Q.I love your site! I do have a question that you may not be able to answer. Are you familiar with withdrawal symptoms of Ephedrine and Ma Huong? For years, I was taking large does of Ephedrine and some Ma Huong for energy to workout. Well it finally caught up with me and I had a two Panic Attacks in January; and since, its been severe anxiety almost every day. I should say every day since I stopped taking the both stimulants three weeks ago. I am wondering if these could be withdrawal symptoms?

Just when the symptoms seem to be residing in the past week, wham!, I get hit for a small panic or severe anxiety attack that lasts for a full day. I don't know if my body is still adjusting to the lack of stimulants and reacts with severe anxiety? One titbit you should be aware of, while I'm working out, I have no signs of any anxiety. In fact, if I could work out 24-hours a day, I would be fine.

A. We have never heard of Ma Huong and we are not sure if you mean Ephedrine as in 'pseudo ephedrine' used in most cold and flu tablets.

Although this is not going to answer your question, Pseudo ephedrine in cold and flu tablets can induce a chemical panic attack and/or anxiety. If you take a 4-hour tablet, the attack / anxiety could last for 4-hours, a 12-hour tablet, the attack / anxiety could last for 12-hours, etc. People taking antidepressants cannot use cold and flu tablets as mixing the 2 drugs can be dangerous.

We are not sure about withdrawal symptoms. Perhaps you could ask your doctor and do a search on one of the medication internet sites. We are linked to two via our links page.

One titbit you should be aware of, while I'm working out I have no signs of any anxiety...in fact if I could work out 24 hours a day I would be fine.

Exercise/working out burns up the hormones from the fight-and-flight response. But the secret is to stop the fight-and-flight response by working and managing your thinking. Then, you don't need to work out so much!!

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Q.I experienced my first panic attack yesterday while sitting at a red light. It frightened me ALOT! Now I'm afraid this will happen again and I am avoiding this situation. I just read a question and answer about the dissociation, and yes I do avoid highways because of the "trance-like state". I am relieved to finally see that I am not the only one to have this. For years, I could not really have a conversation in the car (while I was driving) because of this. I just "lived with it". How can I live with this? What should I do? Any help would GREATLY be appreciated.

A. It is really a matter of learning how and why the dissociation happens, and learning not to be frightened of the dissociative states. People who dissociate need to see when they are driving, or in other situations, that their gaze does not become 'fixed,' ie, by staring. Staring is one of the major ways we can dissociate. Staring at the traffic lights, a book, tv, computer, out the window etc. Florescent lights can also induce these states.

People are more vulnerable to dissociation when they skip meals, don't get enough sleep and are under stress.

It is important for you to see a Cognitive Behavioral Therapist (CBT). They can help you work with your thinking and can help you overcome your avoidance behavior. We are not sure which country you are from, but many Universities through their Dept. of Psychology run CBT clinics.

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Q:Could you please steer me in the direction of articles/information dealing with people who have experienced panic while driving on the highway (no pun intended) and subsequent avoidance behavior? Also, I am working with a certified EMDR therapist. Any info on that approach? Thank you so very much.

A: There are various reasons why people panic while driving. The most common are.

1. They are frightened of driving ie being in control of the car and/or the traffic
2. They are frightened of having an accident
3. They have had an accident and may have Post Traumatic Stress Disorder
4. They have the ability to dissociate and can enter a trance state very easily.

Point 4 is the major reason people with Panic Disorder have problems driving. Most people with Panic Disorder have the ability to dissociate ie enter trance states. Driving, especially on the highway or freeway, means we are usually staring straight ahead at the road. Our gaze becomes fixed and without realising it we can go into a deep trance state very easily. People without an anxiety disorder can also go into a trance state while driving and this is known as 'highway hypnosis' eg they may get to their destination and not know how they got there. For people with panic disorder the trance state can be a lot deeper. It can also happen while waiting for a red traffic light to change. People can experience a range of symptoms: 'nothing seems real', 'they don't feel real', they seem to be looking through a white or gray mist, stationary objects appear to move up or down, back and forth etc, they may have an 'out of body experience' and of course they panic, If this happens to you, it is a matter of learning how you dissociate and by learning to stop it as you begin to dissociate.

Re EMDR. It isn't being used a lot in Australia and it is difficult to comment about it. We are seeing people through our organization who have used EMDR, but it hasn't been successful. This may not be indicative of EMDR, but of some of the therapists who are using it. From comments made by our clients it appears as if the therapists have not had a great deal of training in its use.

Clinical trials of EMDR for Post Traumatic Stress Disorder have just commenced here in South Australia at one of our Anxiety Disorder Clinics. The Clinicians involved in the trials are appropriately trained so it will be interesting to see the results.

As far as Panic Disorder is concerned we do agree with the international literature which demonstrates Cognitive Behavioral Therapy, with the emphasis on 'Cognitive' is the most successful therapy which gives long term results.

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Q:For the past 6 weeks I have felt continually anxious and worried, and have had frequent panic attacks. Some involve heart palpitations, squeezing of the chest and tingly arms. Others are a surge of negative energy, sending me into a frenzy and making me feel as if I am going insane. Lately, I have had trouble interacting with other people because I feel as if I am watching myself talk to them. My mind is constantly thinking about the fact that I am talking. How can this be treated???? I have talked with numerous social workers, counselors and psychiatrists.
Is depersonalization associated with anxiety? Do you have any behavioral suggestions, such as breathing exercises or phrases?? Please help!

A: We can't diagnose but depersonalization (also called dissociation, self induced trance state) can be part of an anxiety disorder, usually panic disorder. You're description of the 'negative' energy sounds like a panic attack...but as we have said we can't diagnose.

Have you been into our research section on our site? We did a study a few years ago which showed many people dissociated first and then panicked.

Quite a few people have the ability to dissociate very easily. Depersonalization is just one of a number of dissociative states. Usually we do this by staring, at the person we are talking to, the traffic lights, the road, out of the window, reading a book, watching tv, studying, staring at the walls etc.

To break the dissociative state you need to be aware that you are staring and break your gaze, blink or turn your head etc.   As far as we are aware this is the only book on Panic Disorder which describes dissociation and the 'surges of energy' in relation to Panic Disorder and also teaches people how to control it. Have you seen a Cognitive Behavioral Therapist? A CBT therapist can teach you how to work with your thinking which will assist you in breaking the ongoing anxiety and can teach you how to manage you panic attacks.

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Q:Thank-you for your site! I stumbled across it while totally overwhelmed by symptoms one day at work - no more work was done that day but I felt so comforted! I've had a disorder for almost 5 years now, and I experience dissociation, a "moving brain" feeling that literally never stops and incredibly intense itching sensations beneath the skin that make me want to scream! I can't seem to find any reference to the itching and moving-brain sensations in any literature: is this common?

I have been in therapy for about 2 years and am taking and things have improved but I'm still very uncomfortable almost all the time. It sounds ridiculous but only now am I gradually realizing that I'm "causing" these symptoms myself. I would love to feel at peace - I can't remember the last time I could just relax and get some relief from the symptoms. It helps so much to know you're out there!

A: We are glad the site has been of help to you. We know how important it is to be able to identify with other people who have an Anxiety Disorder.

Re the itching and the 'moving brain'. Have you checked with your doctor to make sure the symptoms are not an effect of or any other medication you may be taking. We assume from your letter your Disorder is an Anxiety Disorder as our reply is based upon the symptoms you mention in an Anxiety Disorder context.

We have found over the years many people with Panic Disorder do dissociate and the itching underneath the skin can be part of it. Some people comment it can also feel like 'ants' crawling. It isn't written up in the Panic Disorder literature but we know it does happen to some people. The 'moving brain'. We are not sure what you mean by this. Some people report a tingling or the 'ant' crawling sensations across the scalp. Some people report a vibration sensation, or they feel as if the top of their scalp is being cut off, others report a great pressure from within the head pressing against the scalp. None of these symptoms are in the literature but they not uncommon. There can also be the dissociative sensation of stationary objects moving, buildings swaying, the road undulating etc.

People with panic disorder usually also develop allergies, food, environmental etc. Do you know if you are allergic to anything? Some people report that acupuncture can help with the 'itching' sensation and this may also be worth looking into.

The way we think does create many of our symptoms. We always suggest people contact a Cognitive Behavioral Therapist (CBT). They can assist us to begin to work at changing our negative thinking patterns. And if you are prepared to really work at it, it can change your life.

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Q:I am someone who suffers from panic disorder and generalized anxiety. Your theories on dissociation and how these detached/spacey feelings trigger panic attacks really struck a chord with me. Dissociation is one of my biggest symptoms. I am currently taking a drug called Clonopin to control my panic attacks. In general I am more relaxed, however, it does nothing to help the dissociation. In fact, I would say the drug makes me feel more spacey/bewildered and detached. Now that I realize this is a major panic trigger, is there anything I can do or tell myself while in this state to halt my panic attacks?

A: We have found over the years, dissociation is playing a major role in spontaneous panic attacks. Those of us who do dissociate have had this ability since we were children, although many of us have forgotten we did it as children. It seems some of us 'grow' out of it but when as adults we experience major stress and/or are not eating or sleeping properly, this ability is activated once again.

The major way we do this during the day is by staring. Either out of a window, at the wall, TV, computer, book etc. Staring can induce a trance state and most of the dissociative 'symptoms' show the trance states we can reach are quite deep. Fluorescent lighting also appears to be a cause for the trance states. The research on nocturnal panic attacks shows they happen on the change of consciousness from dreaming sleep to deep sleep or deep sleep back to dreaming. The same way as we can change consciousness during the day when we induce the trance states.

The essence of all of this is to be (a) aware of how we can induce these states during our normal daily activity and why they happen at night, and (b) lose our fear of them so we don't panic.

I dissociate quite a bit, but now I don't panic. I am simply aware of how easily I can do it. If I begin to get the sensations of dissociation, depending on what I am doing, I'll either break my stare/concentration or let it happen! Needless to say I don't let it happen while driving, I simply break my stare. Sometimes I will say to myself, 'Not a good time to do this' or words to that effect.
We teach people why there is nothing to be frightened of by this ability and that they are not going insane. After all, we as individuals are proof we don't go insane. If that was going to happen it would have happened to us a along time ago!

We also teach people to become aware on a moment to moment basis if they need to, of how it happens and how it can happen so easily. When people can see this, we teach them to work with their thinking and not buy into the panic/anxiety thoughts, 'What's happening to me'...'I'm going insane' etc. We all put ourselves under more stress by the way we think about our symptoms. This only makes us more vulnerable to it happening. The harder we resist it, the worse it becomes.

We teach people to break their stare by blinking, moving their head, their gaze etc, let go of their thoughts and to get on with what ever they are doing. If they are still anxious or feel as if they may panic, we teach them to let it all happen and not buy into it with their thinking. With practice people can get the dissociation and the attacks down to about thirty seconds with no residual anxiety or fear.
Meditation is also a great way to desensitize ourselves to the various trance states plus a great way to practice non resistance and working with thoughts.
Have you spoken to your doctor about your medication? The increase in symptoms may be a side effect.

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Q:I do have panic attacks, but before they start I get a feeling that nothing is real, including myself. I sometimes feel as if I am standing behind myself and it is really frightening. I can also feel really dizzy which only makes everything worse. I do panic, but I panic as a result of these feelings. No one seems to understand what I am saying. They think that it is all part of the attack, but it isn't. Stop these unreal feelings and I won't panic.

A: The research on Dissociation is now speculating that some people with Panic Disorder, Dissociate first and then panic or become anxious. A theory we, again, are in complete agreement with.

Another word for Dissociation is Self Hypnotic trance. When people Dissociate they get a variety of symptoms, including 'out of body' experiences, not feeling real, seeing their environment through a white or a gray mist, stationary objects may appear to move, tunnel vision, sometimes they may feel an electric shock move through the body, or a 'whoosh' of intense energy. It is quite easy to induce this state in people who are vulnerable to them. One of the easiest ways to induce this state is by staring.

When people are driving, they stare at the road ahead or sit and stare at a red traffic light and without warning they get a number of the above symptoms. It can also happen watching TV., working on a computer, reading and many people report fluorescent lights also help to induce this state. The symptoms are not harmful in themselves and once people can see how they are doing it, they lose their fear of them and some people report they now actually enjoy it when it happens!

If you are not eating properly and/or not getting enough sleep you become more vulnerable to Dissociation. The American research is showing that many of us can enter a Dissociate state within a 'split second.' Recent research is showing that some people can feel quite dizzy or lightheaded when they dissociate and the fear of what is happening to them helps to hold them in that state.

I have been working with this theory of Dissociation with very successful results and I feel it is the major cause for a large sub group of people with Panic Disorder.

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Q.Do anxiety and depression go hand-in-hand?

A. Yes, depression and anxiety can go hand-in-hand. We have done research into this subject. About 53% of people with an Anxiety Disorder develop Major Depression as a secondary condition. Many people, during the course of the Anxiety Disorder, will experience repeated episodes of depression. People diagnosed with Major Depression can also go onto develop panic attacks and anxiety problems.

Many people feel it is because depression and anxiety responses reside in the same place in the brain and, more specifically, are due to a serotonin deficit. However, a more even view is to look at the quality of life of a person with an anxiety or depression condition. For anxiety, with ongoing symptoms the effect on a person's life and sense of self is like living in an internal cage. All aspects of life are affected in a detrimental way. It is only natural a person would start to feel depression and have depressed thoughts. The basic joys and freedoms of life are no longer enjoyed.

The same in the case of depression going into anxiety. There is also the other side of the coin. Many people say if you experience depression, the question they will ask is "What are you depressing ... what are you repressing?" Well in the case of anxiety, a person with an anxiety condition will be depressing/repressing huge amounts of anxiety energy. Trying to resist the symptoms and the actual physical/emotional experience. This is why the depression can arise. Trying to hold down a huge amount of anxiety is causing a loss of energy in the system and so is interpreted by the perception system of the mind as a depression; the energy drop plus emotional response to the actual experience. On the other side is Depression, and the anxiety response to the experience of ongoing depression. The actual depression can be a huge stressor and therefore contribute to the triggering of panic attacks and development of ongoing anxiety symptoms.

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Q. Over a two-year period, I've suffered from three hospitalised episodes of paralytic ileum (2), a panic attack and presently have signs of chronic fatigue such as joint/muscle pain, flu-like symptoms, restless sleep for the past two months. Has there been any "speculation" about Chronic Fatigue Syndrome and Panic attacks being interrelated?

A. We are not sure what paralytic ileum is so we cannot assist you with this. In answer to your question about Chronic Fatigue and panic attacks : as far as we are aware there isn't any speculation about CFS and Panic Attacks within the main stream literature, but there certainly is speculation about the link with many people with Panic Disorder! But Panic Disorder is very precise in its experience of uncued panic attacks. As you would know, the attack can be very 'violent' and people do feel as if they are going to die or lose control in some way. People with Panic Disorder also have joint/muscle pain, flu-like symptoms and restless sleep, but the sleep disturbances are usually a result of anxiety over having another attack or people will be woken from sleep with an attack. There is also no doubt people do become extremely exhausted, but exercise actually helps people overcome this.

There was a report last week in the media here in Australia that researchers in the USA have now found the virus/bacteria which causes Chronic Fatigue and people are being treated successfully with antibiotics. This in itself demonstrates that CF and PD are two discrete disorders.

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Q.My first question is about a link between coffee/caffeine and panic attacks. I found that my first few panic attacks occurred after drinking a cup of coffee. Although I used to drink it just about everyday, I have since cut out drinking coffee. Have other people noticed this? I also notice that you recommend meditation to control panic attacks. How often should I meditate and where can I go to learn how to do it??

A. It is interesting about coffee / caffeine. About 50 % of people with an Anxiety Disorder do link it to coffee / caffeine, but the other 50% don't and keep on drinking coffee and other caffeine products. Within this 50%, there is a smaller group who report feeling worse after drinking decaf products as they are allergic to the chemicals used in the decaf process. There are individual differences in many areas of the Disorders and it does make it confusing for everyone.

Re: meditation. We usually get people to meditate twice a day for 20 minutes, although many people cut this down to one twenty-minute session a day as they can't find the time for two.

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