Is panic disorder a physical or mental problem… or both?

by William D. Kernodle, M.D

The following article is excerpted by permission from the book, Panic Disorder: The Medical Point of View, by William D. Kernodle, M.D. This section pertains to “Key Points About Panic Disorder.”

A panic attack is a normal physical reaction occurring at an inappropriate time. Panic disorder may affect 5% of the population. By diagnosing panic disorder early, effective treatment can begin which should control or eliminate panic disorder, as well as prevent any possible complications. Panic attacks are benign; the complications of panic disorder can be malignant. Possible complications are anticipatory anxiety, demoralization, depression, agoraphobia, alcoholism and even suicide.

The best way to prevent complications of panic disorder is to diagnose it early. Panic disorder should be a rule-in diagnosis, not a rule-out diagnosis.

There is strong evidence that panic disorder has a biological core. Its complications are primarily psychological. Panic disorder is believed to have a strong biological core because of its strong familial and genetic tendencies: because panic attacks can be reproduced by physical means in the majority of patients vulnerable to panic attacks; and because medication is highly effective in blocking panic attacks. This same medication can prevent panic attacks from being caused by physical agents such as sodium lactate. PET scan data have established brain abnormalities in panic disorder. More evidence for the biological core of panic disorder should be seen in the future.

Panic disorder fits well into the medical model, including diagnosis, treatment and prognosis. It is analogous to ulcer disease. There are different stages: mild, moderate and severe. It is often chronic. Stress is contributory but not a sufficient cause for panic disorder, just as in ulcer disease.

In motivated patients, treatment using medication, education and cognitive-behavioral techniques is 90% effective. While this treatment combination has been scientifically verified, it is not standard treatment in this area. Supportive psychotherapy may be helpful, but is not as specific in treating panic disorder. Long-term exploratory psychotherapy used to find the cause of panic disorder has been ineffective and cannot be verified scientifically. Psychological and social factors should certainly be addressed if other treatment methods have failed or are not bringing the desired results.

Multiple factors are involved in panic disorder. Even though we have not yet pinpointed the exact cause, or causes, of panic disorder, we now have extremely effective treatment to help patients live normal, productive lives.

Ed. note: We have had numerous inquiries as to the medical viewpoint versus a more psychologically-based causation stance. In an effort to share more of such information with our readers, we are pleased to provide this article. ENcourage Connection is committed to disseminating information supplying a broad spectrum of ideas, and we trust that our readers will benefit as a result of having a well-rounded “education” in furthering each person’s efforts toward wellness.

Image Credit: smokedsalmon / FreeDigitalPhotos.net

(This posted article was originally published in our ENcourage Connection Newsletter, print version.)

Expert advice on dealing with social phobia…

by Thomas A. Richards, Ph.D.

What would it be like to sit in front of the telephone and agonize for hours because you’re afraid to pick up the phone and make a call?

You’re even afraid to call some unknown person’s office although you know that the person will never know who you are. Still, you just can’t seem to lift the receiver and make the call. If you were to make it, you’re certain that your voice will falter, you will begin stammering, and you will sound weak or silly. You don’t want to sound weak or afraid, so you don’t make the call.

You want to go to parties and other social events–indeed, you are lonely–but you don’t go because you’re nervous about meeting new people. Too many people will be there and crowds bother you anyway. If you went, you know you’d be afraid and embarrassed, so you don’t go to the party.

You dread meetings at work because you know you’ll be “on the spot,” tense, and anxious. You’re intelligent, but you won’t be able to discuss matters freely in front of other people because you’re so worried about what they will think about you. You stare at the ground or fix your eyes on the table. When you have to speak, your voice sounds hesitant. You know you sound weak and sometimes you even stammer. Other people are probably thinking you’re dumb or just plain weird. The tension, anxiety, and fear continue to mount. It’s humiliating to feel this way, but the fear in the pit of your stomach won’t go away.

Finally, the meeting is over. A big wave of relief spills over you and you begin to relax. But the memory of the meeting is still with you. You are convinced you made a fool of yourself and that everyone else in the room saw how afraid you were and how stupid you acted in their presence.

In public places, such as work, meetings, or shopping, you feel that everyone is watching and staring at you. You can’t relax and enjoy yourself. In fact, you can never relax when other people are around. It feels like they are evaluating you, criticizing you, or making fun of you. They don’t do this openly, of course, but you still feel the judgment in their presence. So you avoid other people.

Many times you simply must be alone–closeted–with the door shut behind you. Even when you’re around familiar people, you feel overwhelmed and have the feeling that they are noticing your every movement, critiquing your every thought. You feel like they stare at you and that they’re making negative judgments.

What seems to be the very worst circumstance, though, is meeting new people who you think are “authority figures”–people such as bosses, supervisors, principals, and doctors. You feel that these people are more important than you are. You get a lump in your throat and your facial muscles just won’t work up into a smile when you meet them.

A job interview is pure torture; you know your anxiety will give you away. You’ll look funny, maybe you’ll even blush, and you won’t be able to find the right words to answer their questions. It is especially infuriating because you know you could do the job well if you could only get past the interview.

Welcome to the world of the social phobic.

Social phobia is a relatively common problem that affects millions of people–men and women almost equally. Unlike some other psychological problems, social phobia is not well understood by the general public or even among practitioners. Because few social phobics have heard of their problem and have never seen it discussed on the television talk shows, they think they are the only ones who have these symptoms. Unfortunately, without some kind of knowledge and treatment, social phobia continues to wreak havoc on their lives. Adding to the dilemma, social phobia does not come and go like other psychological problems. If you have it, you have it every day.

The feelings I described to you at the beginning of the article are those of people with “generalized” social phobia. That is, their symptoms apply to most social events and functions in almost every area of life. I suffered from social phobia myself for eighteen years before I ever saw the term or read about its symptoms in a textbook.

Luckily, my social phobia has, for the most part, been under control since I learned how to deal with it. I do not say that I’m “cured”–that term is too strong. I do say, though, that life is much easier, more bearable, and even enjoyable compared to how it used to be.

As with all problems, everyone with social phobia has slightly different symptoms. Some people, for example, cannot write in public because they fear people are watching and their hand will shake. Others are so introverted that they lack normal social skills, thus making it impossible to “fit in” with any social group. Still others have a severe phobia about eating or drinking in the presence of other people.

One thing that all social phobics share is the knowledge that their thoughts and fears are basically irrational. That is, social phobics know that people are really not critically judging or evaluating them all the time. They understand that people are not trying to embarrass or humiliate them. Yet, despite this head knowledge, they still continue to feel that way.

It is the automatic “feeling” and thoughts that occur in social situations that must be met and conquered in therapy. Usually, these feelings are tied to thoughts that are entwined in a vicious cycle in the person’s head.

What can be done about social phobia? Many therapeutic treatments have been tried, but cognitive-behavioral techniques have been shown to work best. Some of these techniques are the ones used for panic attacks, agoraphobia, generalized anxiety, and post-traumatic stress problems. Other techniques are entirely different.

Attacking irrational thoughts, role-playing real-life events that will occur, and imagining problems and learning to cope with them are therapeutic techniques that work for some anxiety problems. However, many social phobics benefit from shame-attacking exercises, role-playing and learning new social skills, realistic assertion-skill development, and an all-out campaign to ferret out the inaccurate thinking that is tied to anxiety.

Many times the results are dramatic. If therapy is structured toward teaching the patient to be responsible for thoughts and feelings, then progress generally continues after treatment. This is not to say that social phobics become anxiety-free after treatment. But quality of life is greatly enhanced, and people often find they can do things that they never would have considered before treatment.

Social phobia responds to relatively short term treatment, depending on the severity of the condition. I have seen significant progress in just six sessions, although most people respond better with ten to twelve meetings.

What social phobics do not need is years and years of therapy. In fact, social phobics who learn to “analyze” and “ruminate” over their problems usually make their social phobia worse.

There is hope for a better life for all social phobics. Without treatment, social phobia is a torturous emotional problem; with treatment, its bark is worse than its bite. Many of us have been through the crippling fears and constant anxiety that social phobia produces–and have come out healthier on the other side.

Thomas Richards, Ph.D. is a psychologist in private practice in Phoenix, Arizona and specializes in the treatment of anxiety disorders.

 

(This posted article was originally published in our ENcourage Connection Newsletter, print version.)

Why dropping our unrealistic perfectionism provides anxiety relief…

by Susan Turner

This article is going to be different from past ones as I will not be the only person writing it! Yep, you are getting a break from me! I asked a few of my friends to contribute to this topic as it is a very important one. If you are anything like me, you love to hear from as many people as possible on ways to overcome some traits which most definitely need modifying. And yes, I confess, perfectionism is a trait I continue to work on. Letting go of perfectionism is a process just like our agoraphobic/panic disorder recovery is. Wouldn’t it be fantastic if those of us who suffer with “having to be perfect” could wake up one day ….and poof…that aspect of ourselves was no longer with us? But alas, just like many of us wish we could open our eyes one sunny morning and panic would be no more, it just “ain’t” so. It “ain’t” going to happen! Work, yes, work is involved in ridding ourselves of a trait which can reek havoc in our lives and be extremely debilitating.

My striving for perfectionism came from feeling totally imperfect on the inside. Okay, I knew I was way imperfect, but I decided if I put on this “perfect” front I could fool everyone. Unlike many perfectionist people, though, I did not strive to be the perfect mother, wife or house keeper! Ah, if you could see my house(my kids, my husband!), you would know I am speaking the truth! My family knew I was far from perfect so it was the outside world’s eyes I was attempting to pull the wool over.

Perhaps, I mused, if the world thought I was perfect, then in some magical turn of events, their praise would enter my body and mind, making me less and less imperfect. As you probably already figured out, it didn’t work. No matter how much praise I received, the fuzzy warm feelings were fleeting. I was left empty and off to find something else I could be perfect at.

How have I gone about changing? How have I been able to begin letting go of perfectionism?

The first step actually occurred years and years ago. Way before I had my first panic attack. I may have related this little bit of folklore to you before, but I feel it bears repeating.

I use to do a million different arts, crafts and hobbies. For those of you who knit and crochet, you know it is not fun to have to ” rip back” your work. There you are happily crocheting or knitting away and all of a sudden a few rows down from the row you are you working you spot a MISTAKE! Of course, in reality, you would probably be the only one to notice it…but still….it HAS TO be fixed. YOU CAN NOT HAVE A MISTAKE IN YOUR WORK and that is that! Ripping back( pulling out the stitches) while crocheting is not too bad…but ripping back while knitting is a royal pain. But I did it! There could be no mistakes in my work. So a hobby which was suppose to be creative, relaxing and fun turned into utter frustration for me.

After I complained to a friend( I complain well (and a lot!) about having to rip back to fix my mistakes, she shared this little story with me.

There is a tribe of Indians who weave blankets and make money doing so. These Indians INTENTIONALLY make a mistake in each of their blankets! Why, you ask? I sure did! They make a mistake on purpose and leave it in their weavings to prove they are not perfect–only God is. What a concept! I was blown away by the tale.

I am not a religious nor spiritual person but for some reason, I understood why the Indians did what they did. Who knows? Maybe I needed an excuse! Whatever the reason was, from then on I was able to let a mistake or two( not real noticeable ones, mind you) in my crocheting or knitting go. It was hard, believe me…but after awhile I was okay with it. Unfortunately, unlike panic which generalized by the speed of light to every place outside my house after experiencing my first major attack at work…the Indian- intentionally- made- mistake did not generalize into any other part of my life!

I had gained a small victory in my fight against perfectionism, but the rest of my life was steeped in going for the gold!

As I mentioned above, I experienced my first panic attack at my job. I was working as a teacher’s assistant. One of my duties was to check the students’ spelling tests. The teachers I worked with gave practice tests Tuesday, Wednesday and Thursday. Friday was the main test. Okay, so here I am Miss Perfectionism having to check over fifty tests four times a week. I went nuts going over and over each test. I COULD NOT MISS a word spelled incorrectly. Well, of course, on occasion no matter how diligent I was, I did miss a word. When the teacher pointed my mistake out to me, I was devastated. She was not in the least bit upset. She just wanted me to know. For me, the world had crashed down around me. The secret was out…SUSAN WAS NOT PERFECT!

I could recount instance upon instance where striving for perfection made me extremely anxious and caused me much distress. But I think you get the picture. None of us want to be slouchers…but… it is not healthy to forever chase after perfectionism. It can not be run down!

Can a middle ground be found? I think it can be.

I would now like to share with you what some of my friends( in recovery from panic <and perfectionism>) had to say when I asked them to help me out with this topic. Ah….I will be back, though, at the end of the article to tell you how I am doing at present on my quest to rid myself of “needing” to be perfect.

Everything had to look its best or I’d stress out trying to get it there. I would wrap a Christmas present with fancy paper and just the right shade of color for the bow or ribbon. Of course, they have to match…now, don’t they? My son’s socks had to go with his shorts. His cowlick had to have just the right amount of gel to keep it under control. When I took my car to the garage, of course, it had to clean on the inside and out. I didn’t want the people at the garage to think less of me, now did I? Just writing this out is exhausting me….ahhhhhhhhhhhhhhhhh! It didn’t take a day but in time I have changed my perfectionist habits. I still like things clean and neat, but the difference now is I don’t let my house define who I am nor does it control my life. My time is more enjoyable now. I, also, feel much differently about myself. I have lost those negative “SHOULDS” which go along with the need to have everything ” perfect.” Two little words have helped me so much…I say them over and over again…WHO CARES? Who cares if the mechanic sees my messy car? ( like they would even care anyhow) Who cares if my son’s cowlick decides to do what it does best! Who cares if the gifts I give aren’t wrapped neatly and color coordinated with ribbon and just the right bow? ( I know my kids don’t when they are ripping them open!) I still have more work to do, but I ‘m on my way to a much more relaxed life…and it feels good, too Just ask my family.

-Bobbi

 

I’ve never been much of a perfectionist. My husband will attest to that…but… I do like to keep a neat as a pin house. Closets are my biggies. Everything has to be lined up. I would never leave my house without everything being just so. I am not sure if this was a perfectionist behavior or more of a phobia. I had visions of something happening to me when I was out and… I didn’t want anyone coming into my house thinking I was less than a perfect housekeeper.

I have really come a long way where my house is concerned. Now I can leave with beds unmade and dishes in the sink. I could never have been able to do this before. I’ve changed my “what if” thinking revolving around my agoraphobic recovery. I, also, have changed my ” what if they see my house like this” negative talk to “Too bad if they don’t like how my house looks, they can clean it themselves! ”

-Cheryl

 

When I was a child, I lived with parents who were perfect in their cleanliness…and also obsessed with helping the ” universe.” I grew up demeaned for what my parents perceived to be a lack of neatness on my part. I was, also, ridiculed if I did not stop to help every street person or someone who had been in an accident. These rules were stringently observed and religiously obeyed. I did take on some of my parents’ ways.

My family ran to every poor home and helped strangers on the street. I, too, helped others because of my upbringing. I volunteered in hospitals. When in college I volunteered in the department studying brain patterning. Everyone came before me. My parents died when I was in my twenties. My older relatives assumed I would take their place. They expected me to travel across the country running to help every relative and to entertain all the time. I did my share of entertaining but due to my panic attacks, I could not travel to help all of those who felt I should. I lied to my relatives for years giving them a multitude of excuses as to why I could not come to them. In time I realized that I had to let go of my parents’ ways. I had to be myself. So…I told my relatives the truth. I told them I had panic attacks. I could not always be there for them. When relatives visited me, my home was not in the ultimate state of cleanliness my mother’s house had been. For many years, I suffered shame due to my lack of neatness. But now, I am happy with me. My house is not dirty, it is warm and lived in. I do help those that I CAN AND WANT TO help. I can’t travel to the ends of the earth as my parents did nor do I want to anymore. At this stage in my recovery from agoraphobia I do want to travel more, to be there for those I love, but only for those who accept me for who and what I am. I still live with my mother on my shoulder at times. When she is with me, I take a magazine or book and read it in the tub. This is my symbol of freedom from her after thirty years!!

-Rachelle

 

My area of perfectionism lies in not making mistakes. Having a low self-esteem to begin with, making a mistake made me think even less of myself. I had to boost my self-esteem some way and the only thing I could think of was to be “perfect.” Study hard, get good grades, say the right things at the right time, wear the right clothes, please all of the people all of the time…the list goes on and on. Needless to say, it’s a lot of work being “perfect.” Changing wasn’t easy. It meant letting go of a lot of negative self-talk that had become the norm for me. It got easier when I had kids because a lot of the positive reinforcement I gave them, I also gave myself. When they made a mistake, I helped them to learn from it, and consequently, I began to realize that sometimes it’s good to make mistakes, because we learn from them.

-Michele

 

“Would you like to come over for dinner?”

“You and the children can spend the weekend. It will be fun!”

These are some of the things I avoided saying for many years. I always had an excuse: the house is too small, I don’t have time to make dinner for company, I’m not interesting enough to entertain. But the reality is that I am a perfectionist and the thought of people around for extended periods of time bothers me. I’m afraid I won’t have enough time for myself, afraid that people won’t like my cooking, afraid I’ll be boring, afraid I won’t be able sleep while other people are in the house. and afraid my life will be scrutinized. In short…I am afraid I won’t be perfect.

I’m making an effort to change. I ‘ve found a few techniques which help with dinner guests. First, I force myself to invite someone over. Then I make only tried and true recipes and tell them it’s going to be a causal dinner. I accept their offer to bring something( it takes the pressure and focus off me). I have my husband and children help with cleaning the house.

The situation is similar with overnight guests. I only invite close friends and relatives….and even then I have to force the words out of my mouth! I give them lots of privacy. I go into my room early enough at night to have time to myself.

I’m still not an easy-going person who can joyfully entertain day after day. I have to gear up for it. But I have noticed that after a couple of years of having my children’s’ friends spend the night occasionally, I no longer worry about that type of guest.

I know that it gets easier as I force myself to do the things which make me uncomfortable. I’m always very proud once I invite someone over and even more proud once I have pulled it off!

-Lynn

 

I hope you enjoyed reading what some of my friends had to say about there dealings with perfectionism. See…you are not alone! There are many many just like you out in the world.

Okay…so how am I doing on my quest to overcome perfectionism? Well…not too badly! Not sure what is up with me but over the last year or so, I have learned to laugh at myself more. This is not to say that if I was still working at school and I didn’t find a spelling error on a child’s paper I would be thrilled and make a joke out of it…but…I am lightening up. The word ” DUH” has become a big part of my vocabulary…and I use it often to make fun of the some of the mistakes I make. Once I realized my friends did not think less of me( and probably were grateful I was not the robot I appeared to be!) when I made a mistake, I felt as if a gigantic weight had been lifted off my shoulders. This is not to say I run around happily making mistake after mistake because that just is not in my personality. But I have learned that mistakes can be fixed, mistakes can be forgiven, and mistakes will not bring my world crashing down around me. Well, not little mistakes, anyway! HA. And interestingly enough, once I lightened up about my mistakes(because no matter how perfect I tried to be… unfortunately…I still made them), I developed a sense of humor! Surprise! I had been pretty humorless before. I laugh at me and my friends laugh with me. Many times I don’t mind being the butt of a joke which I had created by making a mistake.

Today, I feel so much “lighter!” It is a very heavy burden striving for unattainable

….PERFECTIONISM.

Until next issue…

have a great fall…
and lighten up…
life is way too short…
to carry around our perfectionist baggage

day after day after day…

 

(This posted article was originally published in our ENcourage Connection Newsletter, print version.)

How one women dealt with panic attacks during pregnancy…

-  One Woman’s Experience . . . and Joy

by Beth Watson

Like most women, when I found out I was pregnant, my thoughts were filled with questions: Will the baby be healthy? What sex will the baby be? What kind of mother will I be?

Having panic disorder raised some different concerns for me, as well. I worried about my medication; would I be able to continue to take it, and what about side effects to the baby? I worried about the delivery; how would I ever manage the normal anxiety associated with labor and delivery compounded with my heightened level of anxiety because of the panic? And the question, “what kind of mother would I be,” included questions about whether or not I could handle the daily care that a child requires. Could I take the baby to the doctor even though I was having a bad day? What if there was an emergency; could I handle it or would I panic?

When the nurse told me that the pregnancy test was positive, I was shocked, overjoyed, and scared to death–all at the same time.

The first trimester of my pregnancy was very easy for me. I went to my ob/gyn and together we researched the medication I was on (an antidepressant and a tranquilizer). After doing some reading, we both felt it would be safe to stay on the medication during the pregnancy. I then began reading every baby and parent book I could get my hands on. I was still very nervous about the delivery, so I decided that having a Cesarean section was the answer. I convinced myself that if I had a C-section, I would be able to set the date of the delivery, and I wouldn’t feel much pain because of the epidural. I would be in total control! Now all I had to do was convince the doctor, but I had plenty of time for that. (Hormones do wild things to your perception of reality!)

I moved to another state during the second trimester, which meant changing doctors. When my new doctor learned of the medication I was taking, he became very concerned and started talking about possible birth defects and how my baby would have to be put on drugs after delivery to deal with the withdrawal. He then rushed me to a hospital to begin getting me off medication.

Needless to say, this was all pretty frightening. They proceeded very cautiously because I was pregnant, but within four weeks, I as off all my medication. The withdrawal from the medication wasn’t fun, but I still don’t know how much of that was withdrawal, how much was pregnancy, and how much was panic.

Now here I was in a new city, with no friends or family, pregnant, with no medication. If I could have crawled under the covers and stayed there, I would have, but luckily life doesn’t work that way. And, to my surprise, I was able to handle many new and possibly difficult situations with ease. I’ve heard that the hormones your body produces while you are pregnant can block panic, and that may account for some of it. I also discovered that people are extra friendly and forgiving to a pregnant woman, which gave me a great deal of security. I knew that if I was in a line and began to feel panic, I could simply ask someone to hold my place while I went to the bathroom or ask if I could go ahead of them because I wasn’t feeling well.

By my seventh month, I was feeling great. I was experiencing no anxiety, other than the “normal” new-mother concerns. The doctor had ordered two ultrasounds because I had been on the medication, and our little boy looked just fine. And although I realized at this point that I couldn’t just decide to have a C-section, I was relaxing more and more about the idea of going through labor. After all, the doctors will let you labor for only twenty-four hours, and I could handle anything for twenty-four hours.

I began using the same tools I use to deal with anxiety to prepare for the upcoming event. I used a lot of visualization and rational self-talk, along with relaxation techniques which I planned to use during labor.

My husband and I took a Lamaze course which I highly recommend for all new parents. The fear of the unknown is hard for me, and this course answered a lot of my questions, dispelled a lot of myths, and gave me tools to practice so that I felt more in control of the situation.

Being the typical “high anxiety personality,” I had my Lamaze bag packed six weeks before my due date. My husband and I practiced our breathing techniques regularly, and we even made up a computerized chart to use during the contractions. (The nurses loved it!) At this point, I was pretty confident about my ability to handle labor, but I was still trying to figure out how to get out of going through the delivery.

By my ninth month, I was more than ready to have this baby. I had gone over my list of final questions with my doctor. I must say I was a little disappointed with some of the responses I got. I had been told that there was a mild tranquilizer that could be given early in labor if the mother was very anxious. As my doctor knew of my panic disorder, I asked that this be made available to me if I needed it; I was told, “Don’t worry, honey, everyone’s a little nervous before they have a baby.” I explained my circumstances again, thinking: the doctor sees a lot of patients, maybe he forgot. He then told me I could go back on my medication if I thought it was necessary. It was lucky for him that I was too big to move quickly, or I might have strangled him. After all we had gone through five months earlier–and now he had changed his mind. I know doctors differ on whether the antidepressants and tranquilizers are safe for pregnant women, but I assumed my doctor only had one opinion.

Finally, the big day arrived. My contractions started after breakfast, on my due date, five minutes apart. We called the doctor and he told us to go on to the hospital. We then called the hospital and asked if there was a nurse on duty familiar with panic disorder. They checked on it, and she was waiting for us when we arrived. I was calmer than I had thought I would be. In fact, my husband still teases me that I had to get that last load of laundry done before we left for the hospital.

After twelve hours of labor, I had an epidural. I didn’t like the idea of being confined to bed (I was more comfortable walking than lying down), but once the epidural kicked in, I didn’t mind. When I reached 10 centimeters dilation, the nurse told me I could push when I felt the urge. She came back a half hour later and seemed surprised to find me still lying there watching TV. (Believe it or not, I was still trying to figure out how to get out of delivering this baby!)

After a little coaching from the nurse, I began to push. In less than fifteen minutes, my son was born. Labor and delivery were not as bad as I had thought they were going to be. I had heard so many horror stories. But I found that if I relaxed and went with the contractions, time just seemed to slip by; before I knew it, T.J. was in my arms and I was officially a Mom.

We brought him home two days later. I had spent so much time preparing for the birth, but no one had prepared me for the first few weeks at home. Between the hormones, the lack of sleep, and the new person who literally depended on me for his life . . . I was overwhelmed and had a lot of anxiety. My mom stayed with me for the first week, and when she left I thought I was going to fall apart. To no one’s surprise but mine, I didn’t.

Today T.J. is a healthy, happy nine-month-old. I’m lucky enough to be able to stay home with him. Nothing in my life is the same as it was since the day the nurse told me I was pregnant. I’ve pushed myself at times because my son needed me, when in the past I might have let things slide. I’m stronger and happier (and more tired) than I was then. And I’m even thinking about baby number two.

I worry about what kind of example I will set for T.J. Will panic disorder affect his life, either through me or because he develops it? These are questions I can’t answer now, but my husband and I joke that we aren’t just saving for his college education, we’re saving for his therapy. I know that along with some of the “high anxiety personality” traits that he may pick up from me, I will also teach him how to deal with stress and anger and give him the tools to manage the anxiety if it becomes part of his life.

Having a baby has also helped me to reach a long-term goal that I had set years ago when panic first came into my life. I wanted to learn how to have fun again. Now, when my son giggles, or shows wonderment at a new toy, I feel a joy and playfulness I haven’t known in years. Oh, to see life through the eyes of a child!

Reprinted by permission, ABIL Newsletter, December 1993. ABIL Inc. (Agoraphobics Building Independent Lives) is located at 1418 Lorraine Avenue, Richmond, Virginia 23227.

(This posted article was originally published in our ENcourage Connection Newsletter, print version.)

Another inspirational story of agoraphobia recovery…

an interview with Linda Hyman by Pat Merrill

On March 2, 1995, I watched Linda Hyman with great respect. I had never met her, yet I knew I would want to. She appeared on the “Leeza” show, sharing her experiences in recovering from agoraphobia. I’m glad that we did meet by phone and that she graciously allowed me to conduct this candid interview with her. I learned a great deal from her, and I suspect you will too.

One of the first things I wanted to ask Linda Hyman was, “Why did you go on national television?” I suspected I knew the reason, and I was right. She is one of those special people who wants to help others who are struggling or simply need more help.

It is not easy for the average person to walk onto a Hollywood studio set in front of an audience of strangers, let alone a sensitive person prone to experiencing an intense variety of anxiety. Yet there she sat, an attractive young woman, appearing amazingly poised. She answered Leeza’s questions with candor and conviction.

How did she feel about being on the show? Was she as calm as she appeared? Linda reported that she really was pretty tense, but she knew how to deal with those anxious feelings. “It was exciting,” she revealed. “The fun part of it was when they came to my house to make tapes. What caused me a lot of anxiety was that, knowing the most important things they taped and that we talked about, never would show because they weren’t ‘exploitative’ enough.” All of the tape that was shot showing Linda working with a field worker, showing how one is worked through things such as going to the market, was not aired. Additionally, the O.J. Simpson trial preempted that particular “Leeza” program at least in Southern California where Linda lives and works.

Having had panic disorder off and on for about a dozen years, Linda knew the pain and struggle well. During that time, she additionally went through some immense stresses and personal tragedies–a major accident, painful losses, a stalker.

For a period of time, she managed to–despite panic attacks–continue in her strenuous and stressful career in the Los Angeles area as a salesperson and designer. “I would have to have meetings in front of groups of people to sell a project, and I would go in . . . without remembering a word I said. But nobody knew.”

She tried various forms of therapy including psychotherapy. But she quickly worsened and eventually became very agoraphobic, completely housebound. Deciding to admit herself into a hospital program for treatment, she risked leaving the “safety” of her home for the help she hoped to receive. Linda recounted the difficulty she experienced. “I had to go with a pillow over my face just to get there.” Despite the severity of her symptoms, the evaluating psychiatrist said she wasn’t “bad enough” to be admitted. “All of that trouble and all of that heartache was for nothing,” she lamented.

Another attempt to be treated at a well-known hospital proved equally disappointing. It became clear the first day when she was locked in her nearly empty room by the staff that they did not understand agoraphobia. She left.

But on her way out, she saw a sign that mentioned a treatment program called TERRAP (which stands for Territorial Apprehension, the term coined by its founder, Dr. Arthur Hardy).

She discovered that it was a specialized program for those with panic and anxiety. “We ended up making it there and went to the orientation, and I sat outside on the steps and cried, and my mom went inside. I listened and could kind of hear what was said and I thought, ‘This is me! Wait a minute!’ ” All the staff had experienced the same things Linda had. “The woman that came outside to talk to me is now one of my co-workers.”

Being so phobic, it was difficult for Linda to begin attending the program. She recalled that “the first week I sat outside in the hallway, the next week I went into the door a little ways, the third week I was inside.”

Linda started working as a volunteer for the TERRAP office after she had been part of the program for a relatively brief time. Not driving yet, her mother drove her there to work four days each week. Next, she began driving there herself, with her mother in the car. Later, she began driving in her own car, having her mother follow her in another car. Eventually, she was able to get there on her own.

Does she consider herself recovered? “I call myself recovered, but as you know, ‘recovered’ is a funky word. This is something that I’m born with. It’s never going to go completely away. Everybody gets anxious. I have a lot more chemical imbalance as far as my adrenaline than most people do. . . . To me recovery is knowing when I’m getting anxious, knowing what’s happening, being able to figure out a way to circumvent it and not get into panic.”

On the television program, viewer’s saw Linda’s loving and supportive parents in the audience. But she mentioned that her best friend of twelve years did not understand her panic and phobia; subsequently their friendship ended. “What I tell people is that if others love you, honestly love you, they will try to understand. And if they’re not going to, then you need to find another avenue to make yourself better. If you can’t rely on them, maybe they’re not the people you need to have in your life, maybe that’s why you’re having anxiety. If they’re not going to be supportive, then evidently they don’t love you enough.”

What is the most important thing that she thinks is key to recovery? “It’s hard to do without support,” Linda answered. “But the most important thing is to know is that this is a terrible thing and it’s a terrible feeling, but thank God this is all you have. It could be a lot worse. Even when you’re in the middle of the worst panic attack and feel like you could die this minute . . . if you work hard enough, and you care about yourself enough, building up your self-esteem again, you can get through it. But you have to do it yourself. That’s the most important thing. No one can do it for you.”

Today Linda is able to “do everything.” “I travel, I go everywhere, I can even go to Las Vegas–the most anxiety-provoking city! I can drive, fly, do restaurants and malls.

“The most important message, I think, is for people who have this is to not be scared, to tell someone, to go to their doctor and get the proper care . . . to not be ashamed of it, to have enough love of yourself and you can get better.

“I’m not embarrassed by panic attacks any more. I still hate the feeling, I’m not going to lie about that. They still scare me, but I’m not ashamed.

“A couple of weeks ago, I had a panic attack in the store, and I just sat down on the floor. I sat there for a minute, did my breathing, thought about what was going on. . . . I realized I had [tried to get too much accomplished and was rushing too much]. I don’t think I was exactly doing it the proper way! So, I calmed myself down, went to the phone and [changed some plans] so I could get things done that I needed to.

“Not one person looked at me when I was down on that floor. . . . It helps you to get over this when you know that people aren’t going to just look at you thinking, ‘What a weirdo!’ ”

Linda shared the fact that she had had to work to get past the embarrassment issue. During her treatment, she went to a major department store while with her mother, and had a panic attack in the children’s department. Rather than fleeing, Linda got on the floor and acted out a little temper tantrum just like one of the little children that was fussing in the same area. To her surprise, despite several other shoppers being present, not one person seemed to notice! “Everybody is too busy. . . . I was at the point where I was tired of worrying about it,” she declared. This was a real breakthrough in her progress.

Linda is also no longer embarrassed to request help when necessary, even from strangers. She simply explains matter-of-factly that she is not feeling well and has an anxiety disorder; if she feels the need for some assistance, she has found that someone is always willing to help.

But even more significant, Linda explained how important it was in her recovery when she realized that she could handle her anxiety alone if need be. “The reason before that I wouldn’t drive is because if I had a panic attack and had to stop, I would think, ‘What if I can’t go again? What if I’m stuck here?’

“Well, I cured myself of that by making myself stop without one [a panic attack]. I’d pull over on the side of the freeway; you can pull off and get back in the traffic if you need to.” She added humorously yet with all seriousness, “You could pull over into a shopping center, run around the car 50 times and scream, do whatever you want to do, get back in the car and you can still go!”

Linda’s coping skills and strategies no doubt additionally helped her with a very scary, life-disrupting situation not long ago. She was able to respond well during and after the serious Northridge earthquake that severely damaged her home.

It seems obvious that Linda’s recovery had much to do with her perseverance and willingness to change. Having worked hard to help herself, she is now more than willing and able to help others.

(This posted article was originally published in our ENcourage Connection Newsletter, print version.)

Helpful ways to deal with anxiety…

by Susan Turner

that the words HOLIDAY and STRESS don’t have to be used in the same sentence!

During this time of the year almost everyone becomes anxious . . . not just us! We are used to living with anxiety! By remembering a few things we can make this holiday season less stressful for ourselves and maybe, for once, we will be the calm ones!

Remember there is no “correct” way to shop for gifts. In this day and age we can choose gifts from catalogs, home shopping TV channels, or create our own. We can even order through our computers.

Remember if you plan to shop in stores, begin as early as possible with a prepared list in hand. Shop during the least crowded times. Do as much as you can then leave–tomorrow is always another shopping day.

Remember to be easy on yourself. Give your list of “shoulds” a holiday, too!

Remember to use the word NO a lot! You don’t have to do everything which is asked/expected of you. Pick and choose the events YOU want to be involved in or to attend. Always give yourself permission to change your mind about going or about how long you will stay.

Remember if dinner is being held at your house to delegate responsibilities. You don’t have to do everything yourself. During the dinner, you can go into your bedroom or outside to take a breath of fresh air and regroup. Most importantly, remember the holidays are for YOU too–not just for everyone else!

Wishing you a peaceful holiday season.

(This posted article was originally published in our ENcourage Connection Newsletter, print version.)

Mastering simple anxiety-reduction strategies…

by Pat Merrill

Perhaps it is simply human nature to want a “quick fix.” All of us, especially when we are suffering, want relief NOW. That’s natural. But is there a magical, fast track cure for phobias and anxiety?

It does not appear that there is. However, if we are willing to “go back to basics”–that is, to use the tried-and-true fundamental approaches to recovery-we find our very best shortcut to improvement.

Rather than looking for the fastest way out of our misery, we seem to be far better off in the long run if we are willing to loosen our grip, so to speak, and stop fighting our anxiety. Work with it. (Easier said than done? Yes, but it is doable–and more than worthwhile.)

How many of us have read dozens of books on recovery practices, but as time goes on, we find we are still miserable? And how many of us have been to several doctors/therapists/treatment programs, and remain anxious? Truly, that is so very discouraging.

But we have to honestly look at the reasons for this common situation. Certainly, there are techniques, therapies, and tools that we might practice religiously without good results, and this could simply indicate that they are not useful approaches for a particular individual. If this is the case, then we need to move on and try more approaches that could suit us much better; we must find what works for us.

Another realization is the sad truth that some therapies and approaches are not very good to begin with! For example, there are well-meaning therapists who try to treat folks with anxiety disorders, but they are perhaps not so well-qualified to do such specialized work.

But another important consideration is this: Did we honestly give the program of treatment the effort and length of time necessary to bring results? If we are honest, many of us, though not all, would have to admit that they did not give it the necessary work or time required.

With each individual, there is a unique course of progress. For some of us it goes relatively quickly, for others it seems excruciating slow. As I have said so many times, recovery is a process. And while I wish I could say that it is a straight uphill climb, I have to report that, more often, it is a climb of great effort complete with slips backwards and much exhilarating forward progress!

We have basic tools we need to work with. Breathing skills, cognitive changes, desensitization work, daily relaxation, relieving stressful situations in our lives, healing old emotional wounds, developing a strong sense of self, and perhaps medication is called for. These are among our “basics.” It is up to us to put them into practice and have the patience and drive to see it all through.

No one said is would be easy, but we can do our best to make it as pleasant as possible. Just knowing that we are on a journey to feeling better than ever is a great motivator. And know, too, that this same set of challenges is being met by hundreds of others reading this newsletter along with you, as well as thousands of others. We aren’t alone, and we have so much to look forward to. Recovery is within reach, and that is the most basic–and wonderful–premise of all.

(This posted article was originally published in our ENcourage Connection Newsletter, print version.)

An inspiring story of recovery from agoraphobia…

by Shirley Swede

We are pleased to share this article sent to us by Shirley Swede. Readers may be familiar with her most helpful book, The Panic Attack Recovery Book, which she co-wrote with Seymour Sheppard Jaffe, M.D.

When people have a great fear of something–public speaking, heights, whatever–the natural tendency is to want to avoid those situations. That’s why you often hear this well–meaning advice: “If you want to overcome a fear, if you want to grow, you have to step out of your comfort zone and take a risk.”

Sounds like reasonable advice, doesn’t it? And it IS reasonable. The only trouble is, it’s difficult to do. It’s difficult to let go of the familiar, the comfortable, and just leap into the Unknown.

That’s why I want to present to you a somewhat different approach-and that is: If you want to overcome a fear, don’t leave your comfort zone behind! Instead–take it with you!

Let me give you an example of what I mean:

At one time, I had a tremendous fear of flying. I mean, I’d see a plane in the sky and I’d quake! I wasn’t afraid it would fall on me – I just used to wonder: How can people DO THIS?? How can they even think of walking into this thing?? Oooh!

Well, the first thing you need in order to overcome fear is motivation. You need a magnet to pull you toward something. My magnet came in the form of an invitation. A Dutch family I knew invited me to come to Holland to visit them. On their houseboat. During the tulip season. Wow!

I really wanted to go, but NOT as a white-knuckle flyer. So I knew I had to prepare myself. The unknown is always more scary. So if I could make the unknown more known to me, that would be a good first step in getting more comfortable about the idea of flying.

So I went to Kennedy Airport (I lived in New York City at the time) and I began interviewing people there. I talked to passengers, porters, flight attendants–anybody I could grab hold of. I wanted to know what it feels like to fly; what this experience is like. And I found people were very eager to talk to me. And those conversations began to at least melt some of that firm resolve I had about never, ever flying.

Later, I went up to the observation tower, and I watched those “big birds” take off, one after another. Continuously. Every minute, another plane would go up, up and away . . . ! I was there for about an hour. Then I began to reason logically. (I knew I had to bring my thinking brain into the picture, too!)

So, I multiplied what I saw by all the airports all around the world, and I concluded that the chance of something bad happening to any one particular plane was actually very, very low. So that was a great comfort to me–knowing that statistics were on my side.

Another thing that disturbed me was that the plane was just up there, seemingly without support. What was holding it up??

So–again, to make the unknown more known to me, I began delving into the principles of aerodynamics. And I found out that a plane “rides on a cushion of air.” Believe it or not, that was a big comfort to me, to learn it was ON something; it wasn’t just up there, in the middle of nowhere. And I could even visualize it as a bus–only this bus just happened to ride on air instead of on asphalt.

You see, in order to let go of the fear, I knew I had to see things in a different way. I had to let go of the old mindset. I had to act differently, I had to pretend, I had to learn to relax-and I had to learn all this beforehand so I could bring these skills with me. But it wasn’t easy. It took me weeks to prepare for this trip.

A few days before the flight, I paid a visit to my dentist. Not to fix my teeth, but to get a “relaxation fix.” You see, my dentist was the one who first taught me relaxation techniques. And ever since then, I always felt very comfortable and relaxed in his office. Well, that day, as I practiced relaxation, I purposely tried to memorize everything in that office: the pictures on the wall . . . the smells of the room . . . the way my dentist looked . . . the way his nurse looked, and so on. I wanted to have a strong memory of that comfortable place so I could “bring it” with me on the plane.

When I actually boarded the plane, I saw a lot of babies and small children. So that gave me another idea. I pretended I was a little girl being taken on a trip by my mommy. This image served two purposes: It helped me become more passive (so I wouldn’t be tempted to help the pilot fly the plane . . .) and it also made me more comfortable, because I could begin to see this experience through the eyes of a child.

The plane was long and narrow (much bigger inside than I had imagined), and there were two rows of three seats together. My other seatmates were a young couple on vacation. They seemed very friendly and fun to be with-so that was another pleasant activity I could look forward to.

At the moment of takeoff, I went into my planned meditation/relaxation routine. I leaned back in my seat, let go and relaxed; I was mentally back in my dentist’s office. My state of recall was perfect: I “saw” everything so clearly and “heard” my dentist’s voice. Amazingly, even the medicinal smell of the office came back to me! I felt as if all I had to do was open my eyes and I’d be back there at the office. But I was so relaxed, I didn’t want to disturb myself.

When I did open my eyes, I looked out the window and saw only sky. We were already way up in the air at high altitude, and I didn’t even know it! It was fascinating. All through my journey, I kept my mind busy, searching for interesting and exciting things to wonder about. For example: I kept marveling about the miracle of flight; I thought of the many people ages ago-kings and princes–who had yearned to fly. And here I was, a product of the twentieth century, actually doing it! I watched the sunrise–and it was 3 a.m. by my watch! At one point, I pretended it was wartime, and I was a soldier; our aircraft was being shot at by anti–aircraft guns . . . and suddenly we got word that the war was over, that the enemy guns were silent and that it was safe again to fly. (Here, you see, instead of seeing the plane as dangerous, I was seeing it as safe.) Sometimes I pretended I was a seasoned flyer and acted the part. At other times, I chatted with the young couple; we told each other stories, jokes, etc.

Well, I tell you–it was a wonderful trip, and I had a terrific vacation! Since then, I have flown a number of times, but my favorite memories are of that first trip to Holland.

So I say this: If you want to overcome a fear, don’t just jump into a situation and take yourself out of your comfort zone. Bring your comfort zone with you! Like the commercial says, “Don’t leave home without it!”

(This posted article was originally published in our ENcourage Connection Newsletter, print version.)

Dealing with a loved one with agoraphobia…

by Will Merrill

Over the years, I have been meaning to include an article in this newsletter which is published by my wife-from the perspective of a “support person.” I have wanted to shed some light on this subject through my own experiences with my wife as her support person and through meeting so many others in similar situations.

My belief is that those close to someone experiencing agoraphobia, in particular, can take an active role in the recovery process. With a truly supportive “team,” a recovery process can be especially effective.

I have absolutely no professional background in medicine, psychology or therapy. The only “classroom” training I have had on agoraphobia was experienced over fifteen years ago, at a time when we finally found out that Pat’s condition was known as ” panic disorder with agoraphobia.” (Yes, Pat was one of those sufferers at a time when few professionals knew what this really was or understood how to treat it.)

It was frustrating not knowing what she had or what to do. But eventually we were fortunate to learn of a specialized treatment program and support group whose doctor diagnosed Pat accurately. At last we knew what we were dealing with! I attended the group sessions throught this program along with Pat and was able to gain some valuable insight into being a support person for her.

In the first session, it became obvious to me that these men and women struggling with severe anxiety were far from weak. They were fighting for their emotional survival. I was impressed by the fact that they were all such intelligent people. Even though it was hard for me to relate to their extreme fears, it was clear that they were very “real.”

I remember one night in particular when the doctor, therapists, group members and support people went on a field trip to a local Los Angeles area mall. The doctor had me wait at the top of an escalator, acting as a support person for those working to conquer their panic reaction on escalators. I’ll never forget the terror in the eyes of some of these people, and I’ll never forget their relief when reaching the top. Another support person walked with my wife through the mall as she worked with her breathing and other anxiety management tools to handle being in the “claustrophobic” mall environment. I also watched as an older gentleman made it to the fourth step on a stairway, then sat down in extreme fear and frustration – with tears in his eyes – as the doctor worked with him in managing his anxiety symptoms with heights and crowds. It only took these few experiences to teach me that these people were dealing with something much more complicated than mere nervousness.

Over the years, I have learned a great deal more by reading about the subject and attending seminars given by recovering agoraphobics and treatment professionals. And, of course, ENcourage Newsletter has been most enlightening for me. (I wish we had something like ENcourage Newsletter fifteen years ago!)

Even in this day and age, a person with agoraphobia is too frequently looked upon as someone with a mysterious malady. Many will ask, “Isn’t that about women who can’t leave their houses?” As most readers of this newsletter are already aware, this is not necessarily the case and, sadly, this disorder can be quite misunderstood. Agoraphobia is a complex issue and requires most people much time and patience in order to truly understand it. (This not only includes the layperson but the treatment professional as well.)

A person experiencing agoraphobia and panic attacks can benefit by having a support person that he/she is comfortable with. A spouse or an understanding relative or friend can be among great choices.

A “support person” is one the agoraphobic can trust enough to turn that car around and get back home if he/she insists! I’m trying to be a little humorous here, but in reality, the truth is that the support person needs to learn that the phobic is the one who must feel in control. A bond of trust and comfort develops. I had learned that it was best not to force the agoraphobic into doing things or to “direct” the program of recovery.

A support person can, however, learn to gently urge the phobic to conquer any limitations, but pressure and coercion will inevitably backfire.

“White knuckling” might be the macho or brave-sounding thing to do, but this approach rarely does much good in the recovery process. Often, without first developing the right tools and attitude, it further sensitizes a phobic person.

It is my personal opinion that, ideally, the agoraphobic receives the full support of his/her family. I cannot begin to emphasize this enough. Having the support of the whole family unit (and close friends if possible) makes it easier for the agoraphobic to recover, not only because he/she is getting more backing, but because there is no need to hide the anxiety from anyone.

When I talk about support, I am not saying that a support person should do everything for or with the agoraphobic. I am referring to supporting their efforts to get well, supporting them emotionally, supporting them by getting involved in their desensitization recovery process, or at least getting better educated on what they are going through.

Unless you have suffered from agoraphobia and/or panic disorder, or are really close to someone who has suffered, it is very difficult to comprehend what that person is going through. When dealing with a family member with agoraphobia, the key word here is trust.

When a friend or family member “looks down on” the agoraphobic for, say, not attending a family function or preventing a spouse from attending, what is really being conveyed is that the phobic is not trusted–or respected. This is difficult because it only adds guilt, shame and anger to the person already struggling to overcome their conditioned fears. Obviously, this just helps to undermine their progress by making them feel worse than they already do!

We are not dealing with a person who is simply afraid to do something; we are dealing with something far more complex and unique. It is very easy to assume certain things when an agoraphobic is part of your family. This is where trust comes in. You must trust the agoraphobic to know what is best for the situation at hand (assuming that he or she is actively working on a recovery program and is not simply avoiding doing things). And if the phobic is not getting help, you can offer to aid them in finding the help they might need.

Since agoraphobia has many different variations (one maybe can sit in a restaurant but maybe cannot stand in the grocery store line), it is difficult to distinguish between what a particular phobic person can do and cannot do. I have heard statements such as “Well if you can do this, why can’t you do that?” This shows a lack of understanding of the disorder. There are simply certain things an agoraphobic has trouble with and needs all the trust, help and support possible to move forward. Trying to “reason” with a person about phobias is unworkable and only serves to make the phobic person feel more certain that he/she is not understood or trusted.

Being a support person requires much patience and understanding. It is not an easy role to play and can become frustrating at times. What has been easy and natural for you to do all your life is suddenly impossible for this person close to you to do. When Pat and I first met, she was extremely independent, lived alone, was very outgoing, and so on. But then her panic disorder began to interfere with her life so much that it took me quite a while to adjust to the major changes that were taking place.

But through patience and understanding and trust, I believe recovery can take place. I have seen it happen. (Although setbacks can occur, you can be confident that over time recovery can take place again.)

I would like to share the following quote from the book Living Fear Free by Melvin D. Green that talks about the role of support:

“THERE IS AN ERRONEOUS BELIEF THAT BY ACCOMMODATING THE LIMITATIONS OF AGORAPHOBIA, YOU ARE PROLONGING THE PROBLEM. THIS IS NOT TRUE. YOU WOULD NOT EXPECT A “CHILD” TO FACE THE WORLD WITHOUT BEING PREPARED TO DO SO. THEY HAVE TO DEVELOP CONFIDENCE AND KNOW THAT THEY ARE SUPPORTED. IT IS THE SAME WITH THE AGORAPHOBIC. BEFORE THEY CAN “GROW” OUT OF AGORAPHOBIA, THEY MUST BE READY TO DO SO. THE DEPENDENCY CAN ONLY CHANGE WHEN THEY FEEL INDEPENDENT, AND THIS CAN ONLY HAPPEN WHEN THEY FEEL SECURE.”

Some people have asked me how this situation has affected my life. To be quite honest, it has significantly and dramatically affected my life. To say otherwise would be a lie. Although it is a fair question to ask how my life has been affected, assuming it is hard on me, it is sad that some people still lose sight of the fact of who is really suffering the most. That person is the agoraphobic.

Sure, the problems that arise from agoraphobia affect all who are close to the agoraphobic. But I’ve come to put things into perspective. (So what if there are times I cannot sit in a restaurant with my wife? Things could be much worse!)

Over the years I have worked with Pat to move past her old fears, and in assisting her with her newsletter, I have had the opportunity to meet some wonderful people-people who suffer from agoraphobia and panic disorder. These people are so very creative, caring, sensitive and kind. They are also incredibly brave. I feel so fortunate in many ways that I have been able to meet and work with these people. It really has been a most rewarding experience that I would not trade for anything.

Special thanks to my husband of 17 years for not only being my support person, but my best friend. It is to his credit that his experience with me has broadened his caring for others with any “hard-to-understand” challenges.

Because we are close, we have had to work on a constant balancing act to be sure that I don’t get overly dependent on his support, or pull away from his support too quickly. This we continue to work out together.

We’d both like to add that if one does not have a support person or a supportive “team,” this does not mean that recovery is doomed. In fact, many people without such partnerships find that they do very well independently or with support groups and even other self-help means.

There are treatment approaches that do not advocate the use of support people in general. Yet most other programs and specialists recognize that being without any support is not always a workable strategy.

Since there seems to be no one single pathway to recovery, each must decide what is best for him/herself.

-Ed.

 

(This posted article was originally published in our ENcourage Connection Newsletter, print version.)

How to help someone experiencing agoraphobia and panic attacks…

by Pat Merrill

The following information has been compiled from a great variety of resources, containing the ideas and opinions of many experts in the treatment field.  It is our hope that our agoraphobic readers can share this information with family members, co-workers, and/or friends that may be interested in understanding your condition and ways to assist you.  (It is assumed that we are referring to agoraphobics who are actively pursuing recovery.)

It is justifiably perplexing–and perhaps even frustrating–to attempt to really understand what agoraphobia is if you have not experienced it yourself.

The points made here may be new to you, or even contrary to the ideas you may have held. Agoraphobia is a complex condition, not easily explained. To truly understand, one must have actually had the experience themselves, or must be willing to study the issue in great depth.

What Is Agoraphobia?

Agoraphobia is considered to be especially complex in that it results as an interplay of many factors: possible genetic pre-disposition, state of health, personality traits and attitudes, and more. Total recovery requires attention to many aspects.

Media attention to agoraphobia has often attempted to portray agoraphobics as “hermits”–usually women–imprisoned in their homes by unreasonable fears. In actuality, only a very small fraction (some say 3%) of agoraphobics are fully housebound.

This distorted picture has done a disservice in that it does not accurately represent the experience of most agoraphobics. And though statistics would indicate a larger number of female agoraphobics, there are many male agoraphobics.

Many agoraphobics appear to be functioning quite well, yet they may be experiencing extreme distress; many manage to hide their discomfort so effectively-for fear of possible embarrassment-that others do not believe there is a real problem.

Most agoraphobics become phobic as a result of their attempt to avoid very strong, very uncomfortable and “disorganizing” body and mind sensations caused by extreme anxiety, particularly panic attacks. Severe sensitization of the nervous system can occur, creating further symptomology.

A panic attack can be so traumatic an experience that one begins to become extremely hypervigilant to physical sensations which might signal a pending panic attack. Often this occurs almost unconsciously.

Sometimes very gradually, and other times with great swiftness, a person may begin to link situations or places as potential triggers to an attack. If for example, a person has a panic attack while watching a movie at the theater, he may come to associate such outings with his “attack” and inevitably be on guard for it to happen again. This tense and “on alert” state can in itself cause further anxiety, leading to more panic attacks and a state of chronic, high level anxiety. It takes learning and practice to develop the tools necessary to prevent this response.

This in itself would require a great deal of explanation, but for our purposes we will not attempt to go into the complexity of causes or treatments of the conditions.

Not all panic attack sufferers become agoraphobic; about one-third of panic disorder patients develop agoraphobia.

Though one may be inclined to think that agoraphobics are afraid of people, places, things, or situations, this is not quite the case as with “simple phobias” (i.e. social phobias, animal phobias, needle phobias, etc.)

Again, what the agoraphobic fears is the very feelings of anxiety itself, especially feelings of panic attacks. The agoraphobic may go to great lengths to avoid the possibility of feeling those feelings because they are tremendously powerful and unpleasant.

Panic Attacks

As you may know, panic attacks involve the experience of a cluster of symptoms such as: choking sensations, smothering sensations, rapidly pounding heartbeats, chest pain, difficulty in breathing, visual distortion, disorientation, strong feelings of unreality, confusion, chills or heat sensations, tingling in the extremities, sweaty palms, strong feelings of doom, an urgent need to run or escape, a sense that you are about to go mad or are about to die, and so on. The symptoms themselves do not adequately convey the frantic quality of terror the person experiences as they try to deal with the onslaught of chaotic, extreme symptoms.

The experience of full-blown panic attacks can be so intense and profound, that it is unlike anything else ever felt. If you have never experienced a panic attack, it would be beyond your comprehension to appreciate the enormity and discomfort felt.

Despite its intensity, it is fortunately not dangerous. Agoraphobics may know this intellectually, but may remain somewhat unconvinced because the experiences they have had may have been most distressing.

Guidelines for Friends/Family

• Realize that the fears of the agoraphobic are “real.” Take care not to belittle their experience. Accept that his/her feelings and concerns are legitimate.
• Be as patient as you can. Though it may be frustrating to you, especially if you are limited by the agoraphobic’s fears, remember that his/her frustration is far greater. The agoraphobic must also learn to be patient.
• Be sympathetic, but don’t pity the agoraphobic. Any attempts you make to genuinely understand what he/she is going through will be appreciated greatly.
• Make an effort to learn more about agoraphobia by reading books, articles, or speaking with experts on the subject if you are close to the agoraphobic. This will help BOTH of you.
• Avoid any temptation to say unhelpful things such as, “There’s really nothing to be afraid of,” or, “I have fears too but they don’t rule my life.” Once you comprehend that this is not ordinary fear the agoraphobic is dealing with, you will see why this sort of logic comes across as demeaning and trivializing; it can also create alienation if the agoraphobic feels you really do not understand him/her.
• Do not assume that the agoraphobic is weak or childish, or that they could get better if they just tried harder. Recovery from anxiety disorders are not overcome by willpower alone. To even try to overcome agoraphobic limitations takes great courage. They are facing great terror, not simple nervousness.
• Offer support and encouragement, but do not attempt to control or manage their recovery process. The agoraphobic needs to tackle recovery at his/her own pace and is the one who must do the work. Allow the phobic to tell you what would be helpful.
• Do not shame, lecture, or ridicule. This is obviously unconstructive and hampers progress by further undermining already shaken personal confidence.
• Realize that every tiny accomplishment in the recovery process is really a big deal. Let the phobic know that you realize how much effort went into each accomplishment. You can’t congratulate an agoraphobic too much!
• Do not push the agoraphobic to enter into situations before the agoraphobic person feels ready. Gentle urging to face fears is sensible; pushing is counterproductive.
• If you happen to be a recovered or recovering agoraphobic yourself, or perhaps have had other phobias, don’t assume that what is right for you is right for everyone. Let the agoraphobic decide how best to approach recovery. Right or wrong, it is his/her decision to make, and each person is unique in their experiences in the quest for recovery.
• It is an erroneous belief that repeated exposure alone to the feared situation will bring recovery. While facing fears is imperative, it must be done in such a way that incorporates specific coping strategies and appropriate attitudes. If fears are faced without the “right tools” and attitudes, the agoraphobic can become more severely sensitized to his/her fears. Remember, it is the deeply ingrained, habitual anxious response that the agoraphobic is learning to overcome–not the driving, or shopping, or socializing, etc.
• Since agoraphobics are usually under a great deal of strain, can tire easily from the chronic anxiety, and often experience depression in addition to the phobia, he/she may sometimes become irritable or especially emotional. Accept that this is a part of the package and try not to be overly upset by his/her expressions of anger/frustration/sadness.
• When possible, help to alleviate un-necessary aggravations and stressors. Other demands and conflicts compromise the time and effort needed to be put toward recovery.
• Expect that the person in treatment may need to devote a good deal of time to his/her program (i.e., desensitization practice, listening to program tapes or relaxation tapes, and so forth).
• Be careful not to be overprotective or to foster too much dependency. There is a delicate balance that can be achieved while providing proper and legitimate support.
• Remember that the agoraphobic is every bit as deserving of assistance as someone suffering from any illness.
• Accommodate the agoraphobic’s concerns, within reason. For example, if the agoraphobic says he/she simply cannot drive to the store, make other arrangements until the time when he/she is ready to tackle that limitation.
• Find creative solutions-together with the agoraphobic-that will keep you from “burning out” if you find yourself handling too many of the responsibilities. You may, for example, want to hire help at times, or find a neighbor who wouldn’t mind dropping the kids off at school, etc. You must also take care of yourself!
• Understand that recovery is a process that does not always follow a straight path. It may be riddled with ups and downs, steps forward and steps backward. (Example: Suppose your husband seems to conquer his reluctance to eat in restaurants, but on another occasion he is unable to go out to dinner with you at a new restaurant. This is not uncommon and should not be viewed as discouraging. Remind your husband that he need not be discouraged by temporary “setbacks.”) Expect and allow ups and downs.
• Part of total recovery from severe anxiety includes becoming a more confident, assertive person. It is not necessary to feel threatened or confused by these changes you may see in the recovering agoraphobic. Be willing to explore new patterns in the relationship.
• Be a good listener. Sometimes the agoraphobic needs to talk about what they are going through and what they need. Don’t try to be their therapist; simply acknowledge and respect their feelings.
• Recognize that the phobic individual is sometimes ambivalent about the recovery process. Since it can be so uncomfortable to face long-standing fears and make profound attitudinal changes which may seem overwhelming to him/her, there may be some reluctance to get over the problem. If this does not resolve itself over time, it may be appropriate to suggest counseling or other help to get the person over that common hurdle.

What About You?

Since the typical agoraphobic personality profile shows agoraphobics to be uncommonly intelligent, highly sensitive, creative, conscientious and caring, it is no small wonder why you have chosen to have such a person in your life.

But if this list has left you feeling that your life must revolve around the agoraphobic’s needs, try to come to terms with the fact that agoraphobia is a serious challenge, just as any physical illness would be. Providing compassion, support, and even making sacrifices are small prices to pay for the potential rewards of helping another to regain their health.

By the same token, your needs are important too. Particularly if you are very close to the phobic, perhaps a spouse or child, you will need to do what you can to take care of yourself as well.

The payoff for offering a loving, helping hand to an agoraphobic can be well worth any work involved. The end result will be a more independent, healthy person in your life. And you can be pleased to have been part of that process, while perhaps even learning much about yourself.

The agoraphobic in your life will surely appreciate you for your genuine caring.

(This posted article was originally published in our ENcourage Connection Newsletter, print version.)