Working with the CBT practice after a setback

 03 February 2012


Hiya Robin

The rollercoaster (of recovery) is parked up for a minute so I thought I’d take the opportunity to email you! lol

I have been re-reading through the whole CBT4PANIC programme this afternoon, going over the scripts at the minute

I had an extremeeely stressful morning at work … sometimes I gain strength from knowing yes I have panic disorder at the mo but I’m still managing to work on an extremely stressful course and extremely stressful ward!! Imagine…. phone going, buzzers going, door buzzer going, babies crying, women or relatives at the desk complaining because the ward is full and staff are mega busy, then the EMERGENCY BUZZER goes!!!! All at once!! I didn’t know if I was coming or going. So sometimes I think “come on you’re not that bad, some people can’t go to the shop!!!”


EXACTLY!  A LOT of your anxiety would be absolutely normal anxiety anyone might have in the same situation


Anyway, I have been slowly improving from my setback, I have listened to an audio book of Claire Weekes which is nice to chill out and listen to, and I have also just finished reading the “Overcoming health anxiety” book that you recommended yesterday but I am yet to do the exercises in them. 

What I still can’t seem to accept is that these sensations ARENT harmful – I have read several times they aren’t, but I have such a hard time believing that the way my body reacts in severe panic won’t kill me. Today when it all kicked off I just felt so strange, like I KNEW I was about to drop or start choking with a heart attack… I know you’ve probably heard it all before. And I realise I’m making it thousand times worse with my catastrophic thinking but my body feels so bad that I just keep thinking, if and when I have to run to an emergency (my ultimate phobia) it really will just finish me off. When the emergency buzzer went off today I just felt sick and rooted to the spot – like running towards it was running towards certain death or collapse. I just feel like I’m going to sink to the ground spouting jibberish or breathing very jerkily, or begin choking and convulsing with a heart attack. It feels SO real I can’t believe that my panic is “just” panic…


The thing to KEEP remembering – again and again and again is this – have ANY of the feared consequences actually EVER HAPPENED – and you feel it is as bad EVERY time – yet here you are

When you read Claire Weekes you will hear her talk of people who have experienced that severe anxiety for 40 YEARS – and nothing happened except the severe anxiety


It’s funny because as I type this I know what I need to do!! I’ve just sort of lost faith in it because these sensations scare me so much I feel like I NEED to experience THEM – the catastrophe – to get  over it – but I don’t want to do that for obvious reasons..!! oh dear.


I know this feeling so well – this was my exact experience during recovery – this strange total fear mixed with knowing that I had to go through it to get over it


Really – honestly – can you not be ‘scared’ to death? 


Can you ever in your lifetime remember a news report where the reporter said – “Man (woman) found scared to death”

It just doesn’t happen – severe anxiety or stress may be problematic for someone with a severe health problem – we all have to accept that – but you DON’T – you have been checked out and you KNOW deep down that you have anxiety – and that’s all

you fit the profile – your symptoms are very common – normal – typical – even what you are saying now is very common – normal – in fact I know of MANY MANY people who report much worse anxiety and fear


I’m so up and down, one minute I know what to do – next emotional reasoning takes over and says “look stop listening about this CBT, you have reached a point where your fight or flight is off the radar and any shock too big WILL kill you”


Keep in mind that fight or flight is not like a disease – it is a perfectly normal physical response – just in your case it is being triggered through fear cycles – but it’s not ‘against’ the body – in fact it’s trying to PROTECT the body


Funny thing is – I got home, thought to do the CBT4PANIC workbook – turned my laptop on, (the CD was already in the laptop) and the CD ejected itself as the welcome screen came on – it NEVER does that (and it’s always in my laptop)

It’s like something was saying “Excuse me – do this!!!!” 🙂


I agree 🙂


So this is where I am at the minute…. I have to go to labour ward on the 12th march for several weeks… that is where I will sink or swim as my phobias are of emergencies like ventouse, forceps. I realise I am taking on quite a task because I’m flooding myself really – but I don’t have much choice about this as if I miss my placements it will knock me far back on the course… do you think I can do this?


Trust me – I have been EXACTLY where you are (with the anxiety) and it seems to go on forever – and sometimes it seems way way way too severe and it just seems like it MUST be dangerous – it IS extreme – and it IS very horrible – BUT.. it IS just fight or flight

you have maybe experienced this extreme anxiety a thousand times – and what has happened apart from feeling terrified – nothing – maybe some fatigue – some jitteriness – some low moods – but did anything really ‘dangerous’ ever happen – NO – here you are

You WILL keep making progress – but it will be 2 steps forward 1 step backward

I get the feeling you are doing it the way I did – working on the panic WHEN you panic – that’s the LONG way – read the books – do the INTEROCEPTIVE exercises – they will RAPIDLY speed things up – and then do real life GRADUATED exposure – even if you are always in extreme situations – the situations you are in already you may just be grinning and bearing them – and relieved if you get through them – if you ALSO plan extra ACTUAL graduated exposure that is when you can learn and measure and test the theory and the skills and so on

the information in the program will work – there is no other way to freedom from this – because you ARE still panicking because you are adding fear to the fear – there is no magic wand to take that fear away – just learning, skills and practice

tell yourself you have NO CHOICE but to do this work – regardless of how bad it feels

but also it ABSOLUTELY IS OK TO TAKE A BREAK – forget CBT sometimes – even THAT is part of practice – just say – ‘to hell with it’ – and do other things – read a trash celebrity mag – watch a soap – listen to some music – eat some ice cream – forget about CBT4PANIC

just take it out again when you want to – no pressure

you are ok if you panic – you are ok if you don’t panic – it’s all just a mistaken belief that the feelings mean something more serious

you will get there 🙂


5 Feb 2012

Thanks again 

It’s funny, I feel like I’m teetering on the brink between understanding and not. At the minute, I find it very hard to get ‘relief’ from anxiety i.e. even being at home, lying in bed, although I think that is more to do with the health anxiety side of things – always focused on something like my breathing. Sometimes even talking to my mum or boyfriend make it WORSE when they used to help me feel relieved!! haha.

Do you think it might be something to do with the part of the journey i’m on? i.e. I feel like anxiety is constantly following me and not allowing me to escape until I understand it. i.e. there’s no peace until I myself face it and accept it.

I remember you saying that setbacks can feel ‘worse than ever’ because there is a tendency for the pressure ‘i should know this!’ etc. So I’m thinking that’s what this is.

Onwards and upwards though!


Hi Nat

I would say that you are at that point I reached when I was reading Claire Weekes – she mentioned that you get to the stage where you are accepting 99% but not 100%

and that 1% keeps the anxiety going – at maybe a lower level than panic but still there

it may take a while for this part to pass

what I did was experiment with how I was reacting

observe how much of you is letting go and how much is desperately trying to get rid of the feelings

observe if you get frustrated with not being able to let go

then let go of THAT

or if you think letting go is actually causing MORE anxiety then try NOT letting go – experiment with trying to make the symptoms WORSE

and try remembering that even if you let the sensations increase you are still in no danger


Just have a day when you forget about practice altogether and go for complete distraction

It’s all extremely subtle – it’s amazing what the mind can produce physically in the blink of an eye

If someone walked into the room right now and shouted “FIRE!!” -your body would instantly go into fight or flight

this can happen with us just thinking “this is going on too long – when will it end – maybe I’m a lost cause…” etc

But overall – you are getting there – this is all normal

sorry 🙂

6 Feb 2012


Hiya Robin

Thanks! that’s a good point you made about fire and the body’s automatic response 

I think I’ve sort of had a lightbulb moment!!!!! happened about an hour ago….. I am currently reading the book by Shad Helmsetter “what to say when you talk to yourself”. I have been feeling anticipatory anxiety all day (its standard) and was reading a part where he said something like “Even when you were born, you were alone, maybe your parents and a doctor/nurse were there but ultimately you took your first breath alone” something like that! lol. Anyway, this sentence made me feel VERY uncomfortable, to the point where I could feel myself tense, I clumsily tried to turn the page but my hand was numb and it felt like I couldn’t make it work! basically I felt very panicky. I ‘felt’ like I was losing control and going to faint.

But then I thought “no. don’t be silly. you know this is an emotional trigger, just ride it out.” I felt very scared, that fear you feel when you think you’re careering towards something you can’t control… I wanted to run to my Mum and cry and shake but I didn’t. I sat there and thought ” Just ride it out. Keep reading the book, even if you continue to feel like this.” I even got up and jogged on the spot, did a few star jumps and purposefully held my breath. My heart raced a bit but then it just started to die down..and I felt RELIEF! and PEACEFUL!! I was amazed. It was truly one of those moments where I have learnt from experience and not theory 

So I have been enjoying the feeling for the past hour. My thoughts keep veering to “ah it’s a fluke, the anxiety will be back soon, can you feel that?” blah blah as negative self talk and anticipatory anxiety does. But I just keep practising the true acceptance “fine, bring it on cos im gonna ride it out” and it hasn’t peaked!

Like you say, experience really does trump everything. Fingers crossed this continues!

06 February 2012 17:45:31


Hi Nat

That’s it!!

and it doesn’t matter if the eureka moment wears off – more will come and you won’t really ever forget these little successes

I had a similar experience with obsessional thoughts – I would get a lot of thoughts of unreality – that would trigger fight or flight – then one day I said to myself “I HATE having these thoughts – and then I had the sudden realisation that the thoughts weren’t me in entirety because a part of me was disliking them – so I kind of ‘sat outside myself’ and watched them – and when I stayed in that part of myself that was just a neutral observer the thoughts did their thing and then passed and I wasn’t as affected

I think you have a had a similar experience because you saw that when YOU let the feelings ride out they pass – and YOU choose to let them and not get carried off in them – and when YOU give them less attention – less power – they eventually pass

that is what will happen from now on – but it will STILL take time – our minds need a lot of convincing

remember it’s like swimming – the first time you let go of the edge and swim two strokes doesn’t mean you instantly lose your fear of water and believe you will always float – it takes repeated practice – repeated sinking and floundering and finally floating and eventually swimming before you really believe you CAN do it – it IS true

but you ARE getting this trust me

eventually you will be COMPLETELY free of panic – you may still get anxious – that’s normal – but you will see no reason to ‘panic’

and finally………

true true true acceptance will even allow it to PEAK – because so what – it’s just adrenaline – it’s just a scary feeling – but that’s all

you will get there 🙂

6 Feb 2012


Wahey 🙂 

I am definitely working on my patience – I was at a friends at the weekend playing xbox games and my boyfriend was teaching me how to play (I was playing against very experienced players – aka geeks ;)! ) and everytime I was shot I’d say “I give up, I’m not playing!” etc but by the end of the night I managed to kill the best twice!! haha.

Were you concerned about your health when you had panic disorder? –  when I get scary sensations like I’m about to choke or whatever or a big rush (i.e. in emergencies) I find it hard to believe the panic is not damaging me.

Applying what I’ve learnt so far I would
1) Reason with myself it hasn’t killed me yet
2) Accept the only thing I can do is make sure I do control what I can – i.e. healthy diet , exercising, and of course working on the panic

Like you say I’m sure I will get there. My mind loves to dwell on these scare articles though!!




Yes – I had health anxiety too

It’s pretty hard to reassure you on this because the anxious mind is a hard beast to tame – but all I can say is that you WILL be free of this within weeks months or a year – not long to have anxiety considering some people have it for 40 YEARS

and those people who HAVE had it for 40 years are still here  lol

I always say that panickers will outlive everyone else because they are so ‘safe’ they are less likely than anyone else to eat bad foods – smoke, drink or get into an accident (because they never leave the house 😉

but seriously – you WILL be fine – this WILL seem like a distant memory before long

you ARE now working on the anxiety – it IS becoming less – so ALREADY your body is experiencing less fight or flight than before

this low level anxiety you are experiencing is actually not much body-wise – it just seems a lot in your mind

all those online articles were written by the same people who say that water or air or salads are bad for us

you know the old joke – the guy goes to the doctor and says every time I drink tea I get a sharp pain in my eye and the doctor tells him to take the spoon out of the cup


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