Guest Blog – Kate Carries On

(Kate is a guest blogger from Canada who writes from time to time of her work on overcoming agoraphobia and its effect on her as wife, parent and businesswoman)

Season’s Change

This winter as many of you know, especially those of you living in the eastern half of North America, was colder and snowier than anything we have experienced in years.

Winter has always been a difficult time for me.  The time change, temperature change, shorter days and lack of sun make me fall into SAD (Seasonal Affective Disorder) very easily.  But worse for me is the lack of mobility.

This winter has been one of the worst I can remember and when I look at my agenda compared to last year’s agenda I am down about 75% “going out” ability.  I rely heavily on my bicycle to either ride or balance my walking, to get me out of the prison of my house.  I drive very little in the winter.  I will take it out of the driveway a couple of times during the week and drive a few blocks but that’s about it.  I do it only for the purpose of getting in the car and driving – not to get anywhere.

I live in a bike friendly city but this past February the snow and cold kept coming and never thawed and I was only able to manage going out for dinner once.  At least it was once and better than not at all! But the snow mounds act as a claustrophobic barrier and the ice encrusted roads are not overly bike tire friendly.  So, I have felt particularly trapped this winter as many of us have. I am full of shame and guilt that I can’t just get in my car and drive down to Florida for a break or hop on a plane for that matter.

One of the trickiest parts of the transitions of seasons for me has been the “start-go-stop” cycle.  Now that it’s spring, I will be enthusiastic about the thaw and the budding crocuses.  I will drive more, be with friends more, attend functions more and do regular day to day things more.  It’s an awakening I look forward to each year.  However, I will be good for a few months until the oppressive heat and humidity of July and August hammers down and drives me back indoors to the air conditioned comfort of my living room until September when I resume my going out activities until January when I shut down completely and just want to hibernate until spring.

This “start-go-stop” cycle drives me batty because I can go and go, achieving real headway in my recovery process during the fair-weather months and then the change in season kidnaps me and keeps me hostage until the weather changes.  It feels like learning how to walk all over again every few months.

I have wondered what it would be like to live in a more temperate climate like Hal mentioned in his book Un-Agoraphobic.  There are very few options for moving within Canada where you don’t have to experience winter. Next year in January, I will sign up for an online university course or two to keep me motivated throughout the winter and as an assurance that I will be far too busy to be spending the winter in Florida.


The Fake Sanity Clause*

I have more than once pretended to be happy about something or another in order to please or at least placate someone else, but it turns out I could also fool myself by faking it.

Brain scientists have shown that focusing on and repeating any thought, action or behavior stimulates the brain into creating new neural pathways in order to facilitate that process. It makes sense to me; it’s sort of like you start lifting weights and after awhile it gets easier because your muscles get bigger and more efficient.

If you suffer from panic disorder you have evidence close at hand proving the brain will pay attention to whatever you want to focus on at that particular time. You have subconsciously and consciously informed your central nervous system that you are in some sort of danger, so the system gears up to be ready whenever the “danger” occurs. That’s why you’re nervous. You are tense and tight and hyper-vigilant because your amygdala thinks something bad is going to happen without warning.

Your high level of anxiety of course makes it much more likely you’ll be startled or stimulated which will trigger a flood of adrenaline that creates the extreme feeling of terror we call a “panic attack.” The bad thing happening is happening because you programmed yourself to be on the look out for fear. It’s not something you were necessarily doing on purpose, but because the feeling of being in danger (from a panic attack) creates new thought pathways, pretty soon you’re stuck with being a nervous wreck.

Luckily, your brain will do pretty much anything you want it to, even feeling calm and at ease. You can totally reverse your current situation though the response may be slow in coming. There’s lots to undo and redo, but you can do it. I set up a daily work program in my book, Un-Agoraphobic to accomplish that very thing – to set the brain in motion with positive thoughts and and activities. Creating new neural pathways that relate to safety and comfort and happiness is what will help you recover from panic disorder and agoraphobia.  To start it off, all you have to do is smile, as you’ll learn in the following article.

*A nod to the Marx Brothers

How to Leave Home Without You

When anxiety is having its way with you, leaving your domicile becomes a daily, dreaded chore. Because I struggled getting to work or school for many years as a victim of panic disorder, I want to help you take on the day so you’ll face only new opportunities instead of new threats.

I’m revisiting this because being able to travel to work or school is vital to your survival and there are so many people who struggle with this daily event – the journey into the unknown. This is for the folks who have to make a living or stay in school and suffer panicky feelings in order to do so.

My recovery program for agoraphobes includes a variety of activities and practices throughout the day designed to help make neural changes in your brain, and over time this work is what will set you free. In the meantime, as you battle anxiety throughout the day, the best advice I can give is to stay in the present moment.  Paying close attention to what you are doing and where you are throughout the journey will enable you to step confidently and serenely into the day.

I advise taking along your journal or notebook and a camera as you begin a new way of leaving home and leaving the anxious you behind.  Be mindful of everything around you and record it as a means of getting out of your head and into a connection with your environment. Peace comes from this if you do it right. As you’re walking feel the surface and make note of what your feet are touching. Describe it in detail. And on and on through your daily journey, take a new view of what you encounter.

Getting into and staying in that frame of mind can be admittedly difficult. But once you fully understand what it means to be in the moment you’ll be able to benefit from the values of meditative, mindful behavior. Here’s an excellent piece by psychologist Dr. John Amodeo on living in the present moment. I hope you’ll read it. I learned from it and I hope you will also. Here’s to healing through learning:

Jangle, Jangle, Jangle

 If everything could just kind of jingle this time of year, folks with panic disorder might be okay with all the increases in stimulation. The problem is there’s way more jangling – nerve jangling – than the sweet little jingling we prefer. As a result, this is a time of great suffering for many people with chronic panic attacks.

When your nerves are already jangled with ever-present anxiety, the holiday season can easily put you over the top. I recall my most anxious times during my years with agoraphobia were from T-Day to New Year’s.  Now I understand that my environment of supposedly  cheery, festive occasions was loading up my fight or flight system. The colored lights, the crowds, the noise, the blurs of activity, were just increased stimulus as far as my amygdala was concerned.

If the same cycle occurs for you, I’d be interested to hear about it. Send an email if your panic attacks get much worse during the “holidays” and you want to hide from it all. I was nearly homebound on at least two of the Christmas/Thanksgiving periods. I recall feeling deep despair this time of year. Agoraphobes know they will most likely face demands to travel during the holidays, so their nerves get amped up by that threat.

You are expected to get things for people; online shopping makes life easier, but there are some things you’ll have to go out for. My increased anxiety level was probably also due to the contrasts between how everyone around me was apparently feeling – kind of happy and pepped up and bustling around – and the way I was feeling, which was desperately unhappy and frightened.  I remember more than one holiday season when I felt that I could just no longer go on… I mean go on. I did, and so shall you my friend.

What I needed during periods of heightened anxiety was something to focus on; something I could start doing that would demand all my attention and take my fears away. I didn’t have much to turn to in earlier years, but once I discovered art and clay I had something to go to and begin creating.  When you enter the creative process your fears will nearly or completely disappear. When you live fully focused on the present moment of creation, the past and future are just that.

My advice to you is to start making things for people. Make by hand every present you’ll give this year and enjoy the satisfaction of creation and the delight of discovery from the receiver. Your gifts could range from found and modified art to drawings/paintings/collage, to poems or stories or songs you write. Cookies! Your gift can be homely or lovely, but I guarantee that in the eye of the receiver your gift will be beautiful. You may discover a talent you weren’t aware of and begin pursuing whatever way you decided to make your own presents.

Schedule some daily breathing timeouts throughout the coming weeks and try to sit in meditation at least once a day. This would be a good time to transfer your extra stimulation to your journal. Make a holiday observation every day- remarking on particularly gaudy or tasteful things you saw or heard in passing, for example. Writing will help you focus on recovery.

Be extra mindful of everything around you this year. By focusing on one thing at a time you’ll greatly reduce your anxiety level. Study colored lights closely. Look at people’s faces and clothing with increased interest. Listen intently to each sound you hear and try to isolate it. Doing things of this nature will I hope make the task of being in holiday crowds easier for you.

Social isolation can be a serious matter for homebound agoraphobes this time of year. Reach out to others in whatever way you can – from writing nice letters to phone calls to visits. Stay connected with your world throughout the holiday time. Bake delicious things and invite people over. Give yourself the present of a comfortable holiday season for a change.

How Far Out Are You?

I’d like to de-mystify agoraphobia a bit by discussing the various manifestations of classic panic disorder. I think most civilians equate agoraphobia with hiding in the house, but that’s not true all the time or even at all for everyone who suffers from this mental illness. My personal experience as well as what I learned from mental health clients and peer support group members led me to rate agoraphobia by severity:

Level 1. Housebound or mostly so.

Level 2. Partially mobile.

– Level 3. Mobile with a wall.

Many people who suffer panic attacks when they venture beyond their safe perimeter have experienced all three levels at one time or another. I ran the gamut more than once during my 30 years with agoraphobia. The housebound stage is usually the result of extra stressors; the increase in fear level that drives someone into a corner is demoralizing. Being inside can feel safe, although terror-stricken people will resort to hiding in small spaces to reduce the fear level.  A great day for someone at Level 1 is a trip all the way to the end of the block. The victim’s fight or flight system is on such a high stage of self-imposed alertness that unending anxiety is the result.  Someone at this high level of anxiety feels that a panic attack is so nearby that one dare not rock the boat.

When agoraphobes are at Level 2 they are able to work and go to school, though with great difficulty. Going to and from is likely the most difficult of every day’s difficult tasks.  Those  periods of vulnerability bring out an agoraphobe’s talent for catastrophic thinking.  Anything and everything can be a threat, but bridges, railroad crossings and long lines of streetlights are particularly troublesome for someone at this anxiety level. Work may be the easiest part of the day; a job that requires total focus on the work is good for the agoraphobe who wants to shut out anxious thoughts.

Many people with long-term agoraphobia spent a lot of time at Level 1. I did. When you are able to work and have relationships and feel free from heavy anxiety, you can become complacent. Eventually, though, being stuck at this level is heartbreaking because you are so near yet so far from complete freedom. You’re still a prisoner even if you have a good job and relationships.

So… the truth is out: No one is safe from agoraphobes because not all of them are locked up in their houses.  Some of them are moving about you, working with you, touching you, and even…. Yes! Agoraphobes can appear to be nearly normal, if not more so.

Start increasing your functioning level by decreasing your fear level with the help of “Un-agoraphobic.”

Fear is Fear is Fear

I was interviewed on a radio station recently by co-hosts, each of whom had experienced different kinds of fairly severe fear. The three of us had experienced agoraphobia in one form or another, so knew exactly of what we were speaking when we talked panic attacks. We all agreed the experience is mind altering and often life altering. We 3 also were intimately familiar with self medication (alcohol, chemicals) as well as prescription addiction; you know, tranquilizzzzzers and anti-depressants and mood stabilizers.

One of the hosts had overcome addiction and for the most part fears, but the other was still struggling with anxiety and addiction. Both were very upfront about themselves, as was I. It seemed like a lively discussion and I hope well received. I mostly tried to level the playing field for people with serious anxiety issues. One host suffered severe loss, appearance issues, and abuse at home. The other had loss and physical trauma at the root of a high anxiety state.

I, on the other hand, didn’t experience trauma, something real that happened and sent me into a panic attack. I went straight into a panic attack for no apparent reason, other than something vague may have startled me. That was my trauma. The result for all 3 of us was that our alert system got set a little higher, taking the form of general anxiousness. Additional traumas, mine in the form of panic attacks, programmed our “flight or fight” system to be constantly alert – a higher level of anxiety.

The fact is, all anxiety is fear-based. We are exceptionally self-protective, ever on the alert for danger – via the amygdala, the most primitive part of the brain. I consider it a storage area where memories are kept – memories of all kinds of trauma, danger signals, danger thoughts, all the sorts of things that you have decided to put in the fear category. I’m an English major; I don’t really know much but general information about the brain system, so a lot of what I think about this is sort of made up but based on science. I do know we all have to get out of our anxiety the same way – by reprogramming our neural systems to start working our way.

My book Un-Agoraphobic is the fully equipped, all you need package to begin the recovery process and find yourself standing on the other side of your agoraphobia prison wall – laughing and crying at the same time. But for now, get to work every day on the routine and write of your journey. I had to overcome my fear of panic attacks. I didn’t have to overcome my fear of traveling beyond a certain distance; I had to stop being afraid of having a panic attack. People who have suffered physical and or verbal trauma will probably have to resolve their specific fear issues as they work on the agoraphobia recovery program. It’s hard work but the payoff is unbelievable happiness.

Your Very First Suitcase

If your agoraphobia began early in life – for me it was age 19 – you may have yet to purchase your very own luggage. Who needs a suitcase when you can’t travel more than a few miles away from home – if that far? I probably used family suitcases for trips in my youth before a rather savage recurrence of panic attacks early in my sophomore year of college made me too frightened to travel more than the few blocks I lived from campus. And I wouldn’t travel freely again for another 30 years.

I clearly remember my first suitcase. I didn’t want to buy something shiny new and have people think this is the first time I took actual trips far off into the world. I hunted through second hand stores until I found the perfect statement.  It was a tan, heavy canvas thing with leather trim that folded out sort of like a wardrobe and had lots of cool side pockets. It made me look like a man who’d been abroad, or at least around.

With that suitcase I made a trip back to my parent’s house, my home, that I hadn’t been able to visit for 3 decades. The mountainous trip from Helena to Billings is stunningly beautiful. The first part trails the Missouri River to its origin – where the Madison, Jefferson, and Gallatin Rivers (all named by Lewis and Clark) combine near Bozeman (Three Forks).  Soon after that on the winding, climbing, descending freeway, the legendary Yellowstone River emerges from its namesake national park through Paradise Valley and announces itself to the world as it winds its way beside the highway through  geology ranging from mountainous to hilly to sandstone rimrocks and buttes.  Towering cottonwood trees suckle at its flanks the entire journey through Montana to where it joins the Missouri clear the heck over on the east end of the state. The soaring, glistening Absaroka Mountain Range and then the Beartooth Range, highest in Montana, are your constant companion on your right on that particular stretch of I-90. I was driving on an interstate highway for the first time in my life.  The previous, pre-agoraphobia times I traveled across the state, the massive national highway construction program was just underway.

I had already made months earlier my initial Very Big Trip from Helena to Butte 60 miles away to officially end my agoraphobia. And then I made the 2 hour trip from Helena to Missoula many times as I moved back to my favorite place in the whole world. But the trip from Helena to Billings was another matter – longer at 3 hours, and at times the openness – one of my panic triggers – goes on and on. Luckily I was in a state of awe the whole journey and pretty much didn’t have any anxious times. For this trip, where I was actually going to stay a few days I needed a suitcase.  And after that I took on many sorts of traveling bags as I came across them in thrift shops for my many trips to follow.

The final symbol of freedom from agoraphobia is a large suitcase with wheels, which I now possess. It’s red,  second hand, and large with many zippered nooks and crannies. The wheels say it all: I am a person who travels freely so much that I need wheels on my suitcase.

I’m certain you’re excited to take your first trip away from agoraphobia with a suitcase. Perhaps you should go ahead and buy a suitcase now so it’ll be there on that glorious day when you’re ready to take a long trip with luggage. I know! You can put it at the foot of your bed and call it your “hope chest.” Get it? Sometimes I am so brilliant in an ad agency way I scare myself.

You’ll get there, I promise. Work hard every day on your Recovery Program in Un-Agoraphobic and you will put it all together and solve your mystery with my vast knowledge and experience guiding you along.

If wheels on a suitcase make you look or feel old, try a couple of shoulder bags for a hip-ness  in your new traveling look.

Heal Yourself With Loving Kindness

Meditation is an integral part of recovery from agoraphobia, but meditation can take many forms. I just read a recent article by one of my brother/sister bloggers at Psychology Today pointing that out. Emma Sepalla advises her readers to find a form of meditation that works for them. In her words, “You just have to find the shoe that fits.”

In the Un-Agoraphobic recovery program I recommend both sitting meditation and the meditation that comes while learning and practicing a new skill. I emphasize employing some form of meditation as a means to get out of your own head. Practicing loving kindness was the Buddha’s means of learning and teaching compassion as a way to attain a peaceful mind.

PhD Sepalla, a TED speaker on the subject, elaborates on the virtues of meditation and suggests learning to meditate by starting with something that comes easily to most: kindness. “Loving kindness” meditation, she says, can be a powerful healer because it brings out healing feelings such as empathy, compassion and love.

Her blog, “18 Science-Backed Reasons to Try Loving Kindness Meditation,”talks about the healing aspects of this basic tenet of Buddhism. The Buddha Dharma Education Association website says this about loving kindness meditation: “It acts, as it were, as a form of self psycho-therapy, healing the troubled mind, to free it from its pain and confusion.”

When you can begin focusing on loving compassion toward others you can begin practicing it on yourself – part of healing the whole you which will free you from panic disorder and agoraphobia forever. Un-Agoraphobic is available in bookstores and other places to purchase books on Oct. 1.



Tranquilizers Linked to Alzheimer’s

There are now three very important reasons for people with panic attacks to avoid long term use of tranquilizers in the benzodiazepine family.  The Canadian Broadcasting Corporation online “Health” blog reported Sept. 10 on a Canadian medical study that indicated elderly people taking meds from this family increase the likelihood of developing dementia by about 50%.  That was rather astonishing news to me.  I had already, based on personal and professional experience, advised against use for more than three months  such meds as Valium, Xanax, Klonopin and Atavin for two big reasons: 1. your body becomes addicted to these meds after only two or three months, as their effectiveness declines. 2. Withdrawal symptoms include unending anxiety that can last for weeks or longer as you taper off. I’m basing this on wide reading in the field, interviews with psychotropic prescribers, and my own addiction to Xanax.

The article in “Health” was referring to a study by French and Canadian university researchers on several thousand Canadians over 65 that was reported on the British Medical Journal web site on Sept. 27, 2012. Using national medical records, the researchers tracked those who developed dementia and then the ones in that population who had been prescribed a benzodiazepine medication. Based on those statistics, university researchers said in the report that those people who were taking a benzodiazepine during the study period were more likely by half to be diagnosed by a neurologist as having Alzheimer’s disease, a dementia-like condition that causes severe loss of memory and even death.

Un-Agoraphobic is a non-pharmaceutical approach to recovering from panic disorder. I can tell you that once I got past the edgy, restless period of withdrawal, I felt more calm then when I’d been taking tranquilizers. I loved my benzos, but I know my recovery from panic disorder was delayed by a long time because of my addiction. If you are taking one of the meds from this family, please begin doing research. The study’s researchers included an advisory in their conclusion that essentially asked  medical professionals and medication regulation boards to be prudent when prescribing benzodiazepines.


See if I Care…

When people ask me how I recovered from agoraphobia, I usually avoid a very long story by saying such things as “It was a process,” or “It’s a very long story,” or “I had a lot of help,”  but one thing I always say is “I had to learn to become blase’.” You know, that French word meaning a sort of satisfied boredom.  When I was in the grip of chronic panic attacks I was trying to control everything I could, probably out of desperation to be in control of something, since I couldn’t control my anxiety or fears.  As I came more in contact with others suffering from panic disorder through peer support groups I started or helped organize and my social work job at the Mental Health Center I discovered a lot of anxious people with perfectionist traits. I’m not referring now to “obsessive compulsive disorder,” but rather to the controlling behavior exhibited by those who suffer chronic panic attacks for no apparent reason.

I somehow knew my perfectionist, controlling habits were interfering with recovery from agoraphobia.  Learning to become blase’,  wasn’t that much of a stretch for me.  A lot of my habits are of a casual nature, so I just had to extrapolate from not making my bed to not  making a big deal out of speeded up breathing or heart rate or other kinds of false warning signs that can trigger panic attacks. I had to learn to stop caring about the outcomes of many many things I used to think were necessary to my well being. The whole business of letting go and letting down my guard didn’t happen quickly… but once I could see positive results from forced lack of concern about this or that, I allowed myself to  become kind of casual. The whole process over several years affected everything about me – the way I walk and talk and write and  listen. I can listen a lot better now that I’ve become less self-concerned.

Folks who suffer with agoraphobia will help their recovery efforts by learning to let go – a lot. The question of whether anxiety creates perfectionism or perfectionism creates anxiety is a circular one – worth pondering though. I’m thinking of how perfectionism and anxiety disorders co-occur because of an article written by Psychology Today blogger Max Belkin. His nicely written piece,         “5 Steps to Taming Perfectionism,” appeared in late July and links the obsession of perfect to both low self esteem and procrastination. I’m not saying that agoraphobes are necessarily perfectionists; just that there’s a trait toward controlling one’s surroundings that actually creates more anxiety.

Dr. Bilker advises those who have let perfectionism ruin their dreams to learn to accept themselves just as they are and to acknowledge that they are good enough just as they are. Self love is at the core of recovering from panic disorder and agoraphobia. Healthy self love always radiates out, so once you obtain it, walk it around and shine on some folks in the shadows.