My first visit from a new client, Jane, did not go well. She left my office with a full blown anxiety attack--not a good start! I thought I'd never see her again and hoped I wouldn't hear from her attorney in the form of a law suit. Actually, as apologetic and embarrassed as she was, a law suit was a very remote possibility.
But I wonder how many clients in similar situations might not be considering law suits against clinicians using inward focusing techniques that can bring on panic attacks. Inward focus techniques are generally what most professionals use--it's having the client focus on relaxing one's breadth, muscles, thoughts... to learn relaxation. However, in reality, it's these type of techniques that contribute to anxiety attacks.
Within a few days, Jane did call again. She was too fearful to come to the office - she blamed her anxiety attack on my "small" 12x12 treatment room, which is more than three times the size of most treatment rooms. She asked if I'd consider in-home sessions. Reluctantly I agreed.
A few days later I arrived at her home with an Galvanic Response (GSR) biofeedback instrument in hand. I didn't want a repeat of our first meeting so I avoided using any relaxation exercises that used inward focus. I took more time to get to know Jane. I got the feeling that she could talk for hours about her symptoms, but I wanted to know more about what stressors led to the beginning of the anxiety attacks. According to the Homes-Rahe Stress Scale, I'd be looking for some rather significant life changes six months to a year before the onset of symptoms.
Yes, her panic and anxiety started about six months after she and her family moved back to NJ from the Florida Keys. "Ah ha," I thought to myself, although I didn't know what to do with this information at the moment. I learned that she was unhappy living in Florida. She had no close friends and she missed the camaraderie of her sisters and mother back in NJ.
It was so much of a problem that eventually she convinced her husband to change jobs and move back to NJ with her teenage son in expectation of life being the way it used to be. But much to her disappointment, her sisters were married with other interests and the relationship with her mother was different - the camaraderie she remembered was gone. The result was that she was no happier in NJ with her family than she was in the Florida Keys.
To me it seemed obvious that she'd want to run away from this whole disappointing mess. How could she explain to her husband the move was for naught? And her teenage son was getting into some trouble with drugs - another disappointment for which she was unprepared.
I explained my take on her plight by asking her, "OK, you were unhappy in Florida, convinced your husband to uproot the family, change jobs, and move back to NJ so you'd be happy with your family, only to find that your relationships with your sisters and mother has changed and that your son was getting into trouble. Wouldn't you just like to run away from this whole embarrassing mess?" She acknowledged that she'd like to escape the whole entire mess, but it's not her nature.
I explained that her brain was simply taking action on that desire. I explained the fight/flight reaction to stress - how when we feel threatened the unconscious intelligence gets us ready to fight or run. Even a threat to our ego or family status can have this effect. Since she is not a fighter (personality wise), there was plenty of reason for her to unconsciously want to run away. But being a responsible person, she would never allow herself to run away.
OK, then we talked about diet and how certain foods can trigger anxiety - sweets, refined carbohydrates, caffeinated beverages.
All this was nice, but she still had trouble understanding how she was ever going to gain control of anxiety since it just happens "out of the blue."
Essentially, this is the first step - educating the conscious mind. I left her home without ever using the biofeedback instrument and focused on the challenge of making a difference in her life - how to shift her from the conditioned response of anxiety.
First it was apparent to me that the "panic - anxiety" label her primary doctor gave her was in the absence of understanding much about her background. She came to a conclusion that she had a problem and no one knew how to cure it. That certainly took her mind off her real problems in life - "anxiety" was an escape.
In summary, personality factors of being highly responsible led Jane to want to escape the seemingly impossible situation in which she placed her family--a move for naught. Add to that hi-sugar eating habits, a suggestion she gave herself re another family member having had anxiety attacks, and the fight/flight wanting her to escape her family status, and voila: she created agoraphobia and anxiety panic attacks.