Don’t Say “Don’t Panic”: How To Help Someone With A Panic Disorder

Credit: From Sheryl Ankrom, former About.com Guide

The Experience of Recurring Panic Attacks

To understand panic disorder with agoraphobia, we must first talk about panic attacks. Sudden and recurring panic attacks are the hallmark symptoms of panic disorder. If you have never had recurring panic attacks, it may be hard to understand the difficulties your friend or loved one is going through. During a panic attack, the body’s alarm system is triggered without the presence of actual danger. The exact cause of why this happens is not known, but it is believed that there is a genetic and/or biological component.

Sufferers often use the terms fear, terror and horror to describe the frightening symptoms of a full-blown panic attack. But even these frightening words can’t convey the magnitude of the consuming nature of panic disorder. The fear becomes so intense that the thought of having another panic attack is never far from conscious thought. Incessant worry and feelings of overwhelming anxiety may become part of your loved one’s daily existence.

These Intense Symptoms Must Mean Something…Something Terrible

At the onset of panic disorder, your loved one may be quite certain they are suffering from a heart condition or other life-threatening illness. This may mean trips to the nearest emergency room and intensive testing to rule out physical disease. But, even when he or she is assured that these symptoms are not life-threatening, it does little to put his or her mind at ease. The feelings experienced during panic attacks are so overwhelming and uncontrollable, sufferers are convinced they are going to die or are going crazy.

A New Way of Life Emerges: Fear and Avoidance

So frightening are the symptoms of panic disorder, that your loved one may go to any and all lengths to avoid another attack from occurring. This may include many avoidant types of behavior and the development of agoraphobia. But, despite the efforts to avoid another panic episode, the attacks continue without rhyme or reason. There is no place to escape, and the sufferer becomes a prisoner of an insidious and illogical fear. Without appropriate treatment, your loved one may become so disabled that he or she is unable to leave his or her home at all.

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Self Image Is Redefined

At times, we’ve all experienced nervousness, anxiousness, fear and, perhaps, even terror or horror. But in the midst of a catastrophic event, we understand these symptoms. Once the event is over, so, too, are the symptoms. But, imagine reliving these symptoms over and over again, without any warning or explanation.

This type of fear is life-changing. As abilities become inabilities, things once taken for granted, like going to into a store, become anxiety-filled events. Some enjoyable activities, like going to concerts or movies, may be avoided altogether. It is not uncommon for sufferers to experience a sense of shame, weakness and embarrassment as their self-image is redefined by fear.

Panic disorder is not just being nervous or anxious. Panic disorder is not just about the fear, terror and horror experienced during a full-blown panic attack because it does not end when the panic subsides. It is a disorder that is quick to invade and can alter one’s very essence, redefine one’s abilities and take over every aspect of one’s life.

Your Role As A Support Person

As a support person, you can play an important role in your loved one’s recovery process. Understanding what panic disorder is, and what it is not, will help you on this journey. Author Ken Strong provides a lot of information for supporting a person with panic disorder in his book, Anxiety:The Caregivers, Third Edition.

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A Spoonful Of Sugar DOES Makes The Medicine Go Down! Sweet Solutions Reduce Kids Experience Of Pain From Needles

Infants who receive sweet solutions before being immunised experience less pain and are more comfortable, reveals research published ahead of print in the Archives of Disease in Childhood.

Read The Abstract Here

Healthcare professionals should consider giving infants aged 1-12 months a sweet solution of sucrose or glucose before immunising a child, the international team of researchers recommended, because of the child’s improved reaction to injections.

Existing research shows the effectiveness of giving newborn infants and those beyond the newborn period, a small amount (e.g. a few drops to about half a teaspoon) of sucrose and glucose as analgesics during minor painful procedures.

Little is known, however, about the effect of such solutions on pain, so a team of researchers from Toronto in Canada, Melbourne in Australia and Sao Paulo in Brazil, funded by a Canadian Institutes of Health Research Knowledge Synthesis grant, collected the findings from 14 relevant trials involving 1,674 injections given to children aged 1-12 months.

They found that giving a child a small amount of sweet solution, compared to water or no treatment moderately decreased crying in the child during or following immunisation in 13 of the 14 studies (92.9%).

The authors conclude that infants aged 1-12 months given sucrose or glucose before immunisation had cried less often and for less time.

The amount of glucose or sucrose given made a difference and the researchers found that infants receiving 30% glucose in some trials were almost half as likely to cry following immunisation.

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The researchers could not identify the ideal dose of sucrose or glucose because of the variety of volumes and concentrations used in the various trials.

Analgesic effects of sweet solutions given to older infants were more moderate than those in newborn infants.

They conclude: “Healthcare professionals responsible for administering immunisations should consider using sucrose or glucose during painful procedures.

“This information is important for healthcare professionals working with infants in both inpatient and out-patient settings, as sweet solutions are readily available, have a very short onset of time to analgesia, are inexpensive and are easy to administer.”

Source: Eurekalert

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Regular Exercise Is Important For The Health Of Those Who Have Schizophrenia

Regular exercise can play an important a role in improving the physical and mental wellbeing of individuals with schizophrenia, according to a review published in The Cochrane Library. Following a systematic review of the most up-to-date research on exercise in schizophrenia, researchers concluded that the current guidelines for exercise should be followed by people with schizophrenia just as they should by the general population.

“Current guidelines for exercise appear to be just as acceptable to individuals with schizophrenia in terms of potential physical and mental health benefit,” says lead researcher Guy Faulkner of the Faculty of Physical Education and Health at the University of Toronto, Canada. “So thirty minutes of moderate physical activity on most or all days of the week is a good goal to aim for. Start slowly and build up.”

Schizophrenia is a serious mental illness affecting four in every 1,000 people. It is already known that exercise can improve mental health, but so far there has been only limited evidence of effects in schizophrenia. The new review focused on three recent small studies that compared the effects of 12-16 week exercise programmes, including components such as jogging, walking and strength training, to standard care or yoga.

The researchers found that exercise programmes improved mental state for measures including anxiety and depression, particularly when compared to standard care. Changes in physical health outcomes were seen but they were not significant overall. However, the researchers suggest this may be due to the short timescale of the trials.

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Two previous reviews have found exercise therapy to be beneficial in schizophrenia, but called for more rigorous research. “This new review suggests that such calls are starting to be addressed,” says Faulkner. “But we still need more research that will help us learn how we can get individuals with schizophrenia engaged in exercise programmes in the first place, and how such programmes can be developed and implemented within mental health services. That’s one of the biggest challenges for this type of intervention.”

Source: Eurekalert

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Down By The River: 5 Minutes Of “Green Exercise” Boosts Your Mood

Just five minutes of exercise a day in the great outdoors can improve mental health, according to a new study, and policymakers should encourage more people to spend time in parks and gardens.

Read The Original Article (PDF)

Researchers from the University of Essex found that as little as five minutes of a “green activity” such as walking, gardening, cycling or farming can boost mood and self esteem.

“We believe that there would be a large potential benefit to individuals, society and to the costs of the health service if all groups of people were to self-medicate more with green exercise,” Barton said in a statement about the study, which was published in the journal Environmental Science & Technology.

Many studies have shown that outdoor exercise can reduce the risk of mental illness and improve a sense of well-being, but Jules Pretty and Jo Barton, who led this study, said that until now no one knew how much time needed to be spent on green exercise for the benefits to show.

Barton and Pretty looked at data from 1,252 people of different ages, genders and mental health status taken from 10 existing studies in Britain.

They analyzed activities such as walking, gardening, cycling, fishing, boating, horse-riding and farming.

They found that the greatest health changes occurred in the young and the mentally ill, although people of all ages and social groups benefited. The largest positive effect on self-esteem came from a five-minute dose of “green exercise.”

All natural environments were beneficial, including parks in towns or cities, they said, but green areas with water appeared to have a more positive effect.

Read The Original Article (PDF)

Source: msnbc

Should I Tell Or Not? Mood Disorders & The Workplace

Credit: Therese J. Borchard via psychcentral

Just when I think our world has moved a baby step in the right direction regarding our understanding of mental illness, I get another blow that tells me otherwise. For example, awhile back I quoted an intelligent woman who wrote an article in a popular women’s magazine about dating a bipolar guy when she was bipolar herself. She recently discovered that she had jeopardized a job prospect because the article came up — as well as all those who referenced it, like Beyond Blue — when you Googled her name. So she requested everyone who picked up that article to go back and change her real name to a pseudonym.

Because talking about bipolar disorder in the workplace is pretty much like singing about AIDS at the office a hundred years ago or maybe championing civil rights in the 60s.

I totally get why this woman created a pseudonym. Trust me, I entertained that possibility when I decided to throw out my psychiatric chart to the public. It’s risky. Extremely risky. Each person’s situation is unique, so I can’t advise a general “yes ” or “no.” As much as I would love to say corporate America will embrace the person struggling with a mood disorder and wrap him around a set of loving hands, I know the reality is more like a bipolar or depressive being spit upon, blamed, and made fun of by his boss and co-workers. Because the majority of professionals today simply don’t get it.

Not at all.

They don’t get it even though the World Health Organization predicts that by 2020, mental illness will be the second leading cause of disability worldwide, after heart disease; that major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a new study funded by the National Institute of Mental Health; that the direct cost of depression to the United States in terms of lost time at work is estimated at 172 million days yearly.

I realize every time I publish a personal blog post — one in which I describe my severe ruminations, death thoughts, and difficulty using the rational part of my brain — I jeopardize my possibilities for gainful employment in the future. I can pretty much write off all government work because, from what I’ve been told, you have to get a gaggle of people to testify that you have no history of psychiatric illnesses (and, again, all it takes is one Google search to prove I’m crazy).

It’s totally unfair.

Do we penalize diabetics for needing insulin or tell people with disabling arthritis to get over it? Do we advise cancer victims to use a pseudonym if they write about their chemo, for fear of being labeled as weak and pathetic? That they really should be able to pull themselves up by their bootstraps and heal themselves because it’s all in their heads?

But I don’t want to hide behind a pseudonym. I use my real name because, for me, the benefit of comforting someone who thinks they are all alone outweighs the risk of unemployment in the future. Kay Redfield Jamison did it. She’s okay. So is Robin Williams. And Kitty Dukasis. And Carrie Fisher. Granted all four of those people have talent agents ready to book them as speakers for a nice fee.

In their book, Living with Someone Who’s Living with Bipolar Disorder Chelsea Lowe and Bruce M. Cohen, MD, Ph.D., list the pros and the cons of going public with a mood disorder. I’m paraphrasing a little bit, but here are the pros:

• There’s nothing disgraceful about the condition, any more than there would be about cancer or heart disease.
• Carrying a secret is an enormous burden. Sharing it lightens it.
• The more people who know and are looking out for you, the more likely you’ll be able to get help before the problems turn serious.
• Sharing the information lessons the burden on your partner.
• Lots of people have psychiatric issues; maybe your boss or family member does too.
• Taking about the diagnosis is an opportunity to educate others.

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The authors suggest telling your employer under these circumstances:

• If you are taking a new medication and may need time for adjustment.
• If your schedule doesn’t allow for regular, restful sleep–which is an important factor in controlling the disorder–or if you need to request certain adjustments to your schedule, like telecommuting.
• If you need to be hospitalized or take a leave of absence.
• If the disorder is affecting your behavior or job performance.
• If you need to submit benefit claims through your employer rather than the insurance company, or if your employer requires medical forms for extended absences.

And the cons:

• Prejudice and stigma about psychiatric disorders are still common in our society. A disclosure of bipolar disorder [or any mental illness] will inevitably color your employer’s and coworkers’ perceptions of his job performance: “Did Jerry miss that meeting because the bus was late, or because he was off his meds?” Potential problems include discrimination, stigmatization, fear and actual job loss.
• You can’t un-tell a secret.
• Your chances for promotion could be hurt.
• The employer is under no obligation to keep your condition secret.
• Discrimination is illegal but difficult to prove.
• You could be written off as “crazy.”

It’s Tricky! What are your thoughts?

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“I Saw It Happen”: Children Who Witness Bullying Can Be Traumatized Too

Students who witness bullying of their peers may suffer more psychologically than the victim or the bullies.

Read The Original Research Paper (PDF)

2002 students ages 12 to 16 were surveyed at public schools in England. The survey asked them whether they’d committed, witnessed, or been the victim of several types of bullying behavior (e.g., kicking, name-calling, threatening, etc.) and whether they had experienced psychological stress symptoms such as anxiety, depression, or hostility.

Why bystanders suffer more than victims of bullying

As reported in the article, previous research shows that children who witness bullying feel guilty, presumably for not doing anything to help the victim.

In addition, they may have felt more stressed by vacillating between doing what they thought they should do (i.e., help the victim) on the one hand, and being afraid of being victimized themselves, on the other.  Being in this type of “approach/avoidance” conflict has been shown in numerous studies to create high levels of stress.

The combination of guilt and fear among witnesses that they will experience the same thing may be another reason why they are more affected by bullying than the actual victims.

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Uncertainty, especially combined with feelings of fear or guilt, contributes to stress. Stress leads to depression, anxiety, and other mental disorders.

Sitting down and discussing feelings of fear and guilt with your child may help to minimize the destructive force and ultimate impact of those emotions on mental health.  Practical “survival” tips about how to avoid, distract, or other means of handling bullies would help, too, giving kids options if they are cornered by or are a witness to bullies in action.
Read The Original Research Paper (PDF)

Source: Psychological Association (2009, December 15). Witnesses to bullying may face more mental health risks than bullies and victims. ScienceDaily.

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Anxiety & Depression: Self-Help Internet Interventions Work!

A little while ago I posted a list of free interactive self-help web sites, all research based, which have been shown to effective in the treatment of anxiety & depression. A recent study adds to the body of evidence which supports web based intervention as a viable treatment option or adjunct.

Cognitive behaviour therapy (CBT) via the internet is just as effective in treating panic disorder (recurring panic attacks) as traditional group-based CBT. It is also efficacious in the treatment of mild and moderate depression. This according to a new doctoral thesis soon to be presented at Karolinska Institutet.

Read the original research thesis here (PDF)

“Internet-based CBT is also more cost-effective than group therapy,” says Jan Bergström, psychologist and doctoral student at the Center for Psychiatry Research. “The results therefore support the introduction of Internet treatment into regular psychiatry, which is also what the National Board of Health and Welfare recommends in its new guidelines for the treatment of depression and anxiety.”

It is estimated that depression affects some 15 per cent and panic disorder 4 per cent of all people during their lifetime. Depression can include a number of symptoms, such as low mood, lack of joy, guilt, lethargy, concentration difficulties, insomnia and a low zest for life. Panic disorder involves debilitating panic attacks that deter a person from entering places or situations previously associated with panic. Common symptoms include palpitations, shaking, nausea and a sense that something dangerous is about to happen (e.g. a heart attack or that one is going mad).

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It is known from previous studies that CBT is an effective treatment for both panic disorder and depression. However, there is a lack of psychologists and psychotherapists that use CBT methods, and access to them varies greatly in Sweden as well as in many other countries. Internet-based CBT has therefore been developed, in which the patient undergoes an Internet-based self-help programme and has contact with a therapist by email.

The present doctoral thesis includes a randomised clinical trial of 104 patients with panic disorder and compares the effectiveness of Internet-based CBT and group CBT within a regular healthcare service. The study shows that both treatments worked very well and that there was no significant difference between them, either immediately after treatment or at a six-month follow-up. Analyses of the results for the treatment of depression show that Internet-based CBT is most effective if it is administered as early as possible. Patients with a higher severity of depression and/or a history of more frequent depressive episodes benefited less well from the Internet treatment.

Jan Bergström works as a clinical psychologist at the Anxiety Disorders Unit of the Psychiatry Northwest division of the Stockholm County Council. This research was also financed by the Stockholm County Council.

“Thanks to our research, Internet treatment is now implemented within regular healthcare in Stockholm, at the unit Internetpsykiatri.se of Psychiatry Southwest, which probably makes the Stockholm County Council the first in the world to offer such treatment in its regular psychiatric services,” says Jan Bergström.

Read the original research thesis here (PDF)

Credit: Adapted from materials provided by Karolinska Institutet.

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Compulsive Collecting: Finding Hope In The Misunderstood Mess of Hoarding

Compulsive collecting or Hoarding is a misunderstood and debilitating mental health issue. Many psychologists and counsellors never see someone with this condition as they very rarely present for help. This article from an Australian newspaper provides an excellent overview of the condition and issues underlying hoarding, and I have included links to two brilliant books co-authored by the researchers discussed in the article, who have developed a wholistic and novel approach to it’s treatment.

Credit: Kate Benson, Sydney Morning Herald April 8 2010

They may dress well or hold down a good job. But hoarders are unhappy people who suffer from a debilitating condition.

Every suburb has one. The elderly woman weaving through an overgrown backyard full of cardboard boxes, old tyres and discarded furniture. Cats perch on every surface; kittens roll about among the rusted drums and long grass.

Inside, behind closed curtains, the rooms are piled high with papers, cups, plates and bottles. Broken toys, old clothes and shopping bags spill across kitchen benches and floor, smothering the stove and filling the sink, neither of which has been used in years.

The stench of cat faeces, urine and food scraps fill the house.

To her neighbours, she is an oddity. Or a pest, bringing down house values and encouraging vermin.

But to therapists she is one of a growing band across Australia suffering from a debilitating condition known as compulsive hoarding, where people feel a need to collect and store items that seem useless to others.

Their homes become havens of insurmountable clutter and junk, often leaving them unable to sleep in their beds or use appliances. Many end up with electricity or gas supplies disconnected or their fridge and washing machines unusable because they fear their lifestyle will be revealed if they contact a tradesmen to make repairs.

This secrecy and shame make it difficult to know exactly how many people have the disorder.

Some experts think between 200,000 and 500,000 Australians compulsively hoard, but others put the figure closer to 800,000.

“It’s a sleeping giant,” Chris Mogan, a clinical psychologist and expert on hoarding, says. “There is no systematic estimate of how many hoarders there are in any Australian setting. I suspect there are many, many more out there than we are aware of.”

Louise Newman, the president of the Royal Australian and New Zealand College of Psychiatrists, agrees.

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“I’ve only seen one case in my career [because] these people usually only come to light when the council steps in and orders a clean-up. Hoarders desperately want to keep hoarding. They don’t want to be stopped.”

There is little research on the condition in Australia and not much in the way of funding or treatment programs, but experts are hopeful hoarding will be included in the next (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders, the bible used by mental health experts to diagnose psychiatric conditions.

Many sufferers fall between the cracks because hoarding is not a clinical diagnosis in its own right, but is seen more as an offshoot of obsessive compulsive disorder, muddled with depression, anxiety, panic disorder and low self-esteem.

“But it is different to OCD and once we get it in the DSM-V, therapists, psychiatrists, psychologists and social workers can then be trained in the management of it [and] we can attract funding for research,” Mogan says.

Jessica Grisham, a clinical psychologist who specialises in obsessive compulsive disorder, also believes compulsive hoarding should be included in the next edition as it requires specialised treatment.

She cites recent neural imaging studies in the US that showed that different parts of the brain were activated in hoarders than in obsessive compulsive disorder patients.

Mogan and Grisham agree that cognitive behaviour therapy, where sufferers are slowly taught to change their thought patterns, is more effective than medication alone.

But hoarders responded better to a specially adapted version of the therapy, developed by the American hoarding experts Gail Steketee and Randy Frost. It had been achieving success with about 60 per cent of hoarders – far more than standard cognitive behaviour therapy.

“But it has to be a long-term project. You don’t go in to someone’s place and do a sudden excavation against their will,” Grisham says.

“That’s a violation and it’s very traumatic for them. It might make great TV, but it’s not good clinically.”

Mogan agrees. A pay TV show, Hoarders, was damaging to the public’s understanding of the illness, because it focused on forcefully cleaning houses in three days.

“Within six to 12 months that house will be recluttered because it is a compulsion … they suffer a lot of grief after things are taken away.”

Mogan makes weekly home visits to hoarders, and focuses on getting them to reduce the associated dangers by ensuring their home has two exits for safety, and working appliances and smoke alarms.

“Just as we do with drugs and alcohol, we’re into harm minimisation. Once the house is safe, we gradually set more goals. If they are comfortable with that, they will continue to stay in touch and not reject us.”

Sometimes the problem extends beyond mounds of paperwork and clothes. Mogan and Grisham know patients who hoarded urine or fingernail clippings. Some stored their own faeces or collected one particular item, such as bicycles. One sufferer was hoarding so much junk, the only access to the house was a 30-centimetre gap at the top of the front door.

But for Allie Jalbert, of the RSPCA, the most distressing hoarders are those who keep scores of cats and dogs, all battling for attention and food on a crowded suburban block.

She has been calling for years to have hoarding classified as an illness in its own right to allow more people to receive treatment and put an end to the 100 per cent recidivism rate.

“Often, we find that hoarders might be treated for peripheral symptoms such as anxiety or depression, but their core problem, the hoarding, is not addressed. So once we have cleaned out the house, they reoffend, which is very, very frustrating for everyone involved,” Jalbert says.

Some people threatened suicide and had to be removed by police when faced with the prospect of giving up their animals or clutter.

“There’s a mixed bag of emotion when you deal with hoarders. Firstly, there is the concern for your personal safety but there is also a degree of empathy because often these people are quite emotional and attached to the animals. But it’s quite frustrating to see animals living in such horrific situations,” she says.

“I’ve seen bathtubs full of faeces and rubbish, sinks that no longer work, homes with no heating or cooling. Sometimes it’s quite an overwhelming experience.”

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Who develops the condition and why?

Some studies have shown that many hoarders have been brought up in households where chaos reigned. Some were neglected as children and witnessed pets being treated poorly.

Mogan accepts the aetiology is mostly unknown, but cites an Australian study that found sufferers reported failing to connect with their parents or growing up in households lacking emotional warmth.

“The lack of attachment causes them to become ambivalent about their identity and about other people. As a compensatory mechanism, they link with things, which they find more compelling, more predictable and dependable and less rejecting.”

But Grisham believes there is no real trigger, apart from children of hoarders being rewarded for saving things and getting punished for discarding. “Sometimes there is a traumatic head injury but those cases are very rare.”

The condition affects slightly more women than men but is found across all occupations, age groups and ethnicities. “And they are in relationships,” Mogan says. “Albeit strained ones.

“Some are going out to work, but they make sure no one comes to their house. They’re not agoraphobic. On the contrary, many hoarders go out a lot to escape. But their children’s lives can’t be normalised because they can never sit down for a meal or find space to do homework. It’s a real impost on the family experience.”

Mogan runs group therapy sessions in Melbourne and says that many patients do want to be cured.

“This condition is a disability and the source of quite a lot of human suffering and neglect. A lot of these people are quite relieved to get help.”

//

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Martin Seligman: Author Of “Learned Optimism” Speaks About Positive Psychology And Authentic Happiness

Martin Seligman was originally best known for his classic psychology studies and theory of “Learned Helplessness” (1967) and it’s relationship to depression.

These days he is considered to be a founder of positive psychology, a field of study that examines healthy states, such as authentic happiness, strength of character and optimism, and is the author of “Learned Optimism”.

This is a terrific talk on Positive Psychology and what it means to be happy. It’s about 20 mins. long but definitely worth a watch!

Self Help For Anxiety & Depression: A List Of FREE Interactive Self Help Websites

Today I wanted to get around to doing what I have been meaning to do for a while and post a list of free access interactive and/or educational websites which I have come across. These sites are fantastic resources and each one offers a different way to get involved with your recovery. Please note I am not affiliated with any of these sites and they are not affiliate sites. I hope you find one or more useful as I know many of my clients have.

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Self Help / Educational Websites

Updated 27th March 2010

• Anxiety Online
• Beyond Blue
• —Moodgym
• Depnet
• Bipolar Disorder Education Program
• Blackdoginstitute
• BlueBoard
• BluePages
• CRUfAD – Self Help
• Depression Education Program
• e-couch
• Feardrop – online exposure therapy for phobias
• Living Well Working Well
• MoodSwings
• Multicultural Information on Depression online (MIDonline)
• Virtual Clinic
• Added 27th March 2010
• Depressioncenter.net
• Beatingtheblues (UK)

There you have it! Check them out and let me know what you think. Know of any others? (No affiliate sites please).