"For me, a panic attack is
almost a violent experience. I feel disconnected from reality. I feel like I'm losing control in a very extreme way. My heart pounds really hard, I feel like I can't get my breath & there's an overwhelming feeling that things are crashing in on me."
"It started 10 years ago, when I'd just graduated from college
& started a new job. I was sitting in a business seminar in a hotel & this thing came out of the blue. I felt like
I was dying."
"In between attacks there is this dread & anxiety that it's going to happen again. I'm afraid to go back to places where I've had an attack. Unless I get help, there soon
won't be anyplace where I can go & feel safe from panic."
Panic Attacks: This Truth Will
Set You Free
By Dr Jeannette Kavanagh
Unlike too many
people on the Internet, I don’t claim to have discovered THE CURE for panic attacks
& other anxiety states. I do offer you a beautifully simple insight into panic which will change your reaction to it. Immediately you’ll start you on the path to calm. The insight?
“Accept your panic symptoms & ….they’ll go. Fight them & they’ll intensify.”
Look at that word ‘intensify’. It’s about tensing up. Becoming worried &
even more panicky about….what? Your feelings of panic. Once you really genuinely realize that they’re only feelings, you’ll also come to accept that they can’t harm you.
Yes, I know you don’t want them.
But tell me this, my sweet one, “in the past, has tensing up & worrying even more about
feeling panicky helped those feelings to dissipate?” Your answer? I know it’s NO.
Just so you’re very
clear: tensing up & fighting your symptoms of panic help will NOT HELP YOU today, or
in the future.
One person selling his $47US e-book on the Internet claims that this
insight is his unique discovery to send panic away. The truth?
is that we’ve known for decades that instead of fighting panic & tensing up, you
must do the opposite.
More than 3 decades
ago, the Australian General Practitioner the late Dr Claire Weekes advised people that instead of fighting panic & tensing up, they should float into their panic &
welcome it like an old friend.
From my counseling practice, I know that you know
there’s nothing to fear. At a rational level. At an emotional level, you still feel overwhelmed. For many of you, the fact that you can’t explain why you feel so terrified is often the most upsetting.
Fear of fear itself
Once you accept that there's no real danger, you’ll see that your real & lingering fear IS THE FEAR OF THE PANICKY FEELINGS. If you let those inappropriate messages of fear come & do their worst, you’d learn how to send those fears packing.
So to summarize: When your pulse races, your heart pounds, do the opposite
of what you normally do. Do this:
SMILE… even though you might not want to
B R E
A T H E… D E E P L Y…
O B S E R V E…
OBSERVE YOUR fear… FLOATING AWAY…
Mimic Mother Nature – flow with the hurricane
Just as the grass & the trees sway with the wind, rather than rigidly resist it, let your fear feelings come. Then, just observe what happens as if watching a science experiment.
want to practice that simple approach at home a few times. You’ll soon see how well it works. I know you can make yourself
feel great fear. Bring back those memories of your last panic episode. Right now. Recall every detail.
Feel those fear symptoms & now…. just accept them.
That’s right. I’m not saying TRY to do anything. I’m not
saying try to relax. I’m not saying try to divert yourself from your fear-filled thoughts.
I am saying – do absolutely nothing. Accept your feelings.
Use of diversion
If you normally use
various tricks to divert you from the intense feelings of fear, please reconsider that tactic. It may help in the short term, but all those tactics (counting
backwards, counting bricks, etc), keep you imprisoned in what Dr R Reid Wilson calls ‘the panic cycle’. They can become habits & as difficult to break as the panic
cycle itself. Please visit Dr Wilson’s wonderful website for more information: anxieties.com
When you recognize your role in your own panic episodes, you’re 90% closer to the solution, to a life
without panic attacks. Next time you feel the first fluttering of fear & panic follow the simple steps above.
you’ve been experiencing anxiety & panic for a while, I have to let you know that it’s your fear of the fear-filled symptoms that feed your panic. You're a major part of your problem. But you’re
also the total solution.
It’s all in the mind
I point out in my self help e-kit Calming Words, if you feel terrified standing in that queue at the supermarket, or sitting in the middle of the row at the cinema, the feelings you feel are fine. They’re a perfect reaction to…danger. Where none exists.
mind sent the wrong message “danger, danger” to your body. Your body has then had the right reaction to that danger
message – it’s sent the adrenaline surging to get you out of danger. To end with the good news: those messages
can be rewritten, re-learned. That’s why I wrote Calming Words!
"I couldn't do anything without rituals. They invaded every
aspect of my life. Counting really bogged me down. I'd wash my hair 3 times as opposed to
once because 3 was a good luck number & 1 wasn't.
It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number
that wouldn't add up to a 'bad' number."
"I knew the rituals didn't make sense & I was deeply ashamed of them, but I couldn't seem to overcome them until I had therapy."
"Getting dressed in the morning was tough, because I had a routine
& if I didn't follow the routine, I'd get anxious & would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd
have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety & more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me."
"In any social situation, I felt fear. I would be anxious before
I even left the house, and it would escalate as I got closer to a college class, a party, or whatever. I would feel sick in
my stomach-it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling
of being removed from myself and from everybody else."
"When I would walk into a room full of people, I'd turn red
and it would feel like everybody's eyes were on me. I was embarrassed to stand off in a corner by myself, but I couldn't think
of anything to say to anybody. It was humiliating. I felt so clumsy, I couldn't wait to get out."
"I always thought I was just a worrier. I'd feel keyed up and
unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about
what I was going to fix for a dinner party, or what would be a great present for somebody. I just couldn't let something go."
"I'd have terrible sleeping problems. There were times I'd wake
up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I'd feel
a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were
worse than they really were: when I got a stomachache, I'd think it was an ulcer."
"I'm scared to death of flying, and I never do it anymore. I
used to start dreading a plane trip a month before I was due to leave. It was an awful feeling when that airplane door closed
and I felt trapped. My heart would pound, and I would sweat bullets. When the airplane would start to ascend, it just reinforced
the feeling that I couldn't get out. When I think about flying, I picture myself losing control, freaking out, and climbing
the walls, but of course I never did that. I'm not afraid of crashing or hitting turbulence. It's just that feeling of being
trapped. Whenever I've thought about changing jobs, I've had to think, "Would I be under pressure to fly?" These days I only
go places where I can drive or take a train. My friends always point out that I couldn't get off a train traveling at high
speeds either, so why don't trains bother me? I just tell them it isn't a rational fear."
How to Get Help for Anxiety Disorders
If you think you have an anxiety disorder, the first person
you should see is your family doctor. A physician can determine whether the symptoms that alarm you are due to an anxiety
disorder, another medical condition, or both.
If an anxiety disorder is diagnosed, the next step is usually
seeing a mental health professional. The practitioners who are most helpful with anxiety disorders are those who have training
in cognitive-behavioral therapy and/or behavioral therapy, and who are open to using medication if it is needed.
You should feel comfortable talking with the mental health professional
you choose. If you do not, you should seek help elsewhere. Once you find a mental health professional with whom you are comfortable,
the two of you should work as a team and make a plan to treat your anxiety disorder together.
Remember that once you start on medication, it is important
not to stop taking it abruptly. Certain drugs must be tapered off under the supervision of a doctor or bad reactions can occur.
Make sure you talk to the doctor who prescribed your medication before you stop taking it. If you are having trouble with
side effects, it's possible that they can be eliminated by adjusting how much medication you take and when you take it.
Most insurance plans, including health maintenance organizations
(HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out. If you don't have insurance,
the Health and Human Services division of your county government may offer mental health care at a public mental health center
that charges people according to how much they are able to pay. If you are on public assistance, you may be able to get care
through your state Medicaid plan.
Ways to Make Treatment More Effective
Many people with anxiety disorders benefit from joining a self-help
or support group and sharing their problems and achievements with others. Internet chat rooms can also be useful in this regard,
but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each
other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support, but
it is not a substitute for care from a mental health professional.
Stress management techniques and meditation can help people
with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic
exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications
can aggravate the symptoms of anxiety disorders, they should be avoided. Check with your physician or pharmacist before taking
any additional medications.
The family is very important in the recovery of a person with
an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one's symptoms. Family members
should not trivialize the disorder or demand improvement without treatment. If your family is doing either of these things,
you may want to show them this booklet so they can become educated allies and help you succeed in therapy.
Treatment of Anxiety Disorders
In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both.14
depend on the problem & the person's preference. Before treatment begins, a doctor must conduct a careful diagnostic evaluation
to determine whether a person's symptoms are caused by an anxiety disorder or a physical
If an anxiety
disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified,
as well as any coexisting conditions, such as:
depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder
must wait until the coexisting conditions are brought under control.
People with anxiety
disorders who have already received treatment should tell their current doctor about that treatment in detail.
If they received medication, they should tell their doctor:
- what medication was used
- what the dosage was at the beginning of treatment
- whether the dosage was increased or decreased while they were
- what side effects occurred
- whether the treatment helped them become less anxious
If they received psychotherapy,
they should describe the type of therapy, how often they attended sessions & whether the therapy was useful.
Often people believe
that they've "failed" at treatment or that the treatment didn't work for them when, in fact, it wasn't given for an adequate
length of time or was administered incorrectly.
must try several different treatments or combinations of treatment before they find the one that works for them.
Role of Research in Improving the Understanding & Treatment
of Anxiety Disorders
NIMH supports research into
the causes, diagnosis, prevention & treatment of anxiety disorders & other mental
Scientists are looking at
what role genes play in the development of these disorders & are also investigating
the effects of environmental factors such as:
- physical & psychological stress
In addition, studies are being
conducted on the "natural history" (what course the illness takes without treatment)
of a variety of individual anxiety disorders, combinations of anxiety
disorders & anxiety disorders that are accompanied by other mental illnesses
such as depression.
In reference to the above info concerning environmental factors (here
indicates physical & mental stress & diet being affected) being a contributory factor in mental
Living with two parents who are married to each other is associated with more favorable outcomes for children.1
The proportion of children under age 18
living with two married parents2 fell
Among children under age 18 in 2005:
23% lived with only their mothers
5% lived with only their fathers
4% lived with neither of their parents
Scientists currently think
that, like heart disease & type 1 diabetes, mental illnesses are complex & probably result from a combination of genetic,
environmental, psychological & developmental factors.
i.e., although NIMH-sponsored studies of twins & families suggest that genetics play a role in the development of some anxiety disorders,
problems such as PTSD are triggered by trauma. Genetic studies may help explain why some
people exposed to trauma develop PTSD & others do not.
Several parts of the
brain are key actors in the production of fear & anxiety. 15 Using brain imaging technology & neurochemical techniques, scientists have discovered that the amygdala & the
hippocampus play significant roles in most anxiety disorders.
The amygdala is an almond-shaped structure deep in the brain that's believed to be a communications hub between the
parts of the brain that process incoming sensory signals & the parts that interpret these signals. It can alert the rest
of the brain that a threat is present & trigger a fear or anxiety response.
It appears that emotional
memories are stored in the central part of the amygdala & may play a role in anxiety disorders
involving very distinct fears, such as fears of dogs, spiders, or flying.
is the part of the brain that encodes threatening events into memories. Studies have shown that the hippocampus appears to
be smaller in some people who were victims of child abuse or who served in military combat.17, 18
Research will determine what
causes this reduction in size & what role it plays in the flashbacks, deficits in explicit memory & fragmented memories
of the traumatic event that are common in PTSD.
more about how the brain creates fear & anxiety, scientists may be able to devise better treatments for anxiety disorders.
i.e., if specific
neurotransmitters are found to play an important role in fear, drugs may be developed that'll block them & decrease fear
responses; if enough is learned about how the brain generates new cells throughout the lifecycle, it may be possible to stimulate
the growth of new neurons in the hippocampus in people with PTSD.23
Current research at NIMH on
anxiety disorders includes studies that address how well medication & behavioral therapies
work in the treatment of OCD & the safety & effectiveness of medications for children & adolescents who have a
combination of anxiety disorders & attention deficit hyperactivity disorder.
As you can plainly see, in both sections already...
No one has probably taught you about this... it's just the way things go.
Don 't Fight the Fear!
By David A. Carbonell, Ph.D.
Millions more wrestle with more anxiety than they would like to have, with or without a label.
What makes anxiety such a common problem?
It's this. People have
a natural tendency to fight their anxiety & that makes it worse.
Millions of people, including many capable & successful
people, experience anxiety which doesn't seem to respond to their efforts to calm themselves.
These people often find that, the harder they try, the worse it gets.
There's a reason for this.
kinds of solutions that work with "real world" problems usually don't work with anxiety.
They often make it worse.
Let me tell you why, then I'll suggest a solution.
Consider the following
imaginary scenario (for which I have adapted & embellished upon an idea originally
published in, "Acceptance & Commitment Therapy," by Steven Hayes, Kirk Strosahl & Kelly Wilson).
man comes into my office, a man who I know to be someone who does what he says. He has a gun & he points it at me. He
says "Dave, I want you to move all the furniture from this office out into the waiting room, or else I'm going to shoot you."
What's the outcome?
That's right, I move the furniture into the waiting room & I live.
man comes back to my office a 2nd time, with the same gun. He points it at me & says "Dave, I want you to sing the Star
Spangled Banner - 1st verse will be enough - or else I'm going to shoot you."
What's the outcome?
I sing the Star Spangled Banner & all is well (except for those who had to hear me
Now he comes back a 3rd time & he's got an assistant wheeling in a large mechanical
apparatus. This time, he says "Dave, I'm going to hook you up to this lie detector. It's state of the art equipment. It's
infallible. It can detect any emotion you experience."
He hooks me up to the equipment & points his gun at me
& says "Now, relax. Or else I'm going to shoot you."
What's the outcome?
That's right. I'm a goner.
is this so? Why can I succeed in moving the furniture & singing the song & yet fail so miserably at calming myself?
The reason is simple to state. The rules that govern the "real world" are different from the rules that govern my internal
world - my thoughts, images & emotions.
In the real world, the harder I try, the more I get what I want. If I
set my sight on a goal & persevere, I'll probably get it, so long as I keep working at it.
But in my internal
world, the harder I try & the more I struggle, the more I get what I'm trying to avoid. That's why it's so clear, in the
example above, that neither I, nor most mortals, could relax under those circumstances.
This is one reason why so
many people come to grief in trying to resolve their anxiety. They tell themselves "don't think about it"; they resist it; they try somehow to force themselves to feel better; they get
angry at themselves; they feel shame & embarrassment about feeling anxious; they try to keep it a secret from others & they try to medicate it away with alcohol, nicotine & other substances.
These all make the anxiety worse.
When I was in high school, I had the misfortune to be chubby & uncoordinated. It made gym class a pretty
miserable experience for me. After a while, I expected to do poorly & I usually did.
One time, playing volleyball,
the server on the other team identified me as an easy way to score points & kept serving the ball in my direction, way
over my head. I would lunge up at the ball, barely manage to tip it with my fingertips & the ball would sail out of bounds
- another point against us.
That made me mad.
Each time the ball came over, I'd try even harder. I'd leap
up with all my might & tip the ball out of bounds. Another point against us. My teammates were shouting at me, "let it
go!" I was too upset to comprehend what they were saying. I thought I had to stop that ball, no matter what.
At one point, even the gym teacher yelled "Let it go!". That just made me madder. I tried harder, got more tipped balls,
made more points for the other side.
It wasn't until several days later, when I was reviewing the volleyball rules
for a written exam (that's how I passed gym, the written exams!) that I came to understand why they were yelling "let it go".
If I had "let it go", the ball would have sailed out of bounds untouched.
That would have been a good thing for my team, resulting in us getting the ball.
But,since I kept touching
the ball, it meant a point for the other team. Frustrated, angry & embarrassed as I was, I didn't realize I'd be
better off "letting it go."
And so I made matters much worse by my efforts.
What does this mean for anxiety? Simply that we make life harder
by resisting & struggling against, anxiety. We do better when we accept it - when we allow ourselves to feel the anxiety & work with it, rather than against it.
For those of you familiar with the work of Clare Weekes, this is what she meant by "floating" thru anxiety.
So, how could we work with it? How can we move from resisting to accepting?
The first major step is to become
more aware, on a moment to moment basis, of the ways in which you resist & fight your anxiety. If you're like most people, you do this a lot more than you recognize.
The biggest part of the job is to become aware of what you have been doing so automatically, without noticing. The
best way to become aware is to develop the habit of observation.
I. Get into this habit. Every hour, at the top of
the hour during your waking day, take a moment to notice how you're holding your body, especially the muscles of your neck
Notice where there is tension & tightness. Then sigh or exhale gently (don't
force it!), letting the muscles of your upper body relax as you do this.
Focus on simply going thru these steps, without evaluating how well or poorly you're doing. Have you got 10 seconds?
Do this now, before you read on.
Find a way to do this hourly, during your waking day, for two or three days. You
might need something to remind you, some version of "tie a string around your finger," such as switching jewelry from one
hand to the other.
Once you get this habit established, you can add to it by practicing diaphragmatic breathing for
a minute or two. What's breathing got to do with it? How can I learn?
That's a whole additional subject, the answers to which can be found at http://www.anxietycoach.com/breathing.htm.
II. Pay attention to how you "talk" to yourself in your own thoughts for 2 days & write down as many of the negative
phrases & images as you can. Don't just dismiss them.
It's important to first become aware of these thoughts, just like a dieter needs to first establish
what he/she is actually eating each day.
Carry some 3x5 cards in your purse, briefcase or pocket so they'll be handy
for note taking. Watch particularly for these kind of thoughts:
A. The fake question. It sounds like a question, but
you never actually answer it. It's an accusation, not a question!
- Why can't I stop this?
- What's wrong with me?
- What can't I be like everybody else?
B. The angry criticism
Dummy! Stupid! Jerk! Wimp! Coward!
C. The scary anticipation
What if... (fill in any calamity here)
III. Try this. Imagine what
it would be like to go through your day while every so often, someone came up behind you to say such things to you. A coworker,
say, who periodically comes up to inquire "Why are you such a wimp?" or "What if you freeze up during that meeting tomorrow?".
You'd recognize that as a problem right away, right? But think about how much more frequent & persistent your
own negative thinking can be. It's a far bigger problem than anything anybody else tells you!
IV. Once you have your
list, think about how you talk to someone you genuinely care about when they're anxious & upset. Write down some of those phrases & ideas.
V. Thereafter, when you notice yourself using some of
the negative thoughts & images on yourself:
B. Relax your body & breathing
C. Talk to yourself
like you would talk to someone you really cared for.
Let me know how it goes!
"I was raped when I was 25 years old. For a long time, I spoke
about the rape as though it was something that happened to someone else. I was very aware that it had happened to me, but there was just no feeling."
"Then I started having flashbacks. They kind of came over me like a splash of water. I would be terrified. Suddenly I was reliving the rape. Every instant was startling. I wasn't aware of anything around me, I was in a bubble, just kind of floating. And it was scary. Having a flashback can wring you out."
"The rape happened the week before Thanksgiving & I can't
believe the anxiety & fear I feel every year around the anniversary date. It's as though I've seen a werewolf. I can't relax, can't sleep, don't want to be with anyone. I wonder whether I'll ever be free of this terrible problem."