No More Panic Attacks: A 30-Day Plan for Conquering Anxiety
254
No More Panic Attacks: A 30-Day Plan for Conquering Anxiety
254Paperback
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Overview
Product Details
| ISBN-13: | 9781564146083 |
|---|---|
| Publisher: | Red Wheel/Weiser |
| Publication date: | 09/01/2002 |
| Pages: | 254 |
| Product dimensions: | 6.00(w) x 9.00(h) x 0.60(d) |
| Age Range: | 3 Months to 18 Years |
Read an Excerpt
CHAPTER 1
Anxiety, Up-Close and Personal
Waking up to my beeper's head-banging assault, I tried to focus my tired, bloodshot eyes on my bleak surroundings — a hospital on-call room. I looked around and reached for a piece of stale bagel. Hunger pangs tickled my gut. From outside the room, I heard the bustling sounds of nurses and patients. I smelled disinfectant. Apparently, the night cleanup crew had come and gone, and I was in such a deep sleep I never even knew it.
I looked up and saw a way-too-cheerful face. Sticking his head in the door, a grinning first-year med student was looking to me, of all people, for guidance. Stressors hit full tilt. As a third-year resident in family practice, I was facing the remaining 12 hours of a 36-hour hospital stint, fueled by three hours' sleep in two days. My hair was hanging in grizzled ringlets around my face, and all I had in the way of resources to spiff myself up was a tiny bathroom and my toothbrush and toothpaste. I had three minutes to get myself ready to show up in the hall, out in public, looking and sounding chipper (at best) and, if that failed, lucid (at worst). I stumbled out of the narrow bed, and found my black clogs nearby.
Then I remembered I was facing a presentation that would be in the presence of male doctors who rated me daily. And this talk had to be done, regardless of the fact that I had a fear of public speaking. "Why am I doing this?" I asked myself.
This is anxiety. Dealing with stress makes us stronger; we can use it to amp us up to perform better, soar to greater heights. But dealing with anxiety, on the other hand, just makes us feel crazy.
I knew I wasn't alone. My dilemma during medical school and residency was one that many people face in all realms of life every day of the week — 19 million Americans, to be exact. Anxiety. Panic.
Many times, anxiety froze me, and I felt like I wasn't going to be able to give that speech, or "present" that patient to a group of residents, or please that demanding professor. Sometimes I trembled; other times, I felt breathless. Frequently, I felt certain that I really didn't have what it took to make it through medical school and residency. As shy as I had been growing up, I simply wasn't equipped to compete with the level of "swagger" that's necessary in medicine, which remains very much a male bastion. So, I had to find answers, or give it all up. I reminded myself that I'd put in too many years of grueling study to let crippling fits of anxiety wreck my life, but I couldn't figure out what to do.
I eventually set out the problem in clear-cut terms: "Jennifer, either get a handle on your anxiety — get to the bottom of it — or you're looking at a life lacking peace. Overall happiness will elude you because you'll be too busy untying the knots in your psyche to enjoy life fully."
What seems like grand irony, especially considering my "anxiety history," is that many patients I see in my family-medicine practice suffer from anxiety and/or panic attacks.
Harking back to the not-so-good-olddays
Believe me, I know what you're feeling!
In a heartbeat, I can summon up that old familiar sense of dread that turns the heart into a jackhammer. For example, one time when I walked into a gross anatomy lab, I knew it was the day my attending doctor (who was my supervisor) was going to hit me with a barrage of questions. Borrowing the grief in advance of the dreaded experience, I began perspiring. Soon I felt dizzy and my heart was racing.
And, then I learned to pick apart the panic attack, step by step. In analyzing the situation, I remembered that I had been obsessing even before I arrived about my knowledge compared to that of my peers, who often seemed to know more. I pounded myself with negative self-talk: "They study more and are better informed on the material we're supposed to know. I know I'll be humiliated today because I won't know the answers. I am such a misfit because all the others know exactly what they want. The doctor evaluating me will notice that I am ill-prepared and will judge me."
In retrospect, studying the negative thoughts, I saw why I felt so anxious. I went from feeling bad to feeling worse. And I was the one brewing up the awful thoughts — not anyone else! In fact, I never once experienced ridicule at the hand of an instructor. However, I was plagued by the belief (and panicky feeling) that soon, it was going to happen. It was, in fact, long overdue.
A helpful technique when a recurring situation makes you anxious is scrutinizing the entire chain of thoughts. Try to figure out what caused the low, worrisome mood. Jot down how you felt and what stirred that feeling. Eventually, this insight will help you understand what sets off your bouts of anxiety, making you better able to cope.
What I found was that the very thoughts that seemed to make sense in my head looked totally ridiculous and illogical on paper. Having pinpointed my distorted thoughts, I was able to move them into my consciousness. There, I could work on altering them.
Monitoring self-talk soon became a habit. I increased my self-confidence by practicing positive mantras that said, "So what if someone knows more than I do, and so what if I answer a question wrong?" Look at the blackest possible outcome of any situation, and generally, you'll find that it is something you can deal with. It may not be what you would like to have happen, but it's not the apocalypse, either.
Consider the possibility that your colleagues are also afraid, poorly prepared, or unfocused. Remind yourself that the formidable-world-against-you theory is not an accurate perception. Just like you, the smartest kid in your class or coworker at your job has off days when he or she fails to perform at his best — and that's all right. No one should expect to be a prime performer every single moment of every day — it's a false and overly demanding expectation. (By the way, avoid the clichéd practice of telling your child daily "do your best," because it sends the message that you expect her to be peak-performing all the time, and she can only fall short of that expectation. Far better to tell her to enjoy her day.) Of course, it's fine to encourage your child to do well, but you don't want her to think that she has to be operating at 100 percent all of the time. Being at the top of her game consistently simply won't happen, and she may worry about disappointing you.
Understanding social anxiety
Maybe you're like me — you hate to be under the magnifying glass. But, at the same time, you consider yourself fairly sociable. Does that make sense?
It should. One of today's most common types of anxiety disorders is social phobia, and the person who suffers from this problem isn't always shy. In fact, you may feel very much at ease with people, but certain situations can cause you intense anxiety. Even an outgoing person can suffer from social phobia, which is an enormous fear of being humiliated or embarrassed in social situations. Typically, this begins in childhood when you develop a faulty belief system based on self-doubt. You assume other people are competent, but you, in contrast, aren't. This can make you blush, fumble, and feel as if every eye is evaluating you critically.
Sometimes, your anxiety grows to the point that you actually experience chest pains, sweaty palms, dry mouth, increased heart rate, lightheadedness, dizziness, diarrhea, or frequent urination. Or, you may have symptoms that aren't listed here — ones that are uniquely your own.
Social anxiety disorder is so commonplace that mental health professionals have labeled it "the neglected anxiety disorder," meaning that it's often missed in diagnosis. People want to shrug off anxiety as no big deal. It's almost as taboo as talking about sexually transmitted diseases, menopause, or impotence. Everyone knows about these things, but they're tough to talk about.
Physicians can treat social anxiety disorder, but unfortunately, they see a substantial rate of relapse even after prolonged treatment. Evidence suggests, however, that patients who receive cognitive-behavioral therapy in addition to medication, may have lower rates of relapse. Early and aggressive treatment of social anxiety disorder may prevent development of associated disorders and can substantially improve quality of life.
Sometimes, social phobia gets totally out of hand. Fear of a certain situation provokes anxiety, resulting in a panic attack from fear of the situation. You have ongoing trepidation about a social situation in which you will be exposed to people you don't know. Or you fear people will scrutinize you, and you will be embarrassed. You may realize that your fear is excessive, but you avoid the situation, anyway — or endure it with extreme anxiety. You may have what is called "generalized social anxiety" if you happen to be afraid of almost all social encounters: conversations, dating, parties, speaking to authority figures, among others.
What that mountain looks like
Over and beyond the social anxiety that's fairly ordinary, however, is the mighty panic attack. And you may know all too well what that feels like.
You're climbing Panic Mountain, but not because you want to plant a flag at the top, or "just because it's there." Your Everest came to you unbidden in the form of panic attacks, and now you're stuck with the job of trying to figure out how to mount and subdue it, once and for all. "Straightening up" — the advice friends may offer — isn't going to resolve panic attacks.
Specifically defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), a panic attack is "a period of intense fear or discomfort in which four or more symptoms developed abruptly and reached a peak within 10 minutes." The DSM-IV lists common symptoms: sweating, shortness of breath, numbness or tingling, sensations of choking, palpitations or accelerated heart rate, trembling, chest pain, nausea, dizziness or lightheadedness, fear of losing control or going crazy, fear of dying, and chills or hot flashes. No special stimulus kicks off these symptoms, and the attacks are sudden and brief — usually, minutes. Then they go away without the sufferer having done anything. This attack is a surprise to you.
To fit the diagnostic definition of panic disorder, you must have had recurrent unexpected attacks, and at least a month of anxiety about having another attack; or a month or more of worry about the consequences or implications of panic attacks; or a month or more of a significant change that you made because of your near-debilitating fear of having panic attacks. Also, the attacks must not be related to the effects of drug abuse, a medication you're taking, or a medical condition such as hyperthyroidism.
Sometimes, panic disorder is associated with irritable bowel syndrome, vomiting, and abdominal pain. You may fear having uncontrollable diarrhea or be afraid of losing bladder or bowel control. You can't go anywhere that lacks a handy toilet. And, although the possibility of having a heart attack due to panic is medically unfounded, the fear of losing bowel control is sometimes realized under extreme stress. And that sets up a cycle of fear.
Migraines are yet another problem. Some panic-attack sufferers have migraine headaches so painful that they worry about having a stroke. A survey of 10,000+ people found that women diagnosed with panic disorder reported headaches that were more severe and lasted longer than the migraines experienced by women who do not have panic disorder. A staggering 20 to 40 percent found their headaches disabling.
Doctor, doctor, give me the news!
By now, you may have already seen a doctor. But if you haven't, you need to go in for a physical examination so that your physician can rule out the possibility of a medical condition (other than anxiety) that could be producing your symptoms. You'll probably walk away with a prescription to curb panic symptoms and, hopefully, prevent more attacks. And, if you don't get relief from what you're prescribed or what the doctor recommends, keep searching for answers. You may want to find a doctor who regularly handles panic and anxiety disorders.
The National Institutes of Health offers the following guidelines for finding a physician to treat anxiety:
• Follow the leader. If your physician doesn't treat anxiety disorder, he or she may refer you to a mental health professional, such as a psychiatrist. Psychologists, social workers, and counselors can't write prescriptions, but they often work closely with a primary care physician or psychiatrist, who can prescribe necessary medications.
• Choose someone who knows cognitive-behavioral or behavioral therapy, and who is open to the use of medication, if that is necessary.
• Ask the professional you're considering what kinds of therapy he or she generally uses, and whether medications are available. You need to feel comfortable with the kind of therapy you will receive.
• Get your physician's help in tapering off an anxiety medication (if that's necessary).
• Look for a healthcare professional you like because you'll be working as a team.
Unfortunately, some doctors think panic-attack patients are neurotic when their medical tests don't show signs of any physical problem. However, panic symptoms are very real, certainly not imagined, and they feel life-threatening. Fortunately, with the right treatment, panic attacks can be managed well, and often eliminated entirely.
No doubt, considering the nature of this "closet" disorder, physicians should be vigilant in questioning patients, so that the possibility of anxiety or panic disorder is actually considered — if the symptoms are there. Truth is, few people plagued by these problems will try to get help. Many are afraid that when they voice hard-to-articulate concerns, their doctors' eyes will glaze over, the same way their friends act when the problem is mentioned. It is very helpful for a patient to tell a doctor about any anxiety-related symptoms.
Even though it's hard to admit in an "enlightened" society, Americans still harbor some long-held beliefs that mental problems are embarrassing, at the least. And, some who suffer from anxiety and panic attacks decide to withdraw from society rather than seek help.
Clearly, the toll that anxiety and panic attacks can take is absolutely amazing, and this fact has become increasingly evident to those in the business of healthcare. As many as half of patients with recurrent chest pain and normal coronary arteries don't have heart problems — they have panic disorder.
Chest pains are among the most problematic of anxiety symptoms, in that these often send people to the emergency room. Recurrent chest pains in the presence of normal coronary arteries is a common and perplexing problem in primary care medicine and cardiology, resulting in significant healthcare utilization. A series of carefully controlled studies in the past decade have suggested a strong association between this syndrome and the presence of anxiety disorders. A high percentage (30 to 50) of patients with recurrent chest pain and normal coronary arteries meet existing criteria for panic disorder. Generalized anxiety disorder is also associated with this syndrome.
Drugs that slam-dunk panic
Panic disorder is a biological illness, with real symptoms. It is widely believed that the causes of panic attacks are biological and psychosocial. So, for many people, it takes both psychological treatment and medication to treat this problem. Usually, panic attacks don't just disappear spontaneously.
Prescription drugs used to reduce the symptoms of panic attacks and other anxiety disorders include: selective serotonin reuptake inhibitors (SSRIs), beta-blockers, benzodiazepines, tricyclic antidepressants, phenothiazines, and other medicines, such as BuSpar and Effexor XR.
Researchers believe that panic attacks are associated with neurotransmitter problems — in particular, those involving serotonin, norepinephrine, and dopamine. Long-term drug therapy may be necessary to correct your chemical imbalance. Your physician will monitor your response, and the pharmacologic therapy may be changed, to determine if another medication, or a combination of them, works better. If your doctor takes you off medication after extended treatment, you may have a recurrence of symptoms after you taper off, which may require another startup of drug therapy — or may indicate the need for long-term maintenance therapy.
Thanks to their effectiveness in treating anxiety and depression, the SSRIs have become some of the most widely used drugs in the world. They are believed to increase the amount of serotonin available to the brain. Some of these include Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), and Luvox (fluvoxamine). Paxil is probably the most ballyhooed of drugs for social anxiety disorder.
(Continues…)
Excerpted from "No More Panic Attacks"
by .
Copyright © 2002 Jennifer Shoquist, M.D., and Diane Stafford.
Excerpted by permission of Red Wheel/Weiser, LLC.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Preface: Knowing What It's Like (One Author's Tale of Anxiety),
Introduction: Simple Stress, Panic, or Anxiety Disorder?,
Chapter 1: Anxiety, Up-Close and Personal,
Chapter 2: Take the 2002 Life Quality Test,
Chapter 3: Gearing Up for Success: Your Anxiety-Busting Skills,
Chapter 4: The New You Redo: 30 Days of Anxiety-Busting,
Chapter 5: What to Do When Your Children Make You Anxious,
Chapter 6: Fighting Panic Attacks in College,
Chapter 7: Handling Couple Troubles That Cause Anxiety,
Chapter 8: Getting Rid of Job-Related Anxiety,
Chapter 9: Taking Charge of Extended-Family Situations,
Chapter 10: Knocking the Panic Out of Personal Issues,
Chapter 11: Curbing the Anxiety of Money Troubles,
Chapter 12: Now What? (Alternative Options),
Chapter 13: Maintaining Your Newfound Hardy Approach,
Bibliography,
Index,
About the Authors,