Past, present, and future exist as a single force.

過去、現在、未來 全都匯合成為單一股力量。

A swing without gravity soars to a terrifying height.

沒有重力的鞦韆 擺盪到嚇人的高度。

The outlines of people and things dissolve.

人與物的輪廓在溶解。

Countless poets and writers have tried to put words

無數的詩人和作家都嘗試過

to the experience of a panic attack—

用文字來形容恐慌發作的經歷——

a sensation so overwhelming, many people mistake it for a heart attack, stroke,

這種讓人無法招架的感覺 讓許多人會誤以為是心臟病發作、中風，

or other life-threatening crisis.

或其他會致命的疾病。

Though panic attacks don't cause long-term physical harm,

雖然恐慌發作並不會 造成長期的身體傷害，

afterwards, the fear of another attack can limit someone's daily life—

但之後，對下次發作的恐懼可能 讓病人的日常生活受到限制——

and cause more panic attacks.

反而更常造成恐慌發作。

Studies suggest that almost a third of us

研究指出，幾乎有三分之一的人

will experience at least one panic attack in our lives.

在一生中至少會經歷一次恐慌發作。

And whether it's your first, your hundredth,

不論是你的第一次或第一百次發作，

or you're witnessing someone else go through one,

或者你看到其他人恐慌發作，

no one wants to repeat the experience.

都不會想要再經歷一次。

Even learning about them can be uncomfortable, but it's necessary—

就連去了解恐慌發作都會讓人 不舒服，但去了解是必要的——

because the first step to preventing panic attacks is understanding them.

因為預防恐慌發作的第一步 就是去了解它。

At its core, a panic attack is an overreaction to the body's

恐慌發作的核心，是身體在感受到

normal physiological response to the perception of danger.

危險時的正常生理因應措施 發生了過度反應。

This response starts with the amygdala,

這種反應始於杏仁核，

the brain region involved in processing fear.

負責處理恐懼的大腦區域。

When the amygdala perceives danger,

當杏仁核感受到危險時，

it stimulates the sympathetic nervous system,

它就會刺激交感神經系統，

which triggers the release of adrenaline.

觸發腎上腺素釋放。

Adrenaline prompts an increase in the heart and breathing rate

腎上腺素會使心率提升和呼吸加速，

to get blood and oxygen to the muscles of the arms and legs.

讓血液和氧氣能被送到 手臂及腿部的肌肉。

This also sends oxygen to the brain, making it more alert and responsive.

同時也會把氧氣送到腦部，讓腦部能更有警覺性且更敏感。

During a panic attack,

在恐慌發作時，

this response is exaggerated well past what would be useful

這種反應會被擴大到已經遠遠超過

in a dangerous situation,

對於處理危險情況有幫助的程度，

causing a racing heart, heavy breathing, or hyperventilation.

造成心率飆升、 大聲呼吸、過度換氣。

The changes to blood flow cause lightheadedness

血流的改變則造成頭昏眼花

and numbness in the hands and feet.

以及手腳麻木。

A panic attack usually peaks within 10 minutes.

恐慌發作通常會在 十分鐘內達到高峰。

Then, the prefrontal cortex takes over from the amygdala

接著，前額葉皮質 接手杏仁核的工作，

and stimulates the parasympathetic nervous system.

刺激副交感神經系統。

This triggers the release of a hormone called acetylcholine

這會觸發一種稱為 乙醯膽素的荷爾蒙釋放，

that decreases the heart rate and gradually winds down the panic attack.

讓心率降低，並漸漸緩解恐慌發作。

In a panic attack, the body's perception of danger

在恐慌發作時，身體對危險的感受

is enough to trigger the response we would have to a real threat— and then some.

足以觸發我們面對 真實威脅時的反應——且還更多。

We don't know for sure why this happens,

我們還無法肯定 為什麼會發生這種狀況，

but sometimes cues in the environment that remind us

但有時環境中有某些暗示，

of traumatic past experience can trigger a panic attack.

讓我們想到帶有創傷的經歷，就可能會造成恐慌發作。

Panic attacks can be part of anxiety disorders

恐慌發作有可能是焦慮症的一部分，

like PTSD, social anxiety disorder, OCD, and generalized anxiety disorder.

如創傷後壓力症候群、社交恐懼症、強迫症，以及廣泛性焦慮症。

Recurring panic attacks, frequent worry about new attacks,

重覆恐慌發作、經常擔心會再發作，

and behavioral changes to avoid panic attacks

以及為了避免恐慌發作而改變行為，

can lead to a diagnosis of a panic disorder.

這些是診斷恐慌症的指標。

The two main treatments for panic disorder

恐慌症的治療方式主要有兩種，

are antidepressant medication and cognitive behavioral therapy, or CBT.

抗憂鬱藥物及認知行為治療，或稱 CBT。

Both have about a 40% response rate—

對這兩種治療方式 有反應的病人大概都佔 40%——

though someone who responds to one may not respond to the other.

不過對於一種治療有反應， 不見得會對另一種治療有反應。

However, antidepressant medications carry some side effects,

然而，抗憂鬱藥物會有一些副作用，

and 50% of people relapse when they stop taking them.

且 50% 的病人在停止服用 這類藥物之後又會復發。

CBT, meanwhile, is more lasting, with only a 20% relapse rate.

而 CBT 的效果比較持久，復發率只有 20%。

The goal of CBT treatment for panic disorder is to help people learn

恐慌症 CBT 治療的目的

and practice concrete tools to exert physical, and in turn mental,

是協助病人學習和運用具體的工具，

control over the sensations and thoughts associated with a panic attack.

先後控制身體和心理對造成恐慌發作的感覺和想法。

CBT begins with an explanation of the physiological causes of a panic attack,

CBT 一開始會先解釋 恐慌發作的生理原因，

followed by breath and muscle exercises designed to help people

接著進行設計來協助病人有意識地

consciously control breathing patterns.

控制呼吸模式的呼吸和肌肉練習。

Next comes cognitive restructuring,

接下來是認知重建，

which involves identifying and changing the thoughts

要做的是辨識出在發作時 有哪些常見想法，

that are common during attacks—

並改變這些想法——

such as believing you'll stop breathing, have a heart attack, or die—

比如相信你會停止呼吸、 會心臟病發，或會死亡——

and replacing them with more accurate thoughts.

再用更正確的想法來取代這些想法。

The next stage of treatment is exposure to the bodily sensations and situations

治療的下一個階段，是讓病人接觸

that typically trigger a panic attack.

通常會觸發恐慌發作的 身體感覺和情境。

The goal is to change the belief, through experience,

目標是要透過經歷這些感覺和情境，

that these sensations and situations are dangerous.

來改變認定它們很危險的信念。

Even after CBT, taking these steps isn't easy in the grip of an attack.

即使在 CBT 之後，被恐慌攻擊時，採行這些步驟並不容易。

But with practice, these tools can both prevent and de-escalate attacks,

但是經由練習，這些工具可以同時預防並緩和攻擊，

and ultimately reduce the hold of panic on a person's life.

並根本地減少生活上被恐慌佔據的情況。

Outside formal therapy,

外在的正規治療，

many panickers find relief from the same beliefs CBT aims to instill:

很多恐慌者發現這些CBT主要逐漸灌輸的相同信念，讓他們症狀減輕：

that fear can't hurt you, but holding on to it will escalate panic.

像恐懼並不會傷害你，但是懷抱恐懼會讓恐慌更嚴重。

Even if you've never had a panic attack,

即使你不曾過發生恐慌症，

understanding them will help you identify one in yourself or someone else—

了解他們會幫助你辨識你自己或其他人的情況－

and recognizing them is the first step in preventing them.

而認知是預防恐慌的第一個步驟。