Big Bend Gazette :: Health Tips: anxiety and panic attacks really are curable!

Last month the focus of my article was on stress. If stress is not dealt with, pretty soon, a general sense of anxiousness is felt and becomes subconscious. Soon a person no longer knows what the cause of their unnerving feelings are.

According to Dr. Stuart Crane, psychiatrist practicing in Alpine, “Anxiety is the number 1 emotional problem in the world and the most curable, whether by cognitive therapy (structured talk therapy exercises) or medication.” Thirty million adults (over 16% of Americans) are affected by anxiety, as well as 13% of our children.

It is hard to concisely define anxiety, because it has many components. Anxiety can be good and normal, and serve a funtion, and yet it can become harmful to a person’s mental and physical wellbeing.

Most simply, anxiety is “a feeling of apprehension, uncertainty and fear.” (Dorland’s Medical Dictionary). The Merck Manual says, “Anxiety is a distressing, unpleasant emotional state of nervousness and uneasiness; its causes are less clear (than fear)...it is less tied to the exact timing of a threat; it can be anticipatory before a threat, or it can persist after the threat has passed or can occur without an identifiable threat. Anxiety is often accompanied by physical changes and behaviors similar to those caused by fear.”

Good anxiety helps us adjust to our surroundings so we will survive, makes us study for tests so we won’t fail, makes us practice a skill so we can do our jobs, and makes us rehearse so we can give a persuasive speech or give a great performance in a play. Good anxiety also makes us be careful to avoid accidents and stay out of dangerous situations.

But if anxiety becomes too strong, it becomes a dysfunction, making us unable to adjust to change and warning us to become so overly cautious we cannot even act at all. At this point anxiety becomes a disorder. If the anxiety disorder is not treated, it can even contribute to, or interfere with, treatment of some physical disorders.

There are 6 major faces of anxiety.

Specific phobias top the list in frequency, such as fearing certain situations or environments (closed places, heights, bugs, car trips).

Social phobias are next and almost as common.

Post-traumatic stress syndrome is also extremely common in rape and child abuse survivors, soldiers returning from war, and witnesses to horrific crimes or accidents.

Generalized anxiety disorder overwhelms those who are having emotionally charged stress over multiple issues on a daily basis for 6 months or more.

Obsessive-compulsive disorder is found in both children and adults and deals with habits of repetitive procedures to assure oneself of appropriateness, and an inability to stop worrying about certain possible situations that are perceived as threatening.

A common myth about anxiety is that once you are anxious, you will always be so. The fact is you can control the way you react; you can control the chemicals being released in your brain as it reacts to certain stressful situations.

Some people develop anxiety in stressful situations, while others are not affected the same way. Some people are actually more prone to developing chronic anxiety rather than going through a severe stressful incident or situation, working through it, and getting over it. Factors that influence our dealing with stress include how our family raised us to cope, what our genetic make up is, how low our resistance is at the time of an incident, if the body’s chemical balance of brain and hormone function is working well, if we have a good support system of friends and relatives, and a strong marriage, if we have resources to tap into such as a church network, psychiatric counseling, and whether we already have psychological problems or medical illnesses to begin with.

Some people do not want to admit to having anxiety due to embarrassment, so they do not seek help early. Then things progress. Other causes of delay in dealing with stresses that have progressed to anxiety include lack of insurance, a community lacking resources to help those affected, not being aware of symptoms that would require care, and not feeling confidence in counselors or providers of health care.

There is not just one treatment for anxiety disorders, but several choices. This is helpful, as each person has unique ways to respond to different types of therapy. Treatments include medications, psychotherapy, and self-help programs. Access to information and education about anxiety is paramount to healing regardless of the treatment used. Support groups are very effective in helping people continue to stay focused on new ways of addressing their anxiety.

Like so many conditions, a person has to realize and accept that he/she has an anxiety disorder before help can be found and used. So the first step is to find a checklist of symptoms and see if you have most of them. The most common thought patterns of an anxious person include feelings of needing to be in control at all times, expecting everything in life to be “fair,” feeling guilty when you cannot be available to all the organizations who ask for your time, being a perfectionist, feeling like you cannot trust anyone to do things right and doing most things yourself that could be delegated, extreme fear of failure, worrying about pleasing everyone all the time, avoiding all situations that may cause conflict or confrontation, feeling unappreciated, feeling like you have not accomplished anything worthwhile in life when you’ve given your all, feeling too exhausted to do everything you feel that is absolutely necessary to get done.

What if you are unable to join a support group and you don’t want to take medication if you don’t have to? What if there are no programs accessible to you? There are individual self-study programs that have excellent results for the person who has strong motivation and perseverance to stay with the schedule.

One type of self-help programs I have recently become aware of is the “Attacking Anxiety & Depression” series of audio tapes or compact discs, including a workbook that helps internalize the lessons. The best way to learn more about this very well-known and universally-used program is to go through the internet for a video introduction to the overall product and try some of the helpful exercises such as a self-assessment for anxiety quiz. “Attacking Anxiety” is produced by the Midwest Center for Stress and Anxiety. You can search for this using a search engine, or go to www.skyewebs.com/clients/stresscenter. I called them for the price of their program: it ranges from $480 to $520 with payment in 8 monthly installments.

Another program is available from Recovery, Inc. It can be independent or group focused utilizing a trained leader. The website that will provide you with more information on this resource is www.Recovery-inc.org. The book, Will Training, that guides the program is written by Dr. Abraham Low.

There are many levels of such programs. Some are available in libraries. Most programs will emphasize that you keep your body healthy, exercise and lose weight. Some of my patients tell me how important that has been for them to overcome their anxieties. They now have much healthier lifestyles after addressing their anxiety problems.

Often patients can tell me they know they are having panic attacks but they think only medication can help. One self-help program emphasizes that it is important to look your panic attack in the face and realize its effects are only temporary and not likely to damage your body. Don’t run from the panic. Realize it is okay to be nervous and go with the flow. Keep repeating, “ This will pass.” Breathe in and out slowly.

Distract yourself. One patient told me she took a walk outside during a nighttime episode and the cold air distracted her. Another told me she decided all her symptoms could be possibly related to something she was anticipating and then she could reason herself out of her symptoms. Again, you cannot always pinpoint the cause and will have to believe that you can ride the episode out.

Often a panic attack will cause chest pains, shortness of breath, muscle spasms from too much rapid breathing, sweating, and or nausea. A trip to the emergency room or clinic may be in order to be sure illness is not causing the symptoms. Once you know there is nothing physically causing these symptoms, proceed to be in charge the next time it happens. Avoid caffeine or stimulants that can make you overreact. Learn to relax. Realize that relaxing takes knowledge of how to breathe correctly, how to release the tension in all your muscles properly, and how to think of pleasant situations to distract your anxious mind. In practicing how to relax correctly, you are laying down nerve pathways in your brain that you can later switch on when stress begins, preventing the progression to a full-blown anxiety attack. Again these techniques are available in most libraries.

As I mentioned last month, there will be a peer support group meeting weekly at the Marathon Health Center with structured programs to analyze anxiety, become educated on how to address these distressing feelings, and practice various coping skills. We are planning to start these September 20 and meet weekly from 4-5 pm on Thursdays at the clinic in the meeting room. Please call Isabel Shackelford at the MHC at 432-386-4316 to sign up. There is no charge for this program, but the number of attendees is limited to 8 for this first session, which is expected to last into the New Year depending on schedule adjustments for the holidays. Specifics will be decided by the group.

Have a happy and anxiety free Labor Day weekend!

JoAnn Lister is a Family Nurse Practitioner Certified, at both the Marathon Health Center and Alpine Family Health Care Services. The Marathon Health Center is open Mondays & Thursdays, 8:30 a.m. - noon, 1:00 - 5:30 p.m. Located at South First at Post Road in Marathon. Phone: 432/386.4316. Appts. & walk-ins..