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When Panic Attacks

Random House

Chapter One

Chapter 1

I Think, Therefore I Fear

Practically everybody knows what it's like to feel anxious, worried, nervous, afraid, uptight, or panicky. Often anxiety is just a nuisance, but sometimes it can cripple you and prevent you from doing what you really want with your life. But I have some great news for you: You can change the way you feel.

Powerful new, drug-free treatments have been developed for depression and for every conceivable type of anxiety, such as chronic worrying, shyness, public speaking anxiety, test anxiety, phobias, and panic attacks. The goal of the treatment is not just partial improvement but full recovery. I want you to be able to wake up in the morning free of fears and eager to meet the day, telling yourself it's great to be alive.

Anxiety comes in many different forms. See if you can recognize yourself in any of these patterns.

• Chronic Worrying. You constantly worry about your family, health,
career, or finances. Your stomach churns, and it seems as if something bad is about to happen, but you can't figure out exactly what the problem is.

• Fears and Phobias. You may be afraid of needles, blood, heights, elevators, driving, flying, water, spiders, snakes, dogs, storms, bridges, or getting trapped in closedspaces.

• Performance Anxiety. You freeze up whenever you have to take a test, perform in front of other people, or compete in an athletic event.

• Public Speaking Anxiety. You get nervous whenever you have to talk in front of a group because you tell yourself, "I'll tremble and everyone will see how nervous I am. My mind will go blank and I'll make a complete fool of myself. Everyone will look down on me and think I'm a total neurotic."
• Shyness. You feel nervous and self-conscious at social gatherings because you tell yourself, "Everyone seems so charming and relaxed. But I don't have anything interesting to say. They can probably tell how shy and awkward I feel. They must think I'm some kind of weirdo or loser. I'm the only one who feels this way. What's wrong with me?"

• Panic Attacks. You experience sudden, terrifying panic attacks that seem to come from out of the blue and strike unexpectedly, like lightning. During each attack, you feel dizzy, your heart pounds, and your fingers tingle. You may tell yourself, "I must be having a heart attack. What if I pass out or die? I can't breathe right! What if I suffocate?" You try to hang on for dear life. Before long, the feelings of panic disappear as mysteriously as they came, leaving you bewildered, frightened, and humiliated. You wonder what happened and when it's going to strike again.

• Agoraphobia. You're afraid of being away from home alone because you think something terrible will happen-perhaps you'll have a panic attack-and there won't be anyone to help you. You may fear open spaces, bridges, crowds, standing in line at the grocery store, or taking public transportation.

• Obsessions and Compulsions. You're plagued by obsessive thoughts that you can't shake from your mind, and compulsive urges to perform superstitious rituals to control your fears. For example, you may be consumed by the fear of germs and have the irresistible urge to wash your hands over and over all day long. Or you may get up and check the stove repeatedly after you've gone to bed, just to make sure you didn't leave the burners on.

• Post-Traumatic Stress Disorder. You're haunted by memories or flashbacks of a horrific event that happened months or even years ago, such as rape, abuse, torture, or murder.

• Concerns about Your Appearance (Body Dysmorphic Disorder). You're consumed by the feeling that there's something grotesque or abnormal about your appearance, even though your friends and family reassure you that you look just fine. You may think that your nose is deformed, your hair is thinning, or your body isn't shaped correctly. You may spend vast amounts of time consulting with plastic surgeons or staring into mirrors trying to correct the defect because you're so convinced that everyone can see how terrible you look.

• Worries about Your Health (Hypochondriasis). You go from doctor to doctor complaining of aches, pains, fatigue, dizziness, or other symptoms. You feel certain that you have some dreadful disease, but the doctor always reassures you that there's absolutely nothing wrong with you. You feel relieved for a few days, but soon you start obsessing about your health again.

If you're plagued by any of these fears, I have a question for you: What would it be worth to you if I could show you how to overcome them? Imagine, for a moment, that you had to give a talk or take an important test tomorrow, and you could go to bed tonight without that knot in your stomach, feeling confident and relaxed.

If you're lonely and struggling with shyness, what would it be worth to you to feel relaxed and spontaneous around other people so you could easily engage anyone, anywhere, in a rewarding conversation? And if you're suffering from phobias, panic attacks, or obsessions and compulsions, what would it be worth to you if I could show you how to defeat these fears for good?

These goals may seem impossible, especially if you've been struggling with anxiety or depression for years, but I'm convinced that you can defeat your fears without pills or lengthy therapy. That may not be the message that you're used to hearing. If you go to your doctor, she or he may tell you that you've got a chemical imbalance in your brain and that you'll have to take a pill to correct it. Yet the latest research confirms what my clinical experience has taught me over the years: You can defeat your fears without drugs.(1) All you'll need is a little courage, your own common sense, and the techniques in this book.

There are many theories about the causes of anxiety, but we'll focus on four of them:

• The Cognitive Model is based on the idea that negative thoughts cause anxiety. "Cognition" is simply a fancy word for a thought. Every time you feel anxious or afraid, it's because you're telling yourself that something terrible is about to happen. For example, if you have a fear of flying and the plane runs into turbulence, you may panic because you think, "This plane is about to crash!" Then you imagine passengers screaming as the plane crashes toward the earth in a ball of flames. Your fear does not result from the turbulence but from the negative messages you give yourself. When you change the way you think, you can change the way you feel.

• The Exposure Model is based on the idea that avoidance is the cause of all anxiety. In other words, you feel anxious because you're avoiding the thing you fear. If you're afraid of heights, you probably avoid ladders, high mountain trails, or glass elevators. If you feel shy, you probably avoid people. According to this theory, the moment you stop running and confront the monster you fear the most, you'll defeat your fears. It's like telling a bully "Take your best shot. I'm not running away from you any longer!"

• The Hidden Emotion Model is based on the idea that niceness is the cause of all anxiety. People who are prone to anxiety are nearly always people-pleasers who fear conflict and negative feelings like anger. When you feel upset, you sweep your problems under the rug because you don't want to upset anyone. You do this so quickly and automatically that you're not even aware you're doing it. Then your negative feelings resurface in disguised form, as anxiety, worries, fears, or feelings of panic. When you expose the hidden feelings and solve the problem that's bugging you, often your anxiety will disappear.

• The Biological Model is based on the idea that anxiety and depression result from a chemical imbalance in the brain and that you'll have to take a pill to correct it. Two types of medications are generally recommended: the minor tranquilizers, such as Xanax, Ativan, and Valium, and the antidepressants, such as Prozac, Paxil, and Zoloft. Your doctor may tell you that these medications represent the only truly effective treatment for depression and anxiety and that you'll need to keep taking them for the rest of your life, in much the same way that individuals suffering from diabetes will have to take insulin shots forever to regulate their blood sugar.

So we have four radically different theories about the causes and cures for anxiety. Which theory is correct? According to the Cognitive Model, you'll have to change the way you think. According to the Exposure Model, you'll have to stop running and confront your fears. According to the Hidden Emotion Model, you'll have to express your feelings. And according to the Biological Model, you'll have to take a pill.

All four theories have their advocates. I believe that the first three theories are correct, and I use Cognitive Techniques, Exposure Techniques, and the Hidden Emotion Technique with every anxious person I treat. The Biological Model is much more controversial. Although I began my career as a full-time psychopharmacologist and treated all my patients with drugs, I strongly prefer the new, drug-free treatment methods for anxiety and depression. In my experience, they're far more effective, they work much faster, and they're also superior in the long run because you'll have the tools you need to overcome painful mood swings for the rest of your life.

However, it's not an either/or type of situation. If you and your doctor feel that medications are necessary, or if you strongly prefer to be treated with an antidepressant, you can use a combination of drugs plus psychotherapy. But for the millions of people who haven't been cured by pills, as well as those who strongly prefer to be treated without them, the development of these new, drug-free methods should be good news. Let's see how they work.

The Cognitive Model

The Cognitive Model is based on three simple ideas:

1. You feel the way you think.

2. When you're anxious, you're fooling yourself. Anxiety results from distorted, illogical thoughts. It's a mental con.

3. When you change the way you think, you can change the way you feel.

The French philosopher Descartes once said, "I think, therefore I am." The techniques in this book are based on a slightly different idea: "I think, therefore I fear." In other words, anxiety results from your thoughts, or cognitions.

For example, you're probably having thoughts about what you're reading at this very moment. You could be thinking "This is just another stupid self-help book. What a rip-off!" If so, you're probably feeling disappointed, frustrated, or even annoyed.

Or you might be thinking, "This book couldn't possibly help me. My problems are way too severe." If so, you're probably feeling discouraged and hopeless. Or you might be thinking "Hey, this looks interesting, and it makes sense. Maybe it could help me." If so, you're probably feeling excited and curious.

In each case, the situation is exactly the same. Every reader is reading the same thing. Your feelings about what you're reading will result entirely from the way you're thinking, not from the words on the page.

We constantly interpret what's happening, but we're not aware that we're doing this because it's automatic. The thoughts just flow across our minds, but they have the power to create strong positive and negative emotions.

Cognitive Therapy* is based on the idea that each type of thought, or cognition, creates a certain kind of feeling. Dr. Aaron Beck, from the University of Pennsylvania School of Medicine, has called this the Theory of Cognitive Specificity. For example, if you feel sad or depressed, you're probably telling yourself that you've lost someone you love or something important to your sense of self-esteem. If you feel guilty or ashamed, you're telling yourself that you're bad or that you've violated your own personal values. If you feel hopeless, you're telling yourself that things will never change. And if you feel angry, you're telling yourself that someone is treating you unfairly or trying to take advantage of you. You may also be telling yourself that the other person is a self-centered jerk.

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Excerpted from When Panic Attacks by David D. Burns, M.D. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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