Q. I noticed that there was something wrong with me for awhile, and I was told that it could be anxiety. I read some of the symptoms for it, and I think I do have anxiety disorder. I'm pretty sure it started after I tried some drugs like marijuana. If I stop using the drugs, should it go away?

A. We do advise you to speak to your doctor and have a physical check up to ensure there is no physical cause for your symptoms, as the anxiety symptoms can mimic a number of physical problems.

Unfortunately, many people are developing panic disorder as a result of using marijuana and even though they stop using it, the Disorder can be ongoing until they receive appropriate treatment. We do advise people not to use this, or any other 'recreational' drug, including LSD, cocaine or ecstasy, etc. because they can add to and increase the problem.

If your doctor confirms anxiety and/or an anxiety disorder, then you may need to see an Anxiety Disorder CBT Therapist who will be able to assist you. We notice from your email you are at a University. Many universities run Cognitive Behavioral Programs through their Dept. of Psychology. You may wish to check with your local dept. If they don't the psychologists on staff, they would be able to refer you to someone.

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Q.I am a 46-year old female who has been having anxiety/panic attacks for 2 years now. I have had all of the medical check-ups, and there is nothing physically wrong with me. I am also seeing a psychiatrist who has put me on Prozac and I am also on Oestrogen, a very low dose.

Is it possible for the attacks to be hormone related? My attacks seem to be cyclical, but I cannot correlate them to my periods because I have had a hysterectomy. I wonder if I should be taking more oestrogen, I am on .5mg at this point. Also, how do I know if my Prozac should be increased-I am on .5mg of that also. This past week, I have had 2 panic attacks and many hot flashes. This affects my entire family-how goes Mom, so goes the family. This has also affected my intimacy with my husband. He has been very patient, but we need to get over this hurdle. Thanks for a great website-I have learned a lot in the last 2 hours!!!

A. Although we don't normally do this, I am going to relate my experience as it is similar to yours. I developed Panic Disorder as a result of a physical illness which ultimately led to me having a hysterectomy and surgically induced menopause.

I went onto hormone replacement therapy, but while it helped with the menopause, it did absolutely nothing for my panic attacks and anxiety. I have now spoken with thousands of women in similar situations and their experience is the same. Hormone therapy doesn't help to any great degree.

It can be cyclic, as many women do experience increased panic attacks & anxiety in the week before their period, and it does aggravate any PMS, but again the pill, etc. doesn't help. I saw a recent research article which said researchers were now beginning to investigate this, but they say any definitive answer is 10 years away.

We are not able to advise you in regards to your Prozac dose, but we can suggest you see an Anxiety Disorder Cognitive Behavioral therapist. CBT is the only therapy which has been demonstrated internationally to be the most effective therapy in the long-term for Panic Disorder. This is how I, and so many of our clients, have recovered and are medication free.

We do have a list of therapists worldwide. If you would like us to check our list, please advise us in which Country/State/City/Town you live in.

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Q.I've just been checking out your Anxiety web pages. My Girlfriend suffers from Anxiety and Panic attacks regularly. I am trying to help with her disorder. She wants to help herself - The natural way- self relaxation and overcoming her fear. Do you know of any herbal, or non-medical, natural remedies which may help in the control of her condition.

A. The most important thing your girlfriend can do is to learn Cognitive Behavioral Therapy (CBT) This will assist her in managing the thoughts which create so much of what is happening to her. CBT is not positive thinking. Positive thinking doesn't work for many people in the early stages of recovery. Once she learns to manage her thoughts she will recover.

We don't usually recommend herbal medications, simply because they can work for some people, but not for others. The current trend is to use St. John's Wort and while some people are saying it is great, we have also had other people telling us of quite severe side effects. Can you arrange for your girlfriend to see a Naturopath? They may be able to help, but learning to manage the thought process is the most important.

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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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