DBT for Severe Anxiety and Panic Attacks

You think you’ve made progress. You’ve been doing well, and anxiety and panic attacks almost seem like some surreal experience from long ago. Then, in response to a particular situation (or perhaps for no apparent reason at all), you find yourself overcome and overwhelmed with anxiety and/or panic.

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This was me over the past couple of days. I can’t say that I wasn’t very disappointed and that I didn’t worry that it would “taint” the progress I’ve made in others eyes who see me on a day-to-day basis, but

I’ve mentioned before that I’d be doing a disservice to my readers if I didn’t also share with you the struggles and difficulties that come up. 

Everyone experiences ups and downs. The more we learn to effectively cope with the downs, the more we get to experience the ups. And, the more we share our experiences – especially tools that work – we are helping each other and ourselves.

So, rather than get into the specifics of my particular recent triggers, I am going to focus this post on the DBT (Dialectical Behavior Therapy) skills I used to cope with the distress.

Having Borderline Personality Disorder (BPD) means that I tend to experience my emotions – all of them – much more intensely than someone who doesn’t have the disorder. Dr. Marsha Linehan (the founder of DBT) once likened a person with BPD to that of someone with 3rd degree “emotional burns.” 

When you think about it this way, it’s easy to understand why the more unpleasant emotions and feelings, such as fear, anxiety, and shame can cause some of us to spiral to places that confuse others. They might not understand how we could possibly get so upset and distraught over something that others may be able to handle more easily.

While we can’t always satisfy these questions, we can find ways to take care of ourselves and hopefully shorten the duration of our period of suffering. In doing this, we also improve our ability to deal effectively with others.

Here are some of the ways I have coped with severe anxiety/panic over the past few days:

DBT Skill: Distress Tolerance (also known as “Crisis Survival Strategies”):

According to Dr. Marsha Linehan, these skills come in handy “for tolerating painful events and emotions when you cannot make things better right away” (Skills Training Manual for Treating Borderline Personality Disorder):

  • Distract with “Wise Mind Accepts”
    • Activities:  I STAYED IN MY ROUTINE (got up on time, went to work, ran errands) despite how I felt. I think this is hugely helpful. In the past, I’ve stayed at home and stayed in bed a lot. I’ve found that this makes me feel worse instead of better and often prolongs the episode.
    • Other Wise Mind Accepts skills are: Contributing, Comparisons, Emotions, Pushing Away, Thoughts, Sensations.
  • Self-Soothing the Five Senses
    • Guided Meditations (hearing):

      I have several favorites, but one that I go back to again and again is Time for Healing: Relaxation for Mind and Body. The CD includes 2 tracks – one is a muscle tension and relaxation exercise, and the other is a guided meditation through a country scene. I did this one last night, in fact.

      There are also some excellent, relaxing, self-hypnosis tracks offered by San Francisco Bay Area hypno-therapist, Susan Gold on her website.  Susan’s voice is very soothing, and I find her work to be very helpful.

    • Other ways to self-soothe are through vision, smell, taste, and touch
  • Improve the Moment
    • Prayer: While I am not any particular religion, I find it comforting to believe there is a power greater than myself, or “God.”  I used prayer to improve the moment.
    • Relaxation:  
      • I certainly did not feel up to anything strenuous, but I did do a couple of 2 mile, brisk walks. I think that this particular coping strategy was very effective, as I had so much adrenaline and energy, and this a healthy way to channel it.
      • Took a relaxing, hot shower
    • Used the “Half Smile” skill
    • Other Improve The Moment skills are: Imagery, Meaning, One thing at a time, Vacation, Encouragement

DBT Skill: Mindfulness:

  • Wise Mind: 
    • Caught my “what if” thinking and brought myself back to the present moment
    • Observed my emotions and experiences
    • Described my emotions and experiences
    • Other Mindfulness skills are: Thinking Dialectically, Non-Judgmental Stance, Effectiveness, and Mindfully in The Moment
    DBT Skill: Emotion Regulation:
    • PLEASE” skills (taking care of your mind by taking care of your body): 
      • Ate (even when I didn’t feel like it). I don’t know about you, but anxiety/panic affects my appetite adversely and also gives me an upset stomach.  I didn’t feel up to eating as much as usual, but I made sure that I ate something nutritious at meal times and drank water.
      • Slept
      • Took Ativan (anxiety medication that I take as needed -very infrequently- and at bedtime) as prescribed
      • Got exercise (the 2 brisk walks)
      • Other Emotion Regulation skills are: Build Mastery, Build Positive Experiences, and Opposite to Emotion Action
    I asked my twitter followers their favorite ways to cope or self-soothe during times of intense anxiety, and I really enjoyed these replies (re-posted with permission):

    How do you cope when unpleasant emotions such as anxiety and panic show up?

    Thank you for reading.
    More soon.

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