Chapter 4 of Claire Weekes’ Hope and Help For Your Nerves.   This chapter is entitled “The Commonest, Simplest forms of Nervous Illness”.  In this episode we discuss:

  • Common anxiety symptoms
  • Being over-sensitized (everything is a trigger!)
  • The role of fear and how fear of how we feel is what is keeping us “nervously ill”
  • Why understanding and knowledge of what the situation is so helpful and important as a first step
  • Why fighting against your anxiety, panic and fear, while a common approach, is often the wrong thing to do

Comments, questions and angry rants are always welcomed!

For those that prefer video:

 

 

What Is Nervous Breakdown

 

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What Is Nervous Breakdown?

This week Holly and I discuss chapter 3 of Hope and Help For Your Nerves by Dr. Claire Weekes.  We discuss the use of the somewhat outdated term “nervous breakdown” as it relates to things like panic disorder and agoraphobia.  We talk about how Dr. Weekes defines nervous breakdown, her two classifications of breakdown, and some basic strategies for dealing with the issue including talk therapy and CBT.

For those interested in the book we mentioned, its The Anxiety & Phobia Handbook by Edmund Bourne, which is readily available at Amazon and other booksellers online.

 

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Hope and Help For Your Nerves

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Chapter 2 – How Your Nervous System Works.

In this episode, Holly and I review chapter 2 of Claire Weekes’ Hope and Help For Your Nerves.  We discuss the fight or flight response, its involuntary nature, and the idea that your panic and anxiety symptoms are normal, natural, not dangerous, and not to be feared.  The take-away from chapter 2 is that you cannot stop your body from doing what it’s designed to do, but that you can change the way you interpret and react to your panic and anxiety symptoms.

Learning not to be afraid of how your body feels is the key to breaking the fear cycle that turns panic attacks into panic disorder.  Learning not to react in fear leads to symptoms that don’t feel as strong and don’t last as long.

We also touch briefly on the role of medications on your physiological state, and we discuss the misguided idea that you should try to treat the physical sensations or attempt to become anxiety or panic free.  Neither strategy addresses the cognitive nature of anxiety disorders.

 

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Hope and Help For Your Nerves

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Hope And Help For your Nerves by Dr Claire Weekes is the gold standard by which I judge all other panic/anxiety frameworks.  Dr. Weekes did an amazing job not only explaining the basis of panic disorder, but also in explaining in clear, concise language what needs to be done to address what she described as an “illness of how you think”.  This book is inexpensive and in my opinion should be required reading for anyone dealing with anxiety, panic attacks, agoraphobia,or panic disorder.

My friend Holly thought it might be helpful to break down Dr. Weekes’ book chapter by chapter in a podcast/video format, so here we are.  This is our episode on chapter one of the book – The Power Within You.

Grab a copy from Amazon (or Abe Books in the UK as per Holly) and follow along with us!

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Knowing the difference between panic attacks and panic disorder is an important part of moving forward and building a successful strategy for un-doing the cognitive distortions and bad habits that fuel your avoidance behaviors.  I published a short two-minute “micro podcast” on Anchor discussing this issue.  Several people joined the conversation.  Hit the play button below to listen to the conversation right here:

I am loving the Anchor platform! Its a quick and easy way for me to put out content on the go in small doses, and it allows for almost instant commenting and near real-time discussion.  If you’re an iPhone user, check it out.  Anchor for Android is on the way, at least according to the Anchor team as of this writing (March 2016).

learning the difference between panic attacks and panic disorder

 

morning anxiety

 

Morning Anxiety

Lets talk about morning anxiety. In plain language … its a bitch.  When you start the day feeling like you’re about to panic and all you want to do is hide away, how do you make progress?  I was asked this question today on My Facebook Page and I thought it was worth posting the answer here on the blog.

morning anxiety

First, thank you for the question Jason.  I appreciate the kind words!

Now for the answer.

This is VERY common!  Most people (including me) experience morning anxiety. Many folks even go through periods where high anxiety itself wakes them up well before the alarm clock.  This is no fun at all.

So why does this happen?  Cortisol levels are generally highest in the morning, and cortisol is the “stress hormone” so there’s likely a connection, but we really don’t know to be honest. Lets forget about that though.  If you’ve followed any of my podcasts, videos or blogs, you know that I am NOT a fan of focusing on physical symptoms and sensations.  Its often a dead end and only leads to frustration.

Instead, my best advice is to keep working  – all the time – on three skills:

  1. Breathing.
  2. Muscle relaxation.
  3. Basic meditation.

You really have to practice things things constantly.  Learn to do them when you feel good, so that you can do them when you feel awful. Also, don’t expect that they will stop anxiety or panic dead in their tracks.  That’s not what this is about and that’s not how it works.

The goal here is acceptance!  Get good at controlling your breath, relaxing your body and quieting your mind and it becomes much easier to accept the anxious state, especially when you know it’s going to fade as the day goes on.

Once you’re good at truly accepting feelings of anxiety or panic, once you stop fighting, once you stop fleeing,  and once you stop trying to make it stop … it often does!

Special Note: I’d like you ask you guys a favor.  If you haven’t already done so, please follow/friend me on any or all of the following services.  Once you’ve done that, ask me a question!  Comment on what you’ve read.  Let me know what you think.  PM me, tweet me, snap me, whatever works.  And thanks for reading.  I always appreciate it!

 

tag-tunnel

 

[NOTE] I wrote this a few years back. It appears in quite a few places online. In the interest of helping as many people as might benefit from it, I’m posting it again here.

The single most common mistake I see with regard to dealing with anxiety is the misguided idea that the goal is safety and comfort. On the contrary, you have to be afraid before you’re not afraid. You must experience fear and discomfort before you can be comfortable again. Obviously nobody wants to be afraid or uncomfortable, but this drive for safety and comfort represents the biggest impediment to truly conquering anxiety, be it in withdrawal or otherwise.

To truly overcome anxiety, panic and agoraphobia, you must first accept the fear, face it, relax into it, and expose it for what it is – baseless and harmless. From a logical/intellectual standpoint you may know full well that there’s really nothing to fear in your car, or in leaving your house yet you struggle with these things. You may understand that you’re not really having a heart attack or stroke, yet you still recoil in fear when you feel a twinge in your chest or a skipped heartbeat. The emotional side of your brain isn’t buying it. You’re still afraid, and you run from the fear. Until you actually experience the fear, face it full-on and learn that there’s nothing to be afraid of, learning does not happen and no lasting progress is made.

The recipe for success contains the following:

  • Acceptance – You must accept fear, anxiety and panic. Welcome it.
  • Courage – You must face the fear without running or avoiding.
  • Persistence – You must do it over and over as often as possible.
  • Patience – You must allow time to pass.

Simple plan, really hard to execute because being uncomfortable and afraid is not a natural thing to want to do. You must act when you feel your worst. Waiting until you have a “good day” does not help.

Here’s a short primer to help frame the whole process. Hopefully it serves as a good foundation for future discussion.

Overcoming Anxiety 101

NO REAL DANGER
A panic attack is nothing more than the natural “fight or flight” response triggered at inappropriate times. There’s nothing dangerous about a panic attack. It cannot kill you, damage you physically, or cause you to go insane, lose control, or become psychotic in any way. No matter how scary it may seem, none of these things is going to happen. It can’t be stressed enough – THERE IS NOTHING DANGEROUS ABOUT A PANIC ATTACK.

[Special note: You cannot pass out because of a panic attack. This is impossible because of the rise in blood pressure that comes along with a panic attack. You may hyperventilate in response to a panic attack (tingling sensations in your hands, feet and face are a good indicator that you are hyperventilating), which may then lead to passing out. Learning to control your breathing during high anxiety periods will allow you to avoid that. Even if you do pass out due to hyperventilation, you will regain consciousness shortly and no real harm will be done.]

FEAR FEEDS THE BEAST!

Panic and anxiety are made worse when you fear them. Adding fear to a panic attack or high anxiety situation is a sure way to make it last longer and feel more intense. Being afraid is a natural reaction to danger, but remember that in a panic attack there really is no danger. The key to beating panic and anxiety is to learn not to fear them. This is very hard and takes courage, hard work and patience, but it everyone can do it!

COPING TECHNIQUES

There are many coping techniques that can be used to navigate through a panic attack. Relaxation breathing, progressive muscle relaxation, positive self-talk and visualization/imagery can all be very helpful and effective in limiting the duration of a panic attack. Keep in mind that an actual panic attack involves the release of adrenaline into your bloodstream. Once that happens, there is no way to stop the physical symptoms of panic. It is important to remember that, but also remember that as long as you don’t feed the fear cycle your symptoms will subside naturally, usually within only several minutes. Coping techniques are designed to break the fear cycle and to limit the duration and intensity of a panic attack, not to stop a panic attack instantaneously.

AVOIDING AVOIDANCE

There is a difference between coping and avoiding! Coping skills must be used to allow yourself to be completely immersed in a panic attack, letting it naturally run its rather short course, without adding more fear to the process (which will only prolong the attack and make it feel more severe). Many people mistake avoidance for coping. Avoidance is a problem from a behavioral and learning standpoint because it does nothing to teach you that panic is not harmful, and it creates the false belief that you must try to “get away” from a panic attack to be safe. Both stand in the way of actual recovery from panic disorder.

Examples of avoidance behavior include:

  • Running to be in the presence of a friend or “safe person”
  • Fleeing to a “safe place” (i.e. your home, your car, or a specific room in your home)

REACTING TO SYMPTOMS

It is important not to react physically to the sensations of a panic attack. For example:

  • If you’re feeling short of breath, just let that happen. Don’t run to an open window in a frantic effort to get air into your lungs. Your lungs are working just fine. Remind yourself that shortness of breath is a common panic attack symptom and that if you don’t react to it, you will feel better very shortly.
  • If you’re feeling a tightness in your chest, do not spend all your time poking, probing, stretching or otherwise trying to find a position that alleviates that tightness. Instead, allow your chest to be tight and remind yourself that this is nothing more than a panic attack symptom that will go away within minutes if you don’t fear it.
  • If you suddenly get very hot or very cold, do not start removing clothing or running for the nearest heating duct. Just allow yourself to feel hot or cold and remind yourself that there is nothing dangerous about feeling that way and that the sensation is just part of panic and will subside shortly.

Use your coping techniques to calm your mind and to allow yourself to sit quietly, letting your symptoms come and go. This is a key aspect of recovering from panic disorder. Reacting in fear only leads to the belief that something you did somehow made you “safer”.

THERE’S NO COMFORTABLE WAY

This is a big one. There is no “comfortable” way to recover from panic disorder. Don’t waste your time or money on books, CDs, DVDs or websites that claim to have a “cure” for panic attacks unless you’re willing to face your fear head on as part of the process. Nobody can get you around that. Nobody. Sorry, but that’s just the way it is. The very heart of recovery lies in learning not to be afraid of panic The only way to do that is to fully experience panic without fleeing, avoiding, or adding more fear to the situation. This means that you will experience times of extreme fear and discomfort. That’s just the way it has to be. The good news is that if you’re willing to do that a few times, it will begin to get easier very quickly. It doesn’t take long for your courage to pay off as you suddenly find that you are no longer deathly afraid of having a panic attack. Reach that point and you’re most of the way home!

You have to be afraid, before you can not be afraid.

FINDING THE ROOT OF THE PROBLEM

Finding the causes of your panic attacks is a good thing, but not by itself. Stress, negative thinking, reactions to past traumas and emotional issues are just some of many possible panic and anxiety triggers. We’re all different, our life circumstances are all different, and that means that there is no one “cause” for panic attacks. Learning to identify your triggers and deal with them is an important part of recovery, but only if you’re also facing the panic and learning not to be afraid of it. Again, there’s no way around that. Learn not to fear panic and in the long run it won’t matter what happens in your life – you’ll never spend your time worrying about having panic attacks again.

THERAPY AND PROFESSIONAL HELP

Cognitive behavior therapy (CBT) is hands down the most effective current long-term treatment for panic disorder and related anxiety disorders. If you’re seeking professional help, look for a therapist that specifically specialized in CBT and anxiety disorders. Therapy focused on simply talking about your life might be helpful to a degree, but that is a very long term process and really does very little to address the immediate needs of a panic sufferer. Use CBT and related techniques to get past your panic attacks first. Once that’s done then feel free to talk for years about how your mother might not have hugged you enough as a child.

THE IMPACT OF LIFESTYLE

Lifestyle choices can influence your panic disorder positively or negatively. Eating a healthy diet can go a long way toward making you feel better overall. Avoid alcohol and mind-altering substances like recreational drugs. Anything that changes your mental state can be an anxiety trigger when you’re in a hyper-sensitive state (as many in the grips of panic disorder are). Get regular exercise and expose yourself to sunlight for at least 15 minutes every day if you can (use sunscreen when needed of course). Get plenty of sleep. Learn effective time and stress management techniques. Don’t ignore your emotional and spiritual needs. Living a healthy lifestyle make you feel better physically and mentally, and can really contribute to boosting your confidence and the feeling that you are in control of your life!

THE GOOD NEWS

Panic disorder and other anxiety disorders are among the most treatable conditions on the face of the planet today. Regardless of how long you have dealt with panic and anxiety, full recovery is within your reach at all times, even on what might seem to be your worst day!

 

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Photo Credit: <a href=”https://www.flickr.com/photos/92454606@N00/237660823/”>Stefan Baudy</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by-nc-nd/2.0/”>cc</a>

Women Exercising On Treadmills

 

 

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What’s The Problem?

You’ve been told over and over that exercise will make your anxiety problem better, yet somehow you find that if you exercise it makes you feel WORSE.  This can make you feel like your anxiety is worse than everybody else’s, or special, or untreatable.  You way want to exercise but find yourself avoiding it based on how you feel when you engage in activity.

What’s Going On Here?

Fortunately, this is an easy situation to unpack and improve.  You have concluded that exercise makes your anxiety worse simply because exercise causes changes in your body that mimic all the most common anxiety symptoms.  When you exercise you sweat, and breathe hard, and your heart beats faster, and you experience a chance in muscle tone.  This feels like a panic attack feels and you are conditioned to respond to these sensations with fear.  What may start as an accelerated heartbeat can quickly morph into a full blown panic attack as you add fear on top of fear, triggering an entire array of anxiety and panic symptoms.  The sequence is simple and easy to understand.

  1. You exercise.
  2. You misinterpret the natural response of your body.
  3. You go into fear mode.
  4. You create anxiety and panic where none is required to exist.

I am not saying that it doesn’t feel scary and uncomfortable.  It most certainly does.  That’s not a question.  What I am saying is that you may be afraid and uncomfortable when you exercise, but that doesn’t mean you are unsafe.  This is simply a conditioned inappropriate response to a particular set of natural, harmless, predictable sensations.

This is just part of some bad brain habits!

What Do I do About It?

First, you accept that what is happening is a cognitive issue an not a physical issue that indicates danger that must be avoided.  This is critical.  Once you’ve made peace with this idea, the next step is to accept that you MUST engage in exercise in a controlled way in order to learn by experience that you do not need to fear the associated sensations.  Exercise is an EXCELLENT form of interoceptive exposure!  Let me clarify that I am not necessarily talking about elite athlete level exercise here.  You do not have to run marathons, climb mountains or deadlift 700 pounds to make progress.  ANY activity counts, so get rid of any preconceived notions of what “real” exercise is before you start.

Why Should I Do That?  It Sounds Scary and Hard!

As with many aspects of recovery from an anxiety disorder, it will be scary (especially at the start), and it will be hard word.  It is well worth it however.  Solving the exercise problem means de-sensitizing yourself to anxiety symptoms in general, which is a GIANT leap forward toward recovery.  Using exercise to teach your brain not to fear a rapid heartbeat (for example) in the gym is also teaching your brain not to fear a rapid heartbeat while driving on the highway.  Improving your response to anxiety symptoms will boost your overall confidence, and engaging in a graduated program of exercise as a form of exposure will provide you with a sense of accomplishment. Naturally, moving more comes with all kinds of health benefits, and engaging in regular activity is often a “gateway” to re-engaging overall with things you enjoy or previously enjoyed.  There are many reasons to undertake this challenge.

Great!  What’s Next?

When you’re ready, check out part 2 of this short series where I will walk you through the nuts-and-bolts of going from completely inactive to a regular exercise program.

 

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Woman's Face Blurry

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(If you haven’t seen the previous episode discussing derealization, you might want to check it out first.)

Depersonalization is one of the most disturbing and hard to grasp anxiety symptoms. The feeling of being outside of yourself, “slipping away”, or “losing touch with yourself” can be quite frightening.  If one of the most commonly reported anxiety and panic related fears is going insane, depersonalization would be the number one trigger of that fear.

I like to think of depersonalization as nothing more than a temporary change in the way my brain is perceiving itself, and me.  Processing your perception of yourself is something that normally happens silently in the background and I envision depersonalization as the shifting of that processing into the foreground – where it doesn’t belong.  This is strange, odd, unfamiliar, jarring and disturbing …. but not dangerous.

In the end, as frightening and disturbing as it is, depersonalization in the context of anxiety disorders like panic disorder or agoraphobia is just another symptom. In the end, the goal is to learn through experience and repetition that you don’t have to like it, but you also don’t have to fear it.  Working on letting it happen without fighting, struggling, or trying to escape it can go a very long way toward limiting its impact on your life.

I can say from personal experience that when I recognize depersonalization, immediately going slack and shifting my mind into “neutral” almost always means that its going away pretty quickly.  Here’s the bonus to that … even if it doesn’t I am totally OK with that.  Even if it lingers for some time I can go about my day and engage with the world and 9 times out of 10 that engagement will be what “flips the switch” to brings thing back to a more normal place.

 

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derealization

 

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What Is Derealization?

If you’ve ever felt that suddenly nothing around you feels or looks real any longer, or that the world suddenly looks “strange” or “not exactly right”, you’ve probably experienced derealization.  People who experience derealization as an anxiety symptom have a very difficult time explaining it to others.  I’ve heard it described as looking at the world through glass or a camera lens.  Others have said that it feels like you’ve been shifted “out of phase” with reality and therefore aren’t perfectly attached to it any more. Still others have talked about a sudden shift in the way everything looks, feels and sounds.  Regardless of the description, derealization is common and often quite disturbing.

Derealization is a dissociative state. The dissociative states – derealization and depersonalization – are possibly the most common yet misunderstood and under-discussed anxiety symptoms.  For many, they’re the most difficult symptoms to fully accept and not fear.

Do I Have A Dissociative Disorder?

Dissociative states exist on a continuum. The most common and mild state is that “zoning out/daydream” state that we all experience from time to time.  On the other end of the continuum are serious and frightening things like dissociative disorders that can involve permanent or near permanent states of derealization or depersonalization.  If you’re reading this because you’re dealing with panic attacks and/or agoraphobia, the odds are VERY high that you do not have a dissociative disorder.

Just An Anxiety Symptom

In the case of anxiety disorders like panic disorder, agoraphobia or generalized anxiety disorder, dissociative states are simply anxiety symptoms much like a racing heart or wobbly legs or mild dizziness. They’re no more and no less.  They are not indicative of any grave danger, nor are they permanent or indicative of any serious mental illness or defect. Though they may be extremely uncomfortable, upsetting and frightening, they are merely symptoms and should be approached as we approach all our anxiety symptoms.

Derealization may be based on a shift in the way we process sensory input.  While most of what we see, hear, smell, touch or taste is processed automatically in the background (thankfully), I suspect that derealization may be what happens when our brains shift that processing into the foreground.  Things we don’t normally think about or subjectively interpret are suddenly subject to conscious analysis.  This is an un-natural state that we have no experience with.  I may be completely wrong about this, but even I am, this common sense explanation of what’s going in during derealization helped me accept that state and not fear it.

What Can I Do About It?

So what do you when derealization hits?  The same things you do when every other anxiety or panic symptom strikes.  Relax.  Breathe. Don’t add more fear.  Don’t fight. This is especially difficult with the dissociative state because we’re not really sure why they pop up and we’re never really sure when they’ll end, but the strategy still applies.  One additional trick is to test your ability to interact with and control your environment.  While in the car, I’d tell myself to change the radio station, then I’d do it.  Bingo.  Proof that even though everything felt scary and un-real, I was still intact and in control.

As expected, the more I accepted and the less I added more fear, the shorter my derealization spells would last.  Then they’d come less often.  Ultimately derealization has become something I really only experience during times of high anxiety.  I no longer work so hard to avoid it.  If I can do it, I know you can too.

In the episode we’ll look at depersonalization, another dissociative state that can also be terribly scary and hard to accept, but usually for different reasons.

 

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Intro/Ending Music Credit: Title Autumn Day (Kevin MacLeod – incompetech.com) Licensed underCreative Commons: By Attribution 3.0 

Photo Credit: Dan Cook Archived via Compfight cc