Thursday, May 25, 2006

Taking Responsibility for Everything

The summer after I graduated from high school, I took a job stacking boxes of fruit at a packing house. Basically, I would stand at the end of a converyer belt with two to three other guys. Each time a box would come to us on the belt we would stack it. About the only mentally engaging part of the job was making sure that boxes of peaches were stacked with peaches, plumbs with plumbs, and so forth.

During some parts of the day the boxes came slow and we could easily get them stacked. At other times, the boxes came to us on the conveyer belt at a pace that forced us to work faster. During fast times, if we didn't get all the boxes stacked in time some would fall off the end of the conveyer belt leaving peaches or plumbs to spill out of the box and roll everywhere.

The problem was, when the boxes came faster, everyone didn't work faster. Some guys worked as if they were content just to let the boxes fall. Others of us worked harder to pick up the slack. We took responsibility for not letting the boxes fall no matter how slow the other guys worked.

I was one of the guys that picked up the slack for others.

Looking back, I would guess it was the guys who didn't speed up that never had a panic attack or anxiety disorder in their life.

The guys that picked up the slack for everyone, like me, were probably the ones most prone to having panic attacks - or developing agoraphobia.

Friday, May 12, 2006

How I Developed Agoraphobia

Panic first struck me hard, unexpectedly, and out of nowhere. I was an eighth grader playing right field in a baseball game one night when suddenly everything seemed unreal. My body felt like someone else’s and I felt light enough to float away into the sky. I started breathing fast, as if sucking in lots of air would make me heavy enough to stay on the ground but I was afraid that I might keep getting lighter and lighter until I floated away like a helium balloon.

The stronger this fear became, the more my breathing sped out of control. Pretty soon I felt like I was choking, or maybe even drowning, as if I couldn’t get any air.

That’s when panic kicked in. I had that same dreadful feeling that you get when you have been underwater too long, your lungs are about to burst, and you look up and realize that the surface is high above.

That inning was the longest inning of baseball I can remember playing in my life. I could never slow down my breathing and looking in from where I stood in right field, the batters seemed fuzzier and fuzzier to me. Eventually my arms and legs got tingly and I felt weak all over. My feet went numb in my shoes and my hand felt dead inside the leather interior of my glove.

I didn’t understand what was happening to me and was completely terrified. It was all I could do to stay out in right field and sweat out each pitch, just waiting for the inning to come to a merciful end. By the time it ended, I was so dizzy and weak I could hardly jog off the field.

Back in the dugout, I finally caught my breath. That’s when the feeling returned to my arms and legs, and my vision cleared up. The panic went away, too, but I still felt uneasy. I was afraid that if I went back onto the field it would happen again. I also felt like I couldn’t tell anyone about my experience because they might think I was going crazy.

Because these unpleasant sensations came over me that night in the absence of warning or logical explanation, I felt extremely vulnerable in the following days. I was afraid the experience might revisit me at any time.

Both spring and summer passed that year with thoughts of this waking nightmare lurking in the back of my mind like a foreboding specter. I didn’t feel safe. No matter what I did or where I went, the experience hung over me. I prayed to God it would never happen again.

My prayer wasn’t answered. At least not in the way I wanted it to be. Those same sickening feelings I had felt on the baseball field came back. They broke in on my education and rudely disrupted my life on the Monday morning of my third week of high school. It was my fifteenth birthday.

During my first period algebra class, I lost all sense of security and well-being. My heart’s heavy pounding grabbed my attention first. My chest tightened, and I had trouble catching my breath. It was like I was suffocating from a lack of air in the room.

Almost gasping, my vision blurred as I lost my sense of balance. Desks, chairs, and even the other students seemed to swirl all around me. My disorientation and dimming sense of sight triggered intense waves of panic.

For several minutes of this, I suppressed my terror, in hopes that the symptoms would just go way. Instead, they only got worse and a terrible nausea came over me. I could feel drops of sweat falling onto the cloth of my shirt. I didn’t know what was wrong and hoped I wasn’t having a heart attack. Finally, when I couldn’t sit at my desk another minute, I raised my hand and asked for a pass to see the nurse.

I ran all the way across the campus to the nurse’s office and dialed home with shaky fingers. Waiting for my mom to pick me up seemed like forever even though it was probably only ten minutes. Since I thought I was sick, I went to bed as soon as I got home. For some reason, once I was under the covers, all the bad feelings went away and I felt fine. I was totally exhausted from and confused by the experience, but felt pleasantly relaxed.

The experiences I just described, which I can now identify as panic attacks, started happening closer and closer together after that day in algebra class. Since at first they mostly happened in classrooms I got in the habit of staying home from school to avoid them and continued going everywhere else. However, I eventually had panic attacks in other places and the fear slowly generalized. I had panic attacks at church, in the mall, at friends’ houses, and so on. I stopped going to every place I had experienced panic for fear that I might have another attack.

My world slowly shrank until I hardly left home anymore.Though I didn’t have many full-blown panic attacks at home, fear did not leave me alone to rest there. The physical sensations I felt during panic attacks left me with questions about my health. Since I didn’t even know what panic attacks were, I thought something was physically wrong with me. When I stayed home from school, often I lay in bed most of the day scanning my body. I put my hand over my heart to make sure it was still beating. I blew air into the palm of my hand to make sure my lungs were still expelling air. I worried that I had some hidden tumor, an enlarged liver or spleen, or some rare unexplainable disease.

Fear of the unknown hung over me every day and I had way too much time to think. I found myself turning into a hypochondriac. That’s when I started going to the doctor.

Actually, I didn’t just go to one doctor. I went to many. When I told my general practitioner I was having difficulty breathing and thought I had an irregular heartbeat, he took x-rays of my heart and lungs. Everything checked out fine and he told me it was all in my head. Neither I nor my parents could accept this diagnosis.

You have to understand that my dad was a school psychologist at the time. His job was diagnosing the problems of other people’s kids. In his mind, there was no way his own son could have a psychological problem like agoraphobia or panic disorder.

Most of all, it was I who could not accept that I had a psychological problem.I come from an intelligent, educated family. People like me, I thought, don’t have psychological problems. I saw myself as too smart, too healthy, too young, and overall way too normal to have a mental disorder.

I thought psychological problems were only for “screwed-up” people from dysfunctional families, and I knew there had to be something wrong with me that was real. When I say real, I mean something physical and tangible. I couldn’t see myself as someone who would be staying home from school just because I couldn’t get a mental grip on school or life.

Needless to say, I felt totally insulted by what the doctors told me and vowed that no doctor would make me doubt my sanity. I got a second opinion, and a third and a fourth. Every doctor’s opinion was the same. They all told me there was nothing physically wrong. Though I eventually gave up on learning anything from the doctors, denial kept me from seeking psychological help.

As spring of the next year approached outside, my indoor world had gotten pitifully small. When I tried to go back to school, my knees would get so shaky that I would freeze for fear of falling down. When I attended church with my family, I would feel all the air being sucked out of the sanctuary and run outside just to breathe.

When I went walking through the shopping mall, the ceiling would appear to be so high it would leave me feeling weightless and airy, like I was slightly out of my body and just barely being held down by gravity. When I tried to find a doorway out, everything looked bright and blurry and I found myself walking hurriedly and wildly through an endless and dizzying maze of colorfully-dressed, slow moving people. I started running panicked out of grocery stores, restaurants, and even the baseball card shop where I used to hang out on Saturdays. I felt especially trapped and helpless in moving automobiles. Almost every situation threatened me, stimulating a strong impulse to flee. I didn’t know what to do or where to turn for help, so I got into the habit of retreating home where it felt safer.

I had learned to fear the panic itself. The dreadful anticipation of the next panic attack left me forever uneasy. Though I spent long days at home, sometimes I couldn’t even get comfortable there. The television flashed pictures of public places and scenes before my widened pupils. The stories of shootings in the newspaper left me fearful and ill. Video games became too violent and the rock music I once loved became an intolerable assault on my senses. Even small amounts of sensory stimulation overwhelmed me, throwing me into violent panic attacks.

I woke up tense and nauseous every morning, and I went to sleep each night only after endless pacing around the house, worrying. I kept worrying that my heart would stop. I kept worrying that my lungs would collapse. I even worried that my skeletal system would fall apart, or that my muscles would all freeze. In short, I had no faith that my body would keep itself alive and constantly checked my heartbeat, pulse, and respiration.

My world at home kept narrowing. Every day I surrendered ground. Each panic attack and each terrifying sensation would leave me afraid of one more chair, one more corner, one more lamp stand, or one more room. The fear eventually backed me into my bedroom where I learned to spend long hours alone in quiet darkness, lying prone, and wrapped safely in bed sheets.

At the point of utter defeat, I admitted that the doctors might be right and I finally went to see a psychologist. As you might suspect, I was diagnosed with Panic Disorder with Agoraphobia.

Monday, May 08, 2006

No Overnight Cure for Agoraphobia

If you are looking for a way to recover from Agoraphobia, don't be fooled by all of the ads on the internet that promise an overnight, never-before-heard-of cure if you'll just buy a series of books or CDs for anywhere from 50 to 500 dollars.

Believe it or not, we live in a world where opportunists will try to take advantage of suffering and desperate people who would do anything to get better. I know that when I had agoraphobia, it was so awful that I desperately sought an answer to my problems and would have done anything to recover. But I will tell you this from personal experience - you will save a lot of time in your recovery (and money) if you do not let yourself fall for ads for "quick fixes."

Think about it:

If there were a miracle, sure-fire, quick cure for agoraphobia wouldn't psychologists and mental health professionals everywhere be using it?

The best thing to do if you have agoraphobia is to get informed and then seek professional help if you need it. You can get informed by reading credible books and research articles on the subject - which I am working hard to try to summarize for you on the Agoraphobia Resource Center Web site.

From one agoraphobic to another - don't get taken advantage of by people selling the "quick fixes."

Get real information and qualified professional help if you need it.

Saturday, May 06, 2006

Why You Think You Recovered From Agoraphobia Really Matters

I was up late last night reading some research that's been done on agoraphobia and came across a study with some information I had never considered before:

Why you think you recovered from agoraphobia really matters.

That's right, even if you are just improving toward recovery, it really matters what you attribute your improvement to.

Research was conducted at the Institute of Psychiatry in Denmark Hill, London, involving people with agoraphobia who improved using a combination of Xanax and psychotherapy (either relaxation or exposure). The ones that relapsed were the ones that credited Xanax for their improvement.

The people who credited themselves, and their hard work in therapy, for improvement were the ones who were least likely to relapse.

The moral of the story is - don't give Xanax or any other medication too much credit. Also, don't rely on medication too much in your recovery. Use it when you are practicing exposure or during particularly tough times, but always keep in mind that drugs quit working when you quit taking them.

Its the hard work you put in toward your recovery that can lead to real improvement that lasts a lifetime.

Check out the study and get the details in the articles section on the Agoraphobia Resource Center website. The article is called "Why You Think You Recovered From Agoraphobia Really Matters."

Friday, May 05, 2006

What in the world is agoraphobia?

Most people have heard of most phobias. Mention claustrophobia, social phobia, or arachnophobia and everyone pretty much knows what you are talking about. Mention agoraphobia, and most people will just shake their heads.

Because of this, many people who get agoraphobia often take a year, and in some cases, many years, just finding out what is wrong with them. Since the panic and anxiety symptoms that come with agoraphobia are so physical, people who get agoraphobia commonly visit a succession of doctors trying in search of a diagnosis. Since medical doctors are not usually trained to diagnose agoraphobia, let alone anxiety disorders, agoraphobia has had time to become deeply rooted in most people before they know enough about the disorder to seek the proper treatment and being recovery.

In light of this, here are some basics about agoraphobia:

Agoraphobia is "anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a panic attack or panic-like symptoms.” (DSM-IV)

Agoraphobia is a type of anxiety disorder. The term “agoraphobia” comes from the Greek words “agora”, meaning “marketplace,” and “phobia”, meaning “fear.” Literally translated as “fear of the marketplace,” people with agoraphobia are afraid of open or public spaces.

In reality, most people with agoraphobia are not so much afraid of open and public places as they are afraid of having a panic attack in these settings, especially settings in which there may be no one to help in the case of a panic attack or actual emergency.

The most common symptoms of agoraphobia are:

1) Panic Attacks: Periods of intense fear, usually lasting about ten minutes or so (but sometimes longer).

2) Avoidance Behavior: Avoiding places and situations that are hard to escape from or that might be embarrassing to have to suddenly leave. Most commonly, this is because they fear having a panic attack or unexpected catastrophe and not being able to get help or get away.

3) Developing "Safe" People: People with whom the agoraphobic is highly familiar with and feels emotionally close to. “Safe” people are usually parents, spouses, children, or close friends and relatives.

4) Developing "Safe" Places: Places in which the agoraphobic feels psychologically comfortable. The most common safe place for someone with agoraphobia is his or her own home.

5) Scanning: Obsessive monitoring of one's own body for strange or unusual symptoms.

6) Fear of being alone: This is related to the fear of having no one to help in the case of a panic attack or real emergency.

If you suspect that you or someone you know might have agoraphobia, don’t waste any time in learning about the disorder. Research has shown that the sooner you start the recovery process the more likely your chances of a successful recovery are.

You can learn more about agoraphobia online at the Agoraphobia Resource Center website. The site was started by a recovered agoraphobic with the intention of helping others learn about and recover from agoraphobia. The link to the Agoraphobia Resource Center Website can be found on the sidebar of this blog.

Tuesday, May 02, 2006

What You Need to Know About Xanax

A review of the literature in Germany showed Xanax to be the most effective benzodiazepine (or anti-anxiety agent) for panic disorder with agoraphobia (Bandelow, 1999). In other words, there were more controlled studies with positive results for Xanax published than other anti-anxiety agents.

Because it has been proven effective in studies since it was approved by the United States Food and Drug Administration in 1981, I thought I would write a little about Xanax, what it is and how to use it right so it will help you and not hurt you.

First of all, what is Xanax?

Xanax (Alprazolam) is a benzodiazepine, or anti-anxiety agent, prescribed mainly for temporary relief of mild to moderate anxiety, nervousness, or tension associated with anxiety disorders. It has also been used effectively for panic attacks. In some cases, it has been used to treat stress-related illnesses such as irritable bowel syndrome (IBS).

Xanax comes in two forms - Xanax and Xanax XR. What's the difference? Xanax XR is just the extended release version of the original Xanax which, if you are taking Xanax daily, lets you just take one dose per day rather than three or four.

What's the best way to use Xanax for panic disorder with agoraphobia?

Since Xanax, like most anti-anxiety agents, causes the body to develop tolerance and can be addictive, the best way to use it for panic disorder with agoraphobia is to keep it in your pocket and take it only as needed to get through rough spots, times of unusually high anxiety, or when you are practicing desensitization or exposure therapy.

It's important to remember that no pill will cure agoraphobia. Not even Xanax. Pills only work as long as you are taking them. That's why Xanax is best used as part of a larger recovery plan for agoraphobia that includes a long-term solution like psychotherapy.

So how fast does Xanax work?
Xanax offers pretty quick relief for most some anxiety patients. In healthy adults, it may take an hour or two to take effect.

Is there anything you shouldn't eat or drink when taking Xanax?
Yes. Tell your doctor about any other medications you are taking so he or she can make sure you won't experience a bad interaction. Also, you shouldn't mix alcohol with Xanax or any other benzodiazepine because it amplifies the effects.

Can you take Xanax if you are pregnant or nursing?
It's not recommended. You should definitely not tak Xanax in the first twelve weeks of pregnancy under any circumstances.

How will Xanax effect your daily routine?
It may make you really drowsy, so don't be driving or operating dangerous machinery on Xanax until you test it out and see how it effects you.

If you feel Xanax stops working, should you just take more?
Never. under no circumstances should you increase your dose without talking to your doctor, even if you think it's not working and you need more. This is because even when used as recommended, Xanax can cause emotional and/or physical dependence. In other words, you can get extremely addicted to it.

Can you just stop taking Xanax if it's not working?
No again. It is not safe to just stop taking Xanax cold turkey. Do not even decrease your dose without talking to your doctor. If you stop taking Xanax or decrease your dose too abruptly you are likely to experience serious withdrawal symptoms. Many of the withdrawal symptoms are similar to the panic and anxiety you probably started taking Xanax for in the first place. In the worst case, you can have a seizure if you try to stop taking Xanax too suddenly.

What about side effects?
If you are going to have side effects from Xanax, you will probably have them right when you start taking it. In many cases, initial side effects subside if you keep taking it. Most common side effects are drowsiness, fatigue, impaired coordination, irritability, light-headedness, memory impairment, insomnia, and headache.

Hopefully after reading this, you can use Xanax to help you and not hurt you if you have panic disorder with agoraphobia.