~

[Eldon]

Six Steps That Will Put an End to Panic Attacks

The objectives of this thread is to understand how and why a anxiety/panic attack occurs. To understand that we create the anxiety, the panic and resulting depression with our thoughts. To understand the steps to minimize, if not prevent panic. To understand that you are your “safe” person and your “safe” place. To further evaluate and understand varying degrees of depression. To begin to practice control and comfort techniques for panic, anxiety, stress and depression. To understand that depression is both physical and psychological. To begin comfort measures for depression.

Before I go on, WHY am I sharing this with you all? Simply because it is in my nature to help others and it is a self realization that has taken place with my life and it thoroughly explains a lot of things that have been misunderstood with life in general. This is some powerful information and I believe it can help you as well. You may want to bookmark this thread or try printing it out for future reference.

What causes a panic or anxiety attack?

The answer is really quite obvious.

YOU CAUSE IT!

Nothing outside of you gives you a panic attack. You cause it. Here’s how:

After you experience external anxiety, you then become concerned with your body feelings and symptoms. You think about them to the point where you actually start to scare yourself with them. This creates internally generated anxiety.

Your body senses the fight or flee from whatever it is that’s causing the fear, whether real or imagined. These chemicals include adrenaline, sodium lactate and cortisol.

As your anxiety level grows, more chemicals are released into your system.

This causes you to enter the second stage of anxiety, the endogenous stage. Now your main concern is no longer the particular problem that brought on the stress. Instead, it’s the “weird feelings” and “strange symptoms” that your body is experiencing.

You become so caught up in wondering “What’s wrong with me?” that you become bewildered and confused. So much that all your defenses are down, your sensitivity level is up and you go into panic. The anxiety seems overwhelming. You fear you will loose control.

There is one important thing to remember at this time.

You will not lose control, nor will you go insane.

Your mind and body can only maintain this state of anxiety for a few hours best. Then you may become extremely fatigued and depressed.

Next well talk about external and internal anxiety.

External Anxiety

This type of anxiety is generated or caused by something real, something that is going on in your life.

There is a valid reason to feel this type of anxiety.

It could be brought on by something as traumatic as someone trying to physically hurt you. It also could be initiated be something as simple as watching a television show or by your concern about a future event.

Internal Anxiety

This type of anxiety is generated or caused by your concern about your external anxiety and the way it has made you feel.

You only experience internally generated anxiety if you choose to.

By choosing to be less affected by external events and externally generated anxiety, you minimize internally generated anxiety.

Life is stressful. Both good and bad situations can cause anxiety. Marriage, low self esteem, career change, having a baby – all of these situations can cause externally generated anxiety.

This stress will bring on body symptoms –racing heart, bewilderness, dizziness and the like. It is normal to feel this way.

What the anxious person does at this time is to add internally generated anxiety that really has no validity. “What’s wrong with me? Am I going to faint? Am I going to lose control and do something stupid?” These are not valid thoughts because they are not true. There is no reason to worry about these things.

It is the internal anxiety that gets us into trouble. It’s from the internally generated anxiety that we get obsessive and carried away – scaring ourselves with untrue thoughts and increasing our body symptoms.

You must learn to stop, give yourself permission to have externally generated anxiety, tell yourself why you’re having it and let it pass.

Steps to an Anxiety or Panic Attack and Eventual Exhaustion

STRESSFUL LIFE EVENT

Externally generated (justifiable) anxiety

Chemical releases

Body symptoms

The next move is up to you!
How will you choose to respond?

WRONG WAY TO APPROACH!

Fear of body symptoms
Internally generated anxiety
“Why do I feel this way?”
More chemical releases
More body symptoms
Fear of symptoms worsening
Bewilderment and confusion
Fear of symptoms, bewilderment
More chemical releases
PANIC ATTACK
Bewilderment, fatigue and depression

RIGHT WAY TO APPROACH!

Acceptance
“What is really bothering me?”
Compassionate self-talk
Positive distraction
CALM
No fatigue or depression
No chronic anxiety
No pain

There is a six-step approach to self-control when dealing with an anxiety attack. These are to include;

FIRST – Recognize that you are feeling anxious. Accept your body feelings as a symptom of your anxiety and a sign that something is bothering you.

SECOND – Give yourself permission to feel anxious about whatever it is that is bothering you. “Of course I feel anxious because…and it’s ok to have anxiety.”

THIRD – Breathe. First, inhale through your nose slowly for two-seconds, mentally counting on, one-thousand, two, one-thousand. Then exhale through your mouth to mental count of four-seconds – again by one-thousands. Do this for at least 60 – seconds.

FOURTH – Use positive dialogue to talk yourself through the anxious time. It WILL pass. Examples of dialogue might be, “It’s just anxiety. It will go away. I will not lose control. I can still go about my business feeling spaced-out. It won’t hurt me.”

FIFTH – Get busy. Do something to release some of this self-induced stimulation. Your body is like a car in high gear with the brakes on. Don’t just sit there! Walk, run, clean closets – but DO something. Distract yourself from the way you are feeling.

SIXTH – Try to see a little humor in the way you feel. You may FEEL weird, you don’t LOOK weird. Give yourself permission to feel weird for a little while. It’s no big deal. Try to figure out what is really bothering you. Is it some type of conflict that you don’t want to deal with? Is it a scary thought? Is it a ridiculous expectation you have about yourself? How about the television program you watched last night? What is bothering you?

It takes time and lots and lots of practice. But the only way to stop fearing panic and anxiety attacks is to experience them. Then, work your way through them and begin to see that they won’t hurt you.

There is no need to run.

You are your safe place and your safe person. You can make yourself feel better.

Please answer these questions about anxiety and panic attacks.

1.   What are you afraid of when having an anxiety or panic attack?
(write down at least three things)
2.   What are some of the symptoms you feel right before an anxiety or panic attack? (write down at least three things)
3.   What symptoms do you experience while having an anxiety or panic attack?
(write down at least three things)
4.   What DO you DO when you feel you are going to have an anxiety or panic attack? (write down at least three things)

If you are blessed with a Partner, it is even better to help you with your anxiety or panic attacks. The following is the “Partner’s Guidelines” for things that they should DO. It would be helpful to print this out.

1.   Praise often. For even the smallest successes. Your encouragement is extremely important. Praise the participant for even trying.

2.   Encourage his/her independence. Let them “go it alone” whenever and wherever possible, but only if he/she is ready.

3.   Compliment the participant for their progress as far as attitude is concerned. He/she is the last one to notice how they are changing for the positive. Be sure you point it out.

4.   If he/she wants you to go along as they practice his/her avoidance situations – such as driving, shopping etc…-go with them. But allow him/her some distance, all the while letting him/her know you are there to assist and support them.

5.   If you are in a situation where the anxious partner begins to feel panicky and anxious, try to help him/her by reassuring them that it is just anxiety. Remind him/her that they are not dying, going crazy or having a heart attack. Reassure him/her that there is no reason to run. There is no safe place. Then distract him/her by showing things to them, using humor or talking about something that they are interested in. let him/her know that they will be okay, but do not make a big deal out of the fear and panic.

6.   Let your anxious partner have a big hand in the decision-making process – where you are going, how long you will stay and how you will get there and back. Let your partner feel like he/she is in control of the situation to some extent. He/she will feel more comfortable and probably will stay longer.

7.   If your anxious partner feels discouraged or depressed about his/her progress, give them reassurance that they are doing well.

8.   STAY POSITIVE

Partner’s Guidelines Cont… The things you should NOT do as a Partner are the following:

1.   Do not make fun of the condition. Never be sarcastic about it.

2.   Do not monitor his/her progress by constantly asking how he/she is doing or saying, “Shouldn’t you be doing this or that by now?” This will only make him/her feel like they are not living up to your expectations. It will make the participant very anxious.

3.   Do not tell other people about his/her condition. If your partner wants someone to know about it, it is their right to tell them.

4.   Do not baby him/her. Be supportive and compassionate.

5.   Do not get angry over his/her fears and attacks. He/she cannot help it when they feel this way. The longer you treat him/her badly or make them feel guilty, the longer it will last.

6.   If he/she is having a panic attack while you are with him/her, do not suggest leaving, going home or to the hospital. Distract them as mentioned earlier.

7.   Do not read his/her materials. This program is theirs alone – unless he/she wants to share it with you. Then, by all means, take an interest.

8.   Don’t be too concerned if he/she seems to change into someone who seems a little angry or selfish at first. That will change. It’s just that he/she realizes for the first time that he/she is allowed to be angry and selfish at times and people will still love him/her. He/she will find a happy medium eventually. Praise your partner for being assertive.  

Example Responses – (choose the one which applies to you the most)

What are you most afraid of when having a panic attack?
__embarrassing myself
__having a heart attack
__getting sick
__my legs collapsing/fainting
__having to leave work
__losing my mind
__afraid I am dying of a serious illness

What symptoms do you feel right before the attack?
__feeling light-headed, disoriented
__feeling out of touch with reality
__a need to run
__tightness in chest
__jelly legs
__chest pain
__strong physical symptoms
__pounding heart

What symptoms do you feel during a panic episode?
__sweating
__heart palpitations
__feelings of confusion
__difficulty in breathing
__feeling that something horrible will happen
__acute awareness of body feelings
__muscle tension

What do you do when you feel you are going to have an attack?
POSITIVE – No more running. Accept it.
NEGATIVE – Stop talking, start worrying. How long will it last?
NEGATIVE – Find my “safe” place or person
POSITIVE – Distract myself. It WILL go away.
POSITIVE – Do something physical
NEGATIVE – Drink or self-medicate
POSITIVE – Use positive dialogue. Find something positive to read.

When you are beginning the anxiety cycle, it is a signal to you to accept that something is bothering you. Try to pinpoint what it is and then take action to eliminate some of the anxiety by doing and saying positive things.

It is important for people who suffer with anxiety disorder to understand that a panic attack is not going to hurt them.

People who suffer with anxiety disorder tend to avoid change, risk and conflict.

As such, when you decide to take chances, to practice some of your avoidance behaviors, you will experience feelings of anxiety. It is necessary to have these physical symptoms at this time. They are part of the challenge. Don’t let them scare you.

Use positive self-dialogue to understand the positive side of the anxious episode. Of course you feel anxious – you are trying something challenging. It is ok for your heart to pound and for you to feel strange and confused.

Some of you may try to avoid having panic attacks.

Don’t.

Instead, let yourself experience these feelings. Use this as a practice opportunity to use your new skills. Learn to view some of these anxious episodes as excitement. Once you are not afraid of the feelings, the anxious episodes WILL begin to dissipate.

[Eldon]

BREATHING

When you experience your first sensations of panic, it is suggested that you change your breathing right away.

First, inhale through your nose slowly for two-seconds, mentally counting one, one-thousand, two, one-thousand. Then exhale through your mouth to mental count of four seconds – again by one-thousands. Do this for at least 60 – seconds. Next, immediately fill yourself with positive comfort dialogue. This exercise will help tremendously in preventing a full-blown attack from spiraling.

The mental activity of counting is an extremely effective distraction. The breathing process sends a signal to the brain to relax – things are just fine. The red alert sign is turned off.

Help With Depression

As you read through this series, you will find that the main focus is to give coping skills that lead to physical comfort. How do we get comfortable with depression? Honestly? Recovery from depression and anxiety disorders is a process. There is no “ON” and “OFF” switch. Most physical and psychological changes take time and practice.

Part of getting “comfortable” involves understanding. We must understand that depression is both physical and psychological. If we have been stressed and anxious for a long time (two weeks, two months or two years), the centers in the brain that manufacture the chemicals that keep us in a non-depressed state, slowly become repressed. We are not making enough, for one, serotonin. This is why doctors sometimes recommend an anti-depressant. (Remember, an anti-depressant doesn’t make serotonin – it encourages the brain to do so. This information can be comforting to those who are afraid of medicine.)

If you fall into this category and you are down and out, this week I would like you to begin taking steps towards feeling better. The six-steps outlined in the area above are to be used not only when you feel the beginnings of panic or high anxiety, but whenever you feel a surge of other emotions as well.

For example: You are in a long line at the store and you begin inner dialogue. “Why me?” Why do I always get in the slowest line? Don’t I have enough to contend with?” As soon as you notice a rise in your metabolism from anger and/or fear, use your six steps. Perhaps you come home to an empty house and a wave of down feelings wash over you. “Nobody loves me. Nobody cares.” Immediately initiate the six-steps.

The first three (Notice, Accept, and Breathe) steps will comfort you physically. The fourth step (changing your dialogue from negative to comforting and soothing) will help you physically AND psychologically.

Every emotion carries its own chemistry. We feel what we think. This is a vital insight whether we are dealing with stress, anxiety or depression. Using the six steps is comforting and shows us that we can change our emotional state and therefore, the associated chemistry.

When we are depressed, motivation is very difficult to muster up. Oprah Winfrey once said, “Motivation comes with the DOING” We can only encourage you vigorously to use the aids as outlined for this week.

MOODS – Research seems to support the idea that most “bad moods” are preventable, or at least fairly easy to repair in a relatively short period of time. Steps: 1) Trace the mood, if there is something that you can do about the source-DO it; if not choose your attitude (make it positive) 2) List positives in your life. 3) Exercise. 4) Socialize. 5) Seek humor. 6) Do something nice for someone. 7) Change your environment. Enjoy the arts. 9) Spend time in a natural setting. 10) Speak to yourself as if you were speaking to a beloved friend.

MILD TO MODERATE DEPRESSION – This form of depression effects approximately eleven million Americans. It can take the form of ‘the blues”, to feeling hopeless. Some diagnosticians are labeling this type of depression, dysthymia (dis-THIGH-mee-uh). Use the steps as listed above and the coping skills and the activities, and cognitive restructuring listed throughout this series. In addition, speak with your Doctor for assessment.

CLINICAL – Depression that is severe, to the point the client loses interest in the outside world, has pronounced and prolonged behavior changes, and, at its worst, causes separation from reality – needs professional treatment – don’t just sit there – TELL someone.

(Reader: Please keep in mind that this may not necessarily be you. However it could be a friend or a loved one.)

Most of us are frightened of medication. It is possible to recover from depression without medication. However, if the diagnosis is clinical depression, severe depression, it thoughts of suicide are prevalent and comforting, it is time to find out if medication is appropriate for the time being. Talk with your Doctor, therapist, pharmacist; get good, reliable information. Often, we are very misinformed about anti-depressants.

Depression is like looking through dirty, smudged sunglasses…your view is not clear. Your view is distorted. You aren’t seeing things realistically. You are making decisions based on what you see and what you see is not what IS. “Sometimes the bravest thing we can do is-reach out and ask for help.” YOU DO NOT HAVE TO LIVE THIS WAY.

SUICIDAL- the ultimate level of depression. The person sees no reason to live and evaluates that everyone would be better off without them. The thought of suicide comforts them. See a physician IMMEDIATELY. Leaving may sound like the only answer…pause just a moment and answer honestly: “What will this do to the ones I leave behind?” It is a legacy you do not want to be responsible for.

Reading through this initial information can be anxiety producing. Just because you have some depression does NOT mean it will get worse. Using the knowledge of cause and effect, if we get at the cause (in most cases: stress, anxiety and negative ways in which we think) , we CHANGE the effect. This is great news!

Self-Assessment: How do you feel? The following statements have been made by very depressed people. As you think over the last month, which of these statements can you identify with? If you do not identify with any of the statements you may still be depressed but not as severely. This does not mean that you should settle for being a “little” depressed. Using the coping skills outlined in this series will help you feel better, identify where the “downs” are coming from and make the necessary changes.

__It’s hopeless/I’m hopeless
__I am obsessed with guilt
__watch out! I have a short fuse
__I drag myself through the day
__I wish I could die
__I’ll never smile again
__Just let me sleep
__Everything is dark; I lost my colors
__I drink alcohol to dull the pain
__I can’t……is my litany
__I am lonely, even in a crowd
__I feel like a he weight is on me
__I am empty
__I can’t sleep; I wake up after 3 or 4 hours
__I can’t cry – I used to
__I don’t want to see anyone
__Nothing gives me pleasure
__I barely function
__I wouldn’t wish this feeling on my worst enemy


If you have checked more than three of these statements please consult with your physician and begin using the skills in the ATTACKING ANXIETY & DEPRESSION series.

Exercise is extremely important for someone with depression. Exercise produces endorphins. This is where the “runners’ high” comes from. Going for a brisk walk every day leads to uplifted feelings. Start slow if you have not exercised in a while – gradually increase your speed and distance. Consult your doctor about a reasonable schedule and pace for you.

More Partner’s Guidelines – (client=it is the one who is anxious or depressed)

Client – “If one more person tells me to ‘just get a grip’. I think I may become violent. Do they think I want to be this way?!”

Well meaning friends, family and co-workers, sometimes even therapists, say the most unhelpful things. The intentions are usually wonderful; the messages are often awful.

Client – “ I was brought up to ‘pull myself up by my bootstraps’ I swear, at one time I was so far down in those boots – I couldn’t see daylight”

People with mood disorders sometimes need others to point out their symptoms and they may also need someone to literally make the appointment and go with them to their healthcare provider. When we are depressed, our thinking is affected. We see things through smudged, dark glasses. The depressed person blames himself for not taking action which increases his self-loathing and further insures he will not be able to act.

Stigma, unfortunately, still exists when it comes to depressive disorders. We blame it on the flu, the job, HIV, the spouse and any number of “acceptable” conditions to have. Literally millions are existing rather than living. Somehow, if we were stronger – this wouldn’t have happened, is too often the thinking. When we are depressed, we have somehow failed miserably at just living.

The significant people in the lives of the depressed person can make all of the difference.

Client – “Bless my friends! They didn’t understand panic and agoraphobia, but they sure were scared by the depression. If they hadn’t put me in a car and made me go for help, I don’t know what would have become of me. It’s funny now…they really didn’t understand panic and avoidance behaviors like being scared to drive…they made me drive! I would drive to the Midwest Center and they would leave me there, take my car and go shopping!”

Depression is subtle; it usually builds so gradually that the sufferer may not be aware. “Something is wrong, but what?”

At first there may be phantom pains, fatigue, headaches, lots of gastrointestinal problems, muscle soreness, a reported heaviness in the chest or elsewhere. All of these need to be checked out by the physician, but hopefully someone will mention depression along with all the other symptoms.

Partner’s Guidelines cont…

1.   Family and friends need to step in and encourage the depressed person to get treatment. Go with them and wait in the waiting room.
2.   Help give the history of the depression if your loved one would like you to. Sometimes an observer can point out things the sufferer wouldn’t notice or remember.
3.   Be reassuring. “This is temporary. This is very treatable. You are not weak. You are not a failure.” (Or any other negative self-description) “That is the depression talking. Would you be so critical if it were me? Then don’t do that to yourself. I love you. Give me the gift of letting me help you.”
4.   Get beyond judgment. Your loved on is not doing this for ATTENTION. Depression hurts and it’s real.
5.   Keep your relationship as normal as possible; this helps provide the feelings of security and stability.
6.   It is important to acknowledge their pain but never say, “I know how you feel.” Unless you truly do. “I’m so sorry this is happening to you.” Is comforting.
7.   Communicating that there is help and that “You will feel better” is vital.
8.   Be extra generous with sincere compliments and kindness, even if your loved one seems to brush them aside.
9.   Treat the depressed person as you’ve always treated them, with respect.
10.   ADD ANY OTHER HINT THAT WOULD BE HELPFUL IN YOUR PARTICULAR EXPERIENCE.

If you’re feeling depressed, share this page with your doctor, therapist, family, friends, any one that you trust and know cares about you. The depression might say, “Nobody cares about me” Following through may be your first step on the road to recovery.

Taking Action

1.   Listen to your relaxation music three times daily. You can find some on the internet if you do not have it in your music collection.
2.   Starting this week we need to begin tapering off caffeine and high sugar foods and drink. You may need two or three weeks to accomplish this. If you are smoking or using alcohol to “calm down”, it is time to start charting this and decrease your dependence on these negative behaviors.
3.   Initiate the beginnings of a daily exercise routine. Check with your doctor for the best beginning for you.
4.   Morning meditation. Begin each day: get up fifteen minutes before your household gets busy, sit in a comfortable chair, choose either a spiritual image or an aesthetic one (pink clouds), close your eyes and see the peaceful scene you have chosen. If an intrusive thought occurs simply say calmly, “Goodbye. It’s my time to relax.” Refocus. You may choose a mantra and repeat it over and over. For example, simply the word “peace”.
5.   Precious, present moment living is a healthy habit. You can stress and depress yourself just lying in bed! This occurs when you habitually mentally “live” in the future or in the past. When you focus all your attention on the here and now, it is difficult to feel either stress and worry. Intrusive thoughts can be turned away if you consciously shift your awareness back to the present moment. Practice the next time you are in line, stopped at a light, feel overwhelmed or down. Notice the change in body symptoms as you change back and forth.
6.   Move it meditation. As you begin walking, inhale and exhale deeply three times. Set a pace that is a brisk but very doable. Begin each step by saying, “One, two, one, two…” After two minutes, focus outward. Be fully aware of all that you see, hear, smell, feel (you can even taste the salt on your upper lip if you wish). After five minutes go back to, “One, two, one, two,…” Keep this pattern, or one you design, for the duration of your walk.
7.   Picture peace. Choose several beautiful and detailed postcards or greeting cards. When you feel frazzled or frantic, sit down in a comfortable spot and focus on the details in your pictures one-by-one. Try this several times this week; notice how your body feels after just ten minutes.
8.   Down shift! Do everything this week at a slower pace, walking, speaking, and thinking. (If you are feeling blue and sluggish, you may wish to do the opposite) Make notes in your journal every day regarding this experience. Choose a symbol or image that reminds you to slow down, a rosebud, or an old cane fishing pole. Put this symbol wherever you spend time: the bathroom (shaving, putting on makeup), rear view mirror, work room or in the corner of your computer screen.
9.   Each day use your personal journal as directed. Take ten to fifteen minutes of your time each day and write down your daily events in your journal. Make a sincere effort to write down any new insights you have this week and in the weeks to come. Your journal will enable you to see themes, patterns, progress and growth. There is magic in writing. Even if you write for just five minutes. If you feel you cannot spare the time, maybe we’ve discovered one of the patterns in both thought and outward behavior that is causing some of your discomfort.
10.   Some individuals report that they have found it to be very therapeutic to write a biography, including their experience with anxiety and depression. It is equally beneficial to write it again in two weeks, in six weeks, as many times as you feel the need to. Rule: Do not reread what you’ve written. Some find it helpful to destroy what they have written. This seems to symbolize letting go of the past and moving forward into a peaceful future. You will note the “story” gets shorter as you leave the pieces on the “outside”. You will feel less of an emotional response. This means you are experiencing some closure and resolution.
11.   Rate your panic attacks. How severe are they? (little anxious __1,__2,__3) or (moderately anxious__4,__5,__6) or (very anxious__7,__8,__9) or (panic__10)
12.   Time your episodes of panic. As you breathe, simultaneously count and look at a time piece. You will notice as the days go by the intensity and duration of panic decreases.
13.   Identify the word or sound that you make every time you experience the panic response. Change the word or sound to something comforting.

Final Comments

One vital precept you’ll learn as you go through the series. You have valid needs. Part of our anxiety problems can be traced back to not meeting our own needs, whether that’s self-love, healthy eating or talking through a concern with someone who understands. Part of your review this week is to give yourself permission to be HUMAN, not super human. Begin asking, “Why do I expect more of myself than I expect of others?” Be gentle. Be kind to YOU this week. At the same time, guard against victim thinking. “Why me? Poor me.”

You are your safe place and safe person. You don’t have to go home. You are home. You are fully capable of changing your negative thoughts and achieving a different response.

If you scare yourself with your thinking, you can also soothe, comfort and reassure yourself.


Make the BEST of each Day!

[allopathicholistic]

Thank you. I only got past part 1 of your 2-part post. The checklist seems like it can be a big help to rationalize and rise above inner weirdness. ... I will hit part 2 sometime soon

[Eldon]

Hey Alex,

You are welcome. Most definitely bookmark this thread for your future reference.



Make the BEST of each Day!

[Life]

I think I could have used this about 4 days ago Eldon.... 

[Eldon]

Eric,

I said the exact same thing when I ran accross this. It is some powerful stuff.



Make the BEST of each Day!