Questions & Answers
Panic
Anxiety Education
Management Services
Questions and Answers 1
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Panic
Attacks & Abuse Issues
Q:
I have been having nightmares and flashbacks for a number of
years which relate to abuse in my childhood. I also have
panic attacks and anxiety as well. I often have the attacks
when I'm driving and they can wake me up during the night. I
have stopped driving altogether which is very frustrating
for me and the family. These attacks frighten me because
sometimes I feel as if I am out of my body looking down at
myself and my eyes become so sensitive to light I have to
wear sunglasses all the time. I also feel very giddy during
the attack and it feels as if I have had an electric shock.
I was seeing a therapist who was helping me with the
flashbacks and nightmares, but I stopped seeing her because
my panic attacks and anxiety just got worse and worse. I
have really worked hard in overcoming my problems and I have
come along way but I can't get it together with my driving.
I also feel really angry all of the time and I don't know
what to do about that. My therapist wants me to come back
and keep working on with her, but I am really scared the
panic and the anxiety will get worse again. What can I do?
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A: It
sounds like you have had a very difficult time. From the description
of your letter it sounds as if you have Post Traumatic Stress
Disorder (PTSD), which is an Anxiety Disorder and it is not uncommon
for people with PTSD to also have Panic Disorder and Depression.
Some of the symptoms you mention, including depersonalization,
sensitivity to light are classified as Dissociative symptoms, again
very common in people with PTSD and/or Panic Disorder. Also your
symptom of giddiness can be related to Dissociation or it could be a
result of not eating and/or hyperventilation.
In regards to your driving. What we have
found over the years is there is one type of Panic Attack people
have which is related to Dissociation. Another word for Dissociation
is Self Hypnotic trance. When people dissociate they get a variety
of symptoms, including 'out of body' experiences, not feeling real,
seeing their environment through a white or a gray mist, stationary
objects may appear to move, tunnel vision, sometimes they may feel
an electric shock, or burning heat move through the body, or a
'whoosh' of intense energy.
It is quite easy to induce these states in
people who are vulnerable to them. Research shows we can enter a
Dissociate state within a 'split second.' One of the easiest ways to
induce this state is by staring. When people are driving, they stare
at the road ahead or sit and stare at a red traffic light and
without warning they get a number of the above symptoms. Many people
report the symptoms can happen while working on a computer and a
large number of people report fluorescent lights also help to induce
this state. It can also happen when we relax, watch T.V. or when we
read a book. One study which links dizziness to depersonalization
suggests it is not what we are doing at the time we dissociate it
'is the magnitude of the change.... in consciousness which is
significant.'
The prevailing thought is that when we
relax we have more time to think about our Disorder and this is why
our symptoms increase, but many of us who dissociate and have
recovered using Cognitive Behavioral Therapy, disagree with this
theory. We can enter a dissociative very easily no matter what we
are doing and no matter what we are thinking. Recovery for many of
us means understanding how we induce these states and by using
Cognitive skills to work with our fear and anxiety producing
thoughts about these states.
The research on the 'night' attacks shows
the attack happens on the change of consciousness as we move from
dreaming sleep to deep sleep or from deep sleep back to dreaming
sleep. The research also shows the attack is not related to dreams
or nightmares. Many of us can experience the night attack as we go
to sleep at night or as we wake up in the morning.
If you are not eating properly and/or not
getting enough sleep you become more vulnerable to Dissociation. The
symptoms are not harmful in themselves and once people can see how
they are doing it, they lose their fear of them and some people
report they now actually enjoy it when it happens!
One of the points we picked up in your
letter is your comments regarding your childhood. Many people with
childhood trauma do dissociate, in fact many people learnt to
dissociate as a way of defending themselves against ongoing abuse.
Your therapist is correct in wanting you to
return to therapy to deal with the issue of abuse. There is no
denying that therapy can be traumatizing, as you do need to work
with many of the painful memories. But it is the one way that will
help you resolve the many issues you are currently facing in regards
to the abuse. And therapy can also be a major factor in the inner
healing process. Your anger is a natural result of what has happened
to you. From what you have said in your letter, you have every
reason to be angry and your therapist will help you work with the
anger in a more appropriate way, rather than keeping it locked
inside you.
Many of our clients, who also have an abuse
background, learn to understand and manage their Dissociation,
anxiety and panic, which in turn takes some of the pressure away
from them as they continue in therapy. You are obviously making
great progress in your own personal management of your symptoms.
Remember when it first began it was difficult to believe that the
intense symptoms were anxiety, panic and depression. This is very
normal for all of us. But as you have said, once we begin to accept
what the symptoms are, it does make things easier.
If you do decide to return to therapy, you
will be in the position of having much more knowledge of the
symptoms than you did when they first manifested. This is to your
advantage and will give you much more power over them than you had
previously.
- References
Uhde TW, 1994, Principles and Practice of Sleep Medicine, 2nd
edn, ch 84, WB Saunders & Co.
- Frewtrell WD et al, 1988, 'Dizziness and
Depersonalization', Adv. Behav. Res, Ther., vol 10, pp 201-18
Spontaneous
Panic Attacks
Q.I
have what you have said are spontaneous panic attacks. They just
happen any time any where and they can also wake me up at night. But
my therapist tells me that 'spontaneous' panic attacks is just one
particular theory amongst others. He believes this theory is wrong
and thinks that I must have some sort of phobia that I am not recognizing.
He also says my night attacks are a result of having a nightmare. I
know what I experience, but now I am beginning to become confused
and I am beginning to doubt my own experience. After all my
therapist is an expert.
A.
There was definitely some opposition to the three 'Panic Attack'
categories in the Diagnostic and Statistical Manual Number Four (DSM
4)when it was released in 1994. This manual, is as it says, is the
diagnostic manual for diagnosis of Mental Disorders which is used by
the American Psychiatric Association. Some therapists did question
the validity of these categories, primarily because it appeared to
be at odds with their own particular schools of thought and the
therapies they provide. Irrespective of the other varying theories
about Panic Attacks, the DSM 4 is correct. My own experience of
Panic Disorder and the thousands of people I have spoken with over
the years show that this type of attack is very real and without
doubt does happen. Not only is there the personal experience of so
many of us who have this type of attack, the research and the
subsequent release of the DSM 4 confirms the scientific validity of
these attacks.
The sleep research also confirms that this
type of attack is not a result of dreams or nightmares but occurs at
the change of consciousness from dreaming sleep to deep sleep or
from deep sleep back to dreaming sleep. Many people also report it
occurs as they begin to enter the first stages sleep or as they
begin to wake up.
Even though the attacks do occur for no
apparent external reason, Cognitive Behavioral Therapy is the one
therapy that has been proven Internationally to be the most
successful long term therapy. I would suggest you discuss your
concerns in detail with your therapist. If your therapist does not
agree with your experience and is not prepared to work with you on
that basis then you may wish to consider changing therapists. Your
recovery must be your number one priority. Trying to fit your
experience into a model that does not recognize the latest
scientific research and diagnostic criteria is going to mean an
unnecessary and costly uphill battle in your recovery.
The 1994 edition of the DSM 4 (Diagnostic
& Statistical Manual, American Psychiatric Association) now
shows that Panic Disorder is not a Phobic Response and people are
not afraid of situations or places but are frightened of having a
spontaneous panic attack. A conclusion we agree with without
reservation.
What is
wrong with positive thinking
Q. Why
do you object to replacing our negative thoughts with other ones.
When I feel anxious I divert my thoughts away from the anxiety. I
might read a magazine, or go and work in the garden. If I am out I
might count the number of red cars I see. I might practice my
breathing. This can make me feel a bit better. What is wrong with
that?
A. It
depends on what way you look at it. You may get short term relief
with these diversions, but it is only short term. The root cause is
still there as you have not taken any steps to deal with it. The
root cause of course is your thinking.
How long
does recovery take ..?
Q. I
just want to recover. That is all I think about. I am obsessed with
it and no matter how hard I try I just can't seem to get there.
Everyone is expecting be to be better and I do try everyday to do
everything I have to, but it is all just so hard and I am still so
scared of having a panic attack. How long does all this take?
A.
Recovery takes time and as I also say patience patience patience.
Don't worry about your 'obsessional' need
to recover. This is HEALTHY. The need and drive to recover has to be
absolute, it has to be the most important priority of your life. The
need to recover has to be strong enough to push past all your fears
including the fear of people not liking you.
The length of time for recovery varies with
individual people. It is dependent upon how strong the need is to
recover, how disciplined people are in practicing the management
techniques and for some people the resolution of past issues. As a
rule of thumb, it can take 12 - 18 months from beginning to end, but
during that time people can have days, then months of freedom,
before a set back. The more set backs you have the better, because
it gives you more to practice with and ultimately ensures a life of
freedom.
A note of caution, when the need to recover
becomes very strong, people have to learn to pace themselves and not
push to extreme. Pushing yourself to extreme limits all the time
will cause a set back and the feeling that 'I will never make it.'
Use this time to get to know yourself fully and learn to be kind and
compassionate towards yourself. This way you can learn to push past
your limits with more care and understanding of yourself and the
Disorder. Be kind to yourself and above all be patient.
One day at a time.
Medication
Q. I
was taking medication for awhile and then my doctor suggested I
could taper my dose down until I was finally able to come off
altogether. But now I am off the medication I feel worse than I was
before. I have stopped going out and now only go out when I really
have to but it is still a struggle. I find myself thinking about
suicide. I have never thought like this before and that frightens
me. My doctor suggested I see a psychologist who he thinks could
help me, but I feel so bad I don't know I can do it. I don't want to
go back on medication but I wonder if I should. What do you think?
A. If
we haven't learnt any Cognitive Behavioral Skills we may have
difficulty once we do stop taking medication. Many people who have
not learnt any CBT Skills report that the Disorder can be worse the
second time around.
In regards to medication, it is an
individual choice and one that needs to be assessed with your
doctor. If thoughts of suicide are constant you may need to review
your situation and go back on medication again until you become more
confident of your ability to work with the Disorder. People do
sometimes need to go onto antidepressants to help manage any anxiety
or any secondary major depression that may come as a result of these
attacks and it is best to work closely with your doctor on this
point.
Anxiety
Disorders and their effect on relationships
Q. I
had Panic Disorder and I never told anyone not even my wife. It made
everything very difficult and our marriage suffered to the point we
were separated. Although I didn't want to separate and I did miss my
wife, my panic and anxiety eased up and almost disappeared. I
finally told my wife about the Disorder and after some long heart to
hearts we decided to give our marriage another chance. Now the panic
and anxiety have returned almost back to what it was before.
Thankfully my wife is very supportive, but I don't understand why it
has come back.
A. It
is not uncommon for people not to tell spouses of their Disorder.
The problem with this is that it puts people under so much pressure
to 'be normal' and the more pressure we are under the worse we get,
so the pressure to be 'normal' increases and around and around we
go. During the separation you were able to just be yourself without
having to put on a 'front' all the time. The pressure was off and
the anxiety/panic settled down. In many cases the anxiety and panic
don't just disappear forever. There is a very strong possibility it
would have returned even if you and your wife did not come back
together. It is of course important that you do receive appropriate
treatment so that you can learn to work effectively with the anxiety
and panic. I think it is also important to be aware of you are
relating to your wife and the other people around you. Are you still
trying to be 'normal'. Are you still putting yourself under pressure
by trying to be 'normal'. And/or are you trying to be who you think
your wife wants you to be, instead of simply being yourself. When we
try to be who we think others want us to be, our anxiety and panic
can know no bounds! When we accept ourselves as we are and we we can
be ourselves our anxiety and panic diminish.
New
symptom...?
Q. I
have this new symptom - this left hand sided weakness in my arm and
hand and I can't stop worrying about it or accepting it is part of
the Disorder. Do you think it is real or do you think it is because
I am worrying about it all the time that is making it worse. What do
you think is causing it.
A. Firstly,
I am assuming you have had this checked by your doctor and it has
been confirmed there is nothing physically wrong. If you haven't had
it checked by a health professional, then I suggest you do so as
soon as possible.
If there is nothing physically wrong, then
the answer to your question is actually in your letter! Not being
able to accept it, and because it is predominant in your mind, it is
there! It won't go away while you give it the power to worry you.
Recovery means the experience of many different symptoms. When you
let go of one symptom there always seems that they are more waiting
to take their place. That is why checking each new symptom with your
doctor is so important. You need to know what you are dealing with.
I can't tell you why you are having this
particular symptom but from what I have seen over the years it is
quite a common symptom of the Disorder. I have stopped mentioning to
the various researchers I have been in contact with because no one
appears to know and no one has wanted to follow it through.
As you have this particular type of symptom
, I would guess that you are having the 'whoosh' attacks that move
through your whole body : The electric shock and/or the burning
(sometimes prickly) heat and/or the vibration and/or the unusual
energies and/or the 'rush' and/or the tingling sensation etc. and
you may also Dissociate, that is Depersonalization and/or
Derealization etc. The symptom you mention usually go hand in hand
with these types of attacks.
From what I can gather once you lose your
fear off these types of attacks and they do become less frequent,
this particular symptom does disappear. Although of course you may
still have the attacks on occasion. they can feel quite violent,
they won't hurt you and it really is a matter of letting them
happen.
Therapist
issues
Q.I
feel very offended that I should have to go and see a psychiatrist
or a psychologist. They are for people who have a mental illness. I
have anxiety and panic which is not a mental illness and I am not
some sort of weak person.
A.I
always strongly recommend that people with an Anxiety Disorder see a
Mental Health Professional, either a psychiatrist and/or a
psychologist. Seeing a Mental Health Professional is not a sign of
insanity. Anxiety Disorders are the most common Mental Health
problem in the country, and many psychiatrists and psychologists are
trained in this area. When we have a physical problem we prefer to
see a someone who specializes in that particular area. So it is with
Anxiety Disorders. Most of us need to see a Mental Health
Professional. You are right you are not weak, nor is anyone who has
an Anxiety Disorder. Nor for that matter are people who have a major
mental illness.
Seeing a Professional who is trained in
Anxiety Disorders can mean the difference between a full or
incomplete recovery. I also think it is important that people with
Anxiety Disorders understand mental illness per se. Our own biases
and fear only helps to perpetuate the stigma and shame many people
feel if they have a Mental Health problem and the fear, stigma and
shame won't change until we as individuals change our perception
about Mental Illness/Mental Disorders.
What is
the cause of Anxiety Disorders
Q. What
are the causes for the Anxiety Disorders. I am told they are a
result of a chemical imbalance in the brain that it is some sort of
brain dysfunction or some type of inner ear disturbance and
medication is the only way to treat these Disorders as they fix the
imbalance.
A. In
answer to your question regarding the specific causes of anxiety.
There are five major Anxiety Disorders . Panic Disorder, Post
Traumatic Stress Disorder (PTSD) , Social Phobia (SP), Obsessive
Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD),
the causes of which, excluding PTSD and GAD, are still being
investigated. There is no single defined cause as yet for Panic
Disorder and OCD and arguments abound as to the exact nature of the
precipitating factors, including the biological theory, the behavioral
theory and the psychodynamic theory. In regards to the brain
dysfunction theory and the inner ear dysfunction theory, again we
have not seen any literature to confirm these are the cause.
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