I've always been very open about the fact that I struggle with Panic Disorder and Agoraphobia, which is presumably why so many women in the same boat contact me for advice. (This Thanksgiving Eve will mark... geez... year 12?) I'm not in the medical field so bear that in mind, but I will give you a rundown on what has helped relieve my symptoms.
- Beta blockers - taken daily
- Zoloft - taken daily
- Progressive Muscle Relaxation (PMR) - done daily
- Dialectical Behavioral Therapy (DBT) - done daily
- Cognitive Behavioral Therapy (CBT) - done daily
- Xanax - taken ONLY when absolutely needed
*Beta Blockers are prescribed to heart patients and to PD patients. What they do is stop your resting heart rate from taking unwarranted, unnecessary spikes that lead to Tachycardia (100+ beats per minute, or BPM.) Tachycardia in and of itself isn't usually serious from what I've been told, but repeated, prolonged episodes of it can lead to a stroke. Interestingly and sadly, it wasn't until I moved to Los Angeles for therapeutic help (in year 10) that a doctor prescribed them for me (in year 11.) My doctor is still shocked that he was the first to prescribe them after having seen more doctors than I can count. At any rate, being on a beta blocker has been a true godsend.
*Zoloft actually made my symptoms worse before making them better. Relief didn't start kicking in until after about 2 weeks.
Unfortunately, I know lots of PD patients who gave up Zoloft after a few days because they (understandably) couldn't handle their symptoms getting worse before calming. What I've recommended to others in the past is ask your doctor to prescribe Xanax to take in conjunction with the Zoloft for a couple of weeks... this mitigates the effects of your seratonin levels going bonkers while your body adjusts to the Zoloft. Unless things have changed since I started taking Zoloft, it's the only PD medication that also works on PTSD and OCD symptoms at the same time.
*Progressive Muscle Relaxation (PMR) will give you pronounced, noticeable, longterm relief from PD. PMR is the tensing and squeezing of each muscle group from the top of your head to the tips of your toes, done one muscle group at a time. It takes about 20 minutes to do and should be done daily. Unfortunately, I have not been able to locate a single guided PMR audio CD or download so I had to make my own. You can download my (amateur!) one by requesting it here. I created it using the actual text of a PMR session and combined it with a common anti-anxiety meditation. I think the total length runs 25 minutes.
*Dialectical Behavior Therapy, or DBT, is the brainchild of Dr. Marsha Linehan. Originally created to combat Borderline Personality Disorder, her groundbreaking research is truly a godsend for people with all different types of anxiety disorders. The gist of DBT is practicing "mindfulness," which is being in the moment rather than distracted or preoccupied, while performing "opposite action." So for someone like me who struggles with agoraphobia, an opposite action can be something as mundane as a trip to the grocery store. Linehan (I highly recommend ANY of her videos) explains the need for "opposite action" in a brilliantly simplistic way: if we avoid the things, people, and situations that are anxiety-provoking rather than face them, our brains never get the chance to recognize that we can face those things, people, and situations without anything unbearable happening. Exposure therapy is a big part of DBT because the more we expose ourselves to fears, the faster our brains start processing those fears as mundane. This workbook is a great starting tool.
*Cognitive Behavioral Therapy, or CBT, never helped me as a solo endeavor, but when used in conjunction with DBT... Bamm! Immediate results. (Insert amusing note: my oldest daughter was appalled when I told her the name of my therapy and asked me what in the world Cock & Ball Torture had to do with panic attacks. I told her not THAT kind of CBT and then asked how she even knew what THAT kind was. "Hello. Well past 21 here," she said. I winced.) But I digress...
DBT deals mainly in behavior, while CBT deals mainly in thoughts—namely in challenging dysfunctional thoughts. A lot of the time people with PD experience anxiety and avoid specific situations (and sadly even new situations) where we fear anxious feelings will come into play, even though we don't know why we're anxious about it to begin with! (This typically happens after having PD for a long period of time, during which agoraphobia is usually—but not always—present.) So CBT teaches us how to catch and identify the core belief (thought) that is causing the anxiety and challenge it. If you'd like more information, I'm happy to post "thought records" (just ask) and there are books on the subject, though I've never read any of them so cannot comment on their helpfulness or lack thereof. This researcher is usually on top of his game, but the text appears to be a workbook for clinicians rather than patients. (Can't hurt to try it though!)
*Xanax is a very controversial drug mainly because (a) a lot of people who don't need it use it recreationally and (b) some people who do need it abuse it. Xanax carries a risk of dependency, and if used frequently, tolerance. As I never want to build tolerance to the one medicine (for me) that's been able to stop a full-fledged panic attack, I take Xanax only when all other remedies fail. That stated, if you have PD, no history of drug and/or alcohol abuse, and your doctor still refuses to prescribe it... get a different doctor. You don't want a pill pusher, but neither do you want a doctor who won't prescribe it just because they don't believe it's necessary. (Try having an attack, doc, and we'll see how quickly your tune changes!) If at all financially possible and covered by your insurance, actively seek out a psychiatrist prominent in the field of anxiety. What I've learned to look for is a psychiatrist who:
- Has a small practice because s/he is still...
- Researching and teaching grad students (important because it's a pretty decent indicator s/he is up-to-date on the latest research and available treatments)
- Is NOT a pill-pusher
XANAX IS ONLY TO BE TAKEN WHEN ALL ELSE FAILS!!!! In a later post I will get into different remedies you can use in lieu of Xanax that will work the majority of the time. For now, one effective remedy that works for me is drinking a bottle of ice-cold water as quickly as I can. (This is a DBT technique I learned from Linehan.) For physiological reasons I won't get into in this particular post, your body temperature tends to rise during an attack. The ice-cold water is a fast way to help your body physiologically return to homeostasis. (It really does work!)
If you've gotten this far into my post, chances are you or someone you love is suffering from debilitating panic attacks. I deeply empathize with you and promise that it will get better if you're proactive! Here in Los Angeles where everyone has a psychiatrist and there is zero stigma attached to it, it's a lot easier to get better faster. Having spent a decade in PD hell while living in the midwest and south, I'm also deeply aware of the stigma attached to anything that deals with "mental." So know this: PD isn't even classified as a mental disorder anymore, but as a physical one. The nasties that take potshots are making fun of you for a disease you didn't ask for, want, or can be cured of. But just because you can't be cured, you can learn how to effectively cope.
In closing, I'm going to leave you with some free, guided meditations from UCLA's MARC (Mindful Awareness Research Center) that I've also found very helpful. Click here for their website.
Always remember: pain is inevitable, but suffering is optional.