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13 years ago 0 +0 / -0 5

We are in agreement that in some cases that the exposure alone may not accomplish the desired reduction in anxiety if the thoughts are not identified, challenged and corrected. It seems a combination of the two.

13 years ago 0 +0 / -0 6252

Neil

When I talk about distortion I mean adding things that would not happen or you would not do, such as a person in the shower and all of a sudden in their mind the door won't open and the walls are closing in, In bad cases even escaping to the bathroom is not enough, it too is too small for your body. This distorted thought is hard to break. For some it is a momentary dumb thought, but for others it is very real. This is where exposure with no preparation or coping skills is okay (in my books) You go back into the shower and feel the solid walls and check the door.

But if you are on the freeway and this happens and you can not get off you had best have some coping skills to hold you till you can.

You do not have to go back to the Freeway to do the exposure, the episode is in your mind. You can sit in your house and replay it and pick out all the distorted thoughts and change how you perceived them. Challenging them and building coping skills so that the next time it happens you are prepared. Building a positive thought and challenging the distorted or false thought before they happen. Then when you do the exposure it is reinforcement for the positive thoughts. This is curing a situation. Just going back and doing exposure over and over only builds a tolerance, it does nothing for the trigger that brought it on. Given time it will allow you to face the situation. Isn't it better to bury the thought or trigger than just block it. For people with multiple triggers changing how you perceive them covers all of them so you don't have to build a tolerance to each one. People who do this describe how they now have a hole where the triggers used to be. It is a weird feeling to get no reaction to a false threat because you know in your mind it is false.

I don't mind if you disagree with me. Like I said, what ever works for you we are all different. We here have two things in common, we suffer (me not much) and we care.(me a lot)

Here for you,

Davit.

13 years ago 0 +0 / -0 5

Davit

I think it is important for me to clarify that I believe the Panic Program is all anyone really needs. It is the right information and that matters a lot and it is available on the internet. Anyone following this program is in the right place and doing what is needed to get better. There is no question there in my mind. If anything, the books I listed can be used to create an awareness that the Panic Program is not an island, but in fact a part of a larger body of evidence and similar programs in books that have a proven success rate and I would hope that will create an even greater confidence in those that are following the program. We might be anxious but we are not alone. Believe me, I've clocked about 800 hours of therapy spanning 16 years, was addicted to valium for thirty years and you are in the right place learning the right information.

I am thinking for the time being we will have to agree to disagree about exposure. I think that challenging the core beliefs or anxious thoughts is an important part of the solution and so say the experts but exposure is what really shakes the whole tree, so to speak. Exposure is natures way of putting all systems in drive so your mind can't help but learn that fear is not needed. The success of exposure is one thing all the experts agree on even the ones that have a bias towards cognitive therapy. I look on thought correction as a trial run until it actually becomes integrated into exposure. But that is my opinion and I think you are very correct in saying we have to find our own answers. At least what we are doing here is giving people a lot of resources to form those opinions and there is no harm there.

Worth a mention is that of the books I listed Mastery of your Anxiety and panic would likely be the one to start if anyone wants to venture out a bit. I believe it is based on the same ideas as the Panic Program and it may give different perspective on the same themes. Options are good.

I am thinking that when you talk of distortion that you are talking about distorted interpretation of a trigger. For example "the programs for running ahead of a baton carrying competitor in a race and running ahead of a club-carrying assailant on a racetrack are likely to involve similar stimulus and response information. That which distinguishes the fear structure is the meaning of the stimuli and responses: only the fear structure involves escape from threat". I am right behind you that the interpretation needs to be corrected, but again thinking this corrected interpretation needs a true run with exposure for real learning to take place.

That quote about the race track comes from Edna Foa at http://www.personal.kent.edu/~dfresco/CBT_Readings/foa_%26_kozak_1986.pdf

I'll bet you will have fun with that one too. It's all good stuff but don't go at it if it overwhelms you. Bit at a time, move through the anxiety, bring it up, bring it down, learn that fear is nothing but the wizard in the wizard of OZ pulling strings and making a big padoo about nothing, pull the curtain back and see it for what it is a pathetic little man pulling strings and such. Eilenna Denisoff taught me that.

Got to go, Neil

Now this won't post so I am going to face the anxiety of copying it and putting it into word and repaisting it. Jeez, where does the exposure end. I mean it might disappear or something....oh well I'll move through it.

13 years ago 0 +0 / -0 6252

Neil

I have been reading the previews of the books you recommended with some interest but not enough to spend the money on them. For example, I thought with my first panic attack that I was having a heart attack, based on what else could it be. All future ones were based on the fact that I could not get a negative thought out of my head. The effects of the panic attack I accepted as normal and ignored but the reaction to the trigger I could not get rid of. even when the physical sensation was gone, even when I understood there was no logical reason to panic. My mind still distorted what the trigger opened up. It was this distortion that kept my fight or flight in place. It took some time to change this distortion to some thing understandable, which I did with journaling. It did not stop the trigger, but it did stop the reaction to the trigger, I could then say this is false. There is no danger, fight or flight shut down. And it did. So see it is not always based on that viscous circle of physical sensations making the sensations worse. But again I say it is not the reaction or the trigger that caused it that is the problem, but how we look at the trigger and its reaction. Stop the tendency to think negative and all related reasons to panic fade away. No matter what causes them.

Eg I could have the same trigger pop up at different times and one time it would cause a reaction and at another I could not get a reaction or even find a reason to react. Made no sense till I realized that at different times my perception was negative or positive. I was doing it to myself, not the trigger, but me.

Here for you.

Davit.

Ps We are all different, do what works for you.

13 years ago 0 +0 / -0 5

Sorry for leaving all of a sudden, my wife and I left in a hurry to a show at second city and just got back at 11:30pm. I have a lot of respect for what Davit is saying and will try to respond tomorrow.

Neil

13 years ago 0 +0 / -0 653

NJM, thanks for your ideas about exposure work and reading suggestions. Sounds like you have a had success with them, which is great! By the way, welcome to our community!

Davit, thanks for your commendation of our program! We think it is comprehensive as well.

Good discussion. Remember that there is no right or wrong with this- different things work differently for different people at different stages in their lives! But please continue to help each other in a supportive manner. There are many others in this community who are not posting but are taking solace in your words and encouraging stories.

Tiana, Health Educator

13 years ago 0 +0 / -0 6252

Neil

Panic is a natural reaction to a perceived threat. It is a survival technique. It seldom lasts more than a few minutes. Panic attacks can last hours. Three was my longest. They do not come out of the blue, there is always a reason. The trigger is not the reason, the trigger opens up the reason. The reason is usually illogical. (core belief) Without something logical to deal with the fight or flight can neither react or shut down. Hence the heightened fear that keeps it going. The problem comes in when you try to logically deal with something illogical. During a real panic attack it is almost impossible to think or write. But you must to shut down the attack. You have to give your fight or flight a reason to shut down. This is where journaling and the ten questions work to turn the illogical to logical. so the fight or flight can shut down. It works and it matters not what the fear is as long as it is illogical. Natural fear causes panic but because it is logical it has something to focus on and doesn't turn into a panic attack.

There are people that never have more than one panic attack in their life. They some how have a stable enough out look to be able to say this is not real and drop it, they seem to be able to ignore the trigger so it never happens again. They may be unhappy with the trigger but they don't dwell enough for it to open up the reason to panic. It may well be that there core beliefs are all positive.

Fear of fear is very common in panic disorders.

If it makes sense and yet doesn't stop it then you obviously don't truly believe it, Negative core beliefs are over shadowing the positive thought you re trying to have. You do not believe what you know to be true.

The feed back is the reaction to the cause, and not the cause. Fear of the feed back is the cause. Feed back prolongs the attack but doesn't cause it. Dwelling on the feed back increases it. Same as coffee increases the panic but doesn't cause it.

Now you are into perception. Exposure is not the answer, it is the reinforcing of the answer. First you have to perceive the problem. second you have to want to change it and third you have to really believe you can. Now if you have coping skills and relaxation skills in place you can test the above three with exposure. This can make the difference between your exposure being a one or a ten or anything in between. You are actually changing your thought patterns from negative to positive and using exposure as a gauge.

Finally there has been some linking of panic disorders to intelligence. I would think it has more to do with ones ability to perceive both negative or positive.

Hope this makes sense to you.

Here for you,

Davit.

13 years ago 0 +0 / -0 6252

Neil

The problem with books is the chance that they were wrote for the money. You have no idea whether the author knows what he/she is talking about or if they are just quoting some one else's words or if the information is relevant any more. You do not know what is in a book till you open it. At least with internet (which has a lot of crap in it) you can cross reference and compare with out getting bug eyed and lost or confused. You still have to sift the information. If ten sites are saying the same thing there is a possibility it could be true. You still have to try to see if it is right. Any one who has not had major anxiety or panic attacks can even begin to understand them, no matter how many degrees they have after there name.

My therapist (who has first hand knowledge of panic attacks) does not give me the answers, she gives me the questions and points me to the answer. I have to find it on my own.

Believe me the answers stay in your head a lot longer if you put them there than if some one else does. Every thing she has sent me searching for has been right on the mark. Some of it does not agree with the experts, but it works.

I'm not saying the books are wrong, I'm saying all you need is right here. People are having trouble concentrating on the program, they may not have what it takes to read the books and the books may be in a different order than the program. If you have the time by all means read them. But with a book you are still on your own. Here we have a group of people that can say this works for me or that works. Here we have other people to compare our progress to. And here it is laid out in steps of approximately a week. Some will take more or less time, some will have to be done over and over but you can not get lost here. Stalled in one spot yes but that is what moderators are for to help you over the hump.

Do what ever works for you, but all you really need is right here. Work sheets, information and support.

One last comment there is a difference between panic attacks and panic just as there is a difference between coping and cure. To many books deal only with coping and not curing.

Oh and I think I forgot to welcome you to the site. Sorry, see I have some new toys and have been busy.

A little about me, I have has excess anxiety and difficulty with core beliefs all my life that caused elevated panic till it spilled over into run away panic attacks. I was an Ativan addict for four years. I had panic attacks every night for over two years, I have been free for at least a year now, maybe two. I have been in the psych ward. Nice homy atmosphere, mediocre food and the bed was lousy. Not totally cured, the core beliefs are pretty strong but I am free.

Keep posting please. By the way like everyone else here, these are my thoughts and impressions only given with the hope they will help and comfort.

Here for you,

Davit

13 years ago 0 +0 / -0 5

There is a theory that when we start to panic part of the process is that we lose our cognitive ability of reappraisal of threat, so it is one thing to believe that anxiety is not dangerous during this discussion and another to convince yourself of the same when you start to panic and suddenly feel that you are losing control and thoughts and emotions appear to be running on some auto pilot from hell.

Some people say a panic attack is the most terrifying thing that they have ever experienced so it makes sense that they would develop a core belief that panic and anxiety are dangerous. No one likes to feel that they are losing control and have some physical sensation escalate out of control. Losing control, going insane is a core fear that we are all taught (the movie psycho, shutter island etc.)

Now I am thinking if you are reading this and you have panic disorder just about now you are starting to get really uneasy. That is the fear of panic. So let me take you back to talking a solution.

It makes sense that we are afraid of panic, I mean anybody would not like that to happen to them. So if we are not insane and it makes sense what is happening to us, then how do we stop it?

Panic has been described as a positive feedback cycle between catastrophic thoughts and the sensations of fear. Positive feedback has been described as "A produces more of B, which in turn produces more of A" like a microphone that picks up sound from its own speakers. So you feel your heart beat, feel fear that your heart is beating which feeds back and makes your heart beat more and so on, until you wear yourself out. It is not forever, you pull out of it, but back you go again. Panic is the fear of fear, so we are not afraid of the tiger, we are afraid of the fear that the tiger started so long ago that we don't likely remember.

I am still going to suggest that we are afraid of the sensations of fear and the first step is to remove ourselves from the "emotional jungle" of feeling helpless to our automatic thoughts and emotions and become aware of what those sensations and thoughts are and slowly take control of them through exposure and correcting the catastrophic thoughts.

With exposure you find what you fear and approach it in a way that does not overwhelm you so you don't get "thrown in the water", you put your toes in for 5 minutes and back out, then 10 minutes tomorrow. Whatever you consider a moderate challenge, that is what you expose yourself to. Not to much, not to little, so you keep gaining ground. The anxiety will not suddenly go away, it will lessen and if you keep at it you will see a pattern of relief and that will just keep getting better.

If you feel an interest in the idea of facing the sensations of fear, start very lightly. Maybe sit in a chair and spin 5 times and see what it does (fear of dizzy). You are in control, that is the what you learn. You take the sensations of fear out of the dark and make it into something you can turn on and turn off. Spin the chair, stop the chair. You are not helpless anymore, you are in control. Try staring in the mirror for 2 minutes (fear of unreal) or sitting on the couch with your legs up for 2 minutes (fear of blood pressure changes). The only rule is don't overwhelm yourself. The experts say this is what the therapists should have panic clients doing within the first few sessions. There is no one answer to eliminate anxiety so we go at it one answer at a time.

I am not an expert but I have been in therapy for years, finally feel I am getting somewhere and I can give you links to books that are written by the experts. I think there is evidence that panic patients are very intelligent.

Hoping this post work, I am struggling with his site, Neil

Anxiety and its disorders: the nature and treatment of anxiety and panic By David H. Barlow

Cognitive Therapy of Anxiety Disorders: Science and Practice

By David A. Clark, Aaron T. Beck

Mastery of Your Anxiety and Panic: Workbook

By David H. Barlow, Michelle Genevieve Craske

13 years ago 0 +0 / -0 6252

But it is or isn't depending on your perception. A positive core belief would be that anxiety is annoying but it can't kill you. Attitude would be that you are sick of it and will get all the information to understand it and change it. Belief is simply that if you truly believe the information then it will work.

A negative core belief would be that you can do nothing about it because it has always been there and that it will eventually kill you. (not true) Attitude would be that since you can't do anything about it why try. And belief would be that the core belief is true.

This core belief is more in the realm of depression than Anxiety/panic.

There has to be a reason for a core belief to be. Anxiety in the case of over analysing situations or anxiety in the form of OCD. Or anxiety built on another core belief. But you know anxiety/panic itself is not dangerous. It is a normal reaction. I would think that this would be a relatively new core belief built on some situation or another core belief.

Not like core beliefs built in childhood and reinforced over a life time. Those are very hard to bury because the reason to build them is usually related to a situation brought on by some one else. Family or Peers. Some one you think is right. Now if a parent told you that anxiety was dangerous because it makes you weak and there is no room for weakness in your family then you are dealing with more than one core belief here. This one has off shoots. But it still has one root core. That is the one you deal with, the others will fall with it.

It really matters not what the core belief is, they are all treated the same way. With thought exposure. Negative ones that they are false and positive ones that they are right and need to be built on. Done by attitude or journaling.

I think that anxiety in the severely depressed could be dangerous and calls for immediate medical treatment to control it till it can be dealt with as a core belief.

How would you deal with this core belief if it were yours?

Here for you,

Davit.

Even positive exposure needs safety coping skills in place in case you feel guilty and revert to negative. (allowing a negative core to the surface by some unexpected trigger)

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New Ask the Expert in Panic Center

Anxiety and its disorders: the nature and treatment of anxiety and panic By David H. Barlow

Mastery of Your Anxiety and Panic: Workbook