By Martin Seif, Ph.D. ABPP
Anchor Yourself in the Present: The present is your safe harbor. Stay there by concentrating on “what is” rather than “what if.” Describe your surroundings, talk to someone, count backwards from 100 by threes, read, sing, or listen to the radio. Do not get stuck in your future-oriented imagination. Whenever you start to feel drawn into the future, tell yourself to come back to the present. Stay in the here and now.
By Martin Seif, Ph.D. ABPP
Monitor Your Anxiety Levels: Observe your anxiety level as it rises and falls in relation to what you focus on. Watch your level rise as you try to rid yourself of anxious thoughts and feelings. Watch it fall when you accept and allow them to exist. Your anxiety level will fall even if you do nothing more than wait and let time pass. Once identifying your levels and watching them change becomes a habit, you will be pleasantly surprised to find how relatively infrequently really high levels occur and how quickly they pass when they do arise.
By Martin Seif, Ph.D. ABPP
Identify Your Anxiety Level on a Scale of 0 to 10. Zero means you are feeling no anxiety while ten means you are feeling panic. Identifying and recording your anxiety level makes you an active participant in learning to manage your anxiety and it establishes a baseline against which you can measure your progress.
By Martin Seif, Ph.D. ABPP
Accept, Expect and Allow Anxious Feelings: Try not to feel surprised, disappointed, or angry with yourself when anxious thoughts and feelings arise. These thoughts and feelings, while disturbing, are not dangerous. Allow them to exist, focus on functioning in spite of them and they will soon dissipate. If you fight them or try to get rid of them, your anxiety level will take more time to come down.
Reprinted from The Anxiety Depression Association of America www.adaa.org
You can reduce some of your holiday worry and stress. Try these tips:
Holiday travel can also trigger anxiety. People with panic disorder or agoraphobia may find overcrowded airports and train stations overwhelming. People with travel-related phobiaswho must use mass transit may anticipate their trips with dread, and those with generalized anxiety disorder may find a host of new things to worry about while traveling, further interfering with their daily lives.
It’s important to remember that avoidance will not help overcome an anxiety problem, and it may even stir up other undesirable feelings or consequences, such as being the only family member absent from Christmas dinner.
Instead of dreading travel, consider it a chance to practice facing your fears. Try these tips, too:
For some children the holidays evoke fear and anxiety. “Anxious children tend to be hyperaware of their surroundings. They’re always on the lookout for possible threats or risks in new situations such as holiday parties or meeting new people,” says Elisa Nebolsine, LCSW, a Virginia therapist.
She recommends these ideas for reducing children’s holiday anxiety:
Take care of yourself. Your child will pick up on your stress. So try to make sure the entire family eats balanced meals, drinks enough water, exercises, and keeps stressful holiday shopping and other events to a minimum.
By Judy Shaw
Setback. Just the word can make us cringe. However, a setback is a necessary component to a full recovery from being phobic. As a rule of thumb, we say you can’t experience a true setback for at least 6 months after you have recovered and have been functioning level-free. Until that point you are still learning by taking two steps forward and then a step back, while it may feel like a setback, it isn’t, because you are still in the initial stages of the learning process.
A setback can be a devastating experience. After all the hard work, practicing, and finally achieving success and freedom—then to have that old panic overwhelm you once again, well, I don’t have to describe to you how awful it makes you feel. But take heart! Barbara, a recent participant in a phobia workshop, will help illustrate how a setback can be a blessing in disguise.
About 10 years ago, Barbara was suffering from an acute sinus infection. While driving on a parkway, she became dizzy. Terrified she would pass out and her car would careen off the road, she had a panic attack. (Dr. Neuman assures us that panic cannot cause to pass out.) Of course Barbara drove home safely (as always happens). After many medical tests and an MRI, her doctor prescribed medication to prevent dizziness. Barbara felt fine and for the next five years she was anxiety free. She drove everywhere without a problem. Then, as Barbara relates her experience, “One day I was driving on the Taconic Parkway, and I started watching the rear view mirror. I kept thinking that the cars were coming too fast behind me and they would crash into me. I was really scared and got that dizzy, disconnected feeling which blossomed into a full-blown panic attack. It wasn’t long before I was avoiding all the parkways except a short span to and from work. After ending a long term relationship with my boyfriend, who had been doing all the distance and highway driving, I stayed off all parkways-period! I lived this way for two years until realizing I couldn’t live this way anymore. I was referred to the Phobia Center for help. I liked the fact that I would learn how to do something in spite of what I felt. And so, I began my way back.
As I started the workshop I thought ‘I hope this works for me’. But it was soon clear that I would be doing a lot of work. John, a counselor in training, and Judy, my counselor, spent the next eight weeks driving parkways with me exit by exit. I learned to use tools to focus on something other than my my anxious thoughts or how I felt. I counted to 100 by fives. Since I am a hair stylist, and work with chemicals in coloring, I figured formulas mentally to create all kinds of colors. I made Judy and John drool by describing in detail my preparation of a wonderful Italian dinner. Usually by dessert I had gone the full length of the parkway. (They were always sorry we had to stop.) By the sixth week, we separated. John sat in the back seat and we did not talk. Judy followed behind in her car. This allowed me to have the experience of being alone, while gaining confidence that Judy would not crash into me. I had to practice not constantly looking in the rearview mirror. I sang, counted, and recited recipes and I did fine. My “graduation” involved driving two different parkways with Judy and John following a few cars in back of me. Because of all of our work, together with my rigorous practicing schedule, I didn’t even look back to check on then. It was wonderful! I practiced every day incorporating everything I leaned in the group and my work sessions with Judy and John.
“Yes, I had a major setback, but I know it was necessary. I had not learned how not to be afraid of being afraid. I truly thought I would lose control of the car if I panicked. Now I am prepared to expect that anxiety will arise, and I am now ready to deal with those feelings. I know they won’t hurt me. But, I had to go through that to understand it. I haven’t completely conquered my anxiety, but I understand what’s happening when I feel it, and I know what to do. Fear won’t interfere with my life anymore. I am in control.
“My advice to someone going through a setback is:
Marjorie Mottola, a Counselor at the Phobia Center, describes a setback as “a loose end that needs to be tied.” In Barbara’s case, the loose end was being afraid to have those feelings. She just didn’t want them. (But in reality, who does?) Now, because of her motivation, determination (and Italian recipes), Barbara is prepared to face and deal with the thoughts that produce her anxiety. She is definitely on her way. To quote Dr. Neuman, “A second time around this sort of treatment is very likely to work faster.”
On a personal note, my setback occurred after about two very pleasant years of functioning fairly well. I, too, went back to the basics. I worked even harder, because this time I knew how. As painful as a setback can be, it is an essential part of our learning process. So, when you experience a setback, instead of being discouraged, think of it as the last manageable step you need to take. Dr. Neuman offers come comforting words, “Once someone truly loses the fear of a panic attack, he or she is unlikely to experience a setback of any significance.”
(Excerpted from the Freedom of Fear Foundation Newsletter, July-August 1994)
Use any or all of the following positive coping statements to help you cultivate attitudes of accepting, floating and letting time pass during a panic attack. You may find it helpful to repeat a statement over and over the first minute or two when you feel the panic symptoms coming on. You may also want to do some deep abdominal breathing in conjunction with repeating a statement. If one statement becomes tiresome or seems to stop working, try another.
Write your most helpful suggestions on a 3 x 5 card and keep it with you. The statements and the act of reading the statements to yourself will lessen the anxiety and allow you to stay in the present.
By John Gregory, Ph.D.
People generally tend to divide their experience of themselves and their world into two categories. such as “good” and “bad”, “acceptable,” and “unacceptable”, “beautiful” and “ugly”, “attractive” and “repulsive”, etc. It is usually the case that people are better off psychologically when they do not draw the line between these two categories too starkly, when they allow for more “shades of gray,” and when they are able to be more accepting of the existence of the less desirable aspects of themselves, even if they continue not to like them. As with most lessons in life, this is much easier to agree to in theory than to actually put into practice. And for people who suffer from phobic anxiety, this can be a particularly difficult—and yet a particularly important—goal to strive for.
Most people recognize the desirability of self-acceptance, but it is another matter when one focuses in particular on the acceptance of phobic anxiety. The natural impulse of anyone who has experienced this kind of anxiety is to hope that he or she never experiences it again. Even one experience is too many, a person would naturally feel. This is not unlike the instinctive, self-protective reaction that leads people to avoid touching something very hot once they have been burned. And yet Contextual Therapy encourages the sufferer of phobic anxiety to “expect, allow, and accept” that it will come again. How are we to understand this?
There are at least two inescapable reasons. One is that there is actually no other way. A person who suffers from phobic anxiety is inclined to experience it again; it has become part of their way of responding to certain situations, thoughts or feelings, and it cannot be switched off like n electrical current or snuffed out like a flame. As long as a person holds onto the goal of never experiencing this anxiety again—no matter how understandable this goal is –the person is setting himself or herself up for failure. When a sufferer of phobic anxiety approaches life in this way, he or she is likely to feel dismay, defeat, and even the beginnings of panic, whenever the tell-tale signs of phobic anxiety appear.
Contextual Therapy, therefore, encourages such a person to exchange the goal of never feeling the feelings again, for the goal of being able to function with a manageable degree of they feelings when they (inevitably) reappear. This gives the person a goal that, however difficult, is at least possible. Rather than being doomed to face repeated experiences of frustration and defeat, the phobic person can set himself or herself a goal that can actually be worked on in specific and manageable steps.
A second reason to “expect, allow and accept that fear will arise” is that it makes it possible to see phobic anxiety in a different way. One can discover that this fear need not be just a single, uniform, overwhelming experience. The sufferer can learn that accepting the recurrence of these feelings does not mean that they will always be experienced in their worst and most intense form. It becomes more possible to focus on the fact that the feelings are actually experienced in a wide range of intensity, and that sometimes the feelings are more manageable than others. In fact, accepting these feelings opens the door to being able to think about approaching situations that have become associated with phobic fear, as long as this is done in such a way that the degree of anxiety remains low enough to be manageable. A world of new possibilities opens up.
By Judy Shaw
How long did it take for you to recover from your phobia?
How long until you weren’t anxious anymore?
How did you do it?
These are some of the most frequently asked questions of our counselors at the Phobia Center. There is no one answer. Since it seems to be a major concern, we thought it would be helpful to hear from some of our counselors in their own words.
More than 20 years ago, Doris Johnson was totally housebound in Connecticut. Dr. Zane had referred a counselor to come to her home and work with her.
“I worked with Melanie every week—learning Dr. Zane’s method of how to deal with my phobias. I practiced faithfully every day. I would go for one item at a small store over and over and then on to a bigger store and more items. I did this every day, (except for those days when I felt very sorry for myself and didn’t go—but, the next day I was out there again.) The more I practiced, the more I began to see progress, and eventually I was able to volunteer at White Plains Hospital.”
“At first my counselor met me halfway and soon I was doing it alone. Believe me, it wasn’t easy. I just kept at it, because I knew it was my only hope. My husband, Nick, was incredibly supportive of me. In fact, he was so impressed with the program and how it had helped me, we both became phobia counselors.
“Driving to New Jersey to visit my mom by myself was my ultimate goal, and one day I was able to do it. That was my breakthrough. I realized that the feelings weren’t going to hurt me and, while my agoraphobia didn’t appear overnight, it sure wasn’t going away overnight either. It took me more than a year of dedicated practice before I considered myself recovered.
“Do I still get anxious? Sure. But, now I do it anyway because I’m not afraid of those thoughts anymore.”
The choice is always there: Do I want to stay scared or did I want to feel free?
After seeing a doctor for a year of “useless therapy” for panic attacks, Jackie Kupper attended a lecture at the White Plains Hospital given by Phobia Counselor Bob Mauro. She realized that her problem had a name: agoraphobia.
“I attended a self-help group offered by the Phobia Center and learned to take one manageable step at a time. I practiced every day driving exit by exit on the parkway for at least a year. My goal was to drive to Long Island. Eventually I decided to go. With anxiety levels of 6 to 7 and using my tools, I made it. I said hello to my family and within five minutes, I headed home. I thought that if I stayed longer the anticipation might build and I didn’t want that to interfere with my success.
“All during this time, I made a promise to myself to keep exposing myself to every situation that caused anxiety until I learned to control it. I then volunteered at the Phobia Center and trained to be on staff. A funny story—I worked with a woman in one of the large area malls about 40 times. I had levels of 4 to 5 myself every single time (unknown to her). Finally on the 41st visit, it dawned on me to just accept my anxiety—that it really wasn’t going to hurt me. That felt great!
How long? I think it took more than a year of very hard work. Even after that I didn’t stop practicing. I kept reinforcing what I had learned and tried not to avoid anything because of some phobic or unrealistic fear.”
Barbara Bonder was married and the mother of two small children. She was suffering from panic and severe agoraphobia. She was desperate, and after much searching, found a counselor who was trained in Dr. Zane’s approach and who would come to her home to work with her.
Barbara explained, “I worked with her for two years meeting once a week and practicing diligently every day in between. I knew that was the only way I was going to get well. It was so hard but I never gave up. Things were tight financially, and I reduced the food budget so I would have enough to pay her. She really taught me how to deal with my fear based on Dr. Zane’s Six-Point therapy. I put myself in every phobic situation that faced me. Sometimes the fear was so bad, I would shake, even feel sick, but I didn’t back down. I followed our program to the letter (and I still do today.) My counselor received the PM News, and I saw an article about training to become a counselor, and I decided to do that. Since then I have been asked this question over and over. It’s really hard for me to answer, because everyone is different and they have to work at their own pace.
How long? My answer is: As long as it takes. For me, it took more than 2 years. I was totally committed to doing whatever was necessary to recover. Because I wasn’t going to live like I did before. I was always willing to take the risk to feel bad in order to feel good.”
When the “clinic”(as it was known 30 years ago) started Marjorie Mottola attended a self help group every week.
“I made a commitment to practice three days a week because I needed the day in between to rest. I drove the parkway one exit at a time and became a master at using tools. I’m not kidding—I cried the entire time I practiced because it was so painful, yet I was thrilled with my gradual progress. After about a year, I felt I couldn’t do it anymore.
Then I decided I had a choice: Stay phobic for the rest of my life or continue through the pain. I chose to keep going, and one week later I found myself on the parkway with no anxiety levels. From then on I felt recovered.
Levels still come once and a while, but I’m not afraid anymore. If you are going to recover, you have to stay with it for as long as you have to. That’s the answer to how long. There is no magic.”
“I came to a self-help group with a friend and learned just how phobic I was,” Jo-Ann Weiss remembers with a big smile.
“Then I realized I needed to start practicing driving by myself. I made my friends promise me that no matter what excuse I might come up with (and I was good at it) they would see to it that I got behind the wheel of my car and drove. At first, I needed them to go with me and then after a few months I was able to manage driving alone. (Jo-Ann is noted for having covered her steering wheel with gobs of Silly Putty so she could squeeze it while driving with anxiety.) “I knew that I would be—and was willing to be—scared because Dr. Zane told me that I wouldn’t die from fear. I totally trusted his assurance and believed that nothing bad would happen. I volunteered at White Plains Hospital which would require me to cross the Tappan Zee Bridge twice. I began with incredibly high anticipation, but I was willing to do it anyway.
“How long? After about a year my levels on the highway were low, but I was still practicing. I’m not afraid of those feelings anymore. There’s no time limit as to how long to practice. Just practice, practice, practice. You get out of it what you put into it.”
It’s clear that there is no set answer to how long it takes to recover from a phobia and/or anxiety. Most of the counselors believe it takes about a year or two of consistent practice. The recurring factor in each response is commitment. Commitment can be a term that causes anxiety for many of us—the perception is that of being trapped into something with no escape. Upon reflection, commitment can become an option in itself.
The choice is always there. “Do I want to stay scared or do I want to feel free?” Perhaps the word commitment can be replaced by determination or dedication. The word is not as important as its application.
We need to be willing to make a total commitment to ourselves to learn the process of staying in a feared situation long enough to control the levels of anxiety. Using the all-important Six Points as a guide, recovery is within your reach.
Remember, as our counselors remind us, it always takes longer than we want. Commitment outweighs weather, fatigue, stress, minor illness, headaches, personal problems and sometimes even a job. Commitment always finds time to practice.
I went to Ireland alone, where I met my tour group. There was a time when going to New York or the next town was seemingly impossible. But having worked through my driving and traveling phobias several years ago with my phobia therapist, I have been enjoying new-found freedom of traveling, of living.
Things had gotten so comfortable for me that when I encountered two problems on the trip I was surprised and momentarily set back. But, solving these two problems further reinforced the feeling that not only can I travel alone to Europe or anywhere, but I can deal with problems, solve them and go on.
The first problem occurred after an unusually long day of traveling by bus to Dublin. The bus had gotten quite warm and I had become tired and had not had enough fluids to drink. We stopped at a burial site grounds where visitors can walk into a cave like structure, look around, hear a talk, walk through and leave.
I got into line and the guides asked if anyone had a problem being in close quarters, don’t go in because you cannot turnaround and leave beyond a certain point. I have never had a problem with claustrophobia, but I think the heat, the fatigue, and the thirst got to me and I decided not to go in.
Thoughts started racing in my head. What if I’m getting claustrophobia now? What if there are more small area places to visit during the remainder of the trip? My tired, hot, and thirsty mind had lapsed back into negative, “what if” thinking.
When we arrived in Dublin, I called my Phobia Counselor. She reassured me that it was perfectly all right not to have gone inside, and she pointed out that I should not be so hard on myself.
“It’s okay sometimes not to do something.”
The second experience happened during the last leg of the trip. I had been staying up later than usual because I was having such a wonderful time. One morning we went sightseeing and shopping in a town in County Kerry. I was taking some pictures when suddenly I started to feel “funny”. The thoughts started. What if I faint here in the street before I meet up with the group? ‘That thought and accompanying picture really made me feel queasy. I decided to do some “good” self talking. I’ll take my coat off; it’s too warm. Then I’ll sit for awhile. I’ll go into a cool hotel, put my feet up and drink a lot of water.
That’s exactly what I did. I sat in a hotel coffee shop for about thirty minutes until I felt better. I met up with some of the tour group and forgot about fainting. Although I handled this situation well, it left me a bit shaken.
When I returned from my trip I discussed this problem with my Phobia Counselor. She pointed out that I had handled the problem beautifully and that I had not fainted and that I’m probably not going to faint in similar situations in the future. I realized that I should pay a little more attention to fatigue and heat on a trip and vary the pace.
I love traveling alone so much now that I have forgotten the “what ifs” that used to plague me. I have learned that the difficulties I encounter on a trip provide me with an opportunity to learn new coping skills, enabling me to do even more traveling — and living.