Cognitive-Behavioural Therapy

Copyright (c) 2007 Mary Ann Copson

If you have ever had a panic attack, you don’t want another one. The “fight-or flight” response in your body is involuntarily turned on and your nervous system signals your adrenal glands to start pumping out stress hormones to get you ready to either run away or turn and fight.

Your muscles tense, your heartbeat speeds up, and your breathing becomes more rapid. You might feel like you are smothering, claustrophobic or you may experience an urgency to get away. On top of that, you may get hot flashes, sweating, and/or chills and trembling, plus numbness, tingling sensations, dizziness, and nausea.

You become overwhelmed by an extreme sense of fear and impending disaster and you lose your ability to think calmly and clearly while experiencing a distorted sense of time and a feeling of unreality.

In the face of a physical threat, accident, or natural disaster, this type of response is normal and can be life-saving. But panic attacks that occur unexpectedly in the presence of normal events can be debilitating. They may happen with no forewarning, at any time of the day or night, and last several seconds or more than half an hour.

The triggers for panic attacks are unpredictable. Most panic attacks are set off by some minor or major stressor. But panic attacks can also be triggered by changes in emotions, or as a response to certain drugs, foods, allergies (including hidden food allergies), hypoglycemia, and illnesses.

A panic attack is an example of an acute anxiety disorder and can affect teens to middle-agers and beyond. Women are reported to experience panic attacks twice as often as men but some believe that is only because men are more reticent to report panic attacks.

Recent studies point to a complex set of causes and panic attacks are regarded as a treatable psychobiological condition (i.e. having both psychological and biological causes). Successful resolution of panic attacks requires an integrated, multi-modality approach.

Even though panic attacks are not a simple condition and there are no simple answers for their successful resolution, herbal therapy can be useful as part of an integrated, multi-modality approach.

When you experience anxiety, your body releases a set of neurotransmitters called catecholamines, which stimulate your central nervous system and activate your sympathetic nervous system. Sometimes your sympathetic nervous system (the high alert part of your nervous system) can get stuck in the ?on? mode leaving you in an ongoing state of anxiety – a fertile ground for panic attacks.

A class of herbs called nervines helps to turn off the sympathetic nervous system by gently facilitating the functioning of the parasympathetic nervous system ? the part of the nervous system that prompts relaxation – helping us to wind down and come off ?high alert?.

It is a good idea to experiment with different anti-anxiety herbs before you are in a crisis or panic situation. Try out several herbs in varying doses. Start with a low dose and increase if needed so that you will know how the herb affects you and how to use it when you need it.

Some effective herbal nervines to consider using:

Oatstraw (Avena sativa) ? the green milky tops of oatstraw provide a wonderful soothing, nourishing and gentle herb for frayed and stressed nervous systems. Oatstraw has a restorative effect on an exhausted nervous system reliably strengthening the whole nervous system after prolong stress. Oatstraw has both an immediate effect (useful when experiencing extreme nervousness and anxiety) and a more long-term restorative effect. Oatstraw is well tolerated by even highly sensitive people and is used for nervous debility, stress, weak nerve and energy force, anxiety, depression, exhaustion, and general fatigue.

German Chamomile (Matricaria chamomilla/ Matricaria recutita) ? an all time favorite ?because it works. Chamomile tones the nervous system, relaxes your muscles and calms nervous digestion. It has mild sedating properties and is not as strong an herbal sedative as valerian or passionflower. However, chamomile is a great option for anxiety in children or teens and for anxiety associated with mild sleep problems. If you are allergic to ragweed, asters, or chrysanthemums you are better off choosing another anti-anxiety herb.

Lemon Balm (Melissa officinalis) ?has mild sedative properties and is useful in conditions of nervous agitation with sleep problems and digestive complaints. Lemon balm is especially useful for over-anxiety that causes digestive problems such as nausea, bloating, and colic like pains. Traditionally lemon balm was used to lift the spirits and encourage longevity. Lemon balm is a relaxing tonic for anxiety, restlessness, irritability, and mild depression and its actions will quiet the racing heart that often accompanies anxiety. It has mild anti-thyroid effects and is best avoided by people with hypothyroid problems.

Skullcap (Scutellaria laterifolia) ?tonifies and relaxes the nervous system and is useful for anxiety of all types especially anxiety and irritability that is hormonally based such as premenstrual syndrome. It is a sedative nervine and has mild anti-spasmodic and anti-hypertensive effects. Skullcap is a great herb to use when your anxiety is accompanied by a runaway mind that is stuck on worry. It is tolerated well by most people and has few side effects.

Valerian (Valeriana officinalis) ? one of the most well known anti-anxiety herbs, valerian is a potent herb whose active ingredients, valepotriates, bind to benzodiazepine receptors in the brain (similarly to the drug Valium). The use of valerian does not, however, result in dependence or the development of tolerance but instead tones the nervous system.

Valerian can be used to improve the sleep quality and relax both the skeletal and smooth muscles. Valerian should not be used for those with chronic exhaustion, adrenal fatigue, thyroid disorders, and depression as it may increase anxiety, worsen present symptoms, and/or result in excessive restlessness in these conditions.

Passionflower (Passiflora incarnata) ? a strong calming, anti-spasmodic herb that is good for severe daytime anxiety. Passionflower is also a good choice for middle of the night waking terrors, nightmares, and the onset of sudden anxiety feelings. It acts as a central nervous system depressant giving a calming, relaxing and anti-anxiety effect and is specific for anxiety related to insomnia, muscle tension, restlessness, and nervousness due to worry, overwork, hysteria, or excessive excitement. If you are taking an MAO inhibitor, you should avoid taking passionflower except under supervision.

Stress Relief Tea

Here is a simple herbal tea mixture that I have found effective in my private practice working with women having mood and energy problems.

Mix together equal parts of the following dry herbs:

?Oatstraw

?Lemon Balm

?Skullcap

?Nettles

?Orange

?Chamomile

Use 1-2 teaspoons of the mixture and steep covered in 8 oz. of boiling water for 5-10 minutes.

The use of herbal nervines as part of an integrative program can help restore a sense of calm and well being, soothe distress, stabilize a confused and overwhelmed energy system, and foster clear thinking.

If you are taking anti-anxiety and/or anti-depressant medications or other medications, have a diagnosed condition or illness, are pregnant, breastfeeding, elderly or very young it is important to consult a knowledgeable health care practitioner before using herbs. Consult a licensed physician for diagnosis and treatment of any medical conditions.

Many who suffer from panic and anxiety attacks have given up hope finding any salvation. Some studies have shown that a majority of those who suffer from panic and anxiety attacks have given up trying to find a way to regain life without them. If you are one of them, you will be happy to know there are now new and innovative ways for treating anxiety attacks.

If you think you might be one of those affected, the first important step is understand exactly what a panic attack is, and what it is not. These attacks actually stem from a normally beneficial component of our self defense mechanisms. The “fight or flight” response serves as an early warning system thus alerting us to danger.

The problem arises when this normally protective system becomes activated at inappropriate times when one is not facing any danger. When it happens with regularity it can evolve into a debilitating disorder. Those who suffer from them can attest to the adverse effects they can have upon both family relationships and within the work environment.

Once you gain an understanding of what a panic attack is, then you must learn to recognize the signs which indicate an attack is pending. Sudden increased pulse is the most universally reported signal. Some experience hot flashes, others a damp cold feeling. Many report loss of balance and vertigo. Skin breakouts akin to allergic reactions have also bee reported by many.

In addition to these physical indications, the most intense and feared components are focused in the mind. Sheer terror, sureness of one’s impending death, frozen with fear are common descriptions of the mental state associated with a panic attack. Most usually, this fear does not pertain to any given tangible thing, event or person. It is more a general sense of dread.

Now that you have basic understanding of the origins and indications of what constitutes a panic attack, the next issue becomes how to deal with them. Traditional medicine has identified several pharmaceutical based treatments which some have found greatly beneficial. Others, unfortunately, have not found relief from this avenue of treatment.

Many have found respite using other more natural, holistic techniques. Examples of these include accupuncture, massage therapy and aroma therapy. Classic psychology has proved beneficial for many as well. Most commonly, therapists will employ cognitive behavioral therapy in an attempt to give you control over the internal mechanisms triggering these events.

Suffice to say, there are many available options out there. Different approaches work for varying forms and severity of the disorder. You must explore the various choices and select the one which best suits your needs as an individual. No matter how difficult, keep faith that there exists for you a good way for treating anxiety attacks.

Sometimes people ask me why I spend so much time on what generates panic attacks. My usual response is, beyond my natural curiosity, I simply don’t see how one can manage something if one doesn’t fully understand just what that something is. And, at least to me, a complete understanding has to include insight into genesis. I mean, if you were experiencing chronic chest pain, wouldn’t you want to know what was causing it? And let’s no forget that knowing why something happens leads to more efficacious management strategies and techniques.

I have always placed emphasis on both the psychological and physical contributors to panic attacks. But, in this article I’d like to stick with the psychological and address two theories of treatment. Needless to say, there are many floating about; however, I’d like to briefly discuss the psychoanalytic and cognitive points of view with regard to the generation of panic attacks.

Psychoanalytic

A psychoanalyst would likely submit the generation of panic attacks goes back to infancy and childhood. They would, however, acknowledge that panic attacks may also occur as a result of assorted cues in the present, such as the fear of having a panic attack in a situation where one recently occurred. For the record, an attack occurring within this context could either be situationally-bound or situationally-predisposed. The psychoanalysts consider both conscious and unconscious panic triggers as representations of intense early life wishes and fears. So, panic attacks, in large part, occur in response to cues associated with long past psychological and biological threats to one’s existence. By the way, these cues are based in retained themes of intensely feared eventualities such as castration, separation, and parental disapproval.

Cognitive

A cognitivist would likely submit that a panic attack is a manifestation of an intense feeling of helplessness in the face of intense danger. The vicious cycle of panic, which we know all too well, is generated and sustained by combining the very real terror of vulnerability with one’s traditional distorted thought and feeling responses. Within the context of human genetic predisposition, which from a phylogenetic perspective leans toward the anxious for purposes of survival, it naturally flows that these thought and feeling responses appear to be designed to produce the belief that out-of-control internal distress can lead to grave danger, even disaster. Doesn’t it make sense that it’s this dynamic that so often generates the intense need to seek a caregiver for immediate assistance? I mean, at this point all bets on reason and logic are absolutely off as our primal instincts take over. And then all sorts of physical symptoms arrive on the scene because our mind really believes we’re in imminent danger, and it’s getting us ready to fight the good fight. And the snowball just rolls on down the hill from there.

Finally, the cognitivists would likely submit that though panic attacks are often thought of as spontaneous, some sort of event had to have tripped the trigger. Who knows, the culprit may have been a sudden physiological change; say, feeling faint upon standing, sensing a rapid or palpitating heart beat, or detecting a shortened breath. The thought is that events such as these, in the absence of reason, are interpreted as indicators of immediate physiological danger. And, boom, off to the races we go.

It’s my belief that, individually, both the psychoanalytic and cognitive angles hold great merit. But, for my money a combination of the two is truly the ticket. I mean, so okay, according to the cognitivists a physiological change, such as a shortened breath, may trip the panic trigger. Well that’s great; however, I’d like to know what existed unconsciously that led to the perception that that shortened breath was a signal of coming catastrophe. Hmmm.

As always, the more we understand about our circumstances, the better we become at managing them.

HOW TO MANAGE ANXIETY, CONTROL FEAR, OVERCOME FRIGHT, PANIC, WORRY(Based on author’s site www.geocities.com/frnxty)

Fear, anxiety are controllable. Panic, worry, fright can be rid of. Knowing what are, how work, fear, anxiety, helps solve problems, control fear and anxiety.

Anxiety and fear causes crisis. One must understand fear and anxiety, how fear and anxiety work, to control anxiety, manage fear. Can be overcome anxiety and fear.

Managing fear, overcoming anxiety can be without expensive books, courses. Overcoming children’s fears, anxieties, controlling, managing adult fear and anxiety is possible. Here is, whether in child or adult, how to control, manage, overcome fear and anxiety.

Fear and anxiety, being afraid and anxious, begin when we are, or feel, vulnerable. We experience uneasiness and concern which frightens, makes fearful. This causes timidity, and timidity gives rise to a state of alarm which sometimes involves such hesitation that shrinks us from dealing with a matter or situation that needs to be resolved. The pain and emotion, the tension and stress of fear and anxiety is accompanied by a feeling of helplessness which is negative thought which so affects the functioning of the nervous system in dealing with fear and anxiety.

Fright, fear, anxiety, can cause crises, neurosis; the dread, terror, horror of phobia is fear. Worrying, most worries, are fear; but, often, we can’t cope with worry. Positive thinking helps but is not coping with fear, controlling fear, dealing with worry; to control fear, anxiety, we must know how fear and anxiety work.

Fear and anxiety effect automatically. Our autonomic nervous system regulates how body organs work. Chiefly a part of the autonomic nervous system, called ’sympathetic’, automatically interacts with our mind when we worry, experience anxiety, fear.

When fear is felt the mind signals a threat, danger, or emergency physically (e.g. a hand raised in anger) or psychologically (e.g. distrust); the sympathetic nervous system immediately comes into action to help protect or defend ourselves to our best possible advantage. Suddenly automatically we breath more oxygen which, with cyclic biochemical reactions, energises our ‘electron transport chain’ and synthesises with other substances in our body, upon that fear signal. This synthesising upon that fear signal urgently turns on electrical impulses which fire from cell to cell at very high speeds communicating that fear to the control centre in the brain.

In our fear and anxiety, the brain instantly issues commands to the organs to take action. Our organs immediately divert and concentrate energies from other organs to those relevant to our fear and anxiety. The pupils of our eyes grow bigger to see better, the blood vessels expand to more and faster supply, to enable our muscles to react. In aid of that the body produces adrenaline to enhance alertness and our actions for ‘flight’ or ‘fight’, as our values dictate, and as we feel directed by our fear, anxiety.

Anxiety and fear are not cured by medication. Drugs only help coping with worry; only help cope with fear or anxiety. It is generally agreed by expert that if we know how to, we can better control fear, manage anxiety. Panic confuses and causes worry; but, except for phobias (when one must consult a doctor), it isn’t complicated to manage fear, control anxiety.

Adult fear and anxiety is mostly due to problems; e.g., worry over debt, disapproval, separation, failure.

Children have no adult problems; child fear or anxiety is feeling inadequate about the frightening unknown.

Adults cope with both, whether it is fear or anxiety arising from adult problems or child fear and anxiety over inability to protect or defend as adults can.

In child fear control, managing child fear and anxiety it often suffices to ensure an “I am protected” feeling for the child. A child’s fear, e.g., of the dark is over anxiety that something may go wrong or be hurtful; e.g. a dim light helps ease that fear, anxiety, but the child needs assurance that you are nearby and can protect from or defend against what is causing the child’s fear and anxiety. If fear of the unknown is, e.g., anxiety over a new environment, accompany the child until it is realised that there is nothing to fear.

In adults fear and anxiety does not go away because of their being fear and anxiety with good reason. Adult fear and anxiety involve not unreasonable worry but possible significant consequences. But an adult can control worry, even overcome fear, anxiety.

Coping with, overcoming fear and anxiety begins with realising that problems are solvable, consequences avoidable. This enables to cope with fear and anxiety.

Adults suffer fear and anxiety for two reasons. They do not know how to solve the problem; and, it never occurs to most to find out because panic causes confusion. Panic prevents rational thinking, they can not think how to, e.g., reason arguments, acceptably put a hurt right; they, e.g., forget or never find out that an offer to pay by instalments may not be lawfully refused. The problem seems unsolvable, panic becomes fear, anxiety; worry makes fear worse.

Anxiety and fear often result from failure to clearly identify the problem. That is the cause of panic, a problem’s becoming worse, of the fear and anxiety.

Problem solving involves rational though, and that necessitates calmness. If angry, do ‘count to ten’.

Avoiding panic is avoiding fear and anxiety. If feeling panicky, take a deep breath: inhale, hold it to the count of three, exhale slowly; this is regarded as regulating oxygen intake and avoiding the above-mentioned body functions and chemical reactions which substitute to normal body and mind functions the limited, concentrated, emergency, urgent functioning. You will feel less urgency, less rushed, less panicky and less likely to suffer fear and anxiety.

Similarly easy it becomes then to replace the reduced likelihood of fear, anxiety with rational thought. One only needs to know how to do so.

One cannot apply rational thought to a problem if one is confused. The panic was due to not knowing what to do, confusion. One needs to clear one’s head in order to think and substitute to avoided panic, and reduced fear and anxiety, rational thought.

One’s bodily functions and mental functions interact. Adrenaline enhances what the brain signals. If it signals an emergency, it enhances urgency; if it signals calm though, then it enhances that. This is the basis of ‘positive thinking’. Such automatic biological, electrochemical, functioning of the nervous system enhances mental functions, confusion is rid of. Then can be clearly seen the problem and properly explored the ways of solving it without panic worsening it, causing fear and anxiety.

Then you can identify your fear. What is it that you fear, why? What part or parts of the problem is it that is causing you the worry, the anxiety, the fear? Think of what exactly it is you fear, are afraid of. ‘Know your enemy’ to easier mange anxiety, overcome fear.

One can learn to control one’s fear and, in the verses of Orhan Seyfi Ari in his Mystic Man (translated), one can enjoy the feeling that…

“Neither anxiety has he, nor fear,

The World’s like a rubber ball under his feet rather,

The Sun in one hand, and the Moon in the other.”

Calmness helps solution, managing fear and anxiety.The author has a website at: http://www.geocities.com/eoa_uk

Panic attacks feel a lot like heart attacks. A panic attack might cause your heart to race, and it might cause you to become short of breath. You might find that you feel dizzy or light headed, and they are characterized with the feeling of life or death importance. It is not uncommon to believe that you are dying or about to die when you are having a panic attack. Fortunately for sufferers, they are usually not of a long duration, and will stop when they have run their course, usually a few minutes, or when the cause of the panic is removed.

If you are terrified that you might have another panic attack, you may just end up cutting yourself off from everything in order to avoid having another. You might hide from the world, or otherwise separate yourself from the friends and family who might otherwise be able to help you. If this sounds familiar to you, then you need to consider seeking professional help to empower you to dispel the threat of panic attacks that hangs over your head.

You may also be able to help yourself by avoiding the situations that cause you to have your panic attacks in the first place. One of the biggest causes of panic attacks is stress, and if you are constantly in stressful situation, then you will be at a much higher risk for panic attacks in the future. This stress is not necessarily the stress that comes over a few days over a particular event; panic attacks are triggered by constant stress over a period of months or sometimes even longer. This stress is often too much for people to bear, and even if we do not realize that, our bodies do, and they rebel.

Panic attacks can also be caused by certain situations. If you get a panic attack every time you are running late, or stuck in traffic, or going over a bridge, then you need to make sure to avoid those situations to prevent these same events from triggering more panic attacks in the future. You can take a different route to work, leave early, and avoid roads that you know will be snarled with traffic or even head to a local place for dinner after work before facing the drive home.

If you practice avoiding panic attacks and chart where you were, what you were doing, and how you felt immediately prior to each panic attack, then you can use this information to avoid the things that trigger you. You may be able to save yourself a lot of trouble with your mental and even your physical health later down the road.

Panic attacks do not just feel remarkably like heart attacks; recent studies have linked experiencing panic attacks with an increased likelihood of actually having a heart attack later. Keep your odds low and keep your stress levels down to avoid panic attacks and to remain as healthy as possible. No one likes to suffer, and panic attacks certainly fall into the category of suffering.

If you are at risk for panic attacks or you have had them in the past, then you should examine the past causes of your panic attacks so that you can help yourself to avoid similar situations in the future. You should also get in contact with your doctor to find out if you may need medication or therapy to help you take charge of your life and get away from the panic attacks. It can be difficult to determine exactly the best means of preventing panic attacks, but you may get better results when pairing the practice of avoiding triggers with medication to help you feel calmer. A therapist can also help you learn mental tricks to help you ride through the panic attacks without completely losing your cool the next time you feel one coming on.

This article was presented by Panic Defence, the UK’s leading name in combating panic and anxiety. If you would like a free download with easy and effective tips to end panic, visit www.panichandbook.com now.