Getting Over Panic Attacks and Hospital Phobia - Free Self-Help

By Diana Holbourn

Article Summary

Welcome

This article describes ways of calming panic symptoms down. It explains why panic can have so many unpleasant physical symptoms and what's going on to cause them. And it gives advice on ways of getting rid of thoughts that can lead to anxiety that causes panic attacks.

It talks about being more assertive to reduce fear in everyday life; it describes ways of saying things to people they might not want to hear and being more confident while doing so, and standing up to criticism more, rather than being discouraged by it.

It describes how people can get rid of phobias by gradually getting closer to the thing they fear, and a way of becoming less scared about having panic attacks by desensitising themselves gradually to the physical sensations that come on with panic.

Skip past the following quotes if you'd like to get straight down to reading the self-help article.


Things People Have Said About Fear and Overcoming it

The only courage that matters is the kind that gets you from one moment to the next.
--Mignon McLaughlin

Anything I've ever done that ultimately was worthwhile... initially scared me to death.
--Betty Bender

Courage is being scared to death... and saddling up anyway.
--John Wayne

There are more things, Lucilius, that frighten us than injure us, and we suffer more in imagination than in reality.
--Seneca

We are more disturbed by a calamity which threatens us than by one which has befallen us.
--John Lancaster Spalding

To suffering there is a limit; to fearing, none.
--Sir Francis Bacon, (Essays 1625, Of Seditions and Troubles)

Pain of mind is worse than pain of body.
--Latin Proverb

Optimism is the foundation of courage.
--Nicholas Murray Butler

The Main Contents

Background Information About This Article

The Self-Help Information in the Article

  1. A Relaxation Technique That Can Make People Less Likely to Feel Panicky
  2. A Distraction Technique That Can Stop Panic Coming On
  3. Challenging the Thoughts That Can Cause Panic Attacks
  4. Gradually Getting Out to More and More Places Again
  5. Becoming Desensitised to Worrying but Harmless Bodily Sensations

Part One
A Relaxation Technique That Can Make People Less Likely to Feel Panicky


The best thing about the future is that it only comes one day at a time.
--Abraham Lincoln

Thinking

Julia thinks:

There must be a way I can get over this panic! I'm going to try to find some self-help material and read any books that sound hopeful. OK, I may be setting a bad example for my children now, but they're only young, and if I can get over this in a few months, all the memories of my anxiety might fade into the background of their minds within a year or two, so they'll hardly ever think of them. And then, maybe I'll be able to set a good example for them, not being so anxious, and perhaps they'll stop being so anxious themselves and follow my better example. ...

(A few days later) Oh good. This self-help material I've found is by a charity that's highly recommended, apparently. I'll try it.

What Can Happen When Breatheing is Too Fast and Shallow, as it Is When People Panic

It says that what can start to bring on some of the physical symptoms of panic is over-breathing, where we breathe too fast, which is something people often do when they're stressed. It's called hyperventillation. It says that when we do that, several things can happen to cause the body's systems to go out of balance, which is partly what causes the physical symptoms of panic. But it says the process is harmless and they'll correct themselves in a while. But it says that when we breathe too fast, we get too much oxygen in our blood and not enough carbon dioxide, because we breathe too much oxygen in and too much carbon dioxide out.

Hmmm! I didn't realise we actually needed carbon dioxide! Well, maybe we do.

It says that the body will correct the imbalance eventually.

Slowing Down the Breathing

Relief

But it says that one good way of calming the body's systems down ourselves before the symptoms get too bad is by breathing slowly and evenly, in to the count of four slowly and evenly, and then out to the count of four, slowly, for several minutes.

Ah, so it says it's best to shut our mouths and just breathe through our noses while breathing in, and breathe out through pursed lips, as if we're whistling, so we don't breathe too fast, because our mouths are partly closed.

It says that some people do the breathing wrong, gasping in a large amount of air while they're counting, sometimes breathing in really quickly and then holding their breaths till they finish counting to four, and then letting the air go really quickly and then having an effort to wait till they've finished counting before they breathe back in again. It says that breathing too fast won't work, and might even make us feel dizzy or light-headed. It says that's why we have to breathe slowly, either through our noses with our mouths closed, or through our mouths with our lips partly closed.

I'll think through this to make sure I remember it.

Some of the Things That Happen in the Body and Mind to Cause the Physical Symptoms of Panic

Scared

It says that there are two places people can breathe from, the upper chest and the diaphragm, which is lower down. It says that breathing from the upper chest often means taking breaths that are too shallow, because they don't get all the way into the lungs, and that can mean we have to take more of them, so we breathe faster, and that causes some of the symptoms that make us worry we're about to have a panic attack, and worrying about it can make the symptoms worse.

It says the reason the physical symptoms can get worse when we worry is that part of what's happening when we worry too much or have panic attacks is that part of the brain thinks the body's under threat, because that's what fear is meant to help us cope with, so it releases adrenaline, and then blood gets pumped away from the places that don't need it immediately, like the digestive system, to places that might need it immediately, like the legs and arms, so we can run away more quickly, or fight with more energy if we need to; and it's that that gives us some of the worrying sensations we have. It says that panic attacks are a natural thing the body's programmed to give us when we're in danger, to alert us to the fact that it thinks we have to run away or fight, and to help us do it. They could actually be useful if we really were in danger and needed to get away from something quickly.

Scared

But it says that with people who regularly suffer from panic attacks, the symptoms often start happening at inappropriate times, when there's no real danger, but maybe just a lot of stress. But because they're so unpleasant and after we've had the first panic attack we can start to worry we're going to have another one as soon as we get symptoms like it, our worry gives our bodies the message each time that we're anxious because we are in danger, so it makes the symptoms worse each time. Then we worry more, because the symptoms we can feel make us think we really are going to have a panic attack and we know they're so unpleasant. And because we're worrying more, the body thinks we're in even more danger and so it makes the symptoms even worse. That makes us scared because we think even more that we're about to have this really horrible panic attack, and that makes the symptoms worse still because the body thinks it must be in even more danger, and things quickly spiral upwards like that until the body does bring on a panic attack.

Interesting! So we can bring on the very thing we're worrying about by worrying about it.

How to Breathe to Calm Down

It says that what we're supposed to do when we're calming ourselves down is to breathe air right into our lungs, and we can tell if we're doing that by putting our hand on our stomach while we breathe, and if we're breathing right, our stomach will feel as if it's inflating like a balloon when we breathe in.

A balloon? Anyway, I'll try it.

It says we only need to put our hand on our stomach till we're sure we know how to breathe the right way, so after that, we can do the breathing in public with no one thinking it's odd, because we won't need to have our hand there. And we can breathe out as well as in through our nose if we like, so in public, no one will wonder why our lips are in an unusual position, because they won't be.

This self-help material recommends that we practice breathing slowly, getting air right into our lungs, practising for several minutes a few times a day, even at times when we don't feel that anxious, because it will teach us to breathe the right way more naturally when we are anxious, and it will make us more relaxed, so it takes longer to get to the stage where we're anxious enough to have a panic attack. It says it might be best to start as soon as we wake up in the mornings, spending a few minutes breathing slowly in to the count of four and then out to the count of four.

OK, I'll try that.

Relaxing

It recommends we practice for the first few days by lying down, or sitting down and leaning back in a relaxed way to start with, practising for four minutes at a time, a few times a day.

I'll have to decide on what times of day to do it now, or I might just never get around to it. ...
I could do the first one before I get out of bed in the morning, and then maybe another one in the early afternoon, before I have to get the children from school, sitting in a nice chair, and then the last one after they've gone to bed.

It says that after a few days of practise, it's best to try the breathing in different positions, like standing up or walking around.
And it says that then, it's a good idea to think of something we do regularly throughout the day, like opening the fridge, and every time we do that, take several slow breaths. It suggests we put a little bit of tape on the fridge or something to remind ourselves.

It says it's very important that we practice the breathing every day, because then, we'll calm down our systems so they'll take longer to get to the stage where they're tense enough to go into panic mode. Also, then we'll be good at it and it'll come more naturally when we really need it, at the start of what we worry might be a panic attack.

And it recommends we get into the habit, after a while, of breathing for about four minutes once a day in a relaxed position, and once for a few minutes in other positions, such as when we're standing up or walking around. That's because we're likely to be in other positions when we start to get the symptoms of what we worry might be a panic attack, so it's best to practise the breathing while we're doing different things, to get used to controlling our breathing in different situations.

And it says that whenever we start to feel tense, such as if we notice we're grasping our hands tightly together or holding something more tightly than we have to, or if some other part of us feels tense, it can be good to spend a few minutes doing slow breathing to relax ourselves.

Right, I'll try that. ...

A Few Problems With the Slow Breathing Technique and Solutions

Worrying

(A few days later) I'm having a bit of trouble with this. It doesn't seem to be working all that well for me personally. I'll see what the bit in this literature about what to do if we're finding it difficult says. ...

Oh. It says that most people don't have any problems at all, but if we do have any difficulties with it, it can help if we try the breathing at first lying on the floor on our stomachs with our hands under our heads for a bout ten minutes, a couple of times a day for a few days. It says that way, air almost always gets right into the lungs properly where it should go.

I'd better do the vacuuming to make the floor cleaner!

After that, it says we can lie on our backs doing the breathing, with our hands on our stomachs to check they feel as if they're inflating when we breathe in.

Flying

It says it can help us get air right into our lungs while we're doing the breathing technique if we try imagining things, maybe funny things, like pretending we're a helium balloon, and that as we breathe in, we're gradually being blown up ready for lift-off.

Actually, I think my problems are that when I focus on what my body's doing, I get more anxious, because I feel things going on that I don't usually notice, like my pulse beating a bit faster than I'm sure it should; and then I keep starting to worry that it means something's wrong with me that I might need to go to hospital for. Another thing that bothers me is that I feel awkward about relaxing because it makes me feel as if I'm not going to be alert enough to deal with danger if something wrong happens suddenly. ...

Ah! This self-help material talks about what we should do if we have those problems. Oh good.

It tries to reassure us that if we've been to our doctors and been given the all-clear, like I have, there probably isn't anything to worry about, since minor unusual physical sensations happen all the time in the body for no serious reason. After all, the pulse can beat faster if we've just been exercising or if we've had something to drink with caffeine in it, but it doesn't mean it's doing us any harm, and it goes back to normal after a little while.

So the literature recommends us to carry on the slow breathing, saying our anxiety will probably go down after a while if we keep it up regularly and for several minutes each time.

I don't like the idea of breathing this way even though I'm anxious and if I think it's making me worse!

But this literature tries to reassure us that our anxiety will probably go down quickly over a few days.

Well, I hope it's right. I really do need to get over this panic; it's ruining my life. So I think I'll try it, and hope it works.

The literature does say there are things we can do to make things a bit better.

Oh good!

It says it might help if we have someone in the house with us who we can call if we do get anxious.

Yes, I think that might help. I'll change the time I practice the breathing in the middle of the day to later when my husband's come home and I'm watching television.

Dreaming about being on a beach

Oh this is interesting; it also says it might help if we think of other things while we're breathing, like if we close our eyes and imagine things that engage all our senses, like imagining we're on a nice beach, feeling the warm sun, imagining wiggling our toes in the warm sand, listening to the sound of the waves in the background, smelling the seaside smell, and doing anything else that's relaxing that we can think of. It recommends we make the image as vivid as possible so it'll absorb our attention more, and that whenever we start thinking about a physical sensation, we should pull our minds firmly back to the image.

Maybe I'll try doing that when I'm on my own, instead of waiting till there's someone with me. After all, it would be nice to do something relaxing just before I go out to get the children from school.

It recommends that if we have doubts as to whether the techniques will work, we try them for ten days, keeping a diary of how anxious we feel at our worst during each time we practice, estimating it on a scale of 0 to 10, with 0 being not anxious at all, and 10 being the most anxious we can imagine being; and the likelihood is that over that time, our anxiety will reduce a lot.

Well, I'll try doing that. I know they did several tests on me at the doctor's surgery and they all came back saying there was nothing wrong with me, so I don't suppose I should get so anxious really. I know they make mistakes sometimes, but they did do quite a few tests, and all of them came back saying there was nothing wrong. And the sensations I notice more when I'm calm are probably things that are going on all the time anyway, and most of the time they don't bother me because I don't notice them, and if they meant anything was seriously wrong, something bad would probably have happened by now, or else it would have been picked up by the tests. So there probably isn't anything to worry about really.

The other problem I sometimes have though is that I feel as if relaxing puts me off guard, and I don't like that. I'll see what it says about that. ...

Oh. It says again that there are a few things we can do that might help, like locking the door to reassure ourselves that we're safe, or making sure a trusted friend's nearby, or doing the breathing sitting up with our eyes open.

Maybe that means I can't imagine myself on a beach if I'm doing that then, since we're supposed to have our eyes closed for that. Then again, that's only so we won't be looking at things in the room that distract us from the day-dream, so it might well be possible to keep our eyes open for it and not get distracted.
Well, perhaps I'll decide what to do each time, depending on what's bothering me most at the time.

It says that the longer we try the controlled breathing, the more the anxiety will probably decrease, so we could try keeping the diary for ten days writing down how anxious the breathing technique's making us feel when we're at our worst on a scale of 0 to 10, with 0 meaning no anxiety, and 10 being the worst it could possibly be; and then we can reassure ourselves when it goes down. It says it will probably go down a lot over that time, although there may be days when it goes up a little bit, but we shouldn't worry, because we might just be feeling especially anxious that day, and it might well go down again the next day, till overall, we discover at the end of the ten days that it's much lower than it was when we started.

Nervous

I'm not keen on doing this breathing technique knowing it'll make me anxious, but it's so important that I get over this panic that I think I'll try, noting down how anxious I feel, hoping the anxiety will soon go away. I don't suppose I ought to feel anxious really. After all, hardly anything bad happens to me in this house, apart from feeling anxious!

The self-help material says that most people don't have any problems with the breathing technique.

Perhaps I'm just a hard case! Hehe!

One more problem is that when I go quiet because I'm trying to relax and do the controlled breathing, I just seem to get upset, and that makes me worry and become anxious. I'll see if it says anything about that. ...

Oh yes. It says that sometimes this happens if people try to block disturbing feelings out at other times, so they only come through when we're quiet.

Upset

Well, I'm not sure I really do that, although I have in the past tried to stop myself thinking about Dad dying suddenly when I was in my mid teens, because that just made me feel really depressed, and then I didn't feel like getting on with life.

This self-help material recommends that at the time we get the upsetting feelings, we think of a relaxing image as vividly as we can to take our minds off them and make us more cheerful, like us curling up in a nice chair in front of a fire, or floating around in a hot air balloon amid nice little clouds on a Summer's day, or anything that makes us feel good and relaxed.

I'll have a think about images I like the idea of thinking of.

But it recommends that for several days, after our breathing practice, we write down in a journal anything we can think of that might have made us upset when we tried to relax, any fleeting thoughts that upset us that came to our minds, anything like that that we can remember, even if it seemed unimportant, and any thoughts we have while writing.

It recommends we limit our writing time to about 20 minutes each time though, so we don't write so much we just get thoroughly miserable. But writing the feelings down will clarify what's bothering us in our minds, so we can be more sure why we're getting upset, and deal with it better. ...

A Few Thoughts on Coming to Terms with a Relative Dying

Mourning

(A week later) I've tried that for a while now, and I'm sure that the feeling that keeps coming to my mind when I try to relax is grief for Dad. Well, now at least I'm sure what it is that's troubling me when I try to do the breathing, so I don't have to let it bother me so much.

But maybe I need to overcome the grief properly as well. I know I couldn't overcome it properly at the time, because I felt as if I had to hide it, because Mum got very upset and stressed and couldn't really cope after Dad died, and I thought I needed to be strong for her. So I tried not to show how upset I was. And my friends and teachers told me that the best thing to do was to keep busy, so it would be pushed to the back of my mind and wouldn't bother me.

Well, I needed to keep busy to do my exams, but I think that perhaps I tried to push it out of my mind by keeping busy for too long, because if I'd dealt with the feelings earlier, maybe they wouldn't be causing me problems now.

I was told that time would heal me, but I don't think it can have done. I'll investigate ways to recover from grief now.

Perhaps it would help if to start with, I try to examine the reasons I found Dad's death so upsetting.

Weepy

I think part of the reason was that I feel as if I should have tried to persuade him to stop smoking. It might have cut down the risk of him having that heart attack. I sometimes used to tease him about smoking instead. So that upset me after he died. Thinking about it though, I can't really blame myself at all for him dying, because I didn't know much about the things that make people more likely to have heart attacks in those days, and even if I had tried to persuade him to change, he probably wouldn't have done. And it was wrong of me to have teased him about smoking, but when I think about it, I don't think he was upset by it. And even if he didn't like it much, I can't imagine that he was the kind of person who wouldn't have forgiven me, especially all these years later.

Another reason for my feelings, I think, is that I wish we could have done more things together, like gone on more camping holidays. I'm upset because we didn't have more opportunity to do that kind of thing. And I'd like to have told him how much I was pleased when he did take me out to places like boating lakes and theme parks and picnics in the countryside, and I'm upset because I just took them for granted at the time. I'd like to have told him how much I appreciated it. Still, maybe I shouldn't feel that bad about it, because he would have been able to see I was enjoying myself and wouldn't really have expected me to spend too much time telling him I was grateful, especially since I was only young.

So I can wish I'd done things differently, but I shouldn't blame myself because I didn't, and I don't think he'd blame me either.

And it would have been nice to have gone to more fun places with him, but when I get over my panic attacks, I can at least start going out more with my children. I could try to give them what he gave me. The value of doing that is at least a positive lesson I've learned from this. I think that'll be an added incentive to recover from my anxiety.

Tearful

Another reason I missed Dad is that I realised after he died how much he did for the family, since Mum found it hard to cope with quite a few things after that. I found it quite stressful, because I felt I had to take on more responsibility for things around the house and Mum's well-being than I felt capable of for several weeks, until some of the relatives came and took charge. I found that quite distressing. But I think I did do quite a good job. I sometimes felt angry with Dad for dying and Mum for not looking after us better, since it was such a big change of lifestyle for me. I don't suppose anything that happened was really anyone's fault though. But I think all the feelings I had then were perfectly understandable. At least a few positive things did come out of it, like the skills I developed when I felt I had to look after things.

I'm going to do more work on coming to terms with my feelings. But along with that, I think I'll still try to continue to do this controlled breathing to calm my anxiety. I think I'll feel better about doing it now I know how to cope with any unpleasant feelings I get during it better. So it's breathing in to the count of four, slowly, and then out to the count of four, slowly. In through the nose with the mouth shut, and then out through pursed lips, carrying on the breathing for about four minutes, a few times a day.


Part Two
A Distraction Technique That Can Stop Panic Coming On


Some have been thought brave because they were afraid to run away.
--Thomas Fuller

It is easy to be brave from a safe distance.
--Aesop

Courage is the fear of being thought a coward.
--Horace Smith

I must remember what this self-help material's saying, so I'll think it through carefully, although I can read it again whenever I want.

Trampolining

But it's interesting that it says that panic attacks often start with just a tiny little sensation, like the heart beating a bit faster or if we're a bit out of breath, such as if we've been walking fast or doing something else that was quite energetic. Then we can worry that it'll turn into a panic attack, since it feels like the symptoms of one, or it feels like something abnormal that might be a sign that we're ill, and then when we worry about it for a second or two, that puts the body on alert for danger, so the physical symptoms of anxiety get worse, and that makes us worry more because it feels more like a panic attack coming on, and that worry makes the body increase the physical symptoms because it thinks we might be in danger and need adrenaline to get away, and that scares us more, and it goes on quickly like that until we have a full-blown panic attack.

It says we can stop it in its tracks though, if as soon as we notice ourselves feeling uneasy because we've had a little physical sensation that feels like a symptom of a panic attack, or if we've had a little feeling of worry or something that might set the physical sensations off, we immediately stop ourselves thinking bad thoughts, like the worry that we're about to have a panic attack or worrying if the feeling means there's something seriously wrong with us. It says we can try and make ourselves stop thinking thoughts like that, maybe by saying "Stop it!" firmly in our minds, and instead, we can focus our attention on the things around us as hard as we can, with all our senses. So we can concentrate on what we can see around us, and what we can hear, and maybe anything we can smell, or anything we're touching. Then, at the same time, we can start breathing slowly to calm ourselves down.

It does say that if trying to breathe slowly and distract ourselves at the same time is too confusing and it means we can't concentrate on distracting ourselves hard enough for other thoughts to be banished from our minds, we can just focus on distracting ourselves by thinking about what's going on around us, and never mind the breathing for a while.

It says it's best if we distract ourselves even if we don't feel anxious yet, but just a bit uneasy, because if the body's tense already, it doesn't take much for it to go from uneasiness to panic.

I think I'll try that. If I start to feel uneasy because of a feeling that I know has led to panic attacks before, I'll try and stop myself thinking bad thoughts immediately I notice the sensation, since thinking about it, it's true that the bad thoughts I have make the symptoms worse, which makes me even more anxious. It happens so quickly sometimes that I don't really recognise what's happening at the time, but I think they're right that that's the way it often works. So I'm going to try stopping myself thinking bad thoughts as soon as I notice a feeling that makes me uneasy, or as soon as I notice I'm thinking thoughts that make me anxious, and then I'll start thinking about what's going on around me.

A houseplant

If I have an uneasy feeling indoors, I could tell myself to stop thinking worrying thoughts, and then maybe I could distract myself by sometimes looking at the plants on the window sill and thinking about whether they could do with watering or how nice they are, counting their leaves sometimes, or thinking about what order they'd be in if I decided to put them in order of smallest to biggest, or in order of how big their leaves are, or in order of how many flowers they've got. Or I could look at each flower in turn and count their petals. Or I could try to remember all the names of the plants and then count all the names of plants I can think of.
or I could look at my children's toys and try to think about any new games I could play with them, or think about what housework needs doing, or listen to hear what's going on outside.
Or I could play a game, picking up a book upside-down, and trying to decipher each word on a page.

I'll have a go at thinking of other things as well.

Hoolahooping

Maybe if I'm outside and I feel a sensation or have a feeling that makes me uneasy, I could tell myself to stop worrying about it, and instead think about what's in shop windows, how people's gardens look, or looking at the way people are dressed, or seeing if I can count the number of cars of a particular colour that go by in a minute, or trying to hear snatches of conversation, and any other sounds that are going on around me.
I'll sniff the air slightly and think about what smells there are around.
Maybe if I'm in a shop or cafe, I could look at the food and wonder how much fat it contains or how tasty it is, or I could look at a table or something else and try to think about how it might have been made.
Or maybe I could try to think about how much things cost, and try to work out how much it would cost if, for some strange reason, I bought six of them, or three, or something.
If the sun's shining, I could try to think about how warm it is.
If I'm listening to someone talking, I could try to work out what the three most important things they've said are.
If I hear music, I could think about whether I can remember all the song lyrics. Or I could imagine what it might sound like if it suddenly started speeding up and playing higher and higher. That might make me smile.
If I see someone eating something I like, I'll try to think about how much I like the taste of it.
If I'm eating something, I'll try to concentrate on how nice it tastes, and maybe on its texture.

There are probably lots of things I could think of to do. I'll think of some more, so I've got more ideas when I'm actually in the situations where I start to feel uneasy, although there will probably be lots of things around me then that I can think about.

But it'll probably be best if I don't forget to breathe slowly as well, at the same time, although I think I'll distract myself first, and then bring in the breathing each time if I decide I still need to calm myself down after a while, since it might be a bit difficult to concentrate on both at once.

It might be a bit difficult to decide what to focus on as well if I dither over whether to focus first on what I can see or on what I can hear or on what I can feel.
But it says we can make an effort to focus on five things we can see in turn first if we like, and then five things we can hear, and then five things we can feel, and then back to things we can see. It says it doesn't matter if we can't think of five things in any category; we can just go onto hearing, touch or whatever we're doing next if we run out of things.

I think that if I just tried to stop myself thinking of what makes me anxious without trying to distract myself, it might make things worse, because maybe the more I thought about trying to block the thoughts out, the more they'd be on my mind, and so the more I'd get anxious about them. After all, thinking about blocking them out of course means they're bound to be on your mind while you're trying to. But if I distract myself by thinking about totally different things as soon as I've told myself to stop my anxious thoughts after I start to have them, that probably won't happen.

The self-help material says that if we want to try to do both the distraction and the breathing techniques at once, it's best not to try using the technique of refocusing our minds on other things till we're used to breathing in a slow, controlled way, because when we've practiced the breathing so it comes more naturally, we'll be more likely to be able to do both at once.

And it says we shouldn't start imagining we're miles away luxuriating on a beach somewhere or something instead of distracting ourselves by thinking of what's around us, because that's like not facing up to the present.

Shaking head

And it says that it can be very difficult to concentrate on things that are going on around us, because anxiety stops people from thinking clearly, and if we're used to thinking worrying thoughts, it can be tough to get out of the habit.
I've noticed that!
But it says that if we stick at it conscientiously, it will stop the anxiety in its tracks.

And it sounds as if it's saying that the more we practice, the more we'll get used to doing it, so the easier we'll begin to find it in the end, until we stop feeling so anxious and don't need to do that anymore.

It says that once we realise it's working, we'll get more and more confident about using it, and so we'll get more and more confident about going to places where we used to panic.
I hope it's right. That'll be good.

It says that the more we practice, the sooner we'll start to recognise feelings that might lead to panic attacks, and so the more quickly we'll be able to stop them, because the earlier we try to stop them in their tracks, the easier it will be. The less anxious we are when we start trying to stop them, the less trouble we'll have stopping them.

Stopping Panic Attacks That Seem to Come On Suddenly

Scared

Interestingly, it says that often, people think their panic attacks are coming out of the blue with no warning signs and no spiral of thinking that makes them worse and worse; but if people are really tense to start with, it won't take much to tip them over into a panic attack, so the slightest feeling of unease is all the warning sign we might get, so saying "Stop" to ourselves the instant we notice it and immediately focusing our minds on what's going on around us and breathing slowly might well be the best way to stop it.

And it says the earlier we pick up the feelings that lead to panic attacks, the easier it will be to work out what causes them at any one time rather than at other times. It says that the fear of a panic attack will often be what brings one on, so once we're confident about stopping the anxiety in its tracks when it's hardly started, we'll stop having so many.

It says that some things that can make panic attacks come on more easily than at other times are things like drinking too much alcohol the night before, or too much caffeine, hunger, or too little sleep.

Perhaps I ought to cut down on my tea and coffee, and make sure I get more sleep by going to bed earlier. I'll have to think about what I can drink instead. I suppose it can't be fizzy drinks, since some of those contain caffeine as well.

Practising the Distraction Technique Before we Use it for Real

The self-help material recommends we often remind ourselves of the three steps in the distraction technique - *telling ourselves firmly to stop thinking thoughts that will make us anxious, *refocusing our minds on things around us, and *breathing slowly and steadily to calm ourselves down, by writing them on a card and putting them somewhere where we'll see them often, so they'll become more automatic when we need them, because we'll remember them better.

I'll do that.

It also recommends we practice at home a couple of times a day, by deliberately thinking a little thought that makes us anxious, or thinking of a physical sensation that makes us anxious, and as soon as we do, stopping ourselves and doing the technique.

Biting nails

That sounds a bit scary! I'd hate to provoke a panic attack by deliberately thinking anxious thoughts!

But it says that if we make ourselves think just one thought that just gives us a little bit of anxiety and then immediately start to practice the refocusing techniques, we'll probably stop the anxiety, and we'll get better and better at it the more we practice, so we'll be more prepared to stop anxious thoughts that come while we're out.

I suppose I could give it a go. Yes, it only needs to be one little anxious thought. If I practice in my sitting-room to begin with, where I can turn on the television and refocus my mind on that as soon as I've had an anxious thought, or practice focusing my attention on the plants on the window sill, or any dust that needs clearing up, and whether I can hear the neighbours, or cars outside, or how nice a picture on the wall looks, or other things that are around me there, at least I'll know there's quite a lot there to think about, so it'll be a good start to get me into practice.

It recommends practising twice a day.

Maybe I'll start practising in the sitting-room, and go to other rooms to practice there after a few days. In the kitchen, I could distract myself by seeing if I can remember everything in the freezer and then checking to see if I was right, or counting the cups on the draining board, or guessing the fat content of things and then seeing if I was right, or trying to concentrate on reading recipes and thinking about whether I could make the things and imagining how they might taste, or looking in my cupboards to see if they need a clean. I'm sure I could think of lots of things.

The self-help material says that an alternative to focusing on what's around us is focusing on a phrase that we repeat to ourselves, like, "I'm learning to control my anxiety now so it will stop bothering me soon. I'll get better and better at this." But it says it's best to decide on one thing to do before we need to use the technique, so we don't have too many choices when we need it and so aren't quick enough to block out our anxiety because we're undecided about what to do. ...

Problems with the Distraction Technique, and the Solution

Upset

I'm having a few problems with this. I'm trying to do the distraction technique, but when I do the breathing with it, it just seems to make me more anxious! I'm beginning to wonder if it really does work after all. ...

But thinking about what the self-help material says, maybe I'm breathing wrong. I've stopped bothering to practice my breathing for long at home. I wonder if that means I've got out of the hang of doing it properly. Maybe. I'll start practising three times a day again for a few minutes each time like it recommends. ...

(A couple of weeks later) Yes, that's better. I Must have been breathing wrongly before, maybe too fast, because now I practice a lot more at home, I'm feeling much better when I try it when I'm out. I know to breathe very slowly and evenly now. I think I forgot for a while.


Part Three
Challenging the Thoughts That Can Cause Panic Attacks


Love looks forward, hate looks back, anxiety has eyes all over its head.
--Mignon McLaughlin, (The Neurotic's Notebook, 1960)

None but a coward dares to boast that he has never known fear.
--Ferdinand Foch

Keeping a Diary to Try to Work Out What Triggers Panic Attacks Off

Maybe it would help to stop my panic attacks if I do what this self-help material recommends and try to work out what causes them, and think about whether the thoughts that lead to them are really reasonable, and if I try and understand why I experience certain emotions in certain situations that seem to trigger them off. It might help if I do as the self-help material instructs us and keep a diary for several weeks, and write down whenever I have a panic attack, or one that was developing but that I managed to stop in its tracks, and what I was doing and feeling at the time just before it happened, and what people around me were doing, and all the thoughts I can remember having while I was having the attack and just beforehand. Then it might help me understand what causes them better, because there might well be things the thoughts I have and situations I'm in just before I have panic attacks often have a lot in common. And if I can work out what I'm most afraid of when I have a panic attack, I can think more about whether I need to be as afraid as I am.

I think the two things I'm most scared of are having a heart attack and dying, or losing control and making a fool of myself or hurting others in my rush by running away when there isn't any need. ...

(Three weeks later) OK, now I've kept my diary for a while, so I've got more of an idea of what leads up to my panic attacks.

Unhappy

It seems that I often get panic attacks soon after I've been feeling a bit upset about Dad dying. Since he died fairly suddenly of a heart attack, I found it quite distressing, and now, thoughts of losing other people or things seem to be triggering off my panic attacks. I think it's that. There seems to be a bit of a pattern.

I think that advert I heard on the radio about how smoking can cause heart attacks might have been what triggered one panic attack off, because it made me feel upset because it reminded me of what happened to Dad, and then thinking about heart attacks made me a bit anxious, because the symptoms of my panic attacks make me think I might have a heart attack.

And a couple of days ago, when my sister was talking about moving with her children to another part of the country, I'm sure it was fear of being separated from more people that made me anxious, and that started a panic attack.

And when I read that thing about Father's Day, I think the reason I got one soon after that was because it reminded me of losing Dad, and I got a bit upset, and then I started to feel anxious again.

Upset

I wrote down that just before one of them, I'd just been using disinfectant. Thinking about it, I might have been associating that subconsciously with Dad's heart attack, because there was a smell of disinfectant at the hospital where he spent his last hours.

And another time, I had one just after I saw some beer in the supermarket. It's no wonder I don't go out much at the moment! Maybe the reason that triggered one off was because drinking a glass of beer was one of the last things I saw Dad doing before I left him the last time before his heart attack.

I'm almost sure these things are all connected. Maybe it would help if I did some more work coming to terms with my grief, because feelings of grief seem to be what triggers some of them off.

It seems to be loss, or the fear of loss in general, that can start some of them. I think I must need to deal with more than just Dad's death. I'll try to work out whether other losses I've had in my life have triggered off panic attacks.

Chickenpox

I think that when my children get ill, or when I've just had a test to see if there's anything medically wrong with me, part of what I'm worried about is the loss of the children's or my health. Perhaps that's partly to do with worrying that I won't have any control over the situation, and that bad things will happen that I won't have any power to stop.

But when I think about it, it probably won't really be that bad. I know there isn't much reason to believe that any of their childhood illnesses or my test results will be that serious. And if something serious does happen, there are people much more expert than me who are trained to deal with such things, and I've got no reason to believe they'd want to do me or my children any harm.

So I know that getting over my phobia of hospitals is important. I know they couldn't save Dad. But if he'd got to the hospital earlier, maybe they would have done.

And I know there's a risk of hospital infections. I'll try to find out what can reduce the chances of getting one.

... It's just occurred to me that it seems I've got a phobia of the wrong thing. Funny, that. I've got a fear of hospitals, even though it was actually not getting to the hospital on time that killed Dad.

Still, I don't think just knowing that will stop the feelings. Some part of my brain seems to have just decided that hospitals are a bad thing, and it sets the panicky feelings off automatically now. I think it'll need a bit more re-training before it stops. Still, hopefully if I carry on following this self-help regime, I'll soon learn how to do that.

Anxious

Another time when I had a panic attack, I was running to catch a bus just before I had one. I think it might have happened because it made my heart beat faster, and that made me anxious that it might be a heart attack or that a panic attack was coming, so I started getting a bit scared, and that's what led to the one I had. And feeling breathless felt a bit like the symptoms I get when I have a panic attack, so that scared me even more.

I suppose I should try reassuring myself that I'm bound to feel breathless, and my heart is bound to beat faster when I've been running, because I'm not as fit as I should be. And also, those symptoms are common, and they don't mean that anything serious is happening.

Then there was that panic attack I had soon after I'd drunk some strong coffee. I know I'd had a few cups of strong coffee because I wanted to make sure I kept awake, because I hadn't had much sleep the night before. I've heard that the heart can beat faster sometimes after caffeine intake. Maybe mine beating faster sparked off a worry that I might be having a heart attack, and that made the symptoms worse, which made me more worried, till a panic attack developed.

Relief

Now I know more of the things that trigger panic attacks off in me, I'll be more aware of them when they happen, so I'll be able to start refocusing my attention on other things and breathing slowly earlier, when I spot something similar happening, so it'll be easier to stop panic attacks in their tracks. Now I'll know more about when anxious thoughts might come on, I can be more alert to the first signs, so I can stop them earlier.

I'll carry on keeping my diary and writing down more of the things that I notice happening just before I have my panic attacks, so I'll know more of the things I ought to think of as possible triggers that mean I ought to start distracting myself when they happen if they make me feel a bit uncomfortable.

I don't suppose I'll have to do this forever, just until I'm confident that these things have stopped making me feel panicky.

Examining Evidence For and Against Fears About What'll Happen When Panic Attacks Come On

The self-help material recommends that in the evenings, we sit down when we're calm, and try to challenge all the thoughts we have that help cause panic attacks, thinking about each one and asking ourselves whether it's truthful or whether it's wrong.

Nervous

I know I'm always scared of having a heart attack because of the horrible chest tightening and breathing problems I have when I have a panic attack, and because Dad had one, and I'm worried I might have the same condition as him.

The material suggests getting a piece of paper and putting a line down the middle, and writing the thoughts that concern us on one side, with lots of space between them, and on the other side, we can write about what evidence we have to think the things we do, to see if we can really think of much, or if there's more evidence that we don't need to think them.

We could just do this on a computer, perhaps writing down each thought in capital letters so we can spot it easily as we go through the document, and under each thought, we could write down all the evidence that it's right, and all the evidence that it's wrong, and see what the best and the most amount of evidence says about it.

I could try that. When I'm used to calming myself down with my breathing, I'll sit down with some paper or at the computer, and I'll write down things that might reassure me. ...

OK, here goes.

So I'm worried I might have a heart attack. But:

  • I've had these feelings in my chest when I have panic attacks for nearly a year. If they were being caused by heart problems, something more serious would probably have happened to me by now.
  • I've never had a known problem with my heart before.
  • The symptoms go away when I calm myself down with the breathing and distract myself from my anxious thoughts, and surely they wouldn't do that if they were being caused by heart problems.
  • I know my symptoms are common symptoms of panic attacks.
  • I had some tests at the doctor's surgery and they all came back saying there was nothing physically wrong with me.
  • If these symptoms were being caused by heart problems, why would they usually only happen when I do things that I know make me anxious, or when I'm reminded of Dad? Why would just going past hospitals make them worse, or hearing an advert on the radio about giving up smoking?
  • When I had to walk past a hospital the other day and some nurses came out and I panicked and ran away, why did I end up feeling physically OK, instead of collapsing with chest pains, as I probably would have done if I'd run that fast and been having heart problems?
  • Dad had things physically wrong with him like high cholesterol, and he smoked and drank quite heavily sometimes, but my cholesterol levels are fine, and I don't smoke. I do quite a lot of exercise, or at least I did when I started having these panic attacks, so that should have cut down the risk, and meant that the symptoms were less likely to have been caused by heart problems.
  • I'm a lot younger than Dad was, and heart attacks happen much more rarely in people as young as me. And I try to eat more healthily than he did.
  • I know that sometimes, exercise has caused my heart to beat faster, and drinking too much coffee. And I think I've started to have panic attacks sometimes when I've been angry as well. So I don't have to keep thinking they're being caused by heart problems. There might be other things that cause symptoms like that as well, and since I haven't died yet, and have been cleared by the tests at the doctor's surgery, they're more likely to be being caused by those other things.
  • When Dad had his heart problems, he said he had severe chest pains, and mine are only mild. And exercise began to really tire him out before he had his heart attack, whereas when I've run away from things, I've been full of energy.
  • I only started thinking my symptoms might be symptoms of a heart attack recently. Before, when I got breathless after running and my heart beat faster, I'd just put it down to the exercise, or if it happened after I'd had some strong coffee, I'd just put it down to that. It must have been those things, or I'd have died long before now, surely. So I think it's quite safe to assume that it's still happening because of those things when it happens after I do them.

As for my fear of losing control and going mad or making a fool of myself:

  • Apparently there's no link between panic and psychosis. That's what the self-help material says. So I don't have to worry about going insane.
  • I've never hurt anyone before. The more I can control my panic by refocusing my mind on other things and breathing in a controlled way, the less I'll worry that I will.
  • When people see me running away, they probably don't think I'm crazy; they probably think I'm doing some exercise, or I'm running to catch a train, or I'm trying to catch up with someone who's just left, or I'm late for something, or I've forgotten something and need to rush back and get it. In any case, they probably don't think about it for that long.

I worry that people will think I'm stupid if I have a panic attack somewhere in public and I have to admit to someone that it's happening. But:

  • How likely is that to happen? Most people don't seem to notice there's anything wrong, and If I had to tell someone, thinking about it, they'd probably be more likely to be sympathetic than to think I was stupid.

I suppose there might be other beliefs contributing to my way of thinking. I know I think I'm an unlucky person who bad things are bound to happen to. It might be a good idea to challenge that belief, by thinking of all the good things that have happened to me that I could think of as lucky, and by reassuring myself that I can change my luck to a certain extent, in this case by doing the breathing exercises and distracting myself from thoughts that make me anxious, to stop my panic attacks.

The self-help material recommends that we spend about twenty minutes each evening looking at the evidence against our horrible thoughts that we've written down, thinking of other scary thoughts we've had that day if we have, and thinking of evidence against them as well.

It recommends that we don't try to think of the evidence against them when we're having a panic attack, because we'll be too busy thinking of what's going on around us, trying to stop the anxiety before it gets bad. But it says that if we think about them when we're calmer, either soon after we've had a panic attack when we're feeling better, or later that day, eventually, the evidence against them will just come to our minds when we feel anxious, and that'll help quite a bit.

The self-help material says it's best to write down the evidence against the thoughts we have that make us anxious rather than just thinking it, so we can read it every day and remind ourselves of them in the coming weeks, and because it'll help reinforce the new thinking in our minds.

Maybe I'll jot down a few reassuring things on a card, and carry it with me when I go out, so I can take it out and read it every now and then, to remind me of them.

Maybe soon, the reassuring thoughts will come naturally to me when I start to get anxious.

The self-help material says that after several weeks of doing the distraction technique, if we haven't begun to think reassuring thoughts naturally by then, it's best if we do start to think them deliberately when we start to feel anxious.

What to Do About Disturbing Mental Images

Not wanting to see something

One thing that still worries me is the image I sometimes get in my mind when I get anxious, of me lying on the floor not being able to get up. Thinking about it, I think that's quite possibly related to my fear of having a heart attack as well, so I can use the statements I wrote down about how it's unlikely that I'll be having one, whenever I worry about the image.

Maybe it would help if I do what the self-help material recommends and try to think of another image in its place as well, like one of me lying on the floor but then getting up and feeling healthy and in control.

If that works, maybe I'll try changing the image to an even better one, of me feeling as if I'm going to fall down, but then refocusing my mind on things around me and feeling better, and walking away feeling confident.

I'll practice replacing the bad image I have now with the other ones when I'm in bed at night, imagining I'm lying on the floor not being able to get up, and then quickly trying to substitute that image with the image of me getting up and doing refocusing techniques and calming down and then feeling confident and in control, to stop my anxiety from increasing.

Once I've practised replacing one image with another, it should come easier to me when I'm out.

Challenging the Faulty Thinking that Makes the Hospital Phobia Worse

Having a go at thinking

I think I'll try thinking of the evidence against the thoughts I have that keep my phobia of hospitals going as well, and my fear of answering the phone and getting the post in the morning after I've been medically tested for something.

I'll do some breathing exercises, and if they've worked and I'm calm, I'll imagine I've just had another routine cancer screening, and then get some paper, or go on the computer, and write myself some questions, and then write answers to them, like:

  • When the phone rings, how likely is it to be the hospital on the line, on a scale of 0 to ten, where zero is the worst outcome - that is, that it is the hospital, and ten means it's very likely to be someone else? After all, I know several other people who might phone me.
  • If it is the hospital, how likely, on a scale of zero to ten, with zero being the worst they could tell me and ten being the best, is it that they'll tell me something disastrous? They might be phoning me to reassure me. Am I really at a high risk? I don't think so. No one in my family has had this, and I've never behaved in a way that would dramatically increase the chances of me getting it. And when I've had the tests before, I've always been allright. Since they do the tests regularly, if there is something wrong, it'll mean they've caught it early, which means there's quite a bit more chance of them dealing with it successfully.
  • If it is the hospital and they do tell me something bad, how likely is it that something terrible's going to happen? Terrible things do happen, but I'm sure quite a lot more people who are found to have this problem in a test get cured than get worse. It isn't all that common anyway.

I'll think of all the reassuring thoughts I can. Then if I think about them a lot, if I have some more tests, maybe when the phone rings after that, reassuring thoughts will automatically come to my mind, so I won't be so scared of picking it up.

I could do similar exercises to help me with getting the post in the morning after I've had a test, imagining it's been a few days since I had one. I could write things like:

  • How likely is it really, on a scale of 0 to 10, that I'll hear from the hospital, where 0 means definitely and 10 means definitely not?
  • If I do hear from them, on a scale of 0 to 10, how likely do I really think it is to be bad news? Am I really at a high risk?
  • If it is bad news, on a scale of 0 to 10, how likely do I really think it is that things won't get better, with 0 being the worst that could happen and 10 being the best that could happen?
  • If it was the worst news possible, and they said I only had a few months to live or something, would I inevitably just fall to pieces, collapsing into a shivering wreck for the rest of my time on earth? Or might I be able to cope better than I think? On a scale of 0 to 10, how well do I think I would find a way to cope? For instance, how well would I be capable of making future plans for the care of my children? How inevitable is it that I'd just be too distressed to think clearly at all for all that time?

Maybe if I have to go for another test, I could calm myself down, maybe by doing slow even breathing for a while, and then practice thinking any reassuring thoughts I can think of in answer to questions like that just before I get the post each morning.

Thinking

I could write reassuring things about my anxiety about wasps and bees in the Summer as well, like,

  • How often do I or the children get stung by wasps? When did it happen last, and how many times has it happened in our lives?
  • Baring that in mind, how likely is it that we'll be stung this year, on a scale of 0 to 10, with 0 meaning definitely not and 10 meaning definitely?
  • What can I do to cut down the chances?
    I could make sure we don't eat food near them, especially sugary food, or that if we do, we have something handy to waft them away with. I could buy some fly paper or a Venus Fly Trap plant, because they might get some of the wasps.
  • If I do get stung, how likely is it that I'll go to hospital, bearing in mind what's happened to me before when I've been stung?
    Wasp stings can usually be treated well at home. I'll read up all about the best ways of doing it. And I could ask myself how many of my friends are likely to have been stung before, and how many of them had to go to hospital.
  • If I have an unusually and rare bad reaction and do go to hospital, what's the worst thing that could happen, and how likely is it to happen?
    I could help myself determine that by reading up about hospital treatment for wasp stings and how safe it is, especially in the hospital near me.
  • What's the best thing that could happen, and how likely is it to happen?
    I could help myself answer that by studying the most effective ways to treat wasp stings.

And I could think like that about everything I'm worried about.

Getting Anxious About Little Personal Things

Anxious

But I'm getting silly little thoughts in my mind that keep coming to me, about little problems and character deficiencies I've supposedly got, which I know I haven't really got at all, or they're things that just don't matter, like I'm beginning to worry far more than I need to about the way my voice sounds, and the size of my nose, or whether I'm a bad mother because I don't cuddle my children as much as I should. But I don't think my children really go without enough affection, and I know really that my voice and the size of my nose aren't bad enough to worry about.

I heard that irrational little thoughts like this are really just the anxiety manifesting itself in different ways, and when I get rid of the anxiety, the thoughts will just naturally go away. So when I get a thought like this, I might feel relieved if I just think, "Oh, it's just the anxiety again." And I know I'm on my way to getting rid of all the anxiety I don't need, so hopefully these thoughts will just go away soon.

But I think my isolation might be making those thoughts worse, since I don't get out much now. I've got more time when my thoughts aren't occupied with important things, so useless thoughts have more opportunity to come into my mind, and I'm sure being on my own makes me worry more about differences I might have to other people, some that I'm sure aren't really even there at all, thinking about it, than I would if I got out more and mixed with a variety of people, who all have differences to each other and often don't worry about it. When I don't feel so anxious, I'm going to start going out more, and trying to meet more people, people who share my interests so I'll probably get on with them well. Maybe there are some groups in the area I could think about joining.

I think I'll phone a couple of friends up just to have a chat today. That might help a bit for the time being.

And I'll think of things I enjoy doing that I can occupy my mind with when I'm not busy, to stop me dwelling on horrible thoughts.

I think I'll start by getting a couple of good books from the library, and finding out if they've got any recordings of old comedy programmes. I think having a nice laugh will relieve the tension that's making me get these silly little worries a bit, especially if they're comedies about people doing silly things.

Becoming More Confident By Thinking About Good Personality Traits and Abilities

Maybe I could make myself feel more positive and confident by writing down everything I can think of that I've done well in my life, and any time I know I felt confident, so I know I could again. Then I'll ask myself what good characteristics, talents and abilities having done those things means I have, that make me more likely to be able to get over my problems and succeed in doing well in the future.

Then, I can read what I've written often, to encourage myself.

I know I have done things I can be proud of in my life before.

  • I managed to pass my school exams not long after Dad died and I was upset.
    What does that say about me?
    Er, maybe that I can be determined when I want to be, even when I'm upset; that I can muster up good concentration skills that help me to get things done when I really have to; that I can do things that require intelligence, even when I'm stressed; and that I've done things that make me a credit to Dad.
  • Then there was the time I took the lead part in a school play, and didn't feel nervous or anything performing in front of all those people.
    Well, if I was that confident once, I'm sure I could be again.
  • There was the day I got the top marks out of the whole class in that test.
    So I know that I do have at least some ability. And I might be able to turn it to getting over my panic.

My Problems With Not Having Stood Up to Criticism in the Past

Malicious

But thinking of school reminds me of all the horrible things that happened there. Actually, I wonder whether all the criticism I got there made me more anxious. I think it did. Thinking about it, I think if I'd been more assertive and stood up to the people who belittled me, it might not have happened; but I didn't at the time, and I just kept the feelings inside, and I think they all built up to make me more stressed.

I remember there was that time when that supposed teacher Mr Curtis told me to swim a width with the whole of the rest of the class watching, and then said to everyone, "That's a perfect example of how not to do it!" I've never felt confident about swimming since, and at the time, it just made me feel inadequate. I thought I must just be no good at it. Now, looking back, I realise that a wiser thing for me to have thought was that he was insensitive, impatient, probably not good with children, and if I wasn't good at swimming, it might have had far more to do with his inability to teach than my inadequacy! I wish I could have said that to him at the time! If I had thought like that, I don't think I'd have felt so bad, so I don't think the stress would have built up so much like it did.

But now I've realised I wasn't as much at fault as I thought I was at the time, and can realise what was really going on, I think that in future, if someone criticizes me like that, I will stand up for myself and point out what they're doing wrong! I won't let that kind of thing stress me out anymore!

Nasty teacher

Then there was the time when that bad-tempered Mr Long called me out in front of the whole class and told everyone that if I wrote something in my coming exams that was as bad as the thing I'd written that he'd just marked, the examiners would think it was so bad they'd just laugh at it. That made me feel bad at the time, as if I wasn't coming up to standard, and I think not standing up for myself made it worse. Looking back though, I can see that he was just being a bully, perhaps getting some kind of perverse enjoyment out of humiliating pupils, and if he'd been a more patient teacher, explaining himself properly, I would have been able to do better work. And it would have made me feel much better if I'd said that to him at the time instead of thinking I was entirely the one at fault.

Feeling humiliated

Perhaps a lot of children just aren't experienced enough to recognise unjust or over-the-top criticism in adults and other children who think they know it all for what it really is, and so they blame themselves for things much more than they should. It's a pity. Like there was that time when that boy Charlie and his friends kept calling me clumsy and stupid and dirty for having that stain on my clothes after I'd dropped a bit of food on them, and they kept it up all afternoon, in front of people I'd just met and was hoping to make friends with. That was really embarrassing. I just accepted what they said at the time and didn't show how annoyed and upset I was with them for saying it. But now I realise that I wasn't clumsy just because I dropped a bit of food. Anyone can do that. And maybe I should have gone to try and get the stain out of my clothes quickly before it dried, but calling me dirty all afternoon in front of people was far more criticism than was reasonable, and not trying to get the stain out didn't mean I was stupid, just that at the time, I just wanted to eat the rest of my dinner and then go and play. There was no good reason for them to have made such a big deal out of it. Children can pick on people for the silliest of reasons. I wish I'd realised that at the time, rather than believing what they were saying, and feeling bad about it.

Sad

I think the criticism from those teachers and other pupils made me feel as if I wasn't good enough to fit in, and so I started feeling especially anxious when I had to do something I wasn't sure I could do, or when I felt frustrated because I thought people might get the better of me or were doing things I didn't want them to do and there wasn't anything I could do about it, because I didn't know how to stand up for myself, or thought I wasn't as clever as them and so I wouldn't be able to. I'm sure I'd have felt better if I'd stood up for myself more or recognised their spiteful criticism for what it really was and so didn't feel so bad about myself. If I had, I think I'd have felt better able to cope with life, and so wouldn't have got so anxious.

But one very good thing I'll keep reminding myself of is that I don't have to let that kind of thing happen any more. I can stand up for myself better now.

Sad

I think another thing that made me feel inadequate was that some of the children at my school thought they were superior to people like me, and they looked down on us, just because we weren't interested in the things they thought were the marks of sophistication! When I look back on it, I realise how shallow their interests were compared to mine. They thought things like fashion, under-age drinking and flirting and getting off with the opposite sex were so sophisticated and important, and they were scornful of people like me who they thought weren't sophisticated like them. But I was interested in things that, looking back on it, were far more important, like getting a good education and a good job. And I did end up doing better at school than them, in most subjects. I was interested in some silly childish things as well, as I'm sure most children and teenagers must be, but looking back on it, it was my main interests that were the sensible ones, not theirs, so I should never have believed what they thought, that I was inferior to them because I wasn't doing the things they thought everyone who was anyone among the pupils should be doing! I wish I'd been taught to think these things through when I was at school. I wouldn't have felt bad about myself then.

Also, I feel sure that part of what's causing my problem now is not having enough confidence in my ability to use my talents to their fullest extent. Thinking about it, I'm sure there isn't really any good reason not to be confident about doing that. I think I'll try to use my skills more in the future, and see if I can develop them more. I'm sure I've got talents I could use more, and I'm going to think about what I could do.

I think one skill I'll try to develop more is analysing unjust criticism, so I can recognise it for what it really is! I think children should be taught to think things out more than they are. And I think children should be taught to stand up for themselves more. I wasn't taught either of those things, and so I think criticism upset me much more than it would have done if I'd been more sure of myself. I think I must have been over-sensitive to their criticism because I didn't have the confidence to stand up to it and recognise how unfair a lot of it was.

I think my mum might have had something to do with that, actually, because she used to tell me that even the most mildly offensive things I said were rude. So I think I might have been timid about standing up for myself, and that's why I just let the bad feelings build up and build up, instead of being confident enough to express myself and not let what people said get to me. Maybe not standing up for myself enough is one reason why my mental health started to get worse, even at school.

Angry Feelings and Panic Attacks

Getting annoyed

Actually, maybe the way my mum used to stop me expressing angry feelings all the time might be something to do with the reason I notice I'm more likely to have panic attacks when I have feelings of anger now. I think they stress me out a bit, because I still have this feeling that I shouldn't express them, and so I just let the feelings build up until I'm getting stressed by them.

Now I feel sure that's happening, I'm going to stop it. Angry feelings are only bad if you express them in a way that's bad. Whenever I feel stressed about telling someone about how they've made me angry, as long as what I want to say is fair, I'm going to remind myself that I should never have been made to feel as if it was automatically wrong to express angry feelings, and that I can be glad that I won't need to have feelings of stress like the ones I had because I didn't express them anymore!

But maybe another reason anger makes me feel panicky is that it makes my heart beat faster and me breathe a bit faster, and I'm so used to thinking I'm going to have a panic attack when I have sensations like that that I automatically think I'm about to have one when I have those symptoms, even if they're not really being caused by anxiety at all. Now I've realised that, I might be even better at stopping panic attacks in their tracks, because if I think the symptoms are being caused by anger, instead of thinking, "Oh no, here comes another panic attack" and getting anxious, which will make my body think it's in danger so it will increase the physical anxiety symptoms, which will make me more anxious until it turns into a panic attack, I can stop myself and think, "No, these feelings are angry feelings. They don't mean I'm about to have a panic attack. They just mean I'm annoyed."

Standing Up to Criticism in Future and Being More Assertive

Annoyed

I wonder how much of my panic disorder has to do with all the criticism I didn't have the confidence to stand up to, because I wasn't assertive enough when I was younger, and so it just made me feel less capable of coping with things than other people. Oh well. There's nothing I can do about the past now, so there's no point in going over it in my mind for too long and feeling bad about it. But In future, I'm going to make an effort to stand up for myself more! People won't get away with so much in the future! Things are going to get better! Next time someone calls me useless or something, if they ever do again, I'm going to make sure they realise they're in the wrong! I'll tell them what I think of what they say. I'm going to say to them something like,

"What am I supposed to do with that criticism? What was the point of it? If you're unhappy with anything I'm doing, tell me how you'd like me to change, after you think through your demands and make sure they're reasonable! Just telling me I'm useless doesn't help anyone. It's just meaningless on its own, because it doesn't let me know exactly what you're unhappy with. It's also an exaggeration. I doubt if anyone's useless!"

And I'll keep on questioning what they say and pointing out any faults I can find in it, until they can at least criticize me in a civilised way, not exaggerating, and not always just telling me what's wrong, in their opinion, but telling me how they want me to change, which is better than just telling me what they're unhappy with, because it means they're being more positive and thinking about moving things forward, rather than just thinking about how bad they think things are. And if I disagree with what they're saying, I'll tell them why I think it's wrong in future, and stand up for my point of view! I think children should be taught to analyse what people say like that, so they don't get so upset by it.

Anxious

Well, that's the kind of thing I'd like to say anyway. The idea of doing that makes me feel nervous though, because I hate to do anything that might upset people, in case I put them off me, or in case they get angry with me and I end up feeling upset. But there must be several ways of standing up for myself without risking upsetting people too much. I'll think about some. After all, I don't need to be nasty in response to what they say; just asking them to rephrase what they want to say in a positive manner, telling me what they would actually like to happen, so we can move forward instead of getting bogged down in recriminations, should be enough a lot of the time. And I have to think of my own rights too.

But I think I have a bit of a problem as well with feeling I have to do what other people want when I really feel too tired, or I would prefer to do something else. I don't stand up for myself there either. Perhaps that's because I'm worried I'll lose their friendship if I don't do what they're asking, or they'll be annoyed with me and I'll feel bad about it. And I worry they'll think I'm selfish if I don't do what they want. I wouldn't want to be thought of as selfish.

But maybe those are exaggerated fears. Perhaps I'd feel happier if I distinguished between people's needs and their desires, and didn't think it was so important to please them when it's only their desires that make them want things. After all, thinking about it, it's hardly selfish to refuse to do things for people when it's only their own selfish desires that make them want me to!

And maybe I don't need to feel nervous about standing up for myself. After all, I know people who argue bitterly, but then they make up, and they're as good friends as ever.

Shopping

But then there are the other times when I don't speak up because I'm worried about hurting people's feelings and I'm worried about causing an argument, like when I'm not feeling too anxious and I'm out with Jane, and I do enjoy her company, but I'm sure she's a bit of a shopping addict. She's bought lots of things that I've never seen her wearing, and I'm sure she doesn't need them and might not really be able to afford them. I do feel uncomfortable when she buys them. But I don't like to say anything, because I'm scared she'll disapprove of me and it'll ruin our friendship, or that she'll be upset. If I could think of ways to say things that wouldn't worry me so much, I think I'd feel better about raising matters like that.

Maybe if when she goes to buy something, instead of criticizing her, I ask, "How do you think you'll feel about having bought this tomorrow morning?" it would make her think, and she wouldn't be annoyed with me for saying it. If I could make sure it just sounded curious and a little concerned, and not authoritative as if I'm telling her what to do, then maybe it would be allright.

Driving a car

And perhaps I could do that kind of thing with other people. Like when I'm a passenger in a car that someone else is driving, and I'm sure they're going the wrong way. I get panicky about telling them, because I'm worried they'll disapprove of me for it, or it'll hurt their feelings and then they'll be annoyed. But maybe if I asked a question instead of telling them, with my tone of voice sounding as if I'm not entirely sure myself to make sure it doesn't sound like a criticism, like saying, "Shouldn't we have just turned off there?" then maybe they wouldn't mind. After all, maybe they know a quicker way, so they were going the right way after all. But they might be pleased if they weren't and they can correct the direction they're going in so soon if they were going the wrong way, so they don't spend ages wasting time going round a longer way.

Child

Maybe I can think of ways to make it easier to say other things as well. Like when I've decided it'll be nice to go out for the evening and I ask someone if they'll baby-sit the children, but then I feel as if I just can't face going out, but I know they'll be disappointed because they could really do with the money I said I'd pay them, and they might be annoyed because I'm upsetting their plans for the evening and they might have been able to make other ones if they hadn't offered to baby-sit my children, so I wait till the last minute before telling them, and then they're more annoyed than they would be if I told them straightaway, because they would have been able to plan to do something else if it hadn't been such short notice. I know it's a bad habit. I think I really need to work on my panicky feelings more, so when I make a plan to go out, I'm more likely to have the confidence to stick to it. I think worrying so much about what might happen when I do go out makes me decide not to go after all. So I'll try to do something about my feelings more. But maybe before I get over them, there are ways I can say things that'll make me less worried about upsetting people, so I don't worry and worry till it's the last minute and then upset them more than I would have done if I'd told them straightaway.

Maybe if I always try to make it a rule to begin what I say by saying something nice, that'll make them feel better.

So I could thank them for offering to baby-sit first.
Then I could apologise for inconveniencing them, but say I've decided to do something indoors instead, or explain about my anxiety problem.
Then I could say I'd be really happy for them to baby-sit my children sometime in the future, so they know I haven't just lost confidence in them, and they'll think there's still a chance of working for me sometime.

So I could say something like:

"I'm very thankful for your offer to baby-sit my children. I'm really sorry to inconvenience you; I hope you don't mind too much, but I've had to change my plans now. Sorry to have been a nuisance. But I'd love you to baby-sit at some time in the future, because I know my children like you."

If I praise them and I'm apologetic, and I tell them their services might still be welcome at some point in the future, which they hopefully will be when I feel more confident about going out, because I only get people who my children like to baby-sit them, and also, if I tell them as soon as I've decided I'd prefer to stay in that I won't need them to baby-sit, instead of waiting till the last minute, then hopefully, things won't be so bad.


Another thing that might make conversations easier is if I can think of solutions to difficulties and suggest them to people, instead of just telling them they've done something I don't like. I hate telling them that, because I worry they'll disapprove, and it sparks off arguments. But maybe it wouldn't be so bad if I tried to be as positive about it as I can.

So at times like the ones when my husband goes shopping for me, and I ask if he'll buy me a new teapot or something, and he gets the rest of the shopping but doesn't get that, because it would mean travelling further to get to a bigger shop, instead of getting annoyed with him for not getting one:

Thinking

Maybe it would be a good idea if I expressed my appreciation towards him at first for doing the shopping, because at least he got most of the things I wanted, and I should recognise that, and it would make him less likely to be annoyed.
Then, instead of just saying he forgot my teapot, I could explain why I want it, so he understands my point of view better so he's more likely to do what I want next time, and he doesn't just think I'm bossing him around.
Then I'll tell him I understand why he didn't get it, so he knows I'm a bit sympathetic with his reasons.
Then I could make a suggestion as to what he could do about it, so we aren't just left arguing about why he didn't buy it, but we can hopefully just end the conversation thinking about how nice it will be that the situation will be resolved soon.

So if I remember all that, perhaps I could include all those things by saying something like:

"Thanks for doing all that shopping for me. I really appreciate it. The only thing is, I do want a new teapot, because I'm hoping to invite friends around soon, and it would be nice to have one for that. I understand that it would have taken a bit more time than you were happy with to get one today, because it would mean going to a shop that was further away and standing in another queue. Isn't there a shop near your work that sells them? I'm wondering if you'd mind taking a little time out of your lunch hour or after work tomorrow to go and get me one from there?"

If I smile at him, hopefully that'll be even more persuasive.

I'll try to remember to try out things like that, and maybe I can think of more techniques to use that hopefully won't upset people. I know I've made a mess of conversations in the past. But I'm not going to think too much about what's gone wrong in the past. I'm going to try to think more about the positive things than the negative ones.


Whenever I remember something in the past that I did well, or do something now that I can be pleased about, I'm going to write it down, so I can look at it in future and be encouraged that I'm not such a failure as I might think. If I make a good job of the new ways of saying things to people that I'm thinking of, I'll write that down as well so I can encourage myself.

Making Notes of Positive Things About Myself and Improvements in my Anxiety Levels to Encourage Myself

One thing I could write about is the progress I've made in cutting down the number of panic attacks I have. I'm pleased about that. And whenever I notice a day where I've improved, I'm going to write about it, and try to think about what I did that made the difference. Then I can write that down, so I can work out what I do that helps most, so I can do it more often.

Iced cake

I know I do other things well now. I know I'm very good at making cakes with fancy icing decorations. I get a lot of compliments about those on people's birthdays.

And I know I have a talent for painting.

I'll write those down on the new pages in my diary about my achievements and other good things about myself that I'm going to write. I could have some pages for panic attack progress, and other pages for other achievements and good things I can think of.

Well, I could look back in the diary I've already got to work out my progress with panic attacks, where I wrote down what I think triggers them all off. But it's a bit long-winded going through all that information just to count the number of panic attacks I had each day, although it's encouraging to count them, because they get less and less. I'm writing in it less often now, because I have less. But I think I'll stop looking at that diary when my panic attacks get even less regular, because going through it when I don't really need to will probably only make me depressed. I think I'll start a new diary in a new notebook just to write about every good day I have, and what was happening on them that made me less anxious. Then I'll be able to think more about what I'm doing that's successfully getting rid of the panic attacks and anxiety.


Part Four
Gradually Getting Out to More and More Places Again


I have heard there are troubles of more than one kind.
Some come from ahead and some come from behind.
But I've bought a big bat. I'm all ready you see.
Now my troubles are going to have troubles with me!
--Dr. Seuss

You don't face your fears, you stand up to them.
--Anon

I feel quite a lot better now I've been doing the breathing and distraction/refocusing techniques for several weeks. But I still feel too anxious to go to some places where I had panic attacks before and so I worry I'll have more there, or places like the hospital.

Scared

This self-help material suggests we gradually build up to going to places like that by doing things that make us a bit anxious, getting used to those, and then doing bigger things. It says that's called exposure therapy.

I don't like that idea. But I do worry that I might develop agoraphobia if I keep avoiding things. And I didn't like the idea of doing the breathing at first, because I felt a bit anxious to begin with, but I did it, and it got better quite soon. So maybe the same will happen with this.

And I expect that going out to places that make me afraid won't be so bad now I've learned how to stop anxiety in its tracks. I just must make sure I practice the breathing and refocusing techniques regularly, so I'm quick off the mark when I need to use them when my anxiety's building up, so it doesn't catch me unawares and get really bad before I can stop it. That's what worries me. But I'll be careful about sticking to my distraction practice twice a day at home to keep me on good form.

But I am doing better than I was. When I look back in my diary over my record of panic attacks, I used to have quite a lot more than I do now, so I can be pleased that I'm achieving something.

This self-help material recommends we write down every situation we avoid because it makes us worried we'll have a panic attack, so we can use the information to develop a list of things we need to start practising doing again, from the easiest to the most difficult. It suggests we look in our diaries where we wrote about where we had our panic attacks to remind ourselves.

Right! Hospitals is the main thing for me. But since I had a couple of panic attacks in supermarkets, I suppose I shouldn't have, but I've started avoiding them now, because I'm scared I'll have another one there. Going on buses makes me anxious now, because I've had panic attacks there so I'm scared I'll have more there. They're a few of them, anyway. I'll think of more.

The self-help material recommends we work out ways we could gradually build up to going to those places again, in stages. It says we should think of starting off doing things that don't worry us much and are small steps on the way to achieving what we want to do, and do bigger and bigger things.

Gradually Overcoming the Fear of Going to the Supermarket

So, if I started off trying to get out to the supermarket again, maybe I could start by going with my husband. I don't feel so bad when I'm with someone. So maybe he'd understand if I asked if he could come with me at a time when it isn't busy, like late Saturday afternoon, since I feel better when it isn't so busy as well, and we could just walk around looking at things for a bit without buying anything, and then leave. That way, it won't be as bad as doing my shopping there like I normally do, so it'll be like gradually building up to it again. If I do my breathing exercises and distraction techniques, which will hopefully be easy in the supermarket where there are lots of things around, now I've practised them a lot, I should hopefully be fine.

Maybe I'll write a list of tasks I think I might be able to manage, going from easy to more difficult, that will help me build up to going back to shopping in the supermarket and feeling OK about it again. Going there with my husband can be the first one on the list. Or if I try doing that one and I feel more anxious than I think I can cope with, I'll try doing something less stressful instead to begin with, like just standing around outside a supermarket for a few minutes, maybe reading something so people don't wonder what I'm doing, although they probably won't think of me at all, because they'll be too busy doing their own thing. But I could read something anyway, or sit in the car outside a supermarket while my husband goes in and does a bit of shopping. Then, after I'm happy with that, or after I've done something else that's a bit smaller first, I could move back to the task I was going to do first, going in with my husband but just walking around for a little while without buying anything.

Then, maybe I could have things like:

  • Staying in the supermarket for a bit longer, with my husband, till I feel fairly calm, looking at things I like and talking about something nice I think I'll buy myself as a reward when I feel brave enough to go through the check-out again.
  • Then, I could go with my husband again, and deliberately walk past the isle where they sell the alcohol, where I had my last panic attack in a supermarket. I'll hopefully be allright if I concentrate on my breathing. And I could say a phrase over and over to myself like, "I'm getting much better; I'll soon be able to come here without having panic attacks."
  • Then, I could go with my husband when it's more crowded and buy some stuff. Maybe I'll wait while he goes through the check-out, so I can concentrate on my breathing and distraction techniques more.
  • But then next time, maybe I'll go through with him.
  • The next time, I'll try going through by myself.
  • Then I'll go to the supermarket on my own when it's not busy.
  • Then I'll go when it's more crowded.

I'll see how those go. If I think I need to break those aims down into smaller tasks, I will. If I do one task on the list and stop feeling that anxious about it, but still don't feel ready to go onto the next one, I could always think of other ones that aren't so difficult as the one that worries me to put in my list in between the two. So maybe if I've got used to going to the supermarket on my own when it isn't busy, but just can't face going when it's more crowded, I could go early in the morning when it's not busy a few times, and go around looking at the isles till it fills up a bit, and then leave before it gets all that crowded. And I could go later and later, so it gets a bit more crowded every time I go, till it's really crowded, but I've gradually worked my way up to getting used to it.

Scared

I heard about someone who was trying to recover from agoraphobia and went to a supermarket and didn't feel scared, so he felt really confident that he could get over it quickly and pushed himself to go to lots of other shops. But then he had a panic attack and thought he couldn't be allright after all. And that ruined his confidence so much that he didn't want to go out for months after that. But he would probably have been allright if he'd stuck to what he was confident he could do and hadn't overdone it.

So it seems that it's very important not to be too ambitious and push ourselves if we think it might be a bit risky. It must be best to take things gradually.

If that husband of mine doesn't mind doing this with me at the beginning, I could tell him about my plans so far. Maybe we should stick to going in the evenings when it's quietest for the first few times. He'll have to go in the evenings on weekdays anyway, since that's the only time of day he's at home. Hopefully it won't be long before I'm happy going on my own again. I feel a bit ashamed of asking him to help me with too much. But hopefully it won't be long before I'm over this. I'll try thinking about the future instead of dwelling on how bad things are now. And if he says he can't help for some reason, I might be allright doing it on my own.

Calming down

The self-help material says that with each step we take, we should remain in the situation till we begin to feel less anxious, because it's inadvisable to leave when we're at our most anxious. Perhaps that's so we don't get put off going back, or so we know it's working.

I might feel I have to do a task more than once though before I'm happy with it.
I'm glad it says that's allright. In fact, it says that that's what most people will do, doing one task perhaps several times before they get comfortable with it.

Maybe sometimes, I could ask if my sister could come with me to the supermarket instead of my husband. But the self-help material says we should do these practices every day, so if I have the strength to keep it up, I hope they won't mind. I could try going on my own. Or maybe they'll only have to help me for a couple of weeks before I can go by myself.

Encouraging Ourselves When we can Tell the Treatment's Working

The self-help material recommends that when we've done a task once, we write down how anxious it made us feel when we were feeling at our worst, on a scale of 0 to 10, with 0 meaning no anxiety, and 10 meaning the worst it could possibly be. We can write down a number every time we do the task. Then when we've done the task several times, we should hopefully be able to see in our records that our anxiety level has dropped a lot from when we started, so that will be encouraging, and it will let us know when we're ready to move onto a more difficult task, which will be when we don't feel all that anxious doing the current one. It says that often, people's anxiety levels drop fairly fast over the time they're doing the tasks, and during the next more difficult task, they might well drop even more quickly.

I hope so.

It says that after some time, we should try the tasks without using the breathing and distraction techniques, to prove to ourselves how much progress we're making and that the exposure techniques are working on their own, so we'll stick with them.

Enjoying a cup of coffee

I'm going to go to a little shop that I'm happy about going in, and I'll buy some little cakes every now and then there. Then, every time I come home after having done a task, I'm going to reward myself for having stuck with it even if it made me anxious, by eating one with a cup of tea!

I've got to make plans about how I'm going to tackle going to hospitals and going on buses again now, and other things I'm anxious about. It seems as if it could take ages before I'm better! It would be nice if there was something quicker! Maybe there is. But perhaps if I set a goal for myself, and say, "This time in two months, I expect to be a whole lot better!" then I'll have something to look forward to and aim for. This isn't going to last forever! And as long as I keep up regular practice, it will probably start getting better quite soon. I'm already a lot better than I was before I started following this self-help plan by doing the breathing and distraction techniques. And I can really congratulate myself with every new thing I achieve! It's quite exciting to know I can do things now without too many problems that I would have really dreaded before! I'm really pleased. It's quite a relief. And the more I can get my anxiety levels down by reassuring myself that I can be allright in situations I used to be afraid of, the more confident I'll feel in my abilities, and in the treatment. The more confident I feel, the less I'll worry about having a panic attack, and the less I worry about having one, the less likely I am to have one. Maybe even in a couple of weeks, I'll feel much better in supermarkets.

The self-help material recommends we do these exposure techniques once a day if we can, or most days.

Thinking About Being in Supermarkets

Maybe if I don't feel I can get out to a supermarket in the early stages, because no one will go with me, or because I don't feel brave enough, sometimes, I could try to boost my confidence by imagining going into one instead. I'll relax myself with my controlled breathing first, and then imagine going in, walking around looking at the things, feeling a bit anxious but then calming myself down with my breathing technique and focusing all my attention on things around me, and then starting to feel more confident, and ending up walking around without feeling anxious, and feeling pleased that I'm managing it. I'll try to imagine feeling the emotions of being pleased and confident as vividly as I can, as well as trying to make what I'm imagining doing as realistic as I can in my imagination.

Nervous

I'm sure I'm going to feel anxious every time in the hours before I go to the supermarket for real, because I might not have the confidence that I can handle things if they go wrong. But I could talk to myself about how well I'm coping so far, and about how the worst things I'm afraid of aren't really likely to happen. I'll get that bit of paper I wrote all my challenges to my worrying thinking on and read that every time before I go, and think about things like how I know what causes me to feel anxious when I walk past the alcohol isle now, and I know it isn't really anything to be afraid of.

Unhappy

Understanding why I get anxious when I go past the alcohol is helping me untangle my thoughts about the association between beer and what might happen to me if I have a panic attack, since I've realised that beer makes me think of dad's heart attack, because about the last thing I saw him do before he had it was drink some, and thinking about him having a heart attack makes my heart beat faster because I'm getting anxious, and then I worry I'm about to have a panic attack, and panic attacks make me think I'm going to have a heart attack because they feel so horrible. But now I've worked that out and so I can tell myself that beer isn't the thing that I'm really anxious about, I can understand that I shouldn't have worried so much about being around beer, so I don't need to worry about it now. After all, the last thing I saw Dad doing before he had his heart attack could just as easily have been drinking water, or playing a game of chess as drinking beer.

Getting Over the Fear of Travelling on Buses

I've got to do something about the fact that I've become a bit scared of travelling on buses as well. I think it's just my instincts that make me worry about the idea, because of that panic attack I had on a bus, and I'm scared I might have another one. But I think I only had that because I was feeling breathless and my heart was beating faster because I'd just run for the bus; so I can reassure myself about that. Actually, I remember I did have another one on the bus before that, but I think that was because we were travelling past an optician's, and it made me think of hospitals, and that made me think of dying.

Scared

I don't like going on buses at all now. But I can't keep on avoiding them. I'll just get more and more scared about the thought of travelling on them. And I know really that it's not even buses that made me have those panic attacks. Now I know some techniques for getting down anxiety and I know I can do them well, I'm going to try building up to travelling on buses normally again. I'm going to make a list of tasks, starting with fairly easy ones that won't make me that anxious, and ending with me doing things normally. It'll be like the list I did for the supermarket. Perhaps I could have on it things like:

  • Go and stand at a bus stop and watch buses going by and people getting on and off them.
  • Do that every day till I feel comfortable there.
  • Then, I could go with my sister for company, if she agreed to help, and we could just go on the bus for one stop, and then walk back.
  • If my sister agrees, we could do that several days in succession.
  • Then I could do that journey on my own, walking back again myself.
  • Again, I could do that for several days until I feel allright doing it.
  • Then for several days more, I could go one stop again, and come back again by bus.
  • Then I could start taking longer and longer journeys.

I'll have to remember to do the breathing and distraction techniques on the bus, and I could reassure myself before I go out each time that if I have symptoms of panic, I know how to deal with them, and they're unlikely to be caused by anything more serious than anxiety. I'm getting more confident now about coping.

I think I might write a new list of tasks where I mix my bus tasks in with my supermarket tasks, going from what I think will be the easiest task to the most difficult one.

So first I could just go and stand at a bus stop for several days. Then I could go and stand outside a supermarket for a few minutes and read something for several more. Then I could go into a supermarket when it isn't crowded on several days. Then I could go one stop on a bus for several days, with my sister if she'll go with me. I'll organise the rest of the list. ...

Overcoming the Phobia of Hospitals by Going To Them Gradually

Nurse taking blood pressure

After I've made myself feel more confident on buses and in supermarkets, I think I'll try to overcome my phobia of hospitals. That's the one that really bothers me. But maybe I'll have so much confidence by the time I've done the other things that I'll find it easier than I think.

I'm going to make a list of tasks I can do to build up to going to hospitals normally. I might change it a few times, like if I think the next task on it's too difficult so I want to do something a bit easier first, or if I begin to feel so confident that I think I could miss a few things out; but at the moment, I think that perhaps it could include:

  • Calming myself down at home and then imagining walking past a hospital feeling fairly confident.
  • Imagining having a laugh about something with a nurse who I just happen to meet in the street.
  • Imagining sitting among a group of doctors and nurses who are chatting.
  • Imagining walking into a hospital and finding the restaurant.
  • Beginning to read a book or articles about the jobs of doctors and nurses.
    I could carry on doing that while I do my other tasks.
  • Standing outside a hospital for real for several minutes, reading a book for distraction.
    People might think I'm just waiting for someone, so they shouldn't think it's odd.
  • Walking past a hospital for real.
    Maybe having read about doctors and nurses in a book will make me feel less anxious if I meet one, and I'll have practised my coping techniques a lot by then anyway, so I shouldn't feel as bad as I did before when I ran away.
    Hmmm, but what if I meet the same ones I ran away from? Well, they'll probably have forgotten it by now, and they probably thought I was only running to catch a train or something anyway.

I might have to stand around and walk past the hospital several times, but hopefully I'll begin to feel more comfortable. Then, maybe I could increase the tasks to include things like:

  • Going and sitting in the hospital chapel or restaurant for a while.
    I could take a book the first few times, perhaps with nice pictures in it if I didn't think I'd be able to concentrate on what it says, so that would help distract me from anxiety.
  • Walking past some of the wards, maybe with someone else for distraction so I didn't feel so much like an intruder.
  • Watching programmes about hospitals on television.
    Some might be easy to watch, but ones where they show procedures being done will be more difficult. But I can remember my breathing exercises, and watch the ones that don't show that many horrible things first.
  • Then I can start reading books or reputable articles about treatments for various illnesses, and try to make myself an expert in the best new treatments for things.
    If I feel I'm getting on top of the subject, it might not scare me like it does now.
    But if I decide it might make me worry that I've got the illnesses I'm reading about, I won't do that.

If I'm having difficulty moving from one item on my list to the next, because the next just seems too scary, maybe I could invent others that aren't as bad that I can do first. I suppose it might be a bit of a jump from sitting in the hospital restaurant to going past the wards. Maybe I could first sit in the hospital restaurant and imagine having a conversation with someone in a hospital ward who's got something wrong with them like a broken leg, and then I could stand looking at the signs that direct people to certain wards. Hopefully if someone asks me what I'm doing, they'll understand if I explain. Maybe if I'm with someone to start with and we're talking, strangers won't be so likely to approach me.

Maybe some things will be more difficult than I thought they would be because of things I just didn't expect to happen. I'm a bit worried about the idea of going inside a hospital without having someone to visit in there or anything. I don't know how I'm going to have the courage to go there on my own, feeling as if I haven't got a good reason to be there. Maybe if I speak to my doctor about it, he could arrange for me to go with someone official-looking, so people might not stop and ask us questions. I don't know if the doctor could do that, but it might be worth asking. Maybe it could be a community psychiatric nurse or something. I don't know if they do things like that, but I think it would be worth asking. If he could arrange for that, I hope it wouldn't take months and months, and I hope he wouldn't just try to put me on drugs. Maybe he could give me some ideas about other people I could ask if he can't help me. I hope he'd be sympathetic. I quite like him, so I think he will be. I think it's worth a try.

Then again, I'd be happier going in with anyone else at all rather than on my own. Maybe my sister would help again.

I'll have to work out what to say if someone asks why we're there. And I'd hate the embarrassment of going just at the end of the visiting times, so I'll have to find out when they are.

Anyway, I think I'll start by just imagining myself going into a hospital, so that won't be so bad.

Mourning

Another thing I can do before I get to go into a hospital for real is to recreate some of the things about it that have made me anxious before, so I can get used to those, so they won't bother me so much. The smell of disinfectant is one, because it reminds me of when I was in the hospital when Dad was dying. I could write into my list somewhere that I'll get some disinfectant, use it on something, and then hang around to smell it for a while. Then, on another day, perhaps I'll hang around to smell it for longer.

The self-help material says that while we're trying to get used to going to the places we were once scared to go to, it's best if we still keep up practising controlled breathing and distraction techniques at home, even if we think they're really easy now, since the better we can do them, the easier they'll be when things get difficult and we really need them.


Part Five
Becoming Desensitised to Worrying but Harmless Bodily Sensations


No passion so effectually robs the mind of all its powers of acting and reasoning as fear.
--Edmund Burke

What worries you masters you.
--Haddon W. Robinson

The difference between try and triumph is a little umph.
--Author Unknown

Interesting, this self-help material describes an alternative form of exposure practice, that we can try if physical sensations are making us anxious. It says we can do this instead of going to places we're scared of going to if we want.

I'll think this through, in case I decide to do this.

It says the idea is that we deliberately create sensations that make us a bit anxious, so we can practice doing things that calm us down, and practice reassuring ourselves that they're not dangerous.

I'm not sure I like the idea of deliberately creating them! But since I've been reassuring myself about them for some time now, it might not be too bad.

It recommends we write down a list of all the physical sensations that bother us, and all the ones we have when we have a panic attack.

Anxious

Right! I know I'm bothered by my heart beating faster. And I'm bothered by getting out of breath, because when I have a panic attack, I feel as if I can't get my breath properly. I start shaking, and my legs feel weak. Sometimes, I feel as if everything around me is unreal. I can feel a bit dizzy and faint. And my chest feels uncomfortable. Sometimes I start feeling sweaty and too hot.

The self-help material says we ought to put the sensations in order of the least worrying to the most worrying, and then do things that cause them, starting with the one that worries us least, and causing that several times, for longer and longer, building the sensation up in about five stages till we're making it quite strong. It says it's best to practise one stage a few times a day, and go onto the next stage when the one we've just done doesn't bother us that much anymore.

Suggestions on How we Could Re-Create the Physical Sensations We Associate With Panic Attacks

It says we could recreate the sensation of feeling too hot by putting lots of clothes and a coat on in the warmest room in the house.

It says we could make ourselves feel dizzy by twirling round and round, near a bed or settee so if we fall over, we'll have a soft landing! Or we could shake our heads from side to side for a few minutes, or put our heads between our knees for about thirty seconds and then suddenly sit upright again.

And we could make our hearts beat faster by jogging on the spot for a few minutes or running up and down the stairs.

Scared

It says we can reproduce hyperventilation by sitting down and breathing as fast and deeply as possible, 25 or 30 breaths a minute if we can, gasping air in and forcing it out quickly. It says we can try it for about two to three minutes, and then we'll be recreating the way our breathing feels when a panic attack's starting.

Yikes.

It says we can make ourselves feel shaky by tensing up all our muscles and holding them like that for about a minute before releasing them.

And it says we can make ourselves feel unreal by getting someone to talk to us for about a minute non-stop, and looking at their mouth the whole time.

It says we can make ourselves feel off-balance by standing with our feet very close together for a while with our eyes closed.

And it says we can make ourselves feel as if we can't breathe properly by holding our nostrils shut with one hand and breathing through a straw in our mouths for about a minute, or till we feel the sensation.

It suggests we work out other ways we might be able to create the sensations that make us anxious.

Oh, it says that pregnant women or people with known medical problems shouldn't try any of those things without talking to their doctors first.
I'm not surprised! But I don't think I'm pregnant, and I should be allright, given the tests I've had recently that said there was nothing physically wrong with me.

Wow! That just proves how far I've come! There was a time when I'd never have thought I'd be allright, because I was too worried that I might have a medical problem, or that doing something like this might bring on one! I must be making progress! Oh good.

The idea of doing these things still worries me a bit though! I think they're all things that stop happening on their own though after a minute or so, so it wouldn't be as if they were going on for ages after we'd made them happen.

The self-help material says that if people do have a physical problem, for example if they've had a heart attack in the past, they should ask their doctor to make a list for them of which sensations mean there's something wrong and they need to go to hospital or call a doctor, and which ones don't mean anything's wrong.

With all the tests I had recently that said I was allright, I shouldn't have a problem.

Building Up to Making the Sensations More and More Powerful

It recommends that for the first task in every set of sensations we decide to create, we calm ourselves down by doing slow breathing exercises and sitting somewhere and relaxing first, closing our eyes, and then just imagine we're experiencing the physical sensation we've chosen, imagining it's as real as possible, till we start feeling a bit anxious. Then we should start using distraction techniques and controlling our breathing like before, to stop ourselves thinking about it.

It recommends we do that about four times the first day, with a few minutes between each time, and that we do the same number in the following days if we still feel anxious when we're creating the sensation. It says that with the exposure therapy where we go out for quite a long time to travel to the places that make us anxious, we only have to do one a day, but since these are really short, we can do more.

It says that with the second one of the stages we do to help us get used to that sensation, we should do something physical to make the sensation happen. But if we can't make sensations happen physically, we can just imagine the rest as well.

So with the second stage of each item, it's best if we do it about four times a day, and for however many days it takes us to stop feeling that anxious about it. And it's best to do the same with all the others as well.

I think the least frightening sensation I get is getting hot. I could just imagine I'm doing that first several times. Then I'll have to think about how to make myself hot for real. If I do what the self-help material recommends, I'm wondering what someone would say if they came in while I was wearing lots more clothes than they would think was appropriate for that temperature! Maybe I'll try to create the sensation by cooking something, and then when it's ready, turning the oven off, opening the oven door and standing or sitting fairly near it for a few minutes. That won't look quite so bad! It might not make me so hot though. I could explain to people what I'm doing if I put lots more clothes on though. After all, all the ones likely to see me know I've got panic problems, so even if I was a bit embarrassed, they'd hopefully understand if I explained what I was doing. I'll think about what to do anyway.

Once I'm sure I can quickly get over my worries about the easiest sensations on the list, I'll hopefully feel more confident about doing the other ones, so they won't make me so anxious.

It says that when we imagine each sensation, and the first time we do it for real, we should practice with someone else in the room to reassure us if we can.

Hiding under a chair

The trouble is that I feel ashamed of telling people about my panic attacks and asking for help, because I know I shouldn't get so panicky about the things I do, and I'm worried they won't understand. I don't like to talk about them too much to the people who do know, even though I probably could, because they haven't laughed or anything, and they do seem to sympathise. Maybe I'll create each sensation for the first couple of times with someone in the next room, without telling them what I'm doing, so at least I'll know they're really nearby if I need support.

I don't know what I'll do if they come in while I'm doing things like twirling round and round to make myself dizzy! Hehe! I'll have to stop quickly if they come in.

Actually, I know! I could do the sensations when I'm on my own; but before I do, I could think of a few people I could phone if I get really anxious. If I think of a few people, then if one or two aren't in, at least one of the others might be. But I might be confident enough now to practise without support.

The self-help material recommends we create each sensation in five increasingly difficult stages, the first one only in our imaginations, and the second one for real, with someone around, if it makes us feel better.
With the third stage, it recommends we try the same thing, but on our own.
And then with the fourth stage, ugh! It recommends we produce the sensation as strongly as we can.
And then with the fifth stage, it says we should allow ourselves to feel it for thirty seconds before we even start distracting ourselves and controlling our breathing!

Well, once I've done the others, I might not feel too bad about doing that.

But it recommends we do the distraction techniques afterwards for at least two minutes to make sure we calm down properly.

I'll have to think. Yes, I think the sensation that will make me the least anxious, so it's probably the one it's best to do first, is getting hotter. I could just do that in my mind the first time till I imagine it feeling like it does when I'm just starting off a panic attack, and then immediately start my distraction and breathing techniques for a few minutes. I could do that several times till I don't feel anxious when I do it. Then I could go on to creating the sensation for real.

Cold

Maybe feeling shaky should be the next one on my list. First, I'll just imagine it, and then I'll try and make it happen for real. Then I'll try to make it happen for real when I'm alone, and then I'll do it again and try to put up with making the sensation as strong as I can.

When I've calmed down after that and done it several times till I don't feel that anxious about it anymore, I'll do as this thing suggests and make it happen more times, trying to put up with it for thirty whole seconds before I start doing the breathing and distraction techniques each time. That might mean I have to tense my muscles up before letting them go again for longer and with more effort.

The self-help material recommends we do breathing and distraction techniques for about two minutes after every time we've made ourselves feel each sensation, to make sure we've calmed down properly.

I'll arrange the other things on the list and try them out in the same way.

It recommends that when we start the practices with each new sensation, we still practice the most difficult task with the old one for the next couple of days, just to make sure we're still allright with it.

Yikes. No easy days then!

A clock

It recommends that we have a set time of day when we do the exposure techniques, to make sure we don't keep putting them off and never get around to doing them.

Yes, that sounds sensible. I know what I'm like. I just might find myself not getting around to doing them if I don't discipline myself. I'll plan what time of day suits me best, and stick to it, or at least within half an hour of it, unless something really important happens to stop me.

When I've finished all the exposure techniques I'm doing for the day, I'm going to reward myself for having braved them with a little cake and a cup of tea again!

If I feel too anxious about doing a sensation for longer than I did before, maybe I could start by trying to produce a milder sensation than the one I had in mind, and building up to the last task in more than five steps. Or if I don't feel that anxious, perhaps I could sometimes skip a few tasks, except the last one, where we really test ourselves by making ourselves feel the sensation for thirty seconds before we start doing breathing and distraction techniques! But I don't think I'll really feel confident enough to do that!

Encouraging Ourselves if the Treatment Works

The self-help material recommends we write down how anxious we felt at our worst in every session, on a scale of 0 to 10, so if we notice our anxiety dropping over time, it will encourage us, and we'll know the techniques are working. It says that some days we might feel more anxious about something than we did the day before, so the number we write might go up that day, but overall, it will probably go down quite a lot, or even to nothing sometimes, possibly quite soon.

It recommends we feel a sense of achievement for just doing the things, even while they still make us anxious, since it's bound to have taken "a lot of will power" to discipline ourselves to do them in the first place.

Will power! Yes, perhaps I can add to that list of my life's achievements I'm making that the fact that I'm overcoming my panic attacks even though I still have to feel anxiety while I'm at it proves I have discipline and will power!

After I've finished all the exercises and know I'm well on the road to recovery, I'm going to give myself a big celebration! I'm going to give myself a big reward, like going out to a fancy restaurant for the evening with my family or buying several cakes and having a feast with them! I'm going to really congratulate myself and feel really pleased!


Notes

This article is written slightly differently from most articles. All the information in most of the articles in this series is written as if by someone finding out a lot of helpful information for the first time, just learning about it. That person themselves isn't real; they're just a representative of a lot of others suffering the same thing. Any little anecdotes they tell about their personal lives or those of people they know almost always have really happened though, usually either to the author or to someone else known to the author. The article comes with a very short story about them to set the scene, and presents all the self-help information as if it's what they're finding out and what they think of it.

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The Story

The Way Things Are Before They Begin to Improve

Panicking

After a long period of stress, Julia suddenly starts having panic attacks. She doesn't understand where they came from. She's just walking past a hospital one day, and suddenly, her heart starts to beat faster, she feels as if she can't get her breath properly, her chest feels uncomfortable, and she feels intensely fearful, as if something disastrous is about to happen and she needs to run away. But she's scared that if she does, she'll knock people over and hurt them in her rush. She's scared that she's about to go mad, or that she'll have a heart attack and die.

After that, she's scared to go near hospitals in case it happens again, so she avoids them as much as she can, taking a different route around the town that's longer, but it means she doesn't have to go past them. But the more she avoids them, the more anxious about hospitals she becomes. She starts worrying and worrying that she might one day have to go to one. It turns into a phobia.

Hiding behind a fence

Worse still, soon, she begins to have panic attacks at other times, which she feels have just come on for no apparent reason, just unpredictably, all of a sudden. So she begins to feel scared about doing more and more things in case they happen there as well.

She goes to her doctor, which is a tremendous effort since she's so scared he might say she needs to go to hospital, but he examines her and assures her there isn't anything physically wrong with her. It doesn't convince her, since the symptoms are so bad. Every time she has a panic attack, she still becomes convinced she's about to have a heart attack and die. And she worries that she's about to lose control and do something that everyone will think is foolish, like running away when there isn't a good reason.

This worry, and the wish to avoid any situation that might spark off another panic attack, makes her stay indoors more and more. It's difficult, though, because she has young children, and she has to go out to take them to school and buy shopping for them.

Their childhood illnesses begin to really scare her because of the possibility she'll have to take the children to hospital and there might be something seriously wrong with them. She starts to worry that they might die, because she's anxious that she might not be able to take them to hospital when they need to go because she's too scared to. She knows that most childhood illnesses are only minor, but it doesn't stop her worrying.

Things are bad in the Summer, because when wasps and bees are around, she's constantly worried that they'll sting the children or herself, and that it might cause an extreme allergic reaction, and that'll mean a hospital visit.

Crying

The children are beginning to copy her anxiety and get really scared when wasps and bees are around or when they become ill, and this makes her feel as if she's failing them and damaging them, since it's because of her that it's happened. She even feels suicidal at times, because she's so upset that she thinks she's damaging her children when she should be protecting them. She feels as if she's ruining their lives and that her own life is ruined as well, so she thinks that maybe there's no point in even going on. She worries things will even get worse and she'll develop full-blown agoraphobia.

She feels in an especially high state of anxiety after she's had any medical tests, like routine cancer screenings, and she fears the worst. She feels as if she can't bare to answer the phone or collect the post in the mornings, because she's so scared that if she does, she'll find out bad news.

Once she starts using the self-help information though, her mental health gets better and better.



The End


Note that if you choose to try out some or all of the recovery techniques described in this article, they may take practice before they begin to work.

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The articles are written in such a way as to convey the impression that they are not written by an expert, so as to make it clear that the advice should not be followed without question.

The author has a qualification endorsed by the Institute of Psychiatry and has led a group for people recovering from anxiety disorders and done other such things; yet she is not an expert on people's problems, and has simply taken information from books and articles that do come from people more expert in the field.

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