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.

As Fibromyalgia (FM) sufferers we are often made to feel like our pain is “all in your head”, but research has consistently proven that Fibromyalgia is not a form of depression or hypochondria. IT IS REAL!  However, there is a connection between FM and other chronic pain conditions to depression and anxiety.  Treatment is important because both can make FM worse and interfere with symptom management.

There is some debate by medical and mental professionals about what causes what.  The “What came first?  The chicken or the egg” debate translates into “What came first?  The chronic pain or the depression?”  TRUE Fibromyalgia experts, researchers and others know that the chronic pain of FM & overlapping conditions leads to depression and anxiety. 

Fibromyalgia is a common condition in which a person suffers from chronic musculoskeletal pain. There are points called tender points, sometimes all over the body, and these tender and painful points are used as part of the diagnosis of FM. Individuals with FM may also be more susceptible to pain in general. Whenever the tender points are simply touched, they can send sharp pain impulses. Many Fibromyalgia sufferers experience pain all over and some experience pain only in specific regions. It can involve the muscles and the joints. Sometimes, there is so much pain that it is hard to pinpoint exactly where the pain originates.  Fibromyalgia is often accompanied by other overlapping conditions such as chronic myofascial pain (CMP), chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), restless legs syndrome (RLS), migraine & tension headaches, interstitial cystitis (IC), mitral valve prolapse (MVP), cognitive dysfunction, depression, anxiety and more.  The symptoms of Fibromyalgia, alone, are wide-ranging and debilitating.  Do they really think that depression and anxiety is the CAUSE for ALL of the above?

Depression is a mental illness characterized by feelings of profound sadness and lack of interest in enjoyable activities. It is a constant low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment and if you have Fibromyalgia, you may have to fight it for the rest of your life.

Anxiety is a normal state of apprehension, tension, and uneasiness in response to a real or perceived threat.  Although anxiety is considered a normal response to temporary periods of stress or uncertain situations, prolonged, intense, periods of anxiety may indicate an anxiety disorder. Other indicators of an anxiety disorder are anxiety that occurs without an external threat and anxiety that impairs daily functioning.

What can cause depression & anxiety?  Stressful life events, chronic stress, low self-esteem, imbalances in brain chemicals and hormones, lack of control over circumstances (helplessness and hopelessness), negative thought patterns and beliefs, chronic pain, chronic physical or mental illness, including thyroid disease & headaches can ALL cause both.  Little or no social  and familial support can be a main factor in depression for FM patients. Family history of depression & anxiety can also be a factor.

Lack of quality sleep is also believed to have an influence on depression.  Since FM & Chronic Fatigue Syndrome patients tend to have insomnia and/or other sleep disorders, it stands to reason that poor sleep can lead to depression.

There is a wide variety of medications, vitamins, minerals, herbs and therapies that can help ease the impact of pain, anxiety and depression.  With so many out there, you and your doctor may have to go through the process of trial and error to find what works best for you!

Exercise is not only good for FM, it is also highly beneficial for depression and anxiety.  Recent studies suggest exercise can change your brain chemistry. Exercising can boost your level of serotonin, a brain chemical that is effects mood and pain perception. It can also stimulate the production of endorphins, natural painkillers that can give you an overall feeling of well-being.

Exercise is a great for stress, too. It relieves muscle tension and it gets the heart rate up. The combination makes us more relaxed and alert, which helps us deal with our problems in a calmer and more controlled way.

There are several other methods you can use to combat stress, including: meditation, deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, relaxation to music, biofeedback, counseling – to help you recognize and release stress. 

You can learn more about this topic, medications, supplements, alternative therapies and more at my website AND I will be writing more articles – so check back here!

As Fibromyalgia (FM) sufferers we are often made to feel like our pain is “all in your head”, but research has consistently proven that Fibromyalgia is not a form of depression or hypochondria. IT IS REAL!  However, there is a connection between FM and other chronic pain conditions to depression and anxiety.  Treatment is important because both can make FM worse and interfere with symptom management.

There is some debate by medical and mental professionals about what causes what.  The “What came first?  The chicken or the egg” debate translates into “What came first?  The chronic pain or the depression?”  TRUE Fibromyalgia experts, researchers and others know that the chronic pain of FM & overlapping conditions leads to depression and anxiety. 

Fibromyalgia is a common condition in which a person suffers from chronic musculoskeletal pain. There are points called tender points, sometimes all over the body, and these tender and painful points are used as part of the diagnosis of FM. Individuals with FM may also be more susceptible to pain in general. Whenever the tender points are simply touched, they can send sharp pain impulses. Many Fibromyalgia sufferers experience pain all over and some experience pain only in specific regions. It can involve the muscles and the joints. Sometimes, there is so much pain that it is hard to pinpoint exactly where the pain originates.  Fibromyalgia is often accompanied by other overlapping conditions such as chronic myofascial pain (CMP), chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), restless legs syndrome (RLS), migraine & tension headaches, interstitial cystitis (IC), mitral valve prolapse (MVP), cognitive dysfunction, depression, anxiety and more.  The symptoms of Fibromyalgia, alone, are wide-ranging and debilitating.  Do they really think that depression and anxiety is the CAUSE for ALL of the above?

Depression is a mental illness characterized by feelings of profound sadness and lack of interest in enjoyable activities. It is a constant low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment and if you have Fibromyalgia, you may have to fight it for the rest of your life.

Anxiety is a normal state of apprehension, tension, and uneasiness in response to a real or perceived threat.  Although anxiety is considered a normal response to temporary periods of stress or uncertain situations, prolonged, intense, periods of anxiety may indicate an anxiety disorder. Other indicators of an anxiety disorder are anxiety that occurs without an external threat and anxiety that impairs daily functioning.

What can cause depression & anxiety?  Stressful life events, chronic stress, low self-esteem, imbalances in brain chemicals and hormones, lack of control over circumstances (helplessness and hopelessness), negative thought patterns and beliefs, chronic pain, chronic physical or mental illness, including thyroid disease & headaches can ALL cause both.  Little or no social  and familial support can be a main factor in depression for FM patients. Family history of depression & anxiety can also be a factor.

Lack of quality sleep is also believed to have an influence on depression.  Since FM & Chronic Fatigue Syndrome patients tend to have insomnia and/or other sleep disorders, it stands to reason that poor sleep can lead to depression.

There is a wide variety of medications, vitamins, minerals, herbs and therapies that can help ease the impact of pain, anxiety and depression.  With so many out there, you and your doctor may have to go through the process of trial and error to find what works best for you!

Exercise is not only good for FM, it is also highly beneficial for depression and anxiety.  Recent studies suggest exercise can change your brain chemistry. Exercising can boost your level of serotonin, a brain chemical that is effects mood and pain perception. It can also stimulate the production of endorphins, natural painkillers that can give you an overall feeling of well-being.

Exercise is a great for stress, too. It relieves muscle tension and it gets the heart rate up. The combination makes us more relaxed and alert, which helps us deal with our problems in a calmer and more controlled way.

There are several other methods you can use to combat stress, including: meditation, deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, relaxation to music, biofeedback, counseling – to help you recognize and release stress. 

You can learn more about this topic, medications, supplements, alternative therapies and more at my website AND I will be writing more articles – so check back here!