In this piece, my inaugural blog post, I detail my dawning awareness of my lifelong panic attack affliction. I end up delving into my childhood to discover the source of the panic attacks, and then detailing my seven-session therapeutic journey. Included is the subsequent recognition of negative self-talk, and its effect on me. It is not a warm and fuzzy piece of writing, but it is a critically important one, if you have an interest in anxiety issues, of any degree of magnitude, and wish to discover a few key strategies for dealing with an often overlooked mental disorder.
Six Days a Week
Most voyages begin with great fanfare and include lots of luggage, oodles of bubbly, and a fair amount of confusion; many last weeks or even months. My journey involved no luggage and no bubbly, but made up for it with vast, unlimited quantities of confusion. It actually took only a total of five hours and fifty minutes, stretched out over seven weeks. What existed as a gooey, coagulated mental morass, forty-nine years in the creation, was dissolved in seven visits to a competent therapist at the local health center.
Most people have some personal contact with the process of therapy. I know several folks who have required extensive therapy to deal with a myriad of personal issues. I know a person for whom therapy is a way of life, because he has grown to rely on the ongoing advice and guidance from his therapist. What I have not encountered is a person who suffered from what amounts to a lifelong disability, and who had tried therapy in the past with no success; however, along comes that mythical (mystical?) person who deftly inserts the key to unlock the door to providing a solution for permanently resolving the conflict in that person's life.
For me, that mythical person turned out to be a resident psychologist at the local community health center. Unknown to me, Dr. Jill had been at this clinic for the past thirteen years. Yet I had been going down to Ukiah to see a counselor who told me on my first visit that she could help me with immediate concerns, but was unlikely to be able to make my issue disappear. So you can imagine my surprise to find out that within a half-hour of my rural residence, I could get help to rid myself of a lifetime disorder and its long range effects.
Furthermore, within the first five minutes of my first session, Doctor Jill assured me that there was a cure for my problem, she could effect that cure and all that was left was for me to do the work. Was that possible? I envisioned some sort of disease coursing through my veins that Dr. Jill was going to eradicate with a deft inoculation of penicillin, and I would walk out the door with a new lease on life, but I knew it didn't work like that. I also knew that this beaming, diminutive, effervescent person sat in front of me and declared confidently that my problem was very common, and there was a solution, if I was willing to be an active participant. I told her I was ready for action, ready for danger.
Exactly, what was my lifelong affliction? From the time I was ten until the time I approached my fifty-eighth birthday, I suffered from panic attacks. I didn't know they were panic attacks, I didn't seek medical attention, and the only person I ever told was my mother, who was very supportive, but unable to provide any definitive answers. This overwhelming physical sensation surges up into my brain, takes control, and sends me into a tailspin that results in loss of consciousness if I don't get out of wherever I am trapped and sit down in the fresh air, and drape my head between my knees, not a very dignified posture.
The first time it happened, I was in St. Martha's church for the eight o'clock mass, mindlessly standing there, going through the ritualistic motions of the service, when a girl not much older than me in the pew in front of us, keeled over like an ancient oak, and when she hit the floor, it sounded like a sonic boom. She was standing where the pew met the aisle leading up to the altar, and she toppled out into this center aisle. How could a person make so much noise hitting a tile-encased concrete floor?
The absolute shock of this event seared into my mind as though someone had surgically opened the top of my head and poured in some sort of toxic acid that drained the blood from my brain and caused me to heat up instantly. Spontaneous combustion was a distinct possibility. My vision was clouded, my face was white, my breathing was rapid and shallow, I was sweaty and dizzy and I knew I would be next to go down if I didn't get out of there. I stumbled out the side door just as a man I did not know was approaching the door; he took one look at me and told me I had better sit right down on the curb of the church driveway and get my head between my knees. He told me I looked like a ghost, and that I should take deep breaths until I felt the nausea pass. I was to repeat this series of events countless times in my life.
I had no idea what had just happened to me. I did know that the boom of that girl's body hitting the floor had startled me-terrified me, actually-and that what followed was as confusing as it was sickening, and that I had no idea why it had occurred. The end result was that I began to profoundly worry that the experience would be repeated. Unfortunately, I was required to attend mass Monday through Friday before school, and of course Sundays. Every single time I ever walked into that church, I worried that the stillness of the church and the physically demanding nature of the service would produce another fainting girl and another terrified little boy.
As I reflect back now at the thought of myself, as A.D.D. a kid as you will ever encounter, being required to endure those church sessions under the umbrella of fear, I wonder what kind of impact that would have on the formation of my personality. Whether I was supervised by my father, next to whom I sat, or by the nuns who taught me, I was not allowed to talk, whisper, look around me, jiggle my leg, or so much as twitch without garnering the attention of the adult-in-charge.
I would like to clearly and definitively state that this is not a bash parents/home life diatribe. It is what it is, neither here nor there, neither good nor bad.
It got to the point where even the sudden thud of a small boy's heel against a pew, would initiate those panicky feelings until I was able to establish the source of the noise. When I shared these fears and sensations with my mother, she was sympathetic and gave me advice that proved, about forty-nine years later, to be uncannily accurate. She told me to think of a place in my head where I really wanted to be, and simply go there. At the time I was way beyond that simple solution; by the time the initiating event had occurred to trigger an attack, I was off to the races with no room for alternative agendas. Pretty amazing.
One Sunday morning, instead of attending eight o'clock mass with my father and brothers, I ended up going to church later in the morning with my mom and a sister. Afterwards, we stood out front talking with my friend Mark and his mom. Mrs. C. looked over at me and said to my mom, “How about your Mark? Does he like scary movies too? Because I'm taking Mark to the movies today to see The Pit and the Pendulum and Tales from the Crypt.
Inside myself I was cussing the luck of the draw that put me in this situation, having to either admit that scary films actually terrified me, or to agree to a rare visit to a movie theater. No way could I have vocalized my thoughts. I responded by expressively arching my eyebrows in a look that unmistakably smacked of “That would be too cool for words” even though I could already predict with a fair degree of certainty how the afternoon would play out.
With great fanfare we gathered up all the necessary refreshments that Mrs. C. had been generous enough to pay for, and headed for our seats. Through judicious and timely use of the theater's restroom, the snack bar, the drinking fountain and the trash can, I managed to make it through the tamer Pendulum movie, but it was not to be in Tales. There was too much of an unexpected nature assailing my nerves; the film was loud, the thought of being buried alive in a crypt was in itself enough to make me bail out, and then of course something inevitably triggered the onset of pounding heart, quickened pulse and early exit for me.
I made it to the red velvet steps leading up to the balcony before I collapsed on my bottom step and assumed the position... Which is where Mark found me about ten minutes later.
“What's the matter?” he asked sympathetically. Mark C. being sympathetic? Unheard of, and yet here he was.
“I don't know. I guess I'm sick.”
“Oh, OK. I'll call my mom and have her come and get us.”
I didn't believe how nice he was acting because it was out of character. He simply accepted my sickness at face value, without an inkling that there was a connection to the movies. Therefore, there was no laughter or fun poked at me because I didn't like horror movies.
The third example I want to share is important because-for me-it validates the whole process that Dr. Jill presented in the seven sessions that I attended. This incident is key because it took place when I was in my early twenties and going to school at SJSU. We used to walk from our little back-of-the-main-house dwelling in downtown San Jose to a movie theater called Camera One. This movie house catered to the college crowd, showing vintage films as well as contemporary fare, changing the marquee almost every day, all for the suitably affordable price of one dollar. Generally, it was packed.
Remember, this was before the days of video machines, so the continuous availability of quality movies was a happening scene for the college kids who lived in the area and had limited funds. Unfortunately, especially in the summer heat, the theater could prove very claustrophobic, and I constantly feared for my social comfort.
On this occasion we went to see two classics in Harold and Maude and The King of Hearts. Anyone who has seen these entertaining films, remembers them fondly. Package them together and it's a no-lose proposition. Except for me, whose self-fulfilling prophecy was about to come true. For whatever reason I had a bad feeling about this particular night and I was sure I would be leaving the theater in a rush. I told myself that there would be no unexpected plot developments to derail me and that helped, but ultimately someone in the crowded theater responded outwardly in such a way as to trigger a full-blown panic attack.
Uncharacteristically, probably because I had unknowingly precipitated the attack due to my negative thinking, my response this time was that of disgust, as in, “Way to go, Dimbulb. You played that one perfectly; you got just what you expected.” The net result was that I was so angry at myself that I talked myself down and was able to recover without having to leave the theater.
Was I able to build on this? No way. Maybe because I had manufactured the attack myself, I must have felt that the whole talking down thing was an aberration, a one-time event that could not be repeated. Talk about a self-fulfilling prophecy. I find this third example to be the most intriguing because, had I recognized what had occurred, I could have built on it. I could have served as my own therapist and rid myself of something that I did not understand.
So church was the biggest concern for me as a child, and I got to experience it six days a week. Good Lord, no pun intended. But it wasn't just church; it was any public place where there was a crowd, or any enclosed space into which a bunch of people were jammed. The school district where I taught used to schedule meetings for all district personnel (more than a hundred) in a room the size of a broom closet. I could not force myself to enter; the best I could do was to hover outside the door, while business was conducted.
Needles, blood that was not mine (I saw a lot of my own blood because I was small and I moved entirely too fast and entirely too often for my own good), any kind of horror film, “The Twilight Zone,” “One Step Beyond,” crowds, enclosed spaces and fear of being the last one awake at night, were the ingredients that simmered always at the surface of my panic soup. From my current standpoint, I have to conclude that I was a real mess.
My wife says that this background helps explain my lifelong aversion to organized religion of any form. I consider myself a spiritual person but I'm very cynical about religion in general and Catholicism in particular. I thought it was because of Father Luke in my sophomore religion class who used to thunderously bellow that masturbation (he confused us at first by calling it self abuse) was a mortal sin, and that we would rot in hell for all eternity if we indulged. Now I realize that I had a pretty well-developed foundation for avoiding church already in place long before Father Luke doused the whole thing in gasoline.
One period of my life stands out as being reasonably free of event/crowd-inspired panic attacks, and this puzzled me until my wife pointed out the obvious solution. I refer to that period of time when I was in my late teens and early twenties when I took in a large number of rock concerts, ball games and other public events, but always under the influence of beer or reefer. By altering my state of mind I mostly avoided the consequences of panic attacks. Talk about cause and effect in terms of forming the classic dependency lifeline. By getting wasted, I not only avoided panic attacks, but got the added bonus of the euphoric feeling of being “high on drugs,” even if it was only lousy imported Mexican reefer and two cans of tall Oly. What a scene.
During all the years that I worked in the trades, or during the eight years I worked for the auto parts house, the panic attack issue never cropped up on the job because I was never in that confined environment or in a crowd of people. However, that changed when I began to teach; in fact, there were a number of problematic situations which developed to give me grief. One was the aforementioned crowded meetings in too-small places. Another was the series of films designed to keep educators informed on childhood health issues, either as a means of identifying these issues, or more importantly, avoiding them. If you have ever viewed one of those films on dentistry dilemmas, you will know what I'm saying.
Talk about horror films. The unexpected visual nature of people's dental afflictions was startling, inevitably resulting in my early exit. Of course, there were the usual films depicting inoculations (needles), first aid for injuries (blood), and it seemed as though we always viewed these films in dark, close quarters. Since I didn't have a label for my disorder, I couldn't even coherently explain to my administrator what the problem was.
And so my as-of-yet unnamed disease continued to exert control over my actions in an unplanned and, to a certain extent, unconscious manner. I always sat at the back left of any gathering; I always had a newspaper or some kind of written material on hand to divert my thinking (usually too little-too late); and I always arrived at the last possible minute so as to avoid being in the situation any longer than I needed to. I still did not realize that what I suffered from had a name and was treatable. I was also lucky that my crises had nothing to do with being in control of a class of thirty-two gnarly eighth graders. I never experienced a panic attack when dealing with students in my sixteen years of teaching.
One source of panic was the telephone. One day, two minutes before the morning bell rang, I answered the phone to learn that a specific student was to be joining my class immediately. A student study team had met and determined that this was the best course of action, but had neglected to delegate someone to inform me. The student in question was an emotionally disturbed kid who, two years ago, had spent a couple days with me at the start of his sixth grade. Midway through his second day, he interrupted my animated reading of Where the Red Fern Grows to ask, “Why the f**k do I have to sit here and listen to your stupid voice?” I responded neutrally that he didn't, because the principal would like to speak to him. He did not return.
Until now, that is. This last minute means of conveying critical information broke all conventional protocol concerning these types of situations. The idea of a student study team is to get all involved people on board. I was clearly left out of the loop, and the result was a full-fledged panic attack. I had to get out of there. I was lucky to have had an instructional assistant that period as I fled to the restroom.
One day I read a letter in an advice column, in which a person gave a detailed description of a condition that mirrored my own. In her response, the columnist not only labeled the condition as a panic attack syndrome, but wrote that it was curable. All that was required was a psychologist who specialized in this disorder. I was floored. I was also thrilled because I could do this; I have never had any problem whatever being able to communicate.
Unfortunately, because of my rural setting up in northern Mendocino County, psychologists experienced in panic attacks are not waiting on street corners carrying banners proclaiming their particular skills. I began my search in Willits and then expanded it to Ukiah with no luck. What I didn't do was check my own local community health center. I began by seeing a very competent person in Ukiah who was unable to solve the problem. A year or so after this I experienced such discomfort while anticipating an upcoming wedding that I decided to renew my search for someone who could help me.
I don't even remember how Annie stumbled across Dr. Jill's name; what is amazing to me is that I found the very person I had been looking for in my own backyard. There was no hesitation on my part when I called to make an appointment. What was strange was that there seemed to be hesitation on the part of the doctor to take me on as a patient. The person with whom I made the appointment, told me that Dr. Jill would see me for an initial consultation, and then would decide whether to take me on as a patient. I have to admit that I was taken aback by this approach. I felt as though I had to pass some sort of audition in order to be able to see this doctor. What if my problem was too complicated or, even worse, too boring?
As it turned out, I needn't have worried, at least not about that. Unknown to me until my seventh and final visit was the fact that, after thirteen years in the same place, Doctor Jill was only seven weeks away from relocating out of the area for personal reasons. Her concerns about taking on new patients at this late juncture were due to the nature of the counseling business and her unwillingness to start something that could not be completed. Unfortunately, not knowing this and being in a pretty fragile state, I was not impressed with the concept of “auditioning.”
I addressed this issue when Dr. Jill first escorted me down the corridor to her office. “I don't understand why you have to see me first before you decide to take me on as a patient.”
Her expression was one of surprise. “That's inaccurate. Who told you that?”
“The receptionist,” I responded.
“Well, there's been a miscommunication then, because you're here and if you're ready, we can begin.”
I was certainly ready, especially when she went on to tell me that she had treated many people with this disorder and that her success rate was very high.
“I can cure you,” she announced happily. “It's all about you and your willingness to do the work.”
“Oh, I'm ready; I've been ready my whole adult life.”
“There's a lot of reading, and if we're to make progress, you'll have to come in prepared to discuss what you've read.”
“I'm a good student,” I told her. “Being a teacher has made me realize how critical it is to come into 'class' ready.” I felt this overwhelming rush of emotion, because I was so close to my goal. This is when Dr. Jill uttered those immortal words.
Beaming radiantly, she announced, “I can definitely provide the road map for you, but you have to navigate. Panic attacks are completely avoidable, and once you eliminate them, you eliminate the anxiety that goes along with them.”
“I'm glad to hear that, because ultimately, that's the issue. I have a lot of trouble with anxiety and it makes it hard to leave the house, even for the most mundane of errands, let alone this big wedding that's coming up in October.” Since this was now the end of July, it gave me about ten weeks to get it together. Additionally, I was hoping that if I could succeed with Dr. Jill, I could stop taking the anti-anxiety drug that I had been taking for the last five years. It wasn't one of those notorious drugs which left one a little loopy; I never felt any physical change. However, I was assured by Annie that the drug was very effective.
I was an easier person to be around, she told me, because I was a lot better in the nagging and whining departments. I was also better able to handle excursions such as going to Ukiah or Eureka. But as my doctor had told me, it was a narcotic, and highly addictive. “You can't just stop taking it; you have to taper off over a six or eight week period.” So this was another reason I was hoping to encounter success with Dr. Jill.
We wasted no time. During the next half-hour I sponged up a reservoir of information including the following points: a panic attack is an unexpected, abrupt, intense fear or discomfort that can result in sweating, dizziness, unsteadiness or faintness; in contrast, anxiety is a persistent apprehension or worry that tends to build more slowly and be more generalized. Many people who suffer from panic disorder, develop anxiety issues due to an ongoing fear of an attack, and end up feeling afraid to leave home, a condition known as agoraphobia. When I say many people, just how many are we talking about?
The prevalence rate of agoraphobia is estimated to be about 3%-6% of the general population, which means in the United States alone, 7-12 million people. If we combine this with other phobic and anxiety issues, the rate goes up to 10%-12%. This represents a larger proportion of the population than those with alcohol or other drug abuse problems and makes anxiety disorders the number one mental health problem in the United States.
Though there was a wealth of pertinent information presented to me by Dr. Jill, the final thing I want to focus on is the discussion on the causes of the first panic attack. I have already detailed my own experience, so if I could determine the causes of it, I would have one more piece of the puzzle in place. What Dr. Jill told me about the surge of emotion which causes panic episodes, is that it is a normal bodily function, designed to operate in times of real danger (such as being attacked). What's off is the timing. To experience this flood of emotion or fear in circumstances that don't call for it, produces the onset of the panic, as in, “What's happening to my body and how can I stop it?”
Assuming that there is not a biological dysfunction or disease and that the attacks are not due to a chemical imbalance, then research indicates that the first attack seems to come in stressful times associated with either interpersonal conflict (dealing with important people in your life) or physical hardship.
As a means of coping with these disorders, people form patterns of avoidance or self-medication, or some combination of the two. I have already alluded to my own patterns of avoidance and self-medication, and I note that my case is fairly textbook perfect, though I wasn't able to make these conclusions on the morning of my first appointment. Instead, Dr. Jill spent the last few minutes explaining a strategy that would allow me to immediately start addressing my anxiety, something she called “Steps to Stopping Worry Thoughts,” which consisted of three questions.
The first of these questions required that I put an upcoming, anxiety-producing event in terms of a “What if?” question. Take the upcoming wedding. What is the worst that could happen? What if a sudden noise triggered a full-blown panic attack which forced me to leave in the middle of the ceremony, with everyone watching and my pants fell down as I stumbled out the side door? I suppose that would be a worst-case scenario. This part was easy.
The second question required that I ask if the worst-case scenario was life-threatening. If the answer is no, then the automatic response is, “Don't sweat the small stuff.” If the answer is yes, then you have a legitimate reason for anxiety, and you deal with it using a different strategy.
The third question asked me to simply reflect on the probability of this worst case scenario occurring, and accept the fact that, as far as the big picture was concerned, one panic attack more or less, was not important. What was important was to remember that in an uncertain world, there were many things that could occur that far surpassed a ten-thirty minute period of discomfort.
Dr. Jill sent me on my way with a chapter she xeroxed out of a book entitled Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic by David H. Barlow, and a whole lot to think about. What occupied me most was that last point about the cause of my first panic attack, that research indicated involved either interpersonal conflict or physical hardship. To save my life, I cannot think of an important person in my life with whom I had an ongoing conflict when I was ten years old. I squabbled with my siblings, but I loved them unconditionally, and I was in constant hot water with my parents, but what energetic, quick, severely A.D.D. child would not be in constant trouble? I still felt loved and supported by my parents.
My biggest conflict was trying to fit into the neat little package, which required me to abandon my natural tendency to bounce around my environment, in favor of a more sedentary existence. In other words, the world around me too frequently demanded that I “stifle myself,” a not-too-easy path to follow. This applied particularly to the requirement that all children who attended St. Martha's elementary school, also attend church services daily before school began.
The rules required that students sit with their respective classes, with first graders in the front, eighth graders to the rear, and all others appropriately arranged in between. This means that I was always situated in the center of a whole lot of kids, an unenviable scenario for a small boy who had trouble sitting quietly. This boy had a harder time still being in the middle of a mass of humanity, seemingly with a spotlight on him to regulate proper conduct, while a solemn service went on all around. Is that enough conflict?
As additional incentive for eventually having the proverbial dam burst was the regulation that stipulated that if a student(s) arrived late for the start of the service, he/she/they were required to sit in a special pew by themselves until after all the other kids had returned to class, so that the parish pastor could change out of his vestments, and scurry out to grill all of the tardy miscreants as to the reason for said tardiness. Since the problem in my case involved a carpool issue, over which I had no control, I found myself even additionally pressured by the whole attend-mass-daily mandate.
I have no problem associating the origins of my panic disorder with this forced attendance of a service that consisted of the use of Latin, without a word of English spoken in the entire half-hour. We couldn't eat breakfast before school if we “wanted” to receive Holy Communion, because of the rules on fasting, so I was perpetually hungry in the morning. Of course, all children were conditioned to “want” to receive Holy Communion, because to not do so was to suggest that that child was not pure enough and needed to go to confession. We were allowed to wear only our school sweaters when it was cold (there were no “school jackets”) so we huddled in this cold church and tried to make it through until the start of the school day.
I can remember not whining about the whole church thing, because to do so, would be to open up the unthinkable can of worms, one which might lead to the discovery that certain small boys did not like to go to church, and therefore were in danger of spending all eternity in the fires of hell. One might ponder the possibility that this combination of factors could lead to a great enough internal conflict as to create the surge of emotion necessary to trigger a panic attack. Physical hardship? I think there was plenty to go around.
Though I now find reflecting on these matters to be a fascinating experience, I must emphasize that, at the time of these first visits, I was nowhere near the point where I could start to internalize and draw conclusions. I was happy to take my “Steps for Stopping Worrying” and my chapter on background information home to absorb and try to apply to my own situation. Dr. Jill had suggested that, whereas reading the material was good, reading the material twice was better. I realized that this was the part where I had to follow through on my commitment to come in for sessions prepared to examine and discuss the relevant reading.
It took Dr. Jill exactly half-way through the second of our sessions to conclude that the focus of our work should shift from that of panic attacks to that of anxiety in general. As I write these words, everything seems so straightforward, but that is far from the truth. This specific shift in focus came about through our earliest discussions in which Dr. Jill determined that, because of the infrequency of actual panic attacks (I rarely put myself in that position) and because I seemed to have so many sources of anxiety, we should concentrate on a more generalized strategy for preparing me to get out in the world more often, specifically to the wedding in Grass Valley.
This aspect of my therapeutic journey stands out as critical, simply because time was such a factor. We needed time in the health center to exchange information, and I needed time to sort everything out and try to pinpoint how it applied to me. Dr. Jill knew that we were limited to seven weeks, so her ability to muddle through all of the details of my disorder and settle on the best process to follow is the key component to my success. In determining this approach to be best, Dr. Jill asked me at the end of my second session to go home and brainstorm all of the potential sources of anxiety in my life, jot them down and apply the questions from the stop worrying steps to my list of anxiety issues. She also gave me a chapter of reading to do entitled “Understanding Your Problems.” Again, this dual approach of acquiring background information, while delving inward to see how it applied to me, was right on target.
Of course, now glancing through this list of anxiety issues I compiled, I am embarrassed by the tame nature of some of them; maybe I was stretching for a few of them, and maybe I wasn't. Some seem very simple, very basic: What if our source of water proves insufficient to supply water to three households? Is this a matter of life and death? No, this is a degree of comfort or convenience. There may not be enough water to keep the grass green, but there was enough to water the necessary agriculture that we relied on to get us through the winter. Additionally, this potential water shortage was still only a possibility, so there was no reason to fixate on it. Besides, we had not as yet tapped into the pond, which could supply all the agricultural water we could possibly need, There simply was no logical basis for anxiety. This is what I trained myself to start saying every time I ran the situation through my mind.
Of course, this is what Dr. Jill wanted me to recognize. But it wouldn't work if she herself pointed it out; I had to make that connection on my own. The next item on the list was not so simple, but still seemed to lack substance as far as legitimate fonts of anxiety went. This involved the return of the community softball games that were so popular in the early to mid-eighties. People from all over the mountain showed up to play and we had a lot of fun. In those days I was fleet of foot and pretty daring so I played a mean left field. Unfortunately, in the interim, I had blown out the A.C.L. on my left knee, which meant I could no longer play baseball. The surgeon who had taken the tendon from my ankle to use in my knee had told me that he could only do this once, so I had to give up any physical activity which could result in further damage.
My anxiety stemmed from the fact that, aside from being a public event, it was also an event where people had certain expectations of my participation. I feared that there would be a general, good-natured refusal to accept my explanation, and I would end up feeling like a goat. I felt that for me to remain in the middle of the action without playing would be a very uncomfortable scene. When I apply the three questions, though, things quickly fall into perspective. Life or death? Not. Worst case scenario? People try to goad me into playing; I show them my scar; that ends the discussion. High probability of occurring? I don't think it mattered.
As I continued down my list of anxiety issues and inserted the questions, I began to appreciate the simplicity of the whole process. The concept of mind over matter applied here, that for one to recognize and address a problem, put one more than half-way to the solution. This was working out just fine for me. What was next?
The next thing that Dr. Jill wanted me to work on was the need for me to start monitoring my own reactions to stressful situations or thoughts, by assigning a numerical value to these reactions. She explained the importance of being able to do this as being the difference between having these strong, albeit vague notions of impending doom, versus having well-defined views on a particular issue. Memory can be a tricky thing; certain memories trigger negative reactions. By jotting down specific emotional reactions to particular events, one can review these notes to retain an accurate record of impressions. This helps control later reflection which in the past was apt to return to that vague impending doom approach, rather than a more objective outlook which included specific review of previous responses. The reason people find this numerical evaluation hard, is because feelings and emotions are notorious for being vague and indefinable. Therefore, attempting to keep a finger on the pulse of these feelings requires practice and patience.
I began to keep a “daily mood record” designed as a tool for regulating my rate of anxiety, depression and anticipation/worry on a scale of one (no anxiety/depression) to eight (extreme amounts of either/both). I cannot over-emphasize the importance of this somewhat pedantic approach. Annie tells me that this step of the process was very difficult for me and that I resisted for several days while I tried to come to grips with the proverbial rock and a hard place, and being stuck.
I wanted to succeed, but I was angry that the process was getting in the way. I am now able to see why it is that therapy is so hit and miss. For internal change to happen, paradigm shifts must occur. Being angry about [perceived] unreasonable requests is part of the pattern of negative thinking which creates the ditch in which people get stuck. For me, it meant that I had to overcome the “unfairness” of it all, before I could comply with the request.
I found it impossible to affix a numerical value on my feelings, and that's the whole point. If it were easy, 10%-12% of the general population would not be suffering from various mental health issues. When I reached this point in my thinking, I looked at my recently compiled list of current anxiety concerns, considered my level of stress at that moment and simply assigned a midrange numerical value. Using that moment as an immediate reference point, the following morning I again examined my level of stress at that very moment, and assigned a numerical value based on the number and frame of mind I had been in the previous evening. I repeated this same strategy that night, and again-twice-the following day.
Two “funny” things began to emerge. The first was that, after establishing the criteria, as seemingly arbitrary as it was, the process of assigning a numerical value became easy, so easy that I thought I might not be on the right track. The other funny thing is that as time went by, my numerical rate of anxiety began to drop.
So I learned to build on the numbers already logged. Thus, as days progressed, I found it became easier because I was able to compare my numbers after recording impressions of different events. Instead of reinventing the wheel every day, my recordings became relative to earlier findings.
My “daily mood record” began to pay dividends. Whereas the original purpose of this daily record may have been to try and anticipate or predict the likelihood of a panic attack (Remember, stress and physical hardship contribute greatly to panic attacks), ultimately the daily record provided ongoing daily reminders that anxiety can be quantified, and therefore better managed. Any time one can take what appears to be a vast quantity of anything (in this case anxiety) and put a value on it, one takes the initial steps to get eventual control. Even noting that things are better today than yesterday (according to the chart) is a form of logic that helps overcome negative thinking and patterns of negative action. So this daily record proved to be valuable in its own way, even if the original intended purpose did not apply to me the way it might have applied to someone else.
These tools that Dr. Jill provided for me during our sessions together were (and remain so) instrumental for me to get a handle on my disorder. As with any structure, literal or metaphorical, the foundation must be in place before the main construction can occur. Once I was keeping a daily record of my anxiety rate, I began to realize that the amount of worry I experienced and recorded, began to seem less prevalent, and that I could better regulate my response to upcoming events based on the way I had responded in the past. The key was to be able to benefit from these recordings over a period of time, using the information already recorded as a basis for further evaluation.
Now that I had fortified myself with some background information and had begun to record my daily anxiety rates, I was ready to begin developing a perspective for changing my reactions. In other words, if I could put feelings and emotions down in the form of a number, I could start to form conclusions relating to cause and effect. Because I was able to eliminate the overwhelming nature of impending events by seeing for myself that the amount of stress was measurable and manageable, I was able to become more aware of the nature of my disorder.
Because panic attacks are comprised of physiology, thoughts and behavior, we can break down the overwhelming nature of the anxiety produced by these attacks and address each of the components individually. This allows a person to effectively progress towards management techniques, without getting bogged down by emotions.
So I learned to examine what was happening physically (dizziness, nausea, sweating) and what I was thinking as a result (I'm losing control) with how I behaved (I have to get out of here). Understanding how interconnected these components are allowed me to see how mixing up the order in which these components occur could benefit me. By controlling the way I thought, I could begin to control the way I felt, and therefore the way I behaved. If I could reduce a vague apprehension of an upcoming event to a particular numerical figure reflecting degree of anxiety, I could convince myself that there was no reason to be worried and therefore, a more relaxed state of mind produces a more relaxed state of body.
The natural result is a reduction in anxiety and an eventual cessation of panic attacks. On paper it seems so simple, because the process is simple. That doesn't mean it's easy, just that the concept is an easy one to grasp. Mind over matter is the way I described it earlier, and it's based on the ability to monitor and interpret one's emotions and feelings.
By the time I was beginning my fourth session (total elapsed time in Dr. Jill's office up until this point: two hours, thirty minutes), we were ready to begin work on the concept of self-talk. I frequently put situations in terms of big picture versus immediate picture. As far as my visits to Dr. Jill were concerned, I was never able to get a remote idea of what the big picture was all about, except for the goal of “being cured.” I was all about the immediacy of the moment. Now it all fits neatly together under the umbrella of the process, and I can see how each step led to the next.
Self-talk involves patterns of negative thinking which contribute to social paralysis. Focus on two individuals sitting in a crowded doctor's office. One has nothing in his hands and is fidgeting nervously. His thinking dwells on the length of time he has been sitting there, the length of time still remaining, and the unfairness of it all. The other has brought today's paper, his current who-done-it that he is reading, and his thinking dwells on the realization that, though earlier patients may have gone over the allotted time, when his turn comes, he will have all the time he needs, even if it should go over the allotted time.
The same individual who resents sitting in the doctor's office, also engages in non-stop internal dialogue which frequently consists of such questions as “What if?” as in “What if I panic?” or “What if I can't handle it?” or possibly the most important, “What if someone sees that I am stressed?” This first individual tends to catastrophize, or think the worst. The other individual may ask the same questions, but also has a ready response to each: “Is it a life or death situation?” or “What's the likelihood of this happening?” and additionally, “I've been here before, and not had any of those negative things happen.” The second person builds on the former foundation of his therapy.
What is self-talk and how does it relate to anxiety? Self-talk becomes a way of thinking so ingrained that it becomes part of the flow of consciousness, so one doesn't perceive a change in mood or attitude which explains a sudden reaction to external factors. Only later, after reflection, can one make a connection between self-talk and related feelings. Being aware of this internal discussion is key to being able to control it.
I think of self-talk as mental, spontaneous combustion, the ability to look at one image, or hear one word, and react as though your mind had just processed a series of thoughts/actions/reactions in response to that one image or word. For example, when you feel yourself tense up and hear yourself saying uh-oh, and you know what's coming, you have to have the tools to combat this overwhelming tsunami of emotion, and those tools must be just as capable of supplying a comparable amount of experiences and methods of dealing with these emotions. The net result is the ability to talk oneself down without drama or uncertainty. Cause and effect must apply: Because I have a spontaneous physical reaction to a given word or image, I must have spontaneous internal strategy to cope with it.
Anxious self-talk runs contrary to reason, even though it may sound like the truth. “What-if” thinking, while leading one to fear an unlikely occurrence, happens so quickly that one's mind accepts it as reality, even if logically, one may be aware that there is little chance of this thing happening.
Negative self-talk fosters disorders such as agoraphobia, because one convinces oneself that the solution to avoiding anxiety in public is to simply refrain from going out in public. There, that was easy. Self-talk leads to avoidance, which promotes more self-talk and so on.
Self-talk can start a panic attack or even exacerbate it. (Remember my experience in the movie theater, when I first talked myself into a panic attack, and then talked myself out of it?)
Self-talk is a series of bad mental habits. Any habit develops as a result of repetition, whether it is smoking, jogging or avoiding public places because of negative self-talk. Just as you can change a physical bad habit like smoking by consciously avoiding it, you can also change a mental bad habit by consciously recognizing it as being negative, and then avoiding it. Just as quitting smoking requires perseverance, so does changing your thinking from negative to positive.
Recognizing self-talk for being what it is represents a huge step forward. I found this leg of the therapeutic journey to be most beneficial, as far as life after panic attacks goes. How did I counter negative self-talk? I followed the blueprint I used for my mood chart, plunging right in before I gave myself time to “negative self-talk” my way right out of it.
Just as I found it difficult to measure anxiety by assigning a numerical value to it, so did I find it difficult to address counter-arguments for self-talk. I got out the same list of anxiety issues that I had brainstormed when I was first practicing the steps for stopping worrying, and started plugging in positive statements that refuted the negative ones. Just as negative self-talk builds over time to dominate a person's thinking, it takes time to accomplish the programing of positive, support statements to counter the negativity. The process includes listing the potential anxiety-producing situations, and then writing down the positive counter-arguments.
This takes practice. The ability to first of all identify the negative self-talk, and then to address it by using tangible means (writing it down) allows a person to turn his/her thinking around. One key is to make sure that the positive counter statements are accurate and believable. The practicing part is not possible if the script is not believable. In other words, if I was worried about attending a wedding because of the church ceremony, and I tried to convince myself that I had nothing to worry about because I had never had a panic attack in that particular church, I wouldn't get very far. On the other hand, if I used the argument that I wouldn't have a panic attack because I was fully prepared to use all my new tools to build on the success I had been experiencing the past month or so, I would be in far better shape to cope with the anxiety naturally associated with an event of this kind.
By writing down all of my thoughts tied to this particular occasion, I was then able to review the entire thought process from beginning to end, with the ongoing goal of strengthening my new-found ability for changing negative thought patterns to positive. No therapist or expert in mental health can do this for you; it goes back to the theory of “no pain, no gain.” The act of digging, scratching and clawing up the information so buried in the formation of my personality, was so profoundly difficult, that having succeeded in initiating the process, forward progress became paramount. As with the mood chart, each word that I put down to counter negative self-talk, came easier than the previous one. Success on the small levels portends greater success on the big levels.
How did I measure success? Over time. Therapy was the pebble being dropped into the pond. The initial ripples represent the learning that goes on; the spreading of the ripples to a wide area is the success that you feel in your life as you apply the learning to the life experience. I begin with outward tangible results.
I drove down to Willits two weeks ago, on a Sunday morning, to get some groceries, run a few errands, and pick up a package at my son Ben's house. When he came to the door in response to my knock, he looked around and then behind me. “Where's Mom?” he asked.
“Up in her sewing room? Is this a test?” I laughed.
“No, I mean, Mom's always here when you're here, that's all.”
“Well, I needed some stuff at the store, and I wanted to get my Giants' sweatshirt from you, so here I am. Annie had some quilting to do, so she's not. Here. I mean.”
He took a step back and looked at me closer. “Well, good for you.”
“What's good for me?”
“That you're down here and Mom's not.”
“What's the deal? I am perfectly capable of driving down to Willits when I want. I just usually don't want.”
“No, Dad. I mean, a year ago, you couldn't have driven down here.”
Oh, malarky. I drove down here every other day when Annie was caring for your grandmother,” I protested..
He wasn't having any of it. “That was different, because you were only going one way and you had great motivation. Coming down here by yourself, running errands, including stopping by here to chat, and then going back up on the mountain-that's different. I'm real proud of you; you've come a long way.”
Of course, he was right. It may not have been quantifiable data, but personal observations about a change in someone's routine qualify as measurable data. My agoraphobic tendencies melted away as the tools asserted themselves and negative patterns of thinking gave way to positive change. The fear of an actual panic attack faded quickly, and shortly thereafter followed the cloud of anxiety produced by the panic attacks. I had always considered the panic attacks to be the biggest issue, but I now realize it was worrying about the attacks, not the attacks themselves, that was the biggest problem.
That same logic of the anticipation/anxiety outweighing the event itself, applied to any public venture, including the trips to Willits to shop. Hating to go to town to run errands because it's a pain in the neck is one thing, being anxious about it is a whole different thing. It goes back to the ability to reprogram my mind and address the negative self-talk. Painting a clear picture mentally about what's entailed allows one to diminish the vagueness of “hating to go to town.”
Other signs of success? I'm very excited to be attending a Giants/Braves game on Easter Sunday, taking the ferry from Larkspur in to the ballpark, or even opting to stay over in The City, another thing that couldn't have happened a year ago.
Aside from outward indications, mental changes include a substantial shift in in the way I process words and events and also in the way I monitor what I say. Whining to me always referred to little kids, in a very literal interpretation. Now I understand those flyers with the line through the circle, imposed over the word “whining.” I don't need to hear your problems, just as you don't need to hear every single trial and tribulation I encountered in my day as well. I remember peeling potatoes in the kitchen, while my mom and dad went over the events of the day. There were very few reasons why a kid would ever be in the kitchen at this moment, but peeling potatoes onto a spread-out newspaper, on one end of the picnic-style, kitchen table was one of them.
Going over the events of the day consisted of Papa detailing life at the steel factory where he worked, a day filled with the injustices of a hard job, made harder by heat and cold, and made unbearable by the petty tyrannies of the upper echelon.
Though he got along well with the other workers, and his expertise as a heli-arc welder set him apart, he still struggled daily to deal with what he felt were incapable men asking unreasonable accomplishments, in an unfair amount of time, for a minimal amount of money...the list was endless. I know where my patterns of negative thinking originated, and I now can clearly see how the threat of panic attacks fueled my negative thinking, particularly when it came to catastrophizing upcoming events.
Another non-measurable (except through observation), significant mental shift, was to recognize and stop the passive/aggressive approach of playing the read-my-mind game. This would begin as a trip to it-could-be-anywhere by Annie, an unspoken assumption by me that fill-in-the-blank would be acquired and subsequent “punishment” in the form of-again, non-spoken-actions which indicated displeasure, without explanation for the behavior. My negative self-talk monologue would go something like this: “She knows that I use enough mustard to float the Titanic, why wouldn't she have just known to buy it because she hasn't had to for a while? It's not rocket science. I notice she remembered to buy herself her favorite tea.” It didn't happen very often, or some sort of compromise would have to have been worked out, but it happened often enough to foster the negative self-talk.
Because Annie has gluten issues, we frequently prepare our own separate meals with different components. I began by establishing that Annie was no more responsible for shopping for my food needs, than I would be responsible for shopping for her food needs. If she was going shopping for household groceries, then I could furnish her with the list of my requested items, and if something was not on the list, I would not expect to see it materialize in the kitchen upon her return. By extending this concept of no mind reading to include other potential sources of confusion (trips to the building supply outfit or Costco), I was able to change bad mental habits to form better ways of communicating.
By changing the routine of how we went about acquiring food to meet personal needs, we established a new routine that incorporated the new communication process, and thus helped eliminate one aspect of negative self-talk.
Many of my anxiety issues stemmed from forming conclusions based on faulty logic. The clinical name for this is “distorted thinking,” and there are many different varieties. Dr. Jill asked me to study fifteen of them and single out the ones that applied to me, so I have listed the fifteen with a very brief description of each.
1. Filtering: Take the negative details and magnify them, while filtering out all positive aspects of a situation.
2. Polarized Thinking: Things are black and white, good or bad; you are perfect or you are a failure. There is no middle ground.
3. Overgeneralization: You come to a general conclusion based on a single incident or piece of evidence. If something bad happened once, you expect it to happen again.
4. Mind Reading: Through unspoken means, you know what people are feeling and why they act the way they do. In particular you are able to determine how people are feeling toward you.
5. Catastrophizing: You expect disaster; your world is filled with “What if's?” and visions of tragedy. What if it happens to you?
6. Personalization: You think everything people do or say is in reaction to you; you compare yourself or your actions to others.
7. Control fallacies: If you feel externally controlled, you view yourself as a puppet; the fallacy of internal control assigns you responsibility for the pain and happiness of everyone around you.
8. Fallacy of fairness: You feel resentful because you think you know what is fair, but other people won't agree with you.
9. Blaming: You hold other people responsible for your discomfort, or operate on the reverse level and blame yourself for others' problems.
10. Shoulds: You have a list of ironclad rules about how you and other people should act. People who break the rules anger you, and you get angry at yourself when you can't follow the rules.
11. Emotional reasoning: You believe that what you feel must be true-automatically. If you feel stupid and boring, you must be...
12. Fallacy of change: You expect that other people will change if you just pressure them enough; you need to change people because because your hopes for happiness seem to depend entirely on them.
13.Global labeling: You generalize one or two qualities into a negative global judgment.
14.Being right: You are continually on trial to prove that your opinions and actions are correct. Being wrong is unthinkable and you will go to any length to prove that you are right.
15.Heaven's reward fallacy: You expect all your sacrifice and self-denial to pay off, as if there were someone keeping score. You feel bitter when the reward doesn't come.
Doesn't my self-talk example of Annie not reading my mind and buying the mustard sound like number ten, the “should” category? After all, shouldn't she have known that I would be needing mustard and that she would need to pick some up?
“Filtering” came in to play in the anxiety of anticipating the upcoming wedding; I never focused on the joy of the event or the pleasure of seeing my family members, only on the possibility that I would suffer another panic attack.
I've addressed catastrophizing and how it applies to me, but there's also heaven's reward fallacy. In my role as househusband, there have been times in the past when I have cleaned up the house and then stood back as Annie came home. Though I didn't necessarily expect heaven's reward, I may have been expecting a red carpet or a drum roll.
Failing to get the expected reaction might have had the effect of making me slip into one of those negative self-talk modes, where I then went on to exhibit displeasure without explaining why. Each person who looks at the list of distorted thinking examples, must select the ones that apply and work on developing methods of replacing these thinking distortions with positive change.
Having presented fifteen different types of distorted thinking, I want to present a situation in which I felt an overwhelming rush of emotion, and how I applied the distorted thinking to understand where the emotion came from. My son Casey gave me a laptop for my birthday last September. He had asked me a few days prior to that if I ever thought about replacing my old one, and I had told him only if I could choose the replacement model, so that I could keep it simple. Well, it turned out that he had put the cart before the horse by purchasing the laptop first and then having the conversation with me. Of course, I didn't know he had already bought one, so I just responded honestly. When he presented it to me, he told me he would understand if I chose to pass on it. You have to realize that there was some history here.
A few years back Casey had acquired a laptop that had been assembled by a friend out of components from more than one computer. I used this laptop for quite a while, including writing an extensive journal of my experiences on a trip to Chicago. Unfortunately, there were some features about this computer, including the most sensitive mouse I had ever encountered, that made it frustrating to use, and I eventually abandoned it, but the experience left me feeling hesitant about getting tangled up in computers again.
Being suddenly presented with another, updated laptop, created a surge of emotion which overwhelmed me and made it impossible to think rationally. Of course, tears were already forming as I thanked Casey profusely, but told him that I was going to have to pass, at least for the time being. As I recovered my balance, I tried to impress upon Casey my appreciation for his generosity, but that I was encountering some technical difficulties, and would get back to him. I wanted to let a day or so go by, while I looked over my tools and tried to understand what had happened.
I took the list of distorted thinking examples and tried to apply it to this situation. The first laptop I had owned had proved to be too technologically sophisticated for me to ever get comfortable with, but I had invested so much time and effort in it, that I felt ripped off and vowed to be more careful in the future. Now, with another opportunity to jump into the laptop arena, I was overgeneralizing to the extent that I was allowing one negative experience to affect future decision-making.
I managed to effectively block out the good things about the original laptop, including the fact that I had done a great job on a lengthy piece of writing. Furthermore, I had been able to work in the wee hours of the morning because of its versatility, and I had been able to access the Internet on it. By dwelling only on the problem of the sensitive mouse, which caused numerous difficulties with the location of the cursor, I effectively filtered out all of the positive elements, contributing to the negative self-talk playing in my head.
Within the distorted thinking framework, there is a lot of room for overlapping. This overlapping occurs only in the analytical process, of course, where two strands of distorted thinking obviously parallel one another, and not within the realm of the experience itself. Any blending that occurs meshes well with the general sense of emotional turmoil which accompanies anxiety and panic issues.
I applied the control fallacy to my situation because I realized that one negative element of the first laptop had risen in prominence to the point where it influenced whether or not I could continue writing on the computer. Any time that one factor dominates an agenda to the point where other success is ignored, then control becomes an issue, as in, “Who's running the show, the computer operator or the computer?”
I also remember saying to Annie, “That laptop was a loser from the day it slunk into this house,” whereupon I also assigned the global labeling tag on it. I allowed one negative element to not only dominate the whole experience, but to extend its powers of influence back to a point where the sensitive mouse issue had not yet arisen. This clouding of time frame serves to expand the vague, but pervasive, notion that it was all bad and shouldn't be repeated.
No list of mine could ever be complete without the distorted thinking element of catastrophizing. “What if I get another laptop and the mouse is just as bad? What if I get a new laptop and I can't find a compatible printer? What if I find a new laptop and it has an incomprehensible habit of losing portions of saved documents, irretrievably?” I could have started with catastrophizing, but in real life, there's no starting with this or that; rather, there's a combination of everything all at once. This leads to an inability to receive a gift on one's birthday without falling apart.
Only afterward, when the emotional cloud has dissipated and the tools come out, can the situation be more objectively examined.
Any issue that is clouded by emotion, needs to be objectively examined for instances of distorted thinking. I have that list handy as one of those “tools” I keep referring to when I'm dealing with emotions. I also have all of the chapters of reading that Dr. Jill xeroxed for me. I didn't come close to covering all of the information that was available; instead, I focused on those tools which seemed to fit my needs. I think anyone who reads this narrative, and sees familiar problems or patterns of thinking, should seek out a qualified therapist, whose expertise covers anxiety- related issues.
My own patterns of thinking continue to allow for recognition of negative self-talk, along with a forum for change. This is the part of the whole journey that I never fully grasped or appreciated until now: Establishing normalcy of life after a forty-nine year hiatus, is progress enough, without adding to it the ability to better sift through my flow of consciousness for any stray bits of self-talk. For me to be able to apply the lessons learned in the doctor's office is the ultimate success story.
I've arrived back from my journey now, I've unpacked my bags, and I've written most of it down. The only thing left is to continue trying to help facilitate the changing of bad mental habits to good ones, because good mental habits lead to good physical habits, and these can be observed and noted. This leads to good things happening which leads to less stress. Who knows? Maybe this will lead to me being able to watch a close Giants game through to its conclusion, without having to bail out partway through because of the torture.
Two theorists who have contributed much to combating distorted thinking are Albert Ellis and Aaron Beck.