Top Ten Points for Dealing with Phobias and Panic

Read and Practice

Marty’s Top 10 List: Top ten points for Dealing with Anxiety, Phobias and Panic.

What I would like you to know within the first few sessions:

You have panic and phobias. You are not having a nervous breakdown. You are not going crazy.
Panics will not hurt you, although they can be very uncomfortable.
Panics are self-limiting. They will not go on forever.
When panicking, you won’t do what you are afraid you are going to do.
You are afraid of the feelings inside of you, not the external object or situation.
Initially, it may not be realistic for you to feel comfortable. Working on your anxiety can be uncomfortable
Avoidance is the name of the game in anxiety. Unfortunately, avoiding anxiety only intensifies anxiety.
Be tender to yourself. Panic can be looked at as a way of directing anger towards yourself.
When you experience anxiety, try to stay in the present. Make distinctions between “What is” and “What if?”
We want you to learn that, inadvertently and despite your best intentions, you are somehow creating this anxiety yourself. Once you learn how you do it, you can then learn how not to do it.

You can download and print a pdf version of this list.

Anxiety Management Techniques

Accept Expect and Allow Anxious Feelings: Try not to feel surprised, disappointed, or angry at yourself when anxious thoughts and feelings arise. These thoughts, while disturbing, are not dangerous. Allow them to exist, focus on functioning in spite of them, and they will soon dissipate. If you fight them, or try to get rid of them, your anxiety level will take more time to calm down.
Identify Your Anxiety Level on a Scale of 0 to 10: Zero means you are feeling no anxiety. Ten means are feeling panic. Identifying and recording your anxiety level makes you an active participant in learning to manage your anxiety, and it establishes a baseline against which you can measure your progress.
Monitor Your Anxiety Levels: Observe your anxiety level as it rises and falls in relation to what you focus on. Watch your level rise as you try to rid yourself of anxious feelings. Watch it fall when you accept and allow these feelings. Your level will fall even if you do nothing more than wait and let time pass. Once you get into the habit of identifying your levels and watching them change, you’ll be pleasantly surprised to find how relatively infrequently really high levels occur and how quickly they pass when they do arise.
Anchor Yourself in the Present: The present is your safe harbor. Stay there by concentrating on “what is,” rather than “what if?” Describe your surroundings, talk to someone, count backwards from 100 by threes, read, sing or listen to the radio. Don’t get stuck in your future-oriented imagination. Stay in the here and now.
Don’t Plan Your Escape: Planning your escape tends to intensify anxious thoughts and feelings. It projects you out of the present and into the future where you are most subject to catastrophic thoughts and disturbing feelings. Rather than immediately following your old impulse to avoid and flee, try instead to cautiously stay in contact with what frightens you, while practicing your skill at fear management.
You Can Function Well with High Levels of Anxiety: Try not to be so hard on yourself, don’t go for perfectionism. You can still function even with high levels of anxiety. You are not likely to scream, faint, or do the embarrassing, outrageous, or dangerous things you sometimes picture in your mind. Remember that anxiety is disturbing but not dangerous. Take comfort in the fact that while you may be feeling shaky, your inner anxiety is rarely apparent to others.
Catch Your Disturbing Thoughts as They Occur: “What if this elevator gets stuck?” is a thought. A thought of this kind will produce fear levels because you are sensitized. Even though such thoughts may be fleeting and barely noticeable, they can startle and frighten you all the same. Try to identify such thoughts as they occur, before your fears become intense. Once you recognize it as only a thought, you can begin to focus on comforting realities in the present, such as, “the elevator seems to be operating properly right now,” or ,”there is sufficient air to breathe in any elevator,” or, “I now have skills to better manage my anxiety levels.”
Separate Thoughts from Feelings: Thought is internal speech–what we tell ourselves. Feelings are made up of sensations experienced in some part of the body. “I feel I can’t breathe” is really a thought, which may follow the feelings of tension in your neck, throat, and chest. The thought “I feel I can’t breathe” makes the feelings of tension seem dangerous, and starts a series of scary future thoughts. Instead, try saying, “Although I feel that I can’t breathe, I know that this is just a thought that seems scary because of the tension in my body. I know that my breathing will take care of itself automatically, so I can concentrate on using my skills to help bring my anxiety down.”
Find the “Trigger” to Your Panic Spiral: Despite what you might sometimes feel, your panic does not come “out of the blue.” In truth, it comes from a rapid interplay between thoughts and feared feelings. They may surprise you because you do not become aware of the spiral until your fear level gets very high. Learn to identify the “trigger” to this spiral, so you can begin to manage your fear when your number is a one or two, before it increases to a high level.
Stay inside yourself: Your tendency may be to think for others, to imagine how they perceive you. If you find that you are “looking” at yourself through the eyes of others around you, it is a sign that you are getting outside of yourself. Pay attention to how others look to you, notice what colors they are wearing, and whether you like the style of clothing they have on. Focus on what you think, not what others may be thinking.
Remember to Take Care of Yourself: Define and limit your job. Don’t try to manage the whole world. That will only increase your feelings of being overwhelmed. Let the pilot take care of the plane and let the driver take care of the bus. Your job is to take care of yourself. Make yourself comfortable, monitor your anxiety level, and do manageable things in the present.

You can download and print a pdf version of these suggestions

A Cognitive View of Panic

diagram

From a Cognitive perspective, people with panic and phobias have:

A consistent tendency to catastrophize, along with
A sensitivity to specific mental images and thoughts.

Let’s look at the (mis)interpretation, because it includes the “what if” thinking that is so terrifying.

This is where we say to ourselves things like, “What if I lose control?,” “What if I have a heart attack?” “What if I embarrass myself?” “What if I begin to panic just when…….?

“Notice that these cognitions (1) are involved with events in the future; and (2) are preoccupied with disastrous outcomes.

This is called “catastrophizing.” Your job is to catch yourself when you begin to have these anxiety-raising thoughts, and to change your thoughts to ones that are focused on the present.

You can download and print a pdf version of this diagram

Diaphragmatic Breathing

The purpose of this exercise is to reestablish diaphragmatic breathing as your normal, everyday moment-to-moment resting breathing habit. If you do no other exercise, be sure to practice this one. It is that important. It will be most effective if you practice at least three times a day for ten to fifteen minutes each time; eventually, the easy rhythmic motion of the diaphragmatic breathing will begin to replace the strained, unnatural chest breathing to which you have become habituated. You can speed the process by being aware of your breathing pattern as much as possible during the day, for the more aware of it you became, the more often you correct it (change from chest breathing to diaphragmatic breathing), and the faster you will replace thoracic with diaphragmatic breathing.

To Practice: Before you go to sleep and just after you wake up, place your right hand on your upper abdomen, with the little finger directly above the navel and the fingers spread so that the thumb is almost touching the chest. Place your left hand on the upper chest with the little finger between the two breasts. As you breathe, concentrate on the air moving down into the upper abdomen (as if you are filling your stomach with breath). The right hand should rise with the inhalation and fall with the exhalation; the left hand should not move. You should feel a slight motion in the lower portion of the chest cavity, but the upper portion should remain still. Within a few moments you will become more rested and quiet. Do not try to force the breath. Allow the motion to be gentle and effortless. Notice how easy it is to breathe deeply and easily, without any effort.

Benefits: This will lead to autonomic balance and a relaxed state, generally. After some weeks, depending on the individual, you will begin to notice subtle and gradual changes in your daily breathing patterns. Its movement will be more relaxed and rhythmic. As was discussed earlier, this leads to a greater efficiency of the pulmonary process and reduces the amount of work required for proper ventilation perfusion.

Even Breathing

While you are practicing diaphragmatic breathing, concentrate on making the breath very smooth and even. The inhalation and exhalation should be of the same length and have the same pressure. Do not exhale all the breath at the beginning of the exhalation. Concentrate on keeping the flow pressure even throughout the entire cycle. Eliminate all pauses, stops, and shakiness in the breath, including the pause between inhalation and exhalation. Imagine that the breath is like a large wheel moving through the body without any pauses or stops. It is often helpful to picture the breath flow as a completely smooth, even sine wave.

Benefits: The jerkier the breath, the more disruptive it is to the autonomic nervous system. When the breath is smooth and even, autonomic balance is achieved

Reference: Paul Neurnberger, Freedom From Stress: A Holistic Approach, Himalayan Institute Publishers, Honesdale, Pa, 1985

You can download and print a pdf version of this diagram

Relaxation Exercise:

The more relaxed we are, the less we are disturbed by anxiety and stress. This audio file is a progressive relaxation exercise. You will be asked to gently tense, and then relax, each part of your body. Relaxation is a skill that takes some time to learn, but can become a helpful stress reduction tool as your relaxation skills increase.

Click the play button below to start the tape.

Practice this exercise regularly