Moving the Blog

PanicStation is a really great site dedicated to people with panic, anxiety and agoraphobia issues. The group there is very friendly and supportive. I'd recommend checking it out!

I've started blogging at PanicStation, so check out my blog there.


View my page on PanicStation

The Agoraphobia Workbook 001 - Understanding Agoraphobia

One of my YouTube subscribers recommended a book a couple of weeks ago - The Agoraphobia Handbook (by C. Alec Pollard & Elke Zuercher-White). I found it quickly on Amazon and ordered it. I thought it might be useful if I went through the workbook online, using my blog and my YouTube channel to do the worksheets and discuss the concepts.

The book starts with a section on understanding agoraphobia - what it is, what it isn't, the many forms it can take, and how fear can be transformed into phobia. Its interesting and informative, and the authors boil it down to this:

"Agoraphobia is a maladaptive fear of and desire to avoid situations in which you believe a symptom attack may occur and result in incapacitation, overwhelming humiliation, or some other catastrophe."

I find it interesting that the authors talk about symptom attacks, not panic attacks. There is discussion of panic attacks, naturally, but they define agoraphobia as linked to symptom attacks. There are a wide range of symptoms that we've all experienced in one way or other, but they boil symptom attacks down to this:

"[Symptom attacks] .. all have a sudden and rapid onset and are perceived as unpredictable and uncontrollable. In almost every case, the feared symptom attack is perceived as leading to catastrophe" (i.e. death, insanity, loss of control, humiliation, etc.).

There's a short series of questions at the end of the first section. I'll answer them here.

Exercise: How Your Agoraphobia Has Evolved

1. How did your agoraphobia start?

My agoraphobia started when I began being afraid to drive by myself because I was worried that I would have a panic attack in the car. Being afraid to drive alone meant being stuck at home.

2. What symptom or symptom attack did you fear when you first developed agoraphobia?

I feared the typical symptoms of a panic attack. Racing heart, shaking, sweating, hot/cold flashes, dizziness, weakness, feeling short of breath, etc. I was afraid that there was something physically wrong with me and that I would need immediate medical attention to save my life.

3. If you have high anxiety and panic attacks, are they the main source of fear or do they occur because you fear something else?

Yes. Anxiety and panic are the main source of my fear now.

4. What is your main fear in agoraphobic situations now (Is this different from what you feared when you first developed agoraphobia)?

I no longer worry about having a heart attack or stroke or something being physically wrong with me. My main fear now is the fear itself along with everything that comes with it - primarily derealization and depersonalization. I am afraid that I will lose control and either "slip away" (not even sure what that means) or be unable to get myself home or continue with whatever situation I am in at the moment. I do fear "going crazy", and the "slipping away" feeling does lead to being afraid that I am dying, although for no obvious reason (i.e. I know I'm not having a heart attack or stroke).

In my next post, I'll go through the next part of the workbook, which focuses on the four components of agoraphobic fear.

My Story - Part 3 - Coping Skills and Changing Thoughts

I'd have to say that February of 2006 was a big turning point in my life.   After relying so long on medication to ease my anxiety, panic and depression, it was at that time that I started doing things the right way.

The first thing I did was start seeing a therapist.   My therapist was recommended by my doctor.  She had an office in the same building as him and they knew each other, so it worked out quite well.  Its important to note that she is a therapist and counselor, not a psychiatrist.  As such, medication is not part of her toolkit, which is just the way I wanted it.

Initially, I was going twice a week as I was still in the grip of 5 months of serious anxiety and depression and I needed lots of help.   First, we had to "stop the bleeding", so for the first month or two we focused primarily on making me functional again - learning to relax and knock down the panic and anxiety.  I had already learned much about abdominal breathing and other basic relaxation techniques, but having someone to work with was a big help in actually putting them to good use.   Slowly, I began to regain mastery of my anxiety and panic and I was back among the living (even if I was pretty shaky and close to the edge most of the time).

We also worked on strategies I could use to help change my thinking.  The first step was understanding that I could control my thoughts.  The most powerful cognitive weapon in my arsenal to this day is one simple idea - "This is just a thought.  If I don't like it, I can choose to have a different thought".    I'll never forget my first few days working on that as I tried to go about my daily activities.   It was absolutely exhausting as my mind was constantly "racing", but it worked.  I was starting to feel a difference.  When I stopped fearing my thoughts, things became easier on me.

One of the first tasks she made me to was to make a list of things that made me happy.  I had to make that list, and keep it with me at all times.  In the state I was in, it was often difficult to feel joy, so imagining things that made me happy was a challenge.  She was a huge help, explaining that I didn't need to swing for the fences all the time.  She asked me if there was anything in particular that I liked about the car I was driving at the time.  Well, I guess I liked the fact that it had heated seats.  Bingo.  There was item number one on my list.  I remember laughing out loud because it seemed so silly and simple, but I had the idea.  Within a week or so, I had a decent list that ranged from the mundane to the sublime.  My job was to keep adding to the list as things popped into my head, and to physically look at that list any time I needed to intercept a "bad" thought and turn it into a "good" thought.

I kept that list on my Palm Treo until the day I sold it.  Guess what? The list got transferred onto my iPhone and remains there to this day. 

After a couple of months, I went from twice-a-week sessions to once-a-week.  I was improving and I didn't need her as much.  We kept working on the coping skills and cognitive behavior stuff, and also started working on larger life issues like the fear of failure, having unrealistically high self-expectations and resolving interpersonal conflicts in a more productive manner.  We talked some about the fact that my parents divorced when I was 10 years old and how that may have contributed to my problems later in life.  We chatted about things that were bothering me at home and about how I could take a healthier approach to my professional life that would help minimize stress.  It was all good stuff.

By the summer of 2006, I was doing great.  I was actually going days at a time without any notable anxiety.   My depression and obsessive thinking were gone.  My mild agoraphobia was gone too.  I was out and driving around.

By August I think we had gone to every-other-week sessions.  By Christmas she had closed her office on Long Island and my initial journey through therapy and counseling was over.   Mission accomplished and it was an experience that will serve me for the rest of my life.

I've maintained contact with her since then, and we've done a couple of face-to-face sessions when she's been out in my neck of the woods.  We've done some work over the phone too, when I needed it, most recently in the last 6 months or so when my anxiety and panic returned, brining the mild to moderate agoraphobia with it.  

I'll talk more about that down the road ...

My Story - Part 2

By the summer of 2005, there had been two major periods in my life during which I had to deal with severe anxiety, panic, agoraphobia and depression.   The first time it happened, my "cure" was simply learning what the problem was.  That's cool, but it didn't address the core issues.  The second time it happened, my "cure" was a pill.  That's not cool, because not only didn't it address the core issues, it came with all kinds of crappy side effects.  To make matters worse, when it was time to stop taking the medication, it was like being dragged over broken glass for 6 months.

I was fortunate enough to know that you just can't stop Paxil cold turkey.  I took about 3 months to taper down my dosage until I took my last fraction of a pill in September 2005.  That was still way too fast.  Within about a week, I began to notice that my overall anxiety level was rising steadily  I also found that my temper was very short and that my emotions - which had been virtually missing in action for 8 years - were now uncontrollable.   Physically, I was dealing with horrible headaches, dizziness, visual disturbances and all kinds of stomach and digestive issues.  After a month or two, the anxiety began to spawn actual panic attacks.  From there, the agoraphobic behaviors started popping up. By month three depression was on the scene.  Things were getting worse for me by the day.  By January of 2006, I was swinging wildly from anxiety to full blown panic to crushing depression every day.  I became virtually non-functional.  It was bad.  Very bad. 

Welcome to the wonderful world of antidepressant "discontinuation".   Please don't use the word "withdrawal" when referring to drugs like Paxil.  Companies like Glaxo SmithKline think its too negative sounding and we can't have anything interfering with the otherwise obscenely huge profits Paxil generates for them.    Bitter?  Nah, I'm not bitter at all.

So there I was, out on the ledge without a net below me.  It was horrific, but it left me with two options.  Go back to a pill, return to "zombie land" and mask all my problems, or get to work on myself and fix it the right way.  Most people are not aware that a sensible combination of regular exercise, healthy diet and therapy or counseling is as effective as antidepressants in the short term, and MORE effective than antidepressants over the long haul.  Its true.  Many studies have supported this conclusion.  The problem is that most people, when they are feeling so badly like I was, simply cannot wait 6 weeks for exercise, diet and therapy to kick in.  They want relief IMMEDIATELY.   Who can blame those that suffer for seeking fast relief, right?

So, come the end of January 2006, I started seeing a great therapist (NOT a psychiatrist - I had no need for more pills, thank you), I was forcing myself to exercise every day, and I was eating well.  Sure enough, my depression lifted, my anxiety started to subside, and I was getting my life back again.  I was practicing relaxation skills and other coping strategies to combat panic attacks and wouldn't you know it, it worked!  As a bonus, I was losing weight at a fast and furious pace.  

2006 had started as one of the worst years in my life.  By June, I knew that 2006 would turn out to be one of the best.

More to come in my next post ...

My Story - Part 1

I'm 42, and I've suffered with anxiety, panic attacks, agoraphobia and depression from time to time for the last 23 years.   This is my story.

My first panic attack came when I was 19 years old and a sophomore at a large university.  As with many people, it came "out of the blue" and I was totally convinced that I was dying.  It was, without a doubt, the most terrifying night of my life.   That was the start of 5 or 6 very difficult months filled with almost constant high anxiety, panic attacks, and mounting agoraphobic tendencies.  I managed to finish the semester with the help of my girlfriend.  She was my "safe person" when I needed help, which was quite often.  

Back home for the summer, I caught a major break when I went to see a psychologist to talk about my problem.  At my second session, he gave me a copy of Hope and Help For Your Nerves by Dr. Claire Weekes.  I know it sounds too good to be true, but that book stopped my anxiety and panic within a few days.  Once I could label my problem, and once I knew that it wasn't going to kill me, it went away.  I didn't have another panic attack for probably 9 years.

Fast forward to the spring of 1997.  At that point I was married and had started a business that was really taking off.  Everything was great, but panic attacks and anxiety returned with a vengeance.  Things went downhill very quickly for me, and I found myself crippled by constant anxiety, severe panic attacks, and crushing depression.  I became completely agoraphobic, unable to leave my house, within a period of weeks.  It all happened so quickly.  It was a total disaster.  My family doctor convinced me that my problem was the famous "chemical imbalance" (MUCH more on that issue later) and that Paxil was a possible answer. 

I will admit this much.  At the time, Paxil was a lifesaver.  Within a couple of weeks my depression was gone, anxiety was waning, and my panic attacks were "short circuiting" before they could really happen.  Within a month, I was back to "normal" again.  I had my life back.

Jump ahead to the spring of 2005.  Thanks to Paxil, I was 85 pounds heavier. Also thanks to Paxil, I had been making horrific financial and business decisions for about 8 years.  I had no emotions - even through the birth of my children and the death of three of my grandparents.  I was completely disconnected from my life.  I had no emotional relationship with anyone or anything.  My business was tanking and I was acting like I didn't care . My health was suffering from being so overweight.  My wife was at the end of her rope with me.  My kids, even at the tender ages of 5 and 3, knew that I couldn't be counted on for anything.  Enough was enough.   It was time to get off the Paxil, which I wasn't sure was doing anything any more anyway.

I'll end here by saying that when you stop taking a drug like Paxil after being on it as long as I was, you are entering a world of pain. 

More to come ...