Recovery from Anxiety and Panic

“I was just sitting on the bus when, out of the blue – my heart was pounding, and I
couldn’t catch my breath. Everything around me suddenly looked weird. For a year now,
getting through a simple day can be a nightmare.”

“I’m afraid something terrible will happen to my kid – every time she leaves the house, I’m
on edge till she comes home safe. It’s crazy I know ... I can’t seem to shake it.”

“I obsess a lot about what other people think of me – ok, of what I’m afraid they think …
and so I just freeze up when I’m face to face…

“I can’t stop worrying … I have so many problems to think about that I can’t sleep …but I can’t seem to solve them, either…”

Anxiety, and Anxiety Therapy

I am an anxious person. I come by it honestly, as we all do.

Often, patterns of experience early in life force us to respond with anxiety, and our nervous systems become organized around anxious responses. I ought to know. By age seven – through meticulous study of my parents’ Merck Manual – I’d become the best-informed hypochondriac on the block, and learned never to be reassured by parents, pediatricians, or statistics.

Despite this head-start as a world-class worrier, I have developed a working relationship with anxieties. They are no longer my enemies; I understand that this part of my mind is just trying to keep me safe – with a child’s logic. And I’m able to bring my self-at-best on board to quiet them. I’m pretty good at helping other people do the same.

What Is Anxiety, Anyway?

We humans have a handful of powerful core emotions – our evolutionary endowment, each with a vital reason for being:

Joy

Fear

Sadness

Anger

Disgust

Surprise

Whether vivid or muted, these primary emotions organize our moment-to-moment experience, orient us to the world, and draw our attention to what’s really important: what to reach for, and what to beware. Without them, we’re lost.

Anxiety is related to Fear. Humans are wired to anticipate problems and protect themselves; we have evolved to do this, and we are very, very good at it. When all is going well, anxiety’s threat-detection system runs quietly in the background of our nervous systems, continuously scanning for threats worthy of bodily Fear.

Ping! Threat detected!

Within a second, our bodies are prepared to fight, to flee, or to go completely limp in a predator’s jaws. The feelings of fight, flee, or freeze are very powerful indeed: jumpy legs, shakiness, rapid heartbeat, rapid breathing … or nausea, dizziness, weakness, faintness. When we’re not running from a saber-toothed hippo – just sitting on a bus, drenched in sweat – they are extremely unpleasant. We label these changes in our bodies “the symptoms of anxiety.” Then we label them “horrible”. Then we begin to fear them. This brings a second tier of anxiety.

This dynamic system works beautifully in the face of an objective, external threat; it was designed for a world filled with saber-toothed hippos. During war or disaster, this system saves lives. But in less physically dangerous environments, it finds its primordial power repurposed. It is activated by emotional threats below the surface of awareness, especially threat of loss: loss of relationship and connection, loss of security, or rejection. Sometimes, a sequence of such experiences early in life makes us more alert to potential threats as we grow. Emotional threats are more difficult for our ancient nervous system to evaluate than toothy, growling ones.

We feel anxiety in the body before the mind can know what it’s about: feeling is faster than thought. When the mind tries to catch up and define the threat, it makes errors. Errors that cause us to believe that what we’re afraid of are bus rides, leaving the house, coworkers, public speaking, and all the things we “worry about.” Whereas … the feared thing is often something just outside our awareness. Focused on a “false positive,” our threat system has no clear signal to shut off the alarm. So the alarm goes on and on. Day in, day out, this becomes unbearable. Even more unbearable is the sense of being all alone inside it.

The good news: You’re not alone, you’re only human. Anxiety is treatable. Anxiety treatment begins with understanding what anxiety is. You’re already on the right path.

Anxiety Therapy: Working Together

Social Anxiety, Generalized Anxiety, Obsessive Compulsive Disorder, Panic Disorder … “anxiety disorders” look so different from one another. They are all different strategies for responding to that “something” that our anticipatory defense system has defined as a threat. Our reflexive response is to escape or avoid. But beneath the obvious “something we need to avoid,” is often something else: a feeling, disavowed, just outside our awareness. And we develop a pattern of turning away from this feeling – a feeling rooted in the implicit memory of an experience.

What my treatments have in common is the motto: “Gently turn toward, rather than away…” Gently turn toward, rather than away … from the anxiety that’s arising, and the feeling underneath. By doing so, bit by bit, step by step, you develop and expand the capacity to experience the feelings you misinterpret and fear. The surprise: feeling the feelings you’ve learned to fear actually feels … good! Patients are often surprised to find that they are able to have inspiring moments of courage even in the first session – by connecting to important feelings that they have ignored.

Anxiety therapy often involves some coaching in anxiety regulation skills that help you to “turn toward, rather than away,” coping with symptoms as they arise. These skills use the mind-body connection to reconnect you with yourself, and can help ease some of the more distressing physiological symptoms in a fairly short period of time, often without need for medication.

Mindfulness. Gently “turning toward, rather than away” is a challenge; here, mindfulness-based techniques provide powerful, graceful support to the nervous system. Mindfulness is a spiritual practice; used clinically with counseling for anxiety, it’s also a mind-skill, a potential source of wisdom about the self that can serve you for life. Mindfulness increases your capacity to stay with your experience, focus, and get “unstuck”; it allows you to observe and feel what you’re feeling without becoming engulfed by it. You get a “working distance” from your discomfort. And … it’s no longer so uncomfortable.

Grounding. Extreme anxiety can be very disorienting; it can trigger weird perceptual changes and a sense of unreality. And we may ask ourselves: “Am I going crazy?”

99.9 percent of the time: No. You are just extremely anxious. When we get that crazy feeling, grounding techniques come to the rescue, settling us squarely in the real sensations of right-here-right now.

Questions? Fire away! Skeptics especially welcome.

But what about cognitive behavioral therapy? I thought that was the gold standard.

I did, too, for many years. Aspects of CBT – cognitive restructuring, Socratic questioning, and (most important) graded exposure to the things you fear – are still important in my work. My concern about CBT is that change does not become internalized. It is a nicely-engineered band-aid that – for very many people – eventually falls off, usually in response to a previously undetected trigger or stressor. Deep down, you really haven’t changed your schema. CBT techniques may indeed form a part of treatment – but are not the treatment in themselves.

I’m having a lot of trouble leaving my home – I have agoraphobia.

This is something very important to explore before you come in. If your agoraphobia is fully hermetic at the moment, part of our graduated exposure strategy can involve a target … helping you get into my office. This can be accomplished by a short-term series of HIPAA-compliant video sessions.

When I’m anxious, I can’t stop sighing and gulping air … I always feel short of breath. Can you give me tools to deal with this?

Yes! Anxiety – especially panic – alters breathing patterns. As anxiety is meant to mobilize us for physical survival, the shift is often dramatic – since we are not running from a saber-toothed hippo, we will overbreathe. Overbreathing leads to amplified anxiety symptoms: light-headedness, the sensation that we are out of breath, tingling sensations in hands and face. Breath retraining is quite easy, and can produce dramatic expansion of your comfort zone.

New York is stressing me to the breaking point. You can’t change this environment.

I get it! With its crowds, constant noise, and 24/7 information overload, New York is a matrix of triggers, a laboratory for our anxieties. Here, we’re surrounded with things we can’t control. Understanding your triggers, and the feelings they trigger, is the road to riding the waves of stimuli – surfing, rather than washing out.

What about medication?

How we approach the first few sessions will depend on the severity of your anxiety; if your symptoms are severe, I may recommend your consulting with a psychopharmacologist. Medication is always an option to consider; however, I find it’s often possible to work successfully without it.

This page gives a pretty reliable sense of me – how I think, how I work, and even how I sound. If it resonates with you, so may my approach.

Any questions? Just call or email — you can contact me here. I provide a free consultation by phone or HIPAA-secure video platform.