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When you feel a panic attack coming on, usually everything escalates very quickly. With or without noticing it, your mind begins to race and quickly the negative thoughts overwhelm you furthering the panic. Negative thoughts usually start off with “What if…” “I should be able to ….” “I have to…” or other critical comments like “I’m so weak” or victimization “Its hopeless, why bother”. These thoughts are called Negative Self Talk.

The Anxiety and Phobia Workbook by Edmund J. Bourne lists a quick explanation of what Self Talk is and how it works:

• "It is so automatic and subtle you don't notice it or the effect it has on your moods and feelings.
• It appears in telegraphic form- one short word or image ("Oh no!) contains a whole series of thoughts, memories, or associations.
• Anxious self-talk is typically irrational but almost always sounds like the truth.
• Negative self-talk perpetuates avoidance.
• Self-talk can initiate or aggravate a panic attack.
• Negative self-talk is a series of negative bad habits. (You have to reprogram your brain to say helpful uplifting confident talk to remove the negative thoughts)"

Recognizing that you are doing this is a huge step towards learning to manage your anxiety. The next huge step is successfully slowing your thoughts down, analyzing them, and then reprogramming your mind to think differently. This will greatly reduce the amount and size of panic attacks you have. It helps me stop panic attacks dead in their tracks probably about 80% of the time.

So here is the exercise:

I have many posts where I outline this exercise for myself to help me cope with whatever panic attack I may be having at that time. It is extremely helpful for me to go back and read them when the same situation appears again in the future. I encourage you to read a couple to get some ideas or more details on how to fill this out.

1. When you feel panic coming on, take some deep breaths.
2. Ask yourself, “What am I telling myself to make me feel this way?”
3. Write out any automatic thoughts (fears, concerns) that are making you feel panic.
4. Then write out or ask yourself, “What if the worst case scenario happened? What would I do?”
5. Then write out a rational response or game plan as to what you could do if the worst did happen.
6. Then take each of your fears or concerns you wrote out and challenge their truthfulness. Try replacing that thought with a positive counter statements and/or positive affirmations:
1. Ex: WORRY- “What if people around me see my anxiety and judge me?”
2. POSITIVE COUNTERSTATEMENT- “I am willing to go forward with my life and try to better myself regardless of what others think.”
3. POSTIVE AFFIRMATION- “I respect and believe in myself apart from other's opinions.”
7. Repeat those affirmations or counterstatements over and over while taking deep breaths.
8. If you find yourself not believing them, realize that these can also be considered goals. Place “I am learning” in front of them. Ex: “I am learning to respect and believe in myself apart from others opinions.”
9. If your mind is still racing, choose one that you are working on and write it out ten times on paper (printing not cursive) so that you can really concentrate on the words.
10. By this time you should be feeling calmer, or at least the symptoms aren’t as severe as they were. You can then follow up any more anxiety with medication as needed, or by temporarily leaving the situation if possible and then returning when you feel better.

Following these steps takes practice and patience. But it’s worth it. There are many websites that have lists of positive affirmations. Here are a few:

• bmindful.com
• coping.org
• all the ones I list here at The Reality of Anxiety
  

At one point I even taped them around my house so that I could see them often. At work I have little symbols or stickers that have hidden meaning behind them to help remind me of them. This exercise has probably been the most effective thing I have introduced in my life to help me manage panic attacks. It doesn’t always work. Sometimes it all happens so fast that its too late when I try to slow things down, but if you start doing this the moment you feel a twinge of anxiety, then it will help you keep it at just that level of intensity.

Edmund J. Bourne further says, “Cultivating the habit of countering [negative self talk] is one of the most significant steps you can take in dealing with all kinds of anxiety as well as panic attacks.”

There is so much more you can learn about the art of countering your negative self talk. I encourage everyone to find some that can help you in your life and remember them when the panic comes.

I would love to hear if anyone else has used this type of exercise and whether it helped them or not.

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Yesterday was World Mental Health Day as initiated the World Federation for Mental Health and has been celebrated annually since 1992. The theme for this year is "Mental health in a changing world: the impact of culture and diversity".

"Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

The culture you are surrounded in greatly determines the way in which you deal with your symptoms. However, mental health effects every country no matter where you live. According to the WHO website:

• Mental, neurological and behavioural disorders are common to all countries and cause immense suffering. People with these disorders are often subjected to social isolation, poor quality of life and increased mortality. These disorders are the cause of staggering economic and social costs.
• Hundreds of millions of people worldwide are affected by mental, behavioural, neurological and substance use disorders. For example, estimates made by WHO in 2002 showed that 154 million people globally suffer from depression and 25 million people from schizophrenia; 91 million people are affected by alcohol use disorders and 15 million by drug use disorders. A recently published WHO report shows that 50 million people suffer from epilepsy and 24 million from Alzheimer and other dementias.
• In addition to the above figures, many other disorders affect the nervous system or produce neurological sequelae. Projections based on a WHO study show that worldwide in 2005, 326 million people suffer from migraine; 61 million from cerebrovascular diseases; 18 million from neuroinfections or neurological sequelae of infections. Number of people with neurological sequelae of nutritional disorders and neuropathies (352 million) and neurological sequelae secondary to injuries (170 million) also add substantially to the above burden.
• About 877,000 people die by suicide every year.
• One in four patients visiting a health service has at least one mental, neurological or behavioural disorder but most of these disorders are neither diagnosed nor treated.
• Mental illnesses affect and are affected by chronic conditions such as cancer, heart and cardiovascular diseases, diabetes and HIV/AIDS. Untreated, they bring about unhealthy behaviour, non-compliance with prescribed medical regimens, diminished immune functioning, and poor prognosis.
• Cost-effective treatments exist for most disorders and, if correctly applied, could enable most of those affected to become functioning members of society.
• Barriers to effective treatment of mental illness include lack of recognition of the seriousness of mental illness and lack of understanding about the benefits of services. Policy makers, insurance companies, health and labour policies, and the public at large – all discriminate between physical and mental problems.
• Most middle and low-income countries devote less than 1% of their health expenditure to mental health. Consequently mental health policies, legislation, community care facilities, and treatments for people with mental illness are not given the priority they deserve.

As Dr. Deb says on her post on this topic,

“The goal of World Mental Health Day is to address stigma and to show that mental illness is neurobiological - not a scarlett letter with which to be ashamed or a weakness of someone's character. And this year's theme highlights the importance of culture and diversity among us all.”

I never heard about this until today. I am very excited to spread the word. Rather than regurgitate the entire post, I will just mention it briefly with a link. Awhile back I created a post called "Breaking the Stigma" that talks and shows some videos of some campaigns the United States and the UK are doing to help people become more aware of the support that is needed for friends and families suffering. There are links for places to donate or get more involved if interested.

I have known a few newlywed couples that have a situation where a mental illness is revealed such as depression or an eating disorder. Interestingly, the first thing the parents tell the spouse to do is to annul the marriage before they have any kids. This is shocking to me! That because you have a mental illness you are suddenly unworthy of being loved.

Any other mental health bloggers out there- I urge you to spread the word!

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