Philosophy of Approach

Initially in the 1970's, I was associated with a group of psychologists in the World Trade Center. Their basic philosophy was to assume that those suffering from panic and anxiety attacks most often use the symptoms for secondary reward. In other words, they would use anxiety and panic attack as an excuse to avoid unpleasant situations, relationships, hard work, or for getting attention.

The standard protocol used was to teach the client self-regulation using biofeedback, relaxation, and breath management skills. Needless to say, the results were no better then 30% success -- no better than what would be achieved using a placebo.

It wasn't until several years later after I had opened a biofeedback clinic in New Jersey and had worked with several dozen clients suffering from anxiety and panic attacks that I had to wake up and "smell the coffee." One day while going through the client files I had two face a reality that our results at the center were still no better than if we had used a placebo.

The beginning of this new approach began while working with a client who had recently relocated back to New Jersey from Florida. Because she had difficulty adjusting to life in the Florida Keys she was very unhappy living there and longed to be with her family in New Jersey.

She had many great expectations when she, her husband, and two children returned to New Jersey. She would be near her family that she greatly missed. I learned this information after-the-fact.

Our staff psychologist interviewed Ellen (not her real name), and recommended her for hypnosis and stress management training. Ellen was using Valium, prescribed by her physician, which she found made her very groggy. The staff psychologist diagnosed Ellen as having Agoraphobia. Her agoraphobia was so severe that it made it impossible for her to stay in the counseling room for the entire session. She was so limited that she had to depend upon her husband to bring her to the sessions.

Because her symptoms were so heightened, it was difficult to obtain any meaningful information about the onset or cause of the symptoms other than she described that her life was basically normal until one day all hell broke loose and she just wished that she could get back to her "abnormal normal life."

Any attempts to use any type of relaxation training met in aggravating her symptoms to the point that after just two sessions she refused to come to any more sessions. She was clearly focused on the symptoms that she described as happening whenever she would go into a store (particularly with overhead fluorescent lights), but for that matter any open area. She would panic, have trouble breathing, and an overwhelming desire to escape before she would lose control.

I agreed to go to her home for sessions. After one session I dispensed with using any relaxation, breathing, or stress management skills since they only aggravated her anxiety. Of course, at the time, I had no idea that this would be true of many anxiety and panic attack sufferers.

Being basically homebound, Ellen was tremendously grateful to simply have a visitor. Home was the only place she could feel any sense of comfort. Her husband had no idea how to deal with the situation and was worn out with her neediness.

As we talked, I learned that Ellen's expectations of family life in New Jersey were nothing like she dreamed or thought it would be when she uprooted her family from Florida to move to New Jersey. At first, I thought it was because of Ellen's anxiety and panic attacks -- her neediness -- with which the family had trouble dealing. But no, the anxiety and panic attacks came later in the chronology.

During our discussions, she often expressed the desire to runaway -- escape New Jersey and go back to Florida. But her husband had relocated his job, they sold their home in Florida, bought a new one in New Jersey, and she just couldn't put her kids through relocation again.

Ellen felt very responsible to her husband and children. The irony was that she wanted to run away from the decision to move to NJ (the disappointment), but she was too responsible to her husband and children to runaway. Thus she was stuck here and developed anxiety and panic attacks.

Her subconscious emotional (limbic) brain felt threatened realizing she was stuck in NJ and wanted to escape (take flight). However, her analytical conscious thinking (reticular) brain wouldn't let her run away. The inability to resolve the conscious desire to be responsible and the unconscious necessity to escape kicked in the flight/or fight (fear) reaction. Not understanding why the fear reaction was present, the fear escalated to anxiety attacks.

The true nature of the problem is that without any real explanation as to the reason for the fear response, Ellen came to conclusions--something was wrong with her and she might lose control and faint. Her physician fed into her conclusions by diagnosing her with anxiety attacks -- something that was happening without any reason.

The first step was to counter the costly conclusions. This is a challenge since the educational system largely rewards us for coming to the right conclusions thru reasoning. Wakened hypnosis using an object as a metaphor was integral in making the shift and gaining rapport. Ellen then practiced several exercises every day in developing the skills of observation -- the cornerstone to change.

Next followed cognitive techniques to bring the subconscious intelligence up to date to agree with the conscious intelligence.

And then a shift in cognitions focusing on dealing with the actual emotions resulting from disappointments in life. She acquired the skills to identify and deal with disappointments and learned that life is often more about handling the plans that fall through than it is about the plans we make.

As opposed to the standard relaxation and eye-closure desensitization using visualization, all desensitization was accomplished cognitively in the awakened state.

Her new cognitive shift, within a few months, had her driving on the Garden State Parkway, going anywhere she desired and any time she desired. She did not have to move back to Florida nor did she have to establish a better relationship with her family to get rid of the anxiety.

And yes, she eventually learned stress management and breath management skills with her eyes closed.

The philosophy of this approach in a nutshell is to:

• Teach observation.

• Bring subconscious brain up to date to agree with conscious brain.

• Identify and deal effectively with one's disappointments. In fact, it's my observation, that those suffering from anxiety and panic attack are type A personalities. And because of their responsible nature, they will never allow themselves to runaway from many other disappointments. Oh yes, they will often say," I want to run off to Hawaii are someplace like that and start all over." But, they never will.

• Cognitive desensitization. 

Clara Weaks, nurse, in one of her books notes the anxiety response having up to three levels, a primary response, a secondary response, and a tertiary response. Usually the primary response is relatively low level and what often happens is that the anxiety sufferer becomes so afraid of his or her initial loss of breath or slight tenseness in the chest that he or she becomes afraid of fear itself. Unfortunately, it is usually a snowball effect as it kicks into the secondary and then tertiary response.

The bottom line is that a tertiary response is because of a medical conclusion made by the sufferer who is not a medical doctor. Even after going to the emergency ward many times and having EKG tests that disprove any medical involvement, the patient still assumes that it is a heart attack, or the beginning of a heart attack, whenever he feels the symptoms mainly because no one -- physicians, or psychologists, or psychiatrists -- can explain in a way that makes sense as to why the tertiary reaction is there.

The good news is that out of the 100 or more clients with which I've worked, the template (protocol) is always the same. The sufferer is always a very responsible person with many unresolved disappointments. The propensity to experience anxiety is directly proportional to the number of unresolved disappointments.

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