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Miss Hope
11-04-14, 21:37
Hello everyone,

I am new to this forum but have read some of the messages and it looks like a supportive place. Sorry to start off with a question and asking advice but I'd be really interested to know from other people who have overcome similar issues.

To cut a long story short...several years ago I had very bad panic attacks relating to other stuff going on in my life. Over time I got better and life got more or less back to normal. I had a good job etc. However about ten years later (four years ago) I had a couple of big life changes at once. I moved house to a new area and also two years later started training for a new career. I had a few bad panic attacks again. And slowly I started avoiding going away outside of my home town and avoided lots of things. And I stopped using public transport in my home town beyond about a mile. I cycled everywhere - up to about 10 miles - so I could get home if I needed to. I was lucky in that I never became housebound and was fine within a three mile radius without a bike.

Anyway I got some help and over the last year have slowly started to get better more or less doing exposure therapy. It's been slow but steady. I can now get the bus into town without any anxiety and I also have taken three out of town trips - one was 50 miles away. One was even an overnight stay. It's taken me about a year of really working at it to get to this stage.

However, the problem is this. I'm trying to accelerate the next bit of getting better. This is because in a couple of weeks time I am supposed to be going away - about 250 miles from where I live to a conference related to my new career. And I'm supposed to be giving a paper which I am also nervous about. It's going to mean getting on a train which I haven't done for about three years now. And obviously it is a train going a long way. It will also mean staying overnight in the other city. Today I tried to make a train journey of about 40 miles. I got on the train but then got off again and didn't go anywhere. I feel like I am trying to force the next stage and it's making me very anxious. I'm not sure I can get where I need to in the next two weeks.

To those people who have slowly managed to get better - did you find that the incremental stages got bigger each time or does it seem as though I am trying to do too much too soon.

If anyone has any thoughts I'd be keen to hear. Thanks in advance.

MyNameIsTerry
12-04-14, 01:48
Well done for getting to where you are, it's always hard to challenge our fears.

Firstly, you have a solid event in the future that you feel you must be ready for. Straight away this adds pressure which can cause you to fail the steps you take in building up to it because you will be more anxious than you would be without the deadline.

Secondly, taking a big leap may work and you will feel great about yourself but it may not which ultimately reinforces your anxiety of the situation.

Maybe the added pressure has forced you into a step that you wouldn't have taken for now?

So, why go 40 miles? Why not go a few miles, then 10 miles, then 20 miles, etc? The duration of the journey increases with each and will test you.

An important part of exposure, as I'm sure you know, is habituation. So, you need to expose yourself for longer & longer durations until they become less traumatic to you. Panic tends to fade after about 30 minutes so can you stay on the train longer than this and how did it go? Whats probably something to try.

As I understand it, have a heirarchy of things to expose yourself to, have a starting panic rating (1-100) and stay in each situation until your panic rating drops at least below 50% of it's starting value. Then rate it again before starting and do it again. You should hopefuly find both values decreasing as you habituate.

You know you can do the overnight stay, you've done it but to habituate it will probably take more stays to make you feel more comfortable. So, accept that it may be difficult but you have done it before so can do it again.

Are you giving a presentation? How are you at work doing these? It's only natural to feel nervous about giving presentations. They get easier as you do more but it's only natural to be nervous about giving one to a potentially larger and unknown audience. The added pressure of the rest is probably feeding this and pushing up your anticipatory anxiety. Have you got ways to handle this already?

littlebutterflygb
12-04-14, 20:42
The step you're trying to make isnt a 'step' at all. Its a huge chasm you're trying to leap and because the step is too big, you become frozen and can't do anything. Stop looking at the top of the ladder; stop trying to jump halfway up. Look at the rung above you and that may be just standing on the platform, watching trains come and go before you even contemplate getting on. Then get on and get off. Then go one stop.

You have the added pressure of time: decide what your plan will be if you cant make it. Better to prepare for the worst and plan for the best.

Tessar
12-04-14, 22:36
Hi Miss Hope & welcome :-)

your story is inspirational. What great progress you have made. We all have our issues to overcome and the end, the only way to "get there" so to speak, is to face those fears. And boy have you been doing that & with a great deal of success too.

I feel it is only natural for you to be questioning whether this is too much too soon. But then how do any of us know the answer until we try it?

What I will say is.... If you think back to when you first sought help and how difficult it would have been along the way to overcome any of the situations you describe .... They probably all felt insurmountable at some point. And yet now, you can look back and see that they were not impossible mountains to climb, they were made possible by your own determination and strength.

I think the fears we have do vary from person to person but we can all relate to each others fears no matter what they are based upon. To gain strength and feel more confident we all need determination and strength.

You have already demonstrated that you possess these attributes and this brings me to believe that you can again draw upon your inner strength to climb this latest mountain.

You have proved already that you can overcome what seems impossible so there is no doubt in my mind you can do this & everyone here will be behind you all the way.

Miss Hope
13-04-14, 19:34
Thank you so much for your replies to my message.

TO MynameisTerry thank you for giving such an honest opinion and reminding me what the basics are of exposure therapy and the importance of habituation and small steps. I did have some sessions with a therapist last year (who was very good but didn't focus specifically/only on exposure therapy/CBT). I saw her privately but couldn't afford to carry on and so for the last few months have been using the techniques on my own and really pushing myself. The big lesson I have learnt is that anxiety does subside and that if I can bear it then things gradually become normal again and my body adjusts and isn't on edge all the time in the certain situations. But it's easy to forget the important points you make about habituation and the importance of small steps and repeating each step until it becomes comfortable. Also I think it can be hard for others without similar problems also to realise the significance of what can seem like small steps. I know that I am doing things now that I wouldn't have done a year ago but in the grand scheme of things it is easy to forget that it is progress.

Thank you also for making a similar point littlebutterflybg that taking too big a step is counterproductive and can almost cause paralysis. The fear becomes overwhelming. I think that's what happened with me this week.

Anyway yesterday morning after reading MyNameisTerry's message I decided that I would start again and tackle things at a much smaller level and aim for one or two stops on a local train which goes about a mile per stop. Anyway the good news is that I managed it! I think that was my first time on a train for about three years. I managed two stops!

Your reflections and my own failed train journey have helped me to decide that I am trying to do too much with the impending overnight visit so far from home. And so I have decided not to do it and am arranging things so that I no longer need to go. I'm disappointed but it means that the pressure is off and I can try and do things in my own time. MyNameisTerry is correct in saying that the knowledge of having to do something heaps extra pressure on.

Tessar thank you for your kind comments on my achievements to date and for your belief in my being able to keep challenging the anxiety. You are right in that it is easy to forget progress. And being able to be out and about in town - ten or twelve miles from home - without constantly thinking 'can I get home if I need to' is so refreshing and a reminder that I will be able to achieve other things further down the line if I keep on perservering. As you say it is through facing the anxiety and not avoiding it.

I have been reading some of the other stories on the forum and it is good to see how far people have come in making change in their life. I like the idea of sharing our achievements and setbacks. It's nice to hear from people who understand. Thanks again for your kind comments. I'll keep you updated and will be keen to hear how others are doing too.

MyNameIsTerry
14-04-14, 05:05
Well done Miss Hope.

So, if you think about it you:

- made a plan to push your boundaries
- took your first train journey in 3 years
- managed not just 1 stop, but 2

So, you achieved 3 things there. You could have easily backed out or only gone 1 stop but you blasted through both of them. Nice one.

I think you have done the right thing about work. I didn't want to say this, others have anyway, just incase you boss wasn't sympathetic to your needs which may have made you feel more pressure.

You've now got some breathing space to take a stepped approach to it. The good thing about this is that you will also be able to see the benefits as you move the boundaries a bit at a time. When you feel ready, take a longer journey and if it doesn't go to plan, thats fine, get off and start again with smaller steps.

It's all a learning process I find with anxiety disorders, there is no one size fits all approach.

Have a look at these links as they may be useful to you. I big part of added pressure can be the mental chatter, the I SHOULD when it should be I COULD. The former puts pressure on you and only sets you up to fail. Reviewing some of these thoughts might help you in your plan as you can notice them and challenge them.

There is some useful charts & graphs in here.

http://www.moodjuice.scot.nhs.uk/pdfGuides/Panic.pdf

This one might help you understand more about the panic cycle and whilst I haven't read a lot of it, it does reference Claire Weekes which is a very good sign.

http://www.anxietycoach.com/support-files/panicattacksworkbookchapter7.pdf

Whilst I haven't had Agoraphobia as such, I do have GAD and when it hit my worst points I start to find it hard to go outside. GAD seems to link in with so many of the other disorders so you end up with some appreciation of how they feel, albeit to a lower intensity.

The first time I hot rock bottom, it was an achievement just to go out in the back yard and I couldn't stay there...that came next. You just keep chipping away at it, a little further, a busier place, etc.

I've not had much exposure therapy but aside from duration, I think a useful strategy is to find similiar but less frightening scenarios as the smaller steps. For instance, going in a busy enourmous supermarket can be daunting, so go in a smaller more relaxed one or go in a B&Q where it's really spread out with an outdoor section, it's all a step forward towards the bigger goal.

How did you feel before the train and when you were on it? I'm better you felt better when you got off it and started to realise your achievement.

Trains and hotel rooms can mean you have a lot of time with your thoughts. I've read before that the creative side of the brain uses more of your subconscious than more logical tasks which use more of your conscious side. So, try to stimulate that part and it may help you on the longer journeys and on the hotel stays.

Mindfulness meditation would be useful also. Aside from the fact it helps anxiety disorders in general as well as depression, it's easy to do on a train where people often sleep anyway or in a hotel room on your own with no distractions. It takes time to learn but it is worth it and at first at least helps with relaxation. It has helped me greatly with my various OCD's and has also made me feel that I want to do more as well as changing my attitude in various ways.

All the best.


Terry

Miss Hope
20-04-14, 13:01
Thank you for the vote of confidence Terry and reminding me to focus on the positive. It's a good reminder as I was left feeling rather like I'd failed last weekend. I haven't caught the train since but plan to do so and want to get used to it again and reach the point over a few months where it starts to feel normal again. I know it will take a while but I believe I can get there.

And thanks for the references. I've had a look at them both and they look really good. Yes, I also think Claire Weeks is great. Her books have been so helpful for me at times in the past and really helped me to get through a very difficult time when I was having panic attacks all the time.

It's great to hear that you have overcome your own issues through perseverance and determination. The little bit further every day makes good sense. And you are right about smaller scale scenarios. In part it's why small local train stations are much less daunting than big national stations. In the same way that a local shop is less daunting than a big supermarket. That's a good reminder.

Anxiety is a strange thing. And the one thing I have definitely learnt is that whatever form it takes the more you try and avoid the feeling the smaller your world becomes. It's a horrible truth - and a bit of a cliche - but the only way to overcome it is to face it.

Thanks for recommending the mindfulness guides. I have heard other good recommendations and so am going to look into this.