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Welcome to P.H.O.B.I.A.

Welcome to P.H.O.B.I.A.'s Panic and Anxiety treatment page. We are an OFF-LINE self-help support group that meets every wednesday evening from 7pm to 9pm at St. Stephen's church in Waretown NJ. Our group helps people who suffer from panic and anxiety to find support and compassion among fellow sufferers. We have been established in Ocean county NJ since 1993. Our address for snail mail is

PHOBIA C/O St. Stephen's Episcopal Church, 367 Route 9, Waretown, NJ 08758

Feel free to e-mail me at PHOBIA for more information on group meetings.

The first thing anyone suffering from panic/anxiety should do is get a complete physical check up and medical work up from their doctor to rule out any physical dosorder. Also avoid caffeine and sugar, caffeine is a stimulant and can increase anxiety, sugar can have the similar effect. Some people self medicate with alcohol and this can actually make anxiety worse.

What are Anxiety attacks? Usually panic is a normal reaction to impending danger, but sometimes a person will experience panic when no danger is present. This is called an irrational fear. The physical symptoms of panic are extremely frightening which causes the anxious person even more fear, and so, on goes the cycle of fear. The physical symptoms can include any or all of the following symptoms: Sweating Palpitations Dizziness Jelly legs Numbness and tingling Hyperventilating Chest pains fear of having a heart attack Trembling Shortness of breath Feelings of unreality Nausea Diarrhea Fear of fainting Fear of loosing control Fear of going crazy Perceptual distortions or dreamlike sensations In most cases Panic/Anxiety attacks are an emotional disorder that is characterized by irrational fears. It can be caused by an overload of stress. Any major life change can trigger panic disorder, such as, the death of a loved one, a move to a new home, a divorce or even a marriage, just to name a few. Sometimes a person will have a panic attack in a car and then associate the car with the panic attack, this is how anxious people develop phobias. People develop phobias for many places such as the supermarket, church, schools and any public place. Soon the anxious person is trapped in their own home and afraid to go anywhere. They donít feel safe anywhere except at home or in their safe zone. This is called Agoraphobia.

What is Anxiety? Anxiety is the unpleasant emotional state consisting of Psychophysiological responses to anticipation of unreal or imagined danger. This includes feelings of impending danger, powerlessness, apprehension and tension. What is Agoraphobia? The definition of Agoraphobia means fear of the marketplace. It is the fear of open spaces, characterized by being alone or fear of being in public where escape may seem difficult or help may be unobtainable. What is a Social Phobia? A Social Phobia is the fear of embarrassment in a Social situation. This phobia keeps many people from social situations, including support groups. What is Panic? Panic is acute, extreme anxiety with disorganization of personality and function. What is depression? Depression Affects the Whole Person. Serious depressions are "whole body" disorders, affecting body, feelings, thoughts, and behaviors. They are not the temporary blues or the passing sad moods that everyone experiences after a loss. Depression Sometimes Can Disable. Depressive illnesses involve a set of painful symptoms that can last for months, sometimes years. They change people. Sometimes symptoms are so disabling that they interfere with the ability to function. Some who suffer severe forms of depression are unable to eat or get out of bed. An estimated 15 percent of people hospitalized for depression eventually take their own lives.

What are the symptoms of depression? Symptoms of depression can include: Persistent sad, anxious, or "empty" mood Loss of interest or pleasure in activities, including sex Restlessness, irritability , or excessive crying Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism Sleeping too much or too little, early-morning awakening Appetite and/or weight loss or overeating and weight gain Decreased energy, fatigue, feeling " slowed down" Thoughts of death or suicide, or suicide attempts Difficulty concentrating, remembering, or making decisions Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Are there different forms of depression? Depression can occur more than once. Some people have one episode of depression in a lifetime; many have recurrent episodes. Others have ongoing, chronic symptoms. Depression can involve mood cycles. Almost two million people experience cycles of terrible "lows" and inappropriate "highs." This emotional roller coaster is called "bipolar disorder" or "manic-depressive illness." This material was created by the National Institutes of Health.

What are Obsessions and compulsions? Obsessions are recurrent persistent thoughts, images or impulses that are unwanted and distressing. Compulsions are persistent and irresistible impulses to perform an irrational or apparently useless act repeatedly. Some Doctors think this is due to an incomplete thought. An excellent book about a new treatment is ďBrain LockĒ, by Dr. Jeffrey M. Schwartz What is Anticipatory Anxiety? This is when a person becomes anxious, or panics in anticipation of an event. Some of these people panic at the thought of doing the weekly shopping, because they are afraid they may have a panic attack.

What is a Phobia? A phobia is a learned, automatic, highly intensified irrational fear. It is a conditioned, physiological, emotional and cognitive response which leads to panic attacks. The AGORAPHOBIA syndrome is a complex of multiple fears. It is the fear of open spaces, crowds, bridges, tunnels or driving, just to name a few. It is also the fear of being away from home or a safe spot, and fear of being trapped. It is the fear of loosing control. Coping strategies developed for self protection are avoidance, withdrawal, dependency and passivity, thereby limiting everyday life involvementís which could lead to being homebound or roombound. Agoraphobia usually begins in early adult life, between the ages of 18 and 35. It affects 1 in 160 people, 2/3 of which are women. The panic attack seems to come from out of the blue, but usually begin when one is exhausted, having generalized anxiety and an overload of stress. People who suffer from panic attacks sometimes, but not always come from dysfunctional homes where there is physical or mental abuse. Sometimes a person will start having panic attacks after the death of a loved one or a divorce. These are life changing situations and they can cause panic attacks to start.

How the Brain Works The Brain is a giant chemical factory. When a Neuron fires an electrical impulse, it travels down a fiber called the Axon, until it reaches the end of the line where the chemical molecules are stored in sacks. The blast releases the chemicals. These chemicals travel to a receiving Neuron which has special receptors that bind with them like a lock and key. These molecules are Neurotransmitters. Scientists have identified 50 of these Neurotransmitters. There are many more. Among them are Dopamine, Endorphin, and Seratonin. Noradrenaline stimulates the body to produce more Adrenaline. The chemical Do0pamine regulates activity in our brain by acting as an inhibitor so we are not overloaded. It also helps control smooth and controlled movements. A compromise of the flow of this Dopamine can cause disruptive or incoherent thought and even Schizophrenia and poor working memory. Dopamine also can produce feelings of bliss. Endorphines are natural pain relievers. Researchers think that Endorphines may effect the Dopamine pathways that feed into the Frontal Lobe. The activity of these pathways are held in check by other Neurons that inhibit the flow of Dopamine when vast quantities of Endorphines are released. When other nerves shut off, the result is more Dopamine passing through the pathways, and in the Frontal Lobe which can replace pain with pleasure. This is the HIGH some athletes get from endurance sports. Seratonin is responsible for our moods, appetite, memory and our ability to learn. It is also thought to effect other Neurotransmitters. The part of the Brain called the Thalamus is the gateway for all sensory information. When sensory information arrives here there is a valve that filters the information and it passes on to the other areas of the Cortex and the Frontal Lobe for final processing. Seratonin influences how the Frontal Lobe makes decisions by helping or hindering the Thalamus.

The four symptoms of Post Traumatic Stress Disorder The following are some characteristic experiences that can occur within the four major symptoms of PTSD.

1. Rexperiencing the trauma. Nightmares. Recurrent obsessive thought Sudden reoccurrence of survival behavior in the face of events that resemble the original trauma.

2. Psychic numbing. A sense of depersonalization. Not fitting into ones surroundings A feeling of emotional anesthesia. Constriction of emotions, especially in situations demanding intimacy, tenderness or sexuality.

3. Hypervigilance. Inability to relax. Frequent startle response. Chronic anxiety Panic attacks

4. Survivor guilt. Chronic depression. Sourceless sense of guilt

If you recognize more than one of these charactoristics in yourself it is very likely that you experienced significant stress as a child, weather you remember it or not.

10 Thing to remember during a Panic Attack It does not matter if you feel frightened, bewildered, unreal or unsteady. These feelings are nothing more than an exaggeration of the normal body reactions to stress Just because you have these sensations does not mean you are really sick. These feelings are just frightening and unpleasant, nothing worse will happen to you. Let your feelings come, theyíve been in charge of you, and you have been pumping them up and making them more acute. Donít run away from panic. When you feel it mount take a deep breathe and as you breathe out let it go. Keep trying. Stay there almost if you were floating in space. Donít fight the feeling of panic, accept it. Try to make yourself as comfortable as possible without escaping. If you are on the street, lean against something. If you are in a store find a quiet corner or a chair. DO NOT jump in a car and rush home in fear. Stop adding to your panic with frightening thoughts about what is happening and where it will lead. Donít indulge in self pity and think ďWhy canít I be like normal people? Why do I have to go through this?Ē Just accept what is happening to you. If you do this , what you fear most will not happen to you. Think about what is really happening to your body at this moment. Do not think ďSomething terrible is going to happen, I must get out.Ē Say to your self, ďI am OK, or STOP ITĒ Donít say the word NOT, your mind does not understand it. Now wait and give the fear time to pass. Do not run away. Others have found the strength, you will too. Notice as you stop adding the frightening thoughts, the fear starts to fade away. One day soon you will go through the panic and say ďI did it.Ē Once you say this you will be on your way to conquering panic. Think of the progress you have made. Try to distract yourself from what is going on inside you. When the panic subsides let your body go loose, take a deep breath and go on with your day. Remember each day you cope with panic, you reduce your fear. Remember to take baby steps. Healing is often two steps forward and one step back.

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MEDICATION TREATMENTS

BENZODIAZAPINES: These sedating medications are mild tranquilizers and can be potentially habit forming "if abused", but they give the quickest relief. These medications are used for treating Generalized Anxiety Disorder (GAD), Panic and Social Phobias. I have found conflicting reports as to weather these medication treat Panic or just Anxiety. Some say they do not stop a Panic Attack, only anxiety. These medications include: Ativan (Lorazepam), Centrax, Dalmane (Flurazepam), Klonopin (Clonazepam), Librium (Chlordiazepoxide), Paxipam, Restoril (Temazepam), Serax, Tranxene, Valium (Diazapam), & Xanax (Alprazolam).

BETA BLOCKERS: These medications are used to treat Social Phobias. They work by reducing the ability to produce adrenaline. They are fast acting and non habit forming, but there can be interactions with other medications and ailments. Tell your doctor about all physical ailments before taking this drug. These medications include: Inderal (Propranolol) & Tenormin.

MONOAMINE OXIDASE INHIBITORS (MOA): These drugs are sometimes used in treating panic disorder, social phobias, Post traumatic stress disorder (PTSD) and sometimes Obsessive compulsive disorder (OCD) They work by blocking the effect of a certain enzyme, preventing the breakdown of Seratonin and Noradreniline. There are dietary restrictions when taking these "oral" medications. Some of these medications are: Eldepryl, Eutonyl, Marplan, Nardil (Phenelzine) & Parnate (Tranylcypromine). Now this medication is being offered via a patch which can bypass the dietary restrictions and has no weight gain or sexual side effects, it's called Emsam . The patch, which will be called Emsam and is made by Somerset Pharmaceuticals Inc., a joint venture of Mylan Laboratories Inc. and Watson Pharmaceuticals Inc. It will be marketed in the US by Bristol-Myers Squibb. For more information visit the FDA's website at FDA ,

TRICYCLIC ANTIDEPRESSANTS (TRA's) These were first used to treat depressions but some are effective in treating panic. Most are also used to reduce the symptoms of PTSD and OCD. They work by regulating Seratonin and/or Noradrenaline in the brain These medications are: Adapin (Doxepin), Sinequan (Doxepin), Janimine (Imipramine), Vivactil (Protriptyline), Pertofrane (Desipramine), Elavil (Amitriptyline), Tofranil Imipramine), Pamelor (Nortriptyline), Anafranil (Clomipramine), Surmontil (Trimipramine) & Ludiomil (Marprotiline).

SELECTIVE SEROTONIN REUPTAKE INHIBITORS: These medications are used to treat Panic disorder and OCD. They work by increasing the concentratin of Serotonin in the brain by blocking the neurons from absorbing it so quickly. It may take up to 4 weeks for this medicine to become effective. They may cause nervousness and diarrhea. These medications are: Celexa (Citalopram), Desyrel (Trazodone), Effexor (Venlafaxine), Prozac (Fluoxetine), Paxil (Paroxetine), Zoloft (Sertraline), Serzone (Nefazodone), Luvox (Fluroxamine), Wellbuterin, Celexa & Zyprexa.

BUSPIRONE/AZASPIRONES: This medication is used for treating Generalized Anxiety Disorder (GAD), it increases the activity of Serotonin in the brain. This medication works slowly and you can't switch from a Benzodiazepine immediately. This Medication is: Buspar (Busparone)

SERETONIN-NOREPINEPHRINE REUPTAKE INHIBITOR(SNRI): This medication is used to treat major depression and anxiety. In addition, it is used to relieve nerve pain (peripheral neuropathy) in people with diabetes. It is also used to treat pain caused by a condition called fibromyalgia that affects the muscles, tendons, ligaments, and supporting tissues. This medication is a serotonin-norepinephrine reuptake inhibitor (SNRI) that works by helping to restore the balance of certain natural substances in the brain (neurotransmitters). Duloxetine may improve your mood, sleep, appetite, and energy level, and decrease nervousness. It can also decrease pain caused by nerve damage. This medication is Cymbalta (duloxetine) ,Pristiq (Desvenlafaxine), Effexor (Venlafaxine this is also listed as a SSRI in some literature), Milnacipran

ANTICONVULSANTS: Some doctors prescribe Anti-convulsants medications for people with social phobias. This medication may take 2 to 4 weeks to be effective. These medications are: called Lamictal (Lamotrigine), Neurontin(gabapentin), Trileptal (oxcarbazepine), Depakote, Depakene (divalproex sodium, valproic acid, or valproate sodium), Tegretol (carbamazepine), Keppra & Topamax.

ANTI PSYCHOTICS: These drugs are used for schizophrenia and sometimes for anxiety. These medications affect neurotransmitters that allow communication between nerve cells. One such neurotransmitter is dopamine. These medications are: Abilify (aripiprazole), Clozaril (clozapine), Risperdal (risperidone), Abilify (aripiprazole), Zyprexa (olanzapine), Seroquel (quetiapine) and Geodon (ziprasidone)

ANTIHISTAMINES: Some doctors also prescribe antihistamines like Benadryl. Some people respond very well to this while others will become more anxious.

NON MEDICATION TREATMENTS

BEHAVORIAL THERAPY: This is a therapy which deals with modifying and gaining control over unwanted behavior. People learn to cope with difficult situations by being exposed to them. This may take quite a while but the benefits can last a lifetime.

COGNITIVE THREAPY: This therapy is used to change the thought pattern. People learn to differentiate between realistic and unrealistic thoughts. This can take time and the benefits will last a life time.

RELAXATION TECHNIQUES: These techniques teach people how to resolve and manage stress which can lead to anxiety. It involves breathing and relaxation techniques that can be used for a lifetime.

The cause of Panic and Anxiety is different for everyone and so is the treatment. For people who have situational panic and anxiety, Non medication treatment may be better for them. When Panic "comes out of the blue" medication may be the best treatment option. And there are some people who will benefit from a combination of both treatments. Discuss the options with your doctor.

Change your thinking Some people believe in changing our thinking for the treatment of Panic Attacks. When a negative thought comes into your head, such as ďhere it comes again, I donít feel safe, Iím scared. Iím going to have a heart attack, Iím going to die, Iím going to faintĒ. You must change this negative thought to a positive thought. An example would be, ďI will be fine, I am going to get through this and be OK, I will have a pleasurable shopping experience, etc. Talk to yourself, turn all your negative thoughts into positive ones. This really works. If it does not work the first time you try it, keep trying, it will work. Tell the Panic to ďSTOPĒ.

If your mind is obsessed with thoughts of insecurity and inadequacy it is, of course due to the fact that such ideas have dominated your thinking over a long period of time. Instead of thinking fear thoughts of defeat and ineffectiveness, think thoughts of faith and courage. If you think defeat then you are bound to feel defeated. But practice thinking positive thoughts and, make it a dominating habit, and you will develop such a strong sense of capacity that whatever difficulties arise you will be able to overcome them. Imagine a mental picture of yourself succeeding. Never think of yourself a failing and never doubt the reality of this picture. Whenever a negative thought comes into your mind, deliberately voice a positive thought to cancel it out. Put yourself in Godís hands.

Twice a day try to empty your mind of fears, hates, quilts, regrets and insecurities. When the mind is empty, something is bound to enter, so practice filling it with creative and healthy thoughts. Practice this technique of suggestive articulation, which means to repeat audibly some peaceful words such as, Tranquillity and Serenity. The technique for emptying the mind is on the following page.

When you get up in the morning, you have two choices, be happy or unhappy. People manufacture their own happiness and unhappiness. When you awaken, lie in bed relaxed and drop happy thoughts into your conscious mind. Let a series of pictures pass across your mind of each happy experience you expect to have during the day. Savor their joy. Such thoughts will cause events to turn out that way.

50 to 75 percent of people today are ill because of the influence of improper mental states on their emotional and physical makeup. High blood pressure can sometimes be a result of repressed fear. Thoughts of resentment, ill will, hate and jealousy are attitudes which can produce ill health. Healing can sometimes be accomplished when the thoughts are changed. Positive thoughts attract positive things and negative thoughts can attract negative things.

Positive Thoughts (if the word God offends you, just replace it with whatever you feel is your higher power) Day by day as you fill your mind with faith, there will be no room left for fear. I can do all things through Christ (or God), which strengthens me. (repeat this 10 times daily) God is with me, God is guiding me and God is helping me. If God is for us, who can be against us? Let nothing disturb you or frighten you, everything passes away, except God. God alone is sufficient. God is filling my mind with courage, peace and calm assurance. God is protecting me from all harm.

Emptying the mind Before going to sleep at night say: ďWith Godís help I am emptying my mind of all anxiety, all fear and all insecurity.Ē Repeat this 5 times and then add, ďI believe that my mind is now empty of all anxiety, all fear and all insecurityĒ

Guidelines for stress management Panic is uncomfortable, but not dangerous. No agoraphobic has ever died or become insane from panic attacks. You will not loose control of yourself no matter how severe the feelings become. This is known through experience.

In support group meetings you may hear new symptoms or fears described. Do not think they will happen to you. Everybody has different fears. Someone elseís fears are not yours. Group unity is essential to our common goal of recovery. Try to identify with other group members, but donít compare yourself with others.

You are responsible for your own recovery. Others can help, but the motivation must come from you. None of can make you well, but by working together we can find the strength and courage that is already in us to overcome this disorder. Other physical problems can sometimes be aggravated by panic attacks. If you have not done so already, go get a physical.

Medication is a very personal decision and only you and your doctor can decide if they are right fot you. But we do suggest you learn as much as possible about any drug you do take. Some drugs can not be stopped immediately and some have permanent side effects. Also know that, drugs donít make panic attacks go away, they only control the symptoms. You still have to deal with the cause. Donít stop any medications suddenly, always consult your physician.

Leave yourself an out. Allow yourself to retreat from any situation that frightens you. Retreat is not an escape, but a means to making your anxiety tolerable. When you feel able, try again. Many of us have tried to stay in a situation that triggered anxiety, and our anxiety level got so high that we started avoiding it. Whenever possible expose yourself to these situation long enough to create anxiety, but give yourself permission to leave. Consistency in facing your fears is more important than the length of time you spend at it. Keep trying to face the situation for a few minutes at a time until you feel comfortable. Always knowing that you can leave. This is called desensitization. Helping others sometimes helps yourself. Dwell on you accomplishments not failures. Sometimes after a period of progress, you will experience a set back. Donít dwell on this, it is only temporary. We believe recovery does not mean the complete absence of panic attacks, although this may occur. A recovered phobic is one who can cope with a panic attack and control it.

Anxiety Reducing Techniques Print on a 3x5 card and keep handy

1. Retreat to a safer place or person, or at least move away from your present situation

2. COGNITIVE COPING STATEMENTS: Immediately start to talk to yourself or to someone else. Use positive statements such as "I can handle it", "It`s just anxiety", "It will pass", and "Nothing terrible will happen to me. Ask yourself, "what am I telling myself that`s scaring me"? Remember, NO PAIN, NO Gain.(Some discomfort is helpful)

3. Take deep , slow breaths

4. Do things slowly

5. DISTRACTION or EXTERNALIZATION: Distract your mind. Put it on something else, such as the coins in your pocket, familair fragrances or object from a safe place or person. Describe what your senses tell you. STAY IN THE PRESENT.

6. Picture your calm place. Look at an actual picture of a vacation spot, child or pet. Carry this picture with you.

7. Question or challenge the negative thought.....Don`t accept it as fact.

8.THOUGHT STOP/THOUGHT SWITCH: When you find yourself thinking "What if", STOP and switch your thoughts to "SO WHAT IF"?, or other positive thoughts. Accentuate it with a rubber band.

9. EXPECT and ACCEPT the anxiety to be there, so you are not startled by it. Talk to your anxiety.

10. EXPRESS the fear to a piece of paper, a tape recorder, or another person. Expressing the fear makes it go away.

11. Elizabeth, "THIS IS THE BIG ONE"! In reality, IT`s No DIFFERENT from the others. Every reaction seems to be the worst. If you feel brave, try to make the anxiety more intense.

12. Give a number to your anxiety from 1 to 10. Notice it go up and down.

13. Don`t fight the fear, float with it and let time pass.

14. Take an action. Don`t sit and wait for the anxiety to build.

15. Try to keep your muscles relaxed.

This is for informational purposes only, please consult your physician for treatment.

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Recommended Reading

The Anxiety and Phobia Workbook by Edmund Bourne

Embraced by the light and The Awakening Heart by Bette Eadie

Good food good mood by Gary Null

You can heal your life by Louise Hay

Phobia free by Dr. Harold Levinson

The yeast connection by William G. Crook

All Claire Weeks books

The power of positive thinking by Norman Vincent Peale

NEWS FLASH
Gene Discovered For Common Psychiatric Condition Here is the abstract from the Journal of Molecular Psychiatry: May 1999, Volume 4, Issue 3, Pages 284 - 285 Original Research Article Investigation of cholecystokinin system genes in panic disorder JL Kennedy1,4, J Bradwejn2, D Koszycki2, N King1, R Crowe3, J Vincent1 & O Fourie1 1Neurogenetics Section, Clarke Division, Centre for Addiction and Mental Health, University of Toronto, Ontario, M5T 1R8, Canada 2Anxiety Disorders Program, Clarke Division, Centre for Addiction and Mental Health, University of Toronto, Ontario, M5T 1R8, Canada 3Department of Psychiatry, University of Iowa College of Medicine, Iowa City, USA 4Correspondence: JL Kennedy, MD, Neurogenetics Section, Clarke Division, Centre for Addiction and Mental Health, Toronto, ON, Canada M5T 1R8. E-mail: kennedy@cs.clarke-inst.on.ca Keywords panic disorder; cholecystokinin; CCK-BR; CCK-AR; genetic association study Abstract There is evidence for the role of the cholecystokinin (CCK) neurotransmitter system in the neurobiology of panic disorder (PD).1 The CCK receptor agonist, CCK-tetrapeptide (CCK-4) fulfills criteria for a panicogenic agent1 and there is evidence that PD might be associated with an abnormal function of the CCK system. For example, PD patients show an enhanced sensitivity to CCK-4, and exhibit lower CSF and lymphocyte CCK concentration as compared to healthy controls (reviewed by Bradwejn et al.2). Also, untreated PD patients display an increased CCK-4-induced intracellular Ca2+ mobilization in T cells relative to treated PD, depression and schizophrenia.3 The CCK receptors have been classified into two subtypes: CCK-A and CCK-B. We report here a study of polymorphisms in the CCK pre-pro hormone gene (CCK), CCK-AR, and CCK-BR in DSM-IV panic patients (n = 99) vs controls matched for gender and ethnicity. The CCK polymorphism revealed no association with PD. We identified a new polymorphism for the CCK-A receptor gene, and tested it in our sample, with negative results. A single nucleotide polymorphism has been found in the coding region of the CCK-B receptor gene4 (CCK-BR) and D Collier (personal communication) identified a highly polymorphic dinucleotide (CT)n microsatellite in the 5' regulatory region. For the CCK-B receptor gene polymorphism, PD patients showed a significant association. Our genetic dissection of the CCK system thus far suggests that the CCK-B receptor gene variation may contribute to the neurobiology of panic disorder. Received 25 August 1998; Revised 18 November 1998; Accepted 18 November 1998 Macmillan Publishers Ltd 1999

A summary of GERD and IBS By Dr. Stuart Shipko

As many of you already know, I consider GERD and sinusitius to be a part of panic disorder (PNE). The mechanism for this and IBS is abnormal flow of bile in the absence of its usual stimulant, food. The bile is released into the duodenum, and if it flows downstream, then you get urgent diarrhea. Some goes upstream to the stomach. Bile is caustic and alkaline (like drano) and the stomach makes a lot of acid which then refluxes up into the esophagus or it may shoot up and hit the sinuses. Chronic cough, laryngitis and morning headache/nausea are all GERD related symptoms. Prilosec effectively stops all acid secretion -- and this is helpful as the acid released by the stomach to neutralize the bile mixes only poorly with the gooey bile. We use Prilosec with... Carafate. Carafate actually binds to the bile salts and neutralizes it. Carafate also forms a "bandage" over the eroded gastric mucosa and esophageal mucosa. The combination of Prilosec and Carafate is probably the best for the GERD of panic. Prilosec should not be taken long term as it leads to achlorhydria of the stomach and over the very long term it may be carcinogenic. Not so with Carafate, which is not absorbed into the system and may be used long term with little in the way of side effects (just constipation in some people). Prilosec is the most popular medication in the world, and is the first drug ever to surpass the $5 billion per year mark. Prozac only sold $2.8 billion last year. It is noteworthy that Merck, who owns the patent on Prilosec, owns patents on at least 20 CCK antagonists, also useful for heartburn. The benzo's are all CCK antagonists and will prevent abnormal secretion of bile (and we do use alprazolam for GERD secondary to the stress disorders -- and have published on this which is reprinted under the research page of my website). Merck is holding CCK antagonists off the market for now, until the patent on Prilosec expires. Dr.S.

MANAGING YOUR PERSISTENT FEARS AND ANXIETIES By: Stanley Popovich

Everybody deals with anxiety and depression, however some people have a hard time in managing it. As a result, here is a brief list of techniques that a person can use to help manage their most persistent fears and every day anxieties.

When facing a current or upcoming task that overwhelms you with a lot of anxiety, the first thing you can do is to divide the task into a series of smaller steps. Completing these smaller tasks one at a time will make the stress more manageable and increases your chances of success.

Sometimes we get stressed out when everything happens all at once. When this happens, a person should take a deep breath and try to find something to do for a few minutes to get their mind off of the problem. A person could get some fresh air, listen to some music, or do an activity that will give them a fresh perspective on things.

A person should visualize a red stop sign in their mind when they encounter a fear provoking thought. When the negative thought comes, a person should think of a red stop sign that serves as a reminder to stop focusing on that thought and to think of something else. A person can then try to think of something positive to replace the negative thought.

Another technique that is very helpful is to have a small notebook of positive statements that makes you feel good. Whenever you come across an affirmation that makes you feel good, write it down in a small notebook that you can carry around with you in your pocket. Whenever you feel depressed or frustrated, open up your small notebook and read those statements. This will help to manage your negative thinking.

Learn to take it one day at a time. Instead of worrying about how you will get through the rest of the week, try to focus on today. Each day can provide us with different opportunities to learn new things and that includes learning how to deal with your problems. You never know when the answers you are looking for will come to your doorstep. We may be ninety-nine percent correct in predicting the future, but all it takes is for that one percent to make a world of difference.

Take advantage of the help that is available around you. If possible, talk to a professional who can help you manage your depression and anxieties. They will be able to provide you with additional advice and insights on how to deal with your current problem. By talking to a professional, a person will be helping themselves in the long run because they will become better able to deal with their problems in the future. Remember that it never hurts to ask for help.

Dealing with our persistent fears is not easy. Remember that all you can do is to do your best each day, hope for the best, and take things in stride. Patience, persistence, education, and being committed in trying to solve your problem will go along way in fixing your problems.

A REVIEW OF TECHNIQUES TO MANAGE YOUR DEPRESSION By Stanley Popovich

Some people have a difficult time in managing their depression. Sometimes, their depression and fears can get the best of them. As a result, here is a short list of techniques that a person can use to help manage their depression.

One of the ways to manage your depression is to challenge your negative thinking with positive statements and realistic thinking. When encountering thoughts that make your fearful or depressed, challenge those thoughts by asking yourself questions that will maintain objectivity and common sense. For example, your afraid that if you do not get that job promotion then you will be stuck at your job forever. This depresses you, however your thinking in this situation is unrealistic. The fact of the matter is that there all are kinds of jobs available and just because you donít get this job promotion doesnít mean that you will never get one. In addition, people change jobs all the time, and you always have that option of going elsewhere if you are unhappy at your present location.

Some people get depressed and have a difficult time getting out of bed in the mornings. When this happens, a person should take a deep breath and try to find something to do to get their mind off of the problem. A person could take a walk, listen to some music, read the newspaper or do an activity that will give them a fresh perspective on things. Doing something will get your mind off of the problem and give you confidence to do other things.

Sometimes, we can get depressed over a task that we will have to perform in the near future. When this happens, visualize yourself doing the task in your mind. For instance, you and your team have to play in the championship volleyball game in front of a large group of people in the next few days. Before the big day comes, imagine yourself playing the game in your mind. Imagine that your playing in front of a large audience. By playing the game in your mind, you will be better prepared to perform for real when the time comes. Self-Visualization is a great way to reduce the fear and stress of a coming situation.

Another technique that is very helpful is to have a small notebook of positive statements that makes you feel good. Whenever you come across an affirmation that makes you feel good, write it down in a small notebook that you can carry around with you in your pocket. Whenever you feel depressed, open up your small notebook and read those statements.

Take advantage of the help that is available around you. If possible, talk to a professional who can help you manage your fears and anxieties. They will be able to provide you with additional advice and insights on how to deal with your current problem. By talking to a professional, a person will be helping themselves in the long run because they will become better able to deal with their problems in the future. Managing your fears and anxieties takes practice. The more you practice, the better you will become.

The techniques that I have just covered are some basic ways to manage your depression, however your best bet is to get some help from a professional.

WHEN SOMEONE YOU KNOW STRUGGLES WITH FEAR, ANXIETY AND STRESS By: Stanley Popovich

What do you do when someone you know has to deal with persistent fears, anxieties, or even depression? Well the first thing you need to do is to get the person to seek the services of a professional who can lead them in the right direction and give them the help they need. In addition, here are some other techniques you can use to help the person cope.

Learn as much as you can in managing anxiety and depression. There are many books and information that will educate you on how to deal with fear and anxiety. Share this information with the person who is struggling. Education is the key in finding the answers your looking for in managing your fears.

Be understanding and patient with the person struggling with their fears. Dealing with depression and anxiety can be difficult for the person so do not add more problems than what is already there.

In every anxiety-related situation you experience, begin to learn what works, what doesnít work, and what you need to improve on in managing your fears and anxieties. For instance, you have a lot of anxiety and you decide to take a walk to help you feel better. The next time you feel anxious you can remind yourself that you got through it the last time by taking a walk. This will give you the confidence to manage your anxiety the next time around.

Challenge your negative thinking with positive statements and realistic thinking. When encountering thoughts that make your fearful or anxious, challenge those thoughts by asking yourself questions that will maintain objectivity and common sense. For example, you are afraid that if you do not get that job promotion then you will be stuck at your job forever. This depresses you, however your thinking in this situation is unrealistic. The fact of the matter is that there all are kinds of jobs available and just because you donít get this job promotion doesnít mean that you will never get one. In addition, people change jobs all the time, and you always have that option of going elsewhere if you are unhappy at your present location. Changing your thinking can help you manage your fears.

Another thing to remember is that things change and events do not stay the same. For instance, you may feel overwhelmed today with your anxiety and feel that this is how you will feel the rest of the week or month. This isnít correct. No one can predict the future with one hundred percent accuracy. Even if the thing that you feared does happen there are circumstances and factors that you canít predict which can be used to your advantage. You never know when the help and answers you are looking for will come to you.

When your fears and anxieties have the best of you, seek help from a professional. The key is to be patient, take it slow, and not to give up. In time, you will be able to find those resources that will help you with your problems.

NEVER LOSE HOPE IN DEALING WITH YOUR FEARS AND DEPRESSION By: Stanley Popovich

When your fears and depression have the best of you, it is easy to feel that things will not get any better. This is not true. There is much help available in todayís society and the best way to deal with your fears is to find effective ways to overcome them. As a result, here are some techniques a person can use to help manage their fears and anxieties.

You never know when the answers you are looking for will come to your doorstep. Even if the thing that you feared does happen, there are circumstances and factors that you canít predict which can be used to your advantage. These factors can change everything. Remember: we may be ninety-nine percent correct in predicting the future, but all it takes is for that one percent to make a world of difference.

Challenge your negative thinking with positive statements and realistic thinking. When encountering thoughts that make you feel fearful or depressed, challenge those thoughts by asking yourself questions that will maintain objectivity and common sense. For example, your afraid that if you do not get that job promotion then you will be stuck at your job forever. This depresses you, however your thinking in this situation is unrealistic. The fact of the matter is that there all are kinds of jobs available and just because you donít get this job promotion doesnít mean that you will never get one. In addition, people change jobs all the time, and you always have that option of going elsewhere if you are unhappy at your present location.

Some people get depressed and have a difficult time getting out of bed in the mornings. When this happens, a person should take a deep breath and try to find something to do to get their mind off of the problem. A person could take a walk, listen to some music, read the newspaper or do an activity that will give them a fresh perspective on things. Doing something will get your mind off of the problem and give you confidence to do other things.

Be smart in how you deal with your fears and anxieties. Do not try to tackle everything all at once. When facing a current or upcoming task that overwhelms you with a lot of anxiety, break the task into a series of smaller steps. Completing these smaller tasks one at a time will make the stress more manageable and increases your chances of success.

Take advantage of the help that is available around you. If possible, talk to a professional who can help you manage your fears and anxieties. They will be able to provide you with additional advice and insights on how to deal with your current problem. By talking to a professional, a person will be helping themselves in the long run because they will become better able to deal with their problems in the future. Managing your fears and anxieties takes practice. The more you practice, the better you will become.

The techniques that I have just covered are some basic ways to manage your fears and depression, however your best bet is to get some help from a professional and not to lose hope. Eventually, you will find the answers you are looking for.

BIOGRAPHY: Stan Popovich is the author of "A Layman's Guide to Managing Fear Using Psychology, Christianity and Non Resistant Methods" - an easy to read book that presents a general overview of techniques that are effective in managing persistent fears and anxieties. For additional information go to: http://www.managingfear.com/

Newsgroups are a wonderful source of information and support on the internet. You can find newsgroups through your ISP, ask them for instruction to access the groups or you can go to Google and click on groups. One of the best newsgroups is alt.support.anxiety-panic.moderated

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