Do Something

Psychology Today blogger Sarah Fader wrote a recent piece about what she does when paralyzed by anxiety. She advises making a list, an excellent suggestion for several reasons. Fader said she sometimes gets so overwhelmed by all the things she needs to get done in order to get on with, you know, life, that she developed a survival skill that allows her to go into total zone-out avoidance on the couch.

The very act of doing something – making a list was enough to get her into  a positive flow, according to her report. After that, she advises doing at least one thing on the list. List making will be an important tool for you to use in your recovery. Making lists accomplished several  things for me when I was plagued with panic attacks and anxiety: it allowed me to organize my thoughts; put things in perspective, and make goal setting more possible.

As Fader notes, the most important thing about making a list is that you are doing something, even if it’s only moving a pen around on paper. My experience is that once I got thought patterns moving in a good direction, I could keep the momentum by reinforcing and acknowledging what I was feeling. That understanding allowed me to move directly from the list to working on at least one thing. Your journal can become your place for all lists – except maybe shopping.


Keep it Simple

I’ve noted a phenomena common to many agoraphobic people I’ve connected with over the years. I’m trying to think of a nice name for it. What would you call it when someone exaggerates and distorts reality in order to make someone think something is way more complicated than it actually is? Practicing deceit is I guess what I used to do when explaining my craziness to someone who had never heard of agoraphobia before. And so have some of you, admit it.

Here’s the problem: we’re afraid of panic attacks. That’s all. It’s not like we’re delusional, or have a “”thought disorder” type of mental illness.  We’re not psychotic, but we are disabled because of this one very strong fear.  If your business partner or spouse is waiting on the other side of town for you to show up for a very important reason and you can’t make it, somehow “I’m afraid I’ll have a panic attack” doesn’t carry much weight. I found myself engaging in a lot of psycho babble to make whatever it was I had sound medically complex and almost dangerous whenever I was really blowing something by not showing up. My grandmother’s funeral was painful for the whole family, made harder by my not being able to show up.

I can understand the phenomena. Someone who’d never had a panic attack would think I was a sissy or faking it; that’s how I justified my elaborate and mystifying explanations of my peculiar condition. I was trying to make certain people believe I really was crazy, but in a nice way. I wanted my disability to seem significant to the few people I had to explain myself to. I guess there are times when you might want to use clinical language to obfuscate the reality of your condition. The one person you don’t want to deceive is yourself.

Keep it simple. If you suffer from panic disorder, what you are working on is a way to stop being afraid of panic attacks. Once you accomplish that, your problem is solved. Once you change the messaging in your “fight or flight” system you’ll no longer have false alarms like the ones your amygdala has been triggering because you gave it too many things to be fearful of. Every day that you work on your recovery program you are creating new neural pathways that will lead you to freedom. Keep it simple: all you’re doing is re-training a clumsy elephant

Suffering is Not Just for Succotash

People with panic disorder suffer almost continually from the buzz of anxiety. Certainly there is much worse suffering in the world, but the feeling of dread and hopelessness that sets in with the constant threat of panic attacks is hard to bear day after day. Do you get the feeling that you’ve lost the ability to change your picture – that you have forgotten how or where to find joy?

Prominent Buddhist spokesman Thich Nhat Han says you’re not looking hard enough. The Vietnamese monk advises us that we possess within us happiness and well-being; we just have to find it.  In his book The Heart of Buddhist Teaching, he says, “When you are suffering, look deeply at your situation and find the conditions for happiness that are already there, already available.”  He continues, “Please ask yourself ‘What nourishes joy in me?  What nourishes joy in others? Do I nourish joy in myself and others?'”

The place he advises us to go for relief from suffering is our memory bank. In his words, “If you are not experiencing peace and joy, you can remember having felt peace and joy, and you see that well-being is possible.” Summoning up past positive feelings when you are suffering can give you a present positive feeling. Employ visualizations as a tool to help you achieve this.

People oppressed by panic attacks and agoraphobia should be working daily on getting a positive flow going along the thought highway. Here’s to overcoming suffering through daily practices.

The Irony of Panic

A very weird thing happens when a person has a few panic attacks out of the blue.  If you’re like me, you were so terrified by the experience that you decide you never ever ever want to have another one.   Conscious and subconscious work begins at this point, to guard against this gruesome new threat. The result, through no fault of your own, is that a fox is now guarding your hen house. Let me tell you how that happened and what you can do about it.

First, a brief brain anatomy discourse. If you’re “normal” your five senses are bombarded nearly constantly with data that you see, hear, smell, touch and taste.  So much comes at you, much of it repetitive, that you need a screen or something to filter it. The guards at the gate in our brains are the amygdala and the hippocampus. These two small organs receive, store and pass along data as it arrives at you. The hippocampus essentially converts short term memory to long term and sorts and files experiences. The amygdala (there’s a pair of each – for both hemispheres) is the action organ. It’s the amygdala’s job to alert us to danger, and anyone who’s had a panic attack knows that the amygdala  forces a highly charged cocktail of hormones through your nervous system designed to turn you into a primitive beast that could fight another primitive beast.

Let’s break this down and see what happened – what you unwittingly did to create your current state of high anxiety. You had a panic attack and it made quite an impression on you. Then you had another and another and soon became scared spitless of having yet another. You begin to avoid places and circumstances and you’ve told your brain to be on high alert for one of these, these panic attacks.  Your body and brain has a system for taking care of threats, and the “system” is to shoot adrenaline into your tissue so you will be so suddenly strong and single minded that you can fight or flee with super human strength.

If the amygdala could talk, a conversation like this could take place at the time you decide you need to do something about these panic attacks.

   You: (post panic attack) Holy shit! What was that??!! I’ve never been so scared in my life – what happened to me??!!

 Amygdala: “Norapinephrine”, or what you call “adrenaline.” I just shot a blast of it through your nervous system.

You: Are you sick? Why would you do that?

Amygdala: It was an emergency. I’m here to take care of you – to help you get away from trouble.

You: I was reading a magazine in the library. What “trouble?”

Amygdala: A fluorescent light blinked.

You: And so you, logically, turned a blinking light into a 5 alarm emergency?

Amygdala: Hey, I’m just the messenger here. I don’t program myself, you know.

You: Now you’ve got me scared to death of panic attacks. Since you’re here to “protect” me, how are you going to protect me from panic attacks? What would you do if I felt threatened by a panic attack?

Amygdala: I’d shoot you up with monster juice.

You: You and I need to talk.

And so you do. Schedule daily visualization sessions so that you’re talking with the amygdala, convincing it to go back to its traditional role of guarding against actual danger – you know, mad dogs, mad people and mad cars. Put another organ in charge of watching out for panic attacks so you can get a break from this constant, trembling state of mind you’re in. How about putting your spleen in charge of panic attacks and the amygdala in charge of sabre toothed tigers that started this whole mess in the first place. Daily, positive messages to your subconscious is how we build new neural pathways that can change our messages.

All this is part of the Recovery Program in Un-agoraphobic, which will be published in mid November.

Happy Days Here Again?

Feelings of happiness are hard to come by when anxiety is your constant companion. The healing power of endorphins that are created by feeling and expressing happiness would be beneficial to the panic disordered mind of an agoraphobic if only there was something to be happy about.

Perhaps it’s time to create your own happiness – you know, do something about it.  Huffington Post contributor  Steven Bancarz recently investigated scientifically proven ways to increase one’s “happiness” and wrote a piece (6/24/14) that listed 10 such practices and activities.

Most of these suggestions are included in the Un-agoraphobic recovery program.

1. Exercise.  Bancarz uncovered studies showing even 7 minutes a day of robust exercise will give one a positive flow.

2. Sleep. Studies show the mind needs rest in order to recall happy, pleasant thoughts. Sleep more.

3. Reduce commutes. The article revealed that lengthy commutes 2 times a day, 5 days a week make for such misery that moving close to work is advised. Every agoraphobe would probably love to live as close as next door to work and school.

4. Relationships. Spending quality time with friends and family is a certain way to promote happiness for most.

5. Go outside. Even 20 minutes a day outdoors boosts positive mood, broadens thinking and improves working memory according to studies revealed in the article.

6.  Help others. Volunteering is rewarding and gives a feeling of satisfaction.

7. Smile.  We are advised to practice smiling to make it real. Produce a positive thought and smile about it, using your eyes.

8. Plan a trip.  Researchers discovered that the activity of planning a trip makes a person happy, even if they don’t take it.  Creative trip visualization are, of a course, a big part of my recovery program.

9. Meditate. Daily meditation, at least 10 minutes, clears and calms the mind, making room for contented feelings.

10. Practice gratitude. Expressing thankfulness to meaningful people in one’s life makes both parties feel happier and more satisfied, according to social research.

Putting these into practice in your life daily will require an investment of time and energy, but science has proven your efforts will pay off.  You will make the greatest progress in your recovery from panic disorder when your mind is bright and open instead of panicky.

What’s in a Name?

Would agoraphobia by any other name be as ghastly? The word for avoidant behavior brought on by repeated panic attacks borrows a Greek phrase for “fear of place of assembly/ market place.” There are only two things wrong with this word: it’s long and it’s wrong.  The condition that causes such profound fear is created by fear of having a panic attack.  A crowded place is only one of many circumstances that can produce a panic attack in one whose alarm system is haywire. A long bridge,  long blocks of street lamps, a flickering light, a sudden noise, a harsh word, a memory, a sudden loss or tragedy are among things that can trigger a panic attack.

Of course, if we added all those other possible triggers, the word would circle the block a couple of times. What I – who has probably spoken, written and typed the word agoraphobia more than nearly everyone else – would like is a shorter word that captures the drama a little more accurately. Perhaps I’ll organize a contest on the blog at some point. In the meantime, what we’re really concerned with here is the effect that panic disorder has on a human and what steps said human can take to overcome the fear of panic attacks.

The level of fear is tremendously high that can cause a human to go to great lengths, almost any lengths, to avoid a repetition of the fearful event. We agoraphobes like to be close to home in stressful times just because it’s the place we’re least likely to feel fearful. Folks with other fear conditions have their own avoidance issues, but some of them keep close to home for safety and use the word “agoraphobic.”

I’ll describe a few other anxiety disorders that can cause the sufferer to avoid certain circumstances and places and when severe can force one into being homebound.  During my 17 years as a mental health social worker I worked with hundreds of people whose lives are disrupted if not controlled by fear. Much of my knowledge about mental illness came from my work, but I’ve learned also from personal experience, from reading and from YouTube testimonials.  The other disorders that can cause “agoraphobia:”

1. Post traumatic stress disorder. This anxiety disorder is caused by severe trauma that causes ongoing feelings of extreme fearfulness. Whether it’s a single event like a catastrophe, horrific accident, assault, or ongoing such as abuse, the tremendous blow to one’s ability to maintain is overwhelming.  People with panic disorder are very familiar with an amygdala on overload – constantly sending alert signals throughout the nervous system. Someone with PTSD can have “revved up” feelings ranging from mild agitation to terror so extreme it can’t be described, only experienced. I hope a lot of research money is going into help for PTSD victims. For reasons beyond belief we can’t seem to stop sending soldiers off to kill people in other countries, causing huge traumas in the lives of young people on both sides of the battle lines. Some PTSD victims are so fearful they become homebound.

2. Obsessive compulsive disorder.  By Wikipedia’s definition, this anxiety disorder is characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry. Most engage in defensive behaviors of some sort, from repetitive checking to excessive washing to extreme hoarding. The preoccupations can range from fairly benign to violent, sexual or religious thoughts. OCD, as with most mental illnesses, varies in degree. I had several OCD clients at the Mental Health Center and became accustomed to assisting someone with avoidance when I could. As a former sufferer of excess anxiety I was always attentive to need for safety. The cause is at least half genetic, according to Wikipedia, and the rest of what causes a person to begin extreme defensive behaviors is under study, as they say. OCD can be so severe it can limit mobility.

3. Social anxiety disorder. This anxiety disorder is the most common of such disorders according to Wikipedia, and apparently develops fairly early in life. It also comes with its own perfect acronym. I’ve known a few people with this SAD condition but can’t say that I’ve come to understand it. It’s described as “intense fear in one or more social situations causing considerable distress and impaired ability to function in at least some of life’s general activities.  These fears can be triggered by perceived or actual scrutiny from others.”  Panic attacks and fear of intimacy can confine one with what is also called “social phobia” to staying very close to home if not homebound.

4. Emetophobia  This disorder is one the Greeks hit the mark with: “vomit – fear of.” According, again, to what I read in Wikipedia, this disorder is characterized by excessive  fear of vomiting or seeing vomit or seeing others vomiting. The number of obsessions that arise in a person with severe emetophobia can cause the sufferer to avoid so many things that they can  become homebound.

5. Labyrinthitis.   A search of Harvard Medical School’s website for psychiatric studies reveals that researchers discovered a link between this inner ear disturbance and panic attacks. I suffered from labyrinthitis in my youth, about the same time I started having panic attacks, so I speak as an expert witness. In brief, the researchers discovered the neural signal that triggers sudden imbalance in the inner ear is so similar to the neural signal that triggers a sudden adrenaline flood that the amygdala as guard at the “incoming” gate could be misreading  the signal and mistakenly causing a panic attack.  The problem is so severe for people afflicted with labyrinthis that there are at least 3 online forums dealing with the effects of sudden vertigo. I read several entries by people who suffer regular panic attacks and have even become agoraphobic because of the threat of panic attacks. A similar condition, “vestibular neuritis” can be difficult to shake. I haven’t had vertigo since age 19 and long ago stopped having symptoms of slight loss of balance due to inner ear infections.  The condition is complex and extremely troubling. I’m going to discuss labyrinthitis and VN at greater length in the next blog. It would be a relief to these folks if they could find a way here to overcome the panic attack problem and then only (??!!) have to deal with the extreme dizziness, nausea, and blinding headaches. One entry I read was from a woman who said her labyrinthitis symptoms improved greatly once she was able to overcome the panic attacks.

Hope marches on.