports are notoriously anxiety-provoking places for the following reasons:
- Fears of flying are common and tend to increase as one gets older. People fear flying for any number of reasons and nowadays airports have become synonymous with terrorism. But often, the fear of flying stems from an underlying anxiety that is provoked by the loss of control that being on board presents. A bit like a mild version of claustrophobia. The inability to “tune out” worrisome thoughts of a potential crash, which statistically is very unlikely, has a lot to do with an inability to habituate. You can read more about habituation here.
- Security checks and immigration: Your right of passage rests entirely on a few pages in your passport and the discretion of the officer on duty. Anxiety is aroused by the possibility of losing your passport on route to the check-in gate, a fear that you’ve accidently left a prohibited object in your carry-on luggage or that you’ll be singled out and searched for illicit substances. The public humiliation adds yet another cause for concern.
- Time pressure: Endless queues, ever expanding airports and frequent opportunities to stop and browse the duty-free means that the decks are stacked against you when it comes to finding your way and making it to the gates on time.
- Crowding and noise: These function as veritable “psychological toxins”. The sympathetic nervous system, which prepares the body for “fight or flight” becomes activated under these conditions. This is a wholly unpleasant state to be in, both mentally and physically. But crowding brings with it indirect stress too, such as the increased threat of pick-pocketing and the strain of trying to navigate your way through the traffic.
- Information overload: Airports put your working memory to the test as you struggle to keep in mind the sequence of steps that you need to follow in order to get on the plane. Check-in time, boarding time, gate-closing time, and take-off. Each step requires that you correctly decipher the network of signs that lead the way.
- Financial loss: The plane ticket might be your biggest single cost of an entire vacation. This places immense pressure on making sure that you get onto the plane, because if you miss your flight, it’s a knock-on effect when it comes to things like hotels, transfers and any other activities that you might have already booked and paid for.
- Loss of time: For many, annual leave from work is precious and with overseas flights usually entailing a lengthy stop-over, missing your flight can mean up two 48 hours in lost time. Possibly even 20% of your holiday.
- Strict rules and regulations: Finally, the strict rules with little room for exception make airports an unforgiving place. This swallows up the human aspect of the whole experience. There is no room for appeal or leeway that typical human empathy might normally offer.
Airports therefore impinge heavily on our basic sense of control and agency. They can leave you feeling helpless when you run into trouble. This high pressure environment can be the breeding ground for panic attacks and for people who are prone to panic disorder, the prospect of having an attack mid-journey can turn into a debilitating phobia.
What is Panic Disorder?
Panic disorder is a form of anxiety in which an individual experiences a sudden onset of intense fear, usually accompanied by overwhelming physiological symptoms, including the feeling of shortness of breath and suffocation. Other symptoms may include a sharp increase in heart rate, sweating, trembling, light-headedness and the sense of a loss of motor control. In many cases, the affected person may experience derealisation, which is the feeling of unreality, or depersonalization, feeling detached from oneself. Often the most frightening symptoms include the feeling of losing control of one’s mind and the fear of dying.
There are psychological therapies that can help alleviate panic attacks, but the fact that certain medications are so effective at preventing or relieving symptoms suggests that there is a strong brain basis to them.
Firstly, research in identical twins has shown that genes contribute to the risk of developing panic disorder, but not much is known about which specific genes are involved or how genetic abnormalities translate into panic attacks. One prominent theory is called the false suffocation alarm model (Klein) and is based on findings that increased levels of carbon dioxide more easily triggers an attack in people with panic disorder. Because the brain has a protective mechanism against suffocating, which leads to hyperventilation and the urge to flee as a way of restoring oxygen flow, this theory claims that panic prone individuals are more sensitive to signals of impending suffocation, such as increased carbon dioxide levels. A deep subcortical brain structure called the periaqueductal gray (PAG) is thought to play a key role in suffocation alarm.
This theory has received a lot of support, however, it doesn’t adequately explain why panic attacks occur in well ventilated areas, or that sudden loss, childhood separation or bereavement are major triggering factors in panic disorder.
An alternative theory has been put forward by Panksepp, who argues that there is a distinct, specialized panic system in the brain that evolved to make sure that young animals, and humans alike, maintain proximity to their caregivers. Because proximity is vital to the survival of infants, separation leads to declining opioid levels in the brain, which arouses the panic system, causing intense alarm but not much actual movement. Running away and getting lost would surely diminish the chances of being found by mom. Since emotional feelings have evolved to signal something important, it is not surprising that panic attacks carry with them the feeling of “near death”. At such a young, vulnerable age, a loss of proximity to a caregiver quite literally is a case of life or death. This is the brain’s way of making sure that the affected individual knows it. As an adult, the panic system does not disappear, it simply reacts more generally to other events that we have learned to associate with security and feeling in control.
Thus, although the two theories are seldom considered together, Panksepp’s theory builds on Klein’s model of suffocation alarm. In fact, at the neurophysiological level, there is much overlap between the two models. As in the suffocation alarm system, the PAG is a core structure within the brain’s separation distress system. What’s more, is that brain opioids play a key regulatory role in both separation anxiety and breathing. For example, if opioids are high, low levels of oxygen are well tolerated and the body changes so as to be able to adapt to diminished intake. This in turn implies that a decline in opioids, much like what happens in the brain in response to sudden loss, can trigger the feeling of suffocation.
This explains why sudden feelings of vulnerability and stress can trigger a panic attack. When your fate is at the mercy of outside forces, a sudden loss in your sense of security prompts a sharp drop in brain opioids. Since opioids are the chief source of our feelings of security and well-being, their decline is associated with intense fear and vulnerability. As one starts to catasrophise these feelings – ie. When the symptoms themselves spur on even more alarm – a panic attack may ensue.
The panic attack does not signal real suffocation per se, rather, the emotional system linked to attacks evolved to generate this feeling as a way of signaling the severity of the threat that was able to arouse the panic system in the first place. This is the crux of the matter and understanding this can go along way towards obstructing the course of a panic attack. If you can reassure yourself that the feeling of suffocation is not real, but simply an illusion, this belief alone can help terminate the cycle.
It is unlikely that airports will ever cease to be anxiety-provoking, but if you’re able to convince yourself that missing your flight, for example, is not the “end of the world”, then you can effectively disinvest a lot of your well-being from the process.
For instance, earlier this year when I was on route back to South Africa, my flight home with TAAG airlines was cancelled without warning. In many respects this event is exactly the sort that might tip one over into panic. I had not slept the night before since I had a 4am flight from Santiago to Rio de Janerio, from where my flight home was leaving. After first landing in Sao Paulo, I caught a connecting flight to Rio and when I could not see my flight listed on the screens, I knew something was awry. Not many people spoke English and no one was attending the TAAG customer desk. To top it all, I did not have access to any funds since the week before I had to cancel my bank card after noticing fraudulent activity on it. In the end, I found my way to an airport hotel and they allowed me to cover the costs with Mischa’s credit details after authorisation. Looking back, my saving grace was threefold. I was able to maintain some sense of security because I was familiar with Rio airport and if you read here, you’ll understand how important familiarity is to one’s sense of safety. Secondly, there was free wifi, meaning that I could easily get hold of family. Thirdly, since it was not a case of me missing my flight, I knew that the airport would need to take responsibility and I would not have to suffer any financial loss.
The following tips can help keep airport anxiety at bay:
- Ask your GP for a mild tranquilizer to take before you head off to the airport. A beta-bloka works well too for inhibiting things like an accelerated heartbeat. Do not feel ashamed to use anxiety medication. There are no gold medals for suffering.
- Breathing exercises and focussed meditation is a good alternative if you’re not into medication. What is known to work well is to take some time out to be still and visualise the good things that await you at your holiday destination. Pay attention to sights, smells, textures and tastes.
- Check-in online in advance and call the airline the day before to confirm your flight details.
- Print out your boarding pass as well as the address of where you need to go once you’ve landed at your destination. Take pictures of your passport and visas.
- Pre-book a transfer service. The prospect of arriving in a foreign city and not knowing how to get from the airport to your hotel can “infect” your whole flight.
- Charge all electronic devices. You may need to access the internet at some point.
- Arrive an hour earlier than the prescribed check-in times. That should be 3 hours for an international flight and 2 for domestic.
- Pack your bags from scratch and be organised. Empty out the full contents of your bags, including your hand bag. Then re-pack so you know exactly what you’re taking on board and exactly where everything is located. And, pack everything the day before. The guys at Ready Set Trek recommend this nifty app that takes out all the stress of packing.
- Pre-pack all your toiletries in your hand-luggage in small zip-lock bags.
- Have your laptop ready to take out when you pass security. You cannot send it through the x-ray machine inside your bag.
- Avoid wearing belts or other items of clothing with metal so that you don’t need to remove them when passing through security.
- Carry your passport and boarding pass in a secure place that is easily accessible. A pouch around your neck, for example. Remember, if you do lose your boarding pass, in all likelihood you will still be allowed to board since your details will be logged on the computer.
- Avoid duty-free shopping or eating at restaurants. Instead, get what you need as a take-away, have a book on hand and walk straight to your gate. If you have access to a lounge, alert the staff of your departure time.
- Carry some cash in the destination currency. Not all foreign ATMs will accept your bank card. Make sure that you have authorised your card for international use.
- Understand your fears. Often, until we have a clear idea of what exactly is causing our anxiety, the worry will persist. Simply understanding your fears can make you more proactive towards dealing with them.
- In the case of a panic attack, there are some cognitive tricks you can try to distract your emotional mind. Think of a four letter word without any letter repeats. Then work your way through the words, listing as many words you can think of that begin with each letter. The sooner you can start this exercise, the better.
Have any tips or experiences to share? Please post a comment.