Decent L.A. Times article about panic and anxiety.

A recent article in the L.A. Times provides a pretty good overview of causes of and treatments for anxiety disorders. A sample:

Though the best course of treatment for an anxiety disorder remains trial and error for now, doctors and patients aren't entirely in the dark. Some predictors point to whether therapy, medication or both will likely work best for a patient.

As a general rule, the milder the anxiety is, the better patients tend to respond to psychotherapy.

People who are more insightful and committed tend to respond better to therapy... They must be able to determine why they feel a certain way and to talk about it, and since treatment is very interactive and can be tedious, they have to be motivated to do the work.

Access, of course, is another factor in the probable treatment course: A lot of people see a primary care provider, get medication and never see a therapist. Medication is a lot cheaper than therapy, which is not always covered by insurance.

Artwork by Malin Lind.

Live-tweeting a panic attack.

This is a piece by Summer Beretsky on PsychCentral, documenting a panic attack, as it happens, at a pharmacy.

My experience is that any kind of interaction with others can help you get through a panic attack. With someone behind the counter in a store, for example, or with a friend on the phone. It takes you outside yourself, keeps you occupied with something other what's going on inside. So it makes sense that tweeting can help, too:

Something about texting or tweeting when I panic makes me feel safer. I suppose my logic is this: if I truly find myself in a worst-case scenario situation, like passed out in an aisle at Target, at least someone will have received a text or tweet from me announcing my less-than-well feeling. Prior to hitting the floor, that is. And someone who loves me or cares about me will have a lead when I don't come home at 8 pm as promised.

Call it a safety behavior. Because it is.

But for now, it helps me to stay in the store. It helps me to stay in the midst of what I erroneously perceive as a dangerous situation. It helps me to not run away from my fears.

And, it helps me to track my cognitions. A big part of panic and agoraphobia, of course, is driven by our thoughts. And tracking those thoughts mid-panic elucidates my underlying fears. It captures fear from the moment of panic itself and not what I later perceive the fear to be.

A nice look inside panic and how it can be managed.

"The Architecture of Fear."

If you’re anything like me, your panic- or anxiety-fraught periods produce a sense of place that’s particularly attuned to anything even potentially fearsome. For example, usually I love crowded events, feeding off the energy of the audience, the thrill of watching something happen in person – ballgames, concerts, theater. But when I’m feeling anxious, even the sight of a sports stadium or concert hall gives me the willies. (As do highways, bridges, subways, shopping malls, airports, office buildings, supermarket freezer aisles, crowded sidewalks, parking structures, the gym…. Raise a glass to agoraphobia!)

What if it’s not just your panic or anxiety speaking, though? What if there are ways that “be afraid!” messages are embedded in many aspects of society, whether intentionally or not? This is the kind of question posed by the art in “The Architecture of Fear,” a show at the Belgian gallery Z33.

From the show’s catalog:

The society of fear is more than just a feeling…Think of the many government warnings, the health messages and increased safety measures. Risk elimination is the word…The question of course is how and to what extent this affects an individual. Do these countless warnings not only inspire more fear? Does that camera above the station tunnel not suggest that something is wrong? 

…The fact that fear is used as a life style choice, as a sales pitch or as political bait makes it no less real. The question is how we deal with fear, what kind of world we want to create for ourselves.

Some cool stuff here, in a variety of media. (My inner conspiracy theorist is particularly drawn to Trevor Paglen's "limit telephotography" of secret military bases.) Wish I could afford a quick trip to Belgium!

On emotion, anxiety, panic, and fatherhood.

I grew up out of touch with my emotions. If you consider those with emotional self-knowledge, with an emotional fluency that permits them to discern a wide and nuanced range of their feelings, as being akin to the Sami people of northern Europe, with their ability to identify and name many types of snow (for which they have more than 100 words), I was more like a Floridian whose vocabulary for frozen precipitation is limited to "snow," "sleet," and "slush."

In other words, my understanding of my emotions was simple and stunted. If you asked me how I was feeling, I'd say "great" or "okay" or "bad." I didn't realize there were gradations of feeling beyond these. 

This inability to understand what I was feeling extended even to physical ailments. Even when I was under the weather, I didn't trust the feelings telling me that was the case. I'd tell my mom I didn't feel well, that I had a cold or flu and thought I should stay home from school, but deep down inside, despite the physical symptoms -- the sweat-stained sheets, the sore throat and raspy breath -- I'd be wracked by guilt, by the belief that I was trying to pull something over on my parents, on the school, on everyone who was trusting me to do and be my best. Only when my mother showed me the thermometer, with its reading of well over 100 degrees, would I begin to believe what my body was telling me.

This went on for years. For instance, in graduate school, 20 years ago now, I missed two weeks of classes because I was unable to get out of bed to do much more than cross the street to go to the grocery store. I believed I was depressed, or agoraphobic, or some equally invalid form of invalidism, that what I needed was not medical attention but sufficient willpower to suck it up and power through. In retrospect, I probably was depressed, but that wasn't all that was going on. Months later, a blood test revealed that, in fact, I'd had mononucleosis during that time. Imagine: I had mono, but was unable to accept that I was sick.

It went on for years, and it still goes on. Maybe it's partly a genetic thing; I don't know. But I do know that it was at least partly learned. I grew up in a time and place that frowned upon any display of vulnerability among boys and men, and in a family where anything less than perfection was experienced as a disappointment. Fortunately, good grades came easily for me. But sadness, anxiety, fear -- these were for neurotics, for weaklings. A comedian might get away with expressing these things for a laugh -- think Woody Allen -- but real men were cut from the same kind of cloth as Clint Eastwood and Steve McQueen. And so I spent much conscious effort molding myself in my teens into something more than just an honors student, and became a cocksure jock.

As a result, I never learned to name my more difficult emotions, much less accept them. I never learned that they could be faced and managed, that they could even be transmuted by artistic endeavor into something universal and sublime. These were lessons I would only learn on my own, as an adult, during the passage through periods of tremendous confusion and pain, periods tainted by the severe cognitive dissonance and shame that accompany having to completely rethink who you are and can be.

As I understand it, some people come to panic by modeling the anxious behaviors, the fears and anxieties and depressiveness, of their loved ones. This was not remotely my experience. Rather, I'm convinced, I came to panic by having no model for experiencing an entire swath of my more challenging emotions. I'd been taught to push down those emotions, to disregard them. To disregard my body and a good part of my mind. This had its upsides when it came to performing in the classroom or on the athletic field, but eventually, when panic smashed the dam holding back my darker emotions and my psyche was flooded with knowledge about myself that I was not ready to accept, I was left broken, overwhelmed. Drowning in shame at who I'd become, utterly unable to reach out to others for help, and driven to commit mistake after mistake after mistake as a result, before finally realizing that the ways I knew to make my way in the world were not working and that I'd have to make some major changes if I didn't want to end up slicing my wrists or caked in soot and living under a bridge, a raving lunatic.

So it was with interest that I came across this article, from Psychology Today. Here's a taste:

"I met someone when I was in grad school, and I had butterflies in my stomach," Lisa Barrett, a psychologist at Boston College, says. "I thought this meant that I was in love, but I actually had the flu."

The episode comes up frequently when Barrett describes her conceptual-act model of emotion, an entirely new paradigm that challenges decades of psychological thinking (and won her a $2.5 million NIH grant in 2007).....

Barrett argues that you can learn how to change how you interpret internal states, and even increase your emotional granularity: "If people have 20 words for anger (irritation, fury, rage, hostility), then they will perceive 20 different states and better regulate their emotional states as a result."

It's interesting stuff, stuff that maps to what I've learned doing CBT, psychotherapy, and meditation, and it's absolutely going to inform the way I raise my son. If I have anything to say about it, he will know that all his feelings are valid, and none to be feared; that mistakes are a good thing, a chance to grow and learn; and that he is loved unconditionally, regardless of any stumbles he should make on his path through life.

Adult anxiety: another reason not to hit your kids. (As if anyone should need one.)

Like the Catholic Church scandal before it, the Penn State story has pedophilia on everyone's mind. The details of that story are horrific (as a father, I can say I'd have a difficult time preventing myself from putting Jerry Sandusky or Joe Paterno in the hospital if I were to run into them), but I have to hope that the fact that abuse is now so dramatically on our national radar screen ends up having some positive effects -- that it will embolden victims of and witnesses to abuse to speak out, and result in more accountability among perpetrators.

Of course, pedophilia isn't the only flavor of child abuse. While we've come a long way from widespread acceptance of the "spare the rod and spoil the child" philosophy, non-sexual physical violence is still part of far too many children's lives. (For instance.)

That the ramifications of violence can be severe and long lasting should come as a surprise to only the most cold hearted among us. According to one recent study, even those "without a history of physical or sexual abuse during childhood" can be adversely affected by "slapping and spanking":

...those who reported being slapped or spanked "often" or "sometimes" had significantly higher lifetime rates of anxiety disorders...alcohol abuse or dependence...and one or more externalizing problems...compared with those who reported "never" being slapped or spanked...There appears to be a linear association between the frequency of slapping and spanking during childhood and a lifetime prevalence of anxiety disorder, alcohol abuse or dependence and externalizing problems.

The lesson: Spare the rod. Period.

The best of PANIC!: Perfectionism and anxiety.

"'Good enough' may be good enough for other people, but it's never good enough for me."

"When I make a mistake, I feel like a failure."

"I study hard because I'm afraid to disappoint my parents."

Do any of these lines sound like something you'd say? Then you're a perfectionist.

According to "Pitfalls of Perfectionism", from Psychology Today, perfectionists "are made and not born, commonly at an early age." Once established, perfectionism tends to get in the way of one's ability to live life to the fullest:

Perfectionism seeps into the psyche and creates a pervasive personality style. It keeps people from engaging in challenging experiences; they don't get to discover what they truly like or to create their own identities. Perfectionism reduces playfulness and the assimilation of knowledge; if you're always focused on your own performance and on defending yourself, you can't focus on learning a task. Here's the cosmic thigh-slapper: Because it lowers the ability to take risks, perfectionism reduces creativity and innovation—exactly what's not adaptive in the global marketplace.

Yet, it does more. It is a steady source of negative emotions; rather than reaching toward something positive, those in its grip are focused on the very thing they most want to avoid—negative evaluation. Perfectionism, then, is an endless report card; it keeps people completely self-absorbed, engaged in perpetual self-evaluation—reaping relentless frustration and doomed to anxiety and depression.

Perfectionism, of course, leads to heaps and loads of anxiety. Nobody's perfect, after all -- so expecting perfection is by definition a doomed enterprise. No wonder, then, that it's so prevalent among those with anxiety disorders:

Perfectionists fear that a mistake will lead others to think badly of them; the performance aspect is intrinsic to their view of themselves. They are haunted by uncertainty whenever they complete a task, which makes them reluctant to consider something finished. "People may not necessarily believe they made a mistake," explains Frost, "they're just not quite sure; they doubt the quality of their actions." Intolerance for uncertainty characterizes obsessive compulsive disorder and generalized anxiety disorder, too.

Unfortunately, according to the article, more and more Americans are growing up to be perfectionists. Why? Parents who overschedule and overmanage their kids' lives:

"I don't understand it," one bewildered student told me, speaking for the five others seated around the table during lunch at a small residential college in the Northeast. "My parents were perfectly happy to get Bs and Cs when they were in college. But they expect me to get As." The others nodded in agreement. Today's hothouse parents are not only over-involved in their children's lives, they demand perfection from them in school.

And if ever there was a blueprint for breeding psychological distress, that's it.

So lay off your kids. Let 'em know it's okay to make mistakes -- that mistakes are in fact valuable, in that they provide important lessons. I don't mean you should stop holding your kids to high standards, just that you should strive to let them know you'll love them just as much whether they succeed or fail in whatever they do. Maybe, just maybe, it'll give them the self-acceptance and flexibility of thought and behavior they need to avoid developing panic, anxiety, or OCD.

How we're making our children more anxious and depressed.

When I was a kid on Long Island, summertime would unleash a gaggle of us to roam the streets and sidewalks of our suburban neighborhood from morning 'til dark, with breaks only for lunch and dinner in the kitchens of our ranches and split levels.

Today, those same streets and sidewalks are devoid of children. Why? Here's what a recent Atlantic article says:

"Since about 1955 ... children's free play has been continually declining, at least partly because adults have exerted ever-increasing control over children's activities," says the author Peter Gray, Ph.D., Professor of Psychology (emeritus) at Boston College...

..."It is hard to find groups of children outdoors at all, and, if you do find them, they are likely to be wearing uniforms and following the directions of coaches while their parents dutifully watch and cheer."

Why has this happened? Fear: "...parents mentioned child predators, road traffic, and bullies as reasons for restricting their children's outdoor play."

Never mind that the actual threats facing our kids are likely no greater than they've ever been. If kids' lack of unstructured, self-directed play seems like a bad thing to you, you're onto something. It's the rare kid who doesn't find it stressful having a parent looking over his or her shoulder, and as we've discussed before here on PANIC!, stress is bad news. And the costs to children of not being able to explore and socialize and make mistakes and come to decisions on their own can be high, and may include an increased likelihood of anxiety and depression as they grow up:

There has been a significant increase in anxiety and depression from 1950 to present day in teens and young adults and Gray cites several studies documenting this rise. One showed that five to eight times as many children and college students reported clinically significant depression or anxiety than 50 years ago and another documented a similar trend in the fourteen- to sixteen-year-old age group between 1948 and 1989.

Suicide rates quadrupled from 1950 to 2005 for children less than fifteen years and for teens and young adults ages 15-25, they doubled.

Of course, this doesn't recognize that anxiety and depression rates depend on unknowable changes in rates of people seeking treatment for these problems and psychiatric diagnosis standards, but it seems pretty likely to me that driving our kids harder and giving them less space to find their identity and learn to manage their emotions on their own is a recipe for anxiety and depression later on.

The bottom line for parents? Try a little less structure and a little more "just be home for dinner."

The best of PANIC!: Mental health and the workplace.

For those of us not lucky enough to have been born into great wealth, not working because we have panic or anxiety (or their cousin, depression) isn't a great option.

Trust me. I've tried it. For most of my life since developing panic disorder in the late 1980s, I've avoided working in crowded districts of the cities where I've lived, or anywhere where I might have to endure a busy rush hour to commute to or from work. Over the years I've had panic attacks during all kinds of commutes -- driving, and on buses, subways, and commuter trains -- as well as in elevators, on crowded business-district sidewalks, and while just plain sitting at my desk.

Too often, my morning commute has been one of hyperventilation and white knuckles. More than once, I've left work early because panic was pending or already full blown. Once, I even had a panic attack just steps from the door to the office building where I worked, and was compelled to turn around and go home rather than having to open that door. More times than I care to remember, I've turned down jobs that, before panic, I would have jumped at, whether because of the commute or my growing fear of offices in general.

For much of my adult life I've been chronically underemployed, unable to keep a job for very long, unable to secure enough work that I could do from home to make a real living. Luckily I've now found a full-time job that's interesting, pays well, and allows me to telecommute almost all the time. But I'm in debt, behind on my taxes. My credit score sucks worse than that Kevin Federline CD. I'm in my mid-40s, and I've only just gotten into a situation that allows me to start building a nest egg. I know intimately what it's like to live from paycheck to paycheck, from month to month.

In other words, the price of not working is equally as formidable as the price of going to work while experiencing panic attacks. Unfortunately, a degree (even an advanced degree) and a desire to do good work aren't enough, most of the time; there are few ways to build a career without putting in your fair share of face time with the people you're working with or for.

I believe I might have averted at least some of my problems if I hadn't felt compelled to hide my panic and depression from employers. In that case, I believe, I might've dealt with my mental health issues before they'd conspired to create an agoraphobia as sturdy as the one I've been blessed with.

Which is why I laud the efforts of a Brit named Jonathan Naess. Naess battled bipolar disorder while building a successful legal career, which he's since left to start a non-profit dedicated to fighting stigma against the mentally ill in the workplace. From the link:

"I think there is a really deep-seated and gut reaction to the mental health issue that's been around for hundreds of years," says Naess. "It's socially unacceptable."

To combat stigma effectively he says people "from all walks of life" including those in senior positions need to be visible and to use the exposure to prove that people who experience mental ill-health are not "tarnished, broken, sub-species". For Naess, this means focusing on an arena where people who have a mental illness are more likely than any other group to be discriminated against: work.

Recent research shows the extent of the problem. Mental Health: The Last Workplace Taboo, published last year by the charity Shaw Trust, concluded that there was "widespread discrimination towards people with mental ill-health". In its survey of employers, one in three said they thought people with a mental health problem were less reliable than other employees.

The study found that most companies do not have an effective formal mental health policy and that 71% of employers estimated that only about 5% of their workforce may have a mental health problem - a severe underestimation when considering that three in 10 employees will experience mental health problems during a single year. One in four people are expected to have an incidence of mental health difficulty in their lifetime. Naess says the need to educate employers "cannot be underestimated".

With this in mind he has for the past 18 months been establishing a network of professionals to campaign alongside him and contribute professional expertise. The list includes directors, chief executives, managers from the private and public sectors, lawyers and communications experts, and each with personal experience of dealing with a mental illness while sustaining a successful career. Naess admits that he was concerned people would be reluctant to sign up, fearing negative ramifications at work. "I thought there might be just two or three of us and I wasn't sure if we'd only get retired people." All of the volunteers are of working age.

Naess says he wants to use the collective business experience of the volunteers to convince employers to come to terms with the fact that people who are mentally ill can make good employees, and encourage them to put in place mental health policies.

 First posted here.

Stress: portrait of a killer.

Panic, of course, is an extreme reaction to stress. It may seem like it comes from out of the blue, but it doesn't. More often than not panic disorder develops in one's 20s, a particularly stressful time of life in our society, when most of us first have to deal with the responsibilities and worries that coming with making our own way in the world. (Think: career, rent, finding a mate...) We become more likely to develop panic again in middle age, after we've raised our kids and suddenly have to adjust to an empty nest and increasing reminders of our mortality. (Think: health concerns, ageism in the workplace, increasing numbers of friends and associates passing away...) Regardless of when it happens, though, panic is at least in part the product of stress.

So readers of this blog will be interested in this National Geographic documentary. Among others it features Stanford neurobiologist Robert Sapolsky, whom I've mentioned in the past here on PANIC!

Sapolsky has been studying stress in baboons for decades. He's found that a baboon's location in its social hierarchy is central to its stress level. The more power a baboon has to control its environment, the less stress it experiences. The less power, the more stress.

This is also the case among humans, as the Whitehall Study mentioned in the documentary showed. That study looked at stress among British civil servants. Despite all the subjects sharing the same basic work environment (desk jobs) and access to health care, the lower workers were in the workplace hierarchy, the higher their risk of disease.

There's no way around it: Stress is bad news. Chronic stress shrinks the hippocampus, the brain's seat of memory and learning. It accelerates the shortening of our chromosomes' telomeres, which prevent the ends of chromosomes from fraying. It causes hypertension and heart disease. It surely contributes to anxiety. And it probably even contributes to the global obesity epidemic.

The problem in humans is that in addition to experiencing stress based on real-world threats, we spend so much of our mental energy creating imaginary or only-possibly-justified stress in our minds. As Sapolsky puts it, referencing animals' response to threats from the environment:

We turn on the exact same stress response for purely psychological states. Thinking about the ozone layer, taxes coming up, mortality, but we’re not doing it for a real physiological reason, and we’re doing it nonstop.... No zebra on earth running for its life would understand why fear of speaking it public would cause you to secrete the same hormones.

But there are steps we can take to reduce stress. As Sapolsky discusses, when the baboon troop he was studying lost most of its alpha-male members -- who relied on aggression rather than social skills -- it became permanently less stressful and more healthy.

The same effect holds in humans. By and large, society values aggressive, multitasking behavior. But that's the pathway to higher stress. Compassion and nurturing, on the other hand, not only feel good but make us more healthy and less stressed. Building closer social connections even spurs the repair of shortened telomeres.

The pathway to lower stress is clearly marked. Why not take it?

A Buddhist approach to anxiety and panic.

So I've been spending time lately listening to dharma talks (not familiar with Buddha-speak? think "sermon") and guided meditation recordings from Josh Korda of Dharma Punx NYC, whose plain-speaking approach and ability to connect Buddhist wisdom to 21st century neurology even newbies will find friendly and rewarding. (Free audio downloads here.)

Along the way, I encountered a talk entitled "Anxiety relief", which I found to be of real value. Trust me, you don't need to renounce the world and become a shaven-headed monk to appreciate the Buddha's wisdom regarding coping with anxiety and panic. In this talk, Korda talks about the seven anusayas, or underlying tendencies of the mind:

1. The tendency to latch onto things that feel good

2. Fear of things we have no control over

3. Views and opinions about how we think the world should be and people should behave

4. Lack of faith in things that are good for us in the long term but don't pay off immediately

5. Self-centered thinking, or the tendency to take everything personally

6. The lust for life, or desire to live forever

7. The ignorance of what causes our stress (in Korda's words, "We tend to blame the world and the people in the world for all of our anxiety and our stress and our discomfort, when in fact it's created by the mind itself...As the Buddha said, we shoot ourselves with arrow after arrow after arrow. We tell the stories in our heads over and over again of how we've been wronged, and that causes so much more pain and stress than the original event")

Korda goes on to discuss how the anusayas cause stress, anxiety, and panic:

"The Buddha's perspective is that these tendencies are always present, and they're waiting for something to attach to...And then something comes along, the Buddha said, and we make what's known as contact...and then out of this contact...an underlying physical stress and mental mood arises...Then the thoughts come up, trying to explain why we've got this stress or sudden craving...

The entire mechanism, as the Buddha explained, is largely unconscious. There's the unconscious tendencies, then there's the unconscious contact...then there's the underlying physical and mental state that arises, and then finally consciousness notices...

Then the mind begins to shrink, awareness begins to shrink, and we start going into projections, maybe the future or what people are thinking of us...and the mind rifles through possible explanations [for what we're feeling]...If we leave it unchecked it can blow out into panic attacks or avoidance tendencies.

(Sound familiar?)

Korda then goes through the Buddhist approach to dealing with anxiety:

1. Work first with the physical symptoms; bring tranquility within; don't fight acute anxiety by trying to figure out the source of your anxiety

2. Practice restraining the mind from thinking about things you have no control over; train the mind to focus on things we have control on here and now

3. Take care of yourself. Eat well, have good conversations with wise people, get enough sleep...

4. Tolerate the inevitable rather than taking it personally (Korda: "I was humored to read about the number of people who got virulently outraged after the huge snowstorm that there was snow on their street...")

5. If you've identified a source of stress, avoid it if you can (Korda: "This is one of the 'duh' ones...")

6. Be aware of the body when you have anxiety, and immediately discount any thoughts you have at that moment; those thoughts are not to be trusted

7. "If you have even the most minor of daily meditation practices, that goes an enormous way toward taking your amygdala off of its hair trigger"

Good stuff. Try it; it can only help.

Did that panic attack really come from out of the blue? Nope.

They can seem like they come with no forewarning, for no reason, but there's a back story to every panic attack. It might involve caffeine or alcohol or other drugs, or a period of heightened stress, or a genetic predisposition to panic. We know these things. Now we also know that panic attacks are presaged by measurable physiological activity. According to a new Atlantic article:

Though those who panic don't realize it, their attacks are in fact foreshadowed by minute physiological signals, according to a study led by Southern Methodist University's Alicia Meuret in the journal Biological Psychiatry. "The hour before panic onset was marked by subtle but significant waves of changes in patient's breathing and cardiac activity, not just the moment of onset of the attack or even during the attack," she says. "Our analysis provided us with a whole different pattern."

That pattern goes like this: Physiological instabilities occur in repeated bouts or waves and are often initiated by heart rate accelerations, followed by changes in breathing and carbon dioxide levels. Ultimately, breathing becomes much shallower, causing a spike in carbon dioxide levels that lead to symptoms that could no longer escape the attention of those who panic. More precisely, they experience terrifying sensations, such as dizziness, air hunger, and shortness of breath.

...the researchers could still not determine why sufferers are unable to perceive panic attacks earlier. But some clues did emerge from the physiological patterns they observed. During recurring bouts, the body may be silently fighting off physiological instabilities that "return to a baseline but then restart," Meuret says. As a result, only one wave of disruption, the one that could no longer be pacified in secret, is felt. A gradual crescendo of anxiety never occurs, and the panic attack appears to have come out of nowhere.

UCLA anxiety expert Emanuel Maidenberg says this research may inspire new coping methods. He says since autonomic arousal symptoms precede awareness, the therapeutic practice of identifying and reexamining fears may potentially be initiated earlier, so patients could pursue threatening activities head-on.

The more we pay attention, it seems, the earlier we may be able to get started heading off panic at the pass. Perhaps even more important: While the physiological changes leading up to panic may continue during the attack, they're no more dangerous than what's come before:

...the researchers did not find any indications that physical changes during panic attacks were all that extreme. Meuret says that the fluctuations in heart rate and breathing were significant, but they never spiked to damaging levels....

So would telling the anxious that 'the worst is over' when they panic help? Yes, says Meuret. "Based on our findings, this would indeed be very true."

So, you know, yay panic!

Photo credit.

The best of PANIC!: A Buddhist perspective on coping with anxiety.

I've decided it's time to occasionally republish the more popular PANIC! posts from the past so that newer visitors to this blog will get a chance to weigh in on them. Following is the first such blast from the past, complete with comments to date (you can view the original post here). Please feel free to join the conversation!:

A Buddhist perspective on coping with anxiety.
The website of the Buddhism Society at Brown University has an article by Venerable Thubten Chodron entitled "Dealing With Anxiety" [note: this article is now available here], which posits that anxiety is caused by our natural inclination towards self-centeredness:

If somebody else's car gets dented we say, "Well, that's too bad," and forget about it. But if our car gets dented, we talk about it and complain about it for a long time. If a colleague is criticized, it doesn't bother us. But if we receive even a tiny bit of negative feedback, we become angry, hurt or depressed.

Why is this? We can see that anxiety is very intricately related to self-centeredness. The bigger this idea that "I am the most important one in the universe and everything that happens to me is so crucial," is, the more anxious we are going to be. My own anxious mind is a very interesting phenomena. Last year, I did a retreat by myself for four weeks, so I had a nice long time to spend with my own anxious mind and know it very well. My guess is that it's similar to yours. My anxious mind picks out something that happened in my life -- it does not make a difference what it is. Then I spin it around in my mind, thinking, "Oh, what if this happens? What if that happens? Why did this person do this to me? How come this happened to me?" and on and on. My mind could spend hours philosophizing, psychologizing and worrying about this one thing. It seemed like nothing else in the world was important but my particular melodrama.

When we are in the middle of worry and anxiety regarding something, that thing appears to us to be incredibly important. It's as if our mind doesn't have a choice -- it has to think about this thing because it's of monumental significance. But I noticed in my retreat that my mind would get anxious about something different every meditation session. Maybe it was just looking for variety! It's too boring to just have one thing to be anxious about! While I was worrying about one thing, it seemed like it was the most important one in the whole world and the other ones weren't as important. That is until the next session arrived, and another anxiety became the most important one and everything else was not so bad. I began to realize it isn't the thing I am worrying about that is the difficulty. It is my own mind that is looking for something to worry about. It doesn't really matter what the problem is. If I'm habituated with anxiety, I'll find a problem to worry about. If I can't find one, then I'll invent one or cause one.

One means to coping with anxiety is to adopt a perspective that goes beyond just yourself:

By meditating on the kindness of others, we will see that we have actually been the recipients of an incredible amount of kindness and love from others. In doing this meditation, first think about the kindness of your friends and relatives, all the different things that they have done for you or given you. Start with the people who took care of you when you were an infant. When you see parents taking care of their kids, think, "Somebody took care of me that way," and "Somebody gave me loving attention and took care of me like that." If nobody had given us that kind of attention and care, we wouldn't be alive today...

...Think about the incredible kindness we received from those who taught us to speak. I visited a friend and her two-year-old child who was learning to speak. I sat there, watching as my friend repeated things over and over again just so her child could learn to speak. To think that other people did that for us! We take our ability to speak for granted, but when we think about it, we see that other people spent a lot of time teaching us how to speak, make sentences, and pronounce words. That is a tremendous amount of kindness we have received from others, isn't it? Where would we be if no one taught us how to talk? We did not learn by ourselves. Other people taught us. Everything we learned throughout childhood and everything we keep learning as adults -- every new thing that comes into our lives and enriches us -- we receive due to the kindness of others. All of our knowledge and each of our talents exist because others taught us and helped us to develop them.

It may or may not help you achieve enlightenment, but this sure seems like worthwhile advice.

Blue light: cure for anxiety?

From an April 2011 release from the National Institute of Mental Health:

Scientists, for the first time, have switched anxiety on-and-off in active animals by shining light at a brain pathway. Instinctively reclusive mice suddenly began exploring normally forbidding open spaces when a blue laser activated the pathway – and retreated into a protected area when it dimmed. By contrast, anxiety-like behaviors increased when an amber laser inhibited the same pathway.

Researchers, supported in part by NIMH, used a virus, genetic engineering and fiber-optics to control the pathway in the brain's fear center with millisecond precision.

"Our findings reveal how balanced antagonistic brain pathways are continuously regulating anxiety," explained Karl Deisseroth, M.D., Ph.D., of Stanford University, a practicing psychiatrist as well as a neuroscientist. "We have pinpointed an anxiety-quelling pathway and demonstrated a way to control it that may hold promise for new types of anti-anxiety treatments."

The hope is that ultimately scientists will be able to develop a treatment to "quell anxiety instantly without producing unwanted side effects, such as drowsiness, often experienced with current anti-anxiety medications." In other words, "a treatment something like deep brain stimulation for depression."

Photo credit.

Relaxation? There's an app for that.

If you're interested in the  therapeutic smart phone apps I've discussed in the past here on PANIC!, you may also be interested in a recent New York Times article reviewing apps designed to enhance stress relief and relaxation. From the article:

Unless you’re listening to “Dark Side of the Moon” on your smartphone, it’s hard to see them as devices for relaxation. More often, they’re for aggressive thumb-tapping, Angry-Birding exercises.

But for every yin there is a yang. And mobile phones are no exception.

A path to a quiet mind can travel through apps dedicated to guided meditation and sleep enhancement. And fortunately, for those who need more, or better, rest, or who are inclined to still their minds for a few minutes a day, some good ones exist on all the major mobile platforms.

Relaxation ... the scientific way!

So there I was last week at the neighborhood filling station (probably more accurately described as a gasoline-and-sundries emporium). Inside, should I have desired sustenance, awaited Cheez-Its, Fritos, beef jerky, energy drinks -- all the basic food groups. Avoiding that cornucopia of salty, sugary temptation, instead I stood at the pump, tickled by the great privilege of, for once in a long while, paying fewer than four dollars per gallon to fill my car's tank.

Quick back story: I was under a lot of stress. Work stress. "We're not going to pay you for the 100 hours of work you've done in the past seven business days" stress. But while I recognized that I was feeling peeved, I had no idea how peeved I actually was.

Around me, six or eight other drivers were filling their tanks as well. Above each pump, video screens ran taped advertisements, and several of the other drivers stared at the screens, seemingly enthralled at this rare and exquisite opportunity to consume free audiovisual infotainment. The ads were the same from pump to pump, but they weren't synched, resulting in a Babel of arrhythmically repeated words and intonations.

When my tank was full and I'd returned the pump to its holster, a message on another screen, separate from the one that continued to blare advertisements above it, inquired whether I'd be interested in adding a trip through the drive-through car wash behind the convenience store branch of the emporium. Why, yes, I would, I thought. Conveniently, the car-wash options were listed from most expensive (the Ultra) to least, so that I was forced to scan all the options to find the one I desired (the lowly Express).

Receipt containing my car-wash code in hand, I then drove to the entrance of the car wash. There, another screen asked me to input that code. Which I did, checking its digits carefully as I punched the corresponding keypad buttons. At which point, rather than offering me a message along the lines of "thank you, please drive forward until the red light illuminates" -- you know, a polite "we appreciate your business, we know you're busy, let's get on with it" message -- a metallic female voice blurted suddenly out of a box alongside the screen and keypad.

"Would you like to upgrade your car wash?" the voice asked. "Please insert an additional three dollars to upgrade to Supreme, or an additional six dollars to upgrade to Ultra."

Without realizing what I was doing, bile dripping from my voice, I responded, "Suck my ass."

To a machine. A lifeless piece of technology.

And at that moment, I realized that I was really angry, and really stressed. That the cortisol was probably running through my system like bulls through the streets of Pamplona. That I needed to relax. I might not like many aspects of our modern world, in which the learnings of science are so often used to force upon us a cacophony of messaging urging us to buy, buy, buy, but this was not a healthy way to react to that world.

Thankfully, when I got home, I found this article, outlining five "scientifically proven" relaxation techniques.

Yes! I knew it! Science is not all bad! In fact, it can be downright awesome!

The techniques outlined in the article? 1. Progressive relaxation; 2. Applied relaxation; 3. Autogenic training; 4. Meditation; and 5. Cognitive-behavioral therapy. I've been relying on #4, meditation, to help relieve my stress in recent days, but they're all worth checking out. Read the article to get started.

And good luck! May these techniques help you find relief from stress, anger, and anxiety, and find greater contentment and happiness. Even if just for a moment.