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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 don’t 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 “Brain Lock”, 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 involvement’s 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, they’ve been in charge of you, and you have been pumping them up and making them more acute. Don’t 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. Don’t 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. Don’t indulge in self pity and think “Why can’t I be like normal people? Why do I have to go through this?” 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 “Something terrible is going to happen, I must get out.” Say to your self, “I am OK, or STOP IT” Don’t 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 “I did it.” 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.

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.

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 “here it comes again, I don’t feel safe, I’m scared. I’m going to have a heart attack, I’m going to die, I’m going to faint”. You must change this negative thought to a positive thought. An example would be, “I 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 “STOP”.

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 God’s 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: “With God’s help I am emptying my mind of all anxiety, all fear and all insecurity.” Repeat this 5 times and then add, “I believe that my mind is now empty of all anxiety, all fear and all insecurity”

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 else’s fears are not yours. Group unity is essential to our common goal of recovery. Try to identify with other group members, but don’t 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 don’t make panic attacks go away, they only control the symptoms. You still have to deal with the cause. Don’t 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. Don’t 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.