ALERT: Worry is Out of Control

by Richard C. Raynard, Ph.D.

In a Gallop Poll compiled almost 20 years ago, Americans felt clearly that their emotional health was more out of control than their physical well-being. Three emotional health concerns were clearly identified as the source of more dissatisfaction than any others, making up 75 to 80% of those polled. It was found that we want most of all to 1) have fewer worries; 2) do everything one needs to without undue stress; and 3) have more time for leisure and recreation, as well as for work.

Surprisingly, most Americans now see emotional health as a major part of overall health and fitness. Of the top 10 health concerns, three were clearly emotional: having someone to love, a positive outlook on life, and friends and family who are there when needed. Five of these top 10 concerns were about habits that lead to disease or physical illness, i.e., smoking, unclean environment, avoiding excesses, poor diet and exercise.

Interestingly, the loss of leisure time is not imaginary, as Louis Harris polls have shown. Leisure time slipped from 26.2 hours a week in 1973 to 16.66 in 1987. At the same time, our work hours rose from an average 40.6 hours to 46.8. Are Americans shoring up their economic life at the expenses of their emotional health?

Supporting the Gallop Poll is a survey I completed in my own practice. Of a sample of 45 clients who came to see me, on average they worried "very often" and could not get the worries to stop. Fairly often, worry led to a "physical upset" and ruined "good times and good company".

More recent studies echo these results, with leisure time slipping even more and work hours steadily increasing. In future articles, I will address worry, how it relates to your phobia, and what can be done to reduce it.
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Will your group help cure your phobia?

by Richard C. Raynard, Ph.D.
Clinical Psychologist, Licensed

I receive many calls each month from people asking about phobic groups. Many do not know the difference between self-help groups, support groups, and therapy groups. Knowing the difference can help save enormous time and energy, and can help to keep a phobic person on track and optimistic about their recovery. Groups which focus on symptom-swapping, horror stories and other negatives can be destructive. They can actually set back your progress, take away your confidence, and leave you feeling hopeless. Use the following guidelines to help decide which is best for you.

___________________________________

Self-help groups are often groups which

have been formed by a phobic person

who has completed a certain stage of recovery

and is feeling good about themselves.

___________________________________

The recovered or recovering leader often wishes to help others who are as stuck as they once were. The group meetings are usually very informal and members are free to participate or not. There is usually never any feelings of obligation to continue or need to make specified progress. Self-help groups are often selected by phobics who are first getting started. It can be an excellent place to learn that you are truly not alone.

___________________________________

Support groups can either be formed

by an individual or individuals

who have been phobic

and wish a more structured setting,

or by a health care professional

who wishes to form a group

for clients to provide support and

encouragement for one another.

___________________________________

Although there is usually some information, direction, and group activities, the main focus is usually support. They are not meant to be substitutes for active programs with trained leaders who specialize in phobias, but they can be excellent ways of speeding up recovery.

___________________________________

Therapy groups are usually always

formed by a professional

who has been trained in phobias.

___________________________________

Here, the focus is very directed and specific. Much like individual therapy, a heirarchy and specific goals are set. The group members work together, giving encouragement, support and suggestions towards one another, and at the same time receiving the instruction, support and advice of the professional leaders. Some groups travel together for active practice and exposure. A therapy group usually uses a wide range of methods to reach their goals, such as relaxation training or assertiveness training. Some are directed towards types of phobias such as fear of flying or agoraphobia.

There are some ground rules which apply to ANY useful group:

1) The group must have a common goal and specific direction (in this case overcoming phobia).

2) The group must have a leader. Leaders can change at specific intervals so everyone has a chance, and so that no one person gets "stuck" in this role.

3) There must be no symptom-swapping, no negativism, no put-downs, no story-telling. Support groups are not a place to discuss family or relationship problems. These problems may require the help of a trained therapist.

4) The group must be action-oriented, with the common goal of doing what is necessary to overcome phobias. It is a place to report back on your accomplishments, receive positive feedback from members of the group, also to plan activities to do together, so that practice becomes more fun while you are expanding your world.

5) Everything said in the group remains confidential within the group.

6) Everyone must have a chance to talk and share.

For more information on treatment methods, you may visit www.panicdoctor.com/treatments.htm. Dr. Raynard's latest book, Panic Free, covers this and other topics in much greater detail.
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The Best Treatment Methods for Anxiety and Phobia

by Richard C. Raynard, Ph.D.

Most phobia treatments have been evaluated for effectiveness. I offer you a brief report about the effectiveness of the major treatments.

The use of medications has been a boon for some phobics, and a disappointment for others since the specific drug has widely varying effects on different individuals. For example, 20% to 25% of phobics prematurely drop out of drug treatment programs because of adverse reactions such as allergies, mood changes, or physical symptoms. Relapse rates after going off medication is fairly high, about 25% to 35% in most studies. And, some have shown agoraphobics have extreme sensitivity to even small doses.

Still, medications such as the MAO Inhibitors (Nardil, etc.), the tricyclic antidepressants (Imipramine, etc.), or the benzodiazepines (Xanax, etc.) bring improvement to 53% to 80% of those who can tolerate them. We urge their use when a phobic person is extremely depressed, is in almost continuous panic, is extremely obsessive and worrying, or when facing almost certain panic.

The effectiveness of psychoanalysis is difficult to determine since the reports are mostly of individual cases treated successfully, with little scientific merit. A few research reports show low or inconsistent results.

The body of literature on the more widely used forms of psychotherapy, using methods of understanding, insight, or emotional release report about 30% to 40% effectiveness, with relapse being common.

Attempts by phobic persons at self-help have often failed, and several authors have noted that phobias are remarkably persistent and long lived until effective help arrives. Attempts to "tough out" situations with the worst anxieties and panic usually bring back and reinstate the panic, and subsequent avoidance.

Flooding methods, which coach the phobic person to stay in the fearful place for hours, were some of the first to show promise, particularly for simple phobias such as those of animals or noises. Other helpful methods evolved, such as systematic desensitization, which trained the phobic to vividly imagine the fearful situation while being coached in relaxation. The substantial improvement rates continued to climb to 50% or higher, but not to uniformly high levels for all phobias.

The most recent treatment procedures in psychology have evolved around exposure therapy, which gradually introduces the phobic to more and more fearful situations and trains him/her to bring down anxieties to comfortable levels in a program of daily practice. These methods reach 60% to 70% effectiveness alone, and over 90% when used in judicious combination with medications. Specific techniques continue to be developed in exposure therapy, which improve the success rate to 70% to 80% levels. Group methods, residential or regular, have similarly good results. No symptom substitution or relapse after treatment is reported after 4 to 10 years followup.

There is increasing agreement that the more successful therapies help the person return to the place of fear and that the desensitization that follows when none of the anticipatory fears come true is a basic process that leads to recovery.

For more information on treatment methods, you may visit www.panicdoctor.com/treatments.htm. Dr. Raynard's latest book, Panic Free, covers this and other topics in much greater detail.
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Calming Methods - A Safe Person

by Richard C. Raynard, Ph.D.

This posting starts my monthly series of Calming Methods, a list of ways to bring anxiety down. You may use ideas presented in this series to help you fill out your own worksheet which will become a valuable practice tool.

A safe person is one who makes you feel immediately more secure and less anxious very nearly every time you are with him or her. The safe person does this not only by suggestions and active support, but also by presence, touch, listening, and his or her whole manner. This safe person can be a trained helper, a phobia aide, a husband or wife, a family member or friend, a professional, a stranger, even a child. Let's look at the varieties of safe persons so that you can recognize and cultivate them. You can soon learn to feel you are never far from the comfort of the human contact.

Strangely, the majority of agoraphobic persons have phobic anxiety in just the situations that involve people: crowds, public places, classrooms, groups, and just ordinary contact and conversation! This can appear quite cruel, unfair, and confusing to your efforts to benefit from "safe persons". One of the most demoralizing costs of a phobia that I have found is exactly this kind or erosion of friendships, social events, club memberships, family gatherings and community participation over the years. All the same, the evidence seems that, while some phobics are shy as part of their personality makeup, the majority are warm, extroverted and people-centered in their lives. The basic movement of most phobics is towards people and, given half a chance, that basic nature will prevail over the phobic anxieties.

___________________________

Friends, even without

knowledge of your phobia,

can be more calming than strangers,

but not all friends

will feel "safe" by any means.

___________________________

Consider first the opportunities that total strangers present to you for restoring calm. For many, waiting in a long line is immediately relived by striking up conversation or briefest contact with someone else in line. Many have been able to extend their range of driving by locating on the map how near they were to the homes of friends or hospitals en route. Others find in overcoming a phobia of flying, quickly telling the air flight attendant of their phobia and the possible need for help is calming in itself. Others have made the first steps onto escalators or elevators by getting aboard when a few other passengers are on too. One woman who could not travel to most stores and crowded places, moved without anxiety with her two children within the local fairgrounds and even within the crowded circus arena.

In none of these examples do you absolutely have to ask for help. Just know they are there to help, if needed. Actually asking for help and getting it is even more reassuring and calming. However, most phobic persons have seen many helpers that make it worse. They are worried and discouraged about asking for help. "Getting Help" will be the whole subject in another post, and is another major Calming Method.

Friends, even without knowledge of your phobia, can be more calming than strangers, but not all friends will feel "safe" by any means. Qualities of friends that make for calm are similar to those of helpers who have been trained to help you. Simply put, the most calming friends are those who are compassionate, patient, and accepting of you. The presence of your friend riding with you in your car, or even driving behind you, can help you get desensitized to new highways. Just knowing you can phone a friend can help overcoming the anxiety of being alone. Friends can often agree to stay put in some place just in case you need them, i.e. waiting outside a store for you, while you practice inside.

Close friends or your marriage partner require hard decisions about how involved they get, because their influence can be upsetting as well as calming. For example, a husband who is strong and overprotective can prolong the phobia, keep his partner fearful, protecting her from necessary risks and even healthy changes. Other husbands who have become resentful of the phobic limitations and have emotionally pulled away over a long time, even to making a separate life apart, will upset phobics by their unfeeling demands and intolerance. Partners who are martyrs with lots of hidden anger will rush, scold, ridicule, and become a major barrier to recovery. These are "unsafe" persons for you.

If partners, friends, and helpers have those "safe" qualities of compassion, patience and acceptance, they can become helpers who accelerate your progress and minimize the anxiety. This helper can learn to find opportunities to practice, plan it with you, and be by your side when you do. He or she will help you get out of traps, remind you of reassuring things to do, and help you recognize your progress and effectiveness. And much more.

For now, see if you can acquire the skills in recognizing a safe person and making contact if you need to. My suggestions for immediate benefit are:

1) Quickly choose whoever looks "safe", giving yourself an "out" if that person is more upsetting than not. The longer you wait, the more risk of worrying yourself into delaying, finding something wrong, and more delay.

2) Reach out quickly, without waiting to be asked. In a mixed social situation like a party, making contact with anyone who appears "safe" will help you feel you are welcome, you belong, and are ready for more.

3) Go by your feelings as to whether that person makes you feel "safe", less anxious, and more secure. Don't be swayed by considerations of family relations or duration of friendship or social pressure. Remember, the safe person feels calming and reassuring most of the time.

4) If you need support, ask specifically for what you need. That often may be a touch, a word, or a presence. An explanation of your phobia is not often needed, and is poorly understood anyway.

Basically, the "safe person" gives us another way out of the phobic traps by his or her presence and manner alone. Learn to spot quickly those persons and even now sort out the "safe" ones in all of your acquaintances. The safe person essentially is one you can turn to (and not be turned away), will offer some kind of support (and not scold, push, or give up), and will let you be yourself (without judgment or negativity). When you are recovered, you will not be upset by "unsafe" friends and relatives and you won't need to be so wary.

Are you willing to have benefit of some persons just for being who they are? Is there any better time than right now? They are there, wherever you may travel, in abundance!

Next month, we will look at the use of Conversation as a major Calming Method. I'll show you in clear detail when and how to use this important and very useful method.
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Headaches and Your Phobia

by Richard C. Raynard, Ph.D.
Licensed Clinical Psychologist

Headaches can be a concern for phobic who are obsessed with bodily changes. Headaches can be brought on by a number of triggers such as stress, alcohol, food additives, medication, among others. There are also several different types of headaches.

Since the physical symptoms of headache can mimic some phobic symptoms, such as nausea, blurring of vision, excessive tear secretion, and exhaustion, we want to take a closer look at the types of headache you get. Knowing the type of headache you usually get helps you learn that you don't have to react to all headache-like symptoms with panic or worry. It can be extremely reassuring to know it is only an average headache requiring well-known remedies.

Sometimes headaches can be caused by a drug or other substance. Confirming a drug as a cause of headache is very difficult because of the fact that headaches come from various sources, including the underlying illness that is being treated by medication. For example, fever does produce widening of the blood vessels and can cause headache. But, because you may be treating the fever with medication, it is difficult to say whether the fever itself or the medication is responsible.

This considered, it is known that drugs that suddenly increase blood pressure can induce headaches. When epinephrine or similar drugs are given, there may be a sudden increase in blood pressure. The amphetamine-like drugs which replace norepinephrine at the nerve endings can cause similar effects. Monoamine Osidase Inhibitors (MAO Inhibitors) when used to treat depression, or persistent headache, can interact with drugs used on the sympathetic nervous system, foods containing tyramine, or alcoholic beverages, and induce a very severe hypertensive crisis, headache, or even stroke in less fortunate individuals. Some people will suffer a severe headache when these drugs are withdrawn abruptly. You may also experience headache due to rapid withdrawal of beta blockers, and rapid rebound hypertension is the cause of the headache.

The excessive consumption of coffee, tea or cola, or the excessive intake of caffeine-containing drugs such as Excedrin or Anacin may result in a throbbing headache caused by widening of the blood vessels. Persons taking an excessive amount of caffeine will need to be slowly tapered off these drugs. Abrupt ending will cause severe headaches.

"Hangover" headache has also been found to be a result of widening of the blood vessels. The pain has often been relieved by caffeine. Using fructose, 30g, in the form of honey, can increase the rate of alcohol metabolism.

Some drugs work directly on the blood vessels in the head and induce the widening which leads to headaches. The most common of these drugs are the nitrates and nitrites, such as those used for cardiac purposes - nitroglycerin, amyl nitrate, etc. Headaches occurring after eating hotdogs and cured meats such as ham and bacon are due to the addition of nitrites to the foods as a preservative. Antibiotics, primarily nalidixic acid, tetracycline, and ampicillin, have also been found to cause headaches. It is also believed that excessive amounts of vitamin A may be a factor. Knowing what common foods can trigger headaches can be helpful if you have a problem with regular or severe headaches.

As you can see, there are a lot of points to consider as a cause of headaches. Once you examine the types of headaches you are having and pinpoint some of the causes, you will be in a better position to make an informed choice about what kind of help or doctor you need. Here is a diagnostic guide to the types of headache:

Migraine
Frequency: Usually no more than 1/wk, 1-2 times per month
Duration: 3 hrs to 3 days (typically 12-18 hours)
Onset: Gradual
Pain Area: Unilateral; may switch sides or become bilateral
Characteristic Pain: Throbbing, moderate to severe
Associated Symptoms: Systemic - usually nausea or vomiting (visual aura in classic, no aura in common)
Signs: Usually none
Triggers: Stress, menstruation, alcohol, food additives
Sex Distribution: 3:1 female

Cluster
Frequency: 1-3 per day
Duration: 30-90 minutes
Onset: Sudden; reaches peak intensity in 1-3 minutes
Pain Area: Unilateral, usually retro-orbital
Characteristic Pain: Steady, severe
Associated Symptoms: Usually none
Signs: Tearing, complete or partial Horner's syndrome
Triggers: Reliably triggered by alcohol
Sex Distribution: 10:1 male

Muscle Contraction
Frequency: 1/wk - virtually continuous
Duration: Usually 8-12 hours
Onset: Gradual
Pain Area: "hatband"
Characteristic Pain: Steady, dull
Associated Symptoms: None
Signs: None
Triggers: Stress
Sex Distribution: Equal

Mass Lesion
Frequency: Varied
Duration: Varied
Onset: Varied, though onset of complaint may have been recent
Pain Area: Unilateral
Characteristic Pain: Varied
Associated Symptoms: Varied
Signs: May be focual neurologic
Triggers: None known
Sex Distribution: Equal

Psychogenic
Frequency: Omnipresent
Duration: Omnipresent
Onset:
Pain Area: Varied, but may be bilateral
Characteristic Pain: Described as severe by patient but without corresponding behavior
Associated Symptoms: Usually none
Signs: None
Triggers: None
Sex Distribution: Equal

Physicians analyze specific criteria in order to differentiate between the types of headache in order to determine appropriate treatment methods. Here is some of the criteria which will be examined:

1) Are headaches of recent onset, or do they represent a change in your typical type of headache?
2) Is there a history of trauma?
3) Do headaches occur in well-defined attacks and are they unilateral?
4) Are headaches related to coitus or other exertion?
5) Is chewing difficult and does it aggravate headache pain?
6) Are you over 40 years of age?
7) Are headaches becoming progressively worse, or are they accompanied by neurologic abnormalities?
8) Do you have excruciating retro-orbital headaches that occur several times a day for about an hour?
9) Are the headaches characterized by nausea and/or vomiting?
10) Are the headaches non-throbbing and generally respond to non-prescription analgesics?
11) Is there pain in your temporal arteries and do one or both tend to roll rather than compress?
12) Are attacks preceded by a scotomatous aura?
13) Do you have sleep problems, constipation, backaches?

If you experience sudden, severe, or atypical headaches, it is recommended that you consult a qualified physician to help determine the type of headaches you are experiencing and get appropriate treatment. If your headaches are "typical" for you, I hope you are able to put your worries to rest and not associate them with your panic or phobia.
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16 Major Calming Methods - Do you use them?

Welcome to the first in a new series of monthly articles on Calming Methods. Next week, we'll start with "Safe Person" and add a new one each month until we've completed them all.

One of the major tools in recovery, the Calming Methods are strong, quick and reliable. Each month we will reveal a new Calming Method, give an actual case from one of over 3000 clients Dr. Raynard has treated for panic, and show how they can be applied to a number of panic situations. The articles will highlight excerpts from Dr. Raynard's newest book, Panic Free, available now at http://www.amazon.com/.

The nice surprise is that there are many more ways to calm yourself than you think. Some that you already use, we will develop so that they can be even more helpful to you; others that are new for you will be explained and you'll be able to try them as powerful tools. All will be explained in a clear, natural way that helps you put them to work for you right away. Most methods need both explanation and regular practice to become an everyday way of calming. By the end of this series on Calming Methods, you will have your own reliable Calming Methods you can bring to any phobic situation.

All Calming Methods replace your worry with calming action. Some of these target the anxious feelings in your body; we call these self-control methods. Others address your worries about the situation; we call these situation-control methods. All Calming Methods give you something to do, rather than be frozen in fear and lost in the "what-if's" (worry). As each Calming Method is explained, pick those that feel most compatible with you, so that you feel you have a recipe uniquely your own. Trust yourself. You don't need all 16 Calming Methods for recovery; no one has yet. And some won't work well for you - this is normal.

What are the 16 Calming Methods?

Safe Person
Conversation
Distraction
Pleasuring
Active Workouts
Contact
Grounding
Informing
Predicting
Skill
Diaphramatic Breathing
Relaxation Training
Positive Attitudes
Stepping Aside
Knowing Your Triggers
Getting Help

As we present each Calming Method ask yourself: Do I use this method naturally now? Would I like to develop this method more? Soon, you will see how to put many of these Calming Methods into practice on a daily basis. Don't be fooled by the simplistic names of each of the methods, and don't be tempted to discount them thinking "this will never work at reducing a panic attack". They have worked for thousands of Dr. Raynard's patients, and they can work for you too. The trick is in learning how to effectively use the methods, and at what stage of panic they are most useful.

Some methods you will find very effective, others maybe not so much so. With some experimenting and a little planning, you will find yourself with a whole arsenal of helpful tools. Dr. Raynard's approach has always been to offer you the widest variety of skill and information so that you feel you can chose those particular helpful to you. Rather than worry about using all of the Calming Methods, be reassured that no one on any occasion uses all or many of these methods. Many very individual circumstances - your personality, your preference, your abilities, your situation - determine which you use. We encourage you to check out how they may help you renew your zeal for recovery.

Visit Panic Update each month for another detailed explanation of how to incorporate a different Calming Method into your recovery program. We will also have more frequent articles offering the latest information on advances and treatments.
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ALERT: Benzodiazepine Addictiveness

by Richard C. Raynard, Ph.D.

Despite the controversy over the physical addictiveness of benzodiazepines (BZ's) like Xanax and Ativan, recent evidence shows the risk is quite small. Much of the alarm was raised in the early 1980's when epidemiology studies showed about 2% of the adult population were chronic users of BZ's.

In the late 80's, BZ addictiveness was better defined. Tolerance (one sign of addiction) increases rapidly only during the first 4-6 weeks of dosage, then there is little or none. Withdrawal symptoms can be severe for 80% of those who withdraw all at once, but with a gradual taper of 4-8 weeks, only 10% experience even some symptoms.

Perhaps most important, there is no narcotic "high" or "rush" of the addictive street drugs. In one study, users preferred the sugar pill placebo more than diazepam (Valium). In fact, nearly all abuse of BZ's includes the use of more addictive and lethal drugs.

So, this ALERT is a postive one. By following the usual recommended dose levels and duration of treatment, there is little addictive risk in your getting on or off of the BZ's. We highly recommend continued monitoring and supervision by a qualified MD; initially, throughout treatment, and when tapering off.
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The Instant Cure - An Instant Appraisal

Many self-help groups and get-togethers of phobics spend an inordinate amount of time talking of medication, which if they spent "equal time" on actual exposure, could lead to cure.

Many phobics, it seems, would like to take a magic pill that would end all of their suffering. I hear from many people that they "want that medication I heard cures it", or "isn't there a pill I can take to stop the panic" and other comments like this. We want to take a realistic look at "the instant cure".

First, let us be clear that there is no such thing as an "instant cure". All medications prescribed for panic usually take at least three to six weeks to reach optimal dosage. And, after starting a medication trial, you may need to go through many different medications in order to find one that works for you without the many disruptive side effects which many phobics cannot tolerate well. Many medications do in fact help relieve the symptoms of panic. They simply work to decrease your body's perception of the anxiety it experiences so that these symptoms (heart racing, palpitations, sweaty palms, dizziness, etc.) are suppressed. This act of supressing the panic can at times be very beneficial to a phobic person. It can help the person who needs help initially to set up practice or confront an especially difficult situation.

________________________________

Unfortunately there is no "magic pill"

that can give you an

"instant cure" from your

anxiety or phobia.

________________________________

Medications can be somewhat addicting. This usually means that it takes longer doses over time for the same effect, and that withdrawal is painful. The benzodiazepines, such as Xanax, have the major risk of addictiveness. Medications are psychologically addictive, too. This means you will over time tend to rely on them more and more as a substitute for peace of mind and a balanced life. And, consider the side effects of the specific drug you are taking. Each medication has its own side effects or interacts with several other drugs. This is one reason for keeping a medication chart.

Drugs also may generate fake security about treatment. You can convince yourself that the only reason you're not panicking is the effect of the pills. You then rely on these drugs more and more to keep the panic from returning, and are unwilling to try it without them. When this happens, it is difficult to successfully desensitize yourself completely because you are not sure whether it is the pills, or your own work at desensitizing. You need to be able to give yourself credit when you are doing well in practice.

When you stop the medication, phobic feelings can return again at full force for about 15 to 30% of people. Again, this may be because of your own worries of being able to handle it by yourself, or simply because you never confronted your phobia from a behavioral viewpoint.

So, in considering "cure", you must first subtract those who do not want medication, discontinue because of side effects, do not comply with medical instructions, have allergic reactions, have interactions with other drugs, or stay on medication indefinitely. Less than 50% of desensitized phobics may be left for a full trial of medications.

Medication may provide benefit for some. Symptoms of panic and anxiety can be suppressed for about 30-50% of those who comply with a full medication trial.

The Bottom Line: Medications can help by reducing the symptoms of panic, but to overcome phobias, the majority must also learn behavioral methods.

This article was written by Richard C. Raynard, Ph.D., a Licensed Clinical Psychologist specializing in anxiety and panic disorders. His latest book, Panic Free, was written based on his experience in treating thousands of phobic men and women over the last 30 years.
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School Phobias

True childhood phobias are less common than adult phobias. Most childhood fears do not develop into phobias because the fear goes away, usually on its own, within a year. There are some children, however, who do develop true phobias.

One of the most common childhood phobias is school phobia. School phobia is usually defined as an exaggerated and often handicapping fear of attending school. A child with school phobia causes constant turmoil, often arousing guilt, anger and anxiety in everyone.

Most children have shown reluctance to go to school, but have it go away without treatment, as with children first attending school, or moving to a new school. When a child has avoided school for over a week, it's a significant risk of persisting and growing. School phobias are not like school truants, for they stay at home with their parents' knowledge and are often excellent students. Truants avoid both school and home and have other delinquent behavior.

Children who have a school phobia may show their distress in a variety of ways such as temper tantrums, sulking, and fear. Before school, he/she often has a wide variety of physical symptoms such as nausea, vomiting, headaches, diarrhea, stomach ache, and even complaints of sore throat or other illnesses. These usually disappear after the child has permission to stay home. Typically, an emotional storm ensues first before school time, with the child begging or demanding to stay home from school, and resisting any efforts on the parents part to get him to go. Parents will usually unsuccessfully try reassurance, bargaining or force. Some children may even refuse to attend parties, playgrounds or other activities outside home.

School phobias generally occur at one of two stages in a child's development. In the first stage, the children are usually of kindergarten or elementary school age. Onset of the phobia is rapid and some clinicians feel that the child is having anxieties about leaving his/her mother. Others feel that the child is more afraid of school than of leaving their mothers. These phobias are usually mild and quite treatable.

In the second case, the phobias usually occur in children who are in the junior high school grades and up. The onset is usually much slower and the phobia more severe. Older children attribute their fears to many parts of school life: being bullied or teased, undressing in showers, anxiety about school work, fear of fainting in assembly hall, menstruating, etc. Young children may give no reasons at all and just refuse to go.

Most new school phobias arise when there is a change in the school location, and sometimes other major changes such as illness or death in the family, or a move by the whole family. The data suggests that about 1-2 children per 100 each year develop this phobia, 3 per 1000 being severe cases. The frequency appears to be increasing. The peak age is between ages 6 and 10. It appears equally often in boys and girls, and economic levels, but is more often found in the only child or the youngest child.

What can you do to help your child?

Helping a youngster or adolescent with a school phobia means getting the child back to school as quickly as possible. This is true even if the first step is simply going for a ride to look at the school. The individual situations are usually so different that treatment has to be formed around a variety of considerations which we will look at shortly.

The most common mistake that parents and others such as school personnel make is in their communication with the child. The first instinct is to reassure the child that everything will be fine. This reassurance, however, usually increases the child's need for more reassurance. And, in the long run it would also reinforce the fear that there IS something for him/her to be afraid of. It is sometimes helpful and necessary for the school to be involved in helping the child. When seeking therapy for a school phobia, it is helpful that the therapist outlines the steps to be taken, and go over how to handle the tantrums and other aspects of treatment for both the parents and school. Parents may acknowledge briefly that the child is afraid, and at the same time, encourage him/her to try a small step while feeling afraid. Do not focus too much on how the child feels.

When starting a behavioral treatment program, the cooperation of the child is helpful. Treatment is similar to adult treatment, with games and incentives offered to bring the child steadily closer to the fearful situation and to keep him/her there until the anxiety has gone and he no longer wants to escape. This is done in small steps, first with ones that the child is already able to do. Once the first stepping stone is done, the rest will fall into place with practice and patience.

For a situation of mild school refusal, the immediate determination and plan by parents and teacher to outmaneuver and compel attendance in a non-punitive way is critical. An escalation of pressure is used, leading usually to a "showdown", on which the whole method depends. It is also necessary to block escape routes and remove the benefits of avoiding school.

For the school phobic, a wide variety of techniques are used, in addition, to help him get from home to school. Offering very desirable rewards for going to school can be quickly effective for some. However, play, food, praise, pets, candy, hugs, affection, story-telling, hero models, stopwatch and many other aides have been used in helping the child.

Look for the next article, Average Fears in Young Children, to help determine whether your child has school phobia or passing fears.

This article was written by Dr. Richard C. Raynard, whose latest book Panic Free is offering new hope for those suffering from overwhelming and often debilitating panic attacks. For over 30 years he has helped thousands of his patients with the latest refinements in anxiety and panic treatments. Visit http://www.panicdoctor.com for more information about Dr. Raynard.

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Average Fears in Young Children

A phobic parent usually becomes preoccupied with worry about their child's fears. Even more agoraphobic women are concerned that their condition will affect their child's development. Non-phobic parents too may become alarmed when their child suddenly becomes afraid of everything. If your once aggressive and uninhibited child suddenly is afraid of new faces, a vacuum cleaner, going to bed alone, or the dark, it is easy to assume that you are somehow to blame or that there is something wrong with your child.

Fears in small children are common, and in fact are a normal part of maturing. I have put together some facts about normal childhood fears so that you can take appropriate action.

Children's fears peak at times of rapid learning. Learning about themselves and their environment bring demands. It can create an imbalance in which they may become temporarily oversensitive to things and events around them. This increased sensitivity is likely to show up in the form of fearfulness or expressed fears. Fears help express the normal anxiety that goes along with sorting out one's ideas and awareness. A child with fears is asking for help - to see the limits of the new situations and the limits of his/her own ability to deal with the situation.

Fears are a NORMAL cry for help. They are designed to provide comfort from parents, and cut down on pressures and stresses in other areas so the child can confront the new, more troublesome one.

Many times, parents need to confront the fears with their child. If your little girl is afraid of dogs, for example, she may need to know more about them. You may tell her that dogs bark to say "hello" and also to say "stay away". You might show her by pointing out whether the dog is wagging it's tail, showing her how to offer her hand to pet him, etc. More important is to show the child that it is okay for him/her to be frightened by the bark, the dog, and of the feelings she gets when she's frightened. The fear probably won't go away simply because you have given the information about dogs - she needs to know she can handle her fears.

Parents are likely to overreact, and feel that the fears are really something more serious. The danger is actually reinforcing them. The child needs your confidence and assurance at this time. This is not a time to bend over backwards and pamper your child. The usual limits - even if he doesn't like them - should be kept, and may actually help him/her resolve the issues underlying the fears.

A child's first fears may be a heightened sensitivity to strangers. This usually happens at several points in the first year; first at 4-6 weeks, 4-5 months, and again at approximately 8 months. In addition to being able to differentiate between "Mommy" and "Daddy" and strangers, by eight months, he is learning to crawl and navigate. These changes are more complicated now. He is also learning that when things are out of sight, they haven't stopped existing. These increases in a child's understanding and his wish to keep control over them create an imbalance in him and make him vulnerable to change, to fear of strangers, and of strange situations.

At one year, he becomes sensitive to broad changes, e.g., he's walking, he doesn't want his parents to leave the room, etc. He wants to be in control; he wants to be the one to leave. Control is a necessary basis for making choices (will I walk away, will I stay). With these struggles during the day, he can have turmoil at night. He may wake up screaming 2-3 times a night as if terrified by a bad dream.

Around age 2-1/2 to 3 fears peak again. The child is caught between yes and no; in or out; will I or won't I. Often, no one but the child cares, and he cares so much he can't handle it. Protest or fears are the way children usually get what they need.

By 3-1/2 to 4, fears can accompany the beginning of normal aggression. A child may begin to experience complicated feelings when he sees a toy gun or images using one. When he wants to strike out at someone but is afraid to. There aren't too many ways to handle the feelings that are coming up. Fears help to keep them in check.

Fears serve a major developmental purpose. When fears begin in a small child, the parent must enter wholeheartedly in helping. Remember, most children's fears clear up in one year or less. It is very rare to persist five years or more. If they do, professional help is advised.

This article was written by Dr. Richard C. Raynard, whose latest book Panic Free is offering new hope for those suffering from overwhelming and often debilitating panic attacks. For over 30 years he has helped thousands of his patients with the latest refinements in anxiety and panic treatments.
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Mastering Panic Attacks

Panic attacks are truly dreadful and terrifying experiences that most people try to repress and forget. For phobic persons, they can happen anytime, seemingly out of nowhere and are the root cause of endless anticipatory anxiety. Panic is a sudden flooding or jolt, usually with heart racing, dizziness, choking sensations, sweating, hot and cold flashes, and breathing difficulty. These changing symptoms can confuse and put off relations, friends and physicians. The most common thoughts are, "I'm going to die," or "I'm going to go crazy."

I want to reaffirm how to handle panic for phobics and for those who occasionally have panic, and for those who may need to assist someone in panic. The goal is to attain a victory over panic by not running and not worrying excessively. Then, the next time you are in the same situation, you will have noticeably less anxiety, perhaps none.

The first step is not to avoid the situation of panic, or run home, as that typically leads to more sensitivity and more panic. Each time you are willing to go through the situation of panic, and do, panic is reduced for that situation.

Second, and hardest to do, is to "let panic happen and wait for it to pass". We recommend telling yourself these facts:

"The panic comes from a sudden release of natural stimulants like adrenaline from major glands; they take about two seconds to go through my entire blood stream. If I do nothing at all, they will be reabsorbed by my liver and pancreas in 3-4 minutes. I won't die or be physically harmed."

Third, stay in the situation of panic at a safe, comfortable distance, by stepping aside or standing quietly, or walking back a way. Do not try to push through it or fight it. Distract or amuse yourself; talk to someone; pass the time in an activity normally routine or pleasant.

Fourth, notice when the fear fades. Pay only enough attention to your body to notice how the body feelings fade away. Keep track of how your body actually feels, not what you fear MIGHT happen to your body. Notice when you stop adding frightening thoughts the fear starts to fade.

Fifth, if you MUST think of your panic, think of how much progress you have made despite the difficulties. Think how pleased you will be when you successfully "accept your panic" and avoid doing things that make it worse.

Sixth, go back into the situation of panic in a relaxed way, with no effort or hurry. Do it when you feel better, and can plan what to do next, or how to complete what you had already started.

___________________________

GOLDEN RULE:

Never leave the situation
until your fear is going
DOWN
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Seventh, if you feel you will panic in a situation you cannot avoid, medication that relaxes and has a short-term effect can be helpful. By using it judiciously, you can avoid physiological dependence and the complications of long-term drug usage. Any drug should not be relied on as a substitute for professional help.

By practicing these methods and making them habits, you have powerful tools for undoing panic. Consequently, your avoidance of these situations will weaken, along with your anxiety and worry about them. And, you also have the means to help others who go through panic.

This article was written by Dr. Richard C. Raynard, whose latest book Panic Free is offering new hope for those suffering from overwhelming and often debilitating panic attacks. For over 30 years he has helped thousands of his patients with the latest refinements in anxiety and panic treatments.
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How Your Nervous System Works In Panic

There are many causes of panic: genetic, childhood, personality, precipitating, immediate, physical and sustaining. Let's look first at what happens to you physically, or how your nervous system works in panic.

When your body starts sending confused messages to you and you don't know what is wrong with you, or someone says that you are suffering from "nerves", you usually feel that something has "gone wrong" and that you are somehow at fault. Your nerves are in fact responding accurately to the messages that are being sent to them.

Your nervous system consists of two separate actions: voluntary and involuntary. Voluntary nerves move your muscles and therefore your body - most of the time as you wish. Your nerves are obeying your direct command. Involuntary nerves, on the other hand, allow no direct control over them - they regulate functions of organs such as your heart, lungs and bowels. You do not have to tell them to work - they do so by themselves, so are involuntary.

Your involuntary nerves are divided into two sections: sympathetic and parasympathetic, and under normal conditions, these balance each other out. When you become emotional or excited, the sympathetic usually dominate, and these can stimulate your internal organs and muscles by releasing a number of chemicals including adrenaline into your body. Emotions which can trigger this body reaction include fear, anger and excitement. You may feel your heart race, pound, or skip a beat, or you may sweat or shiver, or feel faint. Your parasympathetic nerves serve to return your body to a natural relaxed state.

Normally, when you are afraid and experience a racing heart or "lump in your gut", you can accept these because you know that you can act in ways that master the fear. You know once you are out of the situation of fear, you will be calm again. You do not have either of these controls when you are in panic, and the experience of panic is so overwhelming, it's often hard to think of anything else.

Certain medications, especially the Tricyclic Antidepressants and MAO Inhibitors, seem to suppress panic for about 2/3's of phobic persons with varying degrees of side effects and relapse following withdrawal of medication.

When fear has grown into panic, the best indirect control is to let the panic happen, wait for it to pass, and let the parasympathetic nerves take over. As mentioned, the symptoms come from a release of natural stimulants to your major glands. These take about two to four seconds for them to go through your entire blood stream. You then experience a jolt or dreadful feeling. They are immediately reabsorbed by your liver, kidney and pancreas (your "cleaning" organs). Then, in two to three minutes, the unpleasant effects disappear, providing you have not added any alarming thoughts or new sources of stress haven't appeared.

When you are first sensitized (conditioned to react in an exaggerated way) to fearful situations or stresses, you may experience a vast range of symptoms including: jelly legs, jitters, faintness, imbalance, difficulty breathing, blurred vision, sweating, nausea, etc. A vicious circle develops of:

body symptoms - worry - anxiety - more body symptoms

To put it another way, worries about what is happening to your body and thinking that you are "going crazy" or that you are "going to die" help to maintain the anxiety and symptoms.

A person who is sensitized begins to fear the fearful state will get worse. This fear of the fear produces more adrenaline and other stimulants which continue to produce more symptoms and then even more fear! In such a way, full blown panic attacks develop quickly and your phobia can spread into other areas of your life.

To recover, you must learn to let the symptoms pass and disappear. If you tense yourself against these symptoms, or tell yourself, "I must not let this get the better of me", you are "fighting" the fear, and not letting it pass. Instead, tell yourself that "this is just a normal alarm reaction of my body to what it sees as a threat. The adrenaline will be reabsorbed by my body and disappear in a few minutes. The symptoms will then disappear and I'll feel fine. I'm just not going to pay much attention to the symptoms and after a rest of 3-4 minutes, I'll go right back into the situation."

If you can do this, then you will have your nervous system working for you instead of against you! And, each occasion of panic can turn into a personal victory.

This article was written by Dr. Richard C. Raynard, whose latest book Panic Free is offering new hope for those suffering from overwhelming and often debilitating panic attacks. For over 30 years he has helped thousands of his patients with the latest refinements in anxiety and panic treatments.

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How to Select a Practice Partner

The help of a friend or family member can be a powerful motivator for someone who suffers from panic. And, they can be a valuable tool if you are being coached in a program of exposure therapy by a specialized therapist trained in desensitization and introceptive conditioning.

Phobic persons take an average of eight to 11 years to find appropriate help after their first panic attack. Those with obsessive worrying and panic get preoccupied in keeping panic away. Many are treated for a physical illness first. Most are easily discouraged from getting help. And, everyone waits MUCH too long for help.

A "safe" person makes us feel immediately more secure and less anxious. This is especially true for persons who panic. A safe person does this not only by active support, but also by being a calming presence. This person can be a husband or wife, a family member or friend, a trained helper, a professional, a stranger, or even a child. Partners can help - or undermine - progress, and spouses in particular have the greatest influence. Not surprisingly, there are qualities and traits that make a good partner to someone who panics, and traits that can undermine and sabotage (even unknowingly) a person's recovery.

Case: Mary and Ron were a middle-aged couple whose children had left home. She was ready for good changes after 33 years with a phobic condition. As she was overweight and arthritic, her husband warned her threateningly about her attempts to travel and condemned her attempts to drive alone. He would not let her drive without his supervision. He even belittled her attempts to overcome her chronic illnesses, haranguing her to apply for disability. Mary did not make progress until she practiced alone or with her sister, who could offer positive attitude and much patience. Mary now could make small first steps in spite of her painful knees and poor health. Soon Mary was able to drive to local stores and visit her sister by herself.

* This case is an excerpt from the book Panic Free by Dr. Richard Raynard, Trafford Publishing, 2006, 311 pp

Here are some points to keep in mind when looking for a good practice partner:
A partner can either make a phobia worse or accelerate progress. Some of the most dramatic improvements have come when a partner gets actively involved. You can select your partner carefully to give yourself the best chance of success.

Practice in the situation of anxiety is not a task which you must do completely alone. Some may be able to do all practice sessions alone, and may prefer to do so. For others, the support and encouragement of a spouse, a friend or a family member (partner) increases success.

Your partner is not going to do the work for you. His or her role is to stimulate you to do the practice you have set for yourself for that day. Your partner is much like basketball coach. He doesn't go out and shoot baskets himself; his players do the scoring. Your partner should be there to help you focus on the tasks ahead of you and provide support when needed.

The most important job is to make sure you don't run away when you come close to or in contact with the fearful situation. Your partner needs to be a flexible yet firm person, full of praise yet tough, warm hearted yet honest enough to see clearly. For example, when you want to quit, he or she will suggest, "Do you want to step back here and take a breather and decide then?"

Naturally, you will want someone who is concerned about your well-being and wants you to overcome your phobia. Is he or she concerned? The job may involve quite a bit of time and effort as well. Does he or she have the time, say three or four practices each week?

If you pick someone only for the reason that they are genuinely concerned about you, that concern can actually get in the way of your progress, and your ultimate goals. For example, when selecting your practice partner, try to imagine how he/she would react when, while practicing you say, "Get me out of here, I need air or I'm going to faint." Would he be so concerned he/she would rush you out of the room immediately? Or, would he help you find a way of staying until your anxiety levels go down? No matter how terrified, dizzy, or "jiggy" you feel?

A good practice partner wouldn't let you run away. He wouldn't let his concern for you allow himself to feel sorry for you. For example, he must be able to say "no" to you and mean it on some occasions.

Your partner should feel comfortable with your leaning on him for support whether to take his arm or getting you out the door. At the same time, he should know when to let go and let you do it on your own and feel comfortable about that, too. He should easily tolerate a lot of clinging and dependency for awhile until you find your own stride in practice.

Probably most important of all, your practice partner should be convinced of your ultimate success based on understanding of your phobia, and what practice involves. He or she believes that you can overcome your phobia through the practice sessions you both do, and he believes in your capabilities. It is recommended that your practice partner learns about desensitization and exposure therapy. It certainly helps if you partner is willing to accept supervision from a qualified therapist, since often there is considerable detail, technique and planning in successful outcome.

This article was written by Dr. Richard C. Raynard, whose latest book Panic Free is offering new hope for those suffering from overwhelming and often debilitating panic attacks. For over 30 years he has helped thousands of his patients with the latest refinements in anxiety and panic treatments.
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Handling Criticism

Phobic persons are sensitive to social situations where they are suddenly pinned down or confronted by an accuser. Phobics often rate criticism as one of their most sensitive areas. In order to help those of you who are "trapped" by such criticism, the following tactics often serve as ways out. Remember your motto, "I am never trapped!", and use these at once to your best advantage.

Most of us react to criticism with surprise, feeling it is unjustified and that the critics' motives are suspect. Criticism hurts most when it is particularly valid. For some, the reaction is more one of shock and disbelief, "I just sat silent and tense, my jaw tightened; I stared in what looked like a helpless way, feeling hurt and mad all at once." At the very time you need to cultivate skill in listening and defusing the situation, you may be the most lost.

Criticism can be just. Ask yourself if you hear the same criticism from more than one person, or whether the critic is knowledgeable about the subject. Are the critics' standards reasonable? Is the criticism specific? Is it important to respond? In the face of fair criticism, finding excuses or trying to side-step it is irresponsible and will seem that way to those who are trying to be fair.

If the criticism is fair, defuse your emotions by immediately agreeing to a specific point, reserving judgment for others later. Immediately project the attitude, "I needed that. I want to think about how I can use what you've told me." This takes the steam out of the critic, puts him/her on your side, and in your control. Even if the valid point is buried in unfair charges, be generous and acknowledge it. This gives you more "credit" for disagreeing with the other points. In committee or debate, the criticism is often deferred by acknowledging the point, and building or extending it to support your argument.

When the criticism seems much unfair, it is easy to succumb to, "He doesn't like me," or "He's out to get me," or "I've lost". If you are sensitive or lacking in confidence, you may internalize it "I'm no good", and you could use a good friend or counselor to put it in perspective. Try not to give in to efforts to play on your guilt or pity. In any case of unfair criticism, show you want to listen and clarify. The facts will reveal the basis of criticism that is easily refuted. For your close friends or family particularly, project the attitude, "I value your opinion. Let's go over this carefully." The fact about all criticism: the critic is acknowledging you need correction in order to get the best results - like a coach on the playing field.

If the criticism is not important and the critic not close to you, let it go and do not make any more of it. It is not likely to come up again. You might need some practice in taking a ribbing, or perhaps a more formal "roasting".

When the criticism is with people close to you or in the family, you can more quickly get behind the criticism - often it is disappointment or hurt. Then you can ask, "What's really wrong?" Also, you have much more space to have your critic deal with your hurt feelings.

In any case, I recommend handling criticism by focusing on the benefit of improving than on the pain of being wrong. After all, the best direction often comes from criticism which may have floored you initially - particularly one "out of left field" that you were blind to. When you get adept at fielding criticism, you will stop your avoiding it.

Remember, the basic way to cure is to desensitize yourself to the situations you dread. When you find you can handle criticism, and even master it, you will be able to stay long enough in the situation to become completely desensitized in time.

For additional reading, see:

Panic Free, Dr. Richard C. Raynard, 2004
Nobody's Perfect, Dr. Hendrie Weisinger, 1981
I Can If I Want To, Dr. Allen Fay, 1977

This article was written by Dr. Richard C. Raynard, whose latest book Panic Free is offering new hope for those suffering from overwhelming and often debilitating panic attacks. For over 30 years he has helped thousands of his patients with the latest refinements in anxiety and panic treatments.
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Common Myths About Agoraphobia

Myth: Attacks come out of the blue.
Fact: Almost always occur where you are trapped in some way, however subtle, with no apparent way to escape or get help. Treatment frees you from these situations by practicing being in them comfortably, to allow desensitization to take place.

Myth: Panic makes people uncontrollable and wile.
Fact: No one ever ran down the street, yelling, screaming or crying. Most phobic persons become more controlled, so that even their intimate friends and partners don't even suspect their condition for many years.

Myth: Phobia is a rare, exotic disorder.
Fact: Changes are you know 50 or more people if you have the average number of acquaintances. At least one in six people are phobic, considering all ages and types of phobia. Most phobics are busy disguising it from others, and they won't tell you because of the shame.

Myth: The cause is biochemical.
Fact: Of course the whole panic syndrome is a real physical event, not imaginary. BUT, it is triggered by your perceiving you are trapped; and there are other contributing causes as well. For example, over 40% of phobics had experienced a major loss or insecurity in the few months before their first attack.

Myth: Ignore the attacks - they'll go away.
Fact: Trying to ignore such an overwhelming feeling is impossible. The worry that panic may return is a 24 hour obsession for some. And, usually the first attacks worsen and spread quickly within the first six months.

Myth: Phobias have always been hard to cure, you have to live with it.
Fact: This was so about 30 years ago, and there are still some ineffective treatments. Now, substantial cures are upwards of 80 to 90 percent or more using exposure therapy with medication.

Myth: Phobias are harmless, minor disorders - no one need ever know.
Fact: In one study, they found 11% become housebound, 30% develop reactive depression, 17% lost their jobs, 27% have poor marital relations, and most all have incurred medical costs of all kinds.

Myth: Panic means I'll faint, have a heart attack, die, or go crazy.
Fact: This has never happened to the best of our knowledge. The hormones and chemicals that are released at the time of panic, in fact, make the body stronger and senses more alert.

Myth: Once phobic, I'll be phobic in some form the rest of my life.
Fact: Recent long-term studies of phobic persons successfully treated with exposure therapy show 4, 5, 9 and 10 years of being symptom and panic free, with no substitution with other symptoms, regardless of age or severity. The key appears to be to finish desensitization by going through ALL the situations of fear.

This article was written by Dr. Richard C. Raynard, whose latest book Panic Free is offering new hope for those suffering from overwhelming and often debilitating panic attacks. For over 30 years he has helped thousands of his patients with the latest refinements in anxiety and panic treatments.
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Letting Fear Work For You

No one is free from fear. It is possible to be fearful or anxious about anything. Fear appears as one of the earliest emotions in infants. Those who say that they are unafraid (counterphobic persons) are most preoccupied with overcoming it. Fears seem to stay with us until we do something about them. Let's accept fear as an unavoidable emotion and look at how to let it work for us.

Fear comes up at sensing some immediate danger, such as a near-accident in driving. Anxiety comes up at anticipated or imagined dangers, and is even more persistant and debilitating. For example, the anxiety in driving after you have had a near-accident. Our position is that the fear is useful in helping us face up to what we must learn about and master for our personal survival. If we keep avoiding the threat, the fear will grow to the enormous proportions of panic or oppression. Those who are phobic about speaking in public, say, can experience exhausting, debilitating panic.

We suggest as a healthy practice to sense your fears in everyday life by tuning into your body's signals (stomach ache, sweating, dizziness, etc.), and associating these to specific aspects of life events. Use these specifics to analyze what skills, information or persons you need to master them and immediately start to master some small part of the fearful situation. For example, if initially speaking up in a committee is the most fearful part, you might immediately practice contacting members before the meeting and being among the first to make a point.

When you are able to expose yourself to the fearful situation and master it, we find fear undergoes a transformation into excitement. It appears any challenging event - skiing, flying, hiking, debating - can be transferred into exhileration after it has been actively mastered. Here are a few guidelines to help your mastery:

- The sooner you face up to fear, the sooner it goes away.
- The more pleasure in the event, the less disorganized the effects of fear.
- The more specific you can be, the more you can do about it.
- The more you study and know your subject, the less fear of it persists.
- The smaller the steps you take, the sooner you experience success.

Of course, some persons who have avoided an anxious situation for a long time under certain conditions can become panicked and phobic. They most often report they feel as if they will faint, die, or go crazy under the terrible sway of panic. Since treatment methods have increased strikingly in the last 15-20 years, they do not have to put up with this condition and should find a specialized therapist.

In any case, here's to your new sense of adventure and mastery about fearful conditions in your life!

This article was written by Dr. Richard C. Raynard, whose latest book Panic Free is offering new hope for those suffering from overwhelming and often debilitating panic attacks. For over 30 years he has helped thousands of his patients with the latest refinements in anxiety and panic treatments.
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Explaining your Phobic Feelings

Many phobic persons have asked how to explain what they feel to their husband or wife or good friend. We feel that most of the time, relatives pass panic off as high anxiety and resist the idea of anything worse being experienced by someone close to them. This probably parallels the denial of close family and friends of conditions like cancer, alcoholism, or chronic pain. It’s hard to accept something terrible happening right before their eyes to someone one loves. For example, one husband thought his wife’s phobic moods and quirky behavior was “cute” and would indulge her change