"I STARTED TO EXPERIENCE ABOUT 5 - 6 PANIC ATTACKS A DAY"

I WAS PUT ON PAXIL IN JULY 1999 , I WAS ON 20 MG UNTIL I TOOK MY LAST DOSE ON JAN 1 2000 IT TOOK ME AWHILE TO GO OFF OF IT. I HAVE BEEN OFF FOR ABOUT 6 WEEKS AND I FEEL BETTER, BUT I CAN ASSURE YOU THAT I WILL NEVER GO ON IT AGAIN. I GOT MARRIED ON JUNE 11 1999 A COUPLE OF WEEKS LATER, I STARTED TO EXPERIENCE ABOUT 5 - 6 PANIC ATTACKS A DAY, I THINK THAT IT WAS JUST A CHANGE OF LIFESTYLE THAT PUT STRESS ON MYSELF, I WENT TO THE DOCTOR AND HE PRESCRIBED ME PAXIL, AND THAT IS WHEN MY NIGHTMARE STARTED. I GAINED ABOUT 40 LBS AND I WAS ALWAYS TIRED AND LOST ALL INITIATIVE TO DO ANYTHING AND I LOST ALL SEXUAL DESIRE. IT DID STOP THE PANIC ATTACKS, BUT IT ALSO MADE ME FEEL THINGS THAT I NEVER FELT BRFORE EITHER. THE WITHDRAWALS WERE HORRIBLE, AND I WOULD NOT RECOMMEND THE DRUG TO ANYONE.

-- submitted by DAWN, 24

"The anxiety was situational. My situation changed, I stopped taking it and the third day I was very ill."

This was the second time I took Paxil. This time 30mg. for anxiety, last time 20mg.for depression. The anxiety was situational. My situation changed, I stopped taking it and the third day I was very ill. I thought I had a stomach virus at first then I found out what it was. PAXIL WITHDRAWAL! I called the doctor and asked for some 20 mg. so I could taper off. She recommended. One a day for a week, then one every other day for a week, then one 3 times a week. Today I went back to the doctor because I have felt so bad. I didn't get much help there. I appreciate everyone that posted here because it validated my illness. I have several(most) of the symptoms posted here. I told someone today that I felt like I had a migrane without a headache. (Thank God) the nausea comes and goes but mainly on the 2nd day of no Paxil. I am going to start 10mg. everyday and see if that is any better. People need to be warned of the withdrawal. The first time I took Paxil, it was worth it because I was so depressed, but there was no withdrawal. Please help get the word out. I feel emotionally better because I know now that is not in my head.

-- submitted by forkers, 34

"This is my 3rd attempt to get off the paxil"

This is my 3rd attempt to get off the paxil. I wonder if I'll be successful? I believe I will (also did the other times). It's now been a year that I was prescribed paxil for panic attacks. Let me tell you that most doctors do not inform us well at all. If I had known there were so many withdrawal syptoms, I would have chosen something else. I can say the paxil at a proper dose really helped me. But when I first started on the paxil it didn't work. The doctors said it was going to be a gradual improvment. A month and 1\2 passed and I wasn't better. (I took 10mg for 3weeks and then 20mg) I was only better 2 to 3 days after the increase but for only a couple of days. I still had to go to the emergency many times, cause the panic attacks persisted uncontrollably. So between the hospital, my GP and the psychiatrist everything got mixed up. The hospital put my dosage up to 30mg. (good for a few days) Then I was worst. Now not only panic attacks but obsessive suicidal flashes. (which I feared tremendously cause I did not want to do that) So again to the emergency room for a huge panic attack and confusion. My dosage was put up to 40mg. What a mistake. It got worse after a few days of feeling good. With the panic attacks and suicidal flashes, add lots of ups and downs (laughing then crying 10-15 times a day). Also the shakes and increased occurrences of the attacks. So my GP put the paxil up to 50mg. What an overdose. You figure between them they would know the increase is worst. So this time the emergency admitted me for a week. I automatically refused to take that high of a dose of paxil. With lots of pushing they agreed to reduce it to 30mg and they gave me some ativan. I felt great after two days and then even better after a week. I say I felt great cause it was really hell before. so when I left the hospital we reduced it to 20mg with regular intake of ativans(ativans for about 1 month). It worked wonders. Panic attacks were controlled and not as frequent. Like once or twice a day instead of 10-12 times. And improving to only a few controlled ones a week to almost nothing. Now 9 months had past. I was well so decided to quit the paxil. Big mistake. I stopped cold turkey. It feels really great for a few days but then it's hell. I experienced major dizziness, being like off balance, nausea, vomiting, diarrhea, being light headed, major tingling and vibrating and numbness in my arms, hands, legs and feet, lack of energy. I coulldn't stand cause I would be sick and I was weak almost not able to move around. I forgot to add the major heart palpitations. fast regular fast regular... After a week I couldn't take it anymore and went back on the paxil at 20mg. a few weeks later I attempted to do it the right way and reduce the dosage slowly to 10mg and the 5mg. But I felt bad everytime I reduced. There's this high everytime for about two days and then it's hell. So I went back to 10mg and stayed at that for a few weeks. I didn't feel good but I wanted off so bad. So I managed to regulate my system at 10mg. Wow. I took it for about 15days after that then reduced it to 5mg for a week and then a few days of every other day. Today I did not take the 5mg and all the withdrawal symptoms came back. I'm so upset. But I'm also determined to get off. I'm taking my last 5mg tomorrow. My doctor said that the withdrawal symptoms would last about 2 weeks and fade away. He said that the symptoms were well documented. Yah right, WHERE? I can someone have access to this info before taking the medication in the first place. I'm pretty frustrated by my experience and the lack of knowledge of the doctors regarding paxil. It almost feels like were rats. Well I'll let you know if I last and how long it took for the syptoms to go away . (if I succeed) Good luck to all of you out there. We'll find what works.

-- submitted by cveer, 27

"I have been having panic attacks since I was 14 or 15."

I have been having panic attacks since I was 14 or 15. Finally, I went to a doctor a year ago and he diagnosed me with social phobia/generalized anxiety disorder. I waited a year to see another doctor. That was Thursday. It's Saturday now. I was prescribed paxil, without knowing anything about it, except the doctor said "it can be weird at first, but stick with it". I am very grateful for this website, because, after only taking it for 2 days, I am not going to take it again, I don't think. I hate it. I feel very weird. I was usually awkward around people, but know I am paranoid. I feel like I am floating. I feel either apathetic or emotional. I can't even listen to music I usually like. I woke up the first morning and looked in the mirror. My pupils were huge and I felt like I was looking at someone else. My jaw started shaking and chattering. This is unlike me. I am only awkward in social situations. I was in my own bathroom and felt very, very strange. I started crying, thinking "this is not me..." Do NOT listen to people who try and say that your withdrawal is because you are "so depressed". Get real, it is no coincidence that so many people experience weird feelings, immediately after they quit. That is weird and messed up. I think all of these new "cures" for depression and anxiety and all, are weird as hell. I have also noticed that doctors do not take people with mental ilness very seriously. For example, one of my first concerns was "Don't even mention Prozac, because I know a girl who took it and and it made her really weird. She was bipolar and she said she felt better when she forgot to take it." The doctor laughed and said "Ha, well, most bipolar people do feel better when they don't take their medicine". He kind of chuckled again. I was thinking, this is my friend, that was rude. Do not let some doctor tell you why you feel the way you do. They might have more insight than you do into the brain, but you know how you feel. They don't. Anyway, thanks a lot for the information. I was looking earlier, and all I saw was : "May cause drowsiness, constipation, decreased sex drive". I wanted to hear something real. They forget to mention that the drug makes you feel insane. Another good example of the weirdness - I am a cashier, and last night when i was working, I became totally paranoid. I thought everyone was laughing at me, and that they knew I was on Paxil. Weird, huh? Oh, finally, I find it impossible to study like this (the major reason I'm not taking it anymore).

-- submitted by page, 20

"I was prescribed paxil for panic disorder related to post traumatic disorder."

I was prescribed paxil for panic disorder related to post traumatic disorder. I was on 40mg of Paxil for one year. I decided to go off the medication because I believe it was making me lethargic and lazy. I also believed that it was causing more anxiety accompanied with heart palpitations. I began reducing the dose by 1mg weekly. I have been off the medication totally for three weeks. I continue to experience withdrawal symptoms which include: dizziness, anxiety, head and facial "jolts". I have also been very emotional. I am easily angered which is not in my character. I wish I could rid myself of these irritating withdrawal symptoms.

-- submitted by monkeyboyt, 29

"I was put on Paxil for a panic disorder"

I was put on Paxil for a panic disorder and I have to say it did work well for that. While on Paxil I put on 50 pounds and was tired all of the time. After being on it for 15 months I started to have flu like symptoms, severe joint pain, night sweats and zaps. My doctor ran numerous tests to find out the source and never came up with anything. I started looking on the internet and that was were I found out that it was probably this medication giving me all these problems. My doctor started weaning me off of Paxil last Sept. and was finally off completely in the middle of November. Even though I was down to only 5 mg. at that time the withdrawals were horrible. The first two weeks were the worse with all of the above symptoms I mentioned only magnified much worse and also severe depression which I had never experienced. It has now been about 12 weeks being off of Paxil and it is much better but I am still suffering from some joint pain but nothing like what it was. I have only taken off 10 pounds so far and I am still tired a lot.

-- submitted by Linda, 51

Healing Panic: Chapter Four: Beginning Your Eight Week Recovery Program

Fou are ready to begin practice breathing in such a way that you will no longer be subject to panic attacks. These same exercises will help you control your tendency to hyperventilate in trigger situations, such as driving, that have brought on panic
attacks before.

This series of exercises is designed to help you quickly gain control of panic symptoms and attacks; to remain in control; and if needed, to help you overcome the residual fears some people have after they gain control of their hyperventilation and panic.

Phase One: GAINING CONTROL

GOAL: Learning deep, relaxed diaphragmatic breathing.

You do this by:

• Learning to switch from upper-chest to diaphragmatic breathing
  
  
• Practice slower, deeper breathing.
  
  
• Increasing your breath volume by practicing with a volumetric exerciser.
  
  
• Cut back on tranquilizing medications as soon as you see progress.
  
  
• Practice neutralizing anxiety-producing thoughts.
  

Once you have gained control, staying in control becomes the focus. This takes some further awareness and practice.

Phase Two: STAYING IN CONTROL

GOAL: Make relaxed, diaphragmatic breathing a part of everyday life.

You do this by:

• Using Reminders during the day to breathe using the diaphragm.
  
  
• Continuing diaphragmatic breathing under stress conditions.
  
  
• Reconnecting breathing with talking and moving.
  
  
• Learning to relax using diaphragmatic breathing, relaxation tape and hand warming.
  
  
• Learning to detect early warning signs
  

As you go through the exercises you will note that there is an overlap between Phase One and Phase Two exercises. Many Phase One exercises are used for the entire eight weeks of practice. Using the volumetric exerciser for more than six weeks, for instance, helps you achieve complete recovery from panic attacks.

Using the Daily Logsheets

As you get into the training you will see that more than one thing is being taught and learned at one time. The logsheets help you keep doing one exercise long enough, drop those exercises that have accomplished their purpose, and start a new phase. By keeping a written record, you can go back through the daily logsheets and see your progress. This is self-validating and provides you with an added measure of confidence.

You will notice that when something is added to the exercises, a + symbol is used to call your attention to the new material.

You have been given daily logsheets for eight Weeks and instructions of how to proceed from the Ninth Week onward. Each Week begins with goals and special instructions for that Week. Many weekly sections are preceded by additional information about the exercises you will be doing that Week. The reading and exercises appear in the order you will be using them. If you want to clarify something, you can go back and reread the information.

You may find that the pace of treatment is too fast. There is no harm, and definite
benefits, in repeating one or more of the Days or Weeks as you go along. How long you continue practicing the various exercises is up to you, but keep in mind that you don't have to achieve perfect mastery before moving on. Some of the exercises may not seem necessary to you. Try them first, then decide whether or not to continue using them. Don't give up if they are too hard; persistence pays off. Only stop if the exercises become too easy!

If you suffer from Panic Disorder without Agoraphobia, you may need only eight to ten
weeks of practice. Some people respond very quickly to this treatment. For people who have suffered for many years and have, through necessity, developed many compensatory strategies to try and avoid panic attacks, eight to ten weeks is a minimum course for learning skills. These skills will provide a good start on the road of recovery.

USING THE GRAPHS IN THE DAILY LOGSHEETS

The graph at the top of each logsheet is where you record the intensity of your symptoms, and this is where you can go back to see your progress. It is important that you fill in the graph at least once a day, as this helps you identify when your symptoms are most intense and any suspected causes of your symptoms. The grids for your charting are labeled by time of day (X axis) and severity of symptoms (Y axis). The severity scale is None (no symptoms), Mild, Moderate, Severe, and Panic Fear. Record the intensity of any type of panic or hyperventilation symptom as Mild, Moderate, or Severe. Symptoms can include trembling, dizziness, chest pains, or abdominal upset. Use "Panic Fear" when you experienced an attack during which you felt like you were being suffocated and could not breathe for a period of time.

This is an idea of how the graph might look after you have marked it to record your
symptoms.

Record the Intensity of Your Symptoms Each Day

SYMPTOMS	4am	6am	8am	10a	12N	2pm	4pm	6pm	8pm	10p	12M	2am
PanicFear
Severe								X
Moderate					X				X
Mild			X	X		X	X			X	X
None	X	X										X

By marking X's in the squares, you can keep a day-to-day record of your improvement.
Also, if the graphs indicate that your symptoms are habitually more severe at certain
times of the day, these are the times to watch your breathing, reduce stress, or make sure your blood sugar doesn't get too low. You may also want to consider changing the time you take a medication.

RECORD ANXIETY MEDICATIONS

The record of medications is another way you can see progress. As your symptoms are
alleviated you will feel less need for medication, take it less often, and probably stop it altogether.

If you are taking one of the benzodiazepine medications (Xanax, Valium, Atavan, and
Klonopin are the most commonly used) or buspirone (BuSpar), it is important that you
get your doctor's help in tapering off and withdrawing as soon as you are able. Starting to cut back during the first week of breathing practice is not too soon, but you may have to take more time to develop confidence in your ability to control the attacks by yourself. Do not stop taking these medications abruptly, as this can lead to extreme anxiety and provoke intense panic attacks or seizures. These medications get in the way of learning and remembering, to a much greater degree than is generally appreciated. Treatment failure for panic disorder is associated with continued use of these types of drugs. This is true even if you are taking benzodiazepine medications on only an "as needed" basis.

Choose whether you want to record each time you take a medication or simply record
your daily intake. In the case of benzodiazepine medications, it is not recommended that you space out your medications, as your body has grown accustomed to having the drug at certain times. Rather, you should taper off by cutting back on the amount you take each time (generally three or four times per day).

The following table shows an example of how you might want to take as long as 8 weeks
to taper off of alprazolam (Xanax) as you do the exercises. This helps prevent rebound anxiety and withdrawal symptoms. Tell your doctor that this is how you want to go about it.

Example of Gradual Reduction of Alprazolam (Xanax) and Other Benzodiazepines

	First Dose (AM)	Second Dose (AM)	Third Dose (PM)	Fourth Dose (Bedtime)
1st Week	Usual dose	1/2 usual dose	Usual dose	Usual dose
2nd Week	Usual dose	1/2 usual dose	Usual dose	1/2 usual dose
3rd Week	Usual dose	1/2 usual dose	1/2 usual dose	1/2 usual dose
4th Week	1/2 usual dose	1/2 usual dose	1/2 usual dose	1/2 usual dose
5th Week	1/2 usual dose	1/4 usual dose	1/2 usual dose	1/4 usual dose
6th Week	1/4 usual dose	1/4 usual dose	1/4 usual dose	1/4 usual dose
7th Week	1/4 usual dose	None	1/4 usual dose	None
From now on	None	None	None	None

Following the Exercise Directions

The program includes three types of exercises. First, there are those that you will do every Day throughout the 8-week training period. Next, there are "fall back" exercises that you will use if you experience symptoms of hyperventilation. Finally, there are those that you will do while you are in a particular phase of your training. The training logsheets are designed to remind you of all three types of exercises.

Meanwhile, you need to be aware of some general directions before you actually begin.

Practice when you are feeling at your best.

Especially in the beginning, your best may not be very good, but that's O.K. The point is that in the beginning this is practice for gaining control soon. Don't try to control panic attack symptoms right from the beginning; at first you are learning to catch the ball, not play baseball.

Stop practicing if you experience hyperventilation symptoms.

If you start to have symptoms during any exercise, stop doing the exercise. Use the "fall back" exercises to regain immediate control so that your symptoms don't escalate and get out of control. Get your mind off your breathing and come back to it later in the day.

This is so important! If you are phobic about other things and you allow symptoms to
build during breathing exercises, you'll soon be phobic about the exercises and not want to do them. That would be one more failure, and you and I want these exercises to be a success.

Build your strength gradually.

It's better to work with the exercises for just a few minutes when you begin and then increase your duration later as you develop more tolerance. When working with your breathing, always stay within the comfort zone. The comfort zone will expand as you practice. Just like with an exercise program, it may be a week or two before you notice improvement. Consider the first week or two an investment; don't give up the program without making an honest effort.

Give yourself some room to make mistakes.

In your trying, you may try too hard or may fail to follow the directions as given. You might provoke some symptoms or slow down your progress. Most people make some mistakes when they begin these exercises, because they are learning something that seems strange and unfamiliar.

Eat an adequate breakfast and a snack before you go to bed.


Many people who suffer from panic disorder seem to be prone to low blood sugar or tolerate it less well. This is stressful to the body and can cause hyperventilation. An adequate breakfast with protein, and a snack at bedtime that includes complex carbohydrates and protein will help level out your blood sugar between meals.

You do not have to do the exercises perfectly in order to feel that you can control hyperventilation symptoms or panic attacks. All you have to accomplish to get control is mostly breathe diaphragmatically and slowly when you are thinking about it. It's a downhill battle from there!

Plan for First Week

• Make an appointment with your doctor to discuss any antipanic, antianxiety, and
  antidepressant medications you are taking. Make a plan with your doctor to withdraw
  from the antipanic and antianxiety medications.

  
  
  

• Each morning before getting out of bed, practice three slow, diaphragmatic breaths. Continue to be aware of your breathing and breathe slowly as you get out of bed.

  
  
  

• Use the daily logsheets, which will help you to switch from upper chest to
  diaphragmatic breathing.
  

GENERAL INSTRUCTIONS

• Always wear loose clothing during the exercises
  
  
• Starting to learn diaphragmatic breathing the first week is easier if you are lying down. Lie on the floor (or bed if it's firm). If you use the floor, use a carpeted surface or get a pad. A bed sheet over the carpet is a good idea.
  
  
• The volume of breath to be taken in for an exercise is either seventy percent
  [70%] or one hundred percent [100%] of maximum. In the beginning you will have to estimate how much this is. If you experience symptoms, reduce the volume of the inhale and exhale more slowly.
  
  
• Unless you have a nasal obstruction, keep your mouth closed and breathe through your nose. If you have a nasal obstruction, breathe through pursed lips.
  
  

CAUTIONS

Be aware of the most common hyperventilation symptoms (especially dizziness). If you experience the symptoms, use the pursed-lips breathing technique explained below to increase the carbon dioxide level in your bloodstream.

Re-breathe air from a paper bag (instructions appear below) only if overwhelmed. Don't become dependent on this technique.

When beginning to use the diaphragm for breathing again, some people experience a fluttering or shaky sensation in their abdomen. If you experience this symptom, use the pursed-lips breathing technique.

Pursed-Lips Breathing Technique

Many people will experience hyperventilation symptoms when checking their breathing or beginning breathing exercises. If this happens to you, discontinue the exercise you are doing. Breathe in slowly and hold it for as long as 20 seconds if you can. Then breathe out slowly by pursing your lips, as if gently blowing out a candle. After only two or three breaths, you should no longer feel dizzy. Then, exercise a little by walking around as you maintain awareness of slow breathing. Come back later and complete the breathing check or exercise.

Instructions for Re-breathing Air from a Paper Bag


If at any time your symptoms escalate and you begin to feel out of control, breathe into a medium-sized paper bag and re-breathe the same air for a few minutes. This will help you replace the carbon dioxide your system has lost from over-breathing. This is a common "fix," but does not help you gain control of your breathing over the long run. Whenever you can, use pursed-lips breathing or the slow exhalation count, which do help you learn to gain control.

Instructions for Slow Exhalation Count beginning on Day Five

Step One

Make yourself comfortable in a recliner or on a couch, where you can lay back but still have your head and upper body raised up a little. Use the sweep second hand of a watch or other timer that shows you the time in seconds to help you gain control of your breathing.

Watching the second hand, gradually slow your breathing to 3 seconds for each inhale and 3 seconds for each exhale. Breathe with your diaphragm as you have been practicing. At this point in the exercise you may be inhaling only 30% of your maximum capacity.

Be sure to exhale completely by squeezing in the muscles of your abdomen at the end of the exhale. As you relax, extend the length of time for each inhale and each exhale to 4 seconds, then to 5 seconds. As you extend the time of each inhale and exhale you will need to take in more air with each breath. Keep at it until you notice that you have more control over your breathing.

Step Two:

Once you feel more in control and relaxed, you can progress to practicing deeper breathing by taking in the deepest possible diaphragmatic breath, pausing for a few seconds at the top of the breath, and then breathing out slowly and counting the seconds in a whisper until you have squeezed out all the air you can. So it's:

1. BREATHE IN SLOW DEEP DIAPHRAGMATIC BREATH [70% to 100%].
   
2. P A U S E;
   
3. BREATHE OUT (Counting) ONE, TWO, THREE, FOUR, FIVE, SIX, SEVEN; etc.

Give yourself a rest of a few normal breaths before you try it again. Then, when you are ready, take another deep, relaxed, diaphragmatic breath and count out to a higher number if possible. You will find that the more relaxed you are, the deeper the inhale and the higher the exhale count.

The idea is to gradually increase the time you take to exhale without getting too much or too little air. This means always staying in your comfort zone. As you work with the timer and the slow exhalation count, you should start feeling a lot more relaxed. These are good exercises to do in the evening before you go to bed, as they help you become relaxed and able to sleep well once you are under the covers.

Medications


Working with your doctor is important, because your need for many types of medications will change as you practice diaphragmatic breathing and your overall breathing becomes more functional. If you are diabetic and take insulin, and if your doctor has approved slow breathing exercises, your need for insulin may change; you may need less than you did before. As you overcome panic attacks, your need for antidepressant medications may also change, or you may no longer require them. Only a medical doctor or psychiatrist in consultation with you is qualified to determine your needs.

As mentioned before, many antianxiety and antipanic medications are known or suspected to cause treatment failures. If you have taken some of these drugs for many months or years, the prospect of withdrawing can be uncomfortable. Taking this type of medication on an "as needed" basis is not recommended. Be willing to put up with some discomfort and to use the breathing exercises you will be learning to control anxious feelings. You should not stop any drug on your own; in some cases doing so can even be dangerous.

Verbal Reward

Give yourself an automatic verbal reward every time you do an exercise. This is important even if you do not feel totally successful. Positive thoughts relax your mind and body and lower anxiety. Even doing an exercise in such a way that you induce some symptoms is a positive learning experience. Such self-talk as "Wow, I did it!" or "That's O.K., I know I'm just learning" sets you up to continue your improvement the next time you practice.


-- Bert A., M.Div., Ph.D.

Healing Panic: Chapter Three: Breathe In - Breathe Out

"Breathe in, breathe out!" I first heard this as a young man, from an old doctor who liked to relax his patients with corny jokes while he prepared an injection. "Do you want to know how to live forever?" he asked. "Sure," I naively took the bait. "Breathe in, breathe out," he said. "As long as you keep breathing in and out you can't die."

Some thirty years later I heard the same words again from another doctor, a Ph.D., who is in the forefront of developing a learning model for retraining people to breathe. The "diploma" which Dr. Erik Peper awards patients and professionals who attend his workshops in breathing bears the title "Breathe In, Breathe Out."

The sequence and types of exercises in the pages to come are the fruits of Erik Peper's many years of careful research. The specifics, however, are the product of my helping people who suffer from panic attacks.

"Breathe In, Breathe Out" Knowing How We Breathe
The old doctor's joke isn't so silly, because it implies that we have control over our own breathing, unlike involuntary actions such as our heartbeat. It's easy to take a breath when we want to, or to blow out the birthday candles just when we're ready; we very consciously take a deep breath and blow hard. Most of the time, though, our breathing is on automatic and we don't think about it.

We humans have some breathing problems, probably because of this part-time conscious control over our breathing. We can easily learn to adjust or modify our breathing, just as singers, actors, and instrument players do. The problems come when we learn the wrong things, which don't have bad effects immediately but eventually become bad habits that create the symptoms of anxiety.

So now it's time to take a close look, from an anatomical standpoint, at how breathing is "supposed" to be done.

The Anatomy of Normal Breathing
The lungs are a complex maze of air passages and minute air sacs (alveoli), with an even more complex mesh of arteries, capillaries, and veins intertwining through the air passages and sacs. For our purposes, though, the lungs (there are two, one on each side of the chest) can be thought of as balloons. The balloons are emptied and filled not in response to their own actions, but in response to the actions of the entire torso, which encloses the lungs.

Breathing takes place through the air passages leading from the nose and mouth into the lungs. Although the bronchial tubes and lungs are lined with smooth muscles that regulate the flow of air, these are not the muscles with which we breathe.

The chest and ribs, which are attached to the spine in the back and the breastbone in the front, form a somewhat flexible cage enclosing the heart and lungs. The chest cage is narrower at the top, which has an opening occupied by the neck.
Looking at the illustration, turn your attention to the wide bottom of the rib cage. The bottom ribs are not connected to the rigid breastbone, but are held together by pliable cartilage. Attached to the bottom edges of the wide cage, from front to back, is a muscle called the diaphragm. The diaphragm is shaped like an inverted bowl or funnel. Through the middle of the bowl (or neck of the funnel) run the arteries and veins that carry blood from the heart, to the organs and lower extremities, and back to the heart. The esophagus runs through the same area on its way to the stomach, and major nerves run through here as well.

The diaphragm should be the main muscle of breathing, because its location in the body gives it the most room to move in a piston-like fashion. Below it are the soft organs and the belly, which can expand outward when a deep breath is needed. Above the diaphragm are the lungs, which are also soft and pliable.

The easiest way to understand how the diaphragm works is to make a relaxed, inverted bowl, with the tips of your fingers just interlocking.

With your fingers still interconnected, tense your hands and wrists, and, if you're doing it right, you'll see the bowl flatten down. That's almost exactly how the diaphragm works.

When it's relaxed, the bowl is most bowl-like (deepest). In terms of the piston illustration, the piston is up when the diaphragm is relaxed. At this position, the diaphragm is pushing up on the soft and pliable lungs, and the air in the lungs is forced out -- exhaled. If you pull in your abdomen at the same time you push up on the underside of the diaphragm, you force out even more air.
The inhale, of course, is the opposite. The diaphragm contracts, just as your fingers flatten out. That brings the piston down, creating more space in the cage. Air, naturally, is the only thing that can fill the space, so it moves into the lungs, filling them.

Other parts of the body also assist in breathing. If you tighten and pull in your stomach, you push more air out of your lungs, because you put pressure on the underside of the diaphragm-piston. If you let your stomach pooch out, the diaphragm has more room to move down into the area of the soft organs and you take in more air.

But the muscles between the ribs all up and down the chest, especially those between the more flexible lower ribs, can also work to make the rib cage bigger. Air comes in, again because there is more space to fill. Even the muscles of the neck, shoulders, and upper back assist in the breathing process.

When you're running hard or doing aerobic exercises, the idea is to breathe hard -- to inhale and exhale a lot of air. The more air the body needs, the more of the various breathing muscles go into action to create additional space for breathing.

When breathing is done correctly, the volume of the lungs is quite phenomenal. The diaphragm can move up and down as much as six inches. In the process, it gently massages the lower organs and aids in the blood's return to the heart. A large person can have a lung capacity of five quarts. Even a small adult can breathe in two or more quarts of air.

Habitual Diaphragmatic Breathing
When at rest, the correct way to breathe is with relaxed shoulders, upper chest, and stomach muscles, allowing the diaphragm and lower rib muscles to carry on the automatic breathing process. When you breathe in this way, your body continually adjusts the volume and breathing rate as needed to maintain the acid/base balance of the blood and other factors. Eight to twelves breaths per minute is normal breathing rate.

Habitual Thoracic (Chest) Breathing
Many, and that may mean most, people breathe in a slightly abnormal fashion. They tend to hold in their stomach, make little use of the diaphragm, and breathe using the muscles of the upper chest, neck, and shoulders. This style of breathing becomes automatic, and the body adjusts volume and rate as it does in diaphragmatic breathing.

Thoracic breathing depends on the more rigid system of muscle action in the neck, chest, and shoulder area. This means that the lungs are given less room to expand or contract and that the body must work harder. As breath volume is lowered, breathing must be speeded up in order for the body to maintain its chemical balance.

My own observations of the breathing of panic attack patients confirm what other researchers have discovered: people who have panic attacks chest-breathe. Their resting breathing rate has speeded up to twenty to thirty shallow breaths per minute. They also try to compensate by sighing frequently, sometimes as often as two or three times a minute, adding significantly to the loss of carbon-dioxide. Sighing is likely the result of the small air sacs' failure to expand, and the sigh allows enough air deeper into the lungs so as to keep the sacs and airways open. When sighing or taking a deep breath, the chest-breather visibly lifts the entire chest up away from the diaphragm, thereby creating more space in the chest cage, rather than allowing the diaphragm to pull the air in.

How Breathing Changes When You Become Anxious
So far we have discussed functional and dysfunctional breathing. Relaxed abdominal breathing is better. Tight thoracic breathing isn't as good and may lead to problems. Now, how did it get that way?

When a person becomes anxious, sad, scared, aroused, or angry, the body immediately begins to go through changes in order to cope with the new situation. Of course, we needn't concentrate only on the negative emotions; changes also occur when we are delighted, loving, excited, joyful, playful, and full of laughter. We increase the amount of air we breathe, by breathing faster and deeper. Our heart quickens its pace, more blood flows through the arteries and veins, our senses become more acute, we become more alert.

Human beings are capable of a great range of emotions and physical responses. We can be placid like the waters of a gentle pond, or raging like the ocean in a fierce storm. The change from placid to raging can happen in the twinkling of an eye. It's all part of being human, even necessary to being human. Problems arise when the emotional and physical responses can't be played out, when the storm has to be held inside, not unleashed in some civilized or uncivilized way.

It is the connection between emotions and physical responses that concerns us when we think about panic attacks. Recently I was watching a person whose breathing was being monitored as he was pretending to be angry with someone else. As soon as he began to work up some pretend-anger his breathing changed as if he were actually angry. His breathing became faster and deeper, and the carbon dioxide level of his body, as monitored in his breath, began to drop. I noticed something else: as this was happening, he didn't breathe out in the same way as when he had been relaxing a few moments before. As a result, he retained more air in his lungs each time he exhaled. His deeper and more rapid breathing was actually on top of the air remaining in his lungs. It was as if his body were trying to hold on to the carbon dioxide by preventing him from exhaling too much!

Actual experiments have shown that just imagining a stressful event will cause a person to breathe faster and retain many times more air in the lungs than when relaxed and unstressed. You can well imagine that if you've had panic attacks, just the thought of another attack can be enough to change your breathing and start you on the road to another attack, without you even being aware of it.

As you begin to check out your own breathing pattern and train yourself in more relaxed and functional breathing, remember how your thoughts and emotions can work for you or against you. Keep a positive attitude.

For many victims of panic disorder, thoughts, fears, and physical reactions become automatic and create a great deal of anxiety. There are proven methods for countering or neutralizing these thoughts and reactions, and these methods need to be part of every course of treatment. These will be found in the exercises you will be doing. Retraining your breathing and knowing positively that you can prevent attacks is essential to success in your recovery from panic disorder.


-- Bert A., M.Div., Ph.D.

Healing Panic: Chapter Two: Panic and Hyperventilation Syndrome

For more than 25 years, I have been counseling people with emotional problems.
Like most of my colleagues, for many of those years I was confounded by the problems of people who sought out my help for their panic and the numerous fears and other problems that accompany this condition.

A lecture I attended some years ago in order to learn some more about these attacks was of little value. The psychiatrist who presented it began by asking how many in the audience had ever experienced a panic attack. A scattering of hands went up. He said that he also had suffered from these attacks. But at the end of the lecture, when asked to pinpoint the actual cause of the attacks, he did not have a ready answer.

Medical treatment for panic usually consists mostly of anti-anxiety or anti- depressant medication and advice to watch stress. Even if the doctor understands that hyperventilation can lead to panic, he will likely do little more than recommend breathing into a paper bag for a few minutes to help re-establish the level of carbon dioxide in the bloodstream.

John

John came to me to get help with intense anxiety. As a manager, he often had to make presentations. When he was called on to lead a meeting or talk to groups, he would become so panicked that he was considering quitting his job just to avoid being put in this position. After John left my office, I reached for a new book that had just arrived in the mail. I began to read the chapter by Dr. Ronald Ley entitled "Panic Disorder, a Hyperventilation Explanation." I was fascinated. In it, Dr. Ley described John's situation exactly.

Ley did not "discover" hyperventilation. As his extensive bibliography showed, that had been documented about a century earlier. But it wasn't until 1975, in an article entitled "Hyperventilation, The Tip and the Iceberg," that Dr. C. M. Lum concluded that "faulty breathing" is the real root cause of hyperventilation and panic, perhaps along with being a perfectionist if you were a woman or a "Type A" if a man. By 1985, over 2,000 patients had been admitted into his program at Papworth and Addenbrook's Hospitals in Cambridge, England. Most of these patients were not only helped but cured.

Not all doctors agree with Dr. Lum's conclusions, but more and more scientists regard hyperventilation as the key to understanding panic.

Traci

Late one day a frantic mother called me about her daughter, who had been having panic attacks since morning. She had gone into convulsions, the mother told me, but they were afraid of going to the emergency room of the local hospital, where Traci had already been more than once. A few weeks before, she had been so agitated that she had to be injected with a powerful tranquilizer before she was able to calm down. She was told that unless she was able to get control of herself the sheriff would be called, and she would be taken to the psychiatric ward of the County Hospital.

When they arrived at my office, Traci was gasping for air. She could hardly walk, and the muscles in her face were twitching. Her eyes were glazed over from fear and exhaustion, and her pupils were dilated. She was unable to concentrate on anything for more than a few seconds. What she needed was to gain control of her breathing. Little by little, I helped her slow down and deepen her breathing. After an hour, she was weak but calm. She had gained moderate control. The panic had passed.

People experiencing a panic attack usually have difficulty breathing, a difficulty commonly thought to be caused by the attack, and one of the many recognized symptoms. But panic attacks are actually brought on by the way a person habitually breathes. That is, the breathlessness and gasping experienced during an attack is an extension of a problem that began before the first attack, sometimes long before.

When Traci began her training in controlling the attacks, I could not see her breathe at all. Only when I attached a sensor around her abdomen and others on her neck and shoulders, all connected to a computer, could I see her breathe, by watching the screen. Her breathing was shallow, rapid, erratic, and she was using only the muscles in her neck and upper chest. Her abdomen wasn't moving at all. She was breathing at a rate of 22 breaths per minute, about twice what is considered normal.

How Hyperventilation Leads To Panic

Like other victims of panic attacks, Traci showed all the characteristics of hyperventilation syndrome recognized by C.M. Lum:

• She took air into her lungs by using her chest muscles.
  
  
• She didn't use her diaphragm when breathing, or only partly used it.
  
  
• She breathed rapidly and shallowly, so it was hard to see her breathe unless she sighed, or took a deep breath on request.
  
  
• Habitual rapid, shallow breathing (something of which the victim is unaware) results in breathing out more carbon dioxide than the body produces, keeping the carbon dioxide level always too low.
  

Over-breathing, or breathing in and out more air than is needed with each breath, creates the same imbalance. This is a more recently recognized cause of hyperventilation and panic attacks in some people.

A case in point is a person who works out at the gym or exercises regularly and whose breathing is unrestricted. The problem is the opposite of what Lum found, but the result is the same. Here it is "habitual deep breathing" that results in breathing out more carbon dioxide than the body is producing.

Without enough carbon dioxide to maintain the acid/base balance of the body, the blood becomes too alkaline, a condition known as "blood alkalosis." Alkalosis causes the arteries to constrict, with the result that blood flow is restricted, especially to the brain. Although the blood contains plenty of oxygen, alkalosis also prevents the essential transfer of oxygen from the blood to the brain, muscles, and organs, as has been frequently verified in panic attack victims who have gone to the emergency room. This is known as the "Bohr Effect" and has long been recognized by those who study hyperventilation.

Under these circumstances, the oxygen available to the brain is reduced drastically. At first vision begins to blur. The typical sufferer reports feeling dizzy, tense, anxious, jittery, and nervous. The sufferer often feels like crying, and feels weak and confused. Starved for oxygen, the sufferer feels as if suffocating. As the condition worsens, the brain gets more confused and sends the wrong messages. One wrong message is the need to breathe even more deeply, which worsens the problem.

The heart is pounding by now, increasing (or lowering) blood pressure, sometimes to the point of causing the person to faint. Pupils dilate, the face, hands, and feet become cold or numb, the hands tremble, and the sufferer sweats. Chest pain may be present. This is usually related to chest breathing and muscle spasms in the chest wall, but in some cases may be actual heart pain.

In brief, when blood alkalosis gets serious, the sufferer is going to experience that a great deal is wrong, even life-threatening.

Maureen

Maureen had been having severe panic attacks for only a few months when she sought treatment. Carrying on the normal activities of her life was becoming difficult, even with anti-anxiety medication. When she filled out the questionnaire I gave her, she checked off all of the statements about breathing: shallow breathing, rapid breathing, breathlessness, trouble catching her breath. She had trouble sleeping, often waking up in the middle of the night and unable to go back to sleep. She had headaches from the tension she carried in her neck and shoulders. Altogether, Maureen was a classic case of advanced hyperventilation syndrome.

Maureen's breathing was very erratic. I had difficulty helping her relax and slow down her breathing. Then, while being monitored for chest and abdominal breathing, Maureen had a panic attack. She had been working on relaxing her neck and shoulders and was making progress. Sometimes when a person relaxes it will bring on an attack, because less carbon dioxide is being produced as metabolism slows.

When this happened, Maureen became apprehensive and began to breathe more deeply. As she felt increasingly short of breath, she began to use her chest, neck, and shoulders as much as she could, causing extreme tension.

For about three minutes she was almost unable to breathe. This is the most frightening part of panic. Then she began to breathe out, but still with some difficulty. As she caught her breathe again at the end of the episode she was able to relax the tension from her neck and shoulders. It was a frightening experience and left her shaky, but at least able to breathe again.

Staying Alive

A careful study of the chart made during Maureen's panic attack showed why she was unable to breathe. As her fear mounted she was not breathing out all the way. With each gasp for air she retained more air in her lungs, unable to breathe it out. At the height of the attack she could simply breathe in no more. Those frightening symptoms, however, are actually the body's way of staying alive. Before their appearance, Maureen had been breathing in such a way that she was exhaling too much carbon dioxide. If her nervous system had not detected what was wrong, she could have died. When she was prevented from breathing at the height of the attack,
it allowed her body to replace some of the carbon dioxide it had lost as she began to breathe harder. Although this was an agonizing experience, a semblance of balance was restored and life could go on.

Because we have for so long thought of panic attacks as an indication of a disease, we have failed to recognize that they prevent something far worse. Panic attacks are like the circuit breaker tripping to prevent a short in the wiring from burning
the house down.

The Habits of a Lifetime

Many panic attack victims are told by the emergency room doctor that they're just reacting to stress. Stress may be the most immediate cause, or trigger, for panic attacks, but many people cannot identify a unique stressor that preceded their first attack. John could identify that making a presentation in front of many people incited his attacks, but he had done this many times before without a problem. We have to assume, therefore, that John had an unrecognized problem that was building towards an attack. Hyperventilation was getting worse, but still did not induce symptoms until he had his first attack.

Bad breathing habits may begin for any number of reasons. Since flat tummy is part of our culture's idea of a good body image, people often learn to chest breathe in order to look trim and fit. Periods of grief, or anticipating harm over a period of time, can begin a pattern of shallow breathing that may later become serious enough to induce an attack.

The truth is that everyone hyperventilates to some degree on a regular basis. Being in a car going fast, being jammed into a crowded elevator, preparing for a dinner party, having a disagreement, going to the hospital, having blood drawn, being given an injection, reprimanding or protecting a child, being scolded, or going for a test where you might not know all the answers. Any or all of these can result in more rapid, shallow chest breathing. For most people, breathing returns to normal when the experience is over.

For people prone to panic attacks, the return to normal breathing and recovery from hyperventilation is delayed and usually insufficient.

The death of a spouse, divorce, loss of a job, being promoted, relocating, going off to college, retiring, buying a home, or starting a new career all can create a great amount of anxiety. None of us would be normal if we didn't hyperventilate while going through these experiences.

Whether stressful experiences will eventually result in panic attacks depends on whether the breathing pattern under stress becomes habitual. Some resilient folks seem to be able to go through many difficult circumstances and never have a panic attack. Yet, others who have difficulty identifying anything ever happening to them will suddenly be struck out of the blue.

The Triggers

Triggers depend on habitual and ongoing hyperventilation. John was habitually hyperventilating before he went to the meeting that triggered his attack. After repeated experiences, making a presentation or even thinking about standing in front of a group would trigger an attack. He started to anticipate the fear, and that made him more fearful.

When John noticed that he felt a little shaky, that his heart was beginning to pound, that his vision blurred, and that he began to sweat, he knew he was losing control. The resultant fear ensured that he would have an attack.

Because the physical symptoms are not actually dangerous, but only "feel" dangerous, there is no reason to fear them, and therefore no reason to panic. Many people have been helped simply by hearing this, but if they haven't solved the problem of habitual hyperventilation they keep on having physical symptoms, which frequently keep on getting worse. In some cases physical symptoms can trigger enough anxiety to cause panic. An example is a muscle spasm that feels like the pain of a heart attack.

Breaking the Habits

If you are reading this because you have experienced panic attacks, you probably already know what will trigger the physical symptoms that trigger an attack. Making a presentation, driving on the freeway, entering a market, going to church, being at work, exercising, excitement, relaxing, traveling. It's only logical that a person avoids trigger situations in order to avoid having panic attacks. The problem, of course, is that this limits your life to living only in the safety zone, places where you believe you are safe from attacks or can be quickly rescued by trusted family members.

The methods for overcoming panic attacks detailed in the coming chapters are based on observations, research, and clinical practice which have been carried out in hospitals, universities, and the practices of many disciplines.

Now that you know what is causing the symptoms you experience, it is time to examine how you breathe now, how you should breathe in order to prevent panic attacks, and what to do to train yourself to do exactly that.


-- Bert A., M.Div., Ph.D.

"I have now lived three years with social anxiety disorder and panic attacks."

First I have to say that I am not currently going through withdrawals and after reading this, I won't ever go through them because I won't start this terrible drug! About three years ago, I was given a three week sample of Paxil for what my "then" doctor prescribed as panic disorder. He told me that he would make sure that I got "my life back". I went to work that afternoon and started taking the drug. The very first day I felt worse than normal. I felt like I was floating and had tunnel vision. I also could not concentrate. I knew that this was not for me. I have now lived three years with social anxiety disorder and panic attacks. Going to the E.R. once with a panic attack. My job and family have suffered because of my "anti-social" behavior. But I am very blessed to have them constantly supporting me. Yesterday, I went to a new doctor, feeling like I just can't take this anymore. I am not depressed, but I want my life back. He gave me a three week sample of 10mg. a day of Paxil and told me to get back with him in two weeks. I thought maybe I was just being silly the last time, but before I took it, I wanted to see if there was anything on the Internet regarding Paxil. I am so thankful that I did! My heart goes out to each and every one of you. We are all fellow sufferers of anxiety or panic attacks, and it is really a crime what doctors are doing to us, or trying to do. I point blank asked my doctor if there would be any side effects and he answered "no". A good friend of mine suggested BuSpar for me, and I found nothing negative through the Internet regarding that drug. But I am so frightened now to take anything, that I guess I will continue fighting this anxiety battle on my own. I welcome anyone to write me with suggestions. I will pray for you all.

-- submitted by hrdfwsouth, 38

"I felt on paxil that I couldn't have a great orgasm or none at all"

Well I have just gone off paxil, I had been on it for 10 months for panic disorder. This is one full week without paxil and first attempt at going off of it, The only problem I experience is what people seem to be describing as brain shocks when ever I turn my head a certain way I feel very strange, like in my head, and nausea from time to time. I was on 20mg then 10 for three weeks and for the last week 10 every other day. I feel ok, for the most part except when I dropped down to 10 I was like whooooa, I had feelings again, I felt on paxil that I couldn't have a great orgasm or none at all, and I had no real emotion towards things, although it has helped me immensely, I have decided regardless of what withdrawal I feel, I am going drug free.

-- submitted by shelagh

Panic Attack Help: Eliminating Panic Attacks

We know what anxiety and panic are, we know what the sources of anxiety can be, and we know how to cope with Panic Attacks when they strike, but now we need to know how to eliminate them altogether. This chapter discusses my ideas on how to "squash the mosquito" and eliminate panic attacks.

To eliminate our panic attacks we had to find out what was causing them. Basically, the build up of adrenaline in our body that was not used to fight or flee a given situation or circumstance that was found to be the primary culprit. It is these fearful, worrisome, or stressful situations and circumstances (lifestyle) that we have to eliminate, take control of, or change to stop the adrenaline flow and thus stop our panic attacks. Sometimes though, it really is not the situation or circumstance that is causing the adrenaline flow but rather it is the way we think about or deal with (psychological) a situation or circumstance that is causing the adrenaline to flow and that is what must be changed or controlled in order to stop our panic attacks.

To help illustrate, think about the Chinese Finger Trap game. It is not really a "trap" until you get caught in it. If we decide to put our fingers in the trap and cannot get them out, then the trap becomes a trap. How could we stop the trap from becoming a trap? We could eliminate the trap altogether by not purchasing it or by getting rid of the trap. We could choose not to play the game. We could learn how to beat the trap so that we did not get caught in it. We could change our thinking about the trap and realize that it is just a game and react to it as such. Or, we could seek out the advice of someone who is an expert at beating the trap or who has beaten the trap themselves and ask for their expertise. All of these things could stop the trap from being a trap. Since Panic Attacks are themselves like a trap we can use similar Strategies to eliminate Panic Attacks from our lives. We can use one of the following Strategies:

PANIC ATTACK ELIMINATION STRATEGIES

STRATEGY 1) AVOID OR ELIMINATE THE SOURCE
*Get rid of trap sources
*Avoid known trap sources
*Take away the fuel and the fire cannot burn

STRATEGY 2) CONFRONT OR TACKLE THE SOURCE
*Learn how to beat the trap
*Only thing to fear is fear itself

STRATEGY 3) TRANSFORM OR CONTROL THE SOURCE
*Change the way we think about trap sources
*You cannot control a TV show so change the channel

STRATEGY 4) SEE A PROFESSIONAL
*Ask an expert on the trap for help and advice
(SEEK OUT PSYCHIATRIC HELP, MEDICAL HELP, OR COUNSELING etc...)

What we will do next is take our Anxiety Attack Sources Chart (5) and go through some examples from each source category and show you how to eliminate your panic sources by one of the 4 Strategies mentioned in this chapter. After a few examples you should see a pattern develop as to how to deal with your sources of panic, whether they are on the chart or not. You will have to ask of each source, is this something that I have to avoid or eliminate from my life? Is this something that I have to confront or deal with differently? Is this something that I have to change or take control of in my life? or is this something that is beyond my own capability that I need to seek professional help for? Once you have determined what your source(s) are and what course of action needs to be taken, then all you have to do is figure out the best way to carry out that action. Hopefully, by following the examples listed you will have a good idea as to
what to do in any situation that you may face.


I. DIET:

The first category on the Anxiety Sources Chart is Diet. The old saying "you are what you eat" certainly is true. What you eat can have a great effect on your body and mind. Certainly you would want to do whatever it takes to make sure you are eating a balanced diet. By eating right your brain will be able to function better and this will help you to handle life better. You will be able to handle stress better as well, and thus deal more effectively with potential Anxiety sources.


EXAMPLE A)

From your Anxiety Sources Worksheet and Chart 5 you have determined that a source of your panic attacks is from drinking to much caffeine. You believe that caffeine is causing your heart rate to increase. What should you do? The answer to this is simple, you would have to use Strategy 1 and eliminate the source. You could try drinking caffeine free soda or decaffeinated coffee. You could also read the labels on all of your food to make sure you are not consuming caffeine in your food. You will have a headache from the withdraw effects when you first stop drinking caffeine, but they will go away after awhile and so to will your panic attacks. Make sure that any medicine you take to alleviate your headaches does not have any caffeine in it. When I found that caffeine was a contributing factor to my panic attacks, I reduced the amount of caffeine in my diet and this greatly reduced the number and severity of my panic attacks. You can see how easy this Strategy was, so let us go on to another example.

EXAMPLE B)

Perhaps you have determined that you have an alcohol problem and that maybe this plays a major role in your panic attacks. Strategy 4 would definitely be recommended in this case. Alcohol is a very addictive drug that requires professional help to try and overcome if there is a serious problem. If you even suspect that you have a problem you should seek out help at once. Panic attacks are probably the least of your worries if alcohol is what you think is driving your attacks. So please use Strategy 4 and seek out professional help. This step may not be so easy, so you might want to have some friends and family help you with this difficult battle. Let us now continue to the next source category the JOB.


II. JOB:

The second category of sources listed on the Anxiety Sources Chart come from the job. One thing to remember about your job and life in general is that "success is a journey not a destination." So many people have anxieties over whether or not they are successful. Strategy 3 is in order here because the source of our anxiety is our own way of thinking, we need to transform our thinking to that of as long we do our best and never give up we are always successful. This is discussed in a little more detail in the PSYCHOLOGICAL section of this chapter.

EXAMPLE A)

What if you have determined from your Panic Sources Chart that you are overloaded with projects to do at work and you do not ever have enough time to complete these projects. This is causing you to be stressed and is contributing to your panic attacks. Well you could use a combination of Strategies to deal with this source of anxiety. If you are in a position to do so you might want to try Strategy 1 and delegate some of your projects to coworkers or you could have your boss help you out. By doing so you would eliminate some of your panic sources.

You could also use Strategy 2 and prioritize you projects. Daily prioritization of your projects is essential in tackling them in an organized and efficient way. Writing down in order of importance your projects allows you to see them and realize that they are not an insurmountable task. As you complete one project you cross it off the list and continue on to the next project. Before you know it the list will be complete. Sometimes it is a good idea to do an easy project first to get one out of the way quickly. When you see an early success, tackling the rest of your projects will seem much easier and more possible. Sometimes you cannot just eliminate a source of anxiety altogether, like school or your job so you have to use Strategy 2 and tackle or confront these sources head on one at a time. When you get control on these seemingly overwhelming projects you then change them from a source of anxiety into a source of self esteem and pride.

Sometimes though, prioritization is not enough. For example, where I worked the projects kept coming and the hours I spent trying to accomplish them got longer and longer. My boss did not seem to appreciate the work I was doing. My wife and child never saw me, so I worried about them. I couldn't pursue personal interests outside of work since all of my time and energy was spent at work. I did not eat right. Things just snowballed and were not getting any better. My panic attacks became more frequent as tension at my job and in my life grew. Fortunately, my company is a large one and this enabled me to make a drastic move in order to deal with my sources of anxiety. I used Strategy 1 to the extreme. After some serious consideration, by using Strategy 1 I single-handedly wiped out multiple sources of anxiety in my life. I did this by transferring to another job within the company. This job was less stressful, had straight hours, and was one that I knew I could be successful at. I took a small pay cut as well, but my health and family were worth the move. The end result was nothing less than spectacular. Since eliminating multiple sources of anxiety, I have not had a single panic attack. Strategy 1 truly worked for me. You may find that you have multiple sources of anxiety emanating from one place, such as your job. You may want to consider whether or not to make such a drastic change in your life in order to improve your health and life. The choice is yours but for me life without panic attacks has been like being set free from a trap. I now have a boss that appreciates the work I do, I have straight hours, I see a lot more of my family, I get to pursue personal interests outside of work, and I feel successful at work. The pay cut has not really had a great impact in my life since I have been prioritizing my expenses and sticking to a budget. All in all, my life is much happier because I made this move to eliminate multiple sources of anxiety in my life. I hope this can work this well for you too. Let us look at another example of Anxiety Sources from the job category.


EXAMPLE B)

What if you have determined that the source of your anxiety is coming from poor relationships with your coworkers. Perhaps someone you work with is very difficult to get along with and nothing that you do seems to help the matter. This is worrying you and is causing you undo stress. The coworker does a good job, but your personalities just clash. In this case you could try Strategy 1 (if it were bad enough) and transfer to another department. If this is not possible Strategy 2 might be viable. You could try and confront your coworker and talk about the specific problem you are having. Focus on the problem and on finding a positive resolution. The key is to confront the problem and not to attack the person. By focusing on the problem in a positive light you don't make the situation worse by insulting or offending the person. Still yet, another Strategy you may want to try is starting a daily exercise routine. This could help you to burn some the extra tension you have away and help you to cope with the situation better. When a source of panic cannot be eliminated the best way to burn of the excess adrenaline is to exercise. Hopefully you can burn enough of the adrenaline away in your exercise, that your panic attacks would stop.


III. SCHOOL:

EXAMPLE A)

Today more and more emphasis and pressure is placed on getting high grades in school and on going to college. There is a lot of competition on standardized tests and for scholarship dollars. You may have found that some of your stress and worry are coming from this area of your life. Maybe poor grades of you or your child have you worrying excessively or maybe you are worried about upcoming tests. In this case you would want to try Strategy 2. The reason most people do poorly in school is due to lack of preparation or study. So you would have to attack this problem up front. This requires some work. In order for you to gain control over your grades you will need to take time and study. To do this you will need to learn how to prioritize your time to allow for study. You can use my Daily Prioritization Chart Workbook included with this manual to help you. On the chart you would want to make study a high priority and things like social events and television a low priority. If you continue to have trouble studying and with your grades after trying this, you may have to use Strategy 4. This means you should see a professional counselor or tutor. Whatever the case you will have to get organized and have a plan of action so that you can get prepared enough to do your best in school. Then and only then will your anxieties be reduced about school. When you are prepared for school you know you are in control and that you can do well. You may not be a straight A student but doing your best is what counts. When you do your best all of your energies are expended on the task and the likelihood of a panic attack happening is reduced. Let us now go to the next anxiety source category-The Family.

IV. FAMILY:

EXAMPLE A)

There are a lot of problems in families these days and the divorce rate is higher than ever. Single parent families are almost the norm in today's society. Many have multiple family problems that create anxiety about the future that drives panic attacks. From your Anxiety Source Worksheet and Chart you have found that your child's rebellious attitude is a source of your anxiety. Many parents today are to busy and to ill-equipped to deal with problems of this type effectively. To challenge a rebellious child head-on is a delicate matter to say the least. My suggestion is for each parent to deduce what the best course of action is in their individual case. A little love does go a long way and that may be all that is needed, but Strategy 4 is probably the best solution. A family Counselor has seen this problem before and is an expert in dealing with this in the most successful way. By confronting the problem through a professional you may gain some control of the situation and thus reduce your anxieties about your child. This in turn should help you to eliminate you Panic Attacks.

EXAMPLE B)

From your Anxiety Source Worksheet and Chart you have ascertained that a major source of anxiety in your life came from worrying about money problems in the household. You find that you are living paycheck to paycheck and that you do not know how you are going to pay all of your bills. To try and eliminate this source of anxiety you can try several elimination Strategies. Using Strategy 1 you can try and design a budget that will prevent you from getting into a situation where money is an overwhelming concern. This however, may require Strategy 4, the help of a professional accountant or credit counseling agency. If you are already in a tight situation you can use these same Strategies to get you out of it. Using Strategy 2 you could attack the problem and set some financial goals. You would want to make your goals attainable and write them down. For instance, maybe you would want to make a goal of paying off your credit card in six months. To do this you could make a budget with goals attached to it. You would follow this budget until your card is paid off. Again if you are not certain about how to make a budget you could seek the advice of a professional credit counselor. Making a budget and setting goals should help you gain control of the problem and reduce your anxiety. I This can be compared to driving your car. When you are out for a pleasant drive you roll down your window and feel great because you are in control and are free. However, when you are driving and you are late for work and you are caught in construction, you lose control and get stressed out. You are no longer free and are at the mercy of other traffic. Then driving becomes a source of stress and anxiety. When we lose control of our money we get the same way. This then is a source of anxiety and can drive our panic attacks. By using Strategy 2 and making a budget and setting goals we get control back and money no longer is a source of anxiety. Sometimes though a budget is not enough. We may need extra income to make ends meet. Then maybe you need to look at getting another job or look at securing overtime to help get a control over your bills. You still need to use Strategy 2 and deduce what the best course of action is to attack the problem. You need to organize, prioritize, and set goals. Another good thing to do is use Strategy 3 in this situation. You have to remember that money does not solve problems. If you were to suddenly come into some money your money problems might be solved but your focus would shift to other problems in your life such as health and family. Sometimes you have to transform your way of thinking and have the ability to see things in a broader perspective in order to eliminate your anxieties. This is easier said than done though and brings us to the final Anxiety Source category- The Psychological category.


V. PSYCHOLOGICAL

From the Anxiety Sources Chart you have seen some similarities in the way you think to those that are mentioned on the chart. If you tend to think the same way of those areas mentioned on the chart you may be your own source of anxiety. All of these ways of thinking: All or nothing, negative, paranoid, exaggerating, and obsessive/compulsive make everyday normal events seem to you worse than they are and thus can make you more stressed, worried, and fearful than you should be about life. This in turn makes your body react more often in the form of panic and thus you may have more panic attacks. To overcome this is difficult because it is in fact who you are and how you have been brought up. The best thing you can do is try Strategy 3 and control your thinking by stepping outside of yourself and recognizing when you are potentially thinking in an extreme way and by curtailing it at that point. Again, this is easier said than done so you may decide that you need help and that you need to see a professional using Strategy 4. A professional Psychiatrist can help you to change your way of thinking and deal with life better. If you are experiencing any of these extreme ways of thinking a visit to the psychiatrist may be the best thing you can do. Panic attacks may be the least of your problems if there is an underlying mental problem that needs to be addressed.



ANXIETY/PANIC SOURCES WORKSHEET EXAMPLE ANXIETY WORKBOOK PROCESS

* NOTE THIS WAS IN THE ORIGINAL MANUAL. YOU CAN USE A DAILY LOG AND FIND YOUR PANIC TRIGGERS. THEN DETERMINE WHAT METHODS TO USE TO DEAL WITH THOSE TRIGGERS.


STEP 1) USE ANXIETY SOURCES WORKSHEETS (OR KEEP A DAILY LOG OF YOUR OWN AND DETERMINE YOUR SOURCES) UNTIL A PATTERN DEVELOPS


STEP 2) COMPARE PATTERNS TO ANXIETY SOURCES CHART AND SEE WHAT CATEGORY YOUR SOURCES FALL UNDER


STEP 3) REFER TO PANIC ATTACK COPING AND ELIMINATION GRID FOR SUGGESTED ACTION ( OR USE YOUR OWN COMMON SENSE TO DECIDE WHAT IS BEST FOR YOU)


STEP 4) LOG SUCCESSFUL Strategies ON YOUR PERSONAL PANIC ATTACK TRIED Strategies GRID (REMEMBER WHAT HAS WORKED IN THE PAST)


STEP5) USE SUCCESSFUL PANIC ATTACK COPING AND ELIMINATION Strategies OFF OF PERSONAL GRID (OR ONES THAT YOU HAVE LOGGED PERSONALLY)


MY WORKSHEET/DAILY LOG EXAMPLE:

WHAT DID YOU DRINK TODAY?
1) I HAD 4 COLAS

WHAT DID YOU EAT TODAY?
1) HAD A BANANA
2) HAD A BAG OF PRETZELS
3) PIZZA
4) LEFT OVER SPAGHETTI

WHAT STRESSES AT WORK ARE THERE TODAY?
1) MORE FLIGHTS CANCELED DUE TO WEATHER
2) PAPERWORK BACKED UP
3) WORKED 9 HOURS
4) BOSS MAD BECAUSE HIS COMPUTER IS BROKEN AND BLAMES ME

WHAT STRESSES IN SCHOOL ARE THERE TODAY?
1) NA

WHAT STRESSES ARE THERE IN THE FAMILY TODAY?
1) WIFE MAD AT ME BECAUSE OF WORKING LATE
2) CANNOT VISIT PARENTS THIS WEEKEND

HOW IS YOUR MONEY SITUATION TODAY?
1) ALL BILLS PAID

IS THERE ANYTHING ELSE WORRYING YOU TODAY?
1) DID NOT GET TO SEE FOOTBALL GAME BECAUSE OF WORKING LATE

ARE THERE ANY EXTREME THOUGHTS THAT YOU HAVE HAD TODAY?
NA


CROSS REFERENCE YOUR ANSWERS WITH PANIC ATTACK SOURCES CHART 5

ARE THERE ANY REPEATING STRESSES OR PATTERNS NOTED FROM PAST LISTS?
1) CAFFEINE
2) LONG HOURS AT WORK
3) OPERATIONAL PROBLEMS AT WORK AND BOSS UNHAPPY
4) POOR DIET
5) NOT SEEING FAMILY ENOUGH IS HURTING FAMILY

Panic Attack Help: Coping With Panic Attacks

Knowing what you are dealing with is a key that allows you to attack panic at its source. You don't have to just shoot in the dark at something you don't understand. That is why you can succeed at eliminating your panic attacks. But before you can eliminate your panic attacks you will have to learn how to cope with them. This chapter discusses some ideas I have on coping with panic attacks and describes some coping Strategies that I have tried. Hopefully, they can help you to cope with your panic attacks as well as they have for me.

Knowing that your panic attack is not a heart attack or something that is going to kill you is a comforting thought in itself. In fact it is the first step in coping with panic attacks. To illustrate this point think of your panic attacks as if they were the Chinese Finger Trap. This is a game that you may have played with when you were a kid. With this game you would stick one finger in each end of a paper woven tube. When you would pull your fingers apart the tube would tighten around your fingers and your fingers would be trapped in the tube. The harder you pulled the tighter the grip of the trap became on your fingers. The trick to the game, in order for you to get your fingers out of the trap, was to relax and push your finger(s) inwards, then the weave of the tube trap would relax and loosen. When the weave loosened you could then get your fingers freed from the trap. The key to getting your fingers out was to relax and work with the trap and not against it.

When a panic attack strikes it is much like the Chinese Finger Trap. The more you fight the panic the more it tightens it's grip on you. When you fight the panic you can work yourself up into a frenzy which only worsens the symptoms of the panic attack. When the symptoms intensify you get more worried about the attack. As you get more worried about the attack the symptoms intensify more. As the symptoms intensify more you tend to get more introverted and focus more and more on the attack. This makes the attack seem even worse and it's grip tightens on you. So what is the key? You have to learn to relax and not fight the panic attack. In fact, you must do the opposite and work with the attack just like you would work with the finger trap. You need to relax and ride the attack out like a surfer rides a wave out, using the wave's energy to propel him forward and not resisting it. By relaxing and riding with the attack and using it's energy it can go by much quicker and soon releases it's grip on you just like the finger trap does. All of this sounds good but it is easier said than done. However, it is not impossible to do and this chapter is going to show you how to cope with panic attacks in this manner.

Once a panic attack strikes the Strategy you choose to cope with it is up to you. There are many techniques commonly used to cope with panic attacks but the results are different for each individual that uses them. In other words what may work for me might not work for you. What this chapter will do is list some coping Strategies that have worked for me. Then you should use the most effective coping Strategy for you anytime a panic attack strikes. Some will work better than others depending on the circumstances.

The coping Strategies described next basically try to get you through the attack as quick as possible by relaxing you and/or by helping you to ride the attack out. This is accomplished by diverting your attention away from the attack and yourself. You are not going to be able to stop the attack once it starts because the adrenaline is already running its course. The best thing you can do is ride the attack out by using the Strategies in this chapter. These Strategies follow the same line of reasoning as Lamaze. Basically the idea is that one's mind can only receive one thought or feeling at a time and no more than that, thus if you can divert your mind away from thinking about the attack it can no longer perceive the attack symptoms. It is a lot like your telephone. The telephone can only receive one signal at a time. When someone else tries to call they get a busy signal. The theory is that if your mind is concentrating on one thing hard enough and constant enough, anything else that tries to get through will get a busy signal (unless you have call waiting..ha ha). An example of this would be when you are daydreaming. When you daydream your mind wonders off and is completely emerged in thought and thus tunes out the rest of the world. Many students have been embarrassed when the teacher called on them to answer a question in class and they did not hear the question because they were daydreaming. So keep all of this in mind when you are trying these Strategies out. The idea is to do them completely and to put everything you got into them so that you can nullify the signals your brain is receiving from your panic attack. Someone once said that the middle of the road is the most dangerous place to drive, so don't try these Strategies halfheartedly because if you do the chances are that they will fail. Just as if you were to drive down the middle of the road, you would probably wreck and not reach your destination. Therefore, when you try these Strategies, to succeed, do them wholehearted.


REACT CALMLY
The most important thing you can do on the onset of an attack is realize what it is and that it is not going to kill you. By doing this you can react to it calmly. You know you are all right and that the attack will pass. You want to allow it to pass and you know that you have the Strategies available to you that will allow it to pass in the most direct route possible. The key is that you use a Strategy and that you use it wholehearted. Think and know that you will make it through the attack and then go onto your coping Strategy of choice. A calm reaction allows you to move forward in this process. The following are some Strategies you may want to try in order to help you cope with your panic attacks.



I BREATHING EXERCISE
To do this exercise lie down in bed and close your eyes. Once comfortable, count to 5 while inhaling a deep breath. Then exhale while counting to 6. Concentrate on breathing from your diaphragm. To ensure you are doing this place your right hand on your stomach and your left hand on your chest. When breathing make sure your right hand is moving and that your left hand is as still as possible. Doing this ensures that you are breathing from your diaphragm. Next sit up in your bed and repeat the inhale and exhale while counting. Then try standing up and repeating the exercise. Do this over and over, lying, sitting, standing, and counting. Take deep slow breaths with the count, making sure your right hand is moving. You might try playing soft music in the background to help with the rhythm. This may seem awkward at first but practice of this Strategy can turn it into a habit. I encourage you to practice this Strategy at least 5 minutes a day. When a panic attack strikes you shouldn't feel awkward and you can turn your full attention to your breathing. This should relax you and thus distract you from your attack. If done properly it should also reduce the amount of panic signals reaching your brain. This will allow you to ride out the attack, relax, and thus cope with it better.
Don't under-estimate the power of proper breathing. Breathing from the belly and not the chest allows the air to go deep into your lungs. This allows more oxygen into your system with less effort, thus your heart rate can decrease along with the number of times you have to inhale and exhale. So too your body is not as stressed to get the oxygen it needs. So, deep breathing alone can help eliminate some of the symptoms of a panic attack!

II MEDITATION
I know this sounds awkward at first but for this exercise I don't mean Yoga style meditation. Rather, I am simply suggesting taking an object, concentrating on it, and turning it over in your mind repeatedly. For example, if you have a candle at home, during an attack you could light the candle and concentrate on the image of the flame until it is the only thing that you can see. Hold that image in your mind as long as you can. After some time close your eyes but try to keep the image of the flame in your mind's eye. Hold the image as long as possible and turn it over in your mind. Make the flame your only thought. If you get distracted by outside noise try listening to soft music on some headphones to block out the distractions. If this exercise is done wholehearted, it should distract you from your attack and allow you to cope with it successfully. You should be thinking so hard about the flame that all other signals going to your brain should be blocked out. Still though, depending on your circumstances you may not be able to use this exercise, so you might want to try another Strategy. This exercise can be done with virtually any object. I chose the flame because it is easier for me to retain that particular image in my mind. Some people like to watch birds or clouds in the sky, some like to watch fish in a tank, or others like to watch a fire in a fireplace. The important thing is that you choose to meditate on something that is easy for you, so that this exercise can be successful for you in coping with your panic attacks. This Strategy should also help you to relax during an attack.



III MEDICATION
Not all panic attacks require distractions in order to cope with them. For instance sometimes the symptoms of panic attacks are the result of something you ate. I noticed that sometimes when I ate spaghetti I felt as though I was having a panic attack. This was probably due to some acid reflux in my esophagus. To help cope with this all I did was take some antacid. The antacid eliminated the symptoms almost immediately. If you have determined from you Anxiety Sources Workbook that your attacks come after eating a specific food you may want to try some antacid and see if this will help you to cope with your attacks better.




IV EXERCISE

You might want to try exercising as a coping Strategy during a panic attack. The idea is that if you concentrate hard enough on the exercise you will be distracted from the panic attack. Also, exercise should help burn off the excess adrenaline in your body that is causing the attack. I have used this Strategy more than once and have found it to be successful for me. All I did was go for a brief jog or brisk walk around the block during the onset of an attack. I ended up being so involved in the exercise that my attention was diverted from my attack, and thus I was able to ride the attack out and cope with it successfully. This coping Strategy may work for you as well. You don't have to do any fancy aerobics or have to have a fancy gym set in your house to do this Strategy either. When you feel an attack coming on, just try going for a fifteen minute jog or brisk walk, and by the time you get done your attack should be over.

V PERSONAL Strategies
A personal favorite coping Strategy that I found to be successful when a panic attack struck was taking a hot bath . I found the bath to be very relaxing and that the heat and sound from the water helped distract me from the attack. By being relaxed I was able to ride out my attacks easier. You might want to go back and try personal coping Strategies that you found to have worked in the past but try them a little harder to get better results. Some Strategies I have heard of include getting a massage, doing a hobby, praying, drinking cold water, or even snapping a rubber band on your wrist. I suppose all of these in one way or another could distract you from your attacks and/or help you to cope with them better. Some people take prescribed medication to help them ride their attacks out easier and/or to relax. If this works for you, you should probably continue taking your medicine. I know that the medications I was prescribed did not help me to cope with or ride out my attacks. If you have any coping Strategies you would like to share please feel free to write me at the same address you ordered this booklet from and maybe I can share those Strategies with others in future editions of this book.

VI. Strategies NOT TO TRY
Well, I have talked a lot about coping Strategies you should try to help you with your panic attacks, but before I continue I would like to suggest 3 things you should not do to help cope with your attacks. Due to their addictive nature and potentially harmful side effects, in my opinion the following items should not be used to cope with your panic attacks:
1) Alcohol
2) Cigarettes
3) Illegal Drugs

These things may seem to work for you but other more serious problems may result from taking them. So think twice about trying these out or in continuing to use these if they are a personal Strategy of yours. You now have the answer to the question of how to cope with Panic Attacks. Some coping Strategies are better than others and some work differently for each individual. Some Strategies shouldn't even be tried. But coping with Panic Attacks can be a lot like coping with mosquitoes. Coping Strategies can help us ride our panic attacks out, just as bug spray can help keep mosquitoes away for awhile, but these things don't eliminate the problem. You can use one coping Strategy after another and you can use bug spray again and again, but the problem is still there. Coping with Panic Attacks does help us though, and can make living with them easier; however, eliminating Panic Attacks from your life should be your goal. My next chapter describes Strategies that you can use in order to reach that goal and eliminate Panic Attacks from your life.

Panic Attack Help: Identifying The Sources Of Anxiety And Panic!

There are many sources of anxiety that can fuel our panic attacks. By identifying these sources we can through different techniques cope with and eliminate panic attacks. We will learn more about this in later chapters but for now we must focus on identifying the sources of anxiety in our lives that are triggering our panic attacks. Make no mistake about it, this is no easy task since these sources vary from person to person and from attack to attack. However, it is not entirely impossible to find these sources. They are there and if you dig deep
enough you can find them. The following describes my ideas on what the most common sources are and how to identify them in your life.

Basically, I have found that the primary sources of anxiety which I believe fuel panic attacks can be broken down into 2 areas. These areas are titled Lifestyle and Psychological. Lifestyle, covers the tangible things in our life and the way that we live that can be sources of anxiety. Psychological, covers the aspects of our personality and the way we think about life that can be sources of anxiety. Both areas have multiple source areas that fall under it which can fuel our panic attacks (SEE CHART 5). I truly believe that the circumstances of our life and/or the way we think about and handle our life can trigger our panic attacks. This is what is at the core of The Panic Sources Chart (5). Since the sources of anxiety that drives panic attacks are different for everyone, it would be impossible to capture all of the potential sources of anxiety on any single chart. This chart does not attempt to capture each individual source. Instead, this chart is organized to capture as many sources as possible by categorizing potential source areas not individual sources. This should make identifying the sources of anxiety in your life easier because the search area for your anxiety sources is narrowed down. It is a lot like an Index in a book. By using an index you don't have to read the whole book to find a specific word or subject because the index can tell you what page(s) to go to. This chart will show you what areas to look for the sources of your anxiety in. It is also flexible enough to allow you to personalize it if your sources of anxiety are not in any of the charted areas.

*Note this section does not try to identify sources of panic for PANIC DISORDERS such as AGORAPHOBIA or other PHOBIAS, rather it solely tries to identify the sources of panic that fuel the panic attacks related to those mentioned throughout this booklet that have no connection to PHOBIAS. Those suffering from PANIC DISORDERS such as PHOBIAS should seek the help of professionals. (SEE CHART 6)

I am confident though, that you can go to any of the categories or areas on this chart and find something that you can relate to in your life or way of thinking that may be a source of anxiety. If you are having a little trouble don't give up hope just yet.

This Chapter may take a little work and self-examination on your part to get through, but don't panic. I have tried to make this manual as short and easy to use as possible so that you do not have to worry or get stressed by reading it. Some books and programs about this subject seem so expensive and complicated that they can give you a panic attack just thinking about them. Hopefully this manual won't do this to you as we attempt to eliminate Panic Attacks from you life. So just because I mention things like work and self-examination try not to panic. I will try to make these next sections as easy and painless for you as possible.

To help you find the sources of anxiety in your life that are fueling your panic attacks I have provided the Anxiety Sources Workbook for you with this kit. This workbook is related to the Anxiety Sources Chart(5) and will aid you in determining your personal anxiety sources. After using this workbook for a while like a diary, you should be able to determine which anxiety source area(s) are driving your panic attacks. You should be able to see a pattern of events, eating habits, or pattern of thinking that is repeating itself over and over that is related to an anxiety source area on Chart(5). Perhaps you will see a pattern of anxiety sources that are not listed on the chart or maybe you will see a pattern of combinations of anxiety source areas from Chart(5). After using the workbook for some time you should be able to look at Chart(5) and use the records from your workbook to identify what is fueling your panic attacks. You do not have to be a genius to see the sources. If you think something is a source it probably is.

The following example workbook sheet is based on my life. As you can see I did not use big words or over analyze when filling out the workbook. I kept it simple and used a little self examination when filling in my answers. After several days a pattern of potential anxiety sources developed. Why don't you see if you can see the patterns.

Now that you have read my examples from the workbook, go ahead and list what you think the sources of my anxiety were, using Chart 5 as a reference.

TO SEE MY PERSONAL WORKBOOK EXAMPLE:CLICK HERE You can go ahead and list what you think my sources are on a piece of scratch paper at home.

From my example I found that job stress, long hours, poor diet and caffeine were the main sources of anxiety contributing to my panic attacks. In these examples these source areas were repeated on almost every sheet. If you saw the same pattern you should be ready and able to go on and use the workbook for yourself. So, before you go any further in this book go ahead and use the Anxiety Sources Workbook along with Chart(5). When you are comfortable that you have identified the anxiety source(s) in your life you may continue on with this manual to see how to cope with and eliminate your panic attacks.

Some of you may have already had a clue as to what was fueling your panic attacks, while some of you had to have your sources identified with the help of my Anxiety Sources Workbook. In either case you now know what these sources are and now have the key to coping with and eliminating your panic attacks. Knowing what you are dealing with is critical because it will help you to make informed and intelligent decisions in coping with and eliminating you panic attacks.

* NOTE IF YOU ARE STILL HAVING TROUBLE IDENTIFYING THE SOURCES OF YOUR PANIC ATTACKS, AT THIS POINT IT MAY BE ADVISABLE FOR YOU TO SEEK THE HELP OF A PROFESSIONAL.

With the question of what the sources of anxiety are answered we can now proceed to the next chapter which talks about panic attack coping Strategies.


CHART 5


ANXIETY SOURCES: LIFESTYLE & PSYCHOLOGICAL

LIFESTYLE


DIET
A) CAFFEINE
B) CHOCOLATE
C) ALCOHOL
D) JUNK FOOD


JOB
A) FIRED
B) LAID-OFF
C) DISCIPLINED
D) BAD REVIEW
E) POOR COWORKER RELATIONSHIP
F) POOR CUSTOMER INTERACTION
G) POOR RELATIONSHIP WITH BOSS
H) LONG HOURS
I) PERFORMANCE PROBLEMS
J)OTHER-
K)OTHER-


SCHOOL
A) UPCOMING TEST/EXAM
B) POOR GRADES
C) POOR STUDENT RELATIONSHIP
D) POOR TEACHER RELATIONSHIP
E) GIRLFRIEND/BOYFRIEND PROBLEMS
F) POOR ATHLETIC PERFORMANCE
G) OTHER-
H)OTHER-


FAMILY
A)SPOUSE RELATIONSHIP PROBLEMS
B)CHILD RELATIONSHIP PROBLEMS
C)MONEY PROBLEMS
D) DEATH/ILLNESS
E) OTHER-
F)OTHER-
G)OTHER-


MISCELLANEOUS
A)
B)
C)
D)



PSYCHOLOGICAL

I ALL OR NOTHING THINKING
*If you don't succeed at one
thing you are a total failure.
*One room of the house is dirty so
the whole house is dirty.

II NEGATIVE PESSIMISTIC THOUGHTS
*You are not worthy of good things.
*You fail to see the good things in life.
*You see the glass as half empty
not half full.
*You feel worthless.
*You don't take action because
someone else will do the job.



III PARANOID THOUGHTS
*You think everyone is out to get you.
*A disagreement with one person
means everyone is against you.
*Failure in one relationship means that
all relationships will fail
*You take criticism
as a conspiracy.


IV EXAGGERATING NEGATIVE THINKING
*You see a small black spot
on a white shirt rather
than see all of the white.
*One old driver cuts you off
so all old drivers are bad.



V OBSESSIVE/COMPULSIVE
*You are obsessed with washing
your hands. You have to clean and tidy
everything.