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A concise guide to overcome panic attacks with the third wave of cognitive behavior therapy and mindfulness.
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Veröffentlichungsjahr: 2012
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Panic defusion essential mini guide
Table of Contents
ForewordAbout the author1. What we are going to doThe vicious circles of panic2. The senses and the mindWorking with the mindDiscovering your triggerDefusing your trigger3. Exposing to real life situationsCommit to your valuesExpose to real lifeA. ResourcesInternetBooksPanic defusion essential mini guide
The third wave of cognitive behavioral therapy for Panic Disorder
Pietro Spagnulo
<[email protected]>Copyright © 2012 Ecomind srl
ISBN 978-88-87795-73-8
Foreword
ACT has become one of the most important advancement of psychotherapy and there are hundreds of resources about it and about how ACT is used for anxiety disorders. There would be no reason to write another ACT guide on the subject of panic attacks unless something really new is said, or it is said from a new perspective.
Well, I think that this guide collects all the essential aspects of ACT interventions in a very concise way. It is like having a comprehensive look at the matter.
On the other hand, and most importantly, I've tried to approach in a more detailed way some aspects of what is possible with ACT. Although many defusing techniques have been described so far, only little efforts have been made to describe how deep one can go while defusing from your mind.
I hope that this little guide might help people who want to overcome their panic problem and, at the same time, want to know where emotional problems come from.
About the author
Pietro Spagnulo is a psychiatrist and a "third wave" cognitive behavioral psychoterapist. He has been working intensively with patients suffering from panic disorder since 1998 and is involved in clinical research in this field. He teaches applications of mindfulness in psychotherapy with Michael Chaskalson and treatment strategies for Panic Disorder. He is author of several educational books on anxiety and mood disorders. He lives in Italy.
Chapter 1. What we are going to do
Warning
This guide cannot and must not substitute professional advice and/or psychotherapy. It simply consists of educational material that may help you better understand your problem and hopefully choose for the better.
This guide is based on a specific defusion technique used by the author with hundreds of people suffering from panic attacks.
Defusion is mainly used in Acceptance and Commitment Therapy which in turn is one of the so called third wave of cognitive behavioral psychotherapies.
The most recent edition of the Diagnostic and Statistical Manual of Mental Diseases (DSM IV TR) states that you suffer from Panic Disorder if you have had episodes of panic attacks and you try to do everything you can in order to avoid further episodes.
There is something very interesting about these diagnostic criterias.
The point is that you DON'T suffer from Panic Disorder if you don't care about having further episodes of panic attacks.
And this is precisely the case with the people who don't suffer from this Panic disorder.
Approximately one in three people in the general population has had episodes of panic attacks, but doesn't worry them. They think of those episodes just as mental states, probably unpleasant, but nevertheless just mental states. Moreover, they think of those mental states as something made of thoughts, emotions, sensations. They are able to distinguish between what happens internally and what happens externally. They know it is kind of a mental-and-body reaction to some fear. Should they have had a panic attack under a subway in a tunnel they would know that they get scared about their own thoughts.
For someone who is a strong Panic Disorder candidate, the situation is quite different.
They are not interested in their thoughts at all. Because they don't even recognize that they have thoughts. They think that their thoughts are their reality.
And their thoughts are: what is happening to me? Am I dying? Am I going crazy? Am I going to lose my control? Am I doing something extremely embarassing for the people looking at me?
Do you see my point? If you don't, you soon will. We just need to work together for a while...
The vicious circles of panic
What is the cause of your problem?
I am sure you ask yourself this question. And I am quite sure that you are tempted to think that if you find the cause of your problem you can get rid of it and solve your emotional problem.
Is that your case? Ok, follow this reasoning.
Scientists never ask themselves what is The Cause of anything. They just try to discover connections (multiple causes, if you want) between events. And the more they discover, the more precise and complex those connections become.
Do you know The Cause that makes a stone gravitate towards the earth? I heard you. You said "gravitational force", didn't you?
And what this gravitational force is? Do you know that it is not a force at all? Do you know that it is something that has to do with time-space distortions?
Have you any idea of how many causes there are that made you have those panic attacks?
Hundreds? Thousands?
Maybe more.
Causes are inside your nervous system.
How many neural connections are there? What do those connections do? How are your receptors implied in your emotions? What are the genetic features of you brain? How did they evolve during your life? Do you know that the structure of your brain is shaped, among other things, by your mind and your behavior throughout your life?
Causes are inside your personal history.
How many events are related to your panic attacks? What kind of experiences have you had that are linked with your panic attacks in some way? Do you remember them all? How is your memory of those experiences affected by your judgement, your thoughts, your reactions and your previous experiences? What kind of thoughts, fears, traumas, biases are linked with your panic attacks?
Causes are inside your current social context.
What kind of problems are you facing nowadays? What is your relationship with your family? Your friends? Your partner? What kind of preoccupations, dissatisfactions, desires, obstacles do you find in your life?
Do you really think it is possible to perfectly know all those causes in detail? And even if you knew all of them, do you really think you could get rid of them all?
The causes of human events include their own intentions and behaviors
We have seen that there are plenty of relationships (multiple causes) behind even a very small event such as an object falling to the ground.
But as far as human beings are concerned there is one more order of causes: their intentions and behaviors.
Human beings are not inanimate object. They are not stones. They respond to the environment and do something.
And they don't do anything because of external forces, whatever they do it is because they have intentions.
A little exercise
Please, answer this question:
Why did you start reading this book?
Have you noticed that you did this because of some kind of intention? Perhaps you want to get rid of panic attacks, so you told yourself something like this: "Let me try this".
Are you now convinced that among the causes of human behavior there must be also intentions (i.e. looking for something, having a goal)?
But what has this to do with panic attacks? Do I really think that you have panic attacks because you have the intention of having them?
Not at all.
This is not your intention. Rather, you have the opposite intention.
Ok, are you ready to know the truth?
One important cause of panic attacks is exactly the following very strong intention: I do not want to have panic attacks anymore, at whatever price!
Surprised? Confused? Did you already know this?
Do you see the point now?
Ok, let me explain something you will find very interesting.
When you think of your problem, you probably think of a condition, a static situation, which has been caused by something.
The point is that emotional problems are not static situations, but processes.
Each time you have a panic attack, you activate a specific process, a chain of mental and behavioral events. You might call them a pattern.
And the pattern is always the same: something scares you (for now we don't need to know what scares you. But we'll talk about that later). At this point your body activates some primitive and physiological reactions related to the perception of danger. Till now nothing serious. Most people experience this.
It is now that the panic problem pattern starts
Imagine you now feel your bodily sensations, and, please read carefully, you interpret them as something dangerous (Am I dying? Am I going crazy? Am I losing my control? Am I going to do something extremely embarassing?), what happens next?
You become more scared!
Whatever was the first thing that scared you, now you are scared because of your reaction.
This is called the vicious circle of panic.
At this point another process starts. And this is where the intentions come in.
Once you discover that the experience you have had is very bad you might decide that you must do whatever you can in order to avoid that experience again.
Your strong intention is now to avoid having the horrifying impression of dying, or going crazy, or losing your control or doing something extremely embarassing.
And what do you do?
You start avoiding all the places and the situations which, in your imagination, might activate the state you fear most. This means that you are trying to avoid whatever condition you might feel anxious about.
But you can't avoid everything, so you also start behaving in a strange way.
Perhaps you ask for someone to stay with you in order not to be alone. If you go somewhere you might take information about the nearest hospitals. You might flee some special occasions at restaurant, cinema, theatre, open spaces, as soon as you feel any kind of sensation (the sensation of unbalance, of your heart beating, tremors), you might try to distract yourself, make a phone call for nothing, etc.
When you act like this you start suffering from Panic Disorder.
And another process starts.
You might happen to think I am inadequate and it makes you feel depressed, your self esteem lowers, and you avoid your feared situations even more.
Do you recognize yourself a little bit?
Now, imagine that you become able to recognize your experience better.
Imagine that when you feel your heart beating you just feel your heart beating.
Imagine that when you feel any tension in your body you just feel tension in your body.
Imagine that when you have a thought like "oh, my God, I'm having another panic attack", or "I'm dying, I'm going crazy, I'm losing my control" you just recognize that you're having those thoughts.
And imagine that you don't follow those thoughts, you don't engage in those thoughts because you know where those thoughts want to lead you.
Imagine you recognize those thoughts exactly as what they really are: just thoughts.
Imagine that when you feel anxious you just feel anxious.
Imagine that when you are really anxious - and most people do feel really anxious sometimes - you just learn how to calm down, exactly as most people do.
Imagine that what you used to call "panic attacks", and what you used to interpret as the "worst thing that might happen to you", now you understand is just a mental state created by physical sensations and catastrophic thoughts about those physical sensations.
And imagine that you know perfectly how to create that mental state, and you know perfectly how not to create that mental state.
Imagine that you know that it depends entirely on you.
Imagine that you just don't care anymore about having panic attacks, because you know that they are just mental states that you used to create by yourself and you know how not to create them anymore.
Well, those things are exactly what you are going to learn.
So, just keep on reading.
Chapter 2. The senses and the mind
We know the world by means of our sight, hearing, taste, smell and touch.
