This is the most personal post I've ever published. I decided to push through the embarrassment in the hopes it will help you somehow. If you're dealing with anxiety and/ or panic attacks, you are not alone. Because, spoiler alert: It has a cure!
Once I started working full time right after graduating college, I was feeling a little off. I honestly thought it was due to the change in lifestyle or maybe getting used to adulthood (ugh). But once I got my first job in the communications industry (my study field!) I started noticing that I was having tachycardia, trouble breathing, sweaty palms, difficulty speaking up in meetings, standing up for myself to people mistreating me and even speaking without stuttering. I was even called out on my nervousness during meetings. They gave me an ultimatum, because they knew I was underperforming due to my stress (I had no idea it was anxiety at that time). I remember being sick to my stomach and sweating my hands off during the entire meeting because I honestly thought I was going to be fired for being the worst employee ever.
*Already getting sweaty palms and difficulty breathing while writing this.*
Since I already knew there was definetely a problem with me, I decided to visit Dr. Cristina Rosario, PhD. She was the first person to ever recognize that I was experiencing panic attacks due to my irrational thoughts. So she quickly gave me all the tools I needed to overcome them, along with several breathing techniques in order to avoid letting a panic attack get the best of me.
Turns out these irrational and catastrophic thoughts of me being a failure after just one year in the communications industry is what led me to start failing at work. I was comparing myself to all my colleagues who already had years of experience, thinking that there was a problem with me because I was not as skilled or witty. I even truly believed that I wasn't intelligent enough to handle the industry.
Thanks to all this treatment, today I am in such a better place. I am more aware than ever that anxiety is directly related to the way we respond to situations, not what happens to us or how people treat us. The only way to get through it, is by learning to identify our triggers and making sure to stop them before the panic attack happens. It is a slow process, but I'm telling you, it WILL get better.
I decided to publish this post, because even though I've never been ashamed of visiting a psychologist regularly (I truly believe everyone needs one), I started to notice many of my friends who were starting their careers at the same time, were experimenting very similar symptoms as I was. I am very pleased to see all increase in mental health awareness in the media, but I still think we are not talking about it in a personal level. I firmly believe that talking about mental health with either a professional or a good friend is the best way to overcome it.
That's why I decided to interview my awesome psychotherapist, Dr. Cristina Rosario, PhD so she can talk a little bit about what is stress, anxiety and a panic attack. Hope this helps!
PS: Special thanks to Mari Nieves from Pink Studios for the amazing infographic at the end of this post!
What exactly is anxiety?
Anxiety is a term used to describe a physiological and cognitive response that our body has due to an event or particular stimulus, perceived by the person as a high threat or danger.
How should I handle anxiety?
During an anxiety response the first step is to ask yourself if your life is in danger. If the answer is yes, we can asume that anxiety is due to an adaptive response.
If the answer is no, we can imply that anxiety is a pathological or mental health symptom.
How can we recognize anxiety as a mental disorder?
When the person expresses a physiological response in the absence of a real dangerous event. Here are some of the key indicators:
The person starts being dysfunctional in their environment.
The person starts having a mix of dysfunctional thoughts that are not grounded to reality.
So how can we diagnose an anxiety disorder?
Anxiety by itself is not a diagnosis. The "anxiety" term helps us to give a title to a diagnosis category where anxiety manifests itself. Some of these diagnosis associated with anxiety are:
Panic disorders without agoraphobia
Generalized Anxiety Disorder
Obsessive Compulsive Disorder (OCD)
Stress reactions (Such as Post Acute Stress Disorder, PTSD and Adjustment Disorders)
Should I start taking anxiety pills?
There are evidence based cognitive behavioral treatments that promise effective results without the need of prescription drugs. Nevertheless, for some people, the combination of psychotherapy and pharmacotherapy is the best option.
How do you decide to refer a patient for pharmacotherapy?
We ask ourselves the following questions:
What is this patient's level of basic needs, dreams, nutrition and higiene accomplishments?
Does this person has avoidance behaviors that impede optimum performance in their environments?
Can you sense the presence of non-functional rituals in their environments?
What's the difference between stress and anxiety?
Stress is a degradation of anxiety and it usually only manifests through thoughts. Stress is a discomfort sensation or concern you go through during an event or unknown event. When we talk about stress, we talk about a sensation that will eventually go away. While the person is uncomfortable, he or she eventually executes the task and fulfills their responsibilities.
Can stress cause a panic attack?
An anxious response can manifest at any place or time. It usually shows through high frequency stress and stress slowly transforms into anxiety.
Similarly, anxiety increases until it reaches its limit. I always tell my patients that the body is very wise and it can handle a lot, but it has a limit. When we have anxiety, we are filling up a tank every time we decide to avoid something until our body says, "enough!". By nature, all that tension and discomfort hast to come out somehow, so the body expels it with symptoms and physical discomfort. This is usually when you experiment your first panic attack.
How can we identify a panic attack?
A panic attack usually manifests in two ways: physically and mentally. While panic attacks share some characteristics, they are usually unique to each person. Not everyone experiments the same group of symptoms or in the same order.
When a person is having physical symptoms, they may suddenly experiment multiple discomforts in a gradual and climbing form, such as: headaches, blurry vision, difficulty speaking, heat flashes, rosacea, drowning sensations, trembling voice, chest pain, tachycardia, difficulty breathing, stomach aches, diarrhea, vomiting, nausea, muscular pains, spasms, irritability, catatonia, repetitive conducts, such as biting nails and somatization (physical pain due to no apparent biological reason).
When a person is having cognitive symptoms, they may be scared that the worst will happen: die, loose control or suffer a heart attack.
Do you have to visit a hospital if you have a panic attack?
It is very common that a person arrives at the emergency room once a panic attack happens. When this happens, the person goes through screening tests that usually turn out negative. In the hospital they will usually treat it with Benadryl or some type of painkillers. Once they observe the patient for some hours, they SHOULD be referred to some type of mental health provider.
You may have heard of a coworker that went to the emergency room because she thought she had a heart attack when it was just a panic attack. Even though the person usually doesn't believe they have a mental health problem, this person usually has negative thoughts, suffers from diarrhea, sweat, headaches and when they arrive at work they feel like they have asthma. Every person has their own symptoms combination.
What is the main cause of a panic attack
In a general or macro level, anxiety is a defense mechanism that the person uses to avoid or confront some type of situation. So it is necessary to evaluate the avoidance component: If you avoid something, you accumulate it until it explotes in a panic attack.
In a micro level, there's something in your immediate environment that makes you have discomforting thoughts. I always tell my patients to evaluate themselves for two weeks so they can identify some pattern.
They should consider multiple factors, like schedule, people, nutrition, menstrual cycle, sleeping patterns and basically everything in order to get a clear x-ray of your mind. After this homework, they always come back to me amazed because they are more consious that their anxiety or panic attacks are usually due to a general response and that they have a very marked pattern.
If I experience a panic attack, does it mean I have a mental condition?
Experimenting a panic attack doesn't mean you have a mental health condition or that you need to start taking pills or have some type of pharmacological treatment. It certainly does not mean that you are unwell or crazy.
What should I do if I experience a panic attack?
Experiencing a panic attack is an indicator that you present some type of stimulus that is making you have emotional and psychological discomfort and that your current efforts to manage them are not being effective. Yes, it is an indicator that you need to look for a mental health provider.
You should schedule an appointment with a clinical psychologist (usually with a PhD or PsyD title), so this person can evaluate, educate you and determine the severity of your symptoms and offer a treatment plan. This may include a referral to a psychiatrist to consider medical treatment.
Why should I visit a psychologist?
Psychotherapy seeks to decrease the intensity and frequency of panic attacks, while educating on how to process and modulate perceived information in a way that does not accumulate so your body doesn't find it necessary to respond in pathological anxiety.
In a nutshell, psychotherapy will help you create a base line so you can auto-evaluate and know how anxiety and panic attacks manifest in yourself. Your psychologist will explore difficult or traumatic events, emotions and repressed thoughts that feed your anxiety. You will finally identify the sequence of your symptoms and offer clear tools adapted to your reality and environment so you know the 1-2-3's once you recognize your first anxiety symptom.
Is there a cure for anxiety?
A manageable doze of anxiety is always motivating. However, pathological anxiety is preventable and has a cure. A person can manage to master and reduce their anxiety in order to eliminate their panic attacks. My opinion is that an anxious person will always be a little nervous, but as you learn, you manage to minimize triggers and learn to use appropriate tools once you recognize that you're experiencing symptoms of anxiety. You will manage ways to avoid (1) a full blown panic attack and (2) live his life without fear and avoidance.
Does fear have any relation to anxiety?
Fear is the consequence of anxiety. The concept of fear develops in the face of discomfort caused by anxiety and/ or a panic attack or any other diagnosis in the anxiety family.
The person identifies some triggers and therefore avoids exposure to them, thus reducing anxiety, while generating dysfunction and avoidance. Whenever we are afraid, we become immobilized and incapacitated.
Can anxiety lead to depression?
Yes, there is a relationship between anxiety and depression and many times they feed from each other.
Like everything in life, anxiety does not like to live alone, so it usually comes with symptoms or a depression diagnosis. By avoiding situations, many times the person is isolated and at the same time feels guilty or embarrassed, while feeding the components needed for depression.
What is a mental health emergency?
A person (adult or minor) engages in one or more of these actions:
Expresses death thoughts or any indicator that they want to end their lives or harm themselves.
Expresses they want to harm another person.
The person is intoxicated and represents danger to themselves and/or others.
The person is psychotic, unconscious, disorganized or having hallucinations.
The person is out of control and aggressive.
What to do during a mental health emergency:
Call 911 and visit your nearest hospital. It can be a regular hospital since the person will eventually be transported to a psychiatric hospital.
We should NEVER assume that the person is being manipulative and we certainly must never assume that the "suicide is trending" as I read in a comment related to 13 Reasons Why.
Here are some health care providers (in Puerto Rico) to consider if you're having sucide thoughts or in case of an emergency:
Suicide Prevention Lifeline – National Network (TALK): 1-800-273-8255
Centro de Control de Envenenamiento (Poison Help): 1-800-222-1222
Administración de Salud Mental y Contra la Adicción (ASSMCA), Línea de Emergencia Primera Ayuda Social (PAS): (787) 763-7575/ Toll Free Number: 1-(800)-981-0023
Hopital San Juan Capestrano
(787) 760-0222 (exts. 7162, 7163, 7196 y 7197)
fax (787) 760-6875 y 760-2944
Toll free number: 1-(888)-967-4357
Hospital Panamericano en Cidra
(787) 739-5555 - (fax) 739-5544
Toll free number: 1-(800)-981-1218
Hospital Ramon Fernandez Marina
Hopital San Juan Capestrano Bayamón / Condado
Hospital Panamericano en Cidra
Inspira Auxilio Mutuo / Hato Rey / Caguas / Bayamón
APS Healthcare Inc, Caguas y Carolina
Hopital San Juan Capestrano
Unidad Psiquiatrica Adolescentes -- Instalaciones del Hospital Universitario Ramón Ruiz Arnau(Hospital Regional de Bayamón)
Hospital San Jorge
Hopital San Juan Capestrano
Hospital San Jorge
Have you ever dealt with anxiety, panic attacks or depression? Feel free to discuss this in the comments bellow! This should never be a shameful topic. :)
Until next time,