Cognitive Therapy Basics

Copyright (c) 2007 Mary Ann Copson

If you have ever had a panic attack, you don’t want another one. The “fight-or flight” response in your body is involuntarily turned on and your nervous system signals your adrenal glands to start pumping out stress hormones to get you ready to either run away or turn and fight.

Your muscles tense, your heartbeat speeds up, and your breathing becomes more rapid. You might feel like you are smothering, claustrophobic or you may experience an urgency to get away. On top of that, you may get hot flashes, sweating, and/or chills and trembling, plus numbness, tingling sensations, dizziness, and nausea.

You become overwhelmed by an extreme sense of fear and impending disaster and you lose your ability to think calmly and clearly while experiencing a distorted sense of time and a feeling of unreality.

In the face of a physical threat, accident, or natural disaster, this type of response is normal and can be life-saving. But panic attacks that occur unexpectedly in the presence of normal events can be debilitating. They may happen with no forewarning, at any time of the day or night, and last several seconds or more than half an hour.

The triggers for panic attacks are unpredictable. Most panic attacks are set off by some minor or major stressor. But panic attacks can also be triggered by changes in emotions, or as a response to certain drugs, foods, allergies (including hidden food allergies), hypoglycemia, and illnesses.

A panic attack is an example of an acute anxiety disorder and can affect teens to middle-agers and beyond. Women are reported to experience panic attacks twice as often as men but some believe that is only because men are more reticent to report panic attacks.

Recent studies point to a complex set of causes and panic attacks are regarded as a treatable psychobiological condition (i.e. having both psychological and biological causes). Successful resolution of panic attacks requires an integrated, multi-modality approach.

Even though panic attacks are not a simple condition and there are no simple answers for their successful resolution, herbal therapy can be useful as part of an integrated, multi-modality approach.

When you experience anxiety, your body releases a set of neurotransmitters called catecholamines, which stimulate your central nervous system and activate your sympathetic nervous system. Sometimes your sympathetic nervous system (the high alert part of your nervous system) can get stuck in the ?on? mode leaving you in an ongoing state of anxiety – a fertile ground for panic attacks.

A class of herbs called nervines helps to turn off the sympathetic nervous system by gently facilitating the functioning of the parasympathetic nervous system ? the part of the nervous system that prompts relaxation – helping us to wind down and come off ?high alert?.

It is a good idea to experiment with different anti-anxiety herbs before you are in a crisis or panic situation. Try out several herbs in varying doses. Start with a low dose and increase if needed so that you will know how the herb affects you and how to use it when you need it.

Some effective herbal nervines to consider using:

Oatstraw (Avena sativa) ? the green milky tops of oatstraw provide a wonderful soothing, nourishing and gentle herb for frayed and stressed nervous systems. Oatstraw has a restorative effect on an exhausted nervous system reliably strengthening the whole nervous system after prolong stress. Oatstraw has both an immediate effect (useful when experiencing extreme nervousness and anxiety) and a more long-term restorative effect. Oatstraw is well tolerated by even highly sensitive people and is used for nervous debility, stress, weak nerve and energy force, anxiety, depression, exhaustion, and general fatigue.

German Chamomile (Matricaria chamomilla/ Matricaria recutita) ? an all time favorite ?because it works. Chamomile tones the nervous system, relaxes your muscles and calms nervous digestion. It has mild sedating properties and is not as strong an herbal sedative as valerian or passionflower. However, chamomile is a great option for anxiety in children or teens and for anxiety associated with mild sleep problems. If you are allergic to ragweed, asters, or chrysanthemums you are better off choosing another anti-anxiety herb.

Lemon Balm (Melissa officinalis) ?has mild sedative properties and is useful in conditions of nervous agitation with sleep problems and digestive complaints. Lemon balm is especially useful for over-anxiety that causes digestive problems such as nausea, bloating, and colic like pains. Traditionally lemon balm was used to lift the spirits and encourage longevity. Lemon balm is a relaxing tonic for anxiety, restlessness, irritability, and mild depression and its actions will quiet the racing heart that often accompanies anxiety. It has mild anti-thyroid effects and is best avoided by people with hypothyroid problems.

Skullcap (Scutellaria laterifolia) ?tonifies and relaxes the nervous system and is useful for anxiety of all types especially anxiety and irritability that is hormonally based such as premenstrual syndrome. It is a sedative nervine and has mild anti-spasmodic and anti-hypertensive effects. Skullcap is a great herb to use when your anxiety is accompanied by a runaway mind that is stuck on worry. It is tolerated well by most people and has few side effects.

Valerian (Valeriana officinalis) ? one of the most well known anti-anxiety herbs, valerian is a potent herb whose active ingredients, valepotriates, bind to benzodiazepine receptors in the brain (similarly to the drug Valium). The use of valerian does not, however, result in dependence or the development of tolerance but instead tones the nervous system.

Valerian can be used to improve the sleep quality and relax both the skeletal and smooth muscles. Valerian should not be used for those with chronic exhaustion, adrenal fatigue, thyroid disorders, and depression as it may increase anxiety, worsen present symptoms, and/or result in excessive restlessness in these conditions.

Passionflower (Passiflora incarnata) ? a strong calming, anti-spasmodic herb that is good for severe daytime anxiety. Passionflower is also a good choice for middle of the night waking terrors, nightmares, and the onset of sudden anxiety feelings. It acts as a central nervous system depressant giving a calming, relaxing and anti-anxiety effect and is specific for anxiety related to insomnia, muscle tension, restlessness, and nervousness due to worry, overwork, hysteria, or excessive excitement. If you are taking an MAO inhibitor, you should avoid taking passionflower except under supervision.

Stress Relief Tea

Here is a simple herbal tea mixture that I have found effective in my private practice working with women having mood and energy problems.

Mix together equal parts of the following dry herbs:

?Oatstraw

?Lemon Balm

?Skullcap

?Nettles

?Orange

?Chamomile

Use 1-2 teaspoons of the mixture and steep covered in 8 oz. of boiling water for 5-10 minutes.

The use of herbal nervines as part of an integrative program can help restore a sense of calm and well being, soothe distress, stabilize a confused and overwhelmed energy system, and foster clear thinking.

If you are taking anti-anxiety and/or anti-depressant medications or other medications, have a diagnosed condition or illness, are pregnant, breastfeeding, elderly or very young it is important to consult a knowledgeable health care practitioner before using herbs. Consult a licensed physician for diagnosis and treatment of any medical conditions.

Anxiety is one of the most prevalent conditions of the mind today. One of the biggest problems with anxiety is its tendency to strike at the most inopportune moments. Being able to keep your anxiety levels in check will make you a more resilient and confident person.

Fortunately, if your anxiety is not at the rarest form, there are many ways to cope with it that do not need medical intervention, one of being cognitive behavioral therapy. Giving anxiety an all encompassing definition is difficult because of its different effects on different individuals. It does, however, share some common traits.

Anxiety is the feeling of fear we all experience (and I can test to that) when faced with threatening or difficult situations. It helps us to avoid dangerous situations, makes us alert and motivates us to deal with our problems. Everybody knows what it’s like to feel anxious-the butterflies in your stomach before a first date, the tension you feel when your boss is angry, or the way your heart pounds if you’re in danger. Anxiety rouses you to action. It gears you up to face a threatening situation. It makes you study harder for that exam, and keeps you on your toes when you’re making a presentation. In general, it helps you cope.

But if you have an anxiety disorder, this normally helpful emotion can do just the opposite; it can keep you from coping and can disrupt your daily life. Many people still carry the misperception that anxiety disorders are a sign of weakness; a problem that happens because you are weak. They say things like “Pull yourself together!” and “You just have a case of the nerves.” Wishing the symptoms away does not work, but there are treatments that can help and one of them to consider is cognitive behavioral therapy.

Anxiety disorders and panic attacks are not signs of a character flaw. Most importantly, feeling anxious is not your fault. It is a serious mood disorder, which affects a person’s ability to function in everyday activities. It affects one’s work, one’s family, and one’s social life. One of the most proven and tested treatments for anxiety disorder come from cognitive behavioral therapy, behavioral therapy that focuses on behavior in response to those thoughts.

Cognitive behavioral therapy (CBT) is based on the belief that people learn most of their unhealthy ways of thinking and behaving over a long period of time. Using a set of structured techniques, a CBT practitioner aims to identify how you are thinking and how this can cause problematic feelings and behavior. You will learn to challenge negative ways of thinking, which helps you react more positively. This can lead to behavioral changes and then to improved self esteem.

Sometimes people ask me why I spend so much time on what generates panic attacks. My usual response is, beyond my natural curiosity, I simply don’t see how one can manage something if one doesn’t fully understand just what that something is. And, at least to me, a complete understanding has to include insight into genesis. I mean, if you were experiencing chronic chest pain, wouldn’t you want to know what was causing it? And let’s no forget that knowing why something happens leads to more efficacious management strategies and techniques.

I have always placed emphasis on both the psychological and physical contributors to panic attacks. But, in this article I’d like to stick with the psychological and address two theories of treatment. Needless to say, there are many floating about; however, I’d like to briefly discuss the psychoanalytic and cognitive points of view with regard to the generation of panic attacks.

Psychoanalytic

A psychoanalyst would likely submit the generation of panic attacks goes back to infancy and childhood. They would, however, acknowledge that panic attacks may also occur as a result of assorted cues in the present, such as the fear of having a panic attack in a situation where one recently occurred. For the record, an attack occurring within this context could either be situationally-bound or situationally-predisposed. The psychoanalysts consider both conscious and unconscious panic triggers as representations of intense early life wishes and fears. So, panic attacks, in large part, occur in response to cues associated with long past psychological and biological threats to one’s existence. By the way, these cues are based in retained themes of intensely feared eventualities such as castration, separation, and parental disapproval.

Cognitive

A cognitivist would likely submit that a panic attack is a manifestation of an intense feeling of helplessness in the face of intense danger. The vicious cycle of panic, which we know all too well, is generated and sustained by combining the very real terror of vulnerability with one’s traditional distorted thought and feeling responses. Within the context of human genetic predisposition, which from a phylogenetic perspective leans toward the anxious for purposes of survival, it naturally flows that these thought and feeling responses appear to be designed to produce the belief that out-of-control internal distress can lead to grave danger, even disaster. Doesn’t it make sense that it’s this dynamic that so often generates the intense need to seek a caregiver for immediate assistance? I mean, at this point all bets on reason and logic are absolutely off as our primal instincts take over. And then all sorts of physical symptoms arrive on the scene because our mind really believes we’re in imminent danger, and it’s getting us ready to fight the good fight. And the snowball just rolls on down the hill from there.

Finally, the cognitivists would likely submit that though panic attacks are often thought of as spontaneous, some sort of event had to have tripped the trigger. Who knows, the culprit may have been a sudden physiological change; say, feeling faint upon standing, sensing a rapid or palpitating heart beat, or detecting a shortened breath. The thought is that events such as these, in the absence of reason, are interpreted as indicators of immediate physiological danger. And, boom, off to the races we go.

It’s my belief that, individually, both the psychoanalytic and cognitive angles hold great merit. But, for my money a combination of the two is truly the ticket. I mean, so okay, according to the cognitivists a physiological change, such as a shortened breath, may trip the panic trigger. Well that’s great; however, I’d like to know what existed unconsciously that led to the perception that that shortened breath was a signal of coming catastrophe. Hmmm.

As always, the more we understand about our circumstances, the better we become at managing them.