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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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I have suffered from panic attacks acute anxiety for the last

Resolved Question:

I have suffered from panic attacks acute anxiety for the last 35 years.
The panic attacks have receded as Im taking Citalapram 40mg.

But im left in an AWFUL limbo of no feelings at all, for ANYTHING...just dead, I cant concentrate on my work or on anything for that matter...its just undescribable and its driving me insane....

I stopped drinking about 3-4 months ago....Im trying to come off a small addiction to codeine....but I have had these symptoms for as long as I can remember.........
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 3 years ago.

Hi! I believe I can be of help with this issue.


First let me say that I can imagine how overwhelming and frustrating this situation must be for you. On one hand you have experienced this for so long but on the other hand you have not found any relief and the symptoms seem to have gotten more extreme as the years have gone by.

And this is actually the key to my answer to you that you need to think about and consider and act on. That you are still hopeful and seeking help is a very good thing. My answer is going to focus therefore on three things: first, on HOPE itself, second on medications, and third on the the type of psychotherapy I recommend for you. I will also at the end of the posting give you a technique you can use on your own as well for when you are in the throes of depression, anxiety, or panic.

First, though, hope:

To bring you a measure of HOPE and some confidence, I'm going to take a moment to have you bookmark two videos that will give you just a moment's break from your own difficulties and will be inspiring. It's not to be curative; it's to give you a sense that we all live in the same world and we all have such different challenges and tests and we all have the ability to come to a good place in life:

Here's one about a young man who has a hard road in life but also had a dream:

http://vodpod.com/watch/1165857-walk-on-espn-video

The next is about a severely autistic girl. Let's see if she can help us here just a bit in the hope department:

http://www.youtube.com/watch?v=a1uPf5O-on0

Now on to the second point and something that is so important for you. I want to say that after this much time we have to reorient your focus from one that focuses on your symptoms exclusively. Remember: medications work on SYMPTOMS, not on what's going on with you as a human being. The problem with just focusing on symptoms is that we are human beings, not biological machines. So very often, when a medication treats one symptom, the underlying human condition that causes you depressed emotions pops up some other way and you are continually chasing after symptoms with your doctors. The research has shown (and my experience as a psychologist has certainly shown this) that psychotherapy WITH medications is much more effective than medication alone. Sometimes it can help the person reduce medications. And this is the tradeoff with medications when they are successful: they relieve SYMPTOMS but they relieve them while they are in your system. They don't actually TREAT the disorder. With pharmaceutical "solutions" you are getting relief from symptoms. That can be very important so that the anxiety from the symptoms doesn't overwhelm you. But if you want to treat the disorder itself--why it's happening, what is it telling me about myself, what changes do I need to make to not feel as I do?--to do that, you would need to explore yourself in a more human way.

So I need you to reorient your view of what's happening to you so that your emotions and to what might be a lifelong pattern of feelings and understandings in life which ARE after all, what is being talked about here with depression, anxiety, and the panic attacks that they are causing.

So I want you to reorient your focus from the medications being your main "work" on your anxiety and depression to your exploring your emotional reactions of feeling so anxious and being in such a depressed dark place as being your MAIN work and the meds as being the boost you need to help you not be so panicked and anxious and in a dark hole so that you CAN work on what's going on inside. Do you see this reorientation? The idea is that YOU ARE A HUMAN BEING and human beings don't just have emotions because they hit 49,000 miles like a car or like tires! We have emotions because they are part of how we grow and learn and become more fulfilled. But if we keep running from them and trying to get them just to go away without ever exploring what's going on, we NEVER get that chance to get anything from them. They just make us feel terrible year after year.

I know that was a long introduction to the discussion on medications but I wanted to make sure that after 35 years you will explore what this is all about as part of your life! But first, the meds themselves: I am not convinced that Valium is the best solution. I am concerned with that "deadening" feeling you refer to and I think that we have to suspect that the Diazepam (Valium) may be contributing to it after extended use. I would like to recommend you discuss with your doctor perhaps tapering off the Valium and replacing it with Xanax. Xanax is very short acting. It is not as pervasive as Valium. It can be used as needed as opposed to a regular regime as your symptoms improve. So, please discuss this and see if it helps to relieve that sense of deadening after a few weeks.

Okay, on to the third part about psychotherapy. You need to find a psychologist to help you with the underlying CAUSES of these symptoms, who can help with the depression itself. You need to feel comfortable with the psychologist and I don't want you to accept just any psychologist. You have the right to interview them until you find one who you feel comfortable with and that you feel will understand your experience!

I have found that with your situation you will do better with a more introspective, humanistic approach in therapy. If we actually look inside, we can find great relief and meaning. And we can feel whole in ourselves in ways that we haven't for decades. However, you have to make sure that your psychologist is very experienced in Cognitive Behavioral Techniques (CBT) for anxiety and panic disorders as well. I don't know who's available in the Isle of Man, but I believe that this combination of experience with CBT and humanistic or psychodynamic therapy is very important for you. Because your symptoms are not just an anxiety disorder,

The idea here isn't that these types of therapy are magic. It's that I want you to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions and panic reactions. You need to explore this if therapy will be ultimately worthwhile.

Now, I want to give you a tool to use for when the depression is overwhelming or there is anxiety panic. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum. And this is good also for just general anxiety without panic attacks and for feeling as though you are in a dark hole of depression as well.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in a panic attack is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5158
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.

Thank u for that...
I need a therapist of the type u describe as Im a emotional man..haha
But the problem is finding one on the Isle of Man...not easy.
The wife of 25 years can be strong and fixed in her views and that bothers me greatly...very little emotional support.
If I can get back to a reasonable work situation I can earn ok money and may be even willing to travel to UK for monthly sessions if I can find somebody really good.
I took part in a programme in Bards 20years ago into panic attacks and they told me my breathing was the worst on the trial...
What to do..to feel out of things so much is ..well undescribable.
We have money problem as well, 2 kids in Uni and falling behind on Mortgage payments, but as I say if I can get back to work (self employed Architect) things could be different.
One last thing..I recently met a really understanding women on line who gives me fantastic support and advice, but I feel guilty about this because Im married.
I know your not a marrage guidenc councellor but would be interested if u had any advice on this?
Thanks again better than I expected.

Iam very concerned that I may need to leave this marriage inorder to sort myself out???? Diffult

Eddie

Sorry dont mean to be funny but do I need to pay more for this follow up..if I do its fine just not sure thats all...

Customer: replied 3 years ago.

Can U please deal with my follow up question as I do not really want another Doctor?

Customer: replied 3 years ago.
Hi are u still online?
Expert:  Dr. Mark replied 3 years ago.
Eddie,

I see couples in my private practice. I am concerned that you have this relationship starting with this woman. You seem to know the answer inside yourself: if you want to keep your marriage, you need to discontinue contact with this woman. But you have signaled me that you are unsure you want your marriage. I can't make that decision for you. However, you have children and they will be affected regardless of their age. And you need to consider all the different aspects of your relationship with your wife before you decide to give it away. So, my advice: discontinue this relationship with this woman right away. You will not be able to think clearly about your marriage with this relationship dangling in front of you, as innocent as you may want to make it seem. Then you need to start having serious discussions with your wife that the relationship is not working. That you are unsatisfied. You probably know that this will unleash her barrage of how much she's unsatisfied. Well, it's going to have to come out and you have to address it together. I imagine it's not any easier to find a good couples therapist where you are either.

the financial troubles is also something that is aggravating your relationship and it should not. Ideally, it should be bringing the two of you closer as you support each other in making it through the tough times. So, again, things need to flow from working on making your marriage a better relationship.

I can't determine your priorities, but I would think that your kids might have to forgo university if you can't afford it rather than losing your home. But, again, the two of you need to be united in your relationship.

I wish you the very best!

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX
Customer: replied 3 years ago.
Thanks for that, I suppose when u get support from someone else it's easy to get side tracked.
I know your right, haven't net this women, she lives in the US, but it is actually putting more pressure in me than good.
The kids are in last year of university so that will be finished soon
After Christmas I will sit with my wife and have a talk, I need comfort, support, cuddles and the rest lol
Do u or can u give more detailed advice online if I was to type out a long mail. This could be via private mail
I don't mind paying as it's worth it and u seem to be a pretty good Doc?????

I will pay on receipt of reply to this OK
Expert:  Dr. Mark replied 3 years ago.
Eddie, You are welcome to write to me. My email isCustomerat)Comcast.net

I wish you the very best!

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5158
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and other Mental Health Specialists are ready to help you

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Dr. Mark
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Dr. Mark is a PhD in psychology in private practice