In this dialogue Julie had been worried about the impact that panic disorder was having on her life in general – on her relationships with family and friends and so on. I could tell that she felt that she had a ‘deeper’ problem that still needed to be ‘fixed’ apart from the panic
J – that’s very important. too.. .. after every major panic attack .. i feel like ending my life… seriously… i know i don’t have guts to do that.. but the thought is very sadly serious
even today i felt that for some time
i just hate that so much
it is living in a prison.. i feel like just being free of that horrible sensation.. and all the
things it stops me from doing.
R – but u are ok now?
J – so its very important to tell people about how to handle life in spite of panic..
because that is going to affect the panic too
yes
but i am ok
R – yes
J – i know .. handicapped or whatever Melanie still needs me..
R – but that is precisely why CBT makes it so important that people do
EXPOSURE practice
J – so that thought made me come out of the depression
R – CBT doesn’t just tell people how to ‘cope’ with panic
that’s not necessary
J – ok
R – if i told you how to ‘cope’ today u would still be in panic
this is important
J – it is very important to tell people how to get out of the guilt
yes
R – Yes – but it can be helpful if people see that the feelings of guilt are another
symptom of having panic disorder
J – yes
R – a symptom
common – normal
if u give it importance by discussing it
then u are into more thoughts that are u this person or that
its just a normal response everyone has to panic
nothing more
Julie: yes
R – its vital to keep focussed on panic as a mistake of body sensations
nothing else
all else is ‘effect’ of that
emotions don’t cause panic
nor does guilt or depression
we are simply reacting with fear to very unpleasant sensations
Misinterpretation and catastrophisation
that’s it
J – but the obstacles that it creates for the people and yourself in leading the day normally is so HUGE .. that it does become a HUGE social and psychological problem.. and it does create relapses … almost like any addiction.
R – it DOES if the panic disorder is untreated
but you are working through the panic now
all else will resolve once you overcome the fear of panic
depression is a secondary disorder with panic very often
but CBT doesn’t work on the depression first
because it is only due to the panic and will resolve once panic is fixed
J – i think the practice and rehabilitation both are necessary together? … you are
helping me in both ways.. so its helping me..
R – yes – but that is different
J – is it not a bad cycle?
R – when I help u with the PANIC – i never talk about your life
J – it constantly blocks you from leading a normal day … then again faced with all the same problems.. and then panic.. of would things ever be ok
R – it is separate from the panic
J – ok
yes
R – panic is TOTALLY separate from life stress in the way it works
J – when one panics.. all those thoughts keep coming in mind
ok
R – yes but to work out each thought about your life would make it WORSE
because in PANIC u cant think logically
J – yes
R – u leave that to one side and deal with the SYMPTOMS
then once it has calmed down u may feel fine ANYWAY
because fear is gone
if u still have unresolved issues in your life then ok – deal with them separately
but don’t mix them into panic practice
J – but so many people around you are affected by it.. every day
R – all the more reason to just stop the PANIC
J – so there is not a moment of relaxation
yes
R – do u see this?
are u confused about what to work on
ALL u should work on – regarding the actual panic attacks – is the cycle of fear
don’t think – “I panic because of .. or..”
THAT causes MORE anxiety
J – for example today it’s susan’s birthday … so now that i am in panic
should i go or should i not go.. if i go feel panic there .. their party will get disturbed..
if i don’t go.. i don’t do something that i am expected to do.. and melanie’s going
there also depends upon my going.. and for me its a horrible experience anyway… so
living completely stops.. ..
R – panic is NOT dangerous
J – ok
R – exactly
u are ADDING anticipatory anxiety
that is a SYMPTOM
J – so its panic , crying , panic , crying for me.. when its this bad.
R – that’s because u aren’t taking practice seriously enough
u aren’t going through the practice every time u think of it all
u are analysing
rather than practicing
when panic thoughts arise u should PRACTICE with them
J – yes… how to deal with people who are there around you .. the situations around you and still practice
R – let go – relax stomach – etc
J – yes
R – but that’s the thing
there is only ONE way
J – when the symptoms are a little bearable.. then all the tension and thoughts come back.
R – to practice through it
yes
J – ok
R – I was the same
that’s why i got stuck with it so long
i want u to see something RIGHT NOW
are u listening
J – when one panics one feels so stupid and clumsy .. because of the fear .. and then feel its necessary to carry forward the image of being ‘stupid’ .. or people will think you were ‘acting ‘ when in panic.. its subconscious.. but it happens..
yes
R – this would NOT happen very much longer if you took the exposure practice seriously if you MADE yourself feel panic EVERY DAY
to practice through it
but you aren’t doing that
so u only practice on panic when it pops up now and then
which is very small exposures
too far apart
J – yes i will
R – so your learning is weakened
can u see this?
J – yes
R – can u see if u FORCED yourself to go through this every day to small degrees
u WOULD HAVE TO learn something
u would be FORCED to memorise the practice statements
can u see how vital that IS
u have gone out yes – but you hardly ever panic because you stay ‘safe’
J – so many variables are at work. .. yes i know.. i am just trying to see the obstacles that come in the way of exposure and practice
R – so the big bad panic is still a fear for you
J – how to stick to the decision..
R – u come back from exposure and say – “it was so great – i didn’t panic”
J – how to have discipline
R – and that was a wasted exposure
J – all these things are important to address
R – yes
J – as the panic does break your will so badly
R – that’s why CBT is SO effective
J – ok
R – because exposure is a big part of the treatment and exposure is THE most effective treatment for panic
J – my brain feels tired today .. still feeling jittery . .. words are looking blur now.
R – practice NOW on that
J – yes
R – let go all over
let your stomach relax
breathe properly
feel feet on floor
come back into room
J – sitting on the floor
yes
R – lol
ok
listen to sounds
LET YOURSELF FEEL BAD
its ok
u are in NO danger at all
it’s JUST feelings
J – yes
R – that’s all
it only ever WILL be just feelings
its just fight or flight
J – i am able to immediately tune when you say it.. but i cannot say it myself.
R – and guess why
lol
J – because i am constantly adding second fear
R – but what else
in answer to your statement
WHY cant u say it yourself
J – my mind not working right now
R – ok – if u practiced on actual anxiety everyday for two weeks
do u think u would know the practice better
J – yes
i will do exposure every day
R – we have only really done proper practice a few times in two months
J – yes
R – not much chance of u being an expert
J – yes
R – that’s why the longer u spread it out the longer u HAVE panic
J – ok
i will do a crash course
R – its a simple equation
J – yes
R – the more practice you put in the faster you recover
J – and wont i get so exhausted doing it and die?
R – Practice where u faced SOME real anxiety
u do it GRADUALLY
J – i am so tired today
feel so sick
R – ok
but that’s ok
i am tired too
VERY tired
J – oh?
R – I also get days when i feel sick – it doesn’t mean anything ‘bad’
J – yes
R – keep that in mind
J – ok
R – everyone feels all this at some time or other
J – i will do practice
R – don’t build it up
not today
J – yes
R – u have done it for today
J – ok
R – although keep practicing on how u feel
J – ok
R – write out the flashcard
J – yes
R – good
then EVERY time your script writing mind kicks in
read that instead
J – yes
R – let panic happen
its ok
J – yes
R – its ok if it has affected your life
so what
that’s just life
why add worry more to that
J – 🙂
R – just get back to practice
J – yes
R – now is now
get on with it
J – yes
R – tell Julie to shut up
lol
J – thank you so much
yes
R – imagine Melanie was going through this
J – NO
R – and u KNEW that practice would clear it if she did it diligently
J – never – she wont
R – but she went on and on about how it ruins her life
J – don’t even want to imagine that
R – lol
relax
J – yes
R – its just an analogy
J – i know .. i will ask her to shut up and do practice
yes
i know
R – good
so go do the practice
lol
J – yes
thank YOU
R – when u catch yourself ‘wandering’ off into catastrophe-land
bring it back to PRACTICE
J – thank you. .. ok
R – ok chat later