PANIC - How to beat panic attacks

About one-third of all Australians will suffer from a panic attack at some point in their lives. So why aren't we talking about it?

 

David Thompson* vividly remembers the first time he had a panic attack. He woke up in the middle of the night with his heart racing and could hardly breathe. "I thought I was dying of a heart attack," the 41-year-old father of two says. He has been experiencing panic attacks for the last 10 years, although he has now learned to recognise and control them. "It's extremely common to think you're dying the first time you have a panic attack," says consulting psychologist Lorraine Corne. "The first experience is very sudden and frightening, but the good news is that later attacks are never as bad as the first."

What causes panic attacks?

Professor Don Jefferys, from the department of psychology at Deakin University, says panic attacks usually stem from a fear of entering a certain situation or location, such as travelling down the freeway or walking into a cinema. "They can happen anywhere, at any time," he says. "Even when you are relaxing or sleeping." He says that nocturnal attacks, such as the ones Thompson experiences, can be the most terrifying ofWhile the trigger for a panic attack is psychological, the process that occurs is physiological.

According to the Victorian Government's Better Health Channel website, when the body is faced with immediate danger, the nervous system activates a "flight-or-fight" response. The body is then flooded with a range of chemicals, including adrenaline, that trigger physiological changes such as palpitations, a pounding heart or accelerated heart rate, feelings of nausea or dizziness, chest pain, shortness of breath and chills or hot flushes. There can also be feelings of losing control and a fear of dying.

Who does it affect?

Panic attacks can happen to anyone, although Professor Jefferys says they are more common in females than males and are mostly likely to occur in people aged 18 to 35. But he adds that children and the elderly can also suffer from them.

Corne says certain personality types can be more vulnerable than others. "If you're a bit of a perfectionist and you put a lot of pressure on yourself and others to get things right, this builds up anxiety and stress, which can lead to panic attacks," she explains.

A vicious cycle

Frequently, when a person starts to experience panic attacks, they will try to avoid situations that might trigger an attack. "One of the most common situations where panic attacks can occur is when someone drives through the Sydney Harbour tunnel," Corne says. "So if you've had an attack while driving through the tunnel, the next time you have to do it, you'll think, 'I'm going to be trapped, there's no way out, I'll crash into the wall'. So you will avoid routes that include having to drive through the tunnel."

What happens next is that your body will recognise the adrenaline signals and start to go through the motions of a panic attack. In short, panic attacks are driven by the fear of having a panic attack. "It's a vicious cycle," Corne says. Professor Jefferys agrees, saying this avoidance can lead to agoraphobic behaviour. "Most people with a panic disorder are concerned about a lack of oxygen. So if a panic attack sets in, the first thing they want to do is rush outside for air. Therefore, they'll avoid places they can't escape from quickly, such as large shopping malls or aeroplanes."

How panic attacks can be treated

Although panic attacks can be extremely frightening and upsetting, the good news is that no-one is untreatable, Professor Jefferys says.Cognitive behavioural therapy (CBT) is the most widely used psychological therapy in the treatment of panic attacks. It teaches patients how to identify their anxiety and change thoughts such as, "I am feeling dizzy, this means panic", to, "This is only dizziness, l can handle it". This helps patients to rationalise and deal with the symptoms they are experiencing, rather than letting them spiral out of control.

Corne says that after just three or four sessions, a patient will usually start to get a handle on the process they go through that creates the panic attack. "The next thing we do is to expose them to the experience that they fear - the one that causes the attack," she says. So, for example, if the patient's fear is of driving through a tunnel, Corne works with them to the point where they actually feel like they can attempt it.

Medication is another option. However, some anti-anxiety drugs are very potent and can produce side effects, so this option should always be given careful consideration. Also, while medication such as Zoloft and Prozac can give short-term relief, it is important that other strategies are used as well, including CBT and education about the condition.

Complementary therapies, diet, exercise, relaxation techniques and meditation can also help. The key is to find out what works for you. Thompson says focusing on slow breathing has helped him. "When I have an attack, my wife does slow breathing techniques with me, and keeps physical contact by holding my hand or touching me for reassurance."

Marisa Galetta*, a 38-year-old small business owner from Sydney's inner west, has suffered from panic attacks since she was just six years old. She says a combination of CBT and medication have helped, but adds that since she's got into the habit of looking after her health and wellbeing, the attacks have become fewer and further between.

"I'm careful with my diet, I exercise regularly and I make sure I get enough sleep," she says. "I'm also very organised. If I know I have a stressful period coming up at work, I diarise down time, including regular massages, and I make sure I don't drink too much to offset the stress. 

Reaching out

Understanding you're not alone, and reaching out to those around you for support, is vital, Professor Jefferys says. "It's important to have people around you can trust, because a lot of people who suffer from panic attacks have a fear that they'll be left alone somehow - a feeling of abandonment."

Charlotte Moore*, a 34-year-old graphic designer, says that when she suffered her first panic attack, she told her mother and partner immediately. "My mother was fantastic," she says. "She called a doctor to the house that very first night, kept a diary of my panic attacks and tried to find information to help me manage them. My partner at the time was a wonderful naturopath and helped me immensely with supplements and herbal concoctions."

Professor Jefferys explains: "Once someone has been treated for panic attacks or panic disorder, a whole new world is opened up to them - one they don't want to lose. So while the chance of a relapse is always there, it's easy to treat with a few 'top-up' sessions.

"I had a patient who suffered from panic attacks for around 20 years. He had become very agoraphobic and could only drive from his home to work and back again. His life was very limited and he couldn't go on holidays. We worked together for around 18 months and he has since gone on to travel overseas seven times - alone. He now has a whole new lease of life."

* Names changed.

How to cope with panic attacks

1. Breathe into a paper bag. Inhaling your exhaled carbon dioxide can quickly balance your blood gases and ease symptoms.
2. If you don't have a paper bag, hold your breath for the count of 10, then take slow and deep breaths using your abdomen rather than your chest.
3. Avoid "self-talk" that focuses your attention on your symptoms - don't tell yourself to "stop panicking" or "relax".
4. Remind yourself that the symptoms of a panic attack are uncomfortable, but not life threatening. Reassure yourself that you've felt these feelings before and nothing bad happened to you.
5. Focus your attention on something outside your own body and symptoms. For example, distract yourself by counting backwards in threes from 100, recall the words from a favourite song or concentrate on the sights and sounds around you.
6. Fleeing from the situation will only reinforce the perception that your panic attacks are unbearable. If you sit and allow the symptoms to pass, you will gain confidence in your ability to cope.

Source: Victorian Governments Better Health Channel website.

Source of this article: http://www.bodyandsoul.com.au/

ANXIETY - Kids Afraid of Life

It's not uncommon for kids -- as well as adults -- to be shy. They may be uncomfortable when meeting new people or being in new situations. But once they've gotten their feet wet, so to speak, they're usually fine. For others though, that initial feeling of discomfort never goes away and keeps them from leading a normal life. When shyness reaches that level, it takes on a different name -- social anxiety.

There's more awareness of social anxiety -- also known as social phobia-- in adults than in children, says Barbara Markway, PhD, co-author with her husband, Greg Markway, PhD, of Painfully Shy: How to Overcome Social Anxiety and Reclaim Your Life. But the condition actually often starts in adolescence, or even childhood, she says. "The sooner you can diagnose it, the sooner you can treat it and avoid the pain and suffering that come along with the disorder," says Markway, who suffered from social anxiety as a young adult.

Adults and kids alike who suffer from social anxiety fear that others are judging them, that they're the center of (unwanted) attention, that they're being scrutinized all the time, says Markway. In kids, those feelings can translate into such behaviors as not raising their hand in class, not eating in the cafeteria with the other kids, not playing with the other kids on the playground, not joining after-school activities, and in some instances, refusing to go to school at all.

In severe cases, a condition known as selective mutism can develop in which a child won't speak to anyone outside his or her family -- interfering with both school performance and social interaction. "It's as if the voice box is frozen," Markway explains.

It's Different for Kids

One difference between kids and adults with social anxiety, says Markway, is that because youngsters find it harder to articulate their feelings verbally -- may not even recognize what they're feeling -- they may be prone to tantrums, crying spells, or frequently complain of stomachaches.

"Adults often realize that their fears are excessive," Markway says. "But kids don't." The bottom line, however, may be the same ... they try to avoid situations that make them nervous.

The difference between garden-variety shyness and social anxiety can be found in how much the condition is affecting daily life. "If the child is avoiding things that normal kids like to do, you may be in the realm of disorder rather than just shyness," says Markway.

Approximately 3-5% of the population suffers from social anxiety, says Deborah Beidel, PhD, professor of psychology and co-director of the Maryland Center for Anxiety Disorders at the University of Maryland in College Park. The incidence in children younger than 12 is about 3%, and in adolescents, about 5%, she says. Beidel is co-author with Samuel M. Turner, PhD, of Shy Children, Phobic Adults: The Nature and Treatment of Social Phobia.
Boys and girls are equally affected, but girls are more likely to admit it, says Beidel. The condition can be clearly diagnosed as young as age 8. Younger children may also suffer from social anxiety, but it's harder to diagnose them because they may be unable to fully express their feelings.

Because the children who suffer from social anxiety usually aren't the troublemakers in school, they may get overlooked, says Beidel.

Social phobia tends to run in families. If a parent suffers from any kind of anxiety disorder, it's more likely the child will, too, says Beidel. The condition may also be learned: If parents are shy, they may not take their child to different places, to meet different people, and the child will not learn to cope with new situations.

Getting Help

It's important to treat social anxiety as early as possible, both experts agree.

"This is not something you outgrow without intervention," says Beidel.
Adds Markway, "Social anxiety can be a precursor to depression in adolescence, and in adults can lead, along with depression, to substance abuse, even suicide."
When treating social anxiety in adults, medications such as SSRIs. Paxil, for example, has been FDA approved to treat social anxiety in adults. Though SSRIs have not received FDA approval for the treatment of social anxiety in children, they can be used successfully, says Markway.
But the standard treatment is cognitive behavioral therapy, geared to the child's age. The use of puppets, for example, can help children change the way they think about things and how they talk to themselves. Kids are also taught relaxation techniques to use in situations that make them uncomfortable.
"Through treatment, the kids can learn that the horrible things they fear won't happen," says Beidel.
Beidel is currently conducting a four-year study funded by the National Institute of Mental Health, comparing behavior therapy, Prozac, and placebo in youngsters aged 8-16. Part of the behavioral component consists of a program in which children in the trial meet with "peer helpers," for an hour and a half at a time, in a social situation.
"This is a chance for the kids with social phobia to mix with the kids who usually ignore them in a setting they usually don't go to," says Beidel. "It gives them the opportunity to practice the skills they have been learning."
While it's important to get help as early as possible, the good news is that studies indicate that treatment is effective and need not go on for an unlimited length of time, says Markway. "Short-term [six to 12 weeks perhaps, although it does depend on the severity of the disorder] usually works," he says. "You're not looking at years and years of therapy."

If you suspect your child suffers from social anxiety or social phobia, look for a mental health professional who specializes in the behavioral treatment of children, says Beidel.

For more information on the condition, these sources may be of help:

• Association for Advancement of Behavior
• Therapy Anxiety Disorders Association of America
• Maryland Center for Anxiety Disorders

Source: http://www.webmd.com/

ANXIETY - Stage Fright (Performance Anxiety)

If you dread the thought of getting up in front of a group of people and performing, you are not alone. Millions of people suffer from performance anxiety, commonly called "stage fright." In fact, most people would rather get the flu than perform. Athletes, musicians, actors, and public speakers often get performance anxiety.

Performance anxiety can prevent you from doing what you enjoy and can affect your career. Worst of all, performance anxiety can negatively affect your self-esteem and self-confidence. Although it may be impossible to totally overcome performance anxiety, there are many things you can do to control your emotions and reduce anxiety.

Performance Anxiety Symptoms

Being the center of attention and having all eyes on you can be stressful. Your body reacts to this situation in much the same way as it would if you were being attacked. Your body's "fight-or-flight" mechanism kicks in, which is why symptoms of stage fright are similar to symptoms that occur when you are in real danger.

Performance anxiety symptoms may include:

• Racing pulse and rapid breathing
• Dry mouth and tight throat
• Trembling hands, knees, lips, and voice
• Sweaty and cold hands
• Nausea and an uneasy feeling in your stomach
• Vision changes
  

Performance Anxiety Causes

Simply put, stress and anxiety about performing in front of people causes performance anxiety. Confronting your fears and vulnerabilities, accepting yourself for who you are, and not feeling like you have to prove yourself to others, is the first step toward overcoming performance anxiety. Keep in mind that nobody is perfect, nobody expects you to be perfect, and it is OK to make mistakes.

The second step is learning how to redirect your negative thoughts, beliefs, images, and predictions about performing in public. Doing this is not as difficult as you might think.

Performance Anxiety Treatments

Here are 10 tips to help you overcome your fears and shine on stage, on the field, or at the podium:

• Be prepared: practice, practice, practice.
• Limit caffeine and sugar intake the day of the performance. Eat a sensible meal a few hours before you are to perform so that you have energy and don't get hungry. A low-fat meal including complex carbohydrates -- whole-grain pasta, pizza, or a bean and rice burrito -- is a good choice.
• Shift the focus off of yourself and your fear to the enjoyment you are providing to the spectators. Close your eyes and imagine the audience laughing and cheering, and you feeling good.
• Don't focus on what could go wrong. Instead focus on the positive. Visualize your success.
• Avoid thoughts that produce self-doubt.
• Practice controlled breathing, meditation, biofeedback, and other strategies to help you relax and redirect your thoughts when they turn negative. It is best to practice some type of relaxation technique every day, regardless of whether you have a performance, so that the skill is there for you when you need it.
• Take a walk, jump up and down, shake out your muscles, or do whatever feels right to ease your anxious feelings before the performance.
• Connect with your audience -- smile, make eye contact, and think of them as friends.
• Act natural and be yourself.
• Exercise, eat a healthy diet, get adequate sleep, and live a healthy lifestyle.
  

Keep in mind that stage fright is usually worse before the performance and often goes away once you get started.

Source: http://www.webmd.com/

PARENTING - Childhood Fears and Anxieties

Experts describe how parents can help when their child is afraid.

Things that go bump in the night. The bane of Miss Muffet's existence. A teacher's harsh rebuke. What do they all have in common? Plenty: They're all typical childhood anxieties and fears.

Nothing to worry (too much) about. But try telling that to your child! As a parent, you can make a big difference in how well your child handles common worries like these. Here are a few ideas that may help.

The Many Sides of a Child's Fears

Not all fear is bad. In fact, a little fear serves as an insurance policy. "Without fear, we'd jump headlong into things we shouldn't," says Tamar E. Chansky, PhD, author of Freeing Your Child from Anxiety. Chansky is also director of the Children's Center for OCD and Anxiety in Plymouth Meeting, Pa.

Some fear is evolutionary in nature, says Chansky. For example, many children -- and adults -- continue to fear things outside their experience. Their brains are wired to protect them from snakes, for example, even though the average person rarely encounters a slithery serpent, venomous or not.

Some children experience anxiety disorders, often a strong emotional response to an intense experience. But mostly, a child's fears are a predictable rite of passage.

Common Childhood Anxieties and Fears

Your child's "anxiety landscape" changes over time. Here are some of the most common childhood anxieties he or she is likely to experience at different stages of development.

Fears of an Infant or Toddler

• Loud noises or sudden movements
• Large looming objects
• Strangers
• Separation
• Changes in the house
  
  

Fears During Preschool Years

• The dark
• Noises at night
• Masks
• Monsters and ghosts
• Animals such as dogs

Fears During School Years

• Snakes and spiders
• Storms and natural disasters
• Being home alone
• Fear of a teacher who's angry
• Scary news or TV shows
• Injury, illness, doctors, shots, or death
• Fear of failure and rejection

Easing Fears in Infants or Toddlers

In the ideal situation, an infant's world is framed by parental security and a sense of calm. Anything that disrupts that -- a loud noise or a stranger, for example -- creates fear, says Chansky. One simple thing you can do to maintain calm is to establish a predictable routine. Also, minimize the numbers of caretakers in your child's life. Strong bonding with your child -- through regular touch, eye contact, and talking or singing -- creates a foundation of trust, helping to inoculate your child against future anxiety, too.

Easing Fears in Preschoolers

As their world expands, preschoolers continue to fear new places and people. New exposures bring fear of the unexpected, Chansky tells WebMD.

"Some of this is the result of concrete experiences, but some of it is due to their developing imagination." Being able to imagine that there reallyisn't anything lurking in that dark closet is a wonderful accomplishment, she says. But, at this age, they haven't quite mastered the skill enough to know how to calm themselves.

Kristin Lagattuta, PhD, assistant psychology professor at the University of California at Davis, does research with preschoolers. She studies how they make connections between the mind and emotions. Lagattuta explains that young children around age 4 or 5 do OK telling the imaginary from the real -- unless it is connected with something fearful. "When the emotion is real, then it is hard for them to determine that the experience that goes with it isn't real, as well."

Source: http://www.webmd.com/

TEENS - Anxiety and Teens

While all teens feel anxious from time to time, some feel it more than others.

Say your best friend tells you she's going to the airport with her dad to learn to skydive. She's totally excited. But just thinking of skydiving causes you tremendous anxiety. Your stomach churns, your heart races, and you feel a lump in your throat when you try to swallow. You can't believe your friend is actually doing this, and think about it all day long. When she calls that evening, she says she can't wait to skydive again -- "It was thrilling!"  While you and your friend are both thinking about skydiving, you perceive the situation in very different ways.

What Is Anxiety?

For teens or anyone else, anxiety is a normal reaction to stress. Things like tests, meeting new people, speaking in public, going on a date, and competing in sports can make us feel apprehensive or uneasy. But some teens react much more strongly to stressful situations than others. Even thinking about the situations may cause them great distress.

Anxiety can be a good thing when it helps you deal with a tense situation. For example, when you're studying for a test, a little anxiety can make you want to study hard so you do well. But at other times, anxiety can be harmful, especially when it is excessive and irrational, and prevents you from being able to focus.

Sometimes the anxiety can come between you and your friends, especially when you avoid going out with them or calling them because you're too panicked or tense. This level of anxiety is harmful and that's when you need to do something to feel less anxious so you can fully enjoy your teenage life.

How Can Teens Cope with Anxiety?

Many teens find ways to cope with the high anxiety they feel. It's important to recognize your emotions, to know what you're feeling and why you're feeling that way. Recognizing the types of situations that cause your anxiety is helpful as well.

Sometimes just admitting that a situation is stressful and being prepared to deal with it can reduce your anxiety. If you try these simple measures and still have too much anxiety, getting treatment from a health care professional or therapist is the next step.

How Much Anxiety is too Much?

Here are some of the signs of excess anxiety:

• You feel anxious, worried, or afraid for no reason at all. Normally, teens feel anxiety because of something specific -- like a test or going out on a date. But if there's no obvious reason for your feelings, your anxiety level may be too high.
• You worry too much about everyday events or activities. Some worry is normal. But if you're constantly worrying about things that are not unusual, your anxiety level is too high.
• You continually check whether you did something right. While it's normal to check something you did to make sure it's right, continuing to check it again and again is a sign that you have way too much anxiety.
• You're so panicky you're unable to function in certain specific situations -- like taking tests or socializing with friends.
  

What Anxiety Treatments Are Available for Teens?

Finding the right treatment is an important first step in reducing your anxiety. Treatment involves seeing a psychiatrist, clinical social worker, or psychologist. Sometimes the counselors at school may serve as a resource to find the appropriate treatment. Treatment can improve many areas of your life, including your performance in school and relationships with your family and friends. 

Here are the most common treatments for anxiety.

Medication. Several types of prescription medications can be useful, depending on the kind of anxiety you have. Generalized anxiety or anxiety in social situations are often treated with the same kinds of medication used to treat depression. These take 4 - 6 weeks to work best. Because of this, your doctor may also recommend another type of treatment such as cognitive-behavioral therapy.

Specific anti-anxiety drugs, called benzodiazepines (the oldest of which is Valium), can also be added or used alone, depending on the circumstances. Specific anxieties, like panic about tests or public speaking, can also be treated by taking a single dose of a medication called a beta-blocker about an hour before the feared event.

New medications are being developed all the time. Your health care provider will work with you to find the one(s) that work best for you. Remember, if you are taking medications for anxiety, it is important to follow your doctor's instructions for taking it. Never stop taking any anxiety medication without talking to your doctor first.

Cognitive-behavioral therapy. You'll need to see a therapist for cognitive-behavioral therapy, or CBT. The therapist will help you identify what types of thoughts and beliefs cause your anxiety, and work with you to reduce them. It's important to see a therapist who has experience treating anxiety in teens, and to plan to see that therapist frequently. Keep in mind that any therapy can succeed only if you work on getting better. The therapist just helps by suggesting ways that may help you change and get better.

Biofeedback. This therapy uses electronics to measure how your body responds to stress. It's based on the idea that when people are given information about their body's internal processes, they can use this information to learn to control those processes.

During biofeedback, you'll be connected to a machine that tells you and your therapist when you are relaxing your body. With sensors placed over specific muscle sites, the therapist can read the tension in your muscles, your heart rate, your breathing pattern, the amount of sweat produced, and/or body temperature. Any one of these readings can let the therapist know if you are learning to relax. Biofeedback can be fun -- it's almost like playing a computer game.

Relaxation techniques. Relaxation techniques can help reduce anxiety and negative thoughts and help you manage stress. Common relaxation techniques include deep abdominal breathing, meditation, listening to calming music, and activities like yoga and tai chi.

Start Your Own Relaxation Program

To reduce normal levels of anxiety, set aside a period of about 20 minutes each day to devote to relaxation. Remove distractions as much as possible. Turn off the sound on your computer and the ringer on your cell phone.

During the 20-minute period, remain as still as you can. Focus your thoughts on the immediate moment, and eliminate any outside thoughts that compete for your attention. Try to notice which parts of your body feel relaxed, and which feel tense.

As you go through these steps, try to imagine that every muscle in your body is becoming relaxed and free of tension. Picture all the muscles in your body beginning to go loose and limp.

Concentrate on making your breathing slow and even. Each time you exhale, picture your muscles becoming even more relaxed, as if with each breath you breathe the tension away.

At the end of 20 minutes, take a few moments to focus on the feelings and sensations you have been able to achieve. Notice whether areas that felt tense now feel looser, and whether any areas of tightness remain.

Some people find that chanting (even a single word) or singing, praying, or focusing their vision on an object or flickering light source (like a candle or fireplace) also helps them achieve a more relaxed state of mind.

Don't be surprised if the relaxed feeling begins to fade once you get up and return to your normal activities. Many teens find that it is only after several weeks of daily, consistent practice that they are able to maintain the relaxed feeling beyond the practice session.

When Should Teens Get Help for Anxiety?

If you have high levels of anxiety as mentioned above, it's important to seek treatment. About 13% of teenagers have high enough anxiety to need medical or psychotherapeutic treatment.

Source: http://teens.webmd.com/

WHAT WE SHOULD KNOW - Panic Disorder Symptoms

Panic Disorder Symptoms

By JOHNNA MEDINA, M.A

People with panic disorder have feelings of terror that strike suddenly and repeatedly, most often with no warning. They usually can’t predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike. In between times there is a persistent, lingering worry that another attack could come any minute.

When a panic attack strikes, most likely your heart pounds and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control. 

You may genuinely believe you’re having a heart attack or stroke, losing your mind, or on the verge of death. Attacks can occur any time, even during nondream sleep. In the United States, this type of panic attack has been estimated to occur at least one time in roughly one-quarter to one-third of individuals with panic disorder, of whom the majority also have daytime panic attacks. While most attacks average a couple of minutes, occasionally they can go on for up to 10 minutes. In rare cases, they may last an hour or more.

Panic disorder strikes between 3 and 6 million Americans, and is twice as common in women as in men. It can appear at any age–in children or in the elderly–but most often it begins in young adults. Not everyone who experiences panic attacks will develop panic disorder– for example, many people have one attack but never have another. For those who do have panic disorder, though, it’s important to seek treatment. Untreated, the disorder can become very disabling.

In the United States and Europe, approximately one-half of individuals with panic disorder have expected panic attacks as well as unexpected panic attacks. Thus, as a recent change made to the criteria in the 2013 DSM-5, presence of expected panic attacks no longer prevents the diagnosis of panic disorder. This change acknowledges that oftentimes a panic attack arises out of an already-anxious state (e.g., the person is worried about having a panic attack in a store and low-and-behold has one). Clinicians now make the decision whether a person’s expected panic attacks will count towards their client’s panic disorder diagnosis. Now, they will usually classify expected panic attacks under panic disorder as long as the person’s concerns accompanying their panic attacks are centered around fears of the panic sensations themselves, their consequences (e.g., “I could have died or gone crazy”), and of having them again in the future (e.g., the person makes special efforts to avoid returning to the place where that attack occurred).

Panic disorder is often accompanied by other conditions such as depression or alcohol/drug use to cope with or prevent symptoms, and may spawn phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while you’re riding an elevator, you may develop a fear of elevators and perhaps start avoiding them.

Some people’s lives become greatly restricted — they avoid normal, everyday activities such as grocery shopping, driving, or in some cases even leaving the house. Or, they may be able to confront a feared situation only if accompanied by a spouse or other trusted person. Basically, they avoid any situation they fear would make them feel helpless if a panic attack occurs. When people’s lives become so restricted by the disorder, as happens in about one-third of all people with panic disorder, the condition is called agoraphobia. A tendency toward panic disorder and agoraphobia runs in families. Nevertheless, early treatment of panic disorder can often stop the progression to agoraphobia.

Specific Symptoms of Panic Disorder:

A person with panic disorder experiences recurrent either expected or unexpected Panic Attacks and at least one of the attacks has been followed by 1 month (or more) of one or more of the following:

• Persistent concern about about the implications of the attack, such as its consequences (e.g., losing control, having a heart attack, “going crazy”) or fears of having additional attacks
• A significant change in behavior related to the attacks (e.g., avoid exercise or unfamiliar situations)

The Panic Attacks may not be due to the direct physiological effects of use or abuse of a substance (alcohol, drugs, medications) or a general medical condition (e.g., hyperthyroidism).

Though panic attacks can occur in other mental disorders (most often anxiety-related disorders), the panic attacks in Panic Disorder itself cannot occur exclusive to symptoms in another disorder. In other words, attacks in Panic Disorder cannot be better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).

Panic disorder is associated with high levels of social, occupational, and physical disability; considerable economic costs; and the highest number of medical visits among the anxiety disorders, although the effects are strongest with the presence of agoraphobia. Though Agoraphobia may also be present, it isn’t required in order to diagnose panic disorder.

Source: http://psychcentral.com/

ANXIETY - 3 Methods That Help You Face Your Fears and Overcome Anxiety

FACE YOUR FEARS

3 Methods That Help You Face Your Fears and Overcome Anxiety

Anxiety can be completely devastating if left untreated. Here are three solutions that can help ease the fear.

PUBLISHED: AUGUST 5, 2014  |  BY KRISTEN DOLD

There are no magic phobia-slaying meds or other quick-fix cures. Many of the best treatments call for confronting the things you're most scared of. These three methods can help.

COGNITIVE BEHAVIORAL THERAPY (CBT)
CBT involves changing phobia-related thoughts and behaviors, then meeting your specific fear factor via "exposure" treatment. If, for example, you have a fear of heights, your therapist might move you through a "fear ladder," from peering out a second-story building window to eventually peering over the edge of a skyscraper balcony. Or, if you're terrified of spiders, your exposure might require first looking at photos of spiders, then standing 10 feet away from a spider terrarium, then touching the terrarium, then touching a spider with the end of a paintbrush, then touching a spider with a glove, then finally petting one with your bare hand. (Arachnophobics who did this in a Northwestern University study were still phobia-free six months later.) Typically covered by insurance, CBT works up to 95 percent of the time, says Martin Antony, Ph.D. But you'll have to commit. It usually can take anywhere from one two-hour session to 10 weekly hour-long sessions, with take-home work in between.

HYPNOSIS
Less studied than CBT and virtual-reality therapy, hypnosis nevertheless has a steady following. Anecdotal evidence shows that the practice, in which a hypnotherapist slips your body and mind into a focused state of awareness and "walks" you through your fears for an hour, can do wonders for phobias, often in combination with CBT. It could be that reorganizing irrational instincts into logical thought patterns is easier when your brain is at rest, says Reid Wilson, Ph.D. And if you can't stand the thought of exposure therapy (touching spiders? No way in hell!), hypnosis can be a good baby step toward getting over your fear. Most patients see improvement in four to 12 sessions.

VIRTUAL-REALITY THERAPY
Some fears, including flying or public-speaking phobias, can be very difficult to replicate in therapist-controlled settings. Enter virtual-reality exposure treatment. You wear a head-mounted simulator (think: a 3-D video screen in front of your face) that "transports" you to, say, an airplane or lecture hall. A trained therapist uses a computer to monitor you as she controls what you see and hear, and your brain reacts to the scenes in the same way it would to real-life scenarios, says Antony. As with CBT, the goal is to eventually retrain your mind to think of these situations as normal and nonthreatening. Weekly treatments can last an hour or more and usually start working after anywhere from three to 12 sessions.

Source: http://www.womenshealthmag.com/

PANIC - 6 Ways to Calm Yourself Down When You Start to Panic

CALM DOWN

6 Ways to Calm Yourself Down When You Start to Panic

You're not in full-on freak-out mode just yet—and with these tips, you don't need to get there.

PUBLISHED: AUGUST 5, 2014  |  BY KRISTEN DOLD

To completely nix a phobia, you'll likely have to confront your trigger (see 3 Methods That Help You Face Your Fears and Overcome Anxiety for ways to get professional help to do that). While you're working on that—and when escape isn't an option—try any of these in-the-moment strategies from Marla Deibler, Psy.D.

Take Deep Breaths
The moment you spot the object of your fear, inhale slowly through your nose for a count of four, pause, then exhale slowly through your mouth for a count of four. Deep breaths trigger the body's relaxation response.

Welcome Any Distraction
Your eyes and ears lock in on your phobic trigger (as in, you're horrified but can't look away). Distract them, and your brain, by checking texts or playing an iPad game. Even better: If you can, join a conversation or listen to calming music.

Find a Helping Hand
Research shows that when the skin's pressure receptors are activated, the body produces more "happy" hormones like dopamine. If you're alone, rubbing your own arms may activate the same response.

Move Your Muscles
Gently clenching and unclenching your muscles can remind your brain who's really in control (you!). Start with your toes and work your way up, slowly squeezing and releasing your calves, thighs, butt, abs, and so on. This can also help maintain blood pressure and thwart fainting.

Question Your Angst
As your mind runs wild—this flight is going to crash!—try to ask yourself logical questions. How likely is it that we'd actually crash? Has anyone in charge signaled an emergency? Some phobics benefit by bringing along pre-written responses (there's only a one in 11 million chance, etc.) to read to themselves.

Accept Your Fear
The more you fight uncomfortable feelings, the greater your discomfort will typically grow. Try repeating to yourself something like Even though I'm not in danger, it's okay I feel this way. I will just ride the anxiety out until it passes, as it always does.

Source: http://www.womenshealthmag.com/

PANIC - What Happens to Your Body When You're in Panic-Mode

PANIC MODE

What Happens to Your Body When You're in Panic-Mode

It takes only a few seconds to spur a phobic meltdown. Here is a play-by-play of a panicked response.

PUBLISHED: AUGUST 5, 2014  |  BY KRISTEN DOLD

0 to 1 second: 
Your eyes or ears identify your phobic trigger (a needle, a snake, the dentist's drill) and instantly send a "threat!" message to your amygdala, the brain's fear center.

1 to 3 seconds: 
The amygdala, in turn, overrides the prefrontal cortex—a.k.a. your brain's logic center—and tells your adrenal glands to shoot out the stress hormones adrenaline and cortisol. Those prompt sweating (to help you stay cool), rapid breathing and heartbeat (to help pump oxygen to your muscles), and dilation of the pupils (to help you better keep an eye on that threat).

Within 5 seconds: 
Your brain begins releasing endorphins, natural painkillers that could protect you during a physical attack. It also secretes a small amount of the feel-good hormone dopamine (hence the "rush" some people get in scary situations)—but not enough to temper your hormone-fueled panic. Some phobics experience sharp rises and drops in blood pressure, causing them to pass out. Many experts believe this stems from an evolutionary "freeze" or "play dead" response.

During and after the next few minutes: 
If you can't calm yourself down, you'll need to flee the scene to get your prefrontal cortex back online. Once the audible or visual threat is gone, it directs the amygdala to put a stop order on those stress hormones. You might still be jumpy for a day or two (every stick could be a snake). If yours is a true phobia, your amygdala will spur this same outsize response every time—until you can retrain your brain to respond to your phobic trigger in a more logical way.

Source: Reid Wilson, Ph.D., associate clinical professor of psychiatry at the University of North Carolina School of Medicine and author of Don't Panic

PANIC ATTACK - Under Pressure: What Is a Panic Attack?

Panic attacks -- a terrifying experience -- is a symptom of panic disorder, which fortunately is one of the most treatable of the anxiety disorders.

WebMD the Magazine - Feature

Reviewed by Patricia A. Farrell, PhD

A man in his mid-40s is rushed to an emergency room. He is sweating, his heart is racing, and he can't catch his breath. He and his wife are convinced he is having a heart attack. He could be-only, this time, the ER doctors tell him his heart is just fine. What he's having is a panic attack.

Though no one should ever ignore heart attack symptoms or assume one is having a panic attack instead, thousands of people each year share this man's experience.

Panic attacks are truly terrifying and can happen without warning or reason, causing sudden fear and extreme nervousness for 10 minutes or more. Physical symptoms intensify the attack: sweating, racing heart, rapid pulse, feeling faint or as if one is choking, and-perhaps worst of all-the sense of "going crazy."

These attacks are a symptom of panic disorder, a type of anxiety disorder that affects some 2.4 million U.S. adults. The disorder most often begins during the late teens and early adulthood and strikes twice as many American women as men. No one knows what causes panic disorder, though researchers suspect a combination of biological and environmental factors, including family history (panic disorder seems to run in families), stressful life events, drug and alcohol abuse, and thinking patterns that exaggerate normal physical reactions.

What happens, exactly? "We all physically respond to stress," says Barbara O. Rothbaum, PhD, psychiatry professor and director, Trauma and Anxiety Recovery Program, at Atlanta's Emory University School of Medicine. "You might feel anxious about work-related problems, taking a big exam, or making an important decision. But someone who suffers from panic disorder may react to those same moderate pressures with an exaggerated physical reaction-as if he or she were about to be attacked by a wild tiger or fall from a great height. It's full-on, adrenaline-pumping, fight-or-flight response."

For this very reason, Rothbaum says, panic attacks are doubly frightening. "Because there is no real danger that provokes them, these episodes can happen anytime, anywhere"-including while walking down the street, dining out with a group of friends, grocery shopping-even sleeping, according to the National Institute of Mental Health.

Over time, many who suffer panic attacks develop an on-going fear of having another attack. This fear can severely hamper daily activities and overall quality of life. Some people refuse to leave their houses or to put themselves in situations that remind them of their previous attacks. Agoraphobia (a fear of being outside of known and safe surroundings) or other mental problems may follow.

Fortunately, panic disorder is one of the most treatable of the anxiety disorders. Psychotherapy (sometimes called talk therapy), cognitive, or biofeedback therapy can all help alter a person's response to stimuli.Medications, such as antidepressants and beta-blockers, are another option. And certain lifestyle changes, such as limiting caffeine and sticking to a daily exercise plan, can decrease symptoms as well.

Source: http://www.webmd.com/

PANIC ATTACK- Why Do We Panic?

Why Do We Panic?

A better understanding of the path from stress to anxiety to

full-blown panic disorder offers soothing news for sufferers

Oct 1, 2008 |By Scott O. Lilienfeld and Hal Arkowitz

"I WAS DRIVING home after work,” David reported. “Things had been very stressful there lately. I was tense but looking forward to getting home and relaxing. And then, all of a sudden—boom! My heart started racing, and I felt like I couldn’t breathe. I was sweating and shaking. My thoughts were racing, and I was afraid that I was going crazy or having a heart attack. I pulled over and called my wife to take me to the emergency room.”

David’s fears turned out to be unjustified. An emergency room doctor told David, a composite of several therapy patients seen by one of us (Arkowitz), that he was suffering from a panic attack.

The current edition of the Diagnostic and Statistical Manual (DSM) defines a panic attack as an abrupt and discrete experience of intense fear or acute discomfort, accompanied by symptoms such as heart palpitations, shortness of breath, sweating, trembling, and worries about going crazy, losing control or dying. Most attacks occur without obvious provocation, making them even more terrifying. Some 8 to 10 percent of the population experiences an occasional attack, but only 5 percent develops panic disorder. Contrary to common misconception, these episodes aren’t merely rushes of anxiety that most of us experience from time to time. Instead patients who have had a panic attack typically describe it as the most frightening event they have ever undergone.

Research has provided important leads to explain what causes a person’s first panic attack—clues that can help ward off an attack in the first place. When stress builds up to a critical level, a very small additional amount of stress can trigger panic. As a result, the person may experience the event as coming out of the blue.

Some people may have a genetic predisposition toward panic, as psychologist Regina A. Shih, then at Johns Hopkins University, and her colleagues described in a review article. The disorder runs in families, and if one identical twin has panic disorder, the chance that the other one also has it is two to three times higher than for fraternal twins, who are genetically less similar. Although these findings do not rule out environmental factors, they do strongly suggest a genetic component.

Panic disorder imposes serious restrictions on patients’ quality of life. They may be plagued by a persistent concern about the possibility of more attacks and may avoid situations associated with them. To receive a diagnosis of panic disorder, patients must also worry that they might have another attack where it would be embarrassing (say, in a public setting such as a classroom), difficult to escape (such as when one is stuck in traffic), or difficult to find help (for example, in an area with no medical facilities nearby). Panic disorder accompanied by extensive avoidance of these situations results in a diagnosis of panic disorder with agoraphobia; in extreme cases, sufferers may even become housebound.

From Normal Anxiety to Crippling Fear
What are the roots of such incapacitating attacks? Psychologist David H. Barlow of Boston University, who has conducted pioneering research on understanding and treating panic disorder and related disorders, and others believe that panic attacks result when our normal “fight or flight” response to imminent threats—including increased heart rate and rapid breathing—is triggered by “false alarms,” situations in which real danger is absent. (In contrast, the same response in the face of a real danger is a “true alarm.”)

When we experience true or false alarms, we tend to associate the biological and psychological reactions they elicit with cues that were present at the time. These associations become “learned alarms” that can evoke further panic attacks.

Both external situations and internal bodily cues of arousal (such as increased breathing rate) can elicit a learned alarm. For example, some people experience panic attacks when they exercise because the physiological arousal leads to bodily sensations similar to those of a panic attack.

Why do some people experience only isolated attacks, whereas others develop full-blown panic disorder? Bar­low has synthesized his research and that of others to develop an integrated theory of anxiety disorders, which states that certain predispositions are necessary to develop panic disorder:

• A generalized biological vulnerability toward anxiety, leading us to overreact to the events of daily life.

• A generalized psychological vulnerability to develop anxiety caused by early childhood learning (such as overprotection from our parents) that the world is a dangerous place and that stress is overwhelming and cannot be controlled.

• A specific psychological vulnerability in which we learn in childhood that some situations or objects are dangerous even if they are not.

Panic disorder develops when a person with these vulnerabilities experiences prolonged stress and a panic attack. The first attack activates the psychological vulnerabilities, creating a hypersensitivity to external and internal cues associated with the attack. As a result, even medication containing a mild stimulant can provoke an ­attack.

Still, there is good news. Two findings in particular can provide reassurance for those with panic disorder. The first is that all panic attacks are triggered by known events, even though the sufferer may be unaware of them. This knowledge can reduce the anxiety associated with the sense of unpredictability. Second, it can be reassuring to learn that a panic attack is a misfiring of the fight-or-flight response in the absence of danger.

Basic research not only has helped us understand panic disorder but also has led to effective treatments. In particular, Barlow and his associates developed panic-control treatment, described in their 2006 book Mastery of Your Anxiety and Panic. It involves education about panic disorder and somewhat gradual exposure to the internal and external cues that trigger panic attacks, along with changing the catastrophic interpretations of bodily cues so that they no longer trigger the attacks. This treatment has in most instances surpassed drug therapies for the disorder over the long term.

Source: http://www.scientificamerican.com/