Q: Can you tell me the effects of drinking too much alcohol and anxiety/depression?

A: Alcohol is known as more of a depressant than a stimulant. It has the effect of dampening the physical system. If someone with anxiety/depression drinks alcohol to excess on a regular basis, then this will most probably contribute to the ongoing anxiety and depression. Some people with an Anxiety Disorder use alcohol as a way of trying to deal with the ongoing anxiety/depression. They do not realize they are making the condition worse for themselves. Not only are there physical, but also emotional and psychological, effects of drinking in excess. The other aspect is that, in the morning, it is very difficult for a person to distinguish between the anxiety symptoms and the "hangover" from the alcohol. This contributes to the major anxiety cycle and therefore perpetuates the Anxiety Disorder.

There is also research which links excessive alcohol consumption with the development of an Anxiety Disorder. It is very difficult for a health professional to ascertain which is the root cause of the Disorder. Did the anxiety exist before the alcohol problem or was the alcohol problem the cause of the ongoing anxiety? It is suggested if people are experiencing the ongoing anxiety and are experiencing an alcohol problem, then it is the alcohol problem that needs to be addressed first. Only when the person is free of the effects of the alcohol can the health practitioner deal with the anxiety (if any remain). We suggest people contact their local Alcoholics Anonymous or other similar organization to get assistance with alcohol dependency. Many of these organizations deal with the anxiety that can be residual from alcohol problems.

Our suggestion to people who experience ongoing anxiety/depression is to not drink alcohol (or very limited use). Deal with the anxiety in an appropriate way and there may be no need to drink in excess. Excessive alcohol consumption is not worth the effects it creates physically, emotionally or psychologically.

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Q: I am a 28 year old female. When I was 23 I experienced my first panic attack. It took months before I was finally diagnosed with panic disorder and put on medication (Xanax & ). I am still taking Xanax but not Zoloft. I am taking Prozac instead (20 mg/day). I do not have panic attacks anymore but do experience some points of high anxiety at times. I am slowly trying to quit taking Xanax since I have been taking it for so long now. I am currently taking 1 mg/day. When I started taking the medication I was taking 5 mg/day. The reason I want to get off of Xanax is so I can have children some day.

Since I have been diagnosed with panic disorder and been on medication there are some things that have changed about me that I am disappointed about but can't seem to "control".

I drink almost on a daily basis (average 4 glasses of wine/day - give or take some). I have gained 40-45 lbs over a 3 year timeframe I don't have energy or motivation like I used to I don't exercise like I used to. When you look at these issues, it looks as though I may be an alcoholic or depressed? However, before I was diagnosed I did drink and could control my drinking (drank socially on weekends - didn't drink on week nights, didn't drink alone, didn't drink at home watching tv, listening to music, or cleaning house) Also, my weight gain obviously has something to do with the fact that I don't exercise anymore (I used to ride my bicycle and walk). I don't exercise primarily because I do not have the energy or motivation to. Please help! I need your advice.

A: We understand how you feel with the lack of energy and motivation. It is not unusual for us to become caught up in this cycle. Although you may feel you don't have the motivation - you do have it - you wouldn't have written to us if you didn't! Only we can break the cycle ourselves and there are a number of things you can do:

Sometimes the medication can contribute to the lack of energy. Have you spoken with your doctor? Perhaps you may need to change the anti-depressants again. We are concerned you are using prescribed drugs along with the alcohol. It is very important you discuss this with your doctor as there are a number of drugs prescribed for Anxiety Disorders/depression, including Xanax, which can't be mixed with alcohol.

Some people do have difficulty coming off Xanax. Our federal government recommends people taking Xanax or one of the other shorter acting tranquillisers transfer over to and once they have stabilised, slowly withdraw from the Valium. Valium can take the edge of the withdrawal.

You may also wish to talk with the chapter of AA in your area. They can be very supportive and many, many people with Panic Disorder belong to AA.

The way we think also can keep us down. Our self talk can be very negative and depressing - 'I can't do this. I have no energy. Why aren't I motivated? I hate myself like this. Why can't I change.' etc, etc. Not the greatest way to motivate yourself! What we need to do is acknowledge to our self, 'Yes, I have no energy and yes I don't feel motivated, but so what! I am going to begin to exercise despite it. Don't buy into your usual head talk. Just get up and walk or ride around the block. Make yourself do the same thing the next day and the next etc extending your walk/ride each day. Physical exercise is very important for all of us as we are recovering. As you begin to exercise you do begin to feel better and your energy does begin to come back.

As we said in the beginning - your motivation is there you just need to see it.

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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 a long 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 with her, but I am really scared the panic and the anxiety will get worse again. What can I do?

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 TV, 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. Many of us who dissociate, and have recovered using Cognitive Behavioral Therapy, disagree with this theory. We can enter a dissociative state 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 how we deal with these states by using Cognitive skills to work with our fear and anxiety-producing thoughts.

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 learned 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

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Chapter 39 of Adam Khan's book Self-Help Stuff That Works

WHAT HAPPENS WHEN you let your mind wander? Studies have shown when a human mind has nothing specific to think about, it becomes chaotic, flitting from one thought to another in a random way. But if any mind - your mind, my mind - keeps wandering, before long, our thoughts will land on something that grabs our attention: some fear or frustration or unfinished business. You know what this is like: Your mind sticks there, like a tire spinning in the mud, dwelling on the worrisome or upsetting thought, and it ruins your mood. This is what happens to a mind without a purpose.

Having a purpose on your mind keeps your thoughts from devolving into chaos and bad moods. You can't stop your mind from thinking, but when you have a goal to think about, your mental resources are less likely to drift randomly into upsetting thoughts. They have someplace to go.

That's why studies show that people are more often in a good mood while working than they are in their free time. It seems unbelievable at first, but it is easily explained by the need for purpose. Most people are more likely to have clear purposes at work than at home.

It is common knowledge that "idle hands are the devil's workshop," but the important factor, the factor that gets you out of the devil's workshop, is something you need to do that compels your attention.

Remember that: Something you need to do that compels your attention. That's the key - think of it as vitamin P.

The human mind needs a purpose. It's like the ocelot scratching off his fur at the Seattle Zoo. The zookeepers didn't know what to do about it. They gave him a female, but he kept skinning himself. They changed his diet. They changed his cage. But he kept clawing at himself.

Finally, someone realized that in the wild, ocelots eat birds. So instead of giving the ocelot meat to eat, they threw an unplucked chicken into the cage. Sure enough, the ocelot - using the same clawing movements he was using on himself - plucked the feathers out of that chicken and stopped skinning himself.

Your mind is like that. It needs a bone to chew or it'll chew the furniture. It needs a purpose. And not just any purpose, but something that challenges you, engages you, something you intend to accomplish, something you want, something real and concrete. Your mind aligns around that goal instead of being pulled into negativity, and you're happier.

Find a purpose that enthralls you and then actively pursue it.

Self-Help Stuff That Works makes an excellent gift. It's a classy hardbound with a sewn binding that says practical stuff in a way that's easy to hear. You can now order it from any of twelve online bookstores. These are the most popular:

• http://www.amazon.com

• http://www.barnesandnoble.com

• http://www.borders.com

While you are pursuing your purpose, you may encounter setbacks now and then. When you do, handle it with optimism. Learn how right here:
Optimism

Here's a conversation on how to change the way you interpret the events in your life so that you neither become a doormat nor get upset more than you need to:
Interpretations

The art of controlling the meanings you're making is an important skill to master. It will literally determine the quality of your life. Read more about it in:
Master the Art of Making Meaning

next: Argue With Yourself And Win!

Alfred Lord Tennyson (1809 - 1892)

Poet of the highest distinction. He was a Poet Laureate and an inspiration to others. The years 1840-5 were in many ways the most challenging in his life. He was separated from his wife; he had lost his money; he felt more nervously ill than ever, and he could not write. So severe was his nervous illness that his friends despaired of his life.

"I have", he wrote, "drunk one of the most bitter draughts out of the cup of life, which go near to make men hate the world they move in."

In 1843 he wrote to a friend

" ... the perpetual panic and horror of the last two years had steeped my nerves in poison: now I am left a beggar but am or shall be shortly somewhat better off in nerves."

He was undertaking Hydropaths treatment which included: no reading, no going near a fire, no coffee, perpetual wet sheet and cold bath and alternation from hot to cold. It didn't work. In 1848 he went to a new doctor who gave him iron pills. It was commented "..this really great man thinks more about his bowels and nerves than about the laureate wreath he was born to inherit..". Many of his friends thought him a hypochondriac. He never received appropriate treatment for his condition and so experienced nervous illness through his life. He was also a brilliant poet and writer of the first order.

Charlotte Bronte (1816-1855)

Gifted poet and writer of the Victorian era. One of the infamous Bronte sisters. Author of, amongst others, Jane Eyre, Villette and Shirley. In 1852 developed a state of anxiety with depression. Charlotte was given a mercury treatment which provoked a violent reaction.

She said she was not writing but instead was swallowing drugs

"for the purpose of chasing away a low nervous fever which after long annoying threats - at last established a somewhat unfair tyranny over spirit - sleep and appetite".

She portrayed her condition in the character of Lucy in Villette. She suggests a connection between mental and physical illness

"my mind has suffered somewhat too much; a malady is growing upon it - what shall I do? How shall I keep well?" She also says "Sleepless, I lay awake night after night, weak and unable to occupy myself".

She would say the breakdown was a result of writing a book in isolation (Jane Eyre). But, she also said

"It would take a great deal to crush me!"

Sigmund Freud

Developed and taught psychoanalysis which is a form of psychotherapy. Psychoanalysis is
associated with the couch, the note pad and the silent listener. Contrary to popular belief, Freud was not the father of psychiatry. Sigmund Freud suffered from Panic Disorder at the time when he wrote his famous papers on anxiety neurosis. He had symptoms of an Anxiety Disorder and worried a great deal about his 'spells'. He had many medical evaluations for them. Nothing of a serious medical nature could be found wrong with him. He was told that his symptoms were 'nervous' in origin. Freud was not satisfied with what he was told. In his quest for a fuller explanation, he searched for a psychological cause. He built an elaborate model based on psychology of the mind and the role of internal conflicts in causing and maintaining anxiety. This model has preoccupied everyone studying anxiety for most of the century*. * The Anxiety Disease: David Sheehan MD

Nikola Tesla (1856-1943)

Genius & greatest inventor the world has ever known. Invented device to harness alternating electrical current, invented radio , fluorescent lighting and bladeless turbine, fundamentals of robotry, computers and missile science. Many of the 'modern conveniences of life' are a result of Tesla's inventions. At 5 years of age, following death of his older brother, he developed many phobias and compulsions and in general became a 'perfectionist' - subjecting himself to iron discipline in order to excel. He was also 'plagued' by panic attack - like symptoms. Strong flashes of light that marred sight of real objects and 'shooting flames' through the body. Their intensity increased as he got older.

'This caused me great discomfort and anxiety ..' said Tesla, 'None of the students of psychology or physiology whom I have consulted could ever explain satisfactorily these phenomena ..'

No surprise here, most people still can't get a satisfactory explanation about what is happening ......

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I hope you see the funny side of this. I find this tickles my funny bone.

Let's say a guy named Roger is attracted to a woman named Elaine. He asks her out to a movie; she accepts. They have a pretty good time. A few nights later he asks her out to dinner, and again they enjoy themselves. They continue to see each other regularly, and after awhile neither one of them is seeing anybody else.

And then, one evening when they're driving home, a thought occurs to Elaine, and, without really thinking, she says it aloud: ''Do you realize that, as of tonight, we've been seeing each other for exactly six months?''

And then there is silence in the car. To Elaine, it seems like a very loud silence. She thinks to herself: "Geez, I wonder if it bothers him that I said that? Maybe he's been feeling confined by our relationship; maybe he thinks I'm trying to push him into some kind of obligation that he doesn't want, or isn't sure of."

And Roger is thinking: "Hmmm. Six months."

And Elaine is thinking: "But, hey, I'm not so sure I want this kind of relationship, either. Sometimes I wish I had a little more space, so I'd have time to think about whether I really want us to keep going the way we are, moving steadily toward . . . I mean, where are we going? Are we just going to keep seeing each other at this level of intimacy? Are we heading toward marriage? Toward children? Toward a lifetime together? Am I ready for that level of commitment? Do I really even know this person?"

And Roger is thinking: "so that means it was...let's see...February when we started going out, which was right after I had the car at the dealer's, which means... lemme check the odometer...Whoa! I am way overdue for an oil change here."

And Elaine is thinking: "He's upset. I can see it on his face. Maybe I'm reading this completely wrong. Maybe he wants more from our relationship, more intimacy, more commitment; maybe he has sensed -- even before I sensed it -- that I was feeling some reservations? Yes, I bet that's it. That's why he's so reluctant to say anything about his own feelings. He's afraid of being rejected.

And Roger is thinking: "And I'm gonna have them look at the transmission again. I don't care what those morons say, it's still not shifting right. And they better not try to blame it on the cold weather this time. What cold weather? It's 87-degrees out, and this thing is shifting like a goddamn garbage truck, and I paid those incompetent thieves $600."

And Elaine is thinking: "He's angry. And I don't blame him. I'd be angry, too. God, I feel so guilty, putting him through this, but I can't help the way I feel. I'm just not sure."

And Roger is thinking: "They'll probably say it's only a 90-day warranty. That's exactly what they're gonna say, the rip off merchants."

And Elaine is thinking: "Maybe I'm just too idealistic, waiting for a knight to come riding up on his white horse, when I'm sitting right next to a perfectly good person, a person I enjoy being with, a person I truly do care about, a person who seems to truly care about me. A person who is in pain because of my self-centred, schoolgirl romantic fantasy."

And Roger is thinking: "Warranty? They want a warranty? I'll give them a goddamn warranty. I'll take their warranty and stick it right up their _ _ _.

''Roger,'' Elaine says aloud.

''What?'' says Roger, startled.

''Please don't torture yourself like this,'' she says, her eyes beginning to brim with tears. ''Maybe I should never have...Oh God, I feel so...'' (She breaks down, sobbing.)

''What?'' says Roger.

''I'm such a fool,'' Elaine sobs. ''I mean, I know there's no knight. I really know that. It's silly. There's no knight, and there's no horse.''

''There's no horse?'' says Roger.

''You think I'm a fool, don't you?'' Elaine says.

''No!'' says Roger, glad to finally know the correct answer.

''It's just that...It's that I... I need some time,'' Elaine says.

(There is a 15-second pause while Roger, thinking as fast as he can, tries to come up with a safe response. Finally he comes up with one that he thinks might work.)

''Yes,'' he says.

(Elaine, deeply moved, touches his hand.) ''Oh, Roger, do you really feel that way?'' she says.

''What way?'' says Roger.

''That way about time,'' says Elaine.

''Oh,'' says Roger. ''Yes.''

(Elaine turns to face him and gazes deeply into his eyes, causing him to become very nervous about what she might say next, especially if it involves a horse. At last, she speaks.)

''Thank you, Roger,'' she says.

''Thank you,'' says Roger.

Then he takes her home, and she lies on her bed, a conflicted, tortured soul, and weeps until dawn, whereas when Roger gets back to his place, he opens a bag of Doritos, turns on the tv, and immediately becomes deeply involved in a rerun of a tennis match between two Czechoslovakians he never heard of. A tiny voice in the far recesses of his mind tells him that something major was going on back there in the car, but he is pretty sure there is no way he would ever understand what, and so he figures it's better if he doesn't think about it. (This is also Roger's policy regarding world hunger.)

The next day Elaine will call her closest friend, or perhaps two of them, and they will talk about this situation for six straight hours. In painstaking detail, they will analyze everything she said and everything he said, going over it time-and-time again, exploring every word, expression, and gesture for nuances of meaning, considering every possible ramification. They will continue to discuss this subject, off and on, for weeks, maybe months, never reaching any definite conclusions, but never getting bored with it, either.

Meanwhile, Roger, while playing racquetball one day with a mutual friend of his and Elaine's, will pause just before serving, frown, and say ''Norm, did Elaine ever own a horse?''

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We have million-and-one meditation stories. These are perhaps good entree's to further stories. If you have been trying to meditate, either just beginning or for a long time, you will identify with these.

There is nothing like a meditation session to make you really aware of what the hell your mind is saying to you. The mind can be a tricky customer and we need to be on our game much of the time to catch it in the middle of a huge mind trip.

Doris was attending the first session of a meditation class. She felt this was the way to go, but still had some reservations about this thing called meditation. After the instructions on how to meditate had been given, everyone settled back into a comfortable position to try it out.

The instructor had been specific about letting go of thoughts. "What does that mean," thought Doris. The music began and Doris started out quite well, bringing her mind back to her breath ... in ... out ... in ... out. All of a sudden a thought flashed through her mind: "What if I'm the only one doing this? What if they are all sitting there watching me? I'm making a fool out of myself."

She suddenly felt a wave of self-consciousness move through her body. Every part of her body seemed to tingle from the gaze of a room full of people looking at her, and probably laughing at her, behind their hands. She fought the urge to open her eyes to check out this thought. So it was for 15 minutes. She sat fighting every urge in her body to open her eyes.

When the meditation session was over, the instructor went around the room checking everybody's meditation. Everybody had apparently been meditating (or trying to). The instructor beamed at Doris when she disclosed how "well" she had meditated. "Ahhh!" said the instructor. "This is good. Now you truly see how powerful the mind is. The thought was totally wrong, no one was looking at you, but you gave the thought the power. You believed it and so your body reacted to the thought until you actually felt the gaze of others eyes on you. The mind created the whole thing. Now, can you see it is the same case with your Anxiety Disorder thoughts? You give them the power."

Doris did see this, from experience now. "That's amazing" she thought "and I thought I had a terrible meditation." The mind will tell you anything!!!

Meditation can work

Personally, I had disliked meditation initially. Hated it!!! My perception of meditation has changed completely. Over the years, I have personally seen some truly wonderful things with regards to meditation. One example which sticks in my mind is the lady in her 80's. She had experienced Panic Disorder for close to 60 years in silence and isolation. Her face bore the brunt of this weight. You could actually she the burden she carried and the suffering she must have endured.

During the break in one of the Anxiety Management programs, she came up rather timidly and asked whether it was possible for her to recover. Absolutely, I informed her, it is never too late. In fact, I had seen a lady much like her (age and length of experiencing Panic Disorder) recover totally and was now free from panic and anxiety. She smiled at me uncertainly. She related that the doctors had told her for 60 years she would never recover. Never! I told her "That is no longer true."

We headed back into the seminar room to continue the program. Meditation was the next port-of-call. After much instruction on how to meditate, the lights were dimmed and my favorite Pachelbel Canon C was played for background music. For twenty minutes everyone in the room meditated. I quietly sat in the corner watching in case someone needed me. I saw the old lady. As time passed in meditation, I visibly saw the weight of the world lift from her face. Her face became peaceful. The lines on her face softened. I felt tears fall down my face. At the end of the 20 minutes I checked everyone's meditation. Some good, some bad. All the lady could do is beam at me, her face soft and peaceful and almost seemed to be glowing. Her burden was lifted and SHE knew now that she could recover too.

Even now, as I think of her, wishing with all my heart for her, I feel tears fall down my face. Meditation works in so many ways that I can't even begin to explain.

It was her second-time meditating with a group and June felt she knew what to expect. The first meditation was "good" and she understood the concept of letting go of a thought. The music began and she settled into her focus word. She felt feelings of peace and relaxation descend on her. She felt openness and her body seemed to melt away as the tense muscles totally loosened.

Very quickly, the peace and calm deepened dramatically. She felt as if she was dropping very quickly into deeper -and-deeper states of meditation. She instantly tensed to stop the descent. At that point, she had a panic attack. Contrary, you would imagine, to the supposed purpose of meditation.

The story continues later as she was sharing this story with the group - the ending is not as you would have imagined. June had the attack, and when it was over brought herself out of the meditation and just sat there till the end of the 20 minutes. Everyone in the group her horrified, the worst thing they could have imagined had happened. June, though, said that the experience was not a "bad" experience because when she was in the meditative state she was letting go. The panic attack was upon her, but she still just let it go. It was over in 2-3 seconds, she reported. Smiling broadly, she ended "Usually my panic attacks last for hours. Now I understand what they mean by letting the panic attack happen. I did and it was gone before I knew it. Still damn scary but gone."

Thoughts control reactions

Tara sat for her first meditation session with a group of first-time meditators. Tara decided before the meditation began that the music would be her focus. Easy enough, she thought, I love music. The meditation session commenced.

Initially, Tara could see through the thoughts that passed, one after the other, through her mind. She gently brought her awareness back to the music. Different thoughts arose to distract her: "What will I do after this is finished? I must get the shopping done before the crowds start. Rotten Bill, he never helps me do anything, he just expects. Maybe the music isn't the best focus. What about using a word or breath?"

Each of these thoughts she successfully let go of and returned to the music. Until ... "I don't like this music." Instantly she bought into it. She tensed up and her mind became rigid. "That's right," flowed the thought process. "This is useless. I'd be better going home and using my own music".

Tara was caught in this thinking process for awhile, getting angry at the instructor for not choosing a better piece of music, feeling agitated for not being able to leave NOW. Suddenly, a lightning bolt of awareness shot through her. "Didn't the instructor say the mind will tell you anything? Isn't I don't like this music" just a thought too?"

She returned her focus back to the music. Resolving it didn't matter- if she liked the music or not-it was just a focus after all. By the end of the meditation session, she reported later, she actually liked the music and found it easy to meditate to. She learned the number one lesson - thoughts control reactions and perception. If a thought says "I don't like .." and if you buy into it ... then you don't like.

Just rubbish?

Joe was a man in his 60's and had developed the disorder after he had retired. He was the first to admit he had pushed himself all his working life and now was reaping the revenge. He was also a man who had tried every thing he could. Most of the time, he was led down paths that just didn't help one bit. To say he was sceptical about any treatment for Anxiety Disorders would be an understatement.

His wife, Elizabeth, dearly wished for him to get well. She saw an advertisement for an Anxiety Disorder Management program and had signed them up for it without consulting Joe. He came along only to please her. He had little faith in anything working at this stage. Every word, every sentence that facilitator said he would doubt and question. Then came the meditation session. "Total rubbish!" he exclaimed openly. "Just try it," assured the facilitator. "Just do it as an experiment. Then judge."

The 20 -minutes were over and Joe said not a word. Everyone left for the day. The second day of the workshop, the facilitator was surprised to see Joe and his wife Elizabeth turn up again. At the break Elizabeth pulled the facilitator aside. "Thank you, thank you" she said, holding back the tears. "Yesterday, as soon as we got home, Joe went straight into his study and closed the door without saying a word. I heard that Pachelbel music being played and he came out after half an hour. He loves it. That meditation changed him. Usually he can't sleep, but last night he did. I think he finally feels he has found something."

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Yes, there are some "not very good" therapists out there. And yes, there are very good therapists out there for people with an Anxiety Disorder. Here are some true stories. Remember, your recovery is the Number One Priority.

Annie recounted the following tale:

She was referred to a Psychiatrist who was working out of her own home in Annie's local area. This psychiatrist had cleaners come into her home at certain times of the day. The first session with this psychiatrist was hard to assess, commented Annie. "I couldn't hear a thing which was said because of the constant droning of the vacuum cleaners around us. Also the cleaners would walk through the room whenever they felt and so there was no privacy."

Believing she should give this therapist a second chance, she booked in for a session that was earlier, thinking she would avoid the cleaners this time. Annie turned up early and was told by the household help to sit on the back steps until the therapist was ready for her. Sitting there, she became aware that she could hear every word being said inside. The therapist was with a young man who was obviously having some major emotional problems. Annie shifted position in embarrassment. She was left waiting for an extra half-an-hour until finally the young man left.

The psychiatrist emerged from the house, greeting Annie with "I should be back in half-an-hour, I've just got to run down to the travel agent." Annie was left dumbfounded. What did she do? ... wait or leave?

Yes, she left. A couple of days later, she received a note from the therapist. The note read "Sorry I missed you, hope you are feeling fine." As Annie said later, What a gall of this person?! It was just lucky I wasn't feeling suicidal!!

And then there was...

A young lady goes to her therapist for her normal weekly one-hour session. She has been going for quite some time and is feeling frustrated by her lack of progress. Usually the therapist is late and leaves her waiting for up to 20 minutes.

Finally, she enters the room, the therapist poised behind his big leather desk. Just as she starts to address the issues for this week, he jumps up and tells her to hold that thought. He just had to dash out and talk to a colleague for a minute. Forty-five minutes later, he returned to the room as if nothing had happened. In recounting the story, the lady wondered whether he did it deliberately to test her. What the test was, she didn't know. What do you think?

Waiting for the "best"

Rebecca had 6 months on the waiting-list before she saw a reputedly terrific Psychiatrist. At last, the day came for her appointment. She was kept waiting 2-hours before being ushered into the room. The psychiatrist's initial questions revolved around what she had been experiencing. Then he asked what she was fearful of.

"What do you mean?" she asked.

"Well, you are fearful of something aren't you?" replied the psychiatrist.

"Sure" Rebecca replied "these god damn panic attacks. That's what I've been telling you."

"No, no .." continued the psychiatrist. "There must be something that you are scared of .. elevators, dogs, spiders."

"Well, I guess when I was a kid I was scared of spiders, but I don't see what that has to do with the panic attacks .."

"Great" said the psychiatrist "now we are getting somewhere."

That was the end of the session and so an appointment was set for the next week. Rebecca felt she needed the help, so returned promptly on time for the next appointment. This time she only had to wait 45-minutes. When she entered the consulting room, she noticed a jar of spiders sitting on the desk. The psychiatrist told her for this session she would sit and watch the spiders until her fear of them was alleviated. She would sit at a distance and then get closer-and-closer. He left the room, leaving her to contemplate what this would do to help with the panic attacks she experienced--even when not one spider was in sight. At the end of the session (of course, she couldn't leave early, it would appear rude) she got up and never went back.

Sometimes we are our own worst enemies though...

Paul had the wrong idea about what therapy was for. He, in effect, became the "perfect" patient. Every session, he came back and told the doctor how much better he was getting. He talked in glowing terms about how much the doctor had helped him. In actual reality, he was getting worse. Eventually the therapist had no other option but to release Paul from treatment, congratulate him and to let him go. Paul had no other recourse but to go - how could he tell the therapist the truth now.

Meg had her first appointment with a Psychiatrist. She worried about what he would say about her. Before she went, she tried to calm herself and was poised, cool and collected. She entered the consulting room and sat "relaxed" and spoke in terms that diminished her actual experience. At the end Meg asked the psychiatrist: "Do you think I am having a nervous breakdown?"

He looked over his spectacles at her and replied: "I don't think so ..."

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Self issues can play a very big role in recovery. Hopefully you may be able to identify how some of these self issues held back and increased people's anxiety and delayed recovery. Much of our work involves educating people about healthy ways to deal with the stresses that come along. Sometimes, we are not aware of how these issues are effecting us on all levels.

For example, this lady had for many years avoided going into the supermarket for fear of having a panic attack. Usually, she sent her husband or daughter in to get the groceries. She felt a great deal of guilt about this but couldn't seem to break the cycle (or wall) that prevented her from going in.

On this day she was in a rush. Many things to do, with so little time to do them all. She parked her car and sent her teenage daughter in to get the necessities. She sat and sat .. waiting not so patiently for her daughter to return. Little did she know that her daughter's latest infatuation was with the boy in the fresh produce section of the supermarket. She had forgotten the time as she chatted and flirted with him. Finally, in a burst of shear anger, the mother got out of the car, slammed the door and marched right into the supermarket, grabbed her shocked daughter and promptly paid for the groceries.

It wasn't until she was back in the car that she realized what she had actually done. One point for anger, zero points for the fear cycle. Needless to say, the thing she feared for so long had not happened--and a huge dent was visibly seen in the cycle of fear.

Extremely Sensitive to Others

Patricia was suffering terribly from the increasing cycles of an Anxiety Disorder. Sometimes she thought it was divine retribution for something she might have done in the past - she basically felt she deserved it. She should be kinder, more giving, more compassionate, more everything. One day her friends turned up with an urgent request. Can we borrow your car, they asked. How could she say no, she wondered. They need it and if I say no I would be so selfish. So the car was theirs to use. A couple of days later the "friends" returned the car. Apparently they had an accident in it. They rear ended another car. These "friends" hadn't even bothered to tell her when it happened. They didn't even bother to tell her when they returned the car.

Nothing like a couple of hundred dollars repair bill to increase the suffering. The story didn't end there. A month or two passed and in the mail came an urgent request to pay a parking ticket. Obviously the "friends" had neglected to mention this also. Patricia thought to herself, "How can I ask them to pay for this? It is my car after all." And so the cycle rolled on.

One noted characteristic of people with an Anxiety Disorder is they are incredibly sensitive individuals. Not that everyone else isn't. Klara was very sensitive to other people's opinions. She was also sensitive to what she said to others. If she spoke to someone on the phone, she was intensely alert to even the inflection in her voice. After a phone call her mind would go over-and-over the whole conversation. What she said, how she said it, whether it was appropriate, whether she had displayed the appropriate emotions.

Usually she would find something she said which might have been misconstrued by the other person. After a huge debate within herself, Klara would end up calling the person back and apologizing for saying "hello" the wrong way, or apologising for something said inappropriately, or for not being sensitive enough to the other person's dilemma. The other person had no idea what she was talking about. They would then try to assuage her fears that she had said anything wrong at all. It went round-and-round in circles. So for every phone call, there would be multiple call backs.

Positive Thinking

Many people think positive thinking is all that's needed to stop the anxiety thoughts. Bob had read a "terrific" book on positive thinking and it made sense to him at the time.

Every morning he awoke to the "same" feelings of overwhelming anxiety but pushed through this to stand in front of the mirror to repeat the positive affirmations. "I am a wonderful person," he recited. "Today will be a good day. I am going to be happy. Today is a new start. Today is the beginning of the rest of my life. I am me and that is just fine."

Having finished this exercise, he stepped into the shower to 'freshen and cleanse' his body and mind. As the water gently cleansed his body, his mind had other ideas. "You know that what you just said was a load of rubbish. You won't be happy. You haven't been for the last few years. It's not going to be a good day. You've got to go to work and you feel lousy."

As every thought passed, he started to feel worse. He tried to combat the negative thoughts with the positive thoughts; but the more he fought, the more power he gave into the negative thoughts. In the end he had an anxiety attack and headed out to work. He repeated this process for months, never giving up because he had faith in positive thinking. In the end he realized that positive thinking wasn't for him and started learning the technique of just letting his thoughts go - regardless.

Recovery

We often say in the recovery process that a "setback" is inevitable. Many times we will ask: "Are you meditating?" or "Are you working with your thinking?" The other question we ask is: "What is happening in your life right now?"

Such was the case for a young lady who was perplexed by her current setback. She was meditating and she was, she thought, working with her thinking. So what was happening in her life. "Oh nothing," she replied. "Everything is fine, nothing that I shouldn't be able to handle."

After a little talking, she disclosed her husband was just about to lose his job with no new source of income on the horizon. She couldn't work because she was in her recovery process but her husband didn't seem to understand this. They already lived on a tight budget and they had missed a few home mortgage payments, so the bank was "breathing down their necks". Her teenage son had recently discovered his rebellious streak and was in trouble with the police and her youngest daughter had contracted some strange virus. "Nothing really happening" she finished off, "I should be able to handle it."

There are not even many super heroes I know of that could handle this load of stress. She couldn't see it initially, but after some talking her fears and worry surfaced. This was the cause of the setback. Sometimes we are blind even to our own feelings.

Meditation

Fred was in his sixties and had experienced panic attacks for many years. Finally he found a solution - meditation. He loved it. From the first time he meditated, he felt peace and relaxed. For weeks he flew. Not one panic attack. His face glowed with his new found freedom.

One day, however, the panic attacks came back and it hit him very hard. Why, why? He was still meditating. Why? It seems Fred had a soft heart and had offered to ferry an acquaintance of his into town everyday. They lived 50km from town. He also had to wait 2 hours while the person finished their business before returning. It was taking it's toll on him.

When asked whether he really wanted to keep doing this, his only reply was that he was concerned for the person "How would they get into town without him taking them?" Are they an adult? "Yes," was the reply. Then it is their responsibility, not his. After awhile Fred admitted he hated it now and felt used. Initially, it was from the heart that he offered, but now it was getting a bit long in the tooth. His mind was filled with anger as he waited those 2 hours in town everyday. What should he do?

Robert was your average middle age guy. He had worked for 20 years at the same job. He worked hard too. He played the corporate game well. However he was starting to feel the effects of this. He noted that his fuse was getting shorter and would generally snap at his wife for no reason at all. He also noted that his concentration was fading and he felt "stressed out" much of the time. Strange feelings used to consume his body. The most disconcerting for him, however, was the chest pain. He felt it much of the time. He was, he knew, in the danger zone for major heart troubles. He feared he was going to have a heart attack. The more he worried about it the greater the chest pain - proof enough for Robert.

After much procrastination, he went to the doctor, fearing the worst. The doctor gave him a full examination with all the appropriate tests. The doctor gave the verdict. There was nothing wrong with his heart. He was the perfect specimen of health. Robert quizzed the doctor about this chest pain and it's severity - after all, he wanted answers. The doctor's only reply was that he felt Robert was stressed and needed to relax a little - perhaps take a vacation.

This, of course, answered none of Roberts concerns. Over the ensuing weeks, his anxiety levels increased off the scale. His major fear - he was going to have a heart attack-he had all the symptoms. Repeatedly he went back to the doctor. Nothing wrong with your heart. Why the chest pain? The doctor told him straight out, you are not going to have a heart attack. Robert needed to understand why he was experiencing all these symptoms and didn't get the answer. He later said, after many years of experiencing an Anxiety Disorder, if only the doctors had answered that initial question, the major fear "What if I am going to have a heart attack" would not have taken root.

Recovered?

Harold was well on the way to recovery from Panic Disorder. He was confused, however, as to why he was feeling anger almost all of the time. He wanted to know how he could get rid of it. Surely something is wrong. Every time he felt anger, he would push it away, hold it down, hold his breath - anything but feel it. Every time he did this, the anxiety levels would rise and he had to work extra hard with his thinking and meditation. He felt that it was a barrier to his ultimate recovery.

He was right. Something was wrong, and it was his perception of anger - that it was a "bad" thing. It was explained to him that this anger was very appropriate. All the years of suffering, shame, fear, the decline of his standard of life, the marriage problems that had been caused by this Anxiety Disorder. Didn't he have a lot to be angry about? It was the final healing. The final acknowledgement of all of this. He no longer battled with his anger but acknowledged it as having a right to be there and to be acknowledged and worked with.

next: Are Hormones and Panic Attacks Related?
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BACKGROUND

The main psychoactive ingredient of marijuana in any form is delta 9 tetrahydrocannabinol, shortened to THC. Cannabinoids act on a specific receptor that is widely distributed in the brain regions involved in cognition, memory reward, pain perception, and motor coordination.

WHAT HAPPENS

A lot depends upon the user's mental state before smoking, the environment and the user's expectations. Marijuana causes perceptual changes which make the user more aware of other peoples' feelings, enhance the enjoyment of music and give a general feeling of euphoria. It can also make the user feel agitated if they are in a situation which is not pleasant - if they are with strangers or trying to hide the fact that they are using - which is often referred to as a paranoia. Using marijuana with other drugs, such as alcohol, can make the user feel dizzy and disoriented.

Marijuana causes a number of physical changes. It can produce an increased pulse rate, a decrease in blood pressure, an opening of the airway leading to the lungs and suppression of the vomit reflex. It can also produce bloodshot eyes, dry mouth, dizziness and an increased appetite. Sometimes short term memory loss can occur, although this passes as the effects of the drug wear off.

ACUTE EFFECTS OF MARIJUANA

Marijuana produces euphoria and relaxation, perceptual alterations, time distortion, and the intensification of ordinary sensory experiences, such as eating, watching films, and listening to music. When used in a social setting, it may produce infectious laughter and talkativeness. Short-term memory and attention, motor skills, reaction time, and skilled activities are impaired.

The most common unpleasant side-effects of occasional marijuana use are anxiety and panic reactions. These effects may be reported by users, and they are a common reason for discontinuation of use; more experienced users may occasionally report these effects after receiving a much larger than usual dose of THC.

Marijuana smoking or ingestion of THC increases the heart rate by 20-50% within a few minutes to a quarter-of-an-hour; this effect lasts for up to 3 hours. Blood pressure is increased while the person is sitting, and decreased while standing.

SUMMARY OF ADVERSE EFFECTS OF MARIJUANA

Acute effects

• Anxiety and panic.
• Impaired attention, memory, and psychomotor performance while intoxicated.
• Possibly an increased risk of accident if a person drives a motor vehicle while intoxicated with cannabis, especially if cannabis is used with alcohol.
• Increased risk of psychotic symptoms among those who are vulnerable because of personal or family history of psychosis.

Depressive Reactions

In novice marijuana users, rarely in regular users, marijuana may precipitate reactive or neurotic depressions.

Panic Reactions

The majority of all adverse responses to marijuana are panic reactions in which people begin to fear that they are dying or losing their minds. Panic reactions, or "bad trips", may become so severe as to be incapacitating. Smith (1981) reports that roughly 50% of marijuana smokers in the United States have on some occasion experienced this adverse reaction.

Cognitive effects

The longer marijuana has been used, the more pronounced the cognitive impairment.

Anxiety Reactions

The most common disturbing reaction to marijuana is acute anxiety. The user becomes fearful of dying or going insane. Mounting anxiety may lead to panic. The reaction is not a psychosis; there are no hallucinations. The anxiety reaction or delusional disorder is a milder version of the frightening LSD experience known as a bad trip. A truly nightmarish experience is rare under the influence of marijuana, because it is less potent than hallucinogenic or psychedelic drugs and the user is better able to control its effects.

Use of LSD and other psychedelic drugs is often followed by flashbacks - the recurrence of emotions and perceptions originally experienced under the influence of the drug. They usually last only a few seconds and are not necessarily disturbing, but sometimes they become a persistent problem, which has been labeled post-hallucinogen perception disorder. Marijuana smoking may precipitate flashbacks in psychedelic drug users. A few reports suggest that marijuana flashbacks also occur without the previous use of psychedelic drugs.

Read some of the comments from people who have had experiences with marijuana and anxiety

Comment: Hi, I've had panic attacks for more than 1.5 years now. Fortunately, I can now control the attacks and am aware that "I am not going to have a heart attack"

Approximately twelve acquaintances of mine have since discussed, through different conversations, evidence of having panic attacks. Speeding heart beat, panic, going to hospital, etc. EVERY SINGLE ONE OF THEM HAD THEIR FIRST ATTACK while consuming marijuana, including me. About half of them, including me, were heavy smokers (minimum 1 joint/day).

Also, I saw a small TV report about a year ago where a medical doctor (psy.) says that he's encountered more-and-more adolescents coming to see him about anxiety disorders. The TV report's subject was about high levels of THC in Canadian cannabis plants. He seemed to state that there was a link. I am not a doctor, I am an engineer and am ABSOLUTELY POSITIVE that there is a link between THC levels in cannabis and Panic Attacks. Ever since my first panic attack, I have completely stopped smoking pot! Most of the many acquaintances that I know that also smoked pot have also stooped.

I am available for any further discussions on this subject. The amount of people I know (that I have known for many, many years) who also now have panic attacks is astounding. There should be a lot more studies on this matter. A person who has had panic attacks is the only one who knows how scary and devastating an attack is!!!

Comment: I was reading the information at your website and decided I would write you regarding some questions I have. As a teenager, I experimented with LSD and PCP a couple of times. About a week after taking a half dose of LSD, I was getting high on pot when suddenly I felt as if I was tripping on LSD again.

This frightened me very much and I quickly developed a panic disorder problem. I thought I was doomed to a life where I would never be "normal" again. I got help by learning T.M. (transcendental meditation). This helped me to control the panic, but I never really got over the belief that I was somehow not like everybody else. I felt I was somehow different, that my mind had been permanently changed because of the use of these drugs.

I'm in my thirties now, and over the years I had two-or-three episodes where I've developed panic disorder again. It usually lasts a couple of months and then goes away. The latest bout started this past November. I purchased a book about help for panic attacks and it has been a big help. But my question still remains - have other users of LSD, PCP and pot had these same problems? How have they gotten over them? Is there a group on the internet of people with similar backgrounds? I'm interested in talking with others who have passed through similar experiences.

Comment: I first experienced panic when I was 17 after having marijuana. It was so extreme, the word panic doesn't seem strong enough. It was more like absolute terror. I am now forty, and in recent years depression has also been a problem for me. I have tried most of the antidepressants but I just can't seem to tolerate them, even at a very small dose like a quarter of a tablet. They make me feel more anxious and susceptible to panic.

I know I get quite apprehensive about taking them, but I feel that it is more than psychological. I remember taking moclobomide which is supposed to be non-drowsy and falling asleep for 6-hours in the middle of the day. A half a tablet of tolvon put me in bed for 24-hours. A full tablet of Prothiaden brought on a panic attack. Aropax made me feel drowsy and disconnected with things.

I have been in a support group and never known anyone else to have such weird reactions to drugs. In recent years, I have found even antibiotics make me feel more depressed and anxious. I don't experience full blown panic very often, but when I do it seems to be extreme. To say to myself "don't worry it is only a panic attack" seems ludicrous. It would be like the fear of someone holding a gun to your head and really thinking they were going to shoot. That's what it feels like.

I really feel like a freak of nature. Can you explain to me what's happening? Do other people have these kinds of reactions?

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