Managing Your Anxiety

David Carbonell, Ph.D., our guest, talks about managing your anxiety and panic. We discussed anxiety disorders and panic attacks, how to respond to a panic attack, recovering from a panic attack and using diaphragmatic breathing, anti-anxiety medications, cognitive behavioral therapy (CBT) and progressive exposure used in anxiety treatment.

Audience members shared their ideas for controlling panic and treatments for anxiety including anxiety support groups, helpful books on anxiety, self help tapes for anxiety and video programs to overcome panic attacks.

David Roberts: HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Managing Your Anxiety." Our guest is psychologist, Dr. David Carbonell. He is Director of Chicago's Anxiety Treatment Center and conducts seminars and workshops for a variety of professional groups. Dr. Carbonell also makes frequent presentations on anxiety.

Good evening, Dr. Carbonell and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Many of the people who visit HealthyPlace.com feel pretty hopeless and pessimistic about recovering from anxiety and panic. I'm wondering what you would say to them.

Dr. Carbonell: I'd like to tell them that these disorders, anxiety disorders, are both common and treatable. A good recovery is attainable!

David: You make it sound relatively easy. Yet, for many, it's very difficult? Why is that?

Dr. Carbonell: A number of reasons. As your questions indicated, it's easy to become depressed about these anxiety conditions. It's also true that following common sense instincts often doesn't help. There are tricks to getting over these problems. And so I see many people who, in other areas of their lives can solve all kinds of problems, have a lot of trouble with these.

David: When you use the term, "good recovery," what do you mean by that, exactly?

Dr. Carbonell: In the case of panic disorder, I mean a person can get to the point of no longer fearing a panic attack. And when you get to that point, they tend to fade away. So you can live your life without that shadow.

David: A moment ago, you mentioned "tricks" to getting over these problems of panic and anxiety. What were you referring to, specifically?

Dr. Carbonell: The tricks to working with panic all relate to this:

People's gut instincts about how to respond to a panic attack are almost always exactly wrong, the opposite of what will help.

And so, people will hold their breath during a panic attack; will stand rooted to the ground; will flee. All these responses, unfortunately, make it worse. And so a fundamental trick of a panic attack is learning how to respond differently. It requires:

ACCEPTING the panic, and working with it, rather than opposing it.

David: We have one audience member who agrees with you on the reaction to a panic attack:

sher36: I always feel like running.

Dr. Carbonell: Yes, exactly. And you can come to rely on running. But it just invites the panic back, again and again.

David: Does it take therapy and/or anti-anxiety medications to recover from panic and anxiety, or can one do it on their own?

Dr. Carbonell: I think most, not all, people will require some kind of professional help, although I know some can do it with a good anxiety support group. I think the majority of people can make a good recovery, without anti-anxiety medications, if they find a good source for cognitive behavioral therapy, using progressive exposure. And some, though far fewer than actually use them, will require medications.

David: Here are a couple of audience comments, then we'll continue:

aml782: I went to a support group for about a year and it was a big help.

CorwinPon: I have only actually run once. Normally, my legs bounce.

sher36: Nothing has helped me thus far.

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David: I asked the above question because there are plenty of books on anxiety and video programs to overcome panic attacks on the market that purport to cure you of panic and anxiety. What are your feelings about those?

Dr. Carbonell: Well, I think it's hard to do on your own. There are skills which can be taught in those books and videos, but in my experience many people need some coaching to see how to apply them. I think it's all too easy to get the idea that if you just use those techniques, they will protect you from the panic. And that's not how people recover. You need to learn how to work with, and accept the panic, so that you lose your fear of it. Then it goes away. And you'd have to really believe in a book to make that happen without some personal encouragement and coaching!

David: We have a lot of audience questions, Dr. Carbonell. Let's get to a few:

SaMatter: What if the panic attacks and fears are irrational?

Dr. Carbonell: Well, the fears are irrational, or illogical, however you want to call it. In panic disorder, people become chronically afraid of awful consequences, like death and insanity, which do not occur as a result of panic. So the task is one of learning how to calm yourself when you experience these illogical fears. Simply knowing that they're illogical isn't enough.

leg246: Can you exercise to reduce anxiety and how long must you do it to take effect?

Dr. Carbonell: Cardiovascular exercise is an excellent way to reduce your susceptibility. Don't worry about how long to do it at first. The key is to get started with a regular habit. If that's 10 minutes a day of walking, good, you're started!

David: And why is cardiovascular exercise good for reducing panic and anxiety?

Dr. Carbonell: Several reasons. Cardio in general is "good for what ails you", be it depressed or anxious mood, because it gets you moving. It stimulates natural painkillers the body produces. And, especially for panic, it helps you get used to natural physical sensations, like sweating and increased heart rate, which often seem scary.

Mucky: I know in my head that my fear is not rational but my body reacts to those situations which put me in a similar situation. How do I get my mind and body together?

Dr. Carbonell: First, by accepting that you can get afraid, even when you are in no danger whatsoever. Learn that these fears are not a signal of any danger, they're just a false alarm. And then learn some ways, and practice them, to calm your body. Diaphragmatic breathing would generally be the first one to learn.

cosset: I was in therapy for years for panic attacks, but in therapy, I was never taught any skills. It was like, "ok you have panic attacks," and was not given medications or anything. I have learned so much from the anxiety support groups here at HealthyPlace. They have some great hosts and I've learned a lot. I'm actually overcoming the panic attacks...slowly but surely :)

Dr. Carbonell: And on my site, there are instructions, and a video clip, for the breathing.

David: Here is Dr. Carbonell's website.

Dr. Carbonell: You really do need to learn those skills. Therapy without skills is really missing something important.

Sweetgirl01: Can severe anxiety be caused by biochemical factors?

Dr. Carbonell: It seems to be the case that there are biological predispositions to panic disorder and other conditions. Some people are good candidates to get them, others couldn't have a panic attack if they tried. But these are just predispositions. Learning and habit are what maintain the problem, and also offer the way out.

David: I mentioned earlier that many people who suffer from anxiety and panic feel helpless and pessimistic about recovery.

Here are a few audience comments:

Beans96: I've had this disorder for 23 years now. I've tried everything nothing seems to work for me.

sher36: I have read everything and I only seem to get worse with age.

David: I post these so that those of you who are suffering know that you aren't alone with this; that you are not unique or that there is something terribly different or wrong with you.

What about people who are long-time sufferers, Dr. Carbonell. How difficult is recovery for them?

Dr. Carbonell: Yes, these are discouraging sentiments. I've seen this happen to people. And partly it's happened because it's really been less than 20 years that there has been any good treatment at all for this. And in many parts of the country, it's still very hard to get good help.

But it is possible. So all I could suggest is, be aware that your discouragement can prevent you from finding the help that may be more available now than when you first looked. Keep searching and trying!

David: I don't know if you saw my last question, but I'm wondering how difficult recovery is for long-term sufferers?

Dr. Carbonell: In general, recovery is more difficult for those who have suffered longer. They tend to feel more discouraged, and they tend to have incorporated the phobias into their life to a greater degree.

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David: Here's another comment from a long-time sufferer:

ogramare: I would have to disagree. I have had severe anxiety disorders for 55 years and there is no one near where I live that offers the kind of treatment you are proposing. The only thing that has given me a measure of relief is finally finding some anxiety medications that help----but I do feel that it is now a little late in life to ever get well. Some of the treatments for anxiety have been worse than the disease.

David: On the other side, here are some positive audience comments regarding recovery from anxiety and panic attacks, so everyone knows that it is possible:

kappy123: I am currently in cognitive behavioral therapy (CBT) seems to be working and I feel better.

cosset: After 8 or so years of panic overpowering me, I've gotten mad at the attacks, and I tell them, "go ahead, panic, go ahead die in the panic.. I am still going in Kmart" :) It's worked so far, but I am sure I still have a way to go to become panic free.

Dr. Carbonell: Cosset, I think what really helps in what you're saying is that you've stopped trying to protect yourself. When you accept the panic, you start getting better.

Neecy_68: I have been on anti-anxiety medications for two years. Is it harmful to use them for long periods of time? I am scared to go off. I am afraid I will have worse panic attacks than before I was on the anxiety medications.

Dr. Carbonell: You should really develop a plan with the physician who prescribes them. Don't stop taking them on your own. As to long-term effects, it depends on the medication.

kappy123: Birth control pills made my anxiety/panic worse is this possible?

Dr. Carbonell: Yes.

David: Here is information on specific anti-anxiety medications and their side effects.

Lexio: Birth control pills brought on my anxiety and panic after 10 years of being panic free.

David: Here are some of the things that have worked for audience members in relieving their panic and anxiety:

SaMatter: I try to hypnotize myself through an intense/in-depth thought or daydreaming type of situation. I have also been trying to imagine something I really like when they come on. No matter how irrational that thought may be.

linda_tx: I have done self-help tapes for anxiety. After six weeks into the tapes, I was out of my house again.

camilarae: One good solution to controlling the panic is to remember and learn how to breathe correctly.

codequeen: The most helpful solution I've found to anxiety, for me, is to read or watch something funny, such as comic strips, Dave Barry columns, and Marx Brothers movies work best for me.

angel3171: Relaxation tape with guided imagery has helped me along with deep breathing.

Dr. Carbonell: It still amazes me, after many years of practice, how powerful the breathing is. And humor is great!

David: Here's another audience question:

nino123: I am new to this kind of chat and I would like to ask why it is said that panic attacks only last approx 10 minutes. Mine can last 2 to 3 days?

Dr. Carbonell: Nino, I would guess that what's happening is that you're having numerous panic attacks during that time period, rather than one uninterrupted attack. This is often what I find when I review this carefully with clients.

David: I am getting some general questions about what is anxiety and the diagnosis for it. We have a lot of excellent information on our site in the HealthyPlace.com Anxiety-Panic Community.

wildchic: I get nervous when my family travels far. How do I handle this?

Dr. Carbonell: You mean, when they leave you home alone?

David: No, when she travels with them? I suppose she has a safety zone that she feels comfortable in.

Dr. Carbonell: You could look at what precisely you fear as a result of being away. Many people, for instance, get focused on knowing where a hospital is, thinking that they may have some medical emergency as a result of anxiety. Others just have this sense that they might feel like they have to get home "right away", and they won't be able to.

But in general, fears of this type don't indicate an actual danger. They indicate panic, which needs to be addressed by accepting, and coping with, the symptoms themselves. And it will make a difference if your family is understanding of these fears.

David: We have quite a few people tonight, Dr. Carbonell, who are apparently affected by travel:

codequeen: On the same note...I'm attending college, and I always get very anxious every time I leave my family (I'm fine once I get settled in). It's gotten better since I started taking meds but it's still a problem. How would you suggest dealing with this?

Dr. Carbonell: Notice that what you're describing here is anticipatory anxiety. You're fine once you get settled in. Many people forget this aspect of anticipation, and think that, "if I'm this anxious now, how much worse will it be when I get there!" So it will help to remind yourself that this anticipation is the high point of the anxiety - it will only go down from here.

David: Here are some more helpful recovery tips from the audience:

Ken36: My favorite is to keep reminding myself that it's just a physical feeling, and try not to label it at all. I still feel the physical feelings but they pass quicker if I don't find something to blame the physical pains on. It separates me from the problem.

SaMatter: A tip I use is to let people know that I am experiencing a panic attack. Most people are sympathetic.

Another tip I've found that helps, is know yourself, and what situations can aggravate or instigate the attacks, and plan around them. Give yourself an "out".

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ogramare: I recently had surgery and found it very helpful to tell all involved in my care that I suffer from anxiety disorders. It was a tremendous help and a very different experience than when I kept it a deep dark secret.

Mucky: I have a service dog that alerts to my panic attacks. I got him so that I could get out of the house but I am so afraid of being confronted about him that I still don't go out.

nino123: My husband and I went to Tennessee from Maryland and I made him take our trailer for my "safe" place.

Dr. Carbonell: Yes! In general, secrecy hurts, self disclosure will help. And, since most panic attacks involve a feeling of being "trapped", giving yourself an out is a good strategy.

David: Here's a question about "being alone":

camilarae: I cannot be alone any time of the day. I always need someone home. How do I handle this? My husband is really getting frustrated.

Dr. Carbonell: You could evaluate how realistic the need is. If you're like most people in this situation, it's because you fear having a panic attack, not that you need him to keep you alive or sane. And perhaps then you could work with him to gradually increase the amount of time you can spend alone. Getting some help from others to ease the burden on your husband will help too!

nino123: My husband is frustrated also which is a source of my anxiety. It is a trigger for me.

linda_tx: With the Christmas holidays, I find that I'm more anxious in the stores. How do I handle this?

Dr. Carbonell: I think everybody gets more tense during Christmas shopping! Recognize it's an unusually crowded and stressful situation. A few techniques you can use is breathing, relaxation and take breaks.

dak75: Can the dizziness and hand numbness last for days or weeks?

Dr. Carbonell: Certain symptoms, like dizziness, numbness/tingling, and shortness of breath, can last as long as you engage in short and shallow breathing. These aren't harmful, but they are uncomfortable, and the best way to manage them is with diaphragmatic breathing. Most of the most distressing panic symptoms come from short, shallow breathing and hyperventilation.

I mentioned tricks earlier. Here's an important one:

When you set out to take a deep breath, you actually have to start with an exhale. Not an inhale, an exhale, even though that is the opposite of what you expect.

The reason is, you need the exhale, or a sigh, to relax your upper body enough that you can breathe deeply.

RiverRat2000: Along panic attacks and anxiety disorder, I suffer from PTSD (Post-Traumatic Stress Disorder) and agoraphobia is there any help? I'm afraid of people.

Dr. Carbonell: The treatment for agoraphobia, (lots of avoidances caused by fear of panic attacks) depends on getting better at managing the attacks, then gradually re-entering the feared situations.

In your case, dealing with people - a little at a time. With PTSD, where there are flashbacks and recall of a traumatic event, effective treatment involves ways of dealing with the traumatic memories of the past. This is often difficult, but there is help.

Mistymare4: My anxiety totally revolves around going in public and driving like work, grocery shopping etc..

David: Would you say that agoraphobia is the most difficult anxiety disorder to recover from?

Dr. Carbonell: Well, I would say no, but I realize it's easy for me to say. I find others more difficult to treat. But I think the most difficult one is the one you have.

Lexio: What if the fear of going crazy causes your panic attacks? What do you do then?

Dr. Carbonell: You could start by reviewing your history with panic, and considering why you haven't gone crazy yet. If you're attributing your sanity to support people, support objects, limiting your travel, and so on, this can maintain your fear of insanity, even though a panic attack cannot make a person crazy. You may feel like you're going crazy, but it passes! So you need some coping techniques to help you pass the time until the attack passes.

David: Here is a comment, then a question on generalized anxiety disorder:

ogramare: Anxiety medications have pretty well eliminated my panic but I am left with a giant case of Generalized Anxiety Disorder (GAD). I can feel really nervous with no mental stimulation, no panic and no apparent reason. This may be off-topic for this discussion as I have not been here before.

mclay224: I was wondering what are some ways of coping with and eliminating the generalized anxiety?

Dr. Carbonell: In my experience, when someone with GAD also has a history of panic, the generalized anxiety is usually a form of anticipatory anxiety. They're no longer having the panic attacks, but they're constantly "on guard" against them. So it's usually important to discover the ways you have of being on guard, and replace them. Physical tension, limiting your movements, all manner of "self protective" measures like these can maintain the generalized anxiety.

cosset: Little humor: I've found that the fear of going crazy is overwhelming, but once you get past the fear of going crazy, nuts isn't that bad :)

David: And on that note, I know it's getting late. Thank you, Dr. Carbonell, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful.

We have a very large and active community here at Healthyplace.com. Also, if you found our site beneficial, I hope you'll pass www.healthyplace.com, around to your friends, mail list buddies, and others.

Dr. Carbonell's website is here.

Dr. Carbonell: Thanks very much for having me!

David: Thanks Again, Dr. Carbonell, for being here tonight. Good night, everyone.

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Disclaimer:We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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