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San Diego EMDR therapist
Dana Terrell, LCSW, AC
Articles by Dana Terrell:
• What a Panic!
• Supporting Your Loved One with Panic Disorder
• What is Brain Spotting? How does it compare to EMDR therapy?
• Obsessive Compulsive Disorder and Swine Flu Virus
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What a Panic!
by Dana Terrell, LCSW, AC
Anyone who has experienced a panic attack knows it is no joking matter. On a scale of 1-10, where 10 represents the worst disturbance a person can imagine, panic disordered clients generally rate their panic attacks at 9 or 10. (An anxiety attack might be rated 6-8.) Their negative belief about themselves may be, “I’m dying,” or “I’m having a heart attack.” Because these thoughts are accompanied by such intense emotion, they seem completely true. Thus, the person rushes to the ER, only to get the response: “Good news! You’re not having a heart attack. It’s only Panic.” They are often sent home with Xanax. But they are thinking, “Great! I feel like I’m having a heart attack, but I’m not. They are basically telling me it’s in my head. So I must be crazy.”
People with Panic Disorder, in my practice, often have a backload of negative experiences in which they rarely got the support they needed to resolve them. These experiences could be major trauma, recognized by any objective person as horrific. Or some could be “small t” trauma – those smaller hurts of life. For a young child or teen these became terrible because of the negative conclusions the person drew about himself. From the assessment of their trauma symptoms, they may actually qualify for a diagnosis of Post-Traumatic Stress Disorder (PTSD) in addition to Panic Disorder.
As an EMDR therapist, we often work to resolve the trauma of PTSD after a period of history taking and preparation. But for a client with Panic Disorder, it is essential to treat the Panic before the trauma because the person does not feel safe in the present.
This realization was the discovery of Marcia Whisman, LCSW, of St. Louis, MO, who is an internationally respected expert in anxiety disorders. She has integrated the EMDR approach into the standard cognitive-behavioral treatment of Panic Disorder. After taking Marcia’s training in Seattle in 2005, I hosted her recently in giving her two day EMDR specialty workshop for treating Panic and OCD (Obsessive-Compulsive Disorder) in San Diego.
Ms. Whisman has a 3 stage treatment for Panic. In Stage 1, the therapist assists the client to process the memories of specific panic attacks. The EMDR helps the person’s brain let go of the false beliefs, and accept true beliefs: “this is just an adrenaline reaction in the body,” “this will pass, it always has and it always will.”
In Stage 2, we use EMDR to address the present concerns about learning to manage bodily sensations of panic when they arise. The client is educated in skills for self-calming, and EMDR is used positively to enhance their confidence in those skills.
Finally, in Stage 3, we address the hierarchy of fears. These are situations rated for their ability to trigger panic attacks in the past (and which are often completely avoided by the time a client comes to treatment). We start with the lowest level fear that still feels relevant. Using EMDR, we imagine in detail being exposed to that fear and handling it well. Once the client is confident they can do that, they schedule a time to do it, perhaps with a supportive friend or loved one present during the actual exposure. Any effort is considered success, and the client comes back to evaluate all aspects of success and to note what difficulties may have arisen and process those. This process is continued until each fear can be faced alone comfortably and successfully.
At that point, the client has safety in the present. Then they can begin the processing of old traumas. Those unresolved anxieties (along with possible genetic predispositions) are what made the person vulnerable to some form of anxiety disorder. It is still essential to clear those experiences for EMDR treatment to be complete.
Treating Panic Disorder is hard work for both client and clinician. But it is well worth the effort to get one’s life back from the dictates of anxiety. One client stayed for years in a job she hated, because it was isolated and she didn’t have to face many of the fears she had about being in the world. Now she is working in a bank, and hasn’t had a panic attack. “I’m doing fine,” she said. “I’ll call you if I need to.”
On the radio one day I heard a national expert in treating Panic Disorder state that people have to learn to live with panic. To me that is very sad. I don’t believe it. I am so grateful to be an EMDR therapist and to have received Whisman’s training. I love helping people to free their lives from panic, and regain the ability to joke, have fun and have real choices in their lives.
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