Anxiety, Panic Attacks and allied Depression
Many survivors of abuse find that especially in the early days
after leaving an abusive relationship they suffer from increased
anxiety, depression and sometimes also panic attacks. The combination
of depression and anxiety really can be quite overwhelming and frightening,
and especially if we don’t understand what is happening with
us and our bodies, we can feel as though we are going crazy or may
fear that we are somehow physically ill.
Anxiety is something we are all familiar with
and which everyone experiences at some point in their lives. We
might be anxious about a friend or family member who is ill and
needs an operation, or anxious about an exam or driving test. Generally
anxiety is the body’s response to a potentially threatening
situation, it is like a forewarning or alarm system in which the
mind at an often subconscious level recognises potential danger
or need for action and prepares the body accordingly, pumping oxygen
into the bloodstream and heightening our senses. Anxiety becomes
a problem when it is inappropriate, ie when there is nothing to
be frightened of. We all have an anxiety threshold and it is when
this threshold is much lower than appropriate that anxiety becomes
a debilitating and frustrating problem – we feel frightened
and uptight all the time or much of the time even when there is
no outward obvious reason for it.
A panic attack is a result of anxiety, but anxiety
doesn’t have to result in a panic attack. Panic in itself
is a normal physical response to danger, like the ‘fight or
flight’ response, and as such can serve a useful purpose,
eg if we are crossing a busy road and see a car coming at us at
speed we ‘panic’ and run. That is a normal healthy response
and once the danger is over, the panic subsides. The problem with
panic attacks is that they can be unrelated to the reality of what
is happening to us at that moment in time, and as such is often
described as a fear of fear itself, rather than an appropriate response
to imminent danger. We could have a panic attack in the middle of
shopping or dropping a child off at school, and such panic attacks
become debilitating as we can then develop anxiety around doing
normal things, the additional anxiety over possibly having an panic
attack stresses our body further and the risk of actually having
a panic attack increases.
Sometimes a panic attack can be triggered by events, noises, sights,
smells or thought of previous trauma, and we react with panic as
though we were still faced with the danger as it was at the time.
The symptoms of a panic attack are:
- fast, pounding heartbeat
- difficulty catching your breath
- chest pain
- flushing and sweating
- feeling sick
- trembling
- dizziness
- dry mouth
- needing to go to the toilet
- feeling faint
some people also experience a remote sensation, as though they
were apart from their body and observing themselves, which while
it may sound ‘better’ in some ways, actually is worse
for those experiencing it.
Depression is often allied to anxiety. It is
perfectly possible to feel depressed without being overly anxious
or having panic attacks, but if we do suffer from anxiety and panic
attacks, the likelihood is that we will feel depressed.
The good news is that it will not last indefinitely, and that
there are things you can do to help yourself overcome it sooner
rather than later. You are not going mad, and the nightmare will
end and some day be just one of those memories. Lots of survivors
of abuse and other trauma suffer from depression, anxiety and panic
attacks, and we do live through it and enjoy life again the other
side.
Below you will find several self-help ways of dealing with the
anxiety and panic and depression, which many survivors have found
helpful in alleviating their anxiety and panic attacks, though sometimes
it is necessary to seek professional help from the doctor. The list
is not exclusive but contains suggestions which are fairly easy
to implement, are not too expensive and can be done by ourselves
from our own home. These suggestions are NOT intended to
replace professional advice and resources!
If you feel
overwhelmed by the anxiety and as though you cannot cope or carry
on, if you have urges to harm yourself (e.g. cutting yourself,
starving yourself or making yourself sick after eating etc) or
feel suicidal, please, please, please go and see your doctor.
He/she may prescribe anti-depressants for you, which can help
you short-term to just give yourself a break from feeling so awful
and gain a little more emotional strength and balance, so that
you are then in a better position mentally and emotionally to
help yourself long-term or benefit from outside help if available.
Now for some of the ways of helping yourself to get through this
rough patch.
Coping with panic attacks
Learn some basic breathing techniques to help avoid and cope
with the panic attacks and reduce anxiety.
When we are having a panic attack we hyperventilate (rapid breathing
or over-breathing), the result of this is that we blow out too
much carbon dioxide, which in turn means that it increases the
acidity of the blood (which can cause confusion, dizziness, pins
and needles etc) and increases the percentage of oxygen in the
blood, which in turn means our heart has to work harder, causing
the racing heart you describe. All that lot makes us feel even
more panicky and so it gets worse! Learning how to regulate our
breathing helps to break the cycle, so that we not only have a
way of coping with a panic attack when it happens, but we can
also learn how to recognise when we are getting more anxious and
can even prevent an attack. Practising breathing techniques regularly
means it is easier for us to use them when we need them.
If you are having a panic attack:
-
try to breathe slowly and deeply, making sure you are inhaling
and exhaling for a long time, if possible, exhale for slightly
longer than you inhale. Some people find that inhaling through
the nose and exhaling through a slightly open mouth (as though
you were cooling down a cuppa!) helps.
-
breathe into a paper bag if you have one handy, this means
you are re-inhaling your own carbon dioxide which helps to
redress the balance between carbon dioxide and oxygen in your
blood
-
if you don't have a paper bag handy, try cupping your hands
over your mouth and nose instead :)
Breathing to calm
Breathing exercise to generally calm yourself down when you are
feeling anxious:
- If possible, sit upright with the crown
of the head uppermost, though you can do this in any position
if needed. Close your eyes or keep them open. Relax your jaw.
- Inhale through your nose, as slowly, smoothly
and deeply as you possibly can.
- Exhale through your nose as slowly, smoothly
and completely as you can, focusing attention on your abdomen,
near your navel.
- Before inhaling again, mentally count ‘one
thousand’, ‘two thousand’.
- Keep repeating the inhaling and exhaling,
until your breathing rate has become slower and you feel calm.
Slowing down breathing rate
Breathing exercise to slow down your breathing rate and thereby
become more aware of your breathing:
-
First, time your breathing rate by counting on your fingers
each time you breathe in and out for a minute.
-
After a short rest, do the following breathing exercise
for five minutes:
As you breath in through your nose say to yourself: "IN
TWO THREE"
As you breath out through your nose say to yourself: "RELAX
TWO THREE"
-
After another short rest, count your breathing rate again.
Practise this at least once a day and you will find yourself
more aware of your breathing and better able to voluntarily slow
it down.
The Pranayama
The Pranayama or deep breathing exercise is a breathing exercise/technique
which is generally beneficial for us physically and mentally -
supposedly (!) and I must confess that I have found it somehow
makes me feel better in myself, though it is quite difficult at
first and I don't understand why it should make any difference!
Try starting with maybe a minute and build up slowly from there:
-
Sit upright with your legs folded, either on your bed
or on the ground. Keep your hands relaxed on your lap.
-
Take in a deep breath very slowly.
-
As you intake air pull your belly inwards while heaving
out your chest. Your stomach muscles must be taut.
-
Hold the breath and count five.
-
Then gradually exhale and relax your abdominal muscle.
-
Wait for two seconds and then repeat the whole exercise.
After you master this technique of deep breathing, you should
also try breathing alternating between the left and right nostrils.
-
Block the nostrils alternately using the thumb and the
little finger of the right hand, while the remaining three
fingers should rest gently between the eyebrows.
-
First, breathe in deep through the right nostril and breathe
out through the left. Very slowly. Make sure that your stomach
muscles are flexed considerably.
-
Then change the process - breathe in through the left
and out through the right.
-
Repeat the whole procedure for sometime, aiming toward
10 minutes eventually.
Become more aware of your Self in the present
A lot of our anxiety, stress and depression is allied to the
past or the future, our regrets and experiences in the past keep
replaying in our mind as though we were still in those situations
which were traumatic and influence our expectation and vision
of the future, filling us with dread rather than energy, and effectively
robbing us of the now, the present. We need to remind ourselves
that we are living in the now, not the past or the future. We
also have a tendency of always being busy, doing things, keeping
ourselves occupied and forgetting that we are human 'beings',
not human 'doings'! This constant busy-ness of mind and body robs
us of the peace we can find in ourselves and in getting in tune
with our spiritual self or Higher Power/God - we tend to neglect
our spiritual needs and practising peace/serenity/oneness and
being comfortable in and with our own Selves is an aspect which
many survivors have found to be one of the most vital aspects
of their recovery. This might sound very heavy, especially if
you have never thought much about your spiritual life, or even
worse, have had experience of spiritual abuse/rigidity. It needn't
be frightening and many of us have found it to be freeing. Here
are a few ways in which you can get in touch with your spiritual
self and/or your Higher Power:
The Exercise in being Oneself
... is designed to be just that, an exercise which only takes
a few minutes and can be repeated as often as you like which will
help you find peace within yourself:
First, let the mind be free of any concern
or preoccupation...
Let the mind fall still and come to rest within...
Be aware of where you are...
Feel the touch of your feet on the ground or floor...
The weight of the body on the chair...
Feel the touch of the clothes on the skin...
And the play of air on the face and hands...
If they are open, let the eyes receive colour and form without
any comment...
Taste...
Smell...
Be fully here...
Now be aware of hearing...
Let sounds be received and let them rise and fall without comment
or judgement of any kind...
With the body completely relaxed, let the hearing run right
out to the furtherest and gentlest sounds, embracing all.
Simply rest in this great awareness for a few moments.
You will find that if you repeat this exercise at least twice
a day, you will feel generally more peaceful within yourself after
a few weeks. You might also find that it is very difficult to
begin with - we are so used to filling our mind with all sorts
of things all the time, that we don't even notice how crowded
it is!
Re-discover nature and your creativity
A walk in the countryside or by the sea can really help us put
things into perspective. Try to notice not only the general landscape,
but all the little wonders - spring is wonderful for that ...
the buds on the trees and bushes, snowflakes and daisies coming
out, the grass turning greener ... as in the exercise above, try
to clear your mind of your troubles and anxieties and just be
aware of the colours and sights and textures around you, the smells
of grass, mud or sea and sand, the feel of wind or rain or sun
on your skin, the feel of the ground underneath you. If you don't
feel safe or comfortable going for a walk by yourself (e.g. in
case of a panic attack) ask a friend to go with you, but try not
to fill the time with talk, but enjoy the peace together.
If you have some spare time, or time that you would usually
spend worrying or thinking negatively, try instead to explore
your creativity. Maybe you used to play an instrument, or draw
or paint or do pottery? If you have never really done anything
like that, why not give it a try? It is so easy to get so caught
up in things which have happened and our thoughts and feelings,
that we don't give ourselves time to just do something because
it is fun or because we enjoy it - we might even find that we
feel guilty for doing something for ourselves. Art and music and
other creative activities give us something for ourselves to concentrate
on, something to take our mind off our worries, fears or negative
thoughts (it is difficult feeling depressed when trying to read
music!) and quite a few of us have found that having a creative
outlet for our feelings and emotions has also been therapeutic,
i.e. we have been able to express in our drawings or our music
what we have been unable to express consciously in words.
Self-Talk, Self-Hypnosis and Relaxation
Techniques
Okay, don't panic! It is not complicated and not heavy!
Self-Talk and Affirmations
One of the observations made by many survivors is that they
have a lot of negative thoughts ... this is a normal part of both
depression and anxiety. A lot of people are not aware of their
own negative thinking, they sort of think negatively and feel
bad about themselves, but don't really realise what they are doing.
Negative thinking is basically self-talk, but the negative kind,
and we tend to believe what we tell ourselves, so if I look in
the mirror each morning and think 'I am ugly' then I will believe
I am ugly, if I tell myself over and over again each time I feel
anxious or nervous that I am a failure, I will believe that I
am a failure, no good, can never be successful or happy. Apparently
about 70% of our self-talk is negative - which sort of explains
why there are so many depressed people around with poor self-image
and self-esteem ... but the important thing for us to realise
is that we can change the way we think and talk to ourselves,
and that will have a direct influence on the way that we perceive
ourselves and the way that we feel. The way to do that is by consciously
replacing the negative self-talk with positive self-talk, for
instance by using affirmations.
Okay, so what does an affirmation look like and how do I use
it?
-
Affirmations are short positive messages for ourselves designed
to replace the negative messages we have often carried with
us from childhood - this is because our mind cannot hold two
opposing thoughts or beliefs at the same time, e.g. I cannot
believe 'I am ugly' and at the same time believe 'I
am beautiful'. Try it: lie or sit down and lock the thought
in your mind that your leg is too heavy for you to lift, repeat
it to yourself or out loud over and over again, now hold that
thought in your mind and at the same time try to lift your
leg ... you can't do it, because your mind cannot believe
your leg is too heavy to lift and at the same time believe
you can lift your leg.
-
Affirmations work best when they affirm the positive rather
than denying the negative (e.g. "I am confident"
will work better than "I am not nervous") - this
is because again our mind tends to lock onto words and if
we use the word 'nervous' then our mind will lock onto that
word and sort of ignore the 'not' bit, i.e. we cannot use
a word without thinking of the word and allowing it to enter
our subconscious. If, for instance, I say to you "don't
think of a DOG", what happens? An image of a dog enters
your mind ... we cannot NOT think of a word that we use!
-
Affirmations can be verbal messages we say to ourselves
or they can be written messages which we read out to ourselves.
We can use post-its or little cards and stick them around
the house or keep them by our bed to read morning and evening.
The main thing is the message, when we repeat positive messages
to ourselves frequently they become part of our belief structure
and we begin to behave accordingly.
-
Affirmations are personal and present, i.e. they are statements
which start with 'I', 'me' or 'my' - this is because we cannot
control anything or anyone outside of ourselves, we only have
control over ourselves, our goals, our beliefs, our values.
They are in the present, so we use the present tense, e.g.
"I am gaining confidence every day" is more effective
than "I will be confident". We don't want to leave
our mind the opportunity of putting our recovery off for another
day! :)
You have to make up your own affirmations, they are personal
to you and where you want to be, but examples of positive affirmations
could be "I face each day positively", "I
am at peace within myself", or "I accept/value myself
and my body".
Recognise and reject our 'internal critic'
 One
of the things we have found is that nearly all of us have an 'internal
critic' which may be the internalised voice of our dysfunctional
family of origin or of an emotionally abusive spouse or even employer.
This 'internal critic' is forever picking up on our faults, our
weaknesses, our failings as a human being, it devalues us as human
beings and leaves us with the general feeling that we are 'no
good' or 'doomed to failure', it uses the words 'ought' and 'should'
a lot and heaps guilt and shame on us ... you might well
recognise the little voice in the back of your head which tells
you that you don't deserve to be happy, that you always mess up,
that no matter how hard you try, you will never be as good or
as successful or as confident as .... (fill in the blanks!), that
even if you did manage to do such and such okay today, that it
was just luck and that next time you won't manage, that you ought
to try harder, that you should be more patient. How do you feel
when reading the words of the 'internal critic'? It is likely
to leave you feeling bad about yourself and we tend to find that
we are very quick to agree with the 'internal critic' because
to a large extent it has been a constant companion for us since
childhood.
The good news is that if we can learn to recognise the voice
of our 'internal critic' we can also learn to reject it and instead
replace it with the voice of our 'internal friend' - the voice
inside our head which validates us, encourages us and comforts
us. This also is about awareness and consciously changing our
thought patterns. We learn to listen to ourselves and our self-talk
and recognise when it is our 'internal critic' talking to us,
then say to ourselves (and sometimes it helps to say it out loud):
"no, I am not listening to you, I am being a friend to myself!
". Next we learn and practice being just that - a friend
to ourselves, because we have found that we treat ourselves with
much more harshness and condemnation than we would our friend,
so we ask ourselves 'if I were talking to my friend, what would
I say to encourage/comfort her/him?' and then we consciously tell
ourselves what we would tell our friend if we were our friend.
After consciously practicing rejecting our 'internal critic' and
encouraging our 'internal friend' for a while we find that it
becomes easier and the critic loses its monopoly over us, we become
more considerate and patient with ourselves and are not so dependent
on the opinion of other people either. (Most of us have spent
our lives so far waiting for validation and approval from people
outside ourselves, and have been disappointed many times. Our
'internal friend' helps us validate ourselves and reduces the
pain of rejection by those from whom we previously craved approval.)
Self-Hypnosis
Forget the circus tricks, hypnotic trances and stage hypnotist,
this is not about making you do silly things in public or manipulating
you into being someone you are not :) . Self-hypnosis is
basically about changing our negative thought patterns like above,
but works on the subconscious as well as the conscious level by
helping us relax and feeding our subconscious mind with positive
thoughts and images. The aim of counselling for instance is to
bring the subconscious issues into the conscious, then examine
them, address them consciously and trust that the change will
sink into the subconscious again. In some ways self-hypnosis short-circuits
the process, as when we are in a state of deep relaxation the
subconscious is much more open to suggestion. There are loads
of 'quack' or largely ineffective self-hypnosis recordings available
on the internet, but there are also some very good ones. I have
found that for me the ones which use a combination of hypnosis
and NLP (Neuro-linguistic Programming) are very helpful and do
actually make a difference to the way I feel in myself, and are
not too expensive either! You can order them online at www.justbewell.com and
the CDs which would probably be recommended when suffering from
anxiety and depression would be Stop
Depression and Help
Stop Fears Phobias and Anxieties, though there are many titles
which may be helpful.
Relaxation Technique
This is a basic relaxation exercise which simply helps us be
aware of tension within our body and teaches us a way of reducing
that tension. If the body is less tense, we tend to be less tense,
and therefore less anxious ... the converse is also true, i.e.
when we are anxious, our body tends to tense up, so being able
to voluntarily un-tense our body is generally beneficial for us
both physically and mentally. Here is the exercise:
-
Sit or lie down somewhere warm and comfortable (where
you will not be disturbed).
-
Let your breathing settle into a slow rhythm. Be aware
of your tummy rising and falling, but don’t make an
effort to breathe deeply (when you’re relaxed you
naturally take shallow breaths).
-
Tense and relax parts of your body in tune with your breathing.
Breathe in and tense muscles and relax them when you exhale.
Practice this using a clenched fist to start with. Keep
your breathing regular and try not to hold your breath!
-
Apply this to the rest of your body, starting with feet
and calf muscles, moving to general leg muscles (throughout
the legs), onto buttocks and groin, stomach, shoulders (hunch
up to your ears), arms, hands and face. Repeat each tense-and-relax
at least twice.
-
Spot-check your body for parts that are not relaxed and
do them again. In particular check your stomach, neck, shoulders,
and face (check your forehead, jaw, eyelids, lips and tongue
for tension).
-
When you’re feeling completely floppy and heavy,
keep your breathing steady. Enjoy feeling at peace and completely
relaxed.
This is a good exercise to do before listening to the Self-Hypnosis
CD or trying to settle down for the night, and I also find
that I benefit from doing a 'spot-check' while at work or driving
or typing - all activities where I tend to involuntary tense up
and not even be aware of it!
Help your body along with supplements
Depression and anxiety are both said to be related to serotonin
levels in the brain, which is why anti-depressants of the SSRI
type tend to work fairly well for many people with anxiety and
hence why doctors prescribe it. People who suffer from depression
and/or anxiety tend to have low serotonin levels in the brain
and it is believed that the SSRIs work by inhibiting the re-uptake
of serotonin and therefore providing more of it for the body to
use. Serotonin is associated with mood, sleep and vomiting, apart
from other aspects, and a lack of it is associated with depression,
IBS and anxiety disorders amongst others. The body produces over
80% of its serotonin during deep sleep, so as you can see a vicious
circle occurs: we are depressed so we don't sleep too well, because
we don't sleep too well less serotonin is produced, the low serotonin
levels increase the depression, which means we don't sleep too
well ... ad infinitum. That is the bad news. The good news is
that we can help our body to produce and use serotonin with supplements,
though obviously if the depression is severe or manic, it is unlikely
to be sufficient. The supplements which are worth trying are
5-HTP and St John's Wort.
5-HTP is a substance that is naturally produced in the body
and has the ability to increase production of serotonin in the
brain. St John’s Wort is thought to work by prolonging the
action of serotonin, dampen down the high levels of
stress hormones, as well as increasing night-time production of
melatonin hormone (the brain’s own natural sedative) to
improve sleep. Good, quality (and again not too dreadfully expensive)
tablets can be ordered from Healthspan
and the links for the two supplements mentioned are:
Obviously if you are on any kind of medication, check
with your doctor BEFORE taking either of those supplements,
as they can make some medication less effective. Also, don't expect
miracles overnight, they can help your body to combat the vicious
circle, but they cannot eradicate the depression or anxiety completely,
and like all nutritional supplements they need to be taken regularly
for at least 6-8 weeks before you can accurately assess whether
they are helping or not. As mentioned above, if you really feel
you cannot cope with your life, or your depression and anxiety
is very severe, your doctor can prescribe medication which will
work faster and probably make a greater impact and doesn't condemn
you to a life of being dependent on meds ... just that I like
to know the alternatives and I like to try them first and keep
the prescription meds as an option if the natural stuff isn't
sufficient for my needs!
Also, try to follow the general guidelines on healthy living:
eating at least 5 portions of fruit or veg each day, eating a
regular and balanced diet and moderating alcoholic consumption
and smoking. Sometimes even these obvious 'guidelines' are difficult
for us to follow ... we might well be treating our bodies without
the compassion and respect they deserve because we don't feel
worthy in ourselves, or may at some level be 'punishing' ourselves
by neglecting our bodies. Eating disorders such as anorexia or
bulemia are not uncommon amongst victims and survivors of either
child abuse or domestic violence, and it can be hard to recognise
when we need help with our self-care. If you suspect you may have
an eating disorder, your GP can help.
I hope that at least some of the suggestions will help you get
through this stage - and it really is a stage, it will come to an
end and you can and will get through it and out the other side.
You might like to post a message on the Forum
on Hidden Hurt and ask other survivors for their experiences and
suggestions, you would be very welcome indeed!
© 2007 Lindsey Mason
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