Living with PTSD

Understanding Cognitive Behavior Treatment

by David A. Carbonell, Ph.D.

This month I want to address two misconceptions people have about cognitive behavioral treatment for panic disorder andphobias.

The first misconception concerns the order in which thetreatment progresses.  It's this:

"The doctor will help me become unafraid. Then I can go dothe things I've been avoiding, like highway driving orshopping in malls."

Cognitive behavioral treatment is a very effective method for helping people overcome such phobias. In most cases,I can use it to help people get back on the highway, or intothe mall, or on a plane, or wherever they want to go.  Butwe don't do it in the order they expect.  They start with

the idea that, first they'll become unafraid, then they'lldrive on the highway.

We do the reverse of that.

They need to first go driving, and be afraid.  Later, afterenough practice, they will get to the point of being unafraid while driving.

That's terribly important.  Progress isn't made by staying away from the fear.  Progress is made by practicing *with*the fear.

The fear isn't the main problem, because I know that ifpeople learn to approach it in an accepting way, the fear will gradually disappear.

The main problem is that they resist and avoid the fear. I help them recover by helping them change that.  We do thisin steps, of course, not going faster or further than thecleint is willing to do.  But practice with fear is the wayto achieve progress.

The second misconception comes in two different forms, andhas to do with the way cognitive behavioral treatment helpspeople recover.

The first form is this:

"Cognitive behavioral therapy doesn't really fix the problem.It's just a band-aid.  I don't want to be following theAWARE steps, or filling out journals, or breathing a special way all the rest of my life."

That's understandable.  You don't have to.  These coping tools are a means to an end.  They help you get started withthe exposure so that you can become desensitized to the fear. Over time, you will let them go as part of your progress.

The second form is this:

"Cognitive behavioral therapy will give me the tools to besafe.  I can use diaphragmatic breathing and other tools tokeep me safe."

These tools will help you lose your fear, but they won't keep you safe.  They don't keep you safe because, when youhave a panic attack, you're not in danger.  It's very scary,but it's not dangerous. If you get fooled into believing thatthe coping techniques keep you safe, you will become dependent on them, and never really lose your fear.

If you're presently in treatment for panic disorder, or may do so in the future, it helps to be aware of these potentialmisconceptions.  Review them for yourself and, if you findit helpful, discuss them with your therapist.

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Dr. Carbonell, a licensed psychologist, is the founder and director of the Anxiety Treatment Center.  Dr. Carbonell isavailable for consultation in both the Chicago and New York offices. He publishes The Anxiety Coach®, which you can subscribe to at: http://anxietycoach.c.topica.com/maacBa8aa9yxFbc5hs6b/

A quote about the dual nature of adversity

"Adversity is a powerful force... a force that can disable us, or propel us to achieve beyond our dreams."

- Dr. Mark Lerner, President, American Academy of Experts in Traumatic Stress

A quote about treatment vs. prevention of PTSD

"There will always be a need for treatment. But I think the future lies in the area of how to make people crisis and trauma resistant…. We need to move into the area of primary prevention when it comes to acute and posttraumatic stress disorder."

- George S. Everly, Jr., Ph.D

Some statistics about PTSD

According to the National Institute of Mental Health, an estimated 5.2 million American adults ages 18 to 54 have PTSD.

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According to the National Center for Posttraumatic Stress Disorder, one of the primary differences among people who have experienced a motor vehicle accident versus another traumatic event is the increased likelihood of being injured or developing a chronic pain condition. As a result, many people who have been in an MVA present first to their primary care physicians for treatment and do not consider psychological treatment for some time.

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According to the National Institute of Mental Health, following exposure to a traumatic event, more than twice as many women as men experience PTSD.

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A study conducted at the University of Miami School of Medicine found that preschool-age children commonly exhibit symptoms of Posttraumatic Stress Disorder (PTSD) after exposure to a life-threatening hurricane. Based upon reports from mothers, 16.5% of exposed children met the diagnostic criteria for PTSD one year after a hurricane and 11.6% continued to exhibit PTSD symptomatology eighteen months after. The presence of PTSD places young children at increased risk for failure to achieve normal development in cognitive, social, and emotional skills.

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According to the National Institute of Mental Health, the traumatic events most often associated with PTSD for men are rape, combat exposure, and childhood neglect and physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.

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The results of a recent military study show that 17.4 percent of paratroopers returning from service in Iraq are suffering from PTSD.

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A Yale University Study published in the American Journal of Public Health found that of men exposed to combat, 27.8% showed signs of PTSD over the past 12 months and 21% engaged in spousal or partner abuse. The study's authors note that, "adjusted estimates indicate that without exposure to combat, 21% of current abuse of one's partner or spouse would probably not have occurred had these men not been exposed to combat."

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These statistics are taken from the September issue of Trauma Response^® E-News, which is now sent to over 2.6 million people every month! News and questions should be e-mailed to the Academy’s administrative offices at enews@crisisinfo.org.  Please enter “E-news” in the subject field.

One of my favorite quotes

"The world is full of suffering, it is also full of overcoming it."
-Helen Keller

Bullied workers suffer 'battle stress'

EXCERPT" "The symptoms displayed by people who have been in conflict situations and workplaces where bullying happens are strikingly similar," Dr Tehrani told BBC News Online.

"Both groups suffer nightmares, are jumpy and seem fuelled by too much adrenaline.

"In addition, they show greater susceptibility to illnesses, heart disease and alcoholism."

The favoured definition of bullying amongst psychologists is persistent devaluing demeaning or harassing of someone at work.

Link: BBC NEWS | Business | Bullied workers suffer 'battle stress'.

Stress gene may guide drug choice

EXCERPT: Scientists studying depression have reported finding evidence that a common genetic variation affecting how people manage stress predicts how much benefit they get from taking antidepressants.

Psychiatrists have long known that about  half the people found to be suffering from depression also show signs of  elevated anxiety. Researchers have tried to explain the correlation, as well as why the same drugs can relieve both conditions. The new report, published Thursday in the journal Molecular Psychiatry, is the second in a week to pinpoint a genetic difference that could help doctors tailor antidepressant treatment to those who would benefit most from it.

Read the entire article at  WebMD

You can Cure Yourself of Anxiety and Panic Attacks

According to Charles Linden 20 million people in the USA alone suffer with Anxiety Disorder and/or Panic Disorder.

(PRWEB) December 17, 2004 -- What is Anxiety Disorder?

Put simply, anxiety disorders are conditions which make our physical body react inappropriately to normal fear inducing stimuli.

They are caused mostly by repeated over-stimulation of the system in our body which helps us to react when we feel threatened in some way. This repeated stimulation resets our 'benchmark' for normal anxiety levels in a small organ in the brain called the Amygdala. Even in anxiety disorders, the Amygdala reacts with, what it believes to be, normal levels of anxiety.

By over-stimulating this system, the body and mind creates anxious habits that can escalate into anxiety and panic disorders such as:

Social Anxiety
Situational Anxiety
Phobias
OCD (obsessive compulsive disorder)
PTSD (post traumatic stress disorder)
Panic Attacks

In the US, it is estimated that 1 in 4 people suffer from an anxiety disorder at some time during their life so you are not alone...

That is just under 20 million people.

Anxiety disorder is a debilitating and scary condition which causes its sufferers to retreat and hide both physically and emotionally.

No one can ever know, unless they have suffered from the disorder themselves, how alone and scared it makes you feel.

How and Why has all of this developed?
We are experiencing much higher levels of stress from sources that simply were not there 100 years ago.

Anxiety levels become heightened when situations arise which increase the base level of anxiety, tipping it from appropriate to inappropriate reaction, creating an anxiety disorder. Release of the hormone adrenaline into our bloodstream produces a reaction called the 'flight or fight' response which then creates the scary and uncomfortable sensations and symptoms that anxiety disorder sufferers endure every day. These learned reactions in the subconscious mind (the Amygdala) perpetuate the anxious 'habit' and anxiety disorders stay with us.

The flight or fight response evolved in humans in order to prepare the body for action when faced with danger and is vitally important for survival; but when anxiety is ALWAYS present it becomes a disorder.

This is precisely what happens to the body in modern life, the road rage, money worries, fighting kids, job pressures and credit card bills, and other life stressors increase the 'benchmark' level of anxiety in our bodies.

The body is in a constant state of arousal, ready for “fight or flight”. Some people can cope with this increased arousal, some people actively pursue it by partaking in dangerous sports such as bungee jumping or parachuting, but they seem to have a higher ‘normal’ anxiety threshold.

The 'vicious cycle' of anxiety escalates as the sufferer then starts avoidance techniques such as staying close to home, in order to control anxiety-provoking situations, phobias develop and the disorders worsen.

This vicious cycle escalates until the sufferer becomes unable to function normally.

Does all of this Sound familiar?
Charles Linden has devised a method that stops all of this in its tracks, regardless of the cause of your condition and this could be one of a thousand combinations of factors, hereditary links and stress for example.

The Linden Method doesn’t dwell on giving blame opr looking for reasons, it simply gives you the answers you need right now to defeat YOUR anxiety and return quickly to lasting wellness, anxiety free.

Panic Attacks
Panic attack - a sudden or intense fear, anxiety or sense of impending doom, which reaches a peak very quickly. (Usually within a few minutes of it starting). It may be accompanied by pronounced physical symptoms, including a racing pulse, overbreathing, dizziness. An attack generally peaks within 10 minutes, but some symptoms may last much longer.

There are known to be three types of panic attack, these are:-

Spontaneous panic -
Associated to panic disorder, these attacks come without warning at any time regardless of location or situation.

This sort of attack does not need an external catalyst to start it.

Spontaneous panic often happens during sleep, waking the sufferer in its throws and causing the person to think they are having a heart attack or something similar.

A Panic attack builds subconsciously as a response to an unusual thought or sensation.

In other words, when unusual sensations or disturbing thoughts, which are common in anxiety disorders, suddenly rear their heads, the sufferer’s immediate reaction is to panic.

The brain has been programmed to respond like this through repeated experiences creating habitual or instinctual panic which is stored as a memory deep in the subconscious mind and controlled by the Amydala a small, but important, organ that regulates the anxiety response and other emotional responses.

This reaction starts a downward spiral of anxiety symptoms, the more symptoms there are, the more the person panics and the more they panic the more the symptoms occur; a viscious cycle is created from which it is very difficult to escape . The Amygdala 'learns' that this new level of anxiety is the new 'benchmark' for your 'normal', resting anxiety so next time you experience an anxious thought or sensation, the reaction is more intense.

Fear breeds fear and the cycle starts.

Specific panic attacks -
These attacks happen in relation to a specific situation or place that causes fear.

These attacks are usually the response to agoraphobia or other SPECIFIC fears where revisiting a place where you have panicked or had a bad experience before, could cause an attack.

Situational panic -
Although these attacks, like specific panic attacks, usually happen in certain situations, they are not caused by that situation.

For example a woman who has a panic attack on a bus, may only suffer them in that situation occasionally. She is predisposed to having attacks on the bus but it is not a response to fear of the bus.

The catalyst for your panic is irrelevant, all you need to know now is that you CAN do something about it no matter what you have been told before!

There is no need for drugs or expensive psychotherapy sessions.

Charles Linden can show you the most direct, fast and permanent solution to all forms of panic no matter how long you have suffered, but, you have to be prepared to DO what my method teaches.

It's not difficult, strenuous or painful, it isn't scary or anxiety provoking...and it works... Guaranteed. Click here

Scary faces have subliminal effects, study finds

"People's brains react to a photograph of a frightened face, even when it is flashed on a screen too quickly to be consciously recognized, U.S. researchers said on Wednesday.

"The team at Columbia University in New York found responses in the amygdala, the part of the brain associated with emotional responses, as well as the attention and vision regions of the cerebral cortex.

"What we think we've identified is a circuit in the brain that's responsible for enhancing the processing of unconsciously detected threats in anxious people," said Amit Etkin, who led the study.

"Our study shows that there's a very important role for unconscious emotions in anxiety," Etkin said."

Read the entire story at this link: Reuters AlertNet - Scary faces have subliminal effects, study finds.

Understanding Social Anxiety

"Social anxiety disorder used to be considered quite rare. No more. Epidemiological studies conducted in Canada, France, Germany, and the United States have revealed that it is one of the most common mental health problems. In fact, it appears to be the third most common psychiatric disorder in the United States after depression and alcohol abuse, Mark Pollack, M.D., an associate professor of psychiatry at Harvard University and director of the anxiety treatment program at Massachusetts General Hospital, told Psychiatric News.

"Later in the article: When a person with the disorder is thinking about something anxiety provoking—say, going to a party—his amygdala probably sends out fear signals, and at the same time his prefrontal cortex thinks, "I shouldn't be nervous; they are just ordinary people. What's the big deal?" But because the amygdala is overactive and the prefrontal cortex underactive, the amygdala wins.

"Or as Jack Gorman, M.D., chair of psychiatry at Mount Sinai School of Medicine, explained in an interview: "For some reason, people with social anxiety get more `amygdala' and less `prefrontal,' so that they are unable to gate those fear messages from the amygdala.""

Read the full article at this Link: Understanding Social Anxiety -- Psychiatric News.

Just a tip for derailing the amygdala takeover: Take Six. As soon as you experience a triggering event, name 6 things. 6 of anything. 6 types of fruits. 6 boy's names. 6 European cities. Whatever. The point is that you interrupt the amygdala and shift the action to the pre-frontal cortex. This works great if you recognize your triggers.

It took me awhile to figure out my triggers. Even now that I know them, I have a delayed trigger reaction. I can experience a trigger, think I'm doing fine, and a few hours later, find myself in the middle of increased anxiety. So now I'm working on what kinds of techniques I can use to interrupt a delayed reaction. I'm hoping that the work I'm doing with the Holosync Technology is going to help me with that.