Friday, January 8, 2010

Coping With Panic and Anxiety Attacks

I have had panic and anxiety disorder since 1984. I’ve been to the depths of the
blackest pits and recovered, only to find
myself back in the darkness of despair. I’ve been through this cycle several times
and am, today, well and confident; fully recovered forever and free of the
bewildering and crippling events that held me captive for so many years.

I hope I can be of some assistance to you, in that my experience with ill
health has encompassed panic, anxiety, and depression. Although I have not
been treated specifically for depression, the medication I had taken since 1993
is an anti-depressant with the handy side-effect of blocking panic attacks. But I
have also had many of the symptoms commonly associated with Clinical Depression, and in this short dissertation you may find me using the terms depression and anxiety interchangeably. Furthermore, Dr. Claire Weeks, whose books and tapes saved me much anguish, groups anxiety, panic, depression, and obsession under the single heading “nervous illness”, and treated them all in the same way during her lifetime. Her books can still be found although she passed away in 1986. Her methods held particular credibility for me since she, herself, suffered from these things, and did not base her findings strictly on the impersonal point of view of a laboratory researcher.

My wish here is to provide you with, hopefully, some peace of mind over the
state you may find yourself in. I am not a therapist or doctor, but
I myself often found that hearing from someone who had suffered as I had
brought a semblance of relief, however temporary, from the otherwise dismal
state I found myself in. In other words, knowing others have been there and
recovered offers hope. I don’t know whether or not you are being well cared for by the medical community, friends, or family. Perhaps you’re discouraged by the approach of these people. None of this need hinder you. Whatever state you
find yourself in, I am happy to add a few words of my own. But first let me
stress that you should be examined by a doctor to rule out all possible sources
of your illness.

Because these “nervous illnesses” do not come with visible scars, bandages, or
plaster casts, we tend to suffer alone. The massive void that seems to grow from
the inside and consume our whole being is unseen to those we are in contact with. They may sympathize but they will never truly understand what depths it’s possible to descend to. “How could this happen to him? He was always so cheerful!” They don’t realize that depression and anxiety generally have little to do with that part of your personality. Their well meaning words often do more to hurt than help. There may be those who, through some macabre sense of duty, try to equate your condition with some personal failing. I knew a girl in a neighboring city who, when facing a similar health crisis was given the “helpful” advice from her pastor, “Get your spiritual house in order!” Such thoughtlessness can be devastating to the sufferer looking for even the smallest grain of encouragement. It’s important that you not flog yourself with that same approach. This is definitely NOT your fault. If you’ve been given a clean bill of health, yet continue to suffer from “nerves”, then you can recover on your own.

I will briefly describe the state I found myself in. In 1984 my wife and I
vacationed in Southern California, her childhood home. I’m not a traveler and
went reluctantly, being quite apprehensive about everything from my first air flight to spending 2 weeks away from home in a foreign country. Our one-year-old son was with us. I worried about anything and everything going wrong. At about the mid-point of the holiday, I found myself feeling odd; lightheaded, dizzy, off balance. I also seemed to have broken out in a skin rash. I was fearful of becoming ill so far from home. These symptoms went on for a few days but vanished when we returned home. I felt better but I never forgot those feelings of disorientation and watched uneasily for their return.

Within a year they were back, fueled by my fear of them and undiagnosed by my doctor at the time as being anything more than “tension”. Of course he was right but I was not prepared to discover just how powerful tension can be, and how devastating. In addition to the disorienting feelings I soon developed shortness of breath, rapid and irregular heart beat, trembling; I perspired all day, felt pressure in my head, had an odd crawly-itchy feeling under my skin, blurred vision, felt like I was about to black out, insomnia, weakness in the legs, and the list can go on and on. As the years went by the symptoms worsened. I became phobic about going anywhere in public. I began to associate these attacks with the places where I tended to have them, and began to avoid more and more public exposure. The worst aspect was the fact that I had no
idea what was going on with my body. I was both bewildered and terror stricken, convinced that something was dreadfully wrong with me.

I was given a valium-like drug which helped, but my doctor didn’t really
know how to guide me out of the pit I was rapidly descending into. By 1993 I was virtually housebound, afraid to go to work, afraid to go to the store, afraid to drive, afraid to walk to the corner mailbox by myself. I was suicidal and in complete despair. I was taking tranquilizers all day, exceeding the maximum dose, but with little benefit. Only when my regular doctor went on holiday and I was forced to see someone else did I find, after 9 years, what was really wrong with me. For the first time I found someone who put a name to what I was describing: Panic and Anxiety Disorder. Not only that, he knew exactly where to send me and what I had to do. This brought enormous relief, all by itself. Finally, here was someone who’d seen this before, and who provided some hope and some answers.

To begin with, I found encouragement simply in the way my illness was
described. I don’t like the word “depression”. By its very nature, the word indicates a downward spiral, a whirlpool of circumstance we find impossible to escape, constantly swimming against the current. Try thinking of your state, rather, as one of “depletion”. Your reserves of emotional and mental energy (and, indeed, physical energy) can become so depleted that you find yourself unable to so much as feel anything; not anger, not despair, certainly not joy. It can be as though we have been somehow detached from all our senses and are now trapped in an emotional vacuum. You don’t care about anything; you can’t bring yourself to attempt even the smallest tasks. Nothing matters or is worth the attempt. You’re not even interested in looking at your surroundings. The simple decision of what to make for dinner can be beyond you. Even getting out of bed can take tremendous effort. But the word depletion offers hope of replenishment.

Our bodies are a marvel of design. They are constantly trying to heal themselves. You can fall and scrape your knee over and over, day after day in the same place, but the next day there will always be a new layer of tissue attempting to heal over the spot. Our nerves are no different. They can and will heal. But they can become so sensitive during nervous illness that the slightest stimulus can be extremely irritating. Ordinary sounds can be unbearable, the sunshine too bright, the voice of a loved one irritating and nearly meaningless. Or we become totally unreceptive. We can’t answer questions of the simplest kind. Our minds seem to be stuck in a quagmire, unable to move or
escape. Where thoughts normally flit from one to another quickly and easily, they now seem stalled, backed up, overwhelming us with frustration and confusion. We may not even have the energy to cry. It’s natural to withdraw in the face of this onslaught, and we feel this is our only recourse. Not only that but time now seems to drag by. Where normally we breeze through a days tasks, hardly giving a thought to the fleeting time, now we find ourselves diligently watching the time, waiting for the relief that never seems to come. This provides a fertile environment for a multitude of phobias.

I have painted a pretty bleak picture, but only to provide you with a sense that I have an idea of what it has possibly been like for you. If you are particularly sensitive at this juncture, the mere suggestion of these things may make you feel even worse. Never fear this. Suggestibility was so strong in me at times that I couldn’t even look at a photograph of a busy street or crowded mall, I was so fearful of them. But I have descended to the depths in order for you to know that I have been where you are. I know the way out, and although my illness may technically be somewhat different from your own, after all no two of us are exactly alike, the same attitudes can assist in recovery. I do not pretend to offer a magic cure, but there are ways of facing nervous illness that make enduring it much more bearable. As well, I hope I can offer you some relief from the fear that recovery has become unreachable, or that it will never be complete.

The first thing I had to learn was just to accept the state I was in. This takes
courage and it did not come easily to me. Despair in such circumstances is natural, but to utterly despair works against our body’s natural working toward replenishment. So despair, yes, how could you not, but try to picture just a little, just for a moment a few times each day, that recovery can be within our grasp, no matter how long or how seriously we have been ill. If medication is part of your regimen, take it willingly, not grudgingly. Accept the fact that you may not feel much better for some time. Accept the days that feel like a step backward in recovery, there will be plenty of those. Never be afraid to make an attempt toward accomplishing normal tasks. Physical exertion may seem impossible, but it won’t hamper or harm the road to recovery. Lying around brooding does nothing good for our state of mind.

Dr. Weekes always preferred that her patients over-do things than under-do
them. She once told a patient who had been lying around the house for months
to get up and paint his house. “But I’d have to force myself, Doctor”. Of course
he would, but becoming active again is one of the greatest therapies. Taking
ourselves outside of our introspective minds is the healthiest thing to do. Accept
the fact that there may not be much joy in living when we’re in the worst of our
illness. Never count the days, the weeks, or the months, that you may spend
recovering, no matter how often you must travel that road. Allowing time to pass is difficult, but essential. Don’t fear setbacks before they even happen. Accept that there may be some, possibly many, but each is an opportunity to learn about ourselves. A setback, when viewed as an opportunity to practice coping, can be a positive thing. I realize that you may not be able to visualize that at all right now.

The second thing, closely related to the first, is to face the problem squarely in the eye. Don’t fight the symptoms or try to hide from them. You’ll never win that battle anyway. Rather, try to relax toward them. What I mean by that is: you may find yourself unable to relax much physically at this point, but you can relax your attitude. Try to get your mind on something else, even if only for a short time. Pull some weeds in the garden, sketch a scene with a pencil (even if you can’t draw), phone a friend and ask how they are, read something you used to enjoy. The goal here is to occupy your mind with something other than the way you feel; to become interested in something other than yourself. Don’t mistake this for attempting to just not think about it, or to block the feelings from your mind. Trying hard not to think of something is the best way to bring it right into the spotlight.

This can be difficult to understand but, once you’re able to grasp it, can also take a huge load off your mind. Yes, it’s unpleasant, nobody would want this, but hiding from ourselves only prolongs the road toward recovery. We can’t run from illness of any kind. “Getting a grip on ourselves” is absolutely the worst thing we can do. What we, the nervously ill, need to do is take the grip off ourselves. Worry and tension are the fuel of nervous illness. They are the scrape on the knee that continually re-opens the wound, putting off the healing process.

These two things, facing and accepting, are basically simple assignments. But never confuse simple with easy. It is not easy to accept your state when
overwhelmed with despair. It’s not easy to face your symptoms when they urge you to give up on everything you hold dear. It’s not easy to ‘relax toward the illness’ when our thoughts are racing, head is swimming, legs have turned to jelly, and panic is rising. No, it’s not easy, but it is possible. And it takes practice. Like any acquired skill, facing and accepting an illness like panic/anxiety, can take a long time to master. We find ourselves doing well one day, and back in turmoil the next. Accept even this. Don’t fear the return of symptoms, possibly years after you thought them gone forever. Always deal with them the same way. Face and accept, and allow as much time to pass as needed. The less alarm we add to the situation, the milder the episode will be. Panic attacks always pass. They may seem to last forever but they
don’t, and they can’t; it’s physically impossible for them to do anything but eventually subside. Your body cannot continue to create the adrenalin necessary for sustained panic. It will always pass. There is a state known as “generalized anxiety” where the body seems always on the edge, and this brings us to the next great coping mechanism.

This is something that takes most people by surprise. One of the prime contributors to constant sensations of anxiety is improper breathing. Yes, breathing is supposed to be one of the most natural things we do without having to think about it. But some of us can’t seem to get the hang of it. When the word ‘hyperventilate’ is mentioned, the first thing that comes to mind is a breath line that is extremely rapid. But it can come about because of too little air as well. And the symptoms of anxiety and panic can be duplicated exactly when we starve our bodies of oxygen. According to the head of our local University’s department of psychiatry, it’s well known among therapists that the majority of people who suffer from anxiety problems are not breathing properly.

Here’s how an anxiety attack can result from shallow breathing; the sufferer
typically will notice some little quirk that they have recognized from the past as a pre-cursor to a bout of panic; a twitch, a tingling sensation, a light headed feeling. They stop what they are doing and begin to “listen in”, or examine what their body is up to. Invariably, they stop breathing entirely at this point as they wait for the symptoms to escalate, and then recoil in fear when they do.

The build up of carbon dioxide in the blood will give anyone the sensations of
tingling, dizziness, trembling, itchy-crawly feelings under the skin, and weak legs. At this point the sufferer may feel as though they are about to faint. Don’t be scared, you won’t. And even if you did, you would come around quickly as the unconscious body restores the breathing pattern (only to have us disrupt it again). This is part of a cycle that began when, for some reason, the person in question got into the habit of breathing in a shallow, rapid fashion, usually with their mouth open. This almost always means they are breathing with the top half of the lungs only, never getting a good exchange of air. The solution is simple; abdominal breathing. But like I mentioned previously, simple is not always easy, since long held habits can be very difficult to break. When abdominal breathing is done properly, it’s the tummy, not the chest alone, that expands and contracts. I should point out here, too, that when one becomes acutely aware of what’s supposed to be an automatic bodily function, we tend to overcompensate in one way or another, and continue to compound the problem. Fifteen years after I was taught these things, I still catch myself breathing in a shallow and rapid manner from time to time. And occasionally I still find myself holding my breath when I’m concentrating on some task. The light-headedness that results is a signal my body is giving me that it’s time to get some air. If I still feared that signal, a panic attack could result. Abdominal breathing takes practice and can replace your old habit so it comes automatically.

I am considered fully recovered from Panic and Anxiety Disorder. But this does not mean I never experience the old symptoms. It means I don’t meet the
symptoms with alarm, heightening their strength. It also means I simply no
longer care about the symptoms, and attach no importance to their presence.

It’s easy to go looking for symptoms. When sensitized as fearfully as I once
was, I found myself mentally examining my body with great scrutiny, all day long, terrified that I would find the beginnings of the sensations I so dreaded. And of course I found them. By all my anxious looking, I created most of them. I was not doing myself any favors with this attitude. It took me years to develop a more philosophical view of life. I just wanted to feel normal again. I wasted tremendous amounts of energy looking for WHY this had happened. What triggered this latest setback? Why me? I searched for details of what I had eaten, where I had been, what trauma might I have suffered? For me these things were not helpful. All I needed to do was face and accept (and breathe). Even medications can be defeated through incessant worry.

Today, I am thankful for what I went through. I am a much more patient and compassionate person and far less arrogant (what man can claim to be free of arrogance?). But even if we can’t see a reason, a purpose, or the growth it may
lend to our character, the road to recovery is always the same. The root cause of
any of the aspects of nervous illness can be many things: physical or emotional
trauma, exhaustion, childhood or spousal abuse, constant brooding, stress, a biological imbalance or prolonged illness. But finding the cause is not always necessary to begin recovery.

I took an anti-depressant drug every day for 13 years, and have a prescription tranquilizer to this day for fast relief in case of “emergency”. I seldom need the tranquilizer, but just knowing it’s within reach brings a comfort all its own. I have also gone months without any of the medications at all. However, the real cure is in my own mind. I was taught that medication should never be the sole resource for coping with nervous illness. And I was given a dose that would still allow me to experience the symptoms I would have to learn to cope with. Merely masking the symptoms teaches us nothing. Having to be on medication is NOT a sign of failure. Would a diabetic give up insulin to prove his faith? The majority of us are not that gifted.

I will mention here that I tried the whole gamut of herbal and vitamin therapies for years. I consulted with a massage therapist, a Master Herbalist, a Reflexologist, an Iridologist, and a Certified Nutritionist. However, my recovery did not begin until I finally submitted to my doctor’s wish that I try the anti-depressant, and read the recommended material. There were some annoying side effects for a few weeks, sweating, dry mouth, fatigue, but they gradually faded. I don’t mean to imply that naturopathy cannot be counted on. For many people it is has proven to be all they required. By itself it just didn’t work for me.

One final word about setbacks. Dr. Weekes always cautioned her patients to
expect them. Furthermore, in what I once felt was the worst news possible, she
liked it when they had them. Her view was that, since most nervously ill people will have to cope with this to some degree for the rest of their lives, the more often they have to work through it, the better they master how to do it. I have had many setbacks, sometimes feeling like I’m right back where I started, or even worse, but don’t be discouraged by that. Each time was an opportunity to practice coping correctly.

Today, a setback for me is an experience that may crop up unexpectedly, but is quickly dismissed as being of no importance. I don’t even need the tranquilizer in most cases. Relaxation exercises and proper breathing is generally all I have to do. There may be times when you feel a touch of the old feelings simply by being in a place or circumstance that triggers their memory. You don’t need to ‘stand guard’ against this happening. Once you’ve been through it successfully the first time, you’ll know you can always get through it again. And once more, I will reiterate that it took me many years to master this. Repeated failure is not ultimate failure. It’s not something you’ll ever welcome, but you will gradually gain the confidence that it can be managed effectively and completely.

This has been my experience. These are the things that have worked for me.
My goal in writing this has not been to take the place of your doctor or therapist. It is only to offer hope and encouragement through what happened to me and share the education I was given. I have been asked to speak at public
forums many times by the very professionals who worked with me in the worst of my illness. The message I have given in person at those meetings is the same one I have given here. I realize that my experience may not be something that everyone can draw from. But if you can take even a single phrase or idea from this, then it has been worth my time to write it.

Oh, and did I ever figure out the root cause of all my trouble? Yes. The main one is that I simply have an extremely sensitive nervous system. I feel everything more acutely than the rest of my family, both physically and emotionally. And ultimately I became afraid of the sensations my body kept feeding my brain. I tricked myself into believing that something must be seriously wrong with me. I also was eventually diagnosed with an under-active thyroid. This is why it’s so important to see a doctor and rule out every possibility before undertaking a self-help program. As well, I constantly brooded over the pressure of parenthood, especially when my kids were young; being a dad did not come naturally to me and was not something I looked forward to. All these things
worked together with a vivid imagination and took me on a terror ride I will never forget.

Always meet the symptoms the same way; face, accept, let time pass, and
breathe your way through them. Take the tension out of your muscles by letting
them relax, sag if you will, as best you can. And always, use the breathing technique.

edited, Feb, 2011. After being free of medication for 5 years I am back on a small dose of one. Life was managable but I was returning to the habit of "avoidance" behaviour in order to forestall unpleasant feelings of anxiety. It didn't dominate my life, but I have learned from the past that a break from an increase in syptoms, through prescription medication, can be the wise course to take, either short or long term. I in no way feel dismayed or defeated by this, nor should any sufferer. It won't be the last time and I cope by merely accepting that this is what I do when I need to.
Resource material:
-Peace From Nervous Suffering
-Hope and Help for Your Nerves
-More Help for Your Nerves
         all by Dr. Claire Weekes

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