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Hi I suffer with anxiety panic disorder and agoraphobia. Lost my brother 18 weeks ago. All returned with a vengeance. After introducing myself on site yesterday thought today is time to start re-opening the door again. If only we thought in the right way. I walked down the road and what did I do mind on all the anxiety symptoms came in and cried. I know wrong so if anyone out there can give me some tips on how they approach the going out. I would appreciate.
maybe your 1st goal was set to high,why not set smaller goals
no1 go outside and stand in the garden for ten minutes
no2 walk outside for 5 minutes with a friend
etc etc
build it up very slowly there is no need to rush into this is there ?
take tiny tiny baby steps
Thanks Andy. I did walk up to my local library this morning. Its only 2 minutes from my flat but I did go in. Anxiety was high but I managed to make myself stay in there for a few minutes and even checked a book out. Reading your advice that maybe not good! My biggest problem at moment is my head. I have this pressure feeling in the top of my head. Sometimes I also feel like a crawling feeling across the scalp and at times even a feeling of heat. It can make me feel very unsteady and my mind will keep going on it indoors and outside. More outside as the pressure seem to get worse when I am out. Unfortunately I don't have a garden I can just walk out into. You can only get to it by going round the drive and pass the neighbours flats. But I did walk round there earlier. But I will worry about neighbours stopping me. Now I am going to take your advice and put the kettle on thanks again June
take baby steps and build up your confidence slowly ,no need to rush these things
have a nice cuppa :)
MyNameIsTerry
07-02-15, 04:48
Create an exposure hierarchy so that you start from less intense situations and work up towards those that cause a lot of anxiety. As you progress between steps you will find you habituate to the current ones and the previous ones become even easier. If you hit a brick wall with a step, consider it as too large and break it into smaller goals.
There are templates online for these Exposure Response Prevention (ERP) exposure hierarchies. They involve a rating scale. You can rescore later as you improve to show how they bother you less.
There are also templates for recording your thoughts about a specific trigger or event so it may be useful to record how you felt before and after.
This NHS Moodjuice guide includes some templates you could use:
http://www.moodjuice.scot.nhs.uk/panic.asp
Its all micro goals with this stuff.
Here is a diagram I posted about the effect on anxiety levels during exposure over time:
http://www.nomorepanic.co.uk/showthread.php?t=160784
Try to work towards being in places for a longer period and then you will start to see your anxiety decrease. It can be harder of you are moving from place to place as you can start to suffer anticipatory anxiety so if you can get your out for longer, great and then work towards being in the library longer (maybe sit down with a book and try and distract yourself?)
Thanks Terry I will defiantly read the article and visit the site you listed. I found today I had trouble just opening door but I did go round garden as Andy suggested. I will take the advice of both of you and take it in small steps. I know when I got housebound before come to think of I would just go down the road and sit on bench unfortunately weather here does not permit at moment so your idea about library is good. Thanks again June
MyNameIsTerry
08-02-15, 09:18
Thats ok June, you still did something and thats not avoidance. Well done! :yesyes:
For now, you don't have a structured plan to follow so if you fall back slightly, thats ok. Once you have this hierarchy in place, if that happens again, go back a step and buuld up again (with even smaller steps if required).
You did it before, so you can do it again...its just going to be hard all over again amd you may find yourself getting depressed about having to do it all again but try to accept that and concentrate on the movement forward.
If we have a good day, you could try that bench again if it helps you. Given the dodgy weather though, its definately worth something without environmental factors like the weather so hopefully the less intense atmosphere of the library will help...many struggle with things like supermarkets and busy, big or open plan places so the library is a good one.
Could you see your GP? They have the ability to issue book prescriptions. NHS Direct explains about this scheme here http://www.nhs.uk/conditions/stress-anxiety-depression/pages/self-help-therapies.aspx Here is the website that NHS Direct shows for them http://www.overcoming.co.uk/single.htm?ipg=6320 and there is one on there for agoraphobia. Perhaps you could set a goal to incorporate this? Go pick it up, for instance? Or read it in there? Or maybe, take it home but then take it back to the library with pen & paper and do some of the exercises that are likely to be in it? (subject to you spending more time in there, at your own pace).
Hi thought I would let everyone know how its going. It is hard but I think I am getting there. I have been out everyday alone for past 10 days. It's still hot flushes tearfulness unsteadiness and pressure in top of my head trying to do the gradual exposure. But the good news is over those past 10 days I have sat in the library for 15 to 30 minutes. I have now managed to leave the library and walk round the block. And this morning I actually crossed the road and used the cash point. A was at its peak walking home and still my biggest problem is my mind will keep going on the unsteadiness and this feeling in my head. Even though I constantly tell myself when I am out it is just anxiety take in a deep breath let your shoulders drop and slowly walk on. However as I also see the unsteadiness and so on indoors at present. I know it will take time for my body to distress. Anyone else with anxiety/agoraphobia having these problems? Also when do you know when to proceed and when not? My mind tells me if I wait for the anxiety to completely go before I move on to the next step I will never get further and by doing that I wont show myself even with the anxiety I can still achieve things.
Hi I am still doing the gradual exposure. Can see opening the door is getting easier. I have been up to the library round the block and round my garden this morning. I found what has helped me a lot to get my anxiety levels down indoors is for the past two weeks I have been using a twenty minute relaxation cd daily and also with outside by doing the gradual exposure daily I am seeing my confidence building. This morning I just told myself I am going out. I know I will not feel well but I am still going. I did find it helped as I find it so hard to get my mind away from the anxiety symptoms. I hope other on here are also seeing things improving for them too!
well done June,pat yourself on the back for your hard work and commitment
It can only get better each day you move forward
Thanks Andy also for your own help and support. :hugs:
PanicAttackGurl
26-03-15, 21:20
Thank you to MynameisTerry for sharing the moodjuice panic self-help.
Hi . I started my exposure therapy with walking to the paper shop, then the paper shop further away from home, my next step was to be the library accompanied but my therapist said I had to do it on my own.mi did it but with intense panic every day being physically sick when I came in. Now am back to square one going nowhere. My therapist admitted she had pushed me too far and has referred me for more intense therapy which I have to wait for. I feel so let down and dont feel I'm ever going to get better
There are two thoughts on exposure and they are very different.
The first and most popular and most likely to fail first time round is using it for a cure. This is based on the fact that everyone has a time that a panic attack can last before built in controls let it go. It is supposed to be 5 to 15 minutes. And probably is if you don't keep reopening it. So the theory is that if you make it through the first 15 minutes you will be okay. My Therapist never asked me to do this. She never would. We did the other thought on exposure and that is using exposure to test how well you have your coping skills in place.
This is based on the fact that "want to" is positive and "have to" is negative. So no matter how hard you push exposure because you "have to", and if you are successful you will have to do it for every situation.
Now suppose you were to decide to go to the library because you want to not because you are required to for exposure. And suppose you add that you don't have to if you don't want to. This gives you an out that you won't use unless you feel you have to. There can be no failure this way because there is no requirement. You are only going as far as your coping skills will let you. Remember it is your coping skills you are using this way, not exposure. Exposure is a marker this way, not a requirement. So the plan would be to go to the library if possible. By the way this way taking a friend is considered a coping skill and acceptable. After your exposure says my coping skills are working you can do it alone. So you start out small and work up. If you go ten steps and stop and go another ten steps it is an accomplishment not a failure because you didn't do fifty. Fifty might be the plan but it isn't a requirement.
I think that the problem here is that you want to, but feel you have to and have to is negative. With this it is changing how you see going some where and it covers everywhere not just the one situation you are exposing to. You should never do exposure unless you have coping skills firmly in place.
Just an option, but I feel forcing panic attacks to go away just doesn't work well. Getting tunnel vision and falling down and puking is not going to give you a positive feeling about exposure.
I can go any where I "want to" and now even "have to" situations get treated like "want to".
I only put this here so you know, off the deep end exposure is not the only way. But it is for some Therapists. Except they don't have to do it.
Thank you for your response what you're saying makes total sense. My therapist saw being accompanied as a safety behaviour whereas I did see it as a coping behaviour. Iam going to try baby steps again first and be proud of what I have achieved. I was told that my exposure had to be done on a certain day at a certain time so the build up to it caused massive panic before I'd even started it. So if I decide on the spur of the moment I can go somewhere and cope is this ok?
While since I have been on here. I am still opening the door. Still have high anxiety but I am getting more able to cope with it. I do the exposure on my own as I have no one to do it with me. But even with high anxiety I can now get over the road alone and into smaller shops. Ok I only buy one or two items when no else is waiting to be served but where as at first I could not buy anything and then only if I did not have to wait for change. Now I practise giving a note so I do have to wait for change. I am also still going in the library and round my garden both have become a lot easier. I have even started doing the garden itself. However, I have just changed the way I do the exposure as I was not going to one shop or place and telling myself I have down well. I was forcing myself to walk round the block where all my shops are up road to my doctors surgery. Back to shops go in several smaller shops and then walk round the block again sometimes twice all in one outing. Ok I was doing it but I was also seeing anxiety and depression getting worse in me in general. So I think I may have been trying to hard. Regards safety behaviour I feel use whatever it takes or helps you to start getting out. I have found in past my own safety behaviours start disappearing as I get more confident.
MyNameIsTerry
10-04-15, 05:58
Thats all progress June. ERP is all about micro goals, anything big is counterproductive and its good that you have identified that you are not habituating to what could be too large right now.
So, break it into chunks by inserting goals inbetween what you can do and what you are struggling on right now or change it to a new goal that has less intensity and build it up gradually or come back to it later.
Safety behaviours are not great but it is possible to start with them and then reduce them back out.
Here I am again with latest update. This past week I have spent hours at a time doing my garden and chatting to my neighbours with no anxiety. Where two months ago it was panic attacks just trying to walk round to my garden and the anxiety too high to even stand and talk to anyone. With the going out I am now able to not just shop in my small local shops alone:I am back in my Morrison's supermarket and by keep going back each day over the past two weeks I have got so I am now able to buy and pay for items in there.. Ok I cant do a full shop yet but it feels wonderful to be back in the store. Now I intend to just keep doing the gradual exposure as I can see although prior to going out anticipatory anxiety is still high as I stay out longer and longer the anxiety lessens and my confidence grows. But I also agree with others you do feel done in after exposure but the reward is well worth the freedom you gain from doing it. And now I treat it like a challenge what can I achieve today and it makes me want to go out and find out. Take today my cash point was out of order so I ended up in the bank but again I was so pleased as I could not have even done this a few weeks ago. But what has helped me the most is the support of others on this site and I hope by others reading my experiences it helps them too.
June Have you tried the CBT technique "want to" instead of "have to" it is in the thread Words I believe.
You will note the use of the words "want to" in your post, note the feeling it gives you compared to if You "have to" as in have to do exposure at the same time.
Hi again to everyone. when I came on this site I could not even walk round to my garden. My agoraphobia was house bounding me. It had done for months. I had severe depression anxiety and panic attacks even indoors . I could not get to my doctors but I never wanted back on medication so felt it was not a bad thing. On top I had just lost my brother to cancer so grief was also not helping. Does C B T work? I can tell anyone reading this yes it does. Today thanks to others advice on this site along with the reading of C B T self help books and Drs Clair weeks books I am well on the road to recovery. The depression is no longer seen. The panic attacks indoors have gone. As for the agoraphobia its is getting better all the time. I am now able to shop in all the shops where I live alone even do my own shopping on Saturdays even in my large Morrison's supermarket without anxiety. I have now been back to my doctors surgery and just gone in it to show myself if I needed to see my doctor I now can. I am now practising walking further and further away from my home. I have had no help from anyone other than people on this site and the reading of c b t self help books. When I first started going out again it was with cue cards, band on wrist, Walkman anything to distract my mind from all the symptoms of extreme anxiety but by going out everyday no matter how I felt the anxiety symptoms lessened and today the wristband, Walkman and cue cards are not needed to go to the places I have now overcome. I now enjoy going out again. It may only be local at moment but I am walking further and further away from my home. Where once my home was in site today I am walking two blocks away from it. So anyone on this site who is reading C B T does not work please if you think it will help you give it a try - its what I have done and I am glad I have.
Thanks Paul. So nice to read your doing well yourself too. I have two lots good news. Firstly a lady came to my home two weeks ago to assess if I was eligible for a support worker to do the gradual exposure with me. I have just heard I have been assigned the support worker and they will be calling at my home next week to start work with me. Secondly I have taken the plunge alone and boarded a bus. Started with one stop yesterday going Southward and today went two stops Northwards. Needless to say I intend to keep going. :yahoo:
Hi to everyone. In my last post I was going one or two stop alone on a bus today using gradual exposure, thought challenging and controlled breathing techniques I am now travelling over a mile from my home on buses in both directions alone. I am also getting off the bus and at times walking the mile to mile an a half back to my home. Where as in January I could not even get in my doctors with help or in my dentist. With the help of a friend I have since been to see my doctor and completed a course of dental work involving 3 x rays 2 fillings a dental inlay plus scale and polish and even gone and had my eye test alone. I am not saying its easy - its not. To achieve all of this I have had to experience panic at times but I have seen if I stay in the situations and use the C B T techniques mentioned earlier the anxiety starts lessening. I also find what helps is distraction. I take my mobile with me and where ever I go I take photos of the road signs and places I visit. I later download them onto my computer. I find it not only distracts my thoughts away from the anxiety it also motivates me to keep going. In that when I look at them I cannot believe I went to all these places alone. I also try and tell myself what I fear is not going to happen whilst doing my breathing exercises to aid me to calm down. In my last post I mentioned I was to have a support worker. I now have this lady and she is aiding me with travel therapy. This also helps as instead of her coming to my home and talking to me she gets me to meet her on a bus. So I get the bus to a place I can get to at present and then she boards the bus at this place and we stay on the bus a few more stops and hold the therapy session outside. When we get the bus back she gets off at the stop she got on and I continue on the bus home alone. The thought of doing this at first frightened the life out of me but I find it so much more helpful than just talking therapy.
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