Panic Answers

What is the best thing to do to calm down when having a full blown panic attack?

When a person has a panic attack, their brain functions in the fight or flight responsive part of the nervous system;  this affects their impulse control, executive functioning, reasoning, and other brain activities related to safety. It is possible to recover from the physical symptoms of a panic attack. The first thing the person will want to do is ensure they are in a safe place; that means if they are driving, pulling into a parking lot, or in a meeting excusing themselves, stepping out into the hall, taking a seat so they can focus on Mindfulness and Breathing. Dialectical Behavior Therapy (DBT) is an effective skills-based therapy for treating many mental health ailments, including panic attacks. One of the group categories is called distress tolerance. TIPP is one of the distress tolerance skills that are highly effective.  TIPP stands for temperature, intense exercise, paced breathing, and progressive muscle relaxation.  T - Temperature = changing your core body temperature, drinking ice water, taking a hot or cold shower (not too hot or cold so that you burn yourself), splashing cold water on your face, rubbing ice on the back of your neck.  I- Intense exercise - speed walking, jogging, jumping jacks; the idea is to raise your heart rate and begin to produce endorphins.  P- Paced Breathing. My favorite technique is starfish breathing because it focuses on slow-paced breaths, and you trace your hand, stimulating a tactile response. P- Progressive Muscle Relaxation. There are a lot of techniques for Progressive muscle relaxation, but when at the moment, after your paced breathing, it has helped lots of people to do a small shoulder and/or neck role and shake their hands, shaking off the anxious energy.  Sometimes people will only need to use one of these techniques to control a panic attack other times; they will need to utilize all four techniques to regulate their panic attack. Practice makes perfect. Having a plan helps reduce the fear of an impending panic attack. The more you utilize these skills before a panic attack, the more likely you are to use them during a panic attack.  I hope this helps, and don't hesitate to contact a BetterHelp therapist if you have any questions or would like more support.
Answered on 11/07/2022

How do I overcome the fear of public speaking?

Hey Sunny,   Thank you so much for your question.   You might be familiar with a lot of this already, but I sometimes find it useful to consider the different roles that distinct areas of the body tend to play when it comes to external stimulus. The prefrontal cortex part of the brain for example, is responsible for regulating our emotions as well as allowing us to solve problems in a pragmatic and controlled manner. During moments of anxiety, a much more ancient part of the brain known as the limbic system, or paleomammalian cortex, takes the steering wheel and those aforementioned areas of the prefrontal cortex are relegated to the passenger seat. Furthermore, the limbic system might put on its own playlist and then turn up the volume on the stereo to drown out the prefrontal cortex’s boring suggestions. After all, nobody likes a back seat driver.   The amygdala, a key asset of the limbic system, is one of the few parts of the brain and the nervous system that is fully formed when we are born, whilst key parts of the prefrontal cortex are thought to take around 30 years to fully mature. I think this speaks volumes about our tendency to react in certain ways to unpleasant situations. One of the primary functions of the limbic system is essentially to identify threats and tell us to respond in a way that is designed to keep us safe. We might dissociate, get the heck out of there, or become aggravated to meet the challenge. Upon registering a threat, parts of the limbic system such as the hippocampus may remind us that we’ve seen this kind of situation before and perhaps that it didn’t end well. A chain of events may then occur within the body. A cocktail of neurotransmitters and hormones may prepare us for action, and we might find that our heart rate and respiration rate increases, that we perspire more, we may need the toilet as oxygenated blood is moved from the digestive system to our limbs, and we may even experience tunnel vision, become irritable and become more attuned to details such as sound. In more severe cases, this experience can produce a visceral experience known as a panic attack.   Challenging anxious or intrusive thoughts is perhaps a little easier when we are able to engage the prefrontal cortex. This is because the same parts of the brain responsible for things like task initiation, organization and working memory are also the same tools that we use for functions such as self-monitoring, emotional regulation, and impulse control. There are a number of ways that you can do this, and it is possible to strengthen connectivity within the prefrontal cortex with exercises that target specific functions of your brain such as word and memory games, or puzzles. These exercises can encourage neuroplasticity and reinforce essential neurological interconnections. You might also try learning something new, like a language, or other skill. This is even more effective than word games at engaging and exercising the prefrontal cortex, as it requires those parts of the brain to adapt so that it may understand and piece together new information. Cooking is an activity that engages multiple areas of your brain, including various senses, making it a great grounding activity with a lot of sensory stimulus that can anchor you to the here and now. Cooking requires hand-eye coordination, concentration, multitasking, planning, and working memory to execute a recipe correctly, all of which are executive functions of the prefrontal cortex.   I get however that you can't whip up a recipe when delivering a presentation (unless of course you're presenting a dish!), so perhaps you can try other things that require only a pen and paper to ground yourself in preparation for standing before your audience. Solving math problems with increasing difficulty, for example, can help. Math problems require the use of logic, analytical skills, and trial and error to arrive at correct conclusions. They may also be more in line with the kind of skills you are trying to use when you're feeling that pressure in a work environment, for example.   All the while, control your breathing. It doesn't have to be in a way that feels forced, and you don't have to count for however long you spend holding a breath etc. You can start by taking an inward breath through the nostrils, feeling the coolness of the air as it enters your body and fills your chest, hold it for an undetermined amount of time that feels natural and organic, and then release it through your mouth. Pursing your lips can help to slow the outward breath. You can do this at any time, and continue it whilst engaging in an activity that engages the prefrontal cortex.   If you want to work directly with the intrusive thought, then you could perhaps use that as the source material when you attempt to engage in an activity that helps. You could write the thought down, consider what assumptions you are making, ask yourself why you are making those specific assumptions, consider the evidence that supports those assumptions, ask what other assumptions could also be made based on the same evidence, and in doing so challenge the thought using Socratic methods.   Working with a therapist can be a very effective way to explore this experience in search of ways to manage those feelings. An autonomous and comfortable exploration of these experiences within the safety afforded by a professional therapeutic relationship can provide you with space to unpack what is going on for you, identify triggers and potential coping strategies, and discover meaningful ways to move forward with your personal goals. You might explore breathing exercises, grounding and mindfulness techniques, cognitive behavioural methods for challenging intrusive thoughts, and other ways to manage triggers in relation to public speaking.   Whilst unpleasant, it is perfectly natural to feel overwhelmed by the consuming, collaborative efforts of the cognitive and physiological processes that contribute to the experience of anxiety, and there is nothing unusual or erroneous or about the way that you might be feeling in these moments. Our emotions have important functions. They are an adaptive feature of our survival. Anger, dread, or any of the hues that form a particular shade in our rich emotional palette are a product of our body and mind doing their job, albeit a little too well on occasions perhaps. Those emotions can provide incredibly useful data which we may employ in our pursuit for personal growth. They can sign post things for us, validate us when we’ve experienced something distressing, and motivate action.   So, what does that fear around public speaking mean for you?   If you sit with those feelings and let them guide you, where do they lead?   What do you feel is driving that fear?   Have you felt this way before in other situations?   Does it bring back particular memories?   Do you experience any intrusive thoughts when you think about public speaking, or visualize a ‘worst case’ scenario?     Good luck, and I hope you find all of the answers that you are looking for.
(Level, 6, Therapeutic, Counselling, (BA), Level, 5, Counselling, (FdA), Level, 4, Counselling, (FdA))
Answered on 11/04/2022

What is the best step to deal with continuous anxiety, lack of self-confidence?

This spinning world seems to pick up speed every day. If you're finding modern life overwhelming, you're not alone. Anxiety diagnoses are on the rise. This is in part due to the falling stigma against mental disease, but it is also due to a rise in stimuli. As humans continue to live in bustling cities with demanding lives, it can be difficult to control your anxiety. Technology has not made it easier. With constant notifications and excessive screen time, your attention can be pulled in many different directions. These stimuli exacerbate anxiety. If you're dealing with big life changes or inner dilemmas, the background noise just piles on to that. The sense of everything building and pressure rising, can lead to a full blown panic attack if you're not careful. So how do you limit and tame your anxiety? The first step to calming yourself is to recognize when you are anxious. Does your body tense up? Do you get short of breath? Do you feel like any extra pressure added will make you snap? These are signs of stress and anxiety. Being self-aware enough to know when you're anxious is crucial to reducing your anxiety. You will get better at this over time. At first, you may only know you're anxious when you're about to blow your top. Reflect on what caused that feeling and the points that increase your anxiety. Realizing what compounds your anxiety will make you more prepared the next time you are in a similar situation. Once you can identify situations that trigger anxiety, the next step is to observe it. Picture yourself on a runaway train. As you speed along the tracks, you feel scared and helpless. This train is made of everything that triggers your anxiety. Now picture yourself, not riding on the train, but watching it from a safe distance. You watch everything that adds stress to your life, and instead of choosing to ride on the train, you just observe. From this vantage point, you can have a lot of clarity. To choose not to ride the train, to observe, if even for a moment, you buy yourself time to come up with a plan. If a situation in your life is raising your anxiety, after observing it mentally, focus on what you can control. Often, lack of control is a major contributor to anxiety. By focusing on things you can control, you can regain a sense of agency over your anxiety. This focus means blocking out the things you can't control as well. Like everything, this requires practice. The key to this step is realizing that, by allowing yourself to be anxious over what you can't control, you are sapping energy away from what you can control. Any energy you spend on being anxious is energy you are taking away from something else in your life. In specific terms, this means that if you're spending your day fretting about the weather, you're not spending that energy engaged in your work or being present with your friends and family. By focusing, you can channel anxious energy and use it as a motivator towards what you can control. The more work you do while you're relatively calm means, the more you'll be prepared for anxiety. Developing a plan to cope with your anxiety before it hits means that all you have to do is carry out the plan when you're feeling anxious. If it's within your means financially, consider consulting a professional.  Whether it's your family doctor, a licensed therapist, psychiatrist or the help from a life coach they all have tools and resources to help you. The stigma against taking care of your mental health is falling, with more people taking medication and seeking therapy. Do not let this stigma get in the way of improving your health. Not only can anxiety make your life miserable, but the added stress can also cause health problems down the road. As you navigate your anxiety, developing coping methods are essential to handling stress. Learning how to identify anxiety, distancing yourself from it, and channeling it all takes time and practice. With the help of BetterHelp this can all be easier. Taking care of your mental health is essential to improving your overall health. Your quality of life will improve as well. With anxiety in check, you will have more room for actually living.
Answered on 10/30/2022

I wanted to know how I can manage anxiety?

Hi Kelly, I am sorry to hear that you have been affected by anxiety recently, to help you make a balanced decision on how is best for you to manage it, I will give you some general information on what it is and how therapists may work with it. I think the first thing to note about anxiety is that it is a natural process our minds and bodies go through and it is experienced by everyone at some point. With this in mind, it is beneficial to remember that anxiety is only an issue when it becomes life limiting in some way. The function of it is to keep us safe when we perceive a threat or danger. The Amygdala in our brain does this by producing chemicals that tell our heart to divert blood flow to the muscles and lungs so that we are ready to take action. Often, our brain unconsciously perceives a threat and can start the physical process before we are even aware there is a threat in our vicinity. So when we begin to sweat, our breathing becomes faster and our heart rates speed up without us understanding why, it can be quite disconcerting.  This process has been a part of our self-preservation instincts since we were cave people and the fact that you are here means that your ancestors saw the lion in the savannah and ran, rather than stopping to admire the scenery. The issue in our modern world is that the same level of anxiety that would be raised if we were confronted with a lion can also be raised when we are faced with social events or new experiences. Something that is present when anxiety is active no matter the situation that has provoked it, is that we feel out of control about something. Part of our basic needs in order for us to be content and happy as humans is the need to feel in control, as this gives us security and the feeling of being safe. It sounds to me from the information you have provided that this was the case in both experiences you had with anxiety. The pandemic, although implemented to keep our societies safe, has indeed caused issues with mental wellbeing for a lot of people, especially as there was no fixed dates of when lockdowns would lift and life could return to normal. This would most certainly provoke a feeling of being out of control for the majority of the population. We are social animals which means that we thrive on connection and deteriorate when segregated. This combined with personal difficulties or issues within the home, means that we as therapists have seen an unprecedented dip in mental wellbeing as a result. Your father being taken to hospital would be an especially difficult time for you I am sure. The worry of the impact of his illness on not only your father but also wider consequences would certainly provoke a feeling of being out of control. Your feelings of security that are embedded within your relationship with your father, would only serve to maximize the feelings of anxiety the longer he was absent from your life also. I do hope that he is recovering well. Anxiety can be treated in a number of ways, including but not limited to Cognitive Behavioral Therapy (CBT), and Mindfulness techniques. Through CBT we are able to work with changing how the mind perceives the threat that triggers anxiety, Mindfulness can help to manage symptoms of anxiety through relaxation, breathing and visualization techniques. There are many ways that anxiety can be treated to improve your quality of life, lots of clients choose a multilayered approach to their treatment which can work really well. Not all therapists will have specialisms in every approach so if you are looking to experiment with what works best for you, it may be a good idea to look for a therapist who practices an integrative approach. This is a therapist who has experience in more than one type of therapy and will be able to guide you in your journey.  I hope that my answer has helped you come to an understanding of what anxiety is and has given you reassurance that there are interventions that can help you manage it. I wish you well with your mental wellbeing in the future.  Best Wishes  Claire Howdle
(Psychodynamic, Counsellor)
Answered on 10/28/2022

How to control and live with everyday anxiety and panic attacks?

Thank you very much for sharing asking the question and sharing your current situation. I know it's a difficult position - the one you are living in right now  - and I am very sorry about it. Nevertheless, the good thing is that there are things to change the situation for the better and there are things you can do to improve your current situation.   Panic attacks and anxiety are indeed things that are going to be there in life always, it's not possible to completely remove them from our life, as we are talking about withdrawing the emotion of Fear, which is an important part of life. Anxiety is a way of feeling Fear when we have a challenge to face or there's a situation that worries us and Panic is the emotion of Fear in its highest degree of intensity, which is extremely unpleasant and not very useful.    As we cannot withdraw Fear from our lives, we need to learn how to deal with it and with the rest of our basic emotions (mainly Anger, Joy, and Sadness) as they have an important weight in our day-to-day stuff. It's important to hear our emotions, experience them and see where they come from, as they are there for some reason.    You are struggling now to find the triggers of that anxiety of yours and those panic attacks. I would recommend taking a look at the main areas of your life to see if there are things that you don't like within them. Try to find if there is something to be changed in your social life, your life in a couple, your family life, your life work or study wise and your personal life (the relationship that I have with myself, how much I like myself). I think you will be able to find some situations that you don't like about them. Also, talking to a friend, relative or a professional about it can be very helpful to find the cause. Finally, try to remember if any thoughts around those situations are involved.   I hope things go better for you, I honestly think you will be able to deal with it better after some time working with your emotions and once you have changed what you need to change in your life. Wish you the best. 
(Master's, Degree, in, Third, Generation, Psychological, Therapies, Bsc, in, Psychology, Msc, in, Prevention, of, Addictions)
Answered on 10/27/2022

I would like to question if I suffer from anxiety

Hi Ciho,   Thank you for your question. It sounds as if you are worried about whether you suffer from anxiety. It sounds as if you experienced shortness of breath and shaking which has reoccurred since the initial instance. Thinking about the first time this happened also leads to worry and panic of being out of breath. I wonder if this anxiety prevents you from doing things you would like to, and it is getting you down? It sounds, too, as if you don’t know if you are anxious but you do recognise something does not feel right for you. So, I am glad you have also reached out for help.   It might surprise you that it isn’t uncommon to feel this way and uncertainty around why we have experienced something, especially when it doesn't make sense, can be very difficult to sit with. Some people might call it something else, or have a name for it, which can be isolating. The most important thing to know is that this is how you feel, it is your reality, and it is valid. At the moment, working out why you feel this way and how to change it is hard, which is why counseling can help.   The first step in learning to cope with how we are feeling, about feeling short of breath, is to listen to the wisdom of your body. You want to freely admit and be honest, accepting that just because you're struggling with how you feel doesn't mean you're weak, it just means you're human. Perhaps list all your sources that might be making you anxious and how you might react to them differently and with empathy for yourself. And coming to terms with a problem is difficult, unless we stop denying that there is a problem with how it is responded to. You have been fine up until now, good enough is more achievable than perfect, but if you want to get up and face the day, something needs to change.   The kind of thoughts that we tell ourselves when we feel we can't cope gives us permission to continue to stay in denial and not deal with our emotions, because that can be kind of scary, dealing with emotions, because what does that mean? It doesn't mean you don't want change things; but it might mean you may need help to see the resources you have to cope with what you are experiencing right now.   Thinking about this incident in the cab can be difficult. Sometimes, when we lose control of a memory, we lose track of ourselves, including the things, people and connections that are important to us. I'd invite you too, to have a think about the quality of the relationships you have. How do you know your friends are just that and what stops you from talking openly about how you are feeling? Emotional intimacy, active listening, support, and companionships are all important. When these are missing in your life, it could lead to feelings of emptiness and loneliness, too. Think about how you would be with a friend if they were going through what you are experiencing. Often, we don’t speak to ourselves the same way we do our friends, which damages our relationship with ourselves.   Likewise, to improve our relationship with ourselves, it can be helpful to set goals that feel manageable given where you are at the moment. What can you do with regards to worry about your experience and memory of this past event?   When we have an expectation of ourselves that is asking too much, it can be aspirational, but unrealistic expectations seem to get in the way of consistency at least as often as they support it. For example, it might be you expect yourself to 'just move on' and 'never think of this again'. Is that fair? Is it realistic? This was impactful and has left you with something.   Sometimes our expectations and plans can be so lofty we forget where we are and don't take into consideration how we feel, it is disempowering. As an alternative, we can create a simple list of things you feel able to do that moves you towards the general direction of your goal. For example, you could break down not thinking about this incident into smaller, manageable steps.   Organic growth over time helps identify what we can do with the resources we have. It helps to appreciate that our energy levels change, and our resilience can ebb and grow. And anything that gets us to happily show up every day is the mechanism- expectations that are too high lead to feeling like we want to shut down.   Even if it feels overwhelming and painful, thinking and talking about significant feelings, events or thoughts that trouble you may help you process them. Depending on how strong you feel about these events, going through the process with a counsellor is highly advisable.   Take care of your physical needs. When bodies are run down, you're more susceptible to burnout. Make sure you have a good diet, especially your breakfast, eat something healthy. Avoid abusing yourself with rigid diets. Try to get as much exercise as you realistically can, avoid addictive substances and get plenty of sleep. Attend the basic needs you're not attending- don't work out for hours every day, just your basic needs- eating healthy, not too much caffeine and being mindful of getting enough sleep.   And then you also want to nurture yourself more than others. You need to show up for you as your own carer. You need to have a better balance and you do have a choice, although it is hard, to do so. I want you to always ask yourself, what am I doing today to nurture myself while I'm still there for others and away with my concerns?   It is important to remember that everyone needs support sometimes and care always, including you. Sometimes social media can impact this. Be mindful when you're on social media how much time you spend there and, what type of accounts you follow. How people present themselves is often different to their life- they present their best or worst parts of their day, but rarely show everything, particularly the mundane or things that won’t get them ‘likes’. It can cause comparative behaviour, where one never scores higher than the ones that seem ‘perfect’ or like they have their lives together.   Making time for self-care and listening to yourself is an important part of life. Not taking care of your needs can cause problems of self-worth which could also impact feelings of needing to be more and, do more, too.
(MA, Counselling, Cognitive, Behaviour, Therapy, Level, 5, PGDIP, Integrative, Counselling)
Answered on 10/26/2022

Can anxiety just stop?

Hi there,  I hope you are well.  I can see that you would like to know if anxiety can just stop. You appear to recognise that when your mind is unoccupied with thoughts, you tend to overthink about events. You mention that this process creates panic. You notice this when writing things down, you have to check things several times before you believe it is ok to be sent, and even then, when you have sent it, you still over think it.  Anxiety is an emotion that everyone experiences, like anger, happiness, sadness etc. Our anxiety is there to let us know that something doesn't feel ok and can include feelings of fear and worry. For some, this can become overwhelming. In addition, people can also experience anxiety disorders which require further intervention.  We usually experience anxiety when we are in a situation that triggers feelings of worry or fear. Our body reacts to these feelings creating physical responses such as racing heart, breathing faster, clammy hands, trembling, feelings of butterflies in your stomach or feeling nausea etc. Do you recognise the physical responses you experience when you are anxious? From your question, it appears as though your anxiety is triggered by thoughts, particularly thoughts about events or things you have done/want to do. It seems as if you are in a cycle where your thoughts create feelings of anxiety which then lead to behaviours around responding to the thoughts. For example, you write something down, you think you have written the wrong thing (thought), you feel anxious (feeling), so you check it over and over again (behaviour), send it and then worry it is still wrong (back to the thought again), and so the cycle continues. Can anxiety just stop? Yes and no, it depends on the type of anxiety. For example, if you are experiencing anxiety prior to a job interview, it's not uncommon for this to dissipate when the interview is over, like a "phew! that's finished! It wasn't as bad as I thought it would be". Anxiety can be a good thing as it promotes responses from us, so we worry we won't do well in an interview so we prepare more etc. However, if your anxiety is overwhelming you, it can reach a point where it actually prevents you from acting, it can create negative thought patterns and cycles of behaviour which are difficult to just stop. This is where it can be helpful to consider other types of intervention such as counselling or therapy. You can also explore "self help" books and worksheets, which are readily available online (if you don't feel you are at a point where you need therapy etc.).  As your anxiety shows up in thinking patterns, particularly overthinking, I would recommend starting with addressing the thoughts. Consider things like:  When and where did the thought happen? What situation was I in (just before, during and after the thoughts)? What was the automatic thought I experienced? What emotions did this bring up for me?  Is the thought realistic? Evidence that agrees with the thought and evidence that goes against the thought? Could I see this situation differently? Is there an alternative thought? The more you challenge your thoughts, the more chance you have of breaking the cycle of negative thought patterns.  It's important to remember though that automatic thoughts cannot be stopped, they will just happen, however, you can choose how to respond to them moving forward, this is where exploring the thoughts and challenging them can be really helpful.  I hope that this answer has been useful. If you need anything further, please get in touch.  Thanks  Kim
Answered on 10/26/2022

How to deal with anxiety and intrusive thoughts relating to ADD (ADHD)

Hi Snail! Thank you very much for asking this valuable question on the "Ask a Licensed Therapist" forum. Based on your question, I can tell that you are seeking out advice on how to manage symptoms of anxiety and ADHD as well as keep a healthy balance in your relationship. It is really good to see that you are reaching out for support on this important topic. Based on what you wrote in your initial question, I can tell that you have been feeling anxious and have been experiencing intrusive thoughts. How would you describe your overall symptoms of anxiety? How often do you feel anxious? Would you be willing to rate your anxiety on a Likert scale of 1 to 10 on a daily basis? It might be a good idea for you to complete the GAD-7, which is a standardized assessment for measuring anxiety. This will give you an idea as well as a base line for your symptoms of anxiety. In addition to keeping track of your anxiety symptoms and practicing self assessment skills regarding your experience of anxiety, I recommend trying some relaxation and mindfulness techniques. These methods include deep breathing, sensory grounding techniques, mindfulness meditation activities, and progressive muscle relaxation. From my perspective, mindfulness simply means being present in the moment and focusing on the here and now. If you need some assistance with getting started with utilizing these approaches, check out the myriad of handouts available on Therapist Aid. Also, would you be willing to keep track of your thoughts and feelings by participating in some therapeutic writing or drawing exercises? If you have not done so already, I recommend that you practice writing in a therapeutic journal. Utilize the feelings wheel as a means to connect to your emotional self and document those feelings. Through the process of journaling, you may be able to achieve some greater insight into your experience. Also, you may want to make steps towards identifying your areas of strengths as well as your areas on concern. After some time, you can certainly begin seeking out themes that come up in your writing. It may be helpful for you to create some therapeutic drawings about your thoughts, feelings and experiences. Start with creating a simple scribble drawing when you are having heightened moments of anxiety or stress. The spontaneous aspect of scribble drawings can be an awesome outlet for creative expression. This technique can foster a holistic, healing experience. Did you know that coloring within a circle can produce a sense of relaxation and even lower heart rate and blood pressure? Check out the free mandala outlines that are available online. You can print or purchase a mandala coloring book and draw within the circular format. Perhaps you may want to write your thoughts in the circle as a means to organize the intrusive thoughts that you have been having. Ultimately, it is completely up to you how you want to process and address your thoughts. It is a great thing that you feel like you are in an equal relationship with your partner at this time. What has that been like for the two of you to be in a loving relationship? It sounds like that despite the fact that you are in a loving relationship, you have thoughts that your partner might leave you. When did you begin having these thoughts? How long have you been feeling concerned that you may be emotionless? It appears you have the ability to be consciously aware of your thoughts and that you have been trying your best to rationalize your ways of thinking. I recommend checking out the Wise Mind concept, which is a dialectical behavioral therapy approach. This concept purports that there are three aspects to the mind: the rational, emotional and wise mind. The ideal of the wise mind is to combine the rational and emotional aspects and be intuitive. Do what you can to create a thought balance and combat each negative thought with a more positive one!It seems like it would be helpful for you to check in with your partner and tell your partner how you are feeling. I know that you mentioned that you are in a long distance relationship. Perhaps you may consider writing a letter to your partner or sending a greeting card with a hand written and personalized message. If you can coordinate a scheduled time to talk on a weekly basis, that could be great for both of you to continue to maintain a healthy relationship. I can tell that you are trying to navigate the challenges of having a long distance relationship, which is a really good sign.At this time, I recommend individual counseling sessions on a weekly or bi-weekly basis. BetterHelp offers counseling appointments on the phone, through live chat or via video conferencing. You can also join a group or attend a groupinar. If things do not improve after some time, you could certainly connect with a therapist and your partner in a couples therapy session. Essentially, it is up to you to decide what will work best for you, your individual needs and your situation. Lastly, I want to touch base about the symptoms of ADHD that you have been having. It sounds like you believe some of the anxiety symptoms that you are having are related to ADHD. When were you diagnosed with ADHD? What treatment recommendations has your primary care provider made for you thus far? I can forward you the following information that may clarify your concerns about ADHD. I hope that information in these pdf documents will be useful to consider: Thank you again so much for asking this valuable question on the BetterHelp platform! I really admire your goal of trying to reassure yourself as well as maintain an equal and healthy relationship with your partner. I hope that my response will benefit you in some way. Take good care and have a nice day!
Answered on 10/25/2022

How do I overcome the fear of meeting new people, making friends and being able to keep them.

There are two parts to this issue, how do you go out and meet new people for a start. I would suggest you begin with small steps. What are the thoughts that arise for you when you think about going out to meet new people and are they realistic, it may help to write down what comes to mind, then look at these ideas objectively, as if you were a close friend of the person that has these thoughts and how you would help them to proceed.  Start from where you feel comfortable and push the boundary just a little, for example - is going outside your front door a challenge? Stand in the doorway face the fear of that to begin with, set an achievable goal. Are there ways to make this easier for you, is there someone that could facilitate this, is it easier at certain times of the day or under particular circumstances. It is important to feel safe in challenging yourself. Having self compassion is important when facing challenges of this kind, it can take a long time to overcome difficulties and reach goals that may seem small to others but a big step to us. The fact that you have sought help in making a change is the first step in your journey to reaching your potential. The version of you that you want, already exists, if you can give her space she will grow.   The second part is - what is behind this? Can you think of when this started and what the feelings are? Is the issue going out altogether or about meeting people? It may be there was a life event that triggered this or many changes or difficulties over a period of time. Bringing awareness to what is happening can be this first steps in understanding the reasons for the difficulties we have and understanding can facilitate recovery. Self understanding and self compassion can lead to a sustainable way of managing difficult feelings long term. With self compassion we can see that life can be challenging and offer ourselves kindness and not comparison to a perception of other peoples success. I would love the opportunity to help you explore this further.  June
Answered on 10/24/2022

I am pretty sure I am having anxiety or panic attacks, but I want to know which one.

Hi Sammy, thanks so much for your question!  Without knowing you or your history, it can be hard to know for sure whether you are having anxiety or panic attacks.  However, I can provide some general information about both.  Perhaps some of it will resonate with your experience and be helpful.   Anxiety can be detrimental to one's quality of life.  It is typically future focused.  It takes us to places we have never been, places we never would want to be if we could avoid it.  We are often contemplating scenarios that have not happened, and possibly never will.  There is a protective function here, in that our brains are trying to keep us safe by imagining everything that could go wrong in order to prepare ahead of time and avoid being hurt. Over time, the neural pathways in the brain get reinforced and thoughts start automatically taking the road to the future, making it difficult to function in the here and now.   When anxiety starts to get loud, the nervous system begins to experience dysregulation.  This simply means the nervous system is having a harder time doing its job and things like breathing, heart rate, body temperature, etc. start to change.  This is what eventually will lead to an anxiety attack.  With anxiety attacks, there is often a trigger the precedes the episode.  For example, if a person was in a car accident, they might experience anxiety attacks the next time they get behind the wheel of a car because the body/brain fears another accident.   Panic attacks, while very similar in presentation to anxiety attacks, often do NOT have a defined trigger.  So, it can feel like a panic attack shows up out of nowhere.  Sometimes panic attacks can be a byproduct of a consistently dysregulated nervous system, meaning anxiety has been too high for too long, and now the body is reacting with panic at seemingly random moments.   It is important to note here that there are five foundational areas that support the nervous system: getting enough sleep, eating enough food, moving your body in an enjoyable way, engagement with healthy social connections, and engagement with spirituality (not spirituality as in a particular religion, but spirituality as in matters of the heart, connecting with nature, art, etc).  When these areas are out of balance, the nervous system can become consistently dysregulated, which can also eventually lead to the panic attacks.  Trauma is another thing that can lead to consistent dysregulation, so it is important to recognize that anxiety and panic have multi-factorial causes.   Regardless of whether you are having a panic attack or an anxiety attack, the following information can be useful when trying to intervene.  There are many interventions for anxiety.  One is mindfulness.  In addition to the things already discussed, mindfulness can be a helpful way to regulate the nervous system  Mindfulness is the practice of present-focused awareness, meaning we are in the here and now.  It also entails the acknowledgement and acceptance of thoughts, emotions and bodily sensations exactly as they are in that moment.  We do not judge ourselves, try to solve problems, or plan for the future.  We don't even engage with the thoughts.  We simply notice them like clouds floating in and out of our minds.  The benefit of this practice is that when we are connected to the present, we cannot be lost in the past or future.   Here are some techniques to practice mindfulness:  1. Square breathingBreathe in for four seconds, hold your breath for four seconds, breathe out for four seconds, and rest for four seconds.  Repeat several times. While practicing this deep, slow breathing, imagine a square being drawn in front of you.  This helps because you cannot imagine the square being drawn while examining the past or future.   2. Using the five sensesNotice your surroundings and take mental note of five things you see; four things you feel (noticing the feeling of your chair supporting your back, noticing your feet on the floor, noticing any breeze or how the temperature feels on your skin); three things you hear; two things you smell; and anything you might be currently tasting.  This activity can be done while sitting, lying down or taking a walk. 3. Be an observer of yourselfFind a comfortable place to sit, close your eyes and picture the room you are currently in.  Imagine you are observing from the doorway of the room. You can see yourself sitting on the couch in this present moment.  What do you notice?  Take note of your observations, acknowledge them and let them drift away.  Doing this for even a few seconds can help us step outside of our own distressing thoughts and observe them more objectively.  Creating this space brings us back to the present moment.  4. Utilize the sensation of coldness If you find your anxiety is getting out of control, connecting with something shockingly cold can be a helpful technique to get your body and mind back to the present.  Examples are holding an ice cube, jumping in a cold swimming pool, or taking a cold shower. 5. Using a scentEnergizing scents can be another way to bring your mind/body back to the present. Citrus type smells work best, but other calming scents, such as lavender or lilac, can be helpful, too.  6. The practice of journalingJournaling, or writing out your thoughts, helps force the mind/body to connect to the here and now.  We cannot be writing something if we are not present.  Sometimes called a “brain dump,” this technique creates objectivity to our thoughts as it gets them outside of our minds and puts them on paper.  Try it, it might surprise you!  Remember, when we are in a state of anxiety, the nervous system is taxed and dysregulated.  This starts a chain reaction throughout the body and is why we experience the physical symptoms (such as quickened breath, heightened sensitivity to sound, racing heart, etc).  The goal of mindfulness is to get yourself connected to your body and help the nervous system re-regulate itself.  Utilizing these practices listed above can be a helpful way to do just that—connect with yourself, breathe, and let your body settle itself down.  Mindfulness can be a powerful intervention when it feels like our emotions are taking over. The idea is to remain present-focused, non-judgmental, and aware of your immediate thoughts, feelings and physical sensations.  If you notice you've drifted into the past or future while practicing mindfulness, simply notice this, accept it, and then bring your awareness back to the rise and fall of your breath.  It might take some practice, but it works!  More than anything, practicing self-compassion is vital for our well-being.  Be kind to yourself.  You are trying, and that is more than enough
Answered on 10/21/2022

Anxiety strategies

Hi Goosey, Thank you for your question. Anxiety on some level is perfectly normal, everyone can experience anxious nerves when thinking of trying something new so firstly be kind to yourself. What is important to remember about anxiety is it comes from your own thought process which then triggers your emotional and physical responses which all then trigger your behavior, which will be the outcome. So, imagine a large circle in front of you and right at the top is 'thoughts' and your thought is for example 'a new activity, I've never done this before'. This one thought will trigger your emotions, such as feeling worried, sad or even frustration. Your thought and emotions then trigger your physical symptoms, this can be a fast heart rate, sweating and shaking for example. All three of these will trigger the action, which is your behavior to this ONE thought. Now of course, this explanation is lengthy, however the process of this anxious thought cycle literally happens in seconds. You described your behavior to this one thought to be avoidance, which is a very common action we use when we are anxious about a situation, place or even person. We tend to believe if we avoid what is making us feel anxious, we won't feel anxious anymore, right? Actually, this is wrong. When we avoid a situation because it makes us anxious we are almost enabling the anxiety. What we are telling our brain is 'I'm under threat so I need to avoid this situation', so your brain learns when I am anxious I need to avoid anxious situations, which leads us to avoiding everything we enjoy and even end up stopping doing day to day activities, even simple ones just to feel like you are avoiding the anxiety. BUT, if you feel anxious about a situation, as long as you know rationally you are safe, do it! When you're anxious, your body reacts either using fight or flight mode. Your body is actually doing its job by sending all these emotional and physical symptoms, but it's just at the wrong time because rationally you are not under threat. Your anxiety is sending the signals 'avoid this situation because we don't like it and we are in danger', which is not true. When anxiety begins because of a new social situation or activity, remind yourself 'this is new so I accept it will create some nerves, but I am safe'. Look for the positives in the situation, rather than the negatives because that's all anxiety likes to put out is negative thoughts. Positive Thoughts could be: - 'I will have a new hobby' - 'I will meet new people' - 'It will help me grow confident' It could be helpful to plan an event or activity, so if you recognize you're feeling anxious about going somewhere new or doing a new experience, create a plan to offer yourself some reassurance.  You could take a friend, research the place or activity so you understand it more, complete it in small steps and take it one part at a time, for example.  Remember, we all have many thoughts each day, yet just because we have a thought, it does not make it to be the truth.
Answered on 10/20/2022

What type of professional do I need to seek out to work through anxiety and social panic attacks?

Hello, thanks so much for reaching out!  I'm glad your doctor is recommending therapy for your anxiety and panic attacks.   Although therapy will look a little bit differently for each therapist, the general idea is that you and the therapist will come together to talk about how your anxiety and panic attacks are impacting your life.  When folks come to me with this presentation, I will start by asking them to pay attention to the anxiety to start to gain an understanding of any themes or patterns.  I ask people to look for certain situations that may cause anxiety or panic and to pay attention to what the anxious thoughts are saying.  Often times, the anxious thoughts are irrational, meaning sometimes if you pay attention to them you can notice if the thoughts are inaccurate or disproportionate to the situation (like being afraid telling someone you love "No" will result in them never speaking to you again).  I also ask people to notice what the thoughts might be saying about that person, because I find that a lot of folks can be really harsh and mean to themselves in their heads, in a way they would never think or speak about someone else. After starting to get an understanding about what your anxiety might be saying to you, I would start to introduce skills, techniques and coping mechanisms to help manage the anxiety and panic.  Breathing exercises are commonly recommended for people who struggle with panic, because sometimes the panic can lead to breathing so quickly and shallowly that sometimes people lose consciousness.  Then there are other techniques, such as relaxation, to help calm the anxiety.  There are thought controlling techniques to introduce the idea of trying not to think the anxious thoughts that are making you feel uncomfortable.  And there are also behavioral suggestions that can help, such as exercising and meditating. This attempt to understand the connection between your thoughts and your actions and how you feel is called Cognitive-Behavioral Therapy, and it's been shown to be very effective at helping folks to manage their anxiety, because at its core, anxiety is a thought disorder.  Trying to help you find ways to pay attention to your thoughts and notice when they are being irrational or unhelpful is the first step, and then trying to help you implement skills to manage the anxious thoughts after you notice them spinning out of control is the next step.   Hope this has been helpful!  I wish you huge success in your journey of trying to manage your anxiety and panic.
Answered on 10/19/2022

How do I get through my anxiety attacks?

Anxiety can be one of those tricky issues that seem to come out of nowhere. Sometimes it's hard to understand where the influx of feelings is coming from. So easily if not managed, anxiety can truly do a number to control your life. When you say that your life in your household is causing you anxiety, do you indicate that as the move or from going to living by yourself to now cohabitating? Most of the work in reducing anxiety attacks, is to first identify your trigger patterns and when you get upset. In those moments, using your identified coping skills can help reduce those before they get out of hand. Self-care is a great indicator of how you manage stress. If your self-care is lacking, your stress levels will generally reflect and show that you may be overwhelmed. So, keeping a journal of triggers or onset anxiety attacks can help you determine the patterns and the overall stressors. One of the first things to remember when you are there, in the midst of an attack, is that it is only temporary. The worst of the anxiety in the attack is in the first 10 minutes and then will usually subside. An important idea to remember is that you are uncomfortable, but are not truly in active, physical danger. To help alleviate symptoms, deep breathing is an extraordinary technique to do so. Whether you are box breathing or 4-4-4 breathing, being able to utilize this skill is helpful. I find that using mindfulness and visualizations can also be helpful in these cases. Grounding is especially helpful to regain awareness. The 5-4-3-2-1 method is one of my personal favorites in mindfulness. Your therapist may have assigned you this to practice when becoming overwhelmed, but the basic premise is this: When you are looking for the 5 things, make sure they are 5 different items that you can see. Spend time thinking about each one. Next the 4, you are listening for 4 sounds in the space. It could be the humming of the dryer or the beeping of a microwave. Next, you will touch 3 items. Notice the texture, shape, and weight of that item. You can even think about how you can use the item. After that, you will follow up with 2 things you can smell. Whether it be a perfume or the smell of fresh baked bread (if you are in that environment because who can resist that smell!), take time to breathe into that smell. The 1 thing is something you can taste. That can be the taste of leftover coffee you can still taste or you can try something small like candy or gum to have a taste. Muscle and progressive relaxation can also be beneficial. This is where you tense a muscle and then relax that muscle. You can start from your toes and work up the body.  I hope this was helpful!
Answered on 10/13/2022

How do you cope with the fear of losing your parents?

Hi Floss,   Thank you so much for reaching out and I am so sorry to hear of your struggles with fear of death and losing your parents.    Worry and sadness of loss are normal things to encounter. If someone matters to you, why wouldn’t you be afraid of this loss? It sounds more of a problem that this anxiety is leading to panic attacks. It also sounds as if the frequency of the thoughts around losing your parents is increasing.    The most important thing to know is that this is how you feel, it is your reality, and it is valid. At the moment, working out why you feel this way and how to change it is hard, which is why counselling can help. It might be a number of smaller factors contributing to how you’re feeling, which may also be why it is tricky to work out why you are feeling how you do.   It’s not “crazy” to be worried about a perfectly healthy parent passing away. Something to consider here is that if you have experienced unexpected loss in the past, you can be more prone to this type of worry. These fears can also manifest at times of experiencing stress, upset, unhappiness or vulnerability.   Although it would be unfair to try to diagnose what is happening from your message, generalized anxiety disorder (GAD) is another common reason for preoccupation with an unlikely death. People with this disorder spend a lot of time worrying about bad things happening, to the point where it interferes with their day-to-day functions, which is why this may be relevant. If you feel this applies to you, it might be worth considering talking to your GP or referring yourself to therapy.   This anxiety that you are experiencing sounds as if it has a hold of you at the moment. There are some ways below that can help to loosen this experience for you.    Firstly, worry is your brain’s way of trying to feel safe and in control. Try to explore the meaning of the thoughts of losing your parents. When our thoughts are future focused, it can also be known as dwelling, it takes us away from the resources we have in the present. It can be helpful to think about the things you can control in each situation. Taking action to control how you respond when you are afraid is a good example of this. You can control how you respond to people and yourself. Counselling can help with this, as certain types of therapy can help empower you to see the choices you do have and why you feel anxious since your panic attacks, too.   By focusing on what you can and are able to do, this moves the thought processes away from dwelling, to actively doing. There are situations you cannot control, for example, we cannot control people or, that death may happen. We also cannot control how others respond to us, though in both cases, we can control our emotional and thought responses to them. This can be hard to do and is another example of where therapy can help provide support. Actively working with how you feel and your emotions is important. How you feel right now is how you feel, it is important you work to avoid suppressing or avoiding this, which will only increase your belief that you cannot handle loss in the future. Even if the situation is not one you can control, you can still work with your emotions to address how it makes you feel. This can reduce the anxious and stressful feelings. There are certain types of therapy that can help with fear of death, too.   It is not uncommon to adopt behaviours to try to cope with feeling uncomfortable. As well as overthinking, it might be that you need constant reassurance, or even avoid situations. However, these strategies do not prevent the unknown from happening. Reality often lies on a spectrum- it is neither very good nor horrible all the time. So, as you actively challenge your horrible conclusions, consider what is most likely to happen, as well as the good or bad.   Challenging these behaviours may help reduce the need to dwell. Each time you are faced with a thought of death, consider what the advantages of not knowing are as well as the disadvantages. Not all future outcomes are bad, but perhaps it doesn’t feel like that right now? Learning to sit with uncertainty helps being able to respond to what is happening in front of you, adapt and overcome the challenge. For example, what could you do with your parents in the next 5, 10, 15, etc. years to feel like your relationship is fulfilling and rewarding?   Sometimes, our thoughts convince us that certainty gives us control in a situation, but what does certainty really bring? No matter how certain we feel about something, it can always change. So, craving certainty and feeling as if horrible conclusions are inevitable, does not make it certain, but it does leave you feeling anxious.   Within this, try to consider what your need is to reason your thoughts? Do you think something bad will happen? Or does it mean something bad will happen because you think it will? Even if something bad does happen, does that mean you won’t be able to cope with it? It might not sound easy but try not to underestimate yourself. You do have the resources to cope with your thoughts and events that may happen in the future. What would it be like to ask a friend or family member how they cope with fear of dying? Likewise, if it were a friend struggling with worrying about death, what would you say to them?   It can also be helpful to notice when your fear or anxiety around death starts and the need for certainty begins. The physical signs, the things you notice in your body, tell you when thoughts are becoming irrational. Sickness, tension in muscles and headaches can be a time to notice what action you may need to help alleviate how you are feeling. It is important to allow yourself to feel the effects of your thoughts and work through them. It may feel uncomfortable, and it will pass eventually. It can be helpful to think of ways to find it believable that the discomfort will pass, too. Focusing on the present, what is going on around you, will help you feel and experience what is happening in the present, rather than your thoughts about the future. Staying present, or grounding, is a group of techniques that can be learnt either through counselling or, internet tutorials can also help with this.   Do not be afraid to seek help with this as you explore it further. Be kind to yourself and listen to your needs as you are getting to know these aspects of yourself that help you heal.
(MA, Counselling, Cognitive, Behaviour, Therapy, Level, 5, PGDIP, Integrative, Counselling)
Answered on 10/11/2022

How can I become a better person

First I would ask that you be gentle with yourself regarding your struggle to go out in public to crowded spaces. Tell yourself it's okay and that you will not always be this way, and change takes time and should be eased into gently. Begin with small changes. Could you possibly go into a grocery store and pick up a few things that you can carry in a hand basket instead of a cart (only 3-4 items)? Would it be possible to shop this way for several days instead of going to the store for everything at once? Plan to go when the store is less crowded. What types of things did you once enjoy doing? If reading is one of those things, could you invite a friend to meet you at a local book store - they often sell coffee and tea, and spend a few minutes with a friend. Distracting ourselves in a social situation with someone we feel safe with is a good way to expose our body to anxiety without feeling the impact. After you have done this a time or two, go to the book store on your own when the traffic inside is light and stay for a little while longer, and after the crowd begins to file in, ride the anxiety wave by telling yourself you are fine and notice that the people are busy seeking a book, magazine, music or game, and they are not staring at you. Sometimes watching other people can be calming. After your attempts, write about the experience. Keeping a journal of how you have been able to walk through a difficult task is important for your growth. Being able to look back to see that you have done something that was once difficult and seeing your progress unfold on the pages through your documentation of how the task has become easier is the best way to challenge the negative thoughts that tell you you can't with proof that you can. Finally I suggest addressing your core fear. Anxiety is a result of fear. Ask yourself (as the anxiety begins to grow) "What am I afraid of?" and respond directly to your fears by asking what evidence do you have that your fears will come true and then what is more likely to happen instead. Good luck!
Answered on 10/10/2022

What are the best ways to talk yourself down during a panic attack?

Hi Gail, Thank you for choosing to reach out through BetterHelp. I think it takes a lot of courage and willingness to take that first step even to ask for any type of help. The first thing, which you may have already done, is speak to a medical provider about your symptoms. This is always the first place to look when you are having physical symptoms of this nature.  In general, Panic Disorder is experiencing at least one panic attack. This is an experience in which the person feels heart palpitations, sweating, trembling and shaking, shortness of breath, feeling like your choking, chest pain/discomfort, nausea/vomiting/abdominal pain, feeling dizzy/unsteady/light-headed, feelings of not being connected to self or reality, feeling of losing control, fear of dying, tingling sensations, and chills or hot flashes. All of these symptoms are not required to clinically diagnosis a panic attack. To qualify as a clinical panic attack, a person needs to have four or more of these symptoms during the same episode with no discernible medical reason, underlying mental health issues, chemical interference, or trigger of any kind. The more symptoms the person has; the more severe the attack. Panic Disorder becomes the condition when the person's fear of a panic attack (following the first ones) becomes so great that they create a panic attack or cause themselves an intense degree of anxiety due to the fear of having another panic attack. Given I do not know the circumstances of your case, I will address the rest of the question as if we have ruled our medical issues, chemical interference, underlying mental health issues, and triggers. If you are having these attacks very frequently, this could indicate an underlying mental health concern, such as PTSD or Generalized Anxiety Disorder. Both of these conditions, can create a fight, flight, freeze response, which is not needed for the situation, thus creating the sense of panic. If you think it is possible you are experiencing either of these or something similar, I would suggest seeking individual therapy. These are typically not mental health conditions that a person can effectively treat on their own. Suggestions for other things to try, aside from deep breathing (which by the way I agree really only goes so far, a lot of the time): Grounding (bringing yourself back into the moment by sitting still and making a mental note of the things you see around you "the carpet is very stained and still soft" and continue this until panic subsides. Other ways to use grounding is create a sensory change (e.g., placing your bare feet on a cold floor holding something soft). Sensory changes are often very helpful in these situations (sensory changes meaning things you smell, taste, feel, see, or hear). You can look up Progressive Muscle Relations, as this is another coping skill you may find to be beneficial. Most importantly you have to calm down the body, so that you can then calm down the mind. Without getting the body out of flight/freeze/fight, you are going to have a nearly impossible time getting your thoughts off the panic. This means I need to activate my parasympathetic nervous system. How do I do this? Engage in activities that induce relation (e.g., listening to rain on an app or in real life, laying back and closing your eyes for 20 mins, lighting a candle you enjoy). ANYWAY that will cause a feeling of being more relaxed. Lastly, everyone is different and what works for you will be something you will need to discover for yourself. The only way to do this is to try as many things as it takes to find 2-3 coping skills that work for you. Do not be discouraged if one does not work. Try it a few times and then consider it just to be one that doesn't work well for you and move onto to something else. These episodes you are experiencing sound scary and very distressing. Not knowing why they are happening can make is even more disturbing. I would encourage you to seek counseling from a therapist to explore the most primary reasons for these symptoms. I hope this was helpful, and I also hope you find whatever combination of things will help you to feel better. There is a solution out there! You just have to do the work to find it. Thank you again for your question and willingness to be vulnerable and take the step needed to address this issue.  Sending you all the best, Leslie Hagedorn, LCSW, LSW
(LCSW, EMDR, Therapist)
Answered on 10/10/2022

I’m not sure why I’m having panic attacks and anxiety when I’m with my boyfriend

Hello LadyA: Thank you for your questions and reaching out for help.  Let me start off by letting you know that anxiety has the purpose of warning us that there may be something wrong or something bad may happen.  Your body may react automatically without you even being conscious of the response.  According to Cognitive Behavioral Theory the process is: Life Event -> Automatic Thought -> Feeling -> Behavioral.  An example of this process would be: Hear Thunder -> "I am in danger" -> Fear -> Jump up or Hide.  What is important to target is the "automatic thought."  These are formed in our brains due to our past experiences.  In the example, the automatic thought of "I am in danger" may come up because you saw someone get hurt by lightning or during a storm.  If you are able to identify, challenge and change the automatic thought, then you can experience a more "balanced" feeling and healthier behavior.  A more balanced feeling would be "Lighting can be dangerous but I am safe enough now."  A healthier behavior would be to calmly take appropriate precautions.  For more details and practice you can request to see "Challenging Anxious Thoughts Worksheet."  A panic attack is a more intense case of anxiety which may feel like a heart attack.  Something triggers your brain that you are in danger and sets off the "fight, flight or freeze response" where the need for your extremities be ready and full of blood which causes your heart to beat faster which in turn the need for more oxygen causes breath faster.  All these symptoms faster breathing, heart pumping faster and body temperature lowering mimic a heart attack. In regards to you having anxiety and panic attacks when you are with your boyfriend, it is important to review what is it about this event, being with your boyfriend, that is triggering your brain that there is danger.  I know that this may be confusing since you love your boyfriend.  Being in love is not compatible with danger, consciously.  But your interaction most likely is subconsciously.  So it is important to see what your boyfriend represents or being with your boyfriend triggers "danger" in some way.  We can now discuss and gain insight in order to change that automatic thought. Just to clarify, you mentioned that you are having "a lot of anxiety lately" and that you have panic attacks when you are "with (your) boyfriend."  I am assuming that the anxiety and panic attacks with this particular boyfriend.  Not sure if it has happened with a previous boyfriend, but that is fine, we will focus on your current boyfriend.  I do realize that you love him so it would not be something obvious that triggers danger, like him being threatening, aggressive or abusive.  I am also assuming that he is overall a good guy and there is not a history of any type of him being abusive in any way.  In that case, the danger would be his behavior or previous behavior.  I do not believe that is the case since you would be able to understand what is going on.  Although there are situations where people remain in abusive relationships and confuse "love" for "sentimentality" or overlooking bad behavior in a partner.  I am also assuming that is not the case. In order for you to gain insight into the possible triggers of "danger", you first want to look into your formative years; your childhood and high school years.  How was your childhood?  Were there any negative life events that impacted your life?  Were there any negative male figures or anything that was negative that would in any way resemble your boyfriend?  How about your teenage years?  How were your friendships, your acquaintances and your dating relationships?  Where these relationships healthy?  Where they hurtful? or Where they healthy?  Were you ever a witness or learned about someone else being in some kind of danger with a close relationship?  Any kind of experience like this or something similar may have created an "automated thought" of danger near a boyfriend, or danger in a dating relationship. I want to mention that besides danger of bodily harm, there are emotional, psychological or mental dangers.  By this I mean the danger, or your fear of being rejected, abandoned or not being able to create the kind of relationship with your boyfriend that you wish you can.  There are also other triggers that may have nothing to do with your relationship with your boyfriend.  Some examples of these other "triggers" may be others not approving of your relationship; a smell that reminds you of an unpleasant situation; thoughts of how your relationship may take a turn in life you will not enjoy; or if you may feel guilty or shame for being with your boyfriend.   I know that I am putting forward many different scenarios because I do not know all the details of your past experiences or your current interactions. Obviously, most of my assumptions are not going to be right. I do not want to overwhelm you. You may have to do some reflection and identify what is it about "being with your boyfriend" that triggers your brain that there is "danger."  If you are able to find what this trigger is, you can challenge that automatic thought.  What are the facts that prove this automatic thought is true.  If it is false or partly true, you can change that thought in order to switch your feeling (from anxious to concern) and in turn have healthier behavior.  Your unpleasant interaction with boyfriend to a more pleasant, open dating relationship.  You would greatly benefit from engaging in therapeutic sessions to address this issue.  Respectfully,   
Answered on 10/10/2022

How to avoid the feeling of disassociation? I’ll randomly shut down and feel like disconnected.

What it sounds like you are talking about is a combination of long-term depressive symptoms and intense acute dissociative reactions to stressors. These are difficult things to combat. When we are depressed, especially for long periods of time, our coping skills erode as our depression deepens. As our depression deepens and the copings skills erode, our stress responses become you see where this is then we begin to dissociate when stress occurs. Then when the whole cycle happens, we become anxious because these terrible things are happening in our lives...AGAIN! Does this sound even remotely familiar? If it does you might be caught in a cycle of anxiety, stressors and depression. This can be broken! It's not so much about how do you/will you avoid the feelings of disassociation, but more about how do you look at the whole picture and insert new coping strategies so that the whole system is supported so that the stressors aren't so intense so the mind doesn't feel the need to attempt to take the step back created by the dissociative process. When is the last time you have taken a true deep breath? Don't brush it off. When is the last time you have taken a true deep breath. Try it. We don't remember to do it when we are stressed. The brain when stressed and depressed kind of goes into panic mode and will shut down sometimes when overloaded to super super super simplify a complicated process. I know it sounds way too simple to be true but deep breathing exercises can help calm the mind enough that you can take a step towards calming the anxiety enough that the body can calm down enough that the mind can take a break for a minute. I put it in that order for a reason. The breathing exercises will calm the activated adrenaline (fight/flight) system that is triggering the fear/stress response which is triggering enough anxiety to create dissociative feelings. Why don't we want to calm the activated thoughts that are driving the system? Well because if the adrenaline system is activated then it is in control. The breathing exercises will calm the body down long enough for it (adrenaline/instinct) to take a back seat and controlled breathing (thinking/non-instinct brain) to take control again. Then you can get back under control.  Hope that helps some.  Dr T
Answered on 10/09/2022

How can I help motivate myself to do the things that I want/need to do.

Content/Trigger Warning: Please be advised that the article below might mention trauma-related topics that include types of abuse & violence that could be triggering.   Thank you for reaching out Kori, I will do my best to provide you with useful information, and hopefully, that will help answer the questions that you have. I will go in parts so that you get each issue addressed. The first thing that I will say is that if you are committing self-harm, you need to contact your local mental health clinic or emergency room/center and make sure that you reach out for help so that you don’t continue to self-harm. Self-harm can be controlled once it stops, but in order to stop it, you will need the intervention of a clinical team or group of professionals that can help you exit that crisis state.   Another issue that you mention with the information that you included with your question is the fact that you believe that you have undiagnosed PTSD from childhood traumas and abuse. As a trauma counselor, I can say that it seems that you would fit the criteria for trauma counseling simply based on the types of traumas that you mentioned going through. I would recommend going to get evaluated for PTSD as soon as possible since untreated PTSD can bring a myriad of additional problems throughout your lifetime.    It is important that your trauma is addressed and treated. The most effective way to treat trauma is through something called EMDR. If you want to find out more about EMDR and how that can help you treat your traumas, you can go a simple Google search and find the official website for EMDR providers, which will have all of the information you need in order to get that process started.   You mentioned panic attacks and anxiety, which are directly linked so that would make a lot of sense to also treat them as soon as possible. Through psychotherapy you can learn multiple different approaches and techniques to handle both anxiety and panic attacks, so doing therapy will be your best bet here. Anxiety is the root of many other more severe issues, so it is very important to learn anxiety management techniques and coping mechanisms.    People who pick their skin out of anxiety usually stop the negative behavior once the underlying cause of their anxiety is controlled. This you can most likely also achieve through therapy. In terms of not liking yourself, focusing on self-worth and how to grow your self-worth is another thing that you can work through in therapy. Nowadays, online therapy is a very good and practical way to dive into the therapy realm, so I would highly recommend it, here or on any other platform, so that you can start your healing journey.  I hope that this was helpful, and if you have any more questions, please do not hesitate to reach out, and I wish that you have a great day Kori :)
Answered on 09/30/2022

How can I stop thinking about death? What should I do to stop fearing death?

Hello and thanks for reaching out! It sounds like thoughts about your family members passing away happen daily and are really painful to think about.  It must be difficult to be located in another country and physically so far away from them, even if you don't normally see them a lot. You mentioned your Mom has lung disease and you worry about her frequently and I think that's understandable.  It's scary to have a loved one who has medical issues.  There's that lack of certainty if the treatment(s) will work or not and concerns about their level of comfort.  And then of course, worst case scenario dealing with someone passing and whether you are ready to deal with that pain. While you won't be able to prevent your Mom from eventually passing (we all pass eventually as part of the life cycle), you can make sure you spend time with her (on the phone, in person) and share how much you love her and some of your happy memories together.  Try to remind yourself to stay in the present moment, in the here and now.  Today, she is alive and on this earth so make use of your time together. As for your brother who struggles with a substance use disorder (alcohol), it sounds like you worry about him taking care of himself and/or making safe or unsafe choices. I'm going to assume he's an adult and capable of taking care of himself physically, if he chooses.  If that is correct, sometimes the best thing we can do for ourselves and our loved one(s) is to remind ourselves that we can't control other people or their behaviors.  The only thing we can control is ourself/our responses.  Try to do something to take care of yourself (physically, mentally, spiritually) while educating yourself more about substance use disorders.  You can control how much time you spend with your brother, you can control making calls to him and/or visiting him, and expressing how you feel (if you feel comfortable with that), but he has to be willing to make different choices for himself to prevent health issues or other consequences from alcoholism.  Panic attacks can be scary and super disruptive.  I'm sorry you have to experience those.  They aren't fun!  Distraction can be helpful (focusing on things around you/outside yourself), as well as different forms of mindfulness, using positive self-talk to remind yourself that in this moment you are safe and these feelings are just feelings and will pass, progressive muscle relaxation, etc. Have you taken time to track what happens before a panic attack? What feelings or thoughts or situations are happening before you experience a panic attack?  Here's a link to a no-cost community resource available here in the U.S. - Adult Children of Alcoholics and other dysfunctional families (ACA).  You can visit the website and look for online, phone, or in-person meetings in your area.  I think you'd benefit from the information and support. WWW.ADULTCHILDREN.ORG I wish I could help you resolve the distressing feelings/worries and panic attacks with just one written message, but I don't have a magic wand.  I'm happy to support you with working through these feelings and developing skills to manage if you'd like to connect.  Either way, take good care! 
Answered on 09/27/2022