just opened door again

[June L]

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.

[MrAndy]

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

[June L]

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

[MrAndy]

take baby steps and build up your confidence slowly ,no need to rush these things
have a nice cuppa

[MyNameIsTerry]

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?)

[June L]

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]

Thats ok June, you still did something and thats not avoidance. Well done!

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-...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).

[June L]

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.

[June L]

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!

[MrAndy]

well done June,pat yourself on the back for your hard work and commitment
It can only get better each day you move forward