Covers cognitive behavioral therapy, relaxation techniques, and natural treatments for treating anxiety and panic attacks.

Who hasn't felt it? Anxiety, that unremitting voice in your head warning that something is wrong—or will be wrong very soon. A voice that sets your nervous system aflutter.

The thoughts evoking such unease can be specific, from concerns over avian flu to rodents or finances, but the feeling commonly gets disconnected from the trigger and spirals away into a universe of its own making. When this happens you whirl into worry after worry after worry. For some, such anxiety comes and goes. But for others, this pernicious condition can cast a shadow over day-to-day activities, well being and, yes, even health. That's when anxiety becomes a "disorder."

There is no one-size-fits-all definition of anxiety disorder. However, all types of anxiety do appear to have a strong genetic component, exacerbated by life events, trauma and stress. Those with anxiety most likely suffer from several different manifestations and are also at increased risk of depression.

The different manifestations run the gamut from a generalized anxiety disorder (GAD, characterized by relentless, often unspecified worry) to social anxiety disorder (excessive self-consciousness and fear of social situations), phobias (an intense fear of something that, in fact, poses no danger), post-traumatic stress disorder (PTSD, debilitating fear that arises after a terrifying event), obsessive-compulsive disorder (OCD, recurring, persistent thoughts, images and impulses that manifest in repetitive behaviors) and panic disorder (sudden overwhelming feelings of terror, accompanied by intense physical symptoms).

If you suffer from any of these or know someone who does, take heart. A variety of techniques, some simple and others more involved, can bring a greater sense of peace to your life.

It also may help to know you're not alone. Statistics from the National Institute of Mental Health (NIMH) show some 19 million Americans suffer from anxiety disorders right along with you, making it the most prevalent psychiatric complaint, according to psychotherapist Jerilyn Ross, president of the Anxiety Disorders Association of America and director of The Ross Center for Anxiety and Related Disorders in Washington. Yet only a third of those who suffer seek treatment, she says. She adds that of the millions who wrestle with anxiety disorders, women outnumber men two-to-one, and 10 percent of sufferers are children.

When is worry worrisome?

How do you know you have an anxiety disorder? Give yourself six months. If, after this amount of time, you still regularly wrestle with such symptoms as excessive worry, undue panic, negative thinking or endless obsessing over the "what ifs" of life, or their possible dire outcomes, chances are you have an anxiety disorder. It doesn't much matter what you worry about. It could be a specific problem, or it could just be an amorphous feeling—what you might call the free-floating variety. All this stress wreaks havoc by catapulting you into the fight-or-flight response—the kind of automatic body reaction that occurs when you step off a curb and narrowly miss being hit by a bus. Your autonomic nervous system goes on high alert, and adrenaline and other stress hormones kick in. Immediately your heart rate soars, your breathing becomes shallow, you begin to sweat and your muscles tighten. Over time, these high-stress responses will wear out your body, not to mention your mind.

This state of preparedness is perfectly appropriate when you're reacting to the oncoming bus because it increases your chances of survival. But when the trigger is an everyday event like seeing a spider in the bathtub, riding an elevator or simply leaving the house, then you have a problem. In this day and age, those prone to anxiety are more likely misinterpreting environmental and internal cues by misperceiving them as life threatening when, in actuality, they are not.

One reason anxiety disorder is so well understood is because new brain imaging technology and neurochemical tracing techniques now exist. Researchers can pinpoint particular areas in the brain and certain neurotransmitters involved in different anxiety manifestations. Daniel G. Amen, MD, author of Healing Anxiety and Depression (New York, 2003), has studied the brain patterns for different types of anxiety using SPECT (single photon emission computed tomography) scans. While symptoms only suggest a certain type of anxiety, the scans map, by color, where the brain is inappropriately responding to environmental and internal cues.

"This technology is like looking under the hood of the car," says Amen. Using it in his own medical practice, he has discovered that five parts of the brain are involved with anxiety and depressive disorders.

"We've found that anxiety is not one thing but a bunch of things. Therefore, there is no one fix for each person," Amen adds.

In his research, Amen has traced some people's anxieties to an unfocused brain that is under-functioning in some areas so it can't efficiently process information; some to an overactive brain that can't stop thinking; others to an overly focused brain that fixates on unpleasant thoughts; and still others to injury to the frontal lobe.

Treating Anxiety and Panic

The upside is that such research has led to more specific treatments tailored to different types of anxiety. And experts say anxiety is highly responsive to specific remedies and coping techniques. "Anxiety is actually the most treatable of all mental health complaints," says David Carbonell, a psychologist specializing in anxiety and director of The Anxiety Treatment Centers in the Chicago area and Suffolk County, N.Y.

Amen suggests a multifaceted treatment adjusted to the particular flavor of anxiety disorder a person has. His recommendations include a mix of cognitive behavioral therapy, biofeedback (which provides concrete feedback of physiological reactions—heart rate, muscle tension and brainwave patterns) and physical exercise to increase blood flow to the brain. Other effective therapies, according to Amen, include deep breathing and relaxation techniques, dietary shifts (such as avoiding caffeine, refined carbohydrates and toxins like nicotine and recreational drugs) and taking supplements known to mediate mood disorders (omega-3 fatty acids, for example). He also uses medication when necessary, either short term to get symptoms under control or long term if associated with depression.

Interestingly, what doesn't help much is traditional talk therapy—discussing childhood and life history to understand and, hopefully, eradicate the dysfunction. Carbonell says the reasons behind why you feel anxious are not as important as discovering what factors evoke the anxiety in the present moment. "It's a given that certain people are predisposed to anxiety," he says, "but the more critical questions to answer are how does the anxiety begin and what keeps it going?" Then the next step is to change these anxiety-producing thoughts and behaviors.

Easing the agitation

Cognitive behavioral therapy (CBT) appears to quell anxiety of all kinds. Approximately 12 sessions long, this pragmatic method helps reset your mental and physiological reactions to anxiety. CBT is particularly good at alleviating panic disorder, "one of the most disabling" disorders of all, Carbonell says. Panic attacks can occur during waking hours or even while you're sleeping, causing the whole body (and mind) to be paralyzed with fear—anxiety times 10. At the time of attack, the heart rate soars and the brain races, trying to make sense of what's happening, and you can't get a grip on the world around you. You feel like you're losing control, which in a way you are, and maybe even like you're spiraling toward death (which you really aren't). The overriding interpretation of these reactions is "I am about to experience a catastrophe," Carbonell explains. But, the catastrophe is, in fact, the symptoms, not any actual cataclysmic event.

After the first panic attack, chances are your focus shifts to fear—when will the next one come? Should I simply avoid whatever place or situation set off the initial attack? Unfortunately, this scenario can lead to the birth of new aversions and phobias. If you're not careful, existence becomes constricted to whatever is deemed "safe," and the panorama of life becomes extremely limited.

"Anxiety is a self-protective disorder," Carbonell explains. All the behaviors to which it gives rise are about protecting oneself from perceived threats—be it an insect, flying 30,000 feet above land or contact with germs.

What a person learns through CBT is that the instinctive reaction of avoidance doesn't work because running away inflames the sense of panic. So it's like putting out fire with gasoline. Instead of avoidance, a person needs to face the perceived threat. For example, instead of distracting yourself from fearful thoughts and pretending they don't exist, say them out loud. Carbonell tells a story about a woman who came in to his office after a panic attack sure that she was going to die. Rather than have her deny the thought, he advised her to say 25 times, "I am going to die." By the 11th repetition, he says, she realized the fallacy of her thinking and was even able to laugh about it.

Thus, this cognitive aspect of CBT treatment starts with disengaging from the negative "self-talk"—that little voice in your head warning of impending calamity. If you don't, "anxiety becomes fear of the fear itself," the Anxiety Disorders Association's Ross says. So CBT encourages patients not to deny their reactions but rather to accept them, to realize they are simply sensations rather than symptoms of looming danger. "The point is to change or modify the thoughts that are keeping you stuck," Ross says. "I suggest that people keep a journal to become aware of what might be causing anxiety to flare," she adds. This practice will help demystify the anxiety and provide some control over what brings it on, so you can be better prepared to cope.

The behavioral piece of CBT allows you to look at what makes you anxious, confront your fear and then gradually work to desensitize yourself. This way you learn to neutralize the experience and not react. It allows "the anxiety to lose its punch," Ross says.

This approach is used to treat fear of flying, among other phobias. Carbonell, for example, accompanies patients on a flight and mediates the rising anxiety as it occurs—it usually reaches an apex when the door is locked for takeoff. A CBT professional on board can help deconstruct the fear and provide relaxation techniques to diminish the chronic reactions.

Behavioral changes also come into play in more everyday situations. "Again, treatment is paradoxical," Carbonell says. "I tell patients whatever you think you should do, do the opposite." So when the body starts to react to an anxiety-producing situation, the best response is to do the opposite of what would be appropriate in a truly dangerous situation. In short, be still and relax. "When that discomfort comes, you need to chill out," he says.

This is why relaxation techniques—for use in the moment and as a regular practice—are essential for the anxiety prone. Carbonell tells patients to practice deep, diaphragmatic breathing when anxiety begins to bubble to the surface. This is because one of the first fear reactions is to start breathing fast and shallow, to gulp air or even hold your breath. It is exactly that kind of breathing that brings on light-headedness and dizziness, frightening symptoms in and of themselves, and contributes to the snowballing of anxiety. (See sidebar for deep-breathing techniques.) Yoga, meditation and biofeedback can also ease anxiety, while giving you the tools you need to learn how to control and ease the symptoms of distress.

Another option is Hemi-Sync, a method developed nearly 25 years ago. This technique involves playing different tones into each ear that the brain then processes in such a way that it can move into a more relaxed and focused state. This can be particularly useful in countermanding anxious states, according to Brian Dailey, MD, an emergency room physician in Rochester, N.Y., who provides Hemi-Sync CDs (with head phones) for nervous patients.

Hemi-Sync works to evoke calmer brain waves. Listeners can use the audiotapes and CDs as "training wheels," Dailey says, to learn how to reach that state on their own.

Another critical piece for controlling anxiety is stress reduction. Although stress itself does not cause anxiety, it can exacerbate the symptoms. "I advise my clients to practice stress hygiene," Ross says. "It's important to do what you can to keep stress under control, and that means getting sufficient sleep and exercise and eating a healthful diet." Caffeine can bring on anxiety, particularly panic attacks, and so can numbing analgesics used by dentists, which contain norepinephrine, another possible trigger. Additionally, experts advise anxiety sufferers to eat foods that keep blood sugar steady, since the symptoms of low blood sugar can mimic those of anxious states. So it's best to avoid refined sugars and simple carbohydrates, which send blood sugar on a roller-coaster ride, and make protein a part of each meal.

Natural Treatments for Anxiety Disorders

Also consider supplements. A multivitamin and mineral supplement can ensure that all nutrient bases are covered, since few people—anxious or not—get the full array of food groups each day. In addition, deficiencies in vitamins B and C can result from chronic stress, so some healthcare practitioners recommend supplementation to boost reserves and support immune function. Studies have shown that omega-3 fatty acid supplements are effective in mediating bipolar disorder and perhaps have a similar effect on other mood disorders.

Herbs can help, too. Research shows that valerian (Valeriana officinalis) is an effective palliative for anxiety. Look for a product standardized to 1 percent valerenic acid (the active ingredient), and use one teaspoon of the tincture or one to two tablets at bedtime.

Flower essences are also worth a try. For example, Rescue Remedy by Bach and Five-Flower Formula by Healingherbs Ltd. work for short-term relief in the full flush of fear or anxiety. Aspen (Populus tremula) can treat fear and worries of unknown origin, inexplicable anxiety or a sense of foreboding. Mimulus (Mimulus guttatus) is used for fear of known things such as illness, death and accidents. You can also combine various flower remedies if necessary; but generally no more than seven.

Lastly, not all anxiety is bad. "There's toxic anxiety that interferes with quality of life, but there's also sacred anxiety, which makes us consider our place in the universe. This latter is something we need to work through to get to a place of serenity. It's sort of part and parcel of being human," says Robert Gerzon, a psychologist and author of Finding Serenity in the Age of Anxiety (Bantam, 1998). Anxiety, he says, is a teacher, and it often precedes a period of growth or change. "Society teaches us either to deny anxiety or succumb to it and worry ourselves to death," he says. But there is another way.

Gerzon says the first step is diminishing the toxic fears—those that have no discernible reason for being or are intense, long lasting and take a toll on happiness. Then he advises reframing how you think of the unavoidable residual anxiety. Gerzon suggests viewing it as excitement—the body interprets anxiety and excitement similarly anyway—which is a more positive interpretation of anxious sensations.

But when toxic overload prevails, don't suffer in isolation. "If you find yourself worrying excessively, and if it interferes with your life and relationships with friends and family," Ross says, "don't be ashamed. Reach out and get yourself some help. If one treatment doesn't work, don't give up." Keep tweaking the remedies and coping techniques until you discover the mix that works best.

What to do when you feel a panic attack coming on

The best defense against recurring anxiety is to faithfully practice relaxation techniques, like those mentioned here. This way, in the heat of the moment, you can shift into the well-traveled routine of slowing your breathing, un-tensing your muscles and quieting your mind.

- Calm your mind. Take a deep breath to a count of 10, at the same time consciously creating the sensation that your breath is being pulled up from the earth through your feet to the top of your head. Then exhale just as slowly,
this time feeling your breath whoosh out of you through your fingertips and toes. If you can't make it to 10, don't worry, just take slow, deep inhalations and equally slow exhalations. With each breath, visualize that you are an ocean wave, coming in, going out. You can also add affirmations to the visuals—"I take in love," "I let go stress." Such exercises will help release you from the story line doing its monologue in your mind. When the words start up again, just refocus on your body's sensations. - Relax your muscles. When anxiety encroaches, muscles tense and eventually physical symptoms flare, such as neck and back pain, headaches and even tingles in the hands and feet. A useful technique for relaxing those anxious muscles is to lie still, then progressively tense and release them toe to head. This cues the body into the sensation of relaxation and mitigates the side effects of psychological distress.

- Exercise. Exercise is great for working off excessive energy. It can also decrease stress levels. Yoga is a particularly beneficial form of exercise. Even though doing yoga can give you the deep relaxation you need, sometimes the anxiety you feel prevents you from lying still. So start with an energizing practice, concentrating on standing and balancing poses (to get out of your head and into your body), then follow that up with quiet, restorative poses, meditation or deep-breathing exercises.

- Engage in relaxing diversions. Take a walk, listen to music, take a hot bath, love up your pet—any of these will calm jangled nerves and help you regain a sense of being grounded on the planet.

- Meditate. Mindful meditation brings profound calm, especially welcome to those suffering with anxiety. Meditation is simply sitting or lying still and letting your mind empty. However, for most this is easier said than done. You may even find you feel too agitated to sit still. Do something active first and then try sitting. For detailed techniques, read Calming Your Anxious Mind by Jeffrey Brantley (New Harbinger Publications, 2003).

Source: Alternative Medicine

next: Top Ten Alternative Remedies For Anxiety

An essay on the new millennium, our hopes and dreams, disillusionment and creating your own life story.

Life Letters

"It is important to look at the stories we're telling -- the old stories that still shape our personal and collective lives and the new stories that we might use to educate our hearts." Donald Williams

The two questions I hear the most regarding this upcoming New Years Eve are, "What are your plans?" and, "What do you think will happen when Y2K hits?" My answer to both questions to date has been, "I don't know. What I do know is that I won't be taking advantage of most of the endless options available for bringing in the next century. I won't be catching a plane to a south pacific island to watch the first millennial dawn, joining the crowds in New York City to "party like it's 1999," or celebrating with Oasis, Johnny Depp, Kate Moss, and Sean Penn at the Melleninum party in Bali.

In fact, I've decided just now as I type, that I want to spend a relatively quiet time with friends and family this New Millennium Eve. And I won't need to feel left out, because I'm not alone. According to a Yankelovich poll sponsored by Time magazine and CNN, 72% of Americans are also passing on the once in a life time opportunities that come with once in a life time price tags.

Are we forgoing the major celebrations because we're taking this momentous event in stride? I don't think so. Speaking only for myself, it's not that I don't feel the need to celebrate, I do. In fact, these days I'm feeling enormously grateful, and that's why I not only plan to be quietly gathering my blessings around me on New Years eve, I'll also be counting each and every one of them.

I grew up under the dark and ominous cloud of a religion that warned that the world would come to an end by the year 1975. Before 1975, when I was asked what I was going to be when I grew up, I politely answered that I didn't know. But I did. I knew that I wasn't going to grow up, that there would be no adulthood for me. I was going to suffer a terrible and agonizing death in Armageddon.

Twenty-five years later, I'm hearing the newest apocalyptic warnings, only there are two primary differences between then and now. First, this latest end of the world saga is based less on ancient prophecy and more on a modern day malady, a computer glitch. Second, I'm not a little girl anymore, and this time I'm not listening. I don't mean that I won't take some precautions, I'll have flashlights, extra batteries, some bottled water, etc. stored away, but I refuse to acquiesce to anyone's tales of doom and gloom. It's not that I'm unaware of the numerous perils that confront our planet as the dawning of the new age approaches, nor do I plan to ignore them in the hopes that they will go away. It's just that from my perspective, as important as it is to address past mistakes and present perils, it's absolutely essential that we also embrace the promise of tomorrow.

When viewing the world from the perspective of an American born and raised in a century that has been identified by more than one historian as the bloodiest in human history, optimism might very well seem like an act of blind faith. And yet, as it draws to a close, I look toward the future with a sense of hope. And according to yet another poll conducted by the Pew Research Center for the People and the Press released on October 24th and reported in the Christian Science Monitor, once again I'm not alone. 70 percent of Americans at this particular point in history are also feeling a sense of promise and hope. Is our hopefulness a delusion? Are the statistics skewed because the pessimists among us aren't talking? I seriously doubt it.

While we Americans enjoy more than our fair share of the earth's resources, we also engage, I suspect, in more than our fair share of complaining. And this tendency of ours might have its own redeeming quality. In fact, Harry C. Bauer once wrote, "what's right with America is a willingness to discuss what's wrong with America." Yes, we Americans are more than willing to examine what's wrong with our country and the world at large, after all, we can only transform what we're willing to confront. We acknowledge the social inequities, the injustices, the wars, and the environmental degradation that exist in our world and to which we are significant contributors. Yes, we acknowledge them, and yet, we're not quite ready to truly face them. How and when will we be ready? I don't know. But I do know that effectively dealing with these issues will require that we talk a little less and do a whole lot more. Each of us knows at some level that effective interventions will require profound change, and a significant degree of sacrifice.

Complaining has seemed to have worked reasonably well for the doomsayers, who for the most part don't have to worry too much about personal change and long term sacrifice. Why should they? It's all going to hell anyway. And the ostriches among us who (metaphorically speaking) hide their heads in the sand, escape a significant portion of the angst and anxiety of living on a planet in peril because while they're forced to look from time to time, they don't really see.

Most hard core optimists also have their own emotional escape route when their bright horizons begins to dim, comforting themselves by concluding that someone else will fix the most daunting problems when things get bad enough.

And then there are the rest of us. Where do we fit in? How do we help to create the future that so many of us are hoping for when we're not ready to collectively make significant changes? Once again, the answers evade me. What I do know is that I agree with Harold Goddard who concluded, "the destiny of the world is determined less by the battles that are lost and won than by the stories it loves and believes in."

On January first, 2,000, we'll be closing one book and opening another together. Will there be major computer system failures, power outages, and mass confusion? I have no answer. But I do believe that we'll still be here come the dawn; perils, promises and all. And it will be up to us to determine the kind of story the 21st century will ultimately tell. I suggest that we begin by examining our own personal stories, and narrowing our focus to look closely at what it is that we most love, value, and want to preserve.

Through out the years, I've suffered the pain of disillusionment more than once. I'll never again find solace in that tired old cliché, "everything works out for the best." And it's been a lifetime it seems since I believed for a moment (if I ever believed) in happily ever after. Still, I've lived long enough to have finally discovered that there are still stories that endure, and that the most enduring stories of all are ultimately love stories. I've watched strong folks willingly walk away from that which they dearly wanted or desired because of fear, failure, rejection, or inconvenience; but I've never seen a man or woman yet willingly abandon that which he or she truly loved. On behalf of that which we love, we each seem to have an amazing ability to persevere, to hold fast and to hold on regardless of the cost.

It's been twenty five years since the year that was to be my last. At the start of the new Millennium, I'll be celebrating my silver anniversary of survival. Will I be alive twenty-five years from now, still creating my own story? I have no idea. But I do know that during this next century, while I'm here, I'll be busy working on a story based on love, because from where I stand, therein lies our greatest strength and our greatest hope. And it is love more than anything else that I'll be celebrating on December 31, 1999."

next: Life Letters: On Letting Go

Inter Dependence:
Self-Therapy For People Who ENJOY Learning About Themselves

About 30 years ago John, a coworker, suggested that I attend a workshop in Chicago "to learn about myself." The idea was frightening to me back then, so I made some quick excuses.

John didn't buy any of my excuses. He just looked straight at me - or was it through me - and said: "Don't be afraid to grow, Tony."

I attended that workshop to show I wasn't scared - and I have been all but obsessed by all the powerful methods of therapy, self-therapy, self-help, and self-care ever since.

Because of John I have acquired, collected, used in my practice, and used on myself a massive amount of information about how we can help ourselves psychologically.

I never would have learned any of this without my coworker's gutsy statement to me that day..... but I don't even remember his last name.

In a way I'm working on these pages to pay John back for his kindness - through you.

So, please, look me in straight in the cyber-eye right now and let me suggest to you powerfully and sincerely: "Don't be afraid to grow!"

next: About Me Professionally

Contents in Interdependence Sitemap:

Introduction
Specific Topics
All Self-Therapy Topics
The Biggies: Articles

Introduction

• Inter Dependence Homepage
• About Me
• How to Use These Pages

Self-Therapy for People Who Enjoy Learning About Themselves

Click on a Link to See the Menu of Articles on that Specific Topic

• I'm curious about myself.
• I'm curious about my mental health knowledge.
• I'm a therapist or other helping professional.
• I want to improve and I am willing to work on myself for a while.
• I may be depressed.
• I am often scared or anxious.
• I often feel ashamed.
• I often feel futile or hopeless.
• I want to learn about child abuse.
• I want to learn about addictions.
• I want help with my love relationship.
• I want help socially, with all kinds of relationships.
• I want help with children or with family problems.
• I want help about employment problems.
• Topics everyone should eventually read

All Topics

• About Change
• About Joy
• About Love

• About Shame
• An Inspiration from War
• Analyzing Your Dreams
• Angels, Infants, and Hope
• Are You Considering Therapy?
• Are You Expecting Too Much?
• Basics #1: Your Needs and Wants
• Basics #2: Your Natural Feelings
• Basics #3: Unnatural Feelings
• Bigotry
• Boundaries
• Can You Make Someone Change?
• Clear Communication: #1
• Clear Communication: #2
• Clients and Success in Therapy
• Couples: Passive & Controlling Partners
• Depression In The Culture
• Depression: The Problem
• Depression: What To Do About It
• Discipline
• Do You Think You Can't?
• Employment
• False Memories and Responsibility
• Fantasy And Reality: #1
• Fantasy And Reality: #2
• Feeling Like You Belong
• Feeling Safe
• Finding Purpose
• Getting Enough Attention
• Growing Up Emotionally
• Getting Practical #1: The Basics
• Getting Practical #2: Relationships, Couples, Families, and Careers
• Guidelines For Emotional Health
• Handling Criticism
• Healing From Sexual Abuse: A Strategy
• How Does Abuse Happen?
• How Happy Couples Stay That Way
• How Much Change Is Possible?
• How To Have A Lousy Sex Life
• How To Play
• How To Talk About Feelings
• How Are You Spending Your Life?
• Knowing #1: How Do You Know?
• Knowing #2: How Smart Are You?
• Knowing:#3 Your Core Beliefs
• Knowing #4: Educated Guesses
• Life's Craziest Beliefs
• Living With Alcoholics
• Loneliness
• Love Relationships
• Mistakes Every Good Parent Makes
• Motivation
• My Wishes For Real People
• Natural Anger
• Natural Sadness
• Natural Scare
• Peace On Earth
• Perfectionism
• Personal Freedom
• Powerful Ideas: #1
• Problem Solving #1: Roadblocks
• Problem Solving #2: Defining The Problem
• Problem Solving #3: The Six Aspects of The Problem (#1)
• Problem Solving #4: The Six Aspects of The Problem (#2)
• Problems With Anger
• Problems With Sadness
• Problems With Scare
• Quitting Addictions
• Relationship Analysis (online evaluation)
• Relationships
• Self Love
• Self-help Quiz #1
• Self-help Quiz #2
• Sexual Abuse In Childhood
• Shame: What You Can Do About It
• Should We Blame Our Parents?
• Stages of Therapy
• Stop Making Comparisons!
• Subconscious Life Scripts
• Success
• Taking Care Of Yourself
• Talking To Yourself
• Teenagers
• The Three Stages of Relationships
• Were You Loved As A Child?
• What Helps?
• What Is A Therapist's Job?
• What Terror Does To Us
• What To Tell A Therapist
• Who Can You Trust?
• Who Is A Therapist?
• Who Is The Real You?
• Who Needs Help?
• Who's Healthy?
• Why Are You Treated The Way You Are?
• Why Do We Work So Hard?

The Biggies: Articles

• The Biggies: Article Table of Contents
• Guidelines for Emotional Health
• Are You Emotionally Healthy?
• A Checklist
• Are You Emotionally Mature?
• Comparisons Hurt!
• Are You Self-Loving?
• About Change
• Our Unconscious Life Scripts
• Motivation
• Life's Craziest Ideas!!
• How Are You
  Spending Your Life?
• Talking To Yourself
• Are You Considering Therapy?
• Getting Practical #1: The Basics
• Getting Practical #2: Relationships, Families, Careers
• Self-help Quiz #1

back to: Inter Dependence Homepage

Chapter 64 of the bookSelf-Help Stuff That Works

by Adam Khan

I'VE ALWAYS HAD A distaste for competition. I never liked the feeling of trying to outdo another person. But competition is a fact of life, from the lowliest worms to the executive on Wall Street. Competition is like gravity. We may not like it, but there it is anyway, having its effect on our lives, regardless of what we may think about it. There's nothing nasty about it - gravity doesn't care whether you hurt yourself when you fall or not.

If you have two organisms competing for a limited resource, say, a lion and a hyena competing for the carcass of a gazelle, if the lion doesn't want to compete or feels competition is wrong, then the hyena will eat and the lion will go hungry. If this goes on, the lion will die of starvation and the hyena will have many offspring. Nature is not being cruel. Competition is the way of the world. It's the way life on this planet became so complex and beautiful and amazing. It's the way your incredible brain evolved. Ultimately, competition is good. It makes things better. It forces improvement.

I'm a writer. There are places that pay for writing. And there are other writers in the world who would prefer that the money paid for that skill go into their bank account rather than mine. The money can't really go to every writer's bank account. There's a selection going on. Certain things will be selected for and certain things will be selected against. It is a competition, whether I want to acknowledge that fact or not. And, of course, the ones who compete the best will always out-compete the ones who don't compete as well.

Competition can be an ugly affair, typified by the presidential elections with all the mudslinging and back-stabbing. Although that's obviously competition, so is what goes on at the Olympics.

The presidential elections are ugly, but the Olympics are beautiful - whether you win or lose, you can still shake the hand of your competitor in friendship. You can compete with honor. You can compete for noble reasons. You can compete for the sake of others or for a cause you believe in. The Spirit of the Games raises competition to the elevated place it should hold.

Consider it in this light and you can learn to appreciate competition. It's important because you must either compete well, or those dreams you have will not happen. Whatever your job, this is true. If you've had, like me, a distaste for competition, start changing your attitude. Learn to appreciate and even like competition. Because the truth is, if you can compete well, you can fulfill your desires. If you can't or don't compete well, or if you don't "play the game" at all, someone else will get the raise or promotion or position, someone else's view will hold the floor, someone else's vision will be realized, and your dreams will become pipe dreams. It's up to you. You can compete, play well, and know you've done your best, or not. It's your call.

Learn to like competition and compete with honor.

Achieving goals is sometimes difficult. When you feel discouraged, check this chapter out. There are three things you can do to make the achievement of your goals more likely.
Do You Want to Give Up?

Some tasks are just plain boring and yet they have to be done. Washing the dishes, for example. Learn how to make the tasks more fun.
A Terrible Thing to Waste

Scientists have found out some interesting facts about happiness. And much of your happiness is under your influence.
Science of Happiness

Find peace of mind, tranquility in body, and clarity of purpose with this simple method.
Constitutional Right

The questions you ask direct your mind. Asking the right kind of questions makes a big difference.
Why Ask Why?

next: A Lasting State of Feeling Great

Stress Management

What is stress?

All animals, including humans, respond to threat by fighting or fleeing. While deciding what to do, your body gears itself up to respond. Extra stress hormones (adrenaline, noradrenaline, and cortisol) are secreted, your heart pumps faster, blood pressure rises, breathing quickens, perspiration increases, and digestion slows. Taking physical action exhausts the stress hormones. But when stuck behind a desk or in a car, with one tense situation after another, stress chemicals remain in the bloodstream. This causes headaches, creating further anxiety. Eventually your system is so overloaded that a minor incident can prompt a crisis.

What are some of the physical symptoms of stress?

Aches and pains, palpitations and dizziness, loss of appetite or compulsive eating, digestive problems, grinding your teeth, insomnia, breathing difficulties, stammering or speaking too fast, feeling tired, frequent infections, as well as reduced sex drive.

How does stress affect behavior?

It can make you unhappy -- depression, anxiety, panic attacks, feelings of inadequacy, pessimism, and dissatisfaction with life are all part of the picture. It can make you difficult to live with because people under stress are often irritable, irrational, and hostile. It can affect your work performance -- you may be forgetful, lethargic, and unable to concentrate or make decisions.

Can stress make you sick?

Stress may not directly cause illness but it can be a contributing factor, triggering allergies, asthma, migraines, irritable bowel syndrome, eczema, psoriasis, and hives. It's also thought to contribute to high blood pressure and heart disease.

1. Keep a Stress Journal

Describe situations that make you anxious. Ask yourself why you were so distressed. What were your concerns? (I'll never get to the meeting . . . I'll lose my job . . . We'll have to sell the house . . .) How might you think or act differently in the future to help you cope more effectively? List the pros and cons of possible responses to assess your options

2. Learn To Relax

You've read it countless times, but have you practiced it? Relaxing at will lowers blood pressure and slows breathing, metabolic, and heart rates, enabling your body to recover its equilibrium. It takes only 15 minutes. Lie on your back on a firm bed or mat. Let your feet flop outward and your hands rest by your sides. Close your eyes and sigh to release tension. Breathe slowly, pausing after each exhalation. Release tension in your toes, feet, and legs. Then do the same with your fingertips, arms, and neck. Ease tension in your shoulders by lowering them. Mentally smooth the muscles of your face. Be aware of the relaxation in your muscles. When you're ready, slowly open your eyes and stretch. Bend your knees and roll on your side before slowly getting up.

3. Breathing Effectively

Slow breathing from the diaphragm is one of the most effective ways of managing stress. Quick-fix breathing can release tension in a difficult situation. Calm and control your breathing by taking several deep, slow breaths. Return to normal breathing, then repeat. If the tense situation can't be changed, give a mental shrug, sigh, drop your shoulders, and ask yourself, "Who cares?"

4. Coping Techniques

* Meditation induces deep physical relaxation and mental awareness. Sitting comfortably upright, close your eyes and relax. Focus your mind on an object -- breathing out and in to the count of four, or look at an image such as a candle flame or flower, or repeating a word such as "peace" or "one" for 15 to 20 minutes.

* Visualization. Imagine a calm, beautiful scene in detail, smell the scents, hear the sounds. Repeat affirmative phrases such as "I feel peaceful." Before any high-pressure event, picture the scene. Then review what will happen in your mind, watching yourself deal confidently with the situation.

* Mindfulness or active meditation. Give all your attention to whatever you're doing, whether it's putting out the trash or eating dinner. Observe shapes, colors, textures, the movement of your body. Focus on the moment you're experiencing without worrying about the past or the future.

* Yoga. This combines stretching exercises for fitness with controlled breathing, relaxation, and meditation.

5. Exercise

Exercise helps dispel stress hormones from the bloodstream and stimulates the release of endorphins, opiate hormones that give a feeling of well-being. Aim for 30 minutes of moderate activity most days, 15 to 60 minutes of aerobic activity three to five times a week

6. Avoid Stimulants

Say no to excessive caffeine. Sip herbal teas. And drink water -- at least eight glasses a day

7. Try Aromatherapy Oils

Choose from basil, bergamot, cedarwood, geranium, juniper, lavender, rose, sage, sandalwood, and ylang-ylang. Use them alone or combine two or three

next: My Personal Story: Living with Anxiety
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Probably the most common questions asked about anxiety disorders medication on online forums are about side-effects of anxiety medications. People ask about side-effects before starting medication for anxiety because they want to choose medications that cause the least side-effects. People taking anxiety medication and experiencing side-effects want to know if anyone else has experienced the same.

While it's completely understandable that people would want to compare notes in this way, it can also lead to misinformation and misunderstanding about anxiety medication and side-effects. I'm often surprised that people use peer information as their only research on medication. Peer information should be used as a supplement to research and physician information. Online support groups should be the last place consulted for medication information, after you've read as much as possible and consulted with your doctor.

There are three important facts to remember concerning anxiety medication side-effects:

1. Side-effects generally are not permanent. They often last only a couple of weeks (although they may return if your dosage is increased).
2. Side-effects may be reduced and even avoided by starting on a low dosage and gradually increasing it.
3. Side-effects vary from person-to-person and medication-to-medication. Even medications in the same class (such as SSRI's) will not produce the same side-effects in an individual.

Your prescribing doctor should be knowledgeable of these three facts and sensitive to your concerns about side-effects. Most particularly, she should be willing to start at low dosages and she should give you tips for managing different side-effects. I cannot understand why some doctors are so insensitive to complaints about side-effects. If your doctor is insensitive, consider changing doctors.

Some side-effects either do not go away or are too severe to handle. In those cases, you and your doctor can discuss trying a different medication. Usually, after some trial and error, most everyone can find a medication without side-effects.

Concern about Addiction to Benzodiazepines

Concern about addiction usually focuses on the benzodiazepines (Xanax, Klonopin, Valium, Ativan, etc.). However, there are people concerned about addiction with any psychiatric medication. There is much misinformation and misunderstanding about the differences between addiction and medical dependence. Unfortunately, some of this misinformation is perpetuated by doctors, even when research to the contrary is available.

If you are concerned about addiction and benzodiazepines, I urge you to read more about it before making your decision.

next: Fear or Phobia of Consuming any Medication
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Patti's Panic Place: A Place of Hope & Healing

In this section:

• Concern About Anxiety Medication Side-Effects
• Fear or Phobia of Consuming any Medication
• Self-Help Stress Management

Help and Information for Panic and Anxiety Disorders

Now that you have made your way to this page, I hope you find some answers, some comfort, some reassurance and most of all, HOPE.

My name is Patti and I have suffered with panic - anxiety disorder for most of my life. This site is dedicated to reducing the suffering of those who have to deal with this disorder. I am now a "Functioning Agoraphobic" and have collected a lot of information that I hope will be helpful to you. I am not a professional, but I believe others, like myself, can find comfort in knowing that we are not alone. I have included "My Personal Story" because I understand how hopeless sufferers feel and maybe by reading my story it will help you understand there is hope and help. Please don't ever give up!!

I know that there are so many others who feel as I did, that no one understands what they are going through. A good support group is very beneficial in coping with this disorder. This site is written by a person who has been where you are. I would not want anyone to have to deal with this alone, as I did. When I found help I made a promise to myself that I would find a way to reach out to others and help. This is one of the ways I chose. I think experience is our best teacher so I would like to share my experiences with you.

Butterflies

A man found a cocoon of a butterfly. One day a small opening appeared and he sat and watched the butterfly for several hours as it struggled to force its body through that little hole. Then it seemed to stop making any progress. It appeared as if it had gotten as far as it could and it could go no further. So the man decided to help the butterfly by taking a pair of scissors and snipping off the remaining bit of the cocoon. The butterfly then emerged easily, but it had a swollen body and small, shriveled wings. The man continued to watch the butterfly because he expected that, at any moment, the wings would enlarge and expand to be able to support the body, which would contract in time. Neither happened! In fact, the butterfly spent the rest of its life crawling around with a swollen body and shriveled wings. It never was able to fly.

What the man in his kindness and haste did not understand was that the restricting cocoon and the struggle required for the butterfly to get through the tiny opening were God's way of forcing fluid from the body of the butterfly into its wings so that it would be ready for flight once it achieved its freedom from the cocoon. Sometimes struggles are exactly what we need in our life. If God allowed us to go through our life without any obstacles, it would cripple us. We would not be as strong as we could have been. We could never fly.

next: Concern About Anxiety Medication Side-Effects
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The treatment of bipolar disorder in children and adolescents may include the use of mood stabilizers, hospitalization, and ECT (electroconvulsive therapy).

Medical Care: The treatment and management of bipolar disorder are complicated; hence, most children and adolescents with this diagnosis require referral to a psychiatrist specializing in this age group. In general, a team approach is used in the clinical setting because multiple factors need to be addressed, including medication, family issues, social and school functioning, and, when present, substance abuse. In general, the treatment of bipolar disorder may be thought of as a 4-phase process: (1) evaluation and diagnosis of presenting symptoms, (2) acute care and crisis stabilization for psychosis or suicidal or homicidal ideas or acts, (3) movement toward full recovery from a depressed or manic state, and (4) attainment and maintenance of euthymia.

The treatment of adolescent or juvenile patients with bipolar disorder is modeled after treatments provided to adult patients, since no good controlled studies of bipolar treatment modalities in this age group are available to provide evidence-based medical care. Nonetheless, bipolar disorders in adolescents and children often present to clinicians at times of family or youth despair or family crises surrounding the youth's behaviors. In such critical times, inpatient care often is indicated to assess the patient, diagnose the condition, and ensure the safety of the patient or others. Hospitalization is necessary for most patients in whom psychotic features are present and in almost all patients in whom suicidal or homicidal ideations or plans are present. Inpatient care always should be considered for young persons who have suicidal or homicidal ideation and have access to firearms in their homes or communities and for those who abuse substances, particularly alcohol.

Depressive episodes are not uncommonly the first presentation of bipolar disorders in youths. In these situations, the clinician is wise to recall that approximately 20% of adolescents who have a diagnosis of depression later reveal manic symptoms; thus, antidepressant therapy in a depressed youth should be initiated with a warning to the patient and family of the possibility of later development of mania symptoms. If history of a manic state is known or suggested in a currently depressed patient, then a mood stabilizer must be started first. Once a therapeutic level and response to the mood stabilizer are attained, an antidepressant may be considered as additional treatment needed for the current state of depression.

Inpatient treatment usually requires locked-unit care to assist in safety regulation. Rarely are young persons physically restrained in hospitals, but seclusion rooms remain available in the event of severely agitated states that may culminate in threats or overt expression of physical aggression to self or others.

Mood stabilizers, such as lithium carbonate, sodium divalproex, or carbamazepine, are the mainstays of treatment of patients with bipolar disorder. Additionally, an antipsychotic agent, such as risperidone or haloperidol, may be used if psychotic features or aggressive agitation is present. Lastly, benzodiazepines may be used to improve sleep and to modulate agitation during hospitalization. Once symptoms of psychosis, suicidality, or homicidality are absent or are sufficiently diminished to a safe and manageable level, the patient is discharged to outpatient care.

Although electroconvulsive therapy (ECT) is well documented as an effective and safe treatment option in patients with depressive or psychotic states, most clinicians do not consider this a first-line intervention in children or adolescents. ECT often is initially administered on an inpatient basis because it most frequently is used in severe or refractory cases, and these patients are likely to require hospitalization more often. Still, ECT may be initiated at any point in treatment because each ECT treatment can be performed in a day treatment setting, usually requiring at least a 4-hour visit for the pre-ECT preparations, delivery of the ECT therapy, and monitoring afterward during the recovery time from both the ECT session and anesthesia. All ECT treatments require the presence of an anesthesiologist or anesthetist throughout the administration of therapy.

ECT has been demonstrated to be both safe and therapeutic in adolescents and children. One favorable aspect of ECT is its more rapid onset of therapeutic response versus medications, specifically in days rather than weeks. One drawback to ECT is the associated memory loss surrounding the time just before and after treatments. An ECT treatment episode may involve 3-8 or more sessions, usually at a rate of 1 session every other day or 3 sessions per week. Despite the rapid effect of ECT on mood and psychotic symptoms, medications are still required in the maintenance phase of treatment.

Sources:

• Kowatch RA, Bucci JP. Mood stabilizers and anticonvulsants. Pediatr Clin North Am. Oct 1998;45(5):1173-86, ix-x.
• Kowatch RA, Fristad M, Birmaher B, et al. Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. Mar 2005;44(3):213-35.

next: Bipolar Disorder in Children and Adolescents: Patient Evaluations
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A life letter from mother to daughter on the role of a mother in encouraging her daughter through the pain and uncertainty in life.

Life Letters

I still resent the assertion that childhood is without a doubt the best time of a person's life. Mine wasn't. It was often painful, frustrating, scary, and unfair. In spite of all the hype, I still say that being a kid is almost as hard as being a parent. Our children need our encouragement to make it safely through the tunnel of childhood.

I remember growing tearful as I read about a young woman who ran in a long and difficult marathon. She grew increasingly weary, and it began to look to those observing her, as though she might not make it. Just before the end of the race, an older lady jumped out of the crowd, took hold of the younger woman's hand, raised their joined arms in victory, and they stumbled down the last stretch. Daughter exhausted, mother determined - and they crossed the finish line together.

I can't run your races for you, but I can cheer you on, believe in you, push and pull you a little from time to time, and see you through. To encourage doesn't mean to flatter, give undeserved and thus meaningless praise, or to manipulate you into doing what you don't want to do - even if it's best for you. To encourage means to inspire, to provide reassurance and support, and to give courage to. How can I expect you to face the world with all of its' pain and uncertainty - without regular doses of it? I believe sweetheart with all of my heart that you can do what you need to do. But I have to do my part.

Love, Mom

next: Life Letters: An Open letter to the Handless Maiden