Friday, July 26, 2013

Thinking Outside the Box: PTSD, Panic Attacks, and Social Phobia



Anxiety disorders are becoming more heard of in our culture.  That, I think, is both good and bad.  More and more people seem to be dealing with social phobia, PTSD, and many other facets of anxiety that tend to produce physical manifestations such as panic attacks and emotional problems such as withdrawal, depression, anger, fear, aggression, and paranoia.  I have loved ones dealing with PTSD, and I am actually glad I have a social phobia, because it prompted me to do research on ways to cope which overlap into the PTSD arena.  I have been able to help my loved ones dealing with PTSD in learning how to cope a bit.  

Now let me pre-empt this post by saying I do not practice therapy in the area of anxiety disorders.  I have combined what I know has worked for me with research I have done in professional journals and with friends who do practice working with PTSD, so don’t assume by any stretch that I am saying I have the answers.  I’m just going to share what I know.  If you deal with social phobias, these things might help.  

The problem with our military health care system is that it is abysmal in its ability to effectively treat PTSD.  Much of what is done involves a debriefing that in no way is extensive enough to equip an individual to re-enter society, and there is medication.  That is not to say there are no other services available.  But the standard, from what I have been told, is as I referenced. 
 
Because of recent events with shootings that have occurred and the push to monitor those with mental health issues, I would not encourage one of my near and dear to get themselves documented into the system.  It is just not safe for their individual rights, and I don’t see that changing.  But, I do work with my loved ones who are dealing with extreme anxiety to help them conquer it.  I have managed to take control of agoraphobia which is extreme and debilitating, so I am encouraging others in this realm.
Everyone is different, but basic principles can be applied no matter the person or issue.  So, the first thing is to acknowledge to someone what you have.  This should be someone or a few someones you can trust.  It is very stressful to try to hide something so debilitating, and a good support system is important to have, especially for accountability, which leads us into the next principle.

For PTSD:  When having a flashback, it is good to tell someone you trust that it is happening.  It is even better to describe it if you can make your self do it.  Many cannot do that last part, so telling someone you are having a flashback is a good start.  Here is how I interpret PTSD.  The mind experiences something it cannot fathom, something traumatizing.  As a result, the brain is not able to take that event and shift it over to memory.  The brain has not been told that that particular experience has been seen and is now a memory, so whenever it comes up, the brain automatically thinks it is in real time, happening for the first time.  It has no way to comprehend cognitively that it is a memory.  The brain automatically prepares the body to fight or flee and the physical manifestations include racing heart, sweating, heightened senses, and major adrenaline upload accompanied by fear, paranoia, and panic.  What I have seen is that by saying out loud that a flashback is occurring, there begins to be a reconnection with reality.  

Now some people have PTSD but do not have images flashing.  They may be triggered by sound or smell.  But regardless, the adrenaline systems kicks in and the fight or flight response is engaged.  When this happens and there are no flashbacks, telling someone what has triggered you and that you are experience symptoms (heart racing, sweating, paranoia, etc...) will also help bridge the gap between reality and memory.  Sometimes in this case, distraction works.  Pulling that person away to a different event and location sometimes helps.  

I read a study recently put out by Harvard that found that PTSD is a major cause of insomnia.  People with PTSD often have nightmares and that causes inability to sleep, short spurts of sleep, and twitching and thrashing whilst sleeping.  Many turn to alcohol to help get them to sleep, but the problem with that is that alcohol impacts the brain and its ability to have health productive sleep.  The body and brain are saturated with something it recognizes as poison (the body cannot process alcohol), so it spends those hours of sleep working frantically to rid the body of the toxin, and the brain is stripped of ability to have control and often flashbacks and nightmares in sleep become more frequent.
For panic attacks and social phobias including agoraphobia:  Over-stimulation is the bane of the social anxiety disorder.  Too much visual, auditory, and olfactory input can trigger panic attacks.  Often it is the physical space that triggers, and sometimes the anxiety of being social triggers a panic attack.  So, the first order of business is to recognize you are having a panic attack.  Then get out of wherever it is that has triggered you.  There is medication that helps that isn’t narcotic in nature, but there has to be some cognitive management as well.  So recognize what is going on, get out of the place that is triggering you, and finally, give yourself permission to have a panic attack.  So often panic attacks are exacerbated by trying to stifle them or prevent them.  This just adds more stress.  Tell yourself you are going to have a panic attack and you are going to enjoy it!  (Just kidding J)  But, honestly, give yourself permission to have a little freak out.

What I have noticed is that anxiety disorders take time to overcome, even with medication.  It’s a matter of reformatting the brain and then adding the repetition to cement the reframe.  I have mentioned reframing before, but just to refresh here; reframing is taking an overwhelming thought or situation and narrowing it down.  Here is an example:  I hate everything about Wal-Mart.  It stresses me out.  The lights are yellow.  I’m visually over stimulated.  I have to wait out in the open in line which freaks me out.  There are too many people, and the place smells.  

Cognitive reframe:  I hate Wal-Mart, but I like the prices.  I do not have to go there if I do not want to.  It’s okay if I choose to go somewhere else.  It is my choice, and if I do decide to go, I can just get a few things and get out of there as soon as I start to feel the environment triggering me.  I do not have to stay there until all my shopping is completed.  

Simple, huh?  Well to the anxiety ridden individual who wants most in life to not have another panic attack...ever, it is very difficult to do a reframe.  It’s logical, but the brain is not logical when a sense of threat is present.  So it takes practice.  

These are little things, but with repetition, they will start to help a bit.  In my experience and in watching my loved ones with PTSD, it’s a  very slow process to conquering anxiety, but you have to give yourself some grace even if no one else will.  And you have to be willing to think outside of the box, because right now, in the treatment of major anxiety disorders, the box is just too small. 

Blessings
L

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