A panic attack is
the abrupt onset of intense fear or discomfort that reaches a peak within minutesand includes at least four of the following symptoms:
a)Palpitations,
b)pounding heart, or accelerated heart rate.
C)Sweating.
d)Trembling or shaking.
e)Sensations of shortness of breath or smothering...
For doctors to diagnose a panic attack, they look for at least four of the following signs: sweating, trembling, shortness of breath, a choking sensation, chest pain, nausea, dizziness, fear of losing your mind, fear of dying, flushing, feeling that danger is nearby, a racing heart (heart palpitations), and feeling an ...
How is severe anxiety treated?
When you're feeling anxious or stressed, these strategies will help you cope:
1. Take a time-out. ...
2. Eat well-balanced meals. ...
3. Limit alcohol and caffeine, which can aggravate anxiety and trigger panic attacks.
4. Get enough sleep. ... .
5. Exercise daily to help you feel good and maintain your health. ...
6. Take deep breaths.
What can happen if you have a panic attack?
A panic attack is a sudden surge of overwhelming anxiety and fear. Your heart pounds and you can't breathe. You may even feel like you're dying or going crazy. Left untreated, panic attacks can lead to panic disorder and other problems.
What causes tension in the shoulders and neck?
The main cause of neck pain is tension. During periods of intense anxiety, your muscles tense up dramatically. Muscle tension tightens the muscles, especially in the shoulders, back, and neck. The more anxiety you experience, the more your tensionmay cause significant pain and discomfort.
What exactly is an anxiety?
1. I
1. I become terrified from little things.
Choose one:
Not at all.
Occasionally.
Sometimes but it's bearable.
Yes - I can't stand it.
I do not know.
1. I have a hard time swallowing.
Choose one:
No, i don't.
Just a little.
Yes but it's bearable.
Yes and I can't stand it.
I'm not sure.
1. I feel like I am choking.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes and I can't stand it.
I do not know.
1. I tremble or shake.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes - I can't stand it.
I do not know.
I tremble or shake.
Choose one:
1. I fear I am losing control.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes and I can't stand it.
I do not know.
1. I feel short of breath for no reason.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes and I can't stand it.
I do not know.
1. I feel lightheaded, unsteady, or dizzy.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
I couldn't stand it.
I do not know. ( Maybe or maybe not )
1. I have numbness or tingling.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes - I can't stand it.
I do not know.
1. I sweat and/or feel hot for no reason.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes and I can't stand it.
I do not know.
1. I have a fear of bad things happening.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
I couldn't stand it.
I do not know.
1. I do not like going out.
Choose one:
I like going out.
Sometimes I don't like to go out.
It is unpleasant but bearable to go out.
I can't stand going out.
I do not know.
1. I have a hard time going to sleep.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes and I can't stand it.
I do not know.
Case Study: What I Did to Solve clients Five Years of Panic Attacks
Millions suffer the agony of panic attacks. A crippling emotional allergy. The body musters all its reserves to fight or run from an attacker that doesn't exist.
When clients panic, it's not just an emotional experience. It's a full-blown physical reaction: pressure in the chest, heart palpitations, dizziness, shortness of breath...
And these symptoms make sense.
When we're fleeing in the wild, we need sweaty palms so that when the sweat dries we are better able to grip tree branches and rocks in order to climb to safety. We need to breathe rapidly to get enough oxygen to keep running. In this situation, hyperventilating isn't hyperventilating – it's a physiological necessity. Same goes for a rapid heartbeat. Horrible during a job interview, but essential when fighting off an attacker.
So in context, the so-called 'symptoms' of a panic attack aren't symptoms at all. If we are facing an actual threat, these 'symptoms' may actually save our lives. Of course, this is cold comfort for the panic attack sufferer.
Take Julia, whose session we filmed for Uncommon Practitioners TV. It had been 20 years since she experienced her first panic attack, but it was in the past five years that they'd really struck with a vengeance. She was having as many as ten a day.
Ten panic attacks a day for five years!
I think you'll find Sh panic attacks will have many overlaps with your clients' panic attacks. With the strategies I used, you can help stop panic attacks fast.
Julia had been suffering panic attacks on and off for 20 years. But she left it all behind in one session.
Sharon's story
In her video, Sharon tells us that she is a single mum and works in a school. Raised by parents who were both mute and deaf, life has never been easy for Sharon. Her father left her mother when she was young, and visiting her estranged father seems to be what first set off the panic attacks that would follow her for the next two decades.
I seek to discover the pattern of the panic.
Sharon tells us she invariably has a panic attack within two hours of waking up in the morning. She has them when she's at the local shops, out socializing, taking her children out, going to work... Day after day. It's exhausting. But it never happens when she's "safe" at home.
I ask her what she wants from the session, and her answer is simple: She wants a way to control the panic so it doesn't go anywhere.
What I did to help
I gathered information.
* When did it first occur?
* Can you pinpoint anything else that was happening in your life when the panic attacks started to get bad five years ago?
We also discover that Sharon really worries what other people might think of her. What will others think if she has to flee a situation?
I asked exception questions.
* Are there times you expect it to happen but it doesn't?
We determine that it doesn't happen when Sharon is at work. Why? Because she feels she has the choice to leave a room if she needs to. Because she has to focus outward more on what she needs to do at work. But most interestingly, she tells me that it's also because when she's working, she has to override any feelings of panic.
It never happens when she's working one-on-one with a child. And it never happens when she's relaxing watching TV. Always look not just at when the panic attacks happen, but also when they don't happen.
Finding the answers to exception questions can reveal precious clues as to how the client, on some level, already knows how to solve the problem.
I reframe.
I reframe the 'panic attack' (a horrible metaphor in itself) as a less threatening 'inappropriate exercise response'. Sharon seems to really connect to this way of looking at it. I also describe panicking as "running on more fuel than you need to".
I ask solution-focused questions.
* How is your life going to be without all that time spent panicking or fearing panic attacks?
Sharon tells me she wants to enjoy her time more with her children, and we begin to build a psychological template of life beyond the problem.
I externalize the problem.
I talk in terms of "standing up to it" and "not letting it have any traction". I talk about "it playing up" and her "taming it". The more we can detach the behaviour from who the client really is, the more we can help them leave it behind.
I use deep relaxation.
Next, I conversationally induce hypnosis.
We can use deep relaxation as the medium through which Sharon's unconscious mind can rapidly update its responses to life. During hypnosis, I again reframe the panic as "energy expenditure" and have Sharon rehearse future times when that energy expenditure is "on an even keel".
I also have Sharon observe from the outside the situations in which she had been panicking. Again, we are removing the behaviour from her core identity so that she can detach from it more easily.
Sharon spends around 25 minutes in hypnotic trance. I use just a small part of the Rewind Technique (usually used for PTSD and phobias) to further take the charge out of the old panic pattern so it can no longer try it on with Sharon.
I seek to talk directly to Sharon's unconscious mind – the part of her that has actually been producing the panic attacks, and therefore the part that knows how to stop them. I suggest she'll always be able to control them, and I rehearse with her all the times they used to happen and now don't.
I use a hypnotic therapeutic double bind, suggesting that Sharon won't be able to open her "stuck-together eyelids" until her unconscious mind lets her know it's going to take responsibility for giving her a 60% or 70% improvement – "or more perhaps". She tells me afterwards that she really couldn't open her eyes for a while.
By the end of the session, she is beautifully relaxed.
The outcome
Often we can stop panic attacks in one session. Sharon wrote to me many weeks after this session telling me she hadn't even had one panic attack, but wanted to leave the option open for coming back if need be.
What a great result.
AN OVERVIEW OF ANXIETY DISORDERS
Jack D. Maser, Ph.D.
Fear and anxiety are a normal part of life, even adaptive in many conditions. Who among us has not studied for a test without some anxiety - and scored better for it? Who has not walked down a dark street in a high crime district without mounting fear? Normal anxiety keeps us alert: it makes us question whether we really have to walk down that street after all.
Mental health professionals are not concerned with normal anxiety. Rather, they attend to fear and anxiety that has somehow gone awry; that inexplicably reaches overwhelming levels; that dramatically reduces or eliminates productivity and significantly intrudes on an individual's quality of life; and for which friends, family, and even the patient can find no obvious cause.
Clinicians recognize about 12 relatively distinct subtypes of anxiety disorder: Panic Disorder, with and without Agoraphobia, Agoraphobia Without a History of Panic Disorder, Specific Phobia, Social Phobia, Obsessive-Compulsive Disorder, Post-traumatic Stress Disorder, Acute Stress Disorder, Generalized Anxiety Disorder, Anxiety Disorder Due to a General Medical Condition, Substance-Induced Anxiety Disorder, and Anxiety Disorder Not Otherwise Specified.
Frequently, these disorders are made more complex and difficult to treat because they are accompanied by depression, substance abuse, and suicidal thoughts. Full definitions of each subtype may be found in The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). American Psychiatric Association, 1994, but the primary distinguishing features will be mentioned briefly here:
• Panic Disorder- Within 10 minutes, escalating fear develops into a discrete period of intense discomfort accompanied by at least four of 13 somatic or cognitive systems. The afflicted individual believes that he or she is having a heart attack and dying and often presents to a hospital emergency room with this complaint.
• With Agoraphobia- Often recurrent panic attacks become associated with the places in which they occur. As the person attempts to avoid these places, either in the hope of not triggering an attack or not having help available, or being unable to escape, their freedom of movement and lifestyle may become severely restricted.
• Without Agoraphobia- Panic attacks occur, but without the consequence of avoidant behavior.
• Agoraphobia without a History of Panic Disorder Persona with limited symptoms. Panic Attacks or some other symptom(s) that may be incapacitating or embarrassing (e.g. loss of bladder control) may lead to a pervasive avoidance of a variety of situations. Common agoraphobic situations include being in a crowd, crossing a bridge, or leaving home alone. If the person forces exposure to the feared situation, it is only considerable dread.
• Specific Phobia- Excessive fear upon exposure to a specific object or situation (but not of a panic attack or being embarrassed in a social situation) is the hallmark of a Specific Phobia. When confronted by such objects or events as elevators, funerals, lightning storms, insects, or furry animals, phobic individuals become extremely fearful. Specific phobias may also involve fear of losing control, panicking, and fainting when confronted with the feared object. Adolescents or adults recognize the fear as unreasonable, but can do little to stop it. Often the individual can lead a relatively normal life by simple avoidance, and the diagnosis is not made.
• Social Phobia- Social Phobic individuals have a persistent fear of exposure to possible scrutiny by others. They fear that they will do something or act in a way that will be humiliating or embarrassing. While it is normal to have some anxiety before an encounter with the boss or before giving a speech, most people are not incapacitated and manage to get through the ordeal. This diagnosis is only made if the consequent avoidant behavior interferes with functioning at work or in usual social situations or if the person is markedly distressed about the problem.
• Obsessive-Compulsive Disorder (OCD) - Recurrent, distressful obsessions (thoughts) or compulsions can significantly interfere with normal marital, social, or work routines. The person usually recognized the unreasonableness of the behavior, and this fact adds to the distress. However, resisting the obsession or compulsion means that the anxiety will escalate rapidly to intolerable levels. It is easier to give into the intrusive thought or to execute the behavior.
• Post-Traumatic Stress Disorder (PTSD) - This clinical condition can be traced to a definable, traumatic event in the individual's life. The individual experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. It might have occurred within a soldier who served time in a war zone or after witnessing a shooting, being a rape or street crime victim, or living through some natural disaster. The experience must have produced intense fear, helplessness, or horror. Either shortly thereafter or at some later date, the person may experience flashbacks, recurrent and intrusive recollections of the event, feelings of detachment, guild, sleep problems and a variety of somatic symptoms.
• Acute Stress Disorder- Symptoms, similar to PTSD, that develop within a month after exposure to an extreme traumatic stressor and are time-limited between 2 days and 4 weeks define this disorder.
• Generalized Anxiety Disorder (GAD) - The individual presented with GAD reports uncontrollable excessive anxiety and worry, more days than not, for at least a 6-month period. They are likely to feel constantly "on edge" and tired, they complain of muscle tenseness, they may be irritable and unable to concentrate, and their sleep pattern is disturbed. The more life circumstances about which the individual worries, the more likely the diagnosis.
• Anxiety Disorder Due to General Medical Condition- Anxiety symptoms can include those of GAD, panic attacks, or OCD, and these must be directly linked to a general medical condition by the person's history, physical examination or laboratory findings. The anxiety symptoms likely to be atypical for age of onset, course, and family history.
• Substance-Induced Anxiety Disorder- The clinical presentation of this condition may resemble Panic Disorder, GAD, Phobia, or OCD, but the full set of diagnostic criteria for even one of these disorders does not have to be met. However, it is essential that the anxiety symptoms be due to the direct physiological effects of a drug of abuse, medication, or exposure to a toxin.
• Anxiety Disorder Not Otherwise Specified- A fair number of people may be expected to fit this category. For example, the DSM-IV clinical trials found a number of people with Mixed Anxiety-Depression (i.e. not meeting full diagnostic criteria for either.) Others who fit this category might be persons with symptoms of Social Phobia who also have dermatological conditions, stuttering problems, and Body Dimorphic Disorder.
The prevalence of these disorders is startling. In any given year, approximately 40 million adults in the United States will suffer from an anxiety disorder. That’s 18% of the adult population. What is especially striking is how many times one or more of these anxiety disorders occur with each other and with other mental disorders, such as depression and substance abuse.
It is important that clinicians and patients recognize that effective treatments are available. Phobias can be treated by behavioral methods, while panic disorder can be treated with medication, cognitive-behavioral therapy or both (see Wolfe and Maser, 1994). Obsessive-Compulsive and Post-traumatic Stress Disorders are difficult but hardly impossible to treat, and the symptoms can be markedly reduced, if not eliminated. When the anxiety disorder is effectively dealt with, drug abuse and secondary depression will also usually decline.
Every year the NIMH spends many millions of dollars on research on the causes and treatments of the anxiety disorders. As understanding of the causes has grown, effective treatments have been developed. Treatment allows afflicted individuals to return to relatively normal, productive lives. Recognition that something is wrong is what brings people to this site. They need to know that once identified, anxiety disorders can be treated.
Causes of Anxiety Disorders
Nature or Nurture?
The National Institute of Mental Health (NIMH) is harnessing the most sophisticated scientific tools available to determine the causes of anxiety disorders. Like heart disease and diabetes, these brain disorders are complex and probably result from a combination of genetic, behavioral, developmental, and other factors.
Studies of twins and families suggest that genes play a role in the origin of anxiety disorders. Although heredity alone can't explain what goes awry. Experience also plays a part. In Post-Traumatic Stress Disorder (PTSD), for example, trauma triggers the anxiety disorder; but genetic factors may explain why only certain individuals exposed to similar traumatic events develop full-blown PTSD. Researchers are attempting to learn how genetics and experience interact in each of the anxiety disorders—information they hope will yield clues to prevention and treatment.
Several parts of the brain are key actors in a highly dynamic interplay that gives rise to fear and anxiety. Much research centers on the amygdala, an almond-shaped structure deep within the brain. The amygdala is believed to serve as a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret them. It can signal that a threat is present, and trigger a fear response or anxiety. It appears that emotional memories stored in the central part of the amygdala may play a role in disorders involving very distinct fears, like phobias, while different parts may be involved in other forms of anxiety.
Other research focuses on the hippocampus, another brain structure that is responsible for processing threatening or traumatic stimuli. The hippocampus plays a key role in the brain by helping to encode information into memories. Studies have shown that the hippocampus appears to be smaller in people who have undergone severe stress because of child abuse or military combat. This reduced size could help explain why individuals with PTSD have flashbacks, deficits in explicit memory, and fragmented memory for details of the traumatic event.
Also, research indicates that other brain parts called the basal ganglia and striatum are involved in obsessive-compulsive disorder.
By learning more about brain circuitry involved in fear and anxiety, scientists may be able to devise new and more specific treatments for anxiety disorders. For example, it someday may be possible to increase the influence of the thinking parts of the brain on the amygdala, thus placing the fear and anxiety response under conscious control. In addition, with new findings about neurogenesis (birth of new brain cells) throughout life, perhaps a method will be found to stimulate growth of new neurons in the hippocampus in people with PTSD.
How individuals respond to their environment and how the environment responds to them are very important parts of human behavior. Studies are researching the impact of stress, life changes, social factors and other influences on the development of anxiety disorders. The jury is still out, but one thing is certain, the answer requires much study and will take time. The good news is that science has developed many successful treatments for these illnesses.
Causes of Depression
Substantial evidence from neuroscience, genetics, and clinical investigation shows that depressive illnesses are disorders of the brain. However, the precise causes of these illnesses continue to be a matter of intense research.
Modern brain-imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters-chemicals used by nerve cells to communicate-are out of balance. Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other non-genetic factors. Studies of brain chemistry and the mechanisms of action of antidepressant medications continue to inform our understanding of the biochemical processes involved in depression.
Very often, a combination of genetic, cognitive, and environmental factors are involved in the onset of a depressive disorder. Trauma, loss of a loved one, a difficult relationship, a financial problem, or any stressful change in life patterns, whether the change is unwelcome or desired, can trigger a depressive episode in vulnerable individuals. Later episodes of depression may occur without an obvious cause.
In some families, depressive disorders seem to occur generation after generation; however, they can also occur in people who have no family history of these illnesses. Whether inherited or not, depressive disorders are associated with changes in brain structures or brain function, which can be seen using modern brain imaging technologies.
the abrupt onset of intense fear or discomfort that reaches a peak within minutesand includes at least four of the following symptoms:
a)Palpitations,
b)pounding heart, or accelerated heart rate.
C)Sweating.
d)Trembling or shaking.
e)Sensations of shortness of breath or smothering...
For doctors to diagnose a panic attack, they look for at least four of the following signs: sweating, trembling, shortness of breath, a choking sensation, chest pain, nausea, dizziness, fear of losing your mind, fear of dying, flushing, feeling that danger is nearby, a racing heart (heart palpitations), and feeling an ...
How is severe anxiety treated?
When you're feeling anxious or stressed, these strategies will help you cope:
1. Take a time-out. ...
2. Eat well-balanced meals. ...
3. Limit alcohol and caffeine, which can aggravate anxiety and trigger panic attacks.
4. Get enough sleep. ... .
5. Exercise daily to help you feel good and maintain your health. ...
6. Take deep breaths.
What can happen if you have a panic attack?
A panic attack is a sudden surge of overwhelming anxiety and fear. Your heart pounds and you can't breathe. You may even feel like you're dying or going crazy. Left untreated, panic attacks can lead to panic disorder and other problems.
What causes tension in the shoulders and neck?
The main cause of neck pain is tension. During periods of intense anxiety, your muscles tense up dramatically. Muscle tension tightens the muscles, especially in the shoulders, back, and neck. The more anxiety you experience, the more your tensionmay cause significant pain and discomfort.
What exactly is an anxiety?
1. I
1. I become terrified from little things.
Choose one:
Not at all.
Occasionally.
Sometimes but it's bearable.
Yes - I can't stand it.
I do not know.
1. I have a hard time swallowing.
Choose one:
No, i don't.
Just a little.
Yes but it's bearable.
Yes and I can't stand it.
I'm not sure.
1. I feel like I am choking.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes and I can't stand it.
I do not know.
1. I tremble or shake.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes - I can't stand it.
I do not know.
I tremble or shake.
Choose one:
1. I fear I am losing control.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes and I can't stand it.
I do not know.
1. I feel short of breath for no reason.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes and I can't stand it.
I do not know.
1. I feel lightheaded, unsteady, or dizzy.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
I couldn't stand it.
I do not know. ( Maybe or maybe not )
1. I have numbness or tingling.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes - I can't stand it.
I do not know.
1. I sweat and/or feel hot for no reason.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes and I can't stand it.
I do not know.
1. I have a fear of bad things happening.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
I couldn't stand it.
I do not know.
1. I do not like going out.
Choose one:
I like going out.
Sometimes I don't like to go out.
It is unpleasant but bearable to go out.
I can't stand going out.
I do not know.
1. I have a hard time going to sleep.
Choose one:
Not at all.
Just a little.
It is unpleasant but bearable.
Yes and I can't stand it.
I do not know.
Case Study: What I Did to Solve clients Five Years of Panic Attacks
Millions suffer the agony of panic attacks. A crippling emotional allergy. The body musters all its reserves to fight or run from an attacker that doesn't exist.
When clients panic, it's not just an emotional experience. It's a full-blown physical reaction: pressure in the chest, heart palpitations, dizziness, shortness of breath...
And these symptoms make sense.
When we're fleeing in the wild, we need sweaty palms so that when the sweat dries we are better able to grip tree branches and rocks in order to climb to safety. We need to breathe rapidly to get enough oxygen to keep running. In this situation, hyperventilating isn't hyperventilating – it's a physiological necessity. Same goes for a rapid heartbeat. Horrible during a job interview, but essential when fighting off an attacker.
So in context, the so-called 'symptoms' of a panic attack aren't symptoms at all. If we are facing an actual threat, these 'symptoms' may actually save our lives. Of course, this is cold comfort for the panic attack sufferer.
Take Julia, whose session we filmed for Uncommon Practitioners TV. It had been 20 years since she experienced her first panic attack, but it was in the past five years that they'd really struck with a vengeance. She was having as many as ten a day.
Ten panic attacks a day for five years!
I think you'll find Sh panic attacks will have many overlaps with your clients' panic attacks. With the strategies I used, you can help stop panic attacks fast.
Julia had been suffering panic attacks on and off for 20 years. But she left it all behind in one session.
Sharon's story
In her video, Sharon tells us that she is a single mum and works in a school. Raised by parents who were both mute and deaf, life has never been easy for Sharon. Her father left her mother when she was young, and visiting her estranged father seems to be what first set off the panic attacks that would follow her for the next two decades.
I seek to discover the pattern of the panic.
Sharon tells us she invariably has a panic attack within two hours of waking up in the morning. She has them when she's at the local shops, out socializing, taking her children out, going to work... Day after day. It's exhausting. But it never happens when she's "safe" at home.
I ask her what she wants from the session, and her answer is simple: She wants a way to control the panic so it doesn't go anywhere.
What I did to help
I gathered information.
* When did it first occur?
* Can you pinpoint anything else that was happening in your life when the panic attacks started to get bad five years ago?
We also discover that Sharon really worries what other people might think of her. What will others think if she has to flee a situation?
I asked exception questions.
* Are there times you expect it to happen but it doesn't?
We determine that it doesn't happen when Sharon is at work. Why? Because she feels she has the choice to leave a room if she needs to. Because she has to focus outward more on what she needs to do at work. But most interestingly, she tells me that it's also because when she's working, she has to override any feelings of panic.
It never happens when she's working one-on-one with a child. And it never happens when she's relaxing watching TV. Always look not just at when the panic attacks happen, but also when they don't happen.
Finding the answers to exception questions can reveal precious clues as to how the client, on some level, already knows how to solve the problem.
I reframe.
I reframe the 'panic attack' (a horrible metaphor in itself) as a less threatening 'inappropriate exercise response'. Sharon seems to really connect to this way of looking at it. I also describe panicking as "running on more fuel than you need to".
I ask solution-focused questions.
* How is your life going to be without all that time spent panicking or fearing panic attacks?
Sharon tells me she wants to enjoy her time more with her children, and we begin to build a psychological template of life beyond the problem.
I externalize the problem.
I talk in terms of "standing up to it" and "not letting it have any traction". I talk about "it playing up" and her "taming it". The more we can detach the behaviour from who the client really is, the more we can help them leave it behind.
I use deep relaxation.
Next, I conversationally induce hypnosis.
We can use deep relaxation as the medium through which Sharon's unconscious mind can rapidly update its responses to life. During hypnosis, I again reframe the panic as "energy expenditure" and have Sharon rehearse future times when that energy expenditure is "on an even keel".
I also have Sharon observe from the outside the situations in which she had been panicking. Again, we are removing the behaviour from her core identity so that she can detach from it more easily.
Sharon spends around 25 minutes in hypnotic trance. I use just a small part of the Rewind Technique (usually used for PTSD and phobias) to further take the charge out of the old panic pattern so it can no longer try it on with Sharon.
I seek to talk directly to Sharon's unconscious mind – the part of her that has actually been producing the panic attacks, and therefore the part that knows how to stop them. I suggest she'll always be able to control them, and I rehearse with her all the times they used to happen and now don't.
I use a hypnotic therapeutic double bind, suggesting that Sharon won't be able to open her "stuck-together eyelids" until her unconscious mind lets her know it's going to take responsibility for giving her a 60% or 70% improvement – "or more perhaps". She tells me afterwards that she really couldn't open her eyes for a while.
By the end of the session, she is beautifully relaxed.
The outcome
Often we can stop panic attacks in one session. Sharon wrote to me many weeks after this session telling me she hadn't even had one panic attack, but wanted to leave the option open for coming back if need be.
What a great result.
AN OVERVIEW OF ANXIETY DISORDERS
Jack D. Maser, Ph.D.
Fear and anxiety are a normal part of life, even adaptive in many conditions. Who among us has not studied for a test without some anxiety - and scored better for it? Who has not walked down a dark street in a high crime district without mounting fear? Normal anxiety keeps us alert: it makes us question whether we really have to walk down that street after all.
Mental health professionals are not concerned with normal anxiety. Rather, they attend to fear and anxiety that has somehow gone awry; that inexplicably reaches overwhelming levels; that dramatically reduces or eliminates productivity and significantly intrudes on an individual's quality of life; and for which friends, family, and even the patient can find no obvious cause.
Clinicians recognize about 12 relatively distinct subtypes of anxiety disorder: Panic Disorder, with and without Agoraphobia, Agoraphobia Without a History of Panic Disorder, Specific Phobia, Social Phobia, Obsessive-Compulsive Disorder, Post-traumatic Stress Disorder, Acute Stress Disorder, Generalized Anxiety Disorder, Anxiety Disorder Due to a General Medical Condition, Substance-Induced Anxiety Disorder, and Anxiety Disorder Not Otherwise Specified.
Frequently, these disorders are made more complex and difficult to treat because they are accompanied by depression, substance abuse, and suicidal thoughts. Full definitions of each subtype may be found in The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). American Psychiatric Association, 1994, but the primary distinguishing features will be mentioned briefly here:
• Panic Disorder- Within 10 minutes, escalating fear develops into a discrete period of intense discomfort accompanied by at least four of 13 somatic or cognitive systems. The afflicted individual believes that he or she is having a heart attack and dying and often presents to a hospital emergency room with this complaint.
• With Agoraphobia- Often recurrent panic attacks become associated with the places in which they occur. As the person attempts to avoid these places, either in the hope of not triggering an attack or not having help available, or being unable to escape, their freedom of movement and lifestyle may become severely restricted.
• Without Agoraphobia- Panic attacks occur, but without the consequence of avoidant behavior.
• Agoraphobia without a History of Panic Disorder Persona with limited symptoms. Panic Attacks or some other symptom(s) that may be incapacitating or embarrassing (e.g. loss of bladder control) may lead to a pervasive avoidance of a variety of situations. Common agoraphobic situations include being in a crowd, crossing a bridge, or leaving home alone. If the person forces exposure to the feared situation, it is only considerable dread.
• Specific Phobia- Excessive fear upon exposure to a specific object or situation (but not of a panic attack or being embarrassed in a social situation) is the hallmark of a Specific Phobia. When confronted by such objects or events as elevators, funerals, lightning storms, insects, or furry animals, phobic individuals become extremely fearful. Specific phobias may also involve fear of losing control, panicking, and fainting when confronted with the feared object. Adolescents or adults recognize the fear as unreasonable, but can do little to stop it. Often the individual can lead a relatively normal life by simple avoidance, and the diagnosis is not made.
• Social Phobia- Social Phobic individuals have a persistent fear of exposure to possible scrutiny by others. They fear that they will do something or act in a way that will be humiliating or embarrassing. While it is normal to have some anxiety before an encounter with the boss or before giving a speech, most people are not incapacitated and manage to get through the ordeal. This diagnosis is only made if the consequent avoidant behavior interferes with functioning at work or in usual social situations or if the person is markedly distressed about the problem.
• Obsessive-Compulsive Disorder (OCD) - Recurrent, distressful obsessions (thoughts) or compulsions can significantly interfere with normal marital, social, or work routines. The person usually recognized the unreasonableness of the behavior, and this fact adds to the distress. However, resisting the obsession or compulsion means that the anxiety will escalate rapidly to intolerable levels. It is easier to give into the intrusive thought or to execute the behavior.
• Post-Traumatic Stress Disorder (PTSD) - This clinical condition can be traced to a definable, traumatic event in the individual's life. The individual experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. It might have occurred within a soldier who served time in a war zone or after witnessing a shooting, being a rape or street crime victim, or living through some natural disaster. The experience must have produced intense fear, helplessness, or horror. Either shortly thereafter or at some later date, the person may experience flashbacks, recurrent and intrusive recollections of the event, feelings of detachment, guild, sleep problems and a variety of somatic symptoms.
• Acute Stress Disorder- Symptoms, similar to PTSD, that develop within a month after exposure to an extreme traumatic stressor and are time-limited between 2 days and 4 weeks define this disorder.
• Generalized Anxiety Disorder (GAD) - The individual presented with GAD reports uncontrollable excessive anxiety and worry, more days than not, for at least a 6-month period. They are likely to feel constantly "on edge" and tired, they complain of muscle tenseness, they may be irritable and unable to concentrate, and their sleep pattern is disturbed. The more life circumstances about which the individual worries, the more likely the diagnosis.
• Anxiety Disorder Due to General Medical Condition- Anxiety symptoms can include those of GAD, panic attacks, or OCD, and these must be directly linked to a general medical condition by the person's history, physical examination or laboratory findings. The anxiety symptoms likely to be atypical for age of onset, course, and family history.
• Substance-Induced Anxiety Disorder- The clinical presentation of this condition may resemble Panic Disorder, GAD, Phobia, or OCD, but the full set of diagnostic criteria for even one of these disorders does not have to be met. However, it is essential that the anxiety symptoms be due to the direct physiological effects of a drug of abuse, medication, or exposure to a toxin.
• Anxiety Disorder Not Otherwise Specified- A fair number of people may be expected to fit this category. For example, the DSM-IV clinical trials found a number of people with Mixed Anxiety-Depression (i.e. not meeting full diagnostic criteria for either.) Others who fit this category might be persons with symptoms of Social Phobia who also have dermatological conditions, stuttering problems, and Body Dimorphic Disorder.
The prevalence of these disorders is startling. In any given year, approximately 40 million adults in the United States will suffer from an anxiety disorder. That’s 18% of the adult population. What is especially striking is how many times one or more of these anxiety disorders occur with each other and with other mental disorders, such as depression and substance abuse.
It is important that clinicians and patients recognize that effective treatments are available. Phobias can be treated by behavioral methods, while panic disorder can be treated with medication, cognitive-behavioral therapy or both (see Wolfe and Maser, 1994). Obsessive-Compulsive and Post-traumatic Stress Disorders are difficult but hardly impossible to treat, and the symptoms can be markedly reduced, if not eliminated. When the anxiety disorder is effectively dealt with, drug abuse and secondary depression will also usually decline.
Every year the NIMH spends many millions of dollars on research on the causes and treatments of the anxiety disorders. As understanding of the causes has grown, effective treatments have been developed. Treatment allows afflicted individuals to return to relatively normal, productive lives. Recognition that something is wrong is what brings people to this site. They need to know that once identified, anxiety disorders can be treated.
Causes of Anxiety Disorders
Nature or Nurture?
The National Institute of Mental Health (NIMH) is harnessing the most sophisticated scientific tools available to determine the causes of anxiety disorders. Like heart disease and diabetes, these brain disorders are complex and probably result from a combination of genetic, behavioral, developmental, and other factors.
Studies of twins and families suggest that genes play a role in the origin of anxiety disorders. Although heredity alone can't explain what goes awry. Experience also plays a part. In Post-Traumatic Stress Disorder (PTSD), for example, trauma triggers the anxiety disorder; but genetic factors may explain why only certain individuals exposed to similar traumatic events develop full-blown PTSD. Researchers are attempting to learn how genetics and experience interact in each of the anxiety disorders—information they hope will yield clues to prevention and treatment.
Several parts of the brain are key actors in a highly dynamic interplay that gives rise to fear and anxiety. Much research centers on the amygdala, an almond-shaped structure deep within the brain. The amygdala is believed to serve as a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret them. It can signal that a threat is present, and trigger a fear response or anxiety. It appears that emotional memories stored in the central part of the amygdala may play a role in disorders involving very distinct fears, like phobias, while different parts may be involved in other forms of anxiety.
Other research focuses on the hippocampus, another brain structure that is responsible for processing threatening or traumatic stimuli. The hippocampus plays a key role in the brain by helping to encode information into memories. Studies have shown that the hippocampus appears to be smaller in people who have undergone severe stress because of child abuse or military combat. This reduced size could help explain why individuals with PTSD have flashbacks, deficits in explicit memory, and fragmented memory for details of the traumatic event.
Also, research indicates that other brain parts called the basal ganglia and striatum are involved in obsessive-compulsive disorder.
By learning more about brain circuitry involved in fear and anxiety, scientists may be able to devise new and more specific treatments for anxiety disorders. For example, it someday may be possible to increase the influence of the thinking parts of the brain on the amygdala, thus placing the fear and anxiety response under conscious control. In addition, with new findings about neurogenesis (birth of new brain cells) throughout life, perhaps a method will be found to stimulate growth of new neurons in the hippocampus in people with PTSD.
How individuals respond to their environment and how the environment responds to them are very important parts of human behavior. Studies are researching the impact of stress, life changes, social factors and other influences on the development of anxiety disorders. The jury is still out, but one thing is certain, the answer requires much study and will take time. The good news is that science has developed many successful treatments for these illnesses.
Causes of Depression
Substantial evidence from neuroscience, genetics, and clinical investigation shows that depressive illnesses are disorders of the brain. However, the precise causes of these illnesses continue to be a matter of intense research.
Modern brain-imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters-chemicals used by nerve cells to communicate-are out of balance. Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other non-genetic factors. Studies of brain chemistry and the mechanisms of action of antidepressant medications continue to inform our understanding of the biochemical processes involved in depression.
Very often, a combination of genetic, cognitive, and environmental factors are involved in the onset of a depressive disorder. Trauma, loss of a loved one, a difficult relationship, a financial problem, or any stressful change in life patterns, whether the change is unwelcome or desired, can trigger a depressive episode in vulnerable individuals. Later episodes of depression may occur without an obvious cause.
In some families, depressive disorders seem to occur generation after generation; however, they can also occur in people who have no family history of these illnesses. Whether inherited or not, depressive disorders are associated with changes in brain structures or brain function, which can be seen using modern brain imaging technologies.