What are panic attacks?

What Are Panic Attacks?

By Daniel Hochman, MD and William Schroeder, LPC

Have you ever wondered what are panic attacks and why do people have them? Panic attack symptoms can be incredibly debilitating and embarrassing, and change the way people live. If they make you avoid grocery store and roads, it makes life pretty darn hard to navigate. You may have seen someone experience one, or even suffer from it yourself.

Let’s start with the basics. A panic attack is basically a sudden and unexpected feeling of terror that’s way out of proportion to the actual situation. About one in 20 U.S. adults has one at some point in their lives, with women being twice as likely to experience them.  Here are the common signs and symptoms:

  • Internal symptoms – Usually people sense a racing heart, sometimes with chest pain. It is not infrequent that we have a client come into therapy after they have had several emergency room visits because these symptoms can feel like a heart attack (in fact, most chest pain seen in the ER is due to anxiety and not heart attacks). As far as thoughts go, people feel a sense of doom, might even feel like they’re dying and feel totally out of control. To make it even more fun, people usually feel faint, woozy, tingly in their hands, and might sense a lump in their throat.
  • External symptoms – On the outside, breaths are more rapid. You will notice the person looking quite uncomfortable, at a loss for what to do, and have a hard time making eye contact. Their skin can get sweaty and pale.

What’s the difference between anxiety and panic attacks?

As far at the timing, the major difference is that panic attacks are more intense and usually peak at around 10 minutes, and last less than an hour. Anxiety, on the other hand, can last many hours, or even years. When you ask someone to describe a panic attack, there’s usually a focus on the panic itself, with a fear of having another panic attack. And whatever fear they can describe will usually sound quite unnecessary. If you ask someone with anxiety to describe what’s going on their head, they can usually describe one or several things clearly on their mind about what’s bothering them.

The horrible positive feedback loop

With panic attacks, usually, it starts with just one small fear. Like a fear that people at the mall will be judging you. When you feel scared, your body reacts as if there’s a physical threat. And when your body reacts, it convinces your mind that there’s actually a major threat out there, which only makes the mind more scared, which only makes your body even more hyped up… and so on. What’s more, you start to notice you get scared of the mall during your drive over. And then you start to get worked up about thinking about leaving the house with your car at all. And then you get scared you’re having a heart attack or going to pass out, etc. This is the vicious positive feedback loop where now there is an entire cycle of fear, and the fear feeds itself. No longer is it the initial fear of a crowd, but it’s the drive, the road, the keys to the car, a friend’s invitation to go out, and the symptoms. They all compound. This is the idea behind how panic attacks hit so fast and hard. When I can help my patients explore their primary fear, say a fear about a crowd judging them, it helps reign in the rest. They can begin to emotionally process the underlying issue, and there’s no more fire for the rest of the feedback loop to feed.

If this article was of interest to you, also check out our blog post on why do we get nervous. If we can be of help, you might also want to read more about anxiety counseling or you can contact us to make a counseling appointment.

Daniel Hochman, MD is the founder of Self Recovery, a private online addiction recovery program. It is ideal for those in therapy or post-discharge from rehab and need ongoing programming. The program will help to continue developing prior skills and teach new ones to create a more complete approach.

Photo by Fernando @cferdo on Unsplash

Taking Back Turkey Day

Taking Back Turkey Day!

by Adam Maurer, LMFT, LPC 

Thanksgiving is one of the most challenging holidays for some folx. Sandwiched in between two major month-long events, Halloween and Christmas, turkey day seems rather charming from afar. It’s the kickoff to the holiday season. A short twenty-four hours packed with football, parades, and pumpkin pie. The hardest part of the day for some people will be to hold their tongue while their distant relative prattles on about their political beliefs (also check out our Survival Tips for Holiday Homecomings). A small price to pay for an all you can eat turkey buffet. If you’re really fortunate then you get a four day weekend out of the celebration. So, what is there not to like? There are plenty of reasons people don’t like a conventional Thanksgiving celebration. Colonialism and sexism are often an undercurrent of the holiday. A Disneyesque retelling of what happened to Native Americans challenges some folx ability to joyfully engage in the festivities. Check out this article from the Smithsonian to better understand this concept.

Also, The holiday centers on an elaborate meal that takes a great deal of time, thought, and energy to prepare. This task might fall on the shoulders of women, women who may not particularly enjoy: fighting for a butterball at a crowded grocery store, getting up at 6:00 AM to make sure the turkey is ready for lunch, playing hostess to guests, or cleaning up after a feast. The social script for men on this holiday often allows for much more free time, to either enjoy the game or to hunt. Thanksgiving can also be particularly painful for people with strained family ties. On a day that celebrates homecomings and family relationships, many members of the LGBTQ+ community are not welcome home simply for expressing their authentic selves. So, what alternatives are there to all of this? That’s where I come in! There are so many ways to enjoy some time off together beyond the traditional celebration, so here are some new ideas to get you started on creating your own rituals.

Cooking Competition

Make your Friendsgiving the best with a cooking competition! It brings together your community while having the task of cooking a feast spread out to everyone. You can really spice it up by making your own trophy. To be honest, I tend to be ultra competitive and the idea of bringing home a coveted trophy only makes the event more spirited in my opinion. Another beautiful thing about this activity is that it allows for folx to create dishes they love and they get to share them with their community. You might just find a new favorite dish, or experience something that is truly meaningful for a guest to make.

Wine/Beer/Liquor Tasting

Another way to enjoy a day with your community is to do a tasting of your group’s favorite adult beverages. Last Thanksgiving I hosted a champagne tasting with guests, which was an absolute blast. You can rank the beverages by ballot or conversation, all so that the winning libation can emerge and be offered at future gatherings. You can even set up pairings with different courses of your meal.

Putt-Putt

Make your own putt-putt course at home. Community, competition, fun; and hot tip: if you have some restless kids let them design the course from items you already have. You can typically find some old putters at thrift stores or Amazon has one for under $25. What’s great about this activity is that it can be outdoors or indoors, depending on the weather. Here is an opportunity to make another trophy, I really love to win and take home the gold!

Camp Out

You can forgo all the turkey day hoopla and just enjoy time in nature. A few days away from it all can be relaxing before the gauntlet of holiday obligations begin in December. Also, you might just catch the last few warmish days of the year before it gets colder. What a great time to spend with your chosen family!

Thanksgiving, and any holiday really, are what we make of them. So why not choose to make holidays something that are wonderful for everyone involved? It can be time to reflect on what you want out of life, appreciate the love you have, or take a healthy risk and try something new. If the holidays are creating too much stress for you, therapy can be a wonderful place to find relief. Talking with a skilled clinician can provide a place to do the raw processing of your thoughts and feelings so that you’re better able to present them to loved ones in a way that might be easier to hear. Take care of yourself this turkey day, and every day.

Photo by Mikkel Bergmann on Unsplash

When Love & Addiction Collide

When Love & Addiction Collide

Love is a funny thing; sometimes it makes a lot of sense and other times it’s quite bewildering. Similarly, addiction appears in the same fashion. What we’ll be exploring today is what happens when your love interest develops a substance abuse problem or an outright addiction and how you can help them (and yourself).

What you’ll find below is the result of a large collaboration between three Austin mental health professionals, William Schroeder and Julie Osofsky of Just Mind, and Dr. Daniel Hochman of SelfRecovery.org. Together, we understand the intricacies of addiction and the human mind, as we discuss it regularly amongst ourselves and within our patient sessions. We hear the same questions arise, so we’ve attempted to answer some of the most common concerns and questions below.

What are some character or behavior traits an addict might display?

Addiction affects individuals differently, but there are some commonly seen behavior changes that could be cause for alarm. Most of these are identified by a quick or dramatic change in areas of their life where they used to be very consistent and reliable. Examples of this can include, them not showing up to work or commitments on time, pulling back from mutually-enjoyable and healthy relationships and diving into toxic ones, becoming unreliable, being irritable or on the defensive, disappearing for hours on end, and getting short on once available money coffers. Many of these actions occur because the user is most likely feeling a wave of guilt and shame for their addiction and are trying their very best to keep it a secret. In general, rapid changes in money and/or appearance can be some of the first major indicators of when their controlled-habit is unraveling into full-blown addiction and they’ve saddled up for the ride.

If I become suspicious that a loved one is battling an addiction, what should I do?

There are several things you can do if you suspect your loved one is grappling with addiction, which are meant to help them and protect your own health and happiness. To begin, we suggest talking to them about it, but not in a combative or accusatory way. So many people (with great intentions) jump into this moment in the perfectly wrong way and say something like: “I think you’re an alcoholic and you need to stop.” That’s actually one of the quickest ways to make them defensive and shut down about it. One of the trickier things about addiction is the isolation a person experiences. Many people find themselves using a substance as a way to cope with some turmoil or uneasiness, so shaming them about it is counterproductive.

Many times, addiction is an indicator of something else that the patient is struggling with, so our suggestion is just to try to connect with them in a safe and loving way, while showing your concern. Address some specific changes you’ve noticed in their behavior or actions. Something similar to, “I’ve noticed you’ve been more upset with people recently and you’ve been drinking a lot more… I’m worried about you. What’s bothering you?” This is much easier and inviting for them to respond to or at least begin the conversation.

Lastly, you also need to seek help for yourself. Get your own support through some sort of group or therapist. Ultimately, you cannot control or change what your loved one does. Being able to accept that can be a difficult process, but it’s a needed one for both of you.

How can I best show support? What are some things I should avoid saying?

Like we’ve agreed upon before, we’d avoid judgment or shaming. This helps no one. You’ll likely need to set boundaries, but if done in a transparent and loving way, this is more effective than making them feel badly about their addiction. We’ve considered this next point a lot and we agree, once someone gets to this point, it is not enjoyable for them. Sure, the first drink or hit might provide them with a rush of euphoria, but we assure you that’s followed with anguish and torture.

Research indicates how important it is to have a supportive community for those who are struggling with addiction. This is partially behind the practice of sober houses and the decriminalization of drug crimes in most European cities. Community support and alternative thinking is how Iceland got kids to say no to drugs and essentially wiped out a massive “epidemic” they were experiencing. It’s also quite helpful to distinguish the difference between the person and their addiction; treat the addiction as its own being. You might say, “I love you, but I’m becoming anxious the addiction might come back.” Instead of, “What is wrong with you? Why don’t you just stop?” This depersonalizes the addiction, which can help the person to be less defensive, as it’s a separate entity.

Remember, your goal is to convey that you care and emphasize your willingness to be leaned on as support, while they navigate their options for help. When different approaches are compared, the best ones outcomes come from those that that treat a person suffering in addiction no differently than another illness, such as cancer. Nobody wants a life of addiction (or cancer). Both are absolutely horrible, and we have to understand that.

If my loved one already has a therapist or psychiatrist, should I call them? Can the therapist or doctor speak with me or is that a confidentiality issue?

This is something that has come up in the past, so we thought we should answer this definitively. We have received voicemails or emails from a friend or family member who is expressing concern regarding the patient. This is usually triggered by a recent event, such as suspecting a relapse or displaying troubling behavior like we highlighted above. Other times, it’s overt displays of struggle, like being hospitalized with a high blood alcohol level or overdosing. No matter how much we would love to comfort you in this time of uncertainty, unless we have a signed agreement allowing us to talk with others about the patient (signed by the patient), we can’t reply due to confidentiality. That being said, if you think you have valuable information that could assist in their recovery, a good provider will appreciate your disclosure and will make use of it, albeit discreetly and without acknowledgment, we received your correspondence.

Another approach you could present to the patient is to join them in one of their sessions. This not only strengthens your commitment and resolve, but it also will give you the opportunity to potentially have a voice with them and their counselor. So long as the patient is fine with your joining, most providers won’t have an issue with your addition.  

I’ve had it! Can I have someone committed into rehab involuntarily?

Not really, and for good reason, as it is difficult to legally force a free person into any kind of treatment (yes, even while intoxicated). It is feasible to involuntarily commit someone for a detox program and most states have a system in place for that. This involves proving (with documentation) that the likelihood of imminent physical harm (beyond intoxication) or a fundamental lack of capacity to provide for their own basic needs. However, this is exceedingly rare in practice, considering the amount of people harming themselves with their addiction every day. It can also be impractical to force detoxification without the patient being completely on-board, as they might not be ready for it. So the answer to the question relies on which situation and state you’re in.

Anything else I should know?

With certain substances, it is best not to stop cold-turkey without the guidance of a medical doctor, as some addictions can prove fatal if stopped suddenly. This should not deter any addict from seeking recovery, it just means that should be honest with their desires to stop. Alcohol, benzodiazepines (also called benzos), and opioids are of the gravest concern. To provide the patient with their best foot forward, medically-supervised detoxification should be considered as an option or at the very least, get your doctor’s approval to wean off at home.   

Secondly, addiction recovery can take many forms. The evidence shows that most people can improve greatly at a traditional outpatient clinic that’s well-versed in how to address underlying mood issues that drive addiction. When it comes to recovery, many people often incorrectly believe the best (or only) solution is to arrange for a 30-day on-site rehab. The evidence is quite clear that it’s typically not needed, on top of being only 5-10% effective. Why is the effective rate so low in rehab facilities if I see my favorite celebrities going to them all the time? Well, there are many reasons for this, including very few regulations on the standards of care and the lack of utilizing evidence-based treatments. Additionally, there’s a type of fallacy when you’re part of an in-patient rehab program, as it’s “easier” to get well in this removed and idyllic setting. However, many patients that show promise while in rehab have been known to struggle when they return to their “real life” and all the toxic opportunities, situations, and/or people present themselves. This was the idea behind SelfRecovery.org: to make evidence-based strategies available to everyday people in their everyday environments. One thing we can all do to help is to destigmatize addiction so more people reach out for the help they need and get there earlier.

Finally, a common misunderstanding is around the topic of relapses, which are unfortunately an expected part of the journey. We typically educate clients to not think of a relapse as the worst thing that can occur, but a possible hurdle they might experience. We want to be clear here, we don’t recommend relapses, so don’t strive for them or allow yourself a weekly “cheat day”, as that won’t get you into the clear, but it could happen. The truth of the matter is that if a relapse occurs, the goal is to make them less frequent, less intense, and to decrease the duration. It’s not so much what happens when you get bucked off the horse; it’s what happens when you’re on the ground.

Photo by Ben White on Unsplash

Things To Do With Kids In Austin

What to Do with Kids in Austin

By: Loren Lomme, LPC, RPT

Have you ever thought, “Man, things would be so much easier if parenting came with a handbook!”? (I have!) While it’s true that there’s no one handbook for all things parenting, there are lots of resources out there for parents. The problem is it takes a lot of time and energy to not only find them but to figure out which ones might be helpful. Our goal is to make your life a little easier by offering a “field guide” of what to do with kids in Austin, parenting resources, a one-stop-shop for finding what you need to help w/ parenting skills, stress relief, connecting and engaging with other parents, fun places and activities, and maybe a little humor because, hey, parenting is hard yall!

Parenting Resources:

Most of us are plugged in to the online world in one or several ways, so while you’re there, here are some ways to connect and get advice from fellow parents as well as experts:

thebump.com

  • Full of pregnancy, baby, and parenting tips and information
  • Join their message boards to connect with other parents that have similarities to you
  • (trying to conceive, moms of newborns, parents of multiples, etc.)

ahaparenting.com

  • This is probably one of my favorite, online parenting resources. 
  • The website contains information and advice in the form of articles from a clinical psychologist and fellow mom, Dr. Laura Markham, for every stage from pregnancy through the teenage years.
  • Follow the Aha!Parenting Blog for extra articles and advice.

Facebook Groups

  • Search for FB groups that meet your needs: moms, dads, grandparents, foster parents, moms of girls, parents of kids with food allergies, etc…..if you can think it up, there’s probably a FB group for it where you can connect with others for advice, community, and support.
  • Join Austin Moms’ Network – this group is FULL of local momos, activities, opportunities, and information
  • Follow Austin Moms Blog for articles, funny videos and memes, information, and events geared toward moms and families in the Austin area
  • Join Hike it Baby Austin – this group does both parent and child led hikes and playdates around various parts of Austin

do512family.com

  • This website lists upcoming activities for kids and families around the Austin area.

Are you a reader….or a listener like me (Audible for the win!)? Here’s a short list of must-read books for parents:

  • ANYTHING by Dr. Dan Siegel; seriously, he’s the best! If you need a good starting place, read The Whole Brain Child. The information about child development is paired with strategies for nurturing your child’s mind and their bond with you as well as tackling difficult behaviors. Have a teen? Check out Brainstorm. It’s a bit more of a challenging read, but the information and insights about how the teenage brain works are well worth your time and efforts.
  • The Connected Child by Karyn Purvis, David Cross, and Wendy Lyons Sunshine – If you have (or are planning to) foster and/or adopt a child, this book is for you! This is also a great read for any parent of a child with special behavioral or emotional needs.
  • Hold Onto Your Kids: Why Parents Need to Matter More Than Peers by Gordon Neufeld & Gabor Mate – The focus of this book is attachment and why it’s crucial for your relationship with your child. The updated edition even includes a section on screens and social media.
  • The Highly Sensitive Child: Helping Our Children Thrive When the World Overwhelms Them by Elaine Aron – Dr. Aron discusses the trait of “high sensitivity,” the benefits and challenges that go along with being highly sensitive, and the keys to successfully parenting an HSC and helping them thrive in the world.
  • The Out of Sync Child: Recognizing and Coping with Sensory Processing Disorder by Carol Kranowitz – If your child is affected by any type or level of sensory processing issue, this book will be immensely helpful for you in making sense of your child’s behaviors as well as in providing you with approaches in managing them.

How about those times when your kid’s behavior is so out of control or overwhelming for you that you’re just not sure what to do next? We thought it would be nice to give you a short list of ideas for those hard to handle moments when you feel stuck.

  • First, make sure YOU’RE breathing. I’m talking about the slow, deep breaths that calm our bodies down and engage the parts of our brain that we need for problem solving. The other benefit of keeping calm is that when we regulate our nervous systems, we can influence our child’s nervous system to follow along.
  • Go back to the basics and HALT. Check in with your child or think about your schedule for the day. Is it possible that your child is:

*H – Hungry or thirsty? Sometimes a quick snack or drink of water can make a world of difference.

*A – Angry or experiencing an intense emotion? Try reflecting what you think your child is feeling or experiencing, This often provides good insight about what to do next.

*L – Lonely? Maybe your kiddo needs some nurturing. Offer an opportunity for connection with you – a hug or snuggle, reading together, sing a song together, play a quick game of 20 questions, tag, or something that your child chooses.

*T – Tired or overstimulated? They might just need a nap or a break. Try removing them from the activity or environment for a few minutes to give them a chance to wind down.

Things To Do: Austin has sooooo many indoor and outdoor activities available, and we know it’s hard to keep track of them all. Here are some ideas:

  • Toybrary Austin – check out toys, attend an event, go play.
  • Local libraries – check out a book, play in the children’s area, attend storytime or craft time, check their calendars for events.
  • Austin Nature and Science Center
  • Parks, Pools, and splashpads – use the City of Austin website to find them all.
  • YMCA – there are many locations and each one has activities for adults and kids.
  • Catch Air – Shoot soft colorful balls throughout the air while competing with others or just because it is that much fun. Included in the arena is a ball fountain that is fun for the family.
  • Mt. Playmore – Your kids won’t ever want to leave once they see the largest indoor playground in Central Texas. Food, Games, Parties and prizes round out the fun!
  • The Thinkery – An evolution of the Austin Children’s Museum, Thinkery is Austin’s home for “why” and “how.” It’s a place where science and families play side by side.
  • Austin Aquarium – Come experience the most astonishing underwater view with hundreds of species!
  • Epic Fun – Bumper cars, Laser Tag, ropes course, rock climbing, and so much more.
  • Little Land Play Gym – Little Land Play Gym & Pediatric Therapy. One of a kind indoor playground developed by a pediatric therapist to help kids grow and develop while having fun!
  • Austin Park and Pizza – Attractions include go-karts, bumper boats, mini golf, batting cages & a rock-climbing wall.
  • Chuck E. Cheese
  • Austin Ninjas – Kids go through an obstacle course with training and classes.
  • Little Gym – they offer parent/child classes – The Little Gym is a children’s gym offering activities for kids including parent/child classes, kids dance, gymnastics, sports skills and karate.
  • Coffee shops and restaurants with kids play areas: Maudie’s (in the Triangle), The Hive, The COOP, Hat Creek Burgers, Phil’s Ice House, Cosmic Coffee + Bar, Home Slice (new location on North Loop), Salt Lick (in Round Rock), Almost Grown Play Cafe, Cuba 512, Central Market (North Lamar), Brentwood Social House, Cherrywood Coffee House (they have kids’ bands play outside on Sunday mornings), Whole Foods (downtown location has a playground on the roof with a picnic area & the north location has a small play area with picnic tables and a stage).
  • Winnie app – use it to find nearby places to take your kids and family (parks, restaurants, activities, child care, etc).
  • Free Forest School – find a local chapter and attend their events to engage your child in free nature play groups.
  • Tinkergarten – find a group/class local to you and join in for outdoor classes geared toward building cognitive, social, and physical skills through play-based learning.

What about when you need a break from parenting? It’s so important to take time for yourself and your relationships, both the romantic ones and friendships. Self-care and “me time” can range from anything to taking time to read a book, going to the gym, getting a massage, engaging in a hobby, joining a yoga class, going on dates, going on outings with friends, or really anything that reminds you that you’re not only a parent. (It’s easy to forget this about ourselves). You could even check out UT Informal Classes to learn about a topic or skill that interests you (for fun or to enhance your career goals). The classes vary from semester to semester and are reasonably priced. Here are some ideas for child care so that you can get some much-needed adult time:

  • Check to see if your church offers parents’ night out or other childcare options
  • Many preschools also do parents’ night out
  • Ask around to find a high school or college age kid in your neighborhood that you could get to know as a reliable resource for watching your kiddo
  • Toybrary Austin – drop off childcare 
  • Nanny-share! Child care is expensive, but finding another family to share a sitter or nanny with helps lower the costs and gets your kids playdates with their friends.
  • Care.com – This service connects you with child care providers in your area.
  • Are you in a neighborhood that uses the Nextdoor.com app or website? That can sometimes be a good place to connect with someone close by that is looking to babysit.
  • Find a drop-in child care facility. Here are a few: Ashley’s Playhouse, Kid Spa Austin, Clubhouse for Kids, Tree Tops Learning Center
  • Talk with your friends about taking turns watching each other’s kids for a date night or agree to a group playdate with several friends and split the cost for a sitter

Hopefully some of the ideas and suggestions in this post will save you some time and energy (since parents often have little to spare)! Our hope is that you will be able to spend less time looking for resources you need and more time engaging in meaningful activities and interactions. Good luck and enjoy! If you like this article, you might also like “How to Boost Self Esteem in Kids“, “In Defense of Relentless Problem-Solving“, and “Stop Back-to-School Stress Before It Starts with 4 Simple Tips.”

Photo by Anna Samoylova on Unsplash