Healing Panic: Chapter One: How You Can Succeed

Joni started having panic attacks eight years ago, when she was 28. Although she (and her husband) have raised a son, for most of those eight years Joni rarely ventured outside her home.

She did try to get out. She first took a job at an agency that kept track of credit reports. The first day she sat for about a half hour at her computer nearly paralyzed--then ran out and frantically drove home, where she pretty much stayed for the next several years.

To find some relief from the daily attacks, Joni tried drugs and alcohol, often more than once a day. Nothing worked, not even the numerous medications designed specifically for anxiety. She has been to emergency rooms more than once. She experienced so much dizziness that her doctors gave her a CT Scan to check for inner ear problems. When medical tests revealed nothing, she began to believe she had a tumor of the adrenal glands.

When Joni tried to go to work again, she again found herself in front of a computer taking care of the billing in an office. She wouldn't admit that anything was wrong, but at times the mere act of staying at work must have been real agony. This time, however, Joni was working for me, and at a time when I was serendipitously introduced to the idea of Hyperventilation Syndrome and treatment for panic attack victims.

Over the next few months Joni and I found some people who were looking for help, and we
started a group.

A few months before I started writing this, I asked Joni how she was doing. She wrote me back:

I DO NOT have panic attacks anymore...for almost a year now. A solution to this problem was and is a Godsend. Miracles can really happen in the most unusual ways!!

I don't think Joni used the word miracle lightly. If you have been looking for the miracle that Joni is talking about, the one which brought her the knowledge of what to do, look no further.

Panic attacks are so powerful they seem to be completely beyond your control. Joni thought so. But as easy as it is to believe that panic attacks are an inevitable part of your life, I can assure you that just the opposite is true. Panic attacks are not inevitable. They can be controlled. For a few of the people who read the first few chapters of this book and do the exercises, success (meaning no longer having panic attacks) will be almost immediate. Success will take a little longer for most people, but it will come.

People with Panic Disorder suffer from periods of intense fear or anxiety. The fear is a result of great physical distress that indicates something has gone seriously wrong. For some people attacks come "out of the blue" and for no discernible reason. Others report experiencing warning signs that an attack is coming on. An afflicted person must cope with the possibility of an attack occurring while shopping, driving, attending church, or being with other people socially. For some, the worst fear is that they will be alone when an attack occurs.

If you have panic attacks, you know that you may be out of breath, experience a racing heart, or have pronounced chest pain. Trembling hands, blurred vision, pressure or a knot in your throat, tingling or numbness in your face, fingers, and arm, and profuse sweating are among the dozens of symptoms reported by panic attack sufferers. Being left confused, weak, and exhausted can be a part of your attacks.

What Is the Explanation for Panic Attacks?

In the past, and even today, there is no universal agreement among professionals about the causes of the panic attacks experienced by Joni and millions of others. Many will say that the cause is not really known. Stress or anxiety is often blamed, because attacks often start after periods of unusual stress.

Only in the last few decades has there emerged an explanation for panic attacks that accounts for all the various symptoms. When this explanation is understood and applied to treatment, control is regained and panic attacks are stopped.

Panic attack sufferers have one thing in common: they don't breathe properly. People who suffer from panic attacks breathe shallowly and rapidly. They breathe mostly using the muscles of the chest, neck, and shoulders and make little or no use of the diaphragm. This type of breathing results in a disruption of the exchange of oxygen and carbon dioxide in the bloodstream and body, leading to a condition know as Hyperventilation Syndrome.

Hyperventilation occurs any time a person breathes in such a way that the amount of carbon dioxide breathed out exceeds the amount the body is manufacturing. This results in a condition known as "hypocapnia" in the medical field. When the blood's level of carbon dioxide falls below a critical point, the person begins experiencing apprehension and physical symptoms such as dizziness, shortness of breath, and rapid heartbeat.

If the person doesn't know what to do at this point, the symptoms become more severe and a panic attack results as the condition becomes more pronounced. A few people will experience partial paralysis or faint as a result of hyperventilation.

The symptoms experienced during panic attacks are not "imagined"; they are quite real. The sensation of dying that many people experience during a panic attack has a physiological basis. If too much carbon dioxide were lost from the body, life could not continue. Fortunately, the body has several ways to prevent that from happening.

What we call a panic attack is one of the ways the body protects us. The feeling of not being able to get enough air during an attack arises because the part of the brain that regulates breathing temporarily "shuts down" and allows the rebuild-up of carbon dioxide. This shutting down of the ability to breathe in the normal way can be extremely frightening.

One final point to be made before going on: Panic attacks happen to normal, healthy people who, for whatever reason, are breathing improperly. When panic occurs, the nervous system is doing exactly what it is designed to do: protect the body from death. Mostly, the mental states associated with panic disorder are the result of hyperventilating and the fear of having attacks in the future. Obviously, the place to begin treatment is learning how to breathe without hyperventilating.

Susan

Susan is one of those people who succeeded right away. Susan was never in formal treatment with me for her panic attacks; she only heard me talk in a group of people one time about hyperventilation syndrome and what could be done to remedy the condition. (She was unable to come to the rest of the scheduled meetings because of vacation plans with her husband.)

A few months after she returned from her vacation, Susan wrote the following letter so it could be used to help others who suffer from attacks:

I am so happy with the results of learning how to breathe
diaphragmatically. I wanted to share my experience. It has
changed my life for the better.

I have been a sufferer of panic attacks for over three years.
I have tried everything. I have been to doctors, had all
kinds of tests, even been into urgent care a few times. All
they would tell me is that it was stress. I finally got so
that I could go through life as long as I had my
tranquilizers. But I would still experience panic, feel
dizzy, sick, out of control, and worst of all a feeling like I was
losing my mind. The only thing that sort of worked for me
was to take Ativan and not do all the things in life that I
really wanted to do.

It was while I was at a meeting in Redlands that I met Dr.
Anderson. I was very interested in what he was telling us
about diaphragmatic breathing. It made so much sense, I
decided to give it a GOOD try.

I first started by diaphragmatic breathing before I got out of
bed in the morning. I noticed that I seemed to feel less
shaky and more calm right away. At the time I was on the
highest dosage of Ativan that I had ever taken.

My family was planning a vacation, so I took my [volumetric exerciser] to
practice my breathing. Every time I could I would practice.
By the end of my vacation I had cut my medication down by two-
thirds. I kept breathing diaphragmatically every time I would
think about myself and how I was feeling, which is pretty
often when you suffer from panic disorder.

When I returned to work, the stress returned too. But
breathing really helped. It really works! I did not want to
go back on medication.

I have had a few panic attacks since. But I try to catch it
early. I know this is hard. But there are signs of stress
coming. I also know that after breathing diaphragmatically at
least three times I could feel the panic lift. And the best
feeling of all is the feeling that I am in control again.

I have been totally off medication now for one month. I am
thrilled. I have even been tested pretty good--a trip to
the dentist. I just kept up the diaphragmatic breathing. I
really believe in diaphragmatic breathing. It has changed my
life for the better.

Sincerely,

Susan H________

The wonderful thing about Susan's letter is that she mentions several steps which helped in her
recovery. She began by deciding to give it a good try. She then:

• Practiced diaphragmatic breathing before getting out of bed in the morning.
  
  
• Practiced several times during the day, using a volumetric exerciser.
  
  
• Used inner cues to remind herself to practice.
  
  
• Began cutting back on her tranquilizing medication as soon as she made progress.
  
  
• Stayed off medication even when the stress intensified; she relied on diaphragmatic breathing to deal with symptoms.
  
  
• Became aware of the early signs and learned how to breathe to get rid of symptoms.
  

Keeping Panic Away

Several months later Susan wrote to me that she has the same ability to control attacks as when "treatment ended" and that she doesn't have panic attacks now. Thinking of others, she wrote as follows:

A person needs to stop and think at the first sign of panic
what might be triggering the attack and breathe to slow down
the increasing panic.

Since your tendency to have panic attacks may remain for some time after you've learned the skills of controlling them, it is important, as Susan found, to stay aware of early signs and breathe diaphragmatically to stop the symptoms.

All the former patients who responded to my questionnaire about their success noted that they
continued to practice breathing diaphragmatically as a way of controlling their tendency to have attacks.

Hyperventilation Syndrome is a complicated interaction of many things. This means you have to accomplish several things in order to gain control and live without attacks.

You don't have to learn "perfect" diaphragmatic breathing, but mostly you should be able to do it when you think about it. Give yourself some time to change your habitual breathing pattern.

Reward yourself for making a little progress at a time.

Practice at those times you feel best. If that's not very good, then accept it as your best time and do what you can. Go slowly. If you're in this situation, you probably haven't felt anything close to normal in a very long time.

Tranquilizing medications allow you to function, at least somewhat. But they can get in the way of recovery, because they impair learning and memory and tend to be addictive. When you have gained some skill in recognizing and controlling attacks, you can taper off your medications with the help of your doctor. For now, the medications provide you a window of opportunity that's helpful.

When Joni and I would talk about the struggles she went through and how panic attacks became the focus in her life, we both recognized that after one has mastered diaphragmatic breathing, one needs continuing support to keep on succeeding.

Functional breathing will stop panic attacks, just as stopping drinking will lead to sobriety for a person who has become addicted to alcohol. Relapse is possible, so more than functional breathing is needed. After suffering over years, many panic attack victims have become fearful of life, dependent on others, feel isolated, and have learned to manipulate others in order to protect themselves. Working with a therapist, self-help groups, and your religious faith can help you with these attendant problems.

It would be easy, in the short term, to play it safe. To stay at home. To do nothing. You must be willing to work in order to succeed. And you will succeed if you carefully follow the instructions outlined ahead. All you have to look forward to, after all, is freedom. Freedom from panic attacks and all the limitations they have placed on your life for so long.

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

Healing Panic: Introduction

Understanding Panic

A full-blown panic attack is the sort of thing that in earlier times would have been called possession by demons. This explanation has a certain logic to it; during a panic attack you appear and probably even feel to be under the control of an outside force, unable to control even the most simple physiological processes, such as breathing.

During a panic attack, you may experience the very real sensations of dying, suffocation, dizziness, and going crazy; a sense of unreality; and other frightening feelings. Despite outward appearances and your own perceptions, you are not "crazy" or in any physical danger.

We know that demons are not responsible for panic attacks. The word "Panic," however, is indeed derived from the ancient belief that the ill-tempered and ugly god Pan, who had the horns, ears, and legs of a goat, loved to frighten unwary travelers. Although we do not fully understand everything about panic, we now have better explanations.

Panic is rightfully thought of as a "disorder" and not as an illness or "disease." Perhaps the best explanation is that a panic attack is an overwhelming cascade of emotional and physiological reactions triggered by any number of uncomfortable and frightening sensations. That which has become sufficiently "out of order" to trigger panic attacks now needs to be put back "back in order."

Approaches to Treatment

Often, treatment for panic attacks consists of medication, talk therapy, and perhaps using one or more of the many commercially available workbooks geared towards changing your thought processes and lifestyle.

These approaches have their merits. Talk therapy and workbooks can give you a new outlook that may eventually help you prevent panic attacks. Medication can be useful in allowing you to be more comfortable and perhaps lead a "normal" life while learning techniques to stop and prevent panic attacks. These approaches bring limited success to many people; however, few go on to gain total, permanent freedom from panic attacks, even after years or decades of trying. The main limitation is that none of these approaches are completely effective until you gain control of hyperventilation symptoms, which are the primary triggers of panic attacks.

The first step in learning how to disrupt and eventually prevent the cascade of emotional and physiological reactions typical of panic is becoming aware of and learning how to control over-breathing, which leads to hyperventilation. After you progress in your recovery by learning to control hyperventilation symptoms, you go on to disrupt the cascade at an earlier stage by learning to recognize early symptoms and halt their progression. Eventually you will prevent the cascade from even starting, by having relearned diaphragmatic breathing, successfully countering anxious thoughts, and perhaps effecting changes in lifestyle and outlook. Along the way you will reduce and eventually eliminate any dependence on medication you may have.

This manual guides you through the entire process, providing specific exercises and instructions for every day of a nominal 8-week program. The package you receive with this manual includes all the training aids you will need to successfully complete the program and put your panic attacks behind you.

If you remain phobic or continue to avoid certain situations despite having gained control over attacks, you are recommended to use Healing Panic Agoraphobia Phase.

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

What Exactly Is Social Anxiety?

Social Anxiety Disorder (social phobia) is the largest anxiety disorder and the third largest mental health care problem in the world today, yet most people know little about it. People with this disorder are often labeled as "shy", "aloof", "unsociable" and even "rude", but inside they can feel trapped in their shell by this debilitating problem. The latest government data show that social anxiety may affect up to 7% of the population at any given time - the chances are we all know someone struggling with this disorder, and yet we're not even aware of it.

So, what exactly is social anxiety? It is a fear of social situations that involve interaction with other people: more specifically, the dread of being negatively judged and evaluated by other people leading to feelings of inadequacy, embarrassment, humiliation, and depression. If a person usually becomes anxious in social situations, but seems fine when they are alone, then "social anxiety" may be the problem. The feelings that accompany this disorder include intense fear, nervousness, automatic negative thinking cycles, racing heart, blushing, dry throat and mouth, trembling, weak knees, and muscle twitches. People with social anxiety know that their anxiety is irrational, yet the thoughts and feelings persist and cannot be willed away. Social anxiety is often confused with panic disorder, but people with social anxiety do not experience panic attacks. Most people who have panic attacks seek medical help, believing they are having a health-related problem (like a heart attack), but people with social anxiety realize that it is anxiety and fear that they are experiencing.

In public places, such as supermarket queues, doctor's waiting rooms, work meetings or travelling on buses, people with social anxiety feel that everyone is watching, staring, and judging them. They have great difficulty relaxing, "taking it easy", and enjoying themselves in public. In fact, they never fully relax when other people are around. The anxiety is often so distressing it becomes much easier just to stay away from social situations and avoid other people altogether. Even when they're around familiar people, a person with social anxiety may feel overwhelmed and have the feeling that others are noticing their every action and criticising their every word. People with social anxiety usually experience significant distress in the following situations: being introduced to a stranger, being teased, being the centre of attention, being watched or observed performing a task (sometimes as simple as writing their own name), meeting people of authority, making eye contact with someone, and performing any number of activities in public (making a phone call, talking, eating). The symptoms vary among individuals, and may be a generalized anxiety (overall fear of social situations) or specific (fear of performing a certain activity in public, such as eating).

Since few socially-anxious people realize they are suffering from an actual treatable disorder, they tend to keep their problem to themselves. It would be distressing, after all, if everyone realized how much anxiety they experienced in daily life. It becomes a sort of catch-22 situation - their fear of what others think keeps them from seeking help for the anxiety. If they do finally reach out to mental health professionals, however, treatment of the disorder has a high success rate. Research indicates that, after cognitive behavioural therapy, up to 90% of people with this problem report a changed life - one that is no longer controlled by fear and anxiety. There is hope for sufferers, a doorway into the world of people and healthy day-to-day social interaction.

Managing Anxiety: Expectations Are Killers

STAY AWAY AT ALL COSTS - DON'T LET YOUR EXPECTATIONS GET THE BETTER OF YOU.

We do not want to "set ourselves up" ahead of time for feelings of failure and defeat. We do not want to try to "force" or "pressure" anything into happening on a particular rigid time schedule.

For example: "Today, I will go to work, march into the bosses' office, and get that raise I deserve so much."

Maybe this is a true statement, but there are too many things beyond your control in this statement that have nothing to do with overcoming anxiety.

You are setting yourself up for a fall, and it is likely that you will have one.

Maybe your company no longer is giving anyone raises. They do like your work, and they do not want to lose you, but perhaps company policy dictates that no raises are being given for the next six months.

If you take this personally and allow yourself to feel defeated, you are sabotaging yourself. Don't do it. This is not something to be taken personally.

It is NOT a slap in the face to you. This would occur to anyone asking for a raise during this time.

Or, consider this irrational expectation: "Tonight I will go out and meet someone..."

This is a big, bold, unrealistic expectation. Why? Yes, you can go out and "meet" someone, but what you mean is you want to meet someone interesting that may turn out to be a friend or a lover.

The trouble is, again, you do not have control over WHO is going to be "out there". If you have some scruples, and are really looking for a quality person who shares your interests, you have limited your chances tremendously.

This particular expectation is usually a real killer: you expect way too much, and all of it is out of your control. You are setting yourself up for defeat if you carry this expectation out.

Instead, a healthier, productive outlook is to generally increase your social activities in areas in which you have a legitimate interest. Your interest in the activity should come first, and your focus should be on having a good time that evening - not on any of the people who might be there.

If your FOCUS is on slowly expanding your social activities - and not on other things - you have automatically increased your chances of reaching your goal.

Yes, this is another paradox. the more and more (and desperately and desperately) you seek something and "expect" something, the more and more elusive it becomes.

It can turn into a depressive nightmare, and your progress against social anxiety can be halted. So, FOCUS on moving ahead for yourself, healing yourself, expanding your social circle very gradually for yourself, and you will be moving in the right direction.

Handling Stress: Alternative Cures

Stress has become huge, and when looking for help or relief you will be faced with a barrage of Therapies, Practitioners and Drugs, all of which will claim to give relief from stress, and in most cases they will help. Some of the remedies available are discussed below.

The Doctor's Response

When we first fall foul of stress, we automatically go to the doctor with a whole list of symptoms and feelings, hoping there will be a miracle pill to make it all go away. But the truth is the doctor can only treat the symptoms and not the emotional or physiological reasons for the condition. In the limited time available with you, the GP will try his or her best to get to the bottom of why you are as you are.

Medication is not always the answer to solving stress, so many GP’s will refer you to a counselor or community psychiatric team. They may also refer you to a specialist: Psychotherapist, Psychiatrist or Clinical Psychologist.

Drugs

Depending on the symptoms you present to the GP, in some cases drugs will be prescribed to help you through a difficult time. In most cases these will be tranquillisers, though these will not be prescribed over a long period of time as they can be addictive.

Beta blockers help with anxiety, reduce palpitations, tremors and sweating. Depression caused by stress can be dealt with by another series of drugs, which can be given over longer periods of time, as they are in most cases not addictive, although some do carry some nasty side effects; some people experience withdrawal symptoms when they stop taking them. There are two main types of anti-depressant – the older style tricyclic drugs and the new selective serotonin inhibitors (SSRI’s) such as Prozac. Note: users of these drugs should be aware that it can take up to three weeks for these drugs to take effect and during this time you may experience side-effects, but you should continue taking the drugs under advice from the prescribing GP.

Under times of stress, we may take drugs in other formats that we don’t even consider as drugs, such as alcohol, cigarettes and recreational drugs. These will alleviate the stress short term but will not keep it at bay for good.

Alternative Cures

Talking
‘Talking it out’ is good for stress. Your GP may suggest you try a counsellor or psychotherapist who is free of charge, however the waiting time for these appointments can be up to six months in most cases, or your GP may refer you to someone private.

Counseling
Counselors generally don’t specialize in stress, anxiety or depression. However there are Stress Counselors who do. The counselors will be able to assist you in examining your causes of stress and suggest ways for you to deal with it better.

Psychotherapy
Psychotherapy delves deeper into your background, rooting out possible causes for your stress and the state you may be in. This therapy will tend to go on for longer than counselling.

Cognitive Behavior Therapy (CBT)
CBT has become more popular over the past few years. It focuses on changing negative thought processing into positive. The therapy aims to show you how to identify negative thought patterns and give you positive ways to change them.

Stress Counselling & Stress Management
Over the last ten years we have seen a rapid increase in the interest in Stress Management consultants and counselors. They can help you identify the underlying causes of your stress and give you positive coping strategies.

Aromatherapy
Aromatherapy is a world away from scented bath oils. Practitioners will use a variety of oils best suited to your needs, such as Lavender, Marjoram and Geranium. They may be added in a carrier oil to aid massage or dispensed from a diffuser.

Flower Remedies
Bach remedies are the best known flower remedy and marketed for a range of emotional difficulties.

Healing
Spiritual, Faith and Reiki healing all involve energy being passed through one to another. This can be done via the laying on of hands or distance healing.

Massage
Massage is a very relaxing experience which many people find beneficial when stressed, whether done by a practitioner, partner or friend.

Relaxation
There are many methods of Relaxation (See Services and courses), either taught by professionals or ones you can teach yourself. Many bookstores and health food shops sell books and videos for you to use yourself. Yoga is often recommended because of its relaxing qualities and the use of deep breathing.

Stress and Ulcers — Just a Myth?

"You'd better relax — you're going to get an ulcer!"

Common wisdom holds that ulcers are caused by stress, and until recently, so did medical wisdom. The medical picture changed in the mid-1990s when the National Institutes of Health concluded at a major conference that most ulcers are caused by a bacterium called Heliobacter pylori (H. pylori) and should be treated with antibiotics.

Although the first antibiotic for treating peptic ulcer disease was approved in 1996, many patients and doctors remained unaware that most cases are caused by infection. In an attempt to educate the public and the medical community, government and professional associations launched extensive educational campaigns. The message was simple: ulcers are caused by infection, not by stress or spicy food.

But the pendulum may have swung too far, according to recent research. While it's true that many peptic ulcers are caused by H. pylori infection, many are not. And, only about 20 percent of those who are infected with H. pylori ever develop ulcers. So while recognizing that the bacterium is definitely a big part of the picture, researchers are turning again to look at the role of psychological factors, especially stress.

"Evidence linking psychosocial stress to peptic ulcer is too strong to be ignored," states Dr. Susan Levenstein of the San Camillo-Forlanini Hospital in Rome, Italy. "Psychosocial factors can be estimated to contribute to 30 percent to 65 percent of ulcers."

In a recent issue of Psychosomatic Medicine, Levenstein explains that although many of the studies linking ulcers to stress were poorly done, there are still many that weren't. Important among these are prospective studies that follow a group of people for a period of time to see what factors at the beginning of the study predict later development of ulcers.

These studies report that psychosocial factors such as stress, depression, trauma, job frustration and family difficulties all predict later development of ulcers. Other studies have shown that these factors slow the healing of ulcers. One problem, Levenstein points out, is that some other influence could be causing both stress and ulcers — socioeconomic status or medical conditions, for example.

But even when these factors are accounted for, it appears that stress plays an important role in at least some cases of ulcer. In an Australian study, for example, 44 percent of patients recently diagnosed with duodenal ulcers reported experiencing severe and often chronic stress during the previous six months. Among a comparison group of healthy subjects matched for age, gender and socioeconomic status, only nine percent reported such stress.

Levenstein points out that stress can contribute to the development of ulcers without actually causing them. For example, stress can influence health behaviors such as smoking, drinking and poor eating and sleeping habits — all of which are established risk factors for peptic ulcer. Research also suggests that people who feel stressed are more likely to take medications called non-steroidal anti-inflammatory drugs, or NSAIDs, such as aspirin, ibuprofen, naproxen and a number of prescription medications. These drugs definitely can cause ulcers; this is actually one of their most serious side effects.

But even after accounting for these stress-related health behaviors, says Levenstein, stress itself remains a risk factor for ulcers. A nine-year study in California found that participants with high levels of stress were more than twice as likely to develop ulcers than those without stress, even after accounting for smoking, drinking, eating and sleeping habits.

There are several ways that psychosocial factors might contribute to ulcers, explains Levenstein. Emotional distress and severe stress (as some mood and personality disorders) are significantly associated with increased production of acid in the stomach and small intestine. These psychosocial factors can also affect the body's immune system and hormone balances, impairing its ability to heal.

According to Levenstein, about 20 percent of ulcers appear to be unrelated to either H. pylori infection or taking NSAIDs — the two major causes. Recent studies report that only one-half to two-thirds of ulcer cases involve bacterial infection. Levenstein suggests that in some cases, individuals may be physiologically predisposed to develop ulcers, and the effects of psychosocial stress in the body activate this tendency. In fact, she suggests, some ulcer cases in which H. pylori is found may not actually be caused by the bacterium.

The bottom line, says Levenstein, is to look at peptic ulcers the way we look at cardiovascular disease: as a complex condition that's influenced by a variety of genetic, physiological and psychosocial factors.

"Stress and heliobacter may be two independent risk factors with additive effects, just as diabetes and smoking carry additive risks for coronary artery disease," the researcher suggests. "[Some] ulcers may be destined to develop regardless of the individual's psychological characteristics, but there is some evidence that light infections may be helped to evolve into ulcers by psychosocial factors."

As both the general population and the medical community turns to more complex explanations of diseases from heart attack to the common cold, we can expect to see more and more research showing that psychosocial and physiological forces interact in human disease.

Stress and Asthma: What's the Connection?

Most experts would agree that there is a connection between emotional stress and asthma but beyond that, a great deal of controversy still exists. Does emotional stress trigger asthma or make an attack worse? Or is emotional stress the result of asthma symptoms?

"I believe there's a link between people's emotions and asthma attacks," observes Stuart A. Tousman, Ph.D., associate professor of psychology at Rockford College in Rockford, IL. Nationally recognized for his work in this area, he conducted a workshop on the connection between asthma/allergies and stress at the 56th Annual Meeting of the American Academy of Allergy, Asthma and Immunology in San Diego

While studies show a clear relationship between emotional stress/anxiety, frequency of attacks, amount of medication needed to control symptoms and hospitalizations due to asthma, there are several possible explanations for this. Emotional stress could act as a trigger for asthma, and it could also make an attack worse as it is occurring. At the same time, symptoms and other factors associated with the disease could interfere with an individual's life to the point of damaging his or her self-esteem, and that can be very stressful.

Some researchers believe that individuals with asthma experience much of their stress as a result of asthma attacks or poorly controlled asthma. Many of these experts worry that seeing stress primarily as the trigger might lead health care providers to underestimate the impact that an individual's asthma symptoms are having on his or her emotional health.

On the other hand, researchers who believe that stress can trigger asthma symptoms or make them worse sometimes fear that other healthcare professionals aren't doing enough to help patients with asthma manage the stress in their lives.

While individual experts might focus on one explanation over others, the reality may be a combination of each, and recent studies suggest that adding psychological techniques such as muscle relaxation training and asthma self-management training to conventional asthma treatment can further improve a patient's response to asthma treatment.

Such programs work because they help patients identify and cope with stress related to their disease, and they provide education about asthma and its treatment so that patients can take better care of themselves. In addition, programs like this help patients and their health care providers to identify factors that might be keeping the patient from complying with treatment-- such as an inability to pay for prescriptions or the presence of unpleasant medication side effects.

Patients in one study experienced a reduction in asthma symptoms and anxiety level and an increased quality of life with the addition of psychological techniques to their treatment plan.

Another study, conducted by Dr. Tousman and his colleagues, examined 13 patients who completed a seven-week program that included interactive education, social support, relaxation training and humor therapy. Each week during the study, patients were asked to make a specific behavioral change such as exercising for 30 minutes or practicing relaxation for 30 minutes.

Study participants reported that the program relieved the tightness in their chest, made them feel less tired, improved their ability for achievement and improved their ability to control their asthma. These patients felt they had benefited most from education about medication options for their illness and learning how others cope with their asthma. The study also indicated that patients adhered to their medication plan better and felt more empowered to make lifestyle changes likely to improve their health.