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Panic Disorder
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8/2/18 9:11 AM
Hello everyone,

I'd like to share a major issue that I have been having related to my mental health.

I am a 25 year old male who had a major panic attack for the first time last summer. This has resulted in other panic attacks every few weeks of varying degrees (some of these episodes can last for over an hour with an "afterglow" of a day or two in which I am on edge and super anxious). I won't define panic attack as a quick google search can provide many bullet-pointed lists of what happens during an episode. The overall theme is that my body produces all these stress related sensations and my thoughts become crazy and I begin to think that I am dying. I simply can't control it even when being carful around various triggers. I realize there may be some major potential to gain some insight into the three characteristics during these episodes and even right before these occur (I've even tried noting myself through 2 of the worst ones), however, I'm really looking for a way to get back to a place where I function "normally" as I did before this ever happened (which is to say no panic attacks ever). I've tried samatha techniques as well, but to no avail. I've tried changing my thoughts to be more positive before these attacks start, as well as focus on other neutral sensations or parts of my body, but this also hasn't helped.

I've since gotten a perscription for Xanax which is more of a bandaid at this point and helps me to function (also not a huge fan of taking the stuff since it's known to be abused). However, it is very much an issue now that I face loads of anxiety and it's gotten to the point where I don't want to leave my house. This makes things like going on hikes, runs, grocery store/shopping trips, day trips, social situations, dating etc. very difficult and I can't really see myself doing these things without having to take a pill first.

For some perspective, before this happened, I was able to travel to different countries by myself (Germany, Thailand, etc.) without issues but I can't see myself ever being okay with doing that sort of thing again. Now the mere thought of being in the grocery store can trigger panic since I've had attacks there before.

I was wondering if people had any advice or experience related to what I feel is "Panic Disorder" and an accompanying agoraphobia. Can further path shifts eventually "cure" this (apparently there really are no cures for panic disorder but I've seen that some people have cured or lessen depression or bipolar disorder through meditation). Are there highly awakened folks who need to take medication to deal with mental health issues? Do people have any experience with Cognitive Behavioral Therapy (CBT) or daily anti anxiety medications? Have meditational shifts (paths) made these issues more managable or completely cured them? What can CBT offer me that noting/insight techniques can't?

I'm fully aware that milage may vary, but I'm wondering if there is any long term hope for getting beyond this. I'm a social, and active person, but lately I can't really be that person anymore without fearing the worst all the time. This issue hinders my ability to live a good conventional life which definitely has its place in the realm of spiritual practice.

Thank you for any advice, perspectives, or personal stories regarding handling of these issues both with meditation, and through more "Western Medicine" ways.
 

RE: Panic Disorder
Answer
8/2/18 9:54 AM as a reply to Hibiscus Kid.
I don't have much personal experience with panic attacks, but you may find this post on a possible explanation for panic disorder helpful.  You may find it helpful to work with a somatic experiencing therapist, where they focus on helping you regulate the fight/flight/freeze response.  I've been working with one on trauma, and it's kind of like a guided meditation where they'll closely observe you and suggest different things to focus on if they notice you're getting too anxious.  Trauma-Sensitive Mindfulness may also be a helpful read in terms of how the fight/flight/freeze response works and interacts with meditation.

I would suggest not trying to use the moments of panic attacks as an opportunity for gaining insight.  While insight is great and worth getting to eventually, successfully starting to perform insight practice on a novel kind of sensation has a tendency to make that sensation stick out and increase in frequency and vividness for a period of time -- sometimes until you get through most of a Progress of Insight cycle with it and up into Equanimity.  Increasing the frequency of fight/flight/freeze-linked sensations both makes the fight/flight/freeze response more intense and also can lead to other sensations in the present moment getting linked to the fight/flight/freeze response (e.g. if you're having a panic attack and an ice cream truck comes by and you perform insight practice on the sensations of the panic attack and the ice cream truck music, you become more likely to have a panic attack if you hear an ice cream truck).

RE: Panic Disorder
Answer
7/27/19 12:36 PM as a reply to Hibiscus Kid.
I experienced a lot of panic attacks in the past year, especially when I first got into my practice. They're gone now. What I occasionaly still experience are empty, purely physiological releases that "feel" like a panic attack but no longer have the uncomfortable sense of "Impending Doom happening to me".

What finally allowed me to "break through" them was just noting through the episodes again and again, sometimes for what felt like hours. One night on my first retreat I was alone in bed noting a particularly paranoid episode, suddenly everything sort of just popped. I saw the thoughts as thoughts and the bodily sensations as bodily sensations in a way I had never before. I saw the Mind trying to weave these wild narratives around these physical sensations, yet there was no compelling reason to do so. It was a big "duh!" moment, I laughed and laughed at the now comical narratives being generated in my head that were no longer any problem at all. 

Pay attention to what's going on in the body during a panic attack. Where are the anxious thoughts occuring? What do they feel like? Where are physiological effects happening? Are you thinking the thoughts or hearing/seeing them? Where is you awareness during a panic attack? Is it in your forehead or in the rest of the body? What does it feel like to move awareness to your toes, your fingers, your abdomen, your breathing? Note the quality of the thoughts. Is there doubt, fear, hate? What is the overall emotional feeling-tone of the experience? Are there voices criticizing and doubting the efficacy of your noting? Note those. 

This work was supported by lifestyle changes I had to make, don't discount these either. These provide the groundwork for good practice to unfurl. Spend time in the sun and nature, do vigorous exercise, eat well, avoid adding more drugs and alcohol to the mix if you can. Adding Metta to your practice is an excellent thing to do too. Make time to be around and talk with people you like, trust and feel comfortable around (these might be few and far between at this juncture, but it won't always be like that). Seeing a therapist could be helpful if you haven't done so already. Make sure you let them know about your meditation practice. Preferably find someone who has some experience in this area. 

It could very well suck for a while but if you just keep chipping away at it you're more than likely to break through this stuff. Be gentle to yourself and take your time. Best wishes.   

RE: Panic Disorder
Answer
8/2/18 11:50 AM as a reply to Hibiscus Kid.
Hi Hibiscus,

I've had a few panick attacks in my 30's (I'm now in my 50's).  It's an unpleasant experience to say the least.  Unlike you, I had a couple that were severe and then had a few more, but they weren't as severe and didn't progress.  Now that has resolved.  

Dan Harris talks about his panic attacks on live TV in his book "10% Happier."  He also discusses how he used therapy and meditation to help.  The combination seemed to work well for him.  If you haven't read the book and like to read, it's a fun and easy read that will make its point and make you laugh out loud.  I would say though, just because it worked for him doesn't mean it will work for anyone else.

A couple of thoughts that might be helpful with the obvious caveat that "I'm not a doctor, don't play one on the internet and I didn't stay at a Holiday Inn Express last night."

Not sure what your insurance coverage or financial situation is like, so this may or may not be helpful.  If you have a prescription for xanax, you've been to the doc.  So, assuming you can go again, ask to have some labs drawn.  I worked on a psychiatric unit for a bit and all new admits (anyone who had never been admitted to an inpatient psychiatric facility before) had labs drawn, as anxiety (and other psychological issues) is often a symptom of various common physical issues.  Labs to check thyroid horomones, vitamins D and B12, testosterone, etc.  Your doctor may try to tell you that you are 25 and "there's no way" that your testosterone is the problem.  Push to get it checked anyway, especially if your insurance covers lab work.  Knowing what isn't the problem can help narrow down what is.  

I used a CBT to help with a lifelong sleep issue.  CBT was very helpful, but more helpful was diagnosis and treatment for a lifelong undiagnosed thyroid problem.  Granted, thyroid issues are more common for women, but hormone balance is important for everyone.  Yes, you are young and it seems unlikely, but again, knowing what isn't the problem can help you to figure out what is.  Ruling out a physical cause can allow you to move on to therapy with the assurance that there isn't some underlying physical cause.  Therapy is helpful, but if there is an untreated physical cause, all the therapy in the world is unlikely to help much.  

What can CBT do for you that insight/noting can't:

Based on personal experience, a CBT therapist can guide you in a custom direction, suited for your specific situation, on a customized timeline based on your personal progress.  They will guide you in a step like fashion, to approach and conquer your anxiety.  I have used experts throughout my life to help me learn new skills, so you can look at CBT like that, too.  This is a much more serious issue that learning to play the guitar, for example, though.  In your case it sounds seriously debilitating and you want the most effective, efficient help you can get.  I would posit if you needed an appendectomy, you would seek out a surgeon, hospital and anesthesiologist to help you.  You likely wouldn't do it with a few friends in your kitchen, so don't try to fix your anxiety on your own, either.  Get the best help you can afford to assist you in resolving your panic disorder so you can get back to traveling and living your life. 

As for what insight practice can/can't do, see the Foreword and Warning section of MCTB.  

"This should be seen as another warning: this book and the path presented in it are not for those who at this time find that they are unstable spiritual seekers.  Meditation at the levels I am about to describe requires a baseline mental and material stability;... You must have your psychological trip very together to be able to handle and integrate the intense techniques, side effects, and results I am about to discuss."

And:

"There are plenty of gentle techniques and schools of practice available for people for whom it would be more skillful and constructive to apply those techniques.  There are also many skillful healing modalities available today to help those who need to heal psychological trauma or clear up barriers to more intense preacitce.  If you need those, you are highly encouraged to do that crucial work first.  Many of the techniques and doses recommended in this book are for those who already have a solid platform of mental health and are willing to accept the risks inherent in intensive training."

"Stated much more explicitly:people who do strong and intensive practice can hurt themselves and freak out.  Just as serious athletes can hurt their bodies when they take a misstep or push themselves beyond their limits, just so serious mental athletes can strain their minds, brains, and nervous systems, and strained brains can sometimes funtion in very srange ways.  To rewrite the OS rapidly while it is running doesn't always go so well in the short term or occasionally in the long term.  Thus, while I will include nearly endless exhortations to find he depths of pwer and clarity that you are capable of, I will also add numerous warnings about how to keep from frying yourself."

Hopefully something here is useful.  There is hope to fix your anxiety/panic disorder.  Find the best help you can and don't give up until you have it resolved.  

RE: Panic Disorder
Answer
8/2/18 4:31 PM as a reply to Hibiscus Kid.
I used to have panic disorder, one of the worst cases I know, attacks that would last for days. I was originally set off by a bad mushroom trip and subsequent PTSD in college. It runs in my family. Get the book by Edmund Bourne "The Anxiety and Phobia Workbook". Like right now. Go to Amazon and buy it.  That book saved me, and it has saved everyone else I know who has had panic attacks that I've told to get the book. 

RE: Panic Disorder
Answer
8/2/18 5:40 PM as a reply to Hibiscus Kid.
I've struggled with similar problems recently. The advice already given has been pretty good so I won't rehash it. I'll mention some more points.

If you consume caffeine at all, stop. Why this recommendation isn't given by all doctors and psychiatrists etc for anxiety/panic patients is appalling. Have a persistent cough, oh, and you smoke a pack a day? Maybe stop that. Obviously this extends to all other stimulants or anything stimulating whatsoever -- amphetamines, afinils, etc.

Last year I cut down from 150-300mg of caffeine a day to about 50mg-80mg of caffeine a day. I recently quit all the way and it's made a significant difference.

Don't assume that meditative progress will always improve anxiety/panic problems. Don't assume that meditative progress will never worsen your anxiety/panic problems.

A cheaper and safer alternative to Xanax is propranolol. Look into it, talk to your doctor, this isn't medical advice, etc.

Here's another thing I've realized lately that I don't ever see people talking about. The negative thoughts associated with anxiety/panic can have the same quality as intuition. If you're someone who habitually trusts their intuition then you will, if I'm correct about the previous statement, habitually buy into the negative thoughts.

RE: Panic Disorder
Answer
8/2/18 5:58 PM as a reply to Hibiscus Kid.
Sorry to hear of your troubles, Hibiscus.

Lots of good suggestions for working directly with the problem--someone named a workbook that sounds appropriate and Trauma-Sensitive Mindfulness is a great resource. I'm not so sure sitting meditation is the best treatment for this and worry it could make things worse if you aren't very careful. I know a couple of people who had serious panic attacks for awhile who got better with time, therapy, and meds, though.

I do not have panic disorder, but CBT has benefited me greatly for other issues that meditation ameliorated but could not resolve. I would highly recommend it. In your position, I would also probably be interested in taking a SSRI/other non-addictive daily anxiety med at least temporarily while learning other coping skills and getting back into a normal routine. They can be tapered off at a later date, no big deal.

I have found various techniques from yoga and martial arts (particularly breathing exercises) to be extremely effective in controlling arousal and generally taking my nervous system down a notch. There are TONS of great free online yoga classes to get you started it you're interested so you don't even have to leave the house (let me know if you'd like more info). The more you can make a straight, relaxed posture and deep, relaxed breathing your default, the less frequently anxiety may arise and the more easily you'll be able to notice its early signs and take steps to counteract escalation. Exercise in general is really, really good for one's mental health regardless of the issue. 

A few months ago, I used a breathing technique on a pregnant woman who was having a panic attack because she thought she was losing the baby. She went from screaming to completely calm and relaxed within 2 minutes of me talking her through it. Of course, that's only n=1, but there's research out there and the physiology makes sense. Deep diaphragmatic breathing increases vagal tone which counteracts the sympathetic nervous system's "fight or flight" adrenaline rush. All I did was have her count to 4 on the inhalation and count to 5 on the exhalation so the exhale was a little longer. Very simple, easy to focus on, but effective. Having some techniques like this to have on hand might help give you some control over your nervous system.

I wish you well and hope some of that helps. 

RE: Panic Disorder
Answer
8/3/18 5:44 AM as a reply to Jinxed P.
Funnily enough, I was talking to someone about this very recently and he recommended the same book as he had worked with people with mental issues/phobias in the past. I'll be sure to order it after work today. Your endorsement is promising and inspring.  Thank you for the recommendation!

RE: Panic Disorder
Answer
8/3/18 5:52 AM as a reply to Dada Kind.
Your advice coincides with what I'm currently doing. In college, I could drink 6 cups of coffee a day. I'd be ecstatic and motivated and focussed, etc. Now I become an absolute wreck after a few sips. It's gone from one of my favorite drinks to something that I realize causes me more issues than it is worth. I'm weening myself off and sticking with water.

I'll be sure to discuss other potential medications with my General Practitioner. Xanax has been really helpful and I'm amazed at how well it works, but hearing about addictions makes me tread carefully. I try to use it skillfully which might be once in a while, but I'd still like to explore other options.

RE: Panic Disorder
Answer
8/3/18 6:05 AM as a reply to Alice S.
Hello Alice, your response contains a lot of good information. Thank you! I've had blood work done as well as an EKG and my General Practitioner says that it all checks out and that I'm healthy.

Thank you for detailing your experience with CBT. It seems to be the therapy most recommended for people with panic disorder and my General Pratitioner recommended it as well. I wasn't motivated to find a therapist and spend the money though, but now I'm really considering just going for it. It seems promising and would really help improve my quality of life.

I'm familiar with Dan Harris and his story. I'll be sure to check out his book. Thank you for the recommendation!  I'm very familiar with the warnings in Daniel's book as it is one of my favorites. It is certainly a balance, as meditation is one of my main interests, but sometimes I'm not sure if I'm making anxiety worse. Also tough to say whether I would have developed panic attacks even if I had never meditated since some of these issues happen to people starting in their 20's. 

Thank you for reaching out!

RE: Panic Disorder
Answer
8/3/18 6:10 AM as a reply to JP.
Hello JP, that article was very interesting and makes me consider if deep breathing would help.

Also, I think Daniel Ingram recommended that book as well. I'm interested in reading it and will order it later today. Thank you.

I have only practiced noting in a few of these instances, but I found it's better to try and distract myself. Honestly, it makes things worse.

RE: Panic Disorder
Answer
8/3/18 6:32 AM as a reply to Andromeda.
Hello Andromeda, I am familiar with the warnings associated with hardcore meditation and so I've been cautious. I don't do a ton of formal sitting and my concentration isn't the best (I practice a lot of freestyle noting in daily life though). I'm not trying to use meditation to solve this issue but it would be cool if perceptual shifts in the years to come would help lessen these instances of panic.

For the time being, I'm going to order those books and learn coping mechanisms. I also feel your advice about the daily medication is a good one and I've actually been considering that for the last few weeks. I'd like to take it for a time so I can learn coping mechanisms and maybe do some therapy before weening myself off. Honestly, my goal is to not be dependent on any substance just because if I ever get caught without it, I'd need to be able to deal with whatever arises.

Also, I'm happy that you discuss CBT as a compliment to your spiritual practice. It's tough to know how much meditation can help since mileage may vary from person to person. I like meditating, I'm interested in awakening, but I'm also interested in dealing with this panic through the use of western medicine and psychology as it works for many people. Learning to cope with this anxiety would alone be so beneficial for my mental health and quality of life so it's worth a shot. I also try to exercise and eat a somewhat healthy diet and I'm still improving that area of my life.

Also, I'll experiment with breathing techniques (really interested in this actually!) and try some yoga off youtube. I think these can all be beneficial. Thank you for all the helpful tips!  

RE: Panic Disorder
Answer
8/3/18 5:46 PM as a reply to Hibiscus Kid.
Hi HK,

A couple of years ago, I started having very strong random panic attacks.  I had no idea what was going on, and was so clueless that I thought I was having heart problems.  I spent a fruitless year having various tests done, which all came back negative.  When I finally realized it was just extreme fear, I was able to make progress.

I used the AWARE method that this guy describes:
https://www.anxietycoach.com/overcoming-panic-attacks.html

The real key is to accept the fear and not try to push it away.  Let it come and do its thing, focus on bodily sensations or the breath (anything except the thoughts/doom scenarios that are playing out in your head).  Fear can't hurt you.  After I accepted the fear and just watched it come and go, I had like two more panic attacks and then they stopped permanently.

Assuming you are a healthy and reasonably sane person, you don't need to do tons of research or deep practice or anything.  Literally just accept it without judgment and it will pass.  Or at least that was my experience.

Good luck!

RE: Panic Disorder
Answer
8/5/18 5:34 AM as a reply to Hibiscus Kid.
As others have pointed out, you may just be struggling with fear nana and eventually vipassana might be the way to really get past this problem. It even begs the question: how many people with anxiety/phobias/etc. really just have some variant of insight disease? But in the short term, if your insight disease is causing serious impairments like agoraphobia, you need to use every tool available to you in order to get back on track. Western medicine is a sledgehammer when it comes to this sort of thing, but sometimes a sledgehammer is what we need. 
Breath/body work can help bridge the gap in the meantime. When/if you are ready for serious meditation practice, it would be wise to find a teacher or cultivate a close relationship with a knowledgeable mentor who is prepared to help you if difficulties arise.

RE: Panic Disorder
Answer
8/20/18 9:23 PM as a reply to Hibiscus Kid.
Hello everyone,

Just an update: Thank you for your book recommendations as well as more traditional-western/medical recommendations. I'll be reading them again and considering all options.

I visited my doctor today and after discussing things, she was happy to prescribe Zoloft for me. She was pretty eager to take me off Xanax since it is so widely abused (and honestly, as well as it works, I felt weird taking it since I'm sure I'd feel on edge if I happend to have run out of it). A data point: Usually I'm pretty on edge when I go to the doctor because I had my first serious panic attack at a hospital, but today I was completely normal and my pulse was the lowest it has been while visiting my doctor. 

Another interesting tid-bit: I mentioned to her that I practice a lot of Buddhist-inspired insight meditation (she asked if I had ever meditated) which can have destabilizing aspects to it (not sure if my practice is so intense as to cause these issues, but once I started noting in daily life as much as I could, I started having a lot of anxiety). She told me that she has heard of these destabilizing effects before and told me to try out calming guided meditations on an iphone app. I'll check those out, although I sort of look down on these things since I automatically throw them into the whole "McMindfulness" category, but maybe it's just what the doctor ordered. I've personally always sucked at cultivating samatha since I doze off or get frustrated that I can't get into absorptions so insight meditation has been my go-to.

Either way, thank you to everyone who advised me and motivated me to try different options. I have a feeling that the process of fleshing out this panic stuff will take years, but I am confident that it can be done with a balanced approach. For now, I have some reading to do and other life-stuff to figure out! Still curious as to whether this is meditation related or just a panic disorder arising in someone in their 20's (or a mix of both). We shall see. 

RE: Panic Disorder
Answer
8/21/18 8:19 AM as a reply to Hibiscus Kid.
Thanks for the update, Hibiscus. I'm really happy to hear that you are taking these important steps to get your panic issues under control. And how wonderful that your doctor was knowledgeable about the potentially destabilizing effects of insight practice! It sounds like you found a great physician who really wants the best for her patients. Some calming guided meditations sound like a great idea. Ain't no shame in using technological help like that--you might also check out a binaural beats app as they can be a lot of fun to play with.

Be well and keep us posted on how things unfold for you!