Anxiety, Panic, and Phobias: Seeking Help

Last Editorial Review: 10/1/2004

WebMD Live Events Transcript

Panic disorder, generalized anxiety disorder, social anxiety, phobias, obsessive-compulsive disorder, PTSD -- an estimated 2.4 million Americans suffer from these conditions. Therapist Jerilyn Ross, MA, LICSW, joined us on May 4, 2004, for a frank discussion about these disorders and when to seek professional help.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Welcome to WebMD Live, Jerilyn. How prevalent are anxiety disorders? How do you know when your anxiety is a disorder?

Anxiety disorders affect around 19 million Americans. All of us have anxiety at various times of our life; however, for the 19 million Americans who suffer from an anxiety disorder, their life is often greatly compromised and limited. Things that most of us do without even thinking about them, such as getting in our car, speaking up at a meeting, driving over a bridge, or even going shopping, are things that people with anxiety disorders often have great difficulty doing or, in some cases, cannot do at all.

When somebody is either avoiding common everyday places or situations or has obsessive thoughts they can't get out of their head or can't stop worrying to the point it interferes with their life, these people may, in fact, have a condition that is real, that is serious, and is treatable.

"Even though we have very good treatments, both psychotherapy treatments and medicines, we don't always know immediately which treatment will work best for which people."

I'm suffering from severe panic attacks. I have been having the attacks for the last eight years, but it has been during the last year and a half that it has become extremely debilitating. It was at that point that I suffered from a thyroid disease (Grave's), I had a thyroid storm, and since then I have had a thyroidectomy.

Since this happened I can't remember much about this time in my life. I thought it was probably the meds, but someone on the boards said it might be PTSD. When I think back upon the event I become so consumed with the feeling that I'm going to die it just takes over everything. I start feeling like I'm going to have a heart attack, my pulse races, and my palms become sweaty. I have a huge fear that I'm going to faint and either lose control or die.

I take 3 milligrams of Ativan a day, but it doesn't seem to work. Last week my doctor put me on Lexapro and I just couldn't handle the side effects. Now I feel like I'm at square one again. I have a husband who is so sick of my panic attacks, and he doesn't understand why I just can't get over it. I'm ready to do whatever it takes to get better for me and my family.

What should be my next course of action, and is it possible to have psychological effects from a thyroid problem? And is it also normal for people with panic disorder to feel like they are at death's door every time they have an attack?

Oftentimes the symptoms of panic disorder mimic the symptoms of many other physical illnesses, such as thyroid disease. And it's sometimes difficult to tell whether the symptoms are caused by an illness like thyroid disease or heart disease or low blood sugar, or if they're strictly caused by panic disorder. So it's important to have a full medical workup and identify any underlying illnesses such as Grave's disease that might be causing panic attacks. If there is evidence of a physical illness and in spite of treatment the panic attacks continue, then the person may have panic disorder.

Panic disorder, for those who don't know about it, is when somebody will experience extreme fear and terror that seems to come out of the blue and can make a person feel as if they're dying, going crazy, going to pass out, or having a heart attack. In fact, one of the most important things we want people with panic disorder to know is that as frightening as these attacks are, they are not dangerous; they do not cause people to die, go crazy, pass out, or develop any other illness. As a matter of fact, when people have a panic attack their blood pressure increases. In order to pass out, your blood pressure has to decrease. So unless there is some other underlying reason why somebody might pass out, such as they have the flu, they haven't eaten all day or slept, or they have some other illness, it is almost impossible to pass out from a panic attack.

As far as treatment, I want you to know that panic disorder can be treated. However, even though we have very good treatments, both psychotherapy treatments and medicines, we don't always know immediately which treatment will work best for which people. So it's important for someone like you to know that if you tried a certain medication and it didn't work, or you had uncomfortable side effects, you need to talk to your doctor about trying something else.

You may also want to add what we call cognitive behavioral therapy, which is a very specific kind of treatment that will help you learn tools and techniques to both understand and overcome the feelings and fears you have associated with having the panic attack.

I would also encourage you to go on the web site for the Anxiety Disorders Association of America, which is, and download some of the information and share it with your husband, because it's very difficult for loved ones to understand why people just can't "snap out of it." But that would be like telling somebody with a broken leg to just go ahead and shake your leg and it will get all better. While we can't expect someone who hasn't experienced a panic attack to know how terribly frightening and overwhelming it is, what we do want them to understand is that this is not just something in their loved one's head, nor are they doing it for attention, nor is it something that, without treatment, they can control. Therefore, it has to be treated with the same respect and tolerance as a physical illness.

Over the last couple of years, I've become more and more uncomfortable in certain social situations. When I'm in social situations, I have an uneasy feeling. I have thoughts that I'm doing something wrong or people are noticing me. I also have a hard time focusing on conversations (live and phone) and I loose my train of thought. I've noticed these kinds of things for the last 1.5 years or so but it seems to keep getting worse. Is this anxiety?

While I can't diagnose somebody over the Internet, I can tell you that what you're describing sounds very much like an anxiety disorder called social phobia, or social anxiety disorder. This is a condition where the person has a morbid fear of embarrassing themselves in public or of being scrutinized by others. It is a fear of doing or saying something that will call attention to yourself, a fear of appearing anxious around other people, or in some way doing something that will humiliate yourself.

There are two kinds of social anxiety disorder:

  • One is where the person has fears of being judged or scrutinized in specific situations, such as while giving a talk, meeting new people at a party, or even signing one's name in public, and these people either avoid such situations or endure them with tremendous discomfort.
  • The other type is more generalized and it involves extreme anxiety and difficulty being in any situation where they're interacting with people. So it could range from talking to a salesperson in a store, getting a haircut, having to talk to the barber, or eating in a restaurant.
Most people confuse social anxiety disorder with shyness. And while many people with social anxiety disorder would describe themselves as shy, many don't understand why they feel so uncomfortable and so judged and so scrutinized by others.

We know this disorder tends to run in families, so we know there is a biological as well as a psychological component to it, and we also know we can treat it, again both with cognitive behavioral therapy and, when necessary, along with medication, either along with it or by itself.

Most people with social anxiety disorder are aware that their feelings and thoughts are irrational, but feel as if they can't control them. They feel that the only way to control it is to avoid situations, which tends to only make matters worse, because they then start to feel isolated from friends, family, and acquaintances.

So if you feel you have social anxiety disorder, you may want to go on the web site and take the self quiz to see if you have those symptoms and if so I recommend that you print out the quiz and your responses and take it to either your primary health care provider or mental health care specialist and start the process of getting help.

"The feelings of a panic attack are so overwhelming that our body protects us by shutting down emotionally and going into almost what I call a numb state."

I would just like to know if the feeling of "unreality" after having a panic attack is normal. Why does it happen? Is it a symptom of panic disorder? I have experienced it after having my first panic attack, and I find it even more frightening than the panic attack itself was.

What you're describing is something we call depersonalization. This is a very common and unsettling symptom of a panic attack. When I work with patients who first come in and describe all of the symptoms they have during a panic attack, such as rapid heartbeat, sweaty palms, feeling like they're going to pass out, light-headedness, or trembling, this feeling of unreality is usually the one that frightens them the most. What happens is that the feelings of a panic attack are so overwhelming that our body protects us by shutting down emotionally and going into almost what I call a numb state.

As frightening as this feeling is and as uncomfortable and bizarre as it feels, it is not at all dangerous and it does not lead to anything dangerous. As a matter of fact, I'm often driving in a car with patients who are having panic attacks, and when they talk about going into that state of feeling unreality, I suggest they do things to ground them in the present, such as being aware of what the steering wheel feels like, describing what they see around them; colors, sounds, even sometimes touching the buttons on the radio -- anything to ground them and bring them back into the moment, into the present.

I have them rate their anxiety levels from zero to 10, 10 meaning panic attack, all the symptoms, often including unreality, and I teach them to be aware that when their anxiety levels are up high, 7, 8, 9, or 10, to notice that what they're thinking about is usually all the "what if" dangers, catastrophic thinking of what might happen to them: What if I lose control? What if I go crazy? Everything gets so unreal I don't know where I am. I teach them by coming back into the present, and by focusing on the fact that these feelings are frightening but not harmful and they will always pass. I get them to see for themselves that by staying in the situation, for example, if we were driving, to continue driving and to see for themselves that nothing dangerous will happen to them, and I show them how sure I am of that, or else, as I tell them, I wouldn't be sitting in the car with them.

This type of therapy is cognitive behavioral therapy, where they're actually treated in the situation where they're experiencing the anxiety, so they can learn how to go through the panic attack and learn techniques to help them become desensitized to the symptoms, such as feelings of unreality.

What if it occurs during a drive on the freeway? I feel that I cannot pass a truck and I'm afraid that I will cause an accident, so I just avoid driving on the freeway at all. This causes me to drive "back roads" and is terribly inconvenient to my life.

It's important to understand that people who have panic attacks have scary thoughts, but do not do dangerous things as a result of the panic attack. Each time you avoid a place or situation where you've had a panic attack you reinforce the thought that if you didn't avoid it something awful would have happened. So negative learning takes place. That's why it's very important to go back to driving on the highway with someone who's trained to help you, so that you can replace the negative, frightening thoughts with positive experiences.

During a panic attack your body's "fight or flight" response, the mechanisms that warn us when we're in danger and encourage us to flee, are going off in a "false alarm." So our mind and body are getting the message that something terrible is about to happen and the only way to avoid it is to get off the highway. Each time you do that, it reinforces that negative thought. On the other hand,

Now, obviously, if there are other things going on, like you're not feeling well, you're drinking or using elicit drugs, or have some kind of medical illness where you shouldn't be driving, then of course I would tell you not to drive on the highway. However, if you're healthy and don't have any reason not to drive on the highway other than a fear of having a panic attack, I strongly encourage you to either use self-help materials or a friend to help you get back on the road, or seek professional help. You can also find the names of therapists in your city by going on the web site and putting your zip code in.

"Each time you stay in the situation and allow the feelings to come over you as if a wave in the ocean, you will learn that these feelings always pass and do not lead you to do anything that is dangerous."

Hi, Jerilyn. I'm not sure where to start. I'm 27 and have never had mental issues or problems before last year. Last August I had a panic attack while on a crowded porch at a bar while on vacation. I didn't know what it was, but I couldn't catch my breath and the rest of the night I became acutely aware of "closed-in" situations. Two weeks later I went to Atlanta on business and it happened in a meeting in a room with no windows. I felt like I needed to get out. I couldn't breathe. This anxiety continued in elevators and any unfamiliar buildings, especially high rises and even in traffic. I had a horrible panic attack in the airport on the way home and haven't had one again since.

When I returned to Chicago I felt totally different, like I would never be the same. I avoid riding the El to work, which is the easiest and least expensive way to travel. I feel like this is paralyzing me. In all other aspects of life I'm totally normal. Any idea what my next step should be?

What you're describing sounds very much like agoraphobia, which is when a person begins avoiding places or situations where they fear having a panic attack and not being able to get to safety quick enough. For some people it means avoiding crowded places, closed-in places, and the kinds of things that you're describing. For others it can reach a point where they literally do not want to leave their homes. We don't want you to get to that point. There are a lot of things you can do.

In my book Triumph Over Fear , I described a woman who had not left her home for more than 30 years for fear of having a panic attack. When I began treatment with her it took us less than five months to have her out of the house, using public transportation, and getting a job. So it doesn't matter how long you've had the problem or how severe it is, what's most important is you find the right treatment.

You don't want to get into long-term therapy; you want to find somebody who will do cognitive behavioral therapy, which we described earlier, and someone who is willing to begin the treatment with you in a place that's comfortable. Oftentimes I will meet patients in a lobby of a building or even in their own home. Depending on where you live, there are many therapists trained to do this and are sensitive and understanding of the fact that you may not be able to come to their office until they begin treating you in a place where you feel comfortable.

I strongly suggest going to the web site and entering your zip code and looking at the list of therapists in your city. Then there's a part on the web that talks about questions to ask a therapist before getting treatment. That would be a great starting point and guide to see if this is someone who can help you.

We are almost out of time, Jerilyn. Do you have any final words for us?

The thing I really want to tell people is that as difficult as anxiety disorders are, and as disruptive as they can be in people's lives, they are TREATABLE, and I encourage people not to be ashamed of getting help, to use the web site and other resources to get information and knowledge, and talk to your health care and other professionals about it. If the first thing you try doesn't work, go to someone else. Ninety percent of people with anxiety disorders can be effectively treated.

I want anybody with an anxiety disorder or someone concerned about someone who has one to know that these are real illnesses, they are serious, and they are treatable. So I strongly encourage people to seek help.

Jerilyn, thank you for sharing your expertise with us. Members, for more information, please visit our message boards to talk with others. Links to some of our member communities, plus additional WebMD resources on this subject, are located on page one of this transcript.

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