Panic Update

Key to Recovery: Homebased Practice

2009-09-20T14:44:00.000-07:00

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

Homebased practice is coming to be recognized as one of the most important prognosis for sustained progress, and especially for long-term success.

Homebased practice is simply the everyday exposure you can get in the place of fear within an average walk from home, using the support of people who can help you and the convenience of home. It almost always requires that your family knows of the special time you have set aside, so they protect that time, if not actively assist you. And, following the best practice of exposure therapy, it requires starting at the least anxious situations and setting limited goals that ensure the increasing success, all while practicing the methods in fear management.

The reasons for the effectiveness of this approach are not hard to find. Facing the place of fear every day in itself breeds confidence. The daily progress, however small, is measurable and real and is a solid basis for hope. You can be more flexible about practice at home than anywhere else, particularly in setting up early morning practice. This avoids all the buildup of the worries and "what-if's".

If your practice is successful, as it usually is, the calming effects can last a good portion of the rest of the day. When you write down or "chart" your progress, you can realistically project your ability to travel to those especially important future occasions you don't want to miss.

Perhaps most important of all is that in small amounts of time every day, you have built up an incredible amount of exposure time that is the basis of desensitizing the phobia.

As Dr. Weekes says, "You get cured in the place of fear." And at the same time if you have been practicing the methods of managing fear until they are habitual and automatic, then, when the most fearful situations come up, you are fully prepared.

An added bonus for many is when, after a run of successes and increasing comfort in travel, they reach a point of excitement about their progress and look forward to practice with increasing anticipation of success. This can be a take-off point in accelerating progress through the phobia.

An account by Dr. Hardy in accelerating progress through practice can make this point more clearly. He reported his effort through a team of therapists working on a housebound phobic woman almost round the clock for six days. Phobic five years, and housebound for two years, she could not answer the door or go onto her own patio. A trained staff worked with her in continuous practice from 8am to 8pm every day.

On day 1, she was able to walk around the block four times by the end of the day.

On day 2, her resistance, initially extremely high, fell as she felt confidence in the therapists and their methods. She was able to go in and out of several stores by the end of the day.

On day 3, she mastered much of driving in traffic.

On day 4, expressways, elevators and talking to strangers were the focus of practice. She had passed into a state of excitement about her progress with few anxieties.

On day 5, she focused on doing all of these activities alone, with occasional meetings with her therapists.

On day 6, she kept only telephone contact with the therapists as she moved through stores, airport, escalators, bridges, etc., all alone. She maintained this capacity with several years follow up.

This bold effort at continuous practice speaks for itself: when her practice was that much more frequent, her progress was that much more rapid and dramatic.

For more information about the benefits and methods of homebased practice, refer to:
Agoraphobia: Nature & Treatment (Mathews, Gelder & Johnston, 1981)

Your Concern About Hypoglycemia

2009-04-03T12:41:00.000-07:00

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

At the 5th Annual National Phobia Conference in Washington, D.C., Dr. Frederick Neuman spoke on hypoglycemia and the confusion around this condition, especially in the over-emphasis placed on the links between this and agoraphobia. Dr. Neuman supported his findings by his own clinical research and extensive reviews of literature on the subject.

Dr. Neuman focused on the common over-diagnosis of hypoglycemia in agoraphobics. His own caseload at the White Plains Phobia Clinic was used to draw a clear picture. At one time, 25-50% of his clients reported hypoglycemia upon entry to his clinic. Without exception, none of these clients were hypoglycemic, as was shown by subsequent glucose tolerance tests.

Despite these test results, however, it is generally extremely difficult to convince an agoraphobic that they are not hypoglycemic once they have been told (or have read) that they have this condition. Phobics are frequently in distress, have difficulty concentrating on practice, and are distracted by the attention needed for a hypoglycemic's diet once they believe they have this condition, and this often inhibits treatment.

Dr. Neuman reports that the typical blood sugar levels of the clients he tested for hypoglycemia was between 50 and 60 milligrams or higher, which is within the normal range. The blood sugar level at which normal functioning is disrupted is 35-40 milligrams, however, measures of blood sugar levels below 50 are relatively common in the general population. (Levels of 40-55 milligrams fall in a gray area in which some people have symptoms, but the majority do not.) The overall data suggests that hypoglycemia is as common among non-phobics as it is in agoraphobics!

Not all experts feel that a Glucose Tolerance Test is a completely valid diagnostic tool. Doctors also disagree about what constitutes a normal blood sugar level. According to the American Diabetes Association, normal is between 50mg% and 150mg% (mg% means milligrams of glucose per 100 milliliters of plasma). Individual glucose tolerances wary, though: 50mg% may be normal for one person, but too low for another. Some nutritionists believe that food allergies can also foil the Glucose Tolerance Test. For example, the glucose solution from corn (one of the most allergenic foods around) may cause a reaction that mimics the symptoms of hypoglycemia.

One opinion is that carbohydrates play a part in hypoglycemia. Carbohydrates are divided into two groups: complex (starches) and simple (sugars). The starches in whole gain breads, rice, pasta and potatoes, are absorbed into the blood stream slowly, maintaining a small, steady flow of glucose. The sugars in candies, cakes and fruit juices, however, are broken down at lightening speed, causing blood glucose to shoot up. This causes sensitive insulin-response mechanisms to overreact, dropping blood glucose way down again. When sweets are cut out of your life, the seesaw may stop. It is also normal for blood sugar to dip if you skip a meal, or have an alcoholic drink, especially on an empty stomach.

The American Diabetes Association also agrees that there is no good evidence that hypoglycemia causes depression, chronic fatigue, allergies, nervous breakdowns, alcoholism, among other disorders. Everyone's blood sugar levels drop at one time or another. The ADA says that low blood sugar is overdiagnosed and "used too often to explain problems ranging from overeating to bizarre behaviors".

A thorough Glucose Tolerance Test should take five to six hours, and tests blood sugar levels before you drink a glucose solution and after, at timed intervals. The results are charted on a graph. A healthy response is a steep rise in blood sugar after the drink, then a gradual decline to normal. A hypoglycemic experiences a steep rise, then a very sharp drop below normal.

Another Step Toward Recovery

2009-03-07T06:28:00.000-08:00

by Joan Ward

Joan is a student in Journalism who submitted this essay to her class. She gave permission to Dr. Raynard to publish a copy of the essay in the March 1986 issue of Phobic Update(c).

I am sitting in the classroom listening to the teacher explaining the story we read for homework. Suddenly, I become aware that my heart is beating more rapidly than usual. I feel warm and the palms of my hands begin to perspire. The feeling comes over me that I must run, must leave this place before something terrible happens. My imagination races and I see myself on the floor between the desks, screaming and thrashing wildly while my classmates react in horror. I see myself later trying to explain what happened, and, failing miserably, having to withdraw from the class amid utmost embarrassment.

I am agoraphobic and what is happening to me is what agoraphobics fear more than anything in the world - an attack of panic in a public place.

In the past, when these feelings overcame me, I hurried to my place of safety - my automobile parked as close as possible nearby. The times I rushed from church, supermarket, theater, etc., are too numerous to count. So numerous that, in fact, I had begun to avoid these places and stay at home. But this time I react differently. I say to myself, "This is just a panic attack. It will pass if I do not add danger to it. My body has pumped adrenalin into its system and in five minutes it will be re-absorbed and I will be fine." I look around me at the other students in the classroom. They are listening intently to the teacher and have no idea what I am going through. I try to imagine what their lives are like. I look at the girl who sits next to me and picture her in her home with sisters and brothers. I return my attention to the teacher and find my place in my book. The panic has disappeared. By controlling my thoughts and deliberately placing my attention on people and things around me, I have regained control. And no one but myself is the wiser.

Agoraphobia is a learned behavior. It is, in fact, the fear of fear. One suffers a panic attack, which can be so horrible that one feels one is actually dying, and thereafter spends one's time avoiding the things or places which one blames for causing the attack. But if this behavior is learned, it also can be unlearned. By the process of desensitization, that is by approaching the feared place slowly and staying only moments, and then gradually lengthening the periods of time, one can overcome the fear.

Agoraphobia can be cured. It takes a strong commitment and a great will to effort, but the reward of peach of mind and a happier life is certainly worth the struggle.

Preoccupation with Death & Dying

2009-02-03T15:09:00.000-08:00

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

For most phobics, the very first occasion of panic came with a feeling "I'm going to die". Later on, just anticipating the panic returning can lead to climbing anxiety and a feeling "I'm going to die". The overwhelming number and kind of bodily experiences in panic seem to offer no other explanation. Choking, tightness of chest, fainting feelings, dizziness, shortness of breath - any of these are alarming by themselves, and in combination are overwhelming. It is small wonder, then, that most of us have repeatedly sought out physicians about basic health for reassurance about our survival.

Despite physician reassurances, no matter how sound or authoritative, many go on to become phobic to the bodily symptoms. That is, they anxiously worry about the beginning signs of discomfort and follow each symptom through the day in a worriness that it may become full blown panic. This is not hypochondriasis, or imaginary aches and pains with all the attendant worry. These symptoms are actually felt and can bring on panic by themselves if the viscious circle of worry - anxiety - symptoms - more worry becomes out of control. Even though this kind of worry is unusually persistent in some, it can be brought in control, often with marked reduction in symptoms.

Yet, even for those who are not worried about their health or their symptoms, many are haunted by the imminence of death. For these persons, we feel the preoccupation with dying reflects an emotional and spiritual awareness of how vulnerable one is, of how life is slipping away. In fact, studies of agoraphobics show that over 17% lose their jobs directly from their phobia, over 55% have social relations curtailed, another 27% have marital disruption, and another 10% become housebound. The growing fear is that one is giving up gradually, which is like dying.

These changes do not come about all at once. In every moment phobics choose to live vs. to die in all of life's decisions, big and small. Dying takes the form of avoiding, putting off, retreating, finding excuses, losing one's self, overworking, sitting still, smiling too much, waiting until one feels better, among other forms of retreat. The extent of phobic avoiding gives new meaning to the adage "cowards die a thousand deaths, the valiant die but once." For every retreat, something else is lost about living and one becomes adapted to doing, feeling and experiencing less and less. I believe the majority of agoraphobics come to a haunting sense of the imminence of death, questioning the purpose or worthwhileness of any action.

Those phobics who can face the spiritual crisis of "what am I living for?" are often able to find unusual strength to renew their sense of purpose. In learning to discard things they have been attached to in an unhealthy way, they often renew their purpose in a way that helps them recover directly. For example, one single parent with a nine year old son had developed a phobia for certain places because of a direct threat of violence - even murder - by her ex-husband. When she could feel, "I have nothing to lose", she was able to vigorously pursue life-giving, constructive changes such as a move to the country and major job change. A key resolution, probably, was to defend her life and her son's to even her death, a resolution baked by martial arts and weapons training.

In any case, the haunting sense of death is a crisis for many phobics to sense who they really love and cherish and to make decisions to bring that about, rather than let their life erode away from the influence of the phobic condition. In this way, their phobia seems to present a test to their whole psyche of whether to choose a life-giving or life-denying way of life.

For those phobics who are moved by this article, I heartily recommend a book by Barbara Sober, "Wishcraft". It will help you get in touch with your heart-felt wishes and needs which are the basis of what gives life meaning. It has a wealth of ways to get you back to the life you have almost forgot or given up on, and will show you how to get started - now! Of course, any avenue that is particularly yours - your church, best friend, trusted counselor, loving partner - can be a way out of the illusory trap of losing everything life holds dear.

ALERT: Worry is Out of Control

2007-10-20T05:25:00.000-07:00

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.
.

Will your group help cure your phobia?

2007-10-14T08:44:00.000-07:00

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.
.

The Best Treatment Methods for Anxiety and Phobia

2007-10-06T07:00:00.000-07:00

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.
.

Calming Methods - A Safe Person

2007-10-01T05:58:00.000-07:00

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.
.

Headaches and Your Phobia

2007-09-29T06:55:00.000-07:00

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.
.

16 Major Calming Methods - Do you use them?

2007-09-23T19:40:00.000-07:00

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.
.

ALERT: Benzodiazepine Addictiveness

2007-09-15T06:43:00.000-07:00

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.
.

The Instant Cure - An Instant Appraisal

2007-09-01T07:02:00.000-07:00

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.
.

School Phobias

2007-08-05T11:47:00.000-07:00

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.

.

Average Fears in Young Children

2007-08-04T19:30:00.000-07:00

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.
.

Mastering Panic Attacks

2007-07-08T16:21:00.000-07:00

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
___________________________

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.
.

How Your Nervous System Works In Panic

2007-06-11T12:40:00.000-07:00

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.

How to Select a Practice Partner

2007-05-08T06:12:00.000-07:00

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.
.

Handling Criticism

2007-04-14T09:41:00.000-07:00

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.
.

Common Myths About Agoraphobia

2007-03-09T14:32:00.000-08:00

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.
.

Letting Fear Work For You

2007-02-13T07:02:00.000-08:00

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.
.

Explaining your Phobic Feelings

2007-01-06T07:22:00.000-08:00

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 changeableness as if she were a small child. All phobics know how people in their life minimize, ignore, forget, scoff, or belittle their experience of panic.

Some earnestly wish and ask to know because of the helplessness they feel and the preoccupation and worry their notice. Still, the phobic can be at a loss to explain panic, worry and overwhelming experiences he/she has had to live with for years. He or she may have prettied it up under misleading names like “jiggy”, “spacy”, “getting zinged”, “jumpiness” and so on. Where to begin?

The following suggestions may help clarify your experience to the genuinely interested partner. Of course, it is helpful to have a face to face, uninterrupted talk at a time when both of you feel relaxed. You should have a clear signal your partner has initiated and wants this feedback.

First, consider that you would feel no fear or anxiety at all if you were asked to walk a plank six inches wide if it were on the ground. You associate no danger to that. Then, consider that if that same plank were 15 feet off the ground, fear is a natural thing to feel. Then, consider that if you were sitting down looking up at the plank before you ever walked on it, then you would experience anxiety. Anxiety is anticipation of some future danger even when you are already in a safe zone. Still, you would be willing and able most of the time to climb up on the plank and walk it. If, in addition, you panicked while you were looking up at the plank and did your best to avoid goingup, that would be phobic behavior. Now you would be experiencing the three earmarks of a phobia: anxiety anticipating the situation, panicking at the thought of the situation, and avoiding it anyway you could.

Perhaps the most difficult part to explain is panic. Some have estimated that as many as half of adults have experienced panic sometime in their lives. No doubt many have tried to forget and put away these incredibly fearful experiences by surpressing these memories, others have less consciously repressed them.

Accordingly, you may ask your partner whether he/she has ever been terrified of water, or of the dark or of high places. Many people have panicked to these as children. Surprisingly, others have been panicked at bees or certain insects. In later life, many have panicked at speaking in public, such as in committees, school classes, or assemblies. If that person recognizes any of these, ask how his or her body felt, what sensations were there, and how he/she perceived things around them. If your partner remembers, then he/she can be told that what has been almost forgotten as too painful for them, is something you experience often even now.

If your explanation gets this far, it isn’t so difficult to help your partner understand that anything leading up to the situation of panic or even reminding you of it can make you extremely anxious or even panic. And, he or she can begin to understand and apply all you have learned about desensitization, practice, medication, and getting well. The key is bring your partner to his/her experience of anxiety and panic first so he/she can let go of the natural resistance to facing these painful experiences.

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.
.

For more information about these and other issues of anxiety, panic and phobia, contact The Panic Doctor, Richard C. Raynard, Ph.D. at http://www.panicdoctor.com/ or call him at 505-231-8625.

Revealing your Phobia to Others

2006-12-15T07:02:00.000-08:00

"Agoraphobics are often overwhelmed by concern with trying to avoid embarrassment or humiliation" is the opinion of Dr. Robert L. DuPont, former President of the Phobia Society of America. Yet, the problem of why and how to overcome embarrassment has not been addressed adequately. (I will be addressing how to handle embarrassment in an uncoming article.)

The dread of panic makes the phobic person acutely sensitive to bodily changes. When one excessively worries about body changes, they become enlarged and overwhelming, for example, a momentary weakness in the legs becomes, "another step and I'll fall." And, most phobics feel other people can easily see that they are "about to fall" and cause embarrassment.

Yet, time after time, it is found that the most intimate friends and spouses fail to ever observe or suspect trembling, shaking, redness in the face, dizziness, sweating, tightness and other body changes. It is clear that the embarrassment of being in panic or revealing one's phobia is a problem only to the phobic person.

_______________________

In our opinion, revealing

your phobic condition can

be one of the most critical

first steps in recovery.

_______________________

To start with, covering up takes a lot of time and effort, and nourishes the unhealthy preoccupation with body changes. More important, it puts a truly insurmountable wall between the phobic and those who would help. There is simply no way for the phobic to find out if the help can come than by revealing themselves.

The immediate effect of getting help is to reduce the burden, and sometimes resentment, that comes from always covering up. Another dividend is finding that those you tell already know of other phobics (some in their own family) and some have phobias of their own! For willing partners, the bonus is that they now can be useful and good for their phobic partner, and no longer have to be irritated or put off by their partner's quirky, mystifying ways. Usually, immediate benefits are found at work, by getting more cooperation in bringing about flexible breaks, better access to the boss, use of sick days, etc.

Isn't it remarkable that phobics, who have one of the most common conditions, exceeding in prevalence even alcoholism and depression combined, are so unknown to each other?

"Phobic" is not the loaded word for many that it has become to you. For most people, it is a variant of being fearful or anxious, and may be a bit irrational or silly. There is rarely an appreciation of the overwhelming panic. For some, it may be used in a "cute" sense, just as some people loosely say, "I'm absolutely phobic of green wallpaper!" It seems so non-serious to most that it is rarely used as a reason for a sick day, unlike "stress" and "fatigue".

We usually recommend that a recovering phobic tell their partner first, if he/she doesn't already know. We suggest introducing the word "agoraphobic" quickly, answering your partner's questions directly. You may try giving your partner a short, focused reading on phobia. My new book, Panic Free, (visit www.panicdoctor.com/PanicFree.htm) gives clear, easy-to-understand description and explanation of panic and phobia, as well as sections on how others can help in your recovery from panic. Another book, Agoraphobia (Mathews et al) has a chapter entitled the "Partner's Manual", which can be a great tool for partners who want to actively help. This never guarantees the belief, interest or understanding of the partner, but does give him/her time to come around and accept some kind of helping role.

We recommend that telling friends be briefer, explaining agoraphobia as "being anxious when I feel closed in or trapped." It truly is useless to have someone comprehend panic who has not experienced it, but sometimes giving the examples of "having a near accident when driving" or "looking over a 20th floor patio railing" helps some get the idea.

Thankfully, most friends want to know what they can do, and do not get anxious about your anxieties. We advise being equally clear and brief: "I may need to step outside from time to time", "I may need you to walk with me a ways," "I need to feel it's alright with you if I change my mind when traveling." We don't recommend that you have your friends constantly ask how you feel or make excuses for you. For many friends the above will put their concerns to rest, for others, it allows them to help and be useful to you.

The good news is that once you expose what you are hiding about your phobia, the embarrassment and disgrace drop away. Being known as phobic doesn't matter in time. And, you generally find that knowing of your phobia does not make others either too indulgent of you, nor completely callous, and sometimes has the added benefit of revealing someone who can be extremely helpful.

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.
.

Panic Free - The Book

2006-12-08T07:04:00.000-08:00

Dr. Raynard's eagerly anticipated book, Panic Free, is finally here! Richard C. Raynard, Ph.D., known as "The Panic Doctor" to thousands of panic sufferers, has compiled a state-of-the-art guide to recovery and freedom from panic. In writing the book, Dr. Raynard draws on his experiences with over 3000 phobic men and women, and of over 30 years treating them.

Dr. Raynard is a Licensed Clinical Psychologist. His specialty is the field of anxiety disorders, which include panic disorders, phobias, obsessive-compulsive disorders, post-traumatic disorders, and the varying degrees of anxiety. His ground-breaking treatments led to the start of successful specialized programs including Upward Bound, the Fear of Flying program held at Boston's Logan International Airport from the 1980's to early 90's, as well as programs for public speaking and driving phobia. He has performed extensive research into the causes, treatments and costs of phobia, and has presented before the Phobia Society of America, the Anxiety Disorders Association of America, the Massachusetts Psychological Association and other prestigious national conferences. Because of his specialization and authority in this field, Dr. Raynard has been a popular guest on radio, television and print media, receiving invitations to appear on Oprah, and other popular talk shows. Dr. Raynard has authored a national newsletter Phobic Update, as well as two books on panic and phobias.

After receiving and reviewing an advance copy of the book, I am impressed by the comprehensiveness of the book. Dr. Raynard has managed to put panic in perspective, but at the same time does not minimize how overwhelming and destructive it can be. He sheds new light on the forces that keep panic going, as well as the behaviors and beliefs that people develop which allows panic to become so overpowering.

Best of all, Panic Free provides realistic steps you can take to take back control! This is all done in a thoughtful, easy look-up format. Dr. Raynard's conversational manner is calming in itself, and you'll easily be able to imagine sitting across from this warm, soft-spoken, sincere therapist. To understand more on how the book is written, and to sample the "flavor" of the book, it takes just meeting Dr. Raynard and hearing his approach to counseling his patients. As he describes, "My priority is first to listen with feeling, exploring my client's experiences, concerns and also their life satisfactions - the things they truly love in life, as these are so very important. They become goals to quickly restore so that life again becomes satisfying and joyful. In treatment, we clarify the problems, then explore different treatment methods. While I lean towards the cognitive/behavioral methods, I draw on a wide range of approaches so that they fit the needs of my client." This is perhaps the most difficult thing for the average phobic to do. Most of the books on panic that I am familiar with are sound in content, but do not help you see how you can apply the methods to your own situation. Amazingly, Dr. Raynard has managed to do this with his book Panic Free.

Panic Free gives clear, factual information about causes and treatments, so that readers get direction and reassurance right away, without making it frightening. Dr. Raynard does not hold back. He easily shares what he has learned over the years in a step-wise, easy-to-understand language. Discussions of worry controls, handling sensitivities, developing calming methods, use of a partner, and a plan for desensitization are all geared to help you achieve early successes. In addition, Dr. Raynard handles all of the frequently encountered barriers to recovery such as poor sleep, unsupportive partner, time pressures, negative thinking....and much more. A slight edge of humor keeps the book from reading like a textbook or becoming boring, and in fact, it draws you in and excitement builds.

The self-tests in the book are ones that Dr. Raynard himself developed and and has used with his phobic clients since the mid 1970's when he founded his Fear Clinic in Boston, which later was renamed the Anxiety & Phobia Center. The set of tests are designed to help identify sensitivities and keep you on course, and can be an valuable recovery tool.

I've heard over and over again how alone and trapped panic makes you feel. Panic Free covers all types of phobia, using over 100 actual, inspiring cases as illustrations. For each phobia, it gives you the motivation, skills and action plans to eliminate panic for good. A unique Travel Kit goes with you, including the book itself, into every panic situation. Panic Free spells out the attitudes, skills and success plan you need for your complete recovery. Action plans for virtually every type of phobic situation are covered in detail, as well as suggestions for adapting the plans to suit your specific situation.

Simply put, Panic Free is designed to inspire and motivate you to complete recovery. Visit the book's Table of Contents and see for yourself.

Part I Motivation and panic
Ch 1 A Jumpstart - Fasten your seatbelt, we're on our way!
Ch 2 Motivation - Lighting the fires of desire
Ch 3 The Nature of Panic - The beast unmasked
Ch 4 Desensitization - Wearing panic out
Ch 5 Worry Control - Disarming the terrorist within
Ch 6 Calming Methods - Mastery of you and the situation
Ch 7 Avoiding - Success in facing up to fear

Part II Preparation for action
Ch 8 Self-testing - Keeping on course
Ch 9 Partner/helper - Safety when you need it
Ch 10 Medication - Revving yourself down
Ch 11 Travel kit - Launching yourself to freedom

Part III Action for success
Ch 12 Symptom Desensitization - No more fear of fear
Ch 13 Driving - Getting your world back
Ch 14 Vehicles - Enjoying your passenger time
Ch 15 Stores - Reclaiming your shopping rights
Ch 16 Waiting - Making a wait your best time
Ch 17 Talking up - Renewing your social life
Ch 18 Meetings - Joining in wherever you are
Ch 19 Criticism - Having your critics cheer for you
Ch 20 Airplanes - Flying the friendly skies
Ch 21 Doctors - Putting your doctor to work for you
Ch 22 Crowds - Getting in the swim again
Ch 23 Being alone - Being your best friend
Ch 24 Bugs, etc. - God's creatures big and small

Part IV Finishing up
Ch 25 Setbacks - Getting back in charge
Ch 26 Self-defeat - Vanquishing the inner saboteur
Ch 27 Barriers - Overcoming the obstacles to finshing
Ch 28 Finishing - Realizing it's truely over

Panic Free is a wonderful, well-written book which is bound to be a valued companion to people who panic or are phobic. It's positive, up-beat flavor is sure to get you excited to start your recovery. I highly recommend Panic Free. It will be an insightful teacher to those who panic, as well as professionals wanting to learn more on treating panic effectively.

Panic Free: Breaking out of your prison of panic can be ordered directly from Dr. Raynard by visiting his website at www.panicdoctor.com.

Contributed by Andrea White. Andrea has worked in the medical profession for over 25 years and spent 16 years working in the mental health field. She is webmaster of Dr. Raynard's website, and has held a long-time interest in panic and phobias. She volunteered to read and review Dr. Raynard's book when she heard of it's impending release. Panic Free is available through Amazon.com, Barnes & Noble, Trafford Publishing or direct from Dr. Raynard, the Panic Doctor.

Calming Methods: Mastery of you and the situation

2006-12-01T18:27:00.000-08:00

We're launching a new series of monthly articles on Calming Methods. 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 www.panicdoctor.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; others that are new for you will be explained. All will be formulated in a clear, natural way that helps you put them to work for you right away. 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. In any case, 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. Then again, you owe it to yourself to try a new method that seems promising. For 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. Visit Panic Update often for the latest information on advances and treatments.

Melatonin: A safe, effective sleep aid for some

2006-11-24T12:00:00.000-08:00

Melantonin declines significantly with age, yet it keeps our sleep cycle in tune and appears to regulate a system of self-repair and regeneration in the body. For example, a Finnish study of 7,396 sleepers, those who were longer sleepers had a 72% lower risk of breast cancer.

It seems especially useful for those who find it hard to get to sleep, most often because of worry and over-excitability. Some research has found it increases the speed of falling asleep. Taken before bedtime, it duplicates the body's own secretion of melatonin in the first 5 hours of sleep. A 3 mg capsule per day seems optimal for many.

For more information, check out www.lef.org/newshop/items/item00277.html

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.
.

Phobias: Still undertreated

2006-11-17T06:05:00.000-08:00

A recent survey of 9,282 households found essentially what the National Cachement Area study found over 15 years ago. Phobias are still more likely to affect someone at some point in their lives than any other emotional disorder.

About 25% of adults will be affected in their lifetime, compared to depression (17%) or alcohol abuse (13%). Also, it still takes longer for anxious persons to seek help (9 to 23 years) than for depressives (6 to 8 years) or substance abusers (5 to 9 years).

We will keep up the good fight, of course, but it will require that celebrities and famous people own up to their photias and a bast educational program, before phobias have the visibility and panache that alcoholism and its treatment has in this country.

Source: Archives of General Psychiatry, June, 2005

Theanine supplement helps overall calming

2006-11-10T17:04:00.000-08:00

Theanine is an amino acid found naturally in tea that crosses the blood-brain barrier and has a general calming effect. It increases production of GABA, a brain chemical that calms and produces a sense of well-being. Dopamine, too, increases with similar effects. Some research has found that it offsets the hyper effect of coffee, too. It will not cause drowsiness.

About Dr. Raynard

2006-11-03T17:39:00.000-08:00

Dr. Richard C. Raynard is a Licensed Psychologist who has specialized in the treatment of anxiety, panic and phobic disorders for over 30 years. Dr. Raynard was Director and Founder of the Anxiety & Phobia Center which started in Boston, Massachusetts as the Fear Clinic. There, he pioneered effective treatments for thousands of men and women, developing treatment methods for a variety of phobic situations including specialized groups for Fear of Flying, Public Speaking, and Driving Phobia.

Dr. Raynard has been active in research of panic disorders and has given presentations before the Anxiety Disorders Association of America, the Phobia Society of America and the Massachusetts Psychological Association. He has trained other physicians and clinicians in understanding anxiety and phobic disorders and their treatment and has appeared on many radio and television shows, news broadcasts and in national magazine articles over the years.

Dr. Raynard is author of A Consumer's Guide to Anxiety & Phobia Medications, first published in 1986. His latest book, Panic Free, is due to be released this spring. Advance copies are available by contacting Dr. Raynard at www.PanicDoctor.com or e-mailing him at Richard@PanicDoctor.com. Dr. Raynard is now in private practice in Santa Fe, New Mexico and sees private-pay patients with anxiety and panic disorders.

Join Dr. Raynard as he takes you on the road to freedom from panic.