The Anxiety Treatment Center
How I Work With People Who Have Anxiety and Panic Attacks
One of the most important things I have learned after working with hundreds of clients with anxiety disorder is that in many circumstances anxiety can be controlled. It is possible for you to overcome your anxiety and reduce panic attacks by learning how to control your thoughts. I also use a simple monitoring device to show your how your body physically creates panic by shortening your breath and raising your heart rate.
I am Arlene Foreman, M.S. a licensed mental health counselor. I have been helping clients with anxiety disorder in the Main Line and Philadelphia area for over 25 years. I have the training and experience to help you identify your symptoms of anxiety and I can teach you methods to help mitigate your anxiety.
Read on and listen to my recording. This website will help you identify the symptoms of anxiety and introduce you to our treatment method.
Listen to an Interview with Arlene Foreman about Anxiety Disorders and Treatment
(38 min. 39 sec.)
You know the symptoms – the pounding heart, the sweaty palms, the racing thoughts, the dread that wakes you up in the middle of the night. You know what these symptoms mean – another panic attack. You think you’re going crazy. Our bodies are betraying us but we have no idea why. No matter how many times this has happened to us in the past, it always seems to come as a surprise. What sets it off? It could be anything, it could be nothing at all. It just happens – like a bolt out of the blue.
Naturally, all you want to do is avoid it – but how? How can you run away? It’s as if you’re locked in a house and a tiger suddenly crashes through the window. You scramble to the door, trying to escape – but the door is bolted shut.
How can you open the door? Better yet: What do you have to do to make sure that no tiger ever comes flying in through the window again?
If you’ve lived in fear of this tiger for years – even decades as some of my clients have – you may think that there’s nothing that can be done. But here’s a secret: anxiety can be successfully treated and in many cases even eliminated. Once you identify the source of these symptoms you can stop being scared of them. And when you stop being scared of them they lose their power over you.
First, though, it’s crucial for you to know what anxiety is – and what it isn’t.
Stress in Our Lives: What’s Normal, What’s Not
Anxiety is not a psychological disorder, it’s a medical disorder. In other words, anxiety isn’t a mental illness; all those symptoms you experience during a panic attack – the pounding heart, the dry mouth, the thoughts you can’t stop — arise because your body has gone into overdrive. That happens for any number of reasons – some genetic, some a result of upbringing – but whatever their cause, with treatment, these symptoms can diminish or be made to disappear altogether.
Stress, if it continues long enough, can lead to anxiety. There are many kinds of stresses in our lives, many of them unavoidable. Almost none of us can escape heartache, serious injury and loss. Even small annoyances can add up. We routinely have to endure long lines, traffic jams, and calls from telemarketers. There are even stresses that can be positive – a job promotion, a wedding, a new child in the family; in fact, just about any significant change can produce stress. It really comes down to how we respond to it that counts. Stress can’t be eliminated, but it can be managed.
At one time even doctors used to downplay the role of stress as a contributing factor to illness. Now they know better. According to the American Institute of Stress, up to 90 percent of all health problems are related to stress; some are caused directly by stress while others are made worse by stress. And nothing heightens the impact of stress more than anxiety.
Anxiety is not a matter of being worried a lot. Yes, it’s true that people who have anxiety worry all the time (usually for the wrong reasons), but worry and anxiety are not the same things. Worrying isn’t innate, which is to say we weren’t born worriers; we had to learn how to worry. It’s a habit. We worry because we think it may be a way to forestall disaster. Nor can worrying be confused with concern. A concern is when you have a teenage son who’s not home at three in the morning. Worry is when you go on a trip and think you’ve forgotten something without being sure what it is. Worrying means you don’t do, you stew. Do I need to add that worrying is unproductive? Anxious people often worry about what other people will think of them, they worry about embarrassing themselves or showing inappropriate anger or fear. So in that sense worry can set you up for an anxiety disorder. Worrying, as one wit once put it, is paying interest on a debt that you probably won’t ever owe.
Anxiety isn’t a phobia, either. We all have phobias, some simply quirky (a fear of the number 13), others more debilitating (a fear of flying). But phobias usually come into play only on specific occasions. Anxiety, on the other hand, is constant and unrelenting.
Anxiety shouldn’t be confused with depression. However, when you’re scared year after year and feel out of control you are putting yourself at increasing risk of depression.
Finally, an anxiety disorder isn’t the same thing as being anxious. At one point or another everyone is anxious. If your husband or wife is going to the hospital for surgery, for instance, or your child is in an accident then being anxious is a perfectly normal response. Being anxious implies that there is something concrete to be anxious about. By contrast, in anxiety disorders, people are usually anxious about possible disasters that exist only in their minds.
Have you ever taken a ride on a roller-coaster? If you have then you probably remember how it felt to be perched at the edge of a precipice and feel the rush that comes from hurtling down at an impossible speed. Your heart beats wildly, adrenalin courses through your blood, there’s a hollow at the pit of your stomach – in short, you’re scared. But that’s how you expect to feel on a roller-coaster ride. Those symptoms are part of the thrill. If you weren’t scared you wouldn’t enjoy it so much. But aren’t those the same symptoms you experience in a panic attack? That’s why the symptoms seem so oddly familiar. You’ve had them before – when you didn’t have anxiety. The only difference is context.
As human beings, we have only survived because of the by-now well known flight-or-fight response. If danger threatens – even if the danger is only illusory as it is on a roller-coaster – the body reacts a certain way. It sends signals which tell us we have to do something about the situation – and quickly. The body has become aroused. What happens in anger, panic and anxiety is the same thing: arousal. The body sends messages which say: Fight if necessary, run if that makes more sense. Remember, though, that the body is responding not to danger itself but the perception of danger. Once we perceive that the danger has passed there’s no need for the body to remain mobilized; we can get off the roller-coaster. Normally, the symptoms vanish and the body relaxes. But if you suffer from anxiety, the symptoms are so exaggerated that you fail to realize that these symptoms aren’t so unusual, after all, it’s just that you aren’t connecting the dots. That’s because these same feelings seem to be occurring for no obvious reason; in other words, they aren’t a normal reaction to arousal. Instead, we become convinced that we have never felt this way before and that we must be suffering from some catastrophic disease or that something awful is happening. We look around, expecting to find the tiger. Anxiety is really an adaptive mechanism everyone is born with – it’s just that with people who have anxiety all the time it’s gotten seriously out of whack.
As soon as the body starts sending ‘fear’ messages to our brain it sets in motion a number of predictable biochemical processes: blood rushes to the extremities and pools in our stomach, lungs, and heart. It’s this rapid blood movement that causes dizziness, numbness in the hands and feet, dry mouth and inability to focus clearly. It’s what accounts for your upset stomach and hyperventilation. Naturally, we desperately want to avoid any situation that can produce such a barrage of unpleasant symptoms and get somewhere safe. We come up with excuses to get out of doing things or going places which we consider threatening, in effect, turning ‘I don’t want to’ into ‘I can’t.’ But how can we ever be safe if we’re afraid of our own bodies?
But there’s no reason to run, no reason for avoidance. I cannot emphasize strongly enough that the behavior that generates these symptoms is learned. And that means it can be unlearned.
Anticipating the Symptoms
Without knowing when the next panic attack will occur, you’re always on guard, always living in anticipation of something terrible happening. Unrealistic fears breed more unrealistic fears. We can imagine every conceivable scenario – except a positive one. One of my patients told me that she was afraid that she would harm or even kill a baby. She didn’t have a baby, she’d never harmed a baby in the past, and she had no contact with infants in her daily life. But it didn’t matter. She was convinced that she was a danger to babies. Imagining the worst is, in the words of one writer, “fine-tuning” the panic reaction.
What about a person who feels uneasy all the time but isn’t having a full-blown panic attack? His body isn’t sending signals of danger so much as it’s oozing adrenaline, keeping him perpetually on edge. While no avoidance behaviors develop, every accomplishment seems like a daunting chore. It’s like living with a low-grade fever 24/7. Someone with this kind of anxiety is bearing the burden of too many pressures without having the coping skills necessary to deal with them. That doesn’t mean that a person like this has a weak character. Although chronic anxiety isn’t marked by panic attacks, it’s an anxiety disorder all the same. So the remedy for chronic anxiety and the remedy for panic attacks turn out to be exactly the same, too.
Ready to get in touch?
Call us: (888) 242-1720
People with anxiety naturally wonder what they’ve done to deserve their fate. Why me? Sometimes it’s just the (bad) luck of the draw. Certain people are born anxious – literally. Children can have anxiety. I’ve had clients who tell me that when they were five years old they were terrified of leaving their mother’s side to go to nursery school. But their brothers and sisters never felt that way. These individuals just happened to be born with a super-sensitive nervous system. Environmental factors can promote anxiety, too; children who grow up in families with a history of alcoholism or suffer from sexual or physical abuse are also more likely to develop anxiety. Trauma later on in life can also induce anxiety disorder or worsen its effects. But whether genetic or environmental in origin or more likely a combination of the two, the suffering is just as intense and just as treatable.
What Happens to Our Bodies?
In a state of anxiety, everything is sped up in the body. The adrenal glands are pushed to pump out more adrenaline. The arousal center of the brain –an almond-shaped structure called the amygdala – is so overstimulated that it puts the body in a relentless state of alertness. The amygdala, which has also been termed the body’s “general-purpose defense response control network,” is involved in producing and responding to anger, avoidance, defensiveness, and fear. Because it sends adrenaline and other hormones pouring into the bloodstream, this little mass of gray matter is responsible for the sweaty palms, the clenched jaw and many of the other symptoms that typify a panic attack.
People with anxiety share many characteristics in common:
People with anxiety usually are very bright and very sensitive – they pick up everything. In fact they pick up so much that they’re easily overwhelmed. They’re the people who find lights too bright and sounds too loud when
Feelings of Helplessness
Everyone else around them barely notices.
People who are anxious often feel helpless; because they no longer know how to defend themselves against feelings of anxiety and panic attacks, they lose the capacity to trust their own judgments. They’re wracked with self-doubt, which only heightens their anxiety. But they’re so afraid of making the wrong decision they don’t make any at all. Ironically, they feel guilty because they’re ducking their responsibilities while at the same time always looking for excuses to explain why they can’t do them.
Since anxiety causes such constant stress people tend to deny it and pretend that the anxiety will go away on its own. They hold their emotions in check and avoid confrontations because of the fear their bodies will betray them. They worry about what other people will think of them. They feel a need to cope in every situation. But of course, if people keep on repressing their emotions and needs to maintain the illusion of control (because they’re really not in control at all) while avoiding risk they’re going to pay a fearsome price. You may try to ignore what your body is trying to tell you but just because you won’t listen doesn’t mean that your body has any intention of leaving you alone.
Anxious people are likely to be perfectionists. They set standards of performance so high that there’s no way on earth that they can ever measure up to them. Perfectionism becomes another way of trying to maintain control. If they come from unstable families they may feel the need to become the parent they never had. And if they were subject to constant criticism when they were growing up they tend to be overcritical and judgmental as adults. And they judge no one more harshly than themselves.
A number of people who consult me about their battles with anxiety tell me that they’re psychic. Maybe they are, but what I can’t understand is why, if they can see into the future, the future always so bleak? They never see anything positive happening. But this is typical of anxious people. They are preoccupied with all that could go wrong. The sign of an anxiety disorder is thinking the worst when there is no realistic basis for it. A preoccupation about the prospect of harming a baby or driving off of a bridge or being struck by lightning is an indication of anxiety disorder. Once a negative thought takes hold the mind refuses to let it go. One negative thought triggers another and another. You can’t stop your mind. I’m afraid I’ll have another accident, then I’ll lose my job, and then I won’t have health insurance and then my wife will leave me…You get the idea. But it doesn’t stop there; because you’re always analyzing – thinking about what you’re thinking, trying to decide whether your thoughts are bizarre or abnormal. You’re constantly comparing yourself to other people and in the process, you end up making yourself even more anxious.
Recognizing that you’re Anxious
Ironically, while anxiety causes more suffering than almost any other problem I see in my clients it also turns out to be one of the easiest to treat because it’s not a mental disorder. Months of talk therapy aren’t necessary to alleviate the symptoms. All that’s necessary are some simple, well-proven techniques and a will to practice and apply them.
First, though, you have to realize that you have the disorder. I know how hard it is for my clients to acknowledge. Many people who come to see me know that there’s something’s wrong with them, but they can’t tell me what it is. I need to ask and ask until they finally admit, “Well, I worry a lot.” So then I’ll ask them what happens when they worry and they’ll say, “Well, my heart pounds a lot, too.” So gradually the truth emerges – and when it does and I tell them what they have they’re incredibly relieved. Before they walked into my office they lived in fear that something terrible was wrong with them and they felt alone in the world. In fact, they have a lot of company; it’s estimated that one in five people have an anxiety disorder to some degree. I’ve seen clients who have had it for 20 years without knowing what it was. It’s up to you to assess the extent of your anxiety and decide that you need treatment. No one else can – or should — do it for you.
Ready to get in touch?
Call us: (888) 242-1720
Who Seeks Treatment?
More women seek treatment for anxiety than men. In our culture women are allowed to be scared but men feel that they’ll be thought wimps if they admit to owning up to the disorder. But men are born with sensitive nervous systems too and suffer from traumas just as women do. You can try to grin and bear it – many men do – but don’t be fooled; if you try to ignore your feelings for too long your body will exact a heavy price.
What Happens in Treatment?
One of the first things I’m going to do when you come to see me is to help you understand that you’re not crazy. Then I’ll teach you how to listen to your body. Our bodies are constantly communicating to us in unique ways. We have to learn how to read the signals our bodies are sending and then act accordingly. That means stop doing what we’re doing when our body tells us to stop. Once you recognize that you’re not crazy and begin to learn how to listen to what your body is telling you, you are already on the road to recovery.
Exposing the Physical Aspects of Anxiety
It’s one thing to tell people that they have a physical disorder and not a mental one. But it’s quite another for them to see it demonstrated. I have a computer program developed at the Institute of HeartMath which does exactly that. The program monitors heart rate variability – how fast or slow the heart beats over a given period. My clients can watch how their emotions and thoughts are affecting their heart rate in real time. The computer screen acts as a mirror of their emotions. Normal heart rate variability ranges considerably with peaks and troughs from around 70 beats per minute to 90. But when the heart rate of people with anxiety is measured something very unusual happens: there is practically no variability at all. My clients will watch the screen and see what their heart is doing and panic. Oh, my God, am I going to have a heart attack? Am I going to die?
Of course, they’re not having a heart attack. What they’re witnessing is a dramatic representation of the effect their anxiety is having on their bodies. I tell them that simply by changing their negative emotions to a positive outlook they can simultaneously change their body’s response – and see the effects for themselves. Research has shown that when you learn how to intentionally shift to a positive emotion, heart rhythms immediately change. Now you may not think that a shift in heart rhythms is such a big deal, but in fact, it sets in motion a cascade of neural, hormonal and biochemical events that benefit the entire body. Blood pressure drops. Stress hormones drop. The immune system is strengthened.
But just how do you go about turning negative thoughts into positive ones? It’s simpler than you think. I encourage my clients to focus on the acronym LACE, which stands for love, appreciation, compassion, empathy. When you’re anxious it may be hard to think of anyone you love and you may be short on compassion and empathy. But everyone can think of someone or something that they appreciate: a friendship, a pet, a delicious meal, the memory of a walk along the beach. When you’re expressing appreciation (if only in your mind) it’s a lot harder to think negatively. At the same time, I ask my clients to breathe deeply – five times in and five times out – while watching the screen. At first, because they’re so unused to relaxation techniques, they may be able to only take two deep breaths. That may not register much of a change on the screen, but then I ask them to try for three. And in about five minutes I can actually get them up to five deep breaths. And they’re amazed at the results; they don’t have to take my word for it’ their heart rate begins to show more variability in response to their positive thoughts. And this is just as true for people who’ve battled anxiety for years as it is for someone who has had it for months. They realize that they no longer have racing thoughts; they’ve actually calmed down! But as soon as I turn off the computer the anxiety comes right back.
But that’s to be expected. Anxiety is a habit. And like all habits, anxiety is a very hard habit to break. One of the things that happen when we try to break a habit is resistance. We become attached to our bad habits, even though they’re causing us pain, because we’re so used to living with them and because we don’t know what we’re trading them in for. It takes time and training to break through the resistance and break the habit – but it can be done. By practicing you will be able to recognize the difference between an aroused and a relaxed body. The more you practice the more relaxed you’ll become.
When you are so preoccupied with what’s going on in your head you don’t recognize that the problem isn’t there at all, it’s in the body. So what I do is ask my clients to focus on their bodies. I urge them to sit in a quiet place and try to find the feeling. What are you feeling? Where is that feeling coming from? Why are you feeling that way? Sometimes the feeling manifests itself as pain, other times as tension or as tightness. It may sound counterintuitive to fixate on pain, but actually, it works quite well. If you stay focused on it the feeling won’t get worse, but if you try to avoid the feeling it will get worse. What makes it worse is the fear. Once you stop avoiding, however, and immerse yourself totally in the sensation you can cause it to relinquish its grip. You have to tell yourself that you can feel what is bothering you and go through it and allow it to dissipate. You can literally chase the unpleasant feeling away. That doesn’t mean that the tension will vanish altogether. It will move. If you get rid of it in your belly then it may move up to your chest; so you focus on your chest; then it may move into your solar plexus or up into your arms. Eventually, though, if you keep chasing it, the anxiety won’t have anywhere left to stake a claim and it will vanish. Little by little you will be gaining ground, retaking control. You can, as one writer put it, “walk yourself out of the anxiety.”
There are many things that you can do to kick the anxiety habit. What you’ll find is that with each accomplishment, no matter how small at the beginning, the more empowered you will feel. You’ll be able to get control over your breathing and your thoughts.
The important thing is to find an exercise you enjoy doing. When you throw yourself into exercise you force your body to shift gears; your mind focuses on what your body is doing, not on the stress-producing thoughts bouncing around in your head. Of course, when you perform any kind of exercise your heart beats faster. So for a person used to thinking that a rapidly beating heart is a sign of anxiety exercise can become a source of fear, too. That doesn’t mean giving up exercising – on the contrary. What it means is focusing on the resistance and distinguishing the difference between the effect of exercise and a symptom of anxiety.
When clients come into my office with symptoms of anxiety I ask them what they’ve had for breakfast. You’d be surprised how many of them admit that their breakfast consisted of a couple of donuts and three cups of coffee. You don’t need to be a nutritionist to realize what all that sugar and caffeine can do. Cortisol levels soar, insulin levels go up and adrenaline begins to flow. At first, you’ll feel energized and pumped-up, but after half an hour those hormone levels will plummet and you’ll crash. That’s when the negative thoughts begin to kick in. I don’t prescribe any particular diet to my clients. I don’t, for example, tell people to go on a low carb diet. What I do recommend, though, is to eat only carbs that are natural – those that come from fruits and vegetables and milk, not processed foods out of a box.
Eliminating Negative Thinking
Nothing is harder to do than putting an end to negative thinking. Other symptoms of anxiety are relatively simple to mitigate compared to negative thinking. That’s because we become obsessed by these thoughts. Oh, my God, the plane is going to crash. My car is going to skid off the bridge. I’m going to hurt that child. Once those thoughts start you can’t control them if you’re anxious. What you need to do is turn a negative thought into a positive one. (Remember LACE). I even tell my clients to put a rubber band on one of their fingers. Each time they find themselves having negative thoughts I ask them to snap the rubber band – not to cause pain but to remind them to stop and relax. Take a deep breath. Focus instead on something or someone you appreciate or love. A rubber band may sound a little ridiculous, but believe me, it works. But be wary of falling into the trap of getting down on yourself for having negative thoughts. That’s a mistake. Thinking negatively about thinking negatively is still…thinking negatively.
Treatment and Medication
Often people come to me who are on medication. I’m not a doctor, I advise my clients to go to doctor or psychiatrist and work with him when they start treatments. A prescription may help, but at the same time, many people tend to rely on medication as a crutch, as a way of avoiding the problem, not eliminating it. People on medication still have negative thoughts, they still display negative behavior and they don’t have the incentive to learn relaxation techniques. Medication can mask the bad feelings but it can’t eliminate it. Now if a doctor advises you to take medication, by all means, do so. But for most of my clients, medication for anxiety is only a temporary palliative, a kind of holding action. I’ve never met a client on medication who came to me and said, “I love medication, give me more.” Instead, they want to get off it as soon as possible.
Learning How to Live Without Anxiety
Kicking the anxiety habit can only come with practice and that means homework. For instance, I give clients tapes to listen to that will help them relax. If clients do their homework assignments diligently they’ll get better faster. So when they come into my office I ask them if they did what they were supposed to. If not, I ask them why. I ask them what prevented them from completing the assignment. We work together to try to find out what kinds of changes in thinking or lifestyle might be necessary so that they can do their assignments. I always counsel patience. Habits don’t disappear overnight. Usually, it will take two to four months before you experience major changes although many of the symptoms will begin to fade in just three or four weeks. But that doesn’t mean a cure has occurred. I’ve had clients who will proudly report that they’ve licked their anxiety and then a month later call me and say, “It’s back! What can I do?” It’s not a cause for alarm. All it means is that you have to learn and relearn. You have to integrate a new way of thinking – a new way of being – into your life. You have to learn how to live like other people who don’t have anxiety. You have to learn how to relax but also how to take risks. You have to learn how to get a good night’s sleep instead of shooting bolt upright in bed, worried about all the terrible things you’re sure are going to happen to you. You have to learn how to reclaim your life – and something else: you have to learn how to have fun.
Patients with panic disorder have nearly double the risk for coronary heart disease, and those also diagnosed with depression are at almost three times the risk, according to new research.
The study in the September 2011 issue of Psychosomatic Medicine focuses on the medical histories of nearly 40,000 people from the time they were first diagnosed as suffering from panic disorder. Lead author Andres Gomez-Caminero, Ph.D., says the large cohort study “highlights, for the first time, the potential for additive effects of different psychiatric conditions on cardiovascular health … and it really sets the foundation for new research in the area of cardiovascular risk estimation among patients with mental illness.”
Scientists have done research on acute and chronic pain associated with diseases like cancer and arthritis. They’ve found that whatever its cause, pain is invariably heightened by anxiety. The more anxious you feel the more it will hurt. So by alleviating the symptoms of anxiety anyone fighting another illness will see their pain diminish at the same time.
Recognizing the Value of Inklings
In Africa wildlife experts studying antelopes found that about ten percent of them demonstrate more sensitivity to stimuli. They’re the ones that register the approach of a predator and set off a stampede. Without them the herd wouldn’t survive. It turns out that many people with anxiety have the same kind of special gift, but until the anxiety is removed, they don’t realize it. Because so many people with anxiety are extra-sensitive they pick up on signals in the environment that others tend to overlook. When you’re anxious that sensitivity can be crippling; but once the anxiety disappears that sensitivity can be used like a finely honed radar system. These gifted individuals can look down a block and sense – even without visual cues – that they had better avoid taking that route. They can’t tell you why exactly, they just know that the block is trouble. Call it intuition or an inkling. But if he’s anxious, that same sensitive person may still have that inkling, but because he’s afraid of appearing foolish (even in his own eyes), he’ll decide to tough it out. So what happens is that the person proceeds down the block and gets himself mugged.
There’s actually some physiological evidence to support these inklings. Interesting research on heart transplant patients has shown that there are more nerve pathways from the heart to the brain than in the other direction. Sometimes the heart won’t listen to what the brain says. That street is perfectly safe, I’m being foolish to worry. The heart has a brain of its own. Sometimes the heart knows something and starts ticking a little faster. But that’s not anxiety, that’s an inkling.
I’ve helped hundreds of people let go of their anxiety and get back their lives. For many of them the anxiety has vanished and never comes back. Other clients may suffer a trauma after recovering – an accident, an illness, or a job loss – and the anxiety will return. But when these people come in for retraining we can generally alleviate their symptoms successfully. Then there is a small group of clients who say they want to get rid of their symptoms but don’t do the work necessary for that to happen. It really is up to you. By now you should realize that there’s no reason to stay where you are. There’s no reason to be afraid of being locked up in your house with a roaring tiger in hot pursuit. I will teach you how to open the windows. I promise you: no tiger is going to get in, only fresh air.
Call now for a phone consultation: 1-888-242-1720.
Arlene Foreman M.S.
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