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My life seemed to be coming apart at the seams,
right before my eyes: everything that could go wrong seemed to be going wrong, and I felt completely powerless to change any
of it. Marital issues, a death in the family, financial problems. I was horrified that anyone would discover what a mess I
felt like or that I even had any problems. For the outside world my life was relatively perfect: my husband and I owned our
own business, had a beautiful daughter, were living in Birmingham, great social life. But I knew the truth, I was a disaster
just like my life felt - the business was fledgling, my marriage on the rocks, we could hardly afford the payments on the
house. I simply could not deal with anything, but I simply could not tell anyone that. My lip glossed smile and manicured
nails hid all the hurt and fears from the outside world of my coming undone . . . then all of a sudden - SNAP - like being
hit by a runaway train, my head felt as if it were full of swarming bees, buzzing with crazy thoughts at 75 mph on the expressway
. . . my fingers began to tingle with numbness, my breath quick and shallow, my throat constricting so that I could
hardly swallow. I was trembling from head to toe, my heart beating out of my chest, head spinning with dizziness and I was
so hot, on fire I felt - I just knew I was going to die. Stroke. Heart attack. Seizure. I could not get to my exit fast enough,
time seemed to stand still. I am going to die right here, right now, was all I could think and in the meantime kill others
as my car catapults out of control. I could not reach my destination fast enough. As I finally exited the highway after what
seemed like years, the physical symptoms began to dissipate and the horrible thoughts were replaced with thoughts of having
escaped a dire situation and now I am safe . . . but I must be going insane! What was that? Exhausted and drained I arrived
at my home and felt so safe: so safe indeed, that the very next day when I needed to run an errand, I began thinking of the
previous days events and began thinking "what if" thoughts . . . what if that happens again? As I regretfully pulled
out of my driveway, my thoughts raced and became incomprehensible . . . what if I just die right in the store or have a stroke
and fall on the floor and kill myself, or I just go suddenly blind? Just like that, in the blink of an eye - die, blind, debilitated.
I, like a madwoman, raced through the store tossing items into my cart as quickly as I could, with only the thought of getting
home and being safe again in my mind. The physical symptoms began again . . . my hands trembled so much, simply signing my
credit card receipt was embarrassing (someone could see I was anxious), which, of course, began new thoughts of loss
of motor skills, etc. I began to associate leaving the house and being in public as a threat - something horrible or tragic
would surely become of me or my "problem" would be discovered. Having a family and pets to care for precluded me from not
leaving the house again as I wished, but I did so with dread and resignment. This continued for months and months, dealing
with the thoughts and issues associated with my feelings, I proceeded to have more "attacks", mostly in situations where I
felt I had limited or no escape. I began to avoid each and every situation where an attack had occurred, fearing that encountering
the situation again would bring about another awful, horrible attack. Boulevard turns, the Up escalator, 4 lane roads, etc.
The fear of leaving my home, driving, the stray thoughts of dropping dead, strokes, blindness, loss of motor skills would
always lead to an "attack" and I would consequently avoid that specific situation again. Eventually, the few stores and places
I visited regularly became safe places but not without having extreme anxiety while driving to them. But I swore I would never,
never drive on the highway again. NEVER! Nor any other situation where an "attack" had occurred.
I began researching my symptoms online, knowing they
were irrational and obviously not predicting any misfortune. I was so sick of being sick! I found that I was experiencing
anxiety and/or panic disorder - not going insane. But this did not, however, make the avoided situations any better and I
continued to have anxiety daily about leaving my home, driving, potentially being put in a panic inducing situation. Eventually,
I had a few places within a mile of my house that I could go to "safely", but my life and work did not permit me the exclusiveness
of these locations. Traveling outside my safety zone generally led to a panic attack and subsequently I would avoid that situation
again . . . leaving me sometimes driving miles and miles out of my way to simply avoid a particular intersection or turn.
The ever looming threat of an attack and the avoidance of almost all driving situations took its toll on every aspect of my
life. I was horrified someone would discover my feelings. I was so ashamed of the way I felt. Fed up, crying almost daily,
living in constant fear of some tragic event befalling me, I finally decided I truly needed outside help. I found Dr. Pravel's
website and the insight that he offered was enough to convince me that I was very much in need of help and that I could
be helped!
I was so nervous and terrified before my first meeting
with Dr. Pravel that I almost didn't go. How could I possibly be in this situation? What if even he thinks I'm crazy? I did
go and I was so glad. Dr. Pravel was so calm and expressed true understanding of what I had been experiencing. I loved that
he was not a huge proponent of medication and he explained that I had a "thinking problem" and that together we would change
that - no medicine required, just alot of hard work. He was so easy to talk to: he was funny, tender and wise. Every appointment
would leave me feeling calm (amazing!), knowing I was going to get better. Within a few sessions I discovered two wonderful
things: I was not crazy and most importantly that I would heal! Hope had arrived!
My circle of safely began to increase as Dr. Pravel
challenged my irrational thoughts and helped me to believe that "no matter what, I can handle it". I actually did begin to
believe it. But I still had a long way to go. I needed to conquer my extreme anticipatory anxiety of new events and continuing
specific anxieties. I had to get to the point of truly believing that the anxiety and consequent panic attack was just that
- nothing else and that I could handle it - no matter what. As I developed a wonderful rapport with Dr. Pravel, he
expertly used exposure therapy to help me through these situations in my head with visualization and he taught me how to think
differently - that was my essential problem - I had a "thinking problem". These sessions were very difficult and Dr. Pravel
was very persistent in my staying the course when I wanted to stop (avoidance) or not to deal with the feelings and thoughts
that it evoked. This proved to be the most powerful therapy for me. I was essentially going through the anticipatory and actual
anxiety provoking thoughts and resulting physiological effects within the safety of his office.
One after another we conquered my many avoided situations
in the office, then as homework, I needed to do them in real life. I would leave Dr. Pravel promising to complete one task
or another and then challenge myself to actually do it. The experience at the office made the event so much less of a horror
and I found it to be, most of the time, not a big deal - I actually was enjoying getting out and about! I faced my worst fears
and discovered they weren't so scary after all. As my daily anxiety receded, I began to feel like myself again - making plans,
going places, enjoying life. One and a half years after the debut of my panic attacks and just a few short months in therapy,
I was almost complete again. I hadn't realized how deeply I had been affected - going to lunch with girlfriends always evoked
the same comments on how well or fresh I looked and how long it had been since they had last seen me: what had I
been doing? They had no idea of the living hell my life had been.
I have gotten down on my knees, praying, begging
to God to release me from the horror of what I was experiencing, meditated, learned yoga, walked until my feet were blistered.
Listened to inspirational tapes, soothing music, read books and tried the power of positive thinking. Nothing worked. Nothing
at all. Until I understood what was wrong and why I was feeling the way I was. Until I learned that I was not the first and
certainly not the last to have these issues, and then to find a way - a logical, insightful way - to help myself, I may have
never healed. I could not have done it alone, but I truly believe that my personal dedication and motivation to kick this
darkness that had become my life was a large factor in the fact that I came out healed and whole on the other side. I honestly
don't know where I would be today if it were not for Dr. Pravel. Hospitalized. Divorced. Miserable. His dedication to my metamorphosis
will remain with me throughout my entire life - from a primordial being, he helped me to reemerge as free and beautiful as
a butterfly.
EPILOGUE
As of today I am
successfully and happily driving the expressway, lunching, shopping, smiling and truly enjoying the living of my life. Through
Dr. Pravel's wisdom and experience he taught me to find the strength within myself to conquer my fears and anxieties - he
helped me make myself whole again. He guided my thoughts down the irrational paths they led me and found ways to
replace them with rational ones. I had a thinking problem, nothing more, nothing less. I continue to seek guidance
with Dr. Pravel and continually find new strengths and abilities within myself.
We are what we think. All that
we are arises with our thoughts. With
our thoughts, we make our world.
-- Buddha
CLINICAL SUMMARY:
Bree vividly describes how one panic attack sensitizes an individual to all circumstances and elements associated with that
attack, and causes fear of all of those factors. Therefore a panic attack on a freeway can cause fear of freeways, cars, and
all things related to driving. Bree especially began to fear driving situations that contained the element of limited
escape, which she experienced while driving on the freeway during her first panic attack. She therefore found herself
terrified of traffic jams, being stopped at traffic lights, and being in boulevard turn lanes. While at the time she wasn't
aware of the reason for finding these situations fearful, she later came to understand that the common denominator was the
lack of escape.
After one panic attack, one can develop the fearful associations described above.
Thereafter, the individual is then very sensitive to these associations and can fear them, and come to fear the fear of these
associations for fear that the fear will continue to mount to the point of another panic: the "Fear of Fear " cycle.
In therapy Bree
was able to do the cognitive work to identify her fearful thoughts and images and do the interoceptive or in-session
exposure work to imagine driving in the feared situations to overcome the fear. She was then willing and able to put that
to practice with the in vivo or real life exposure work that is the "Behavioral" component of CBT: actually driving
in those feared situations. By doing this she is overcoming her fear of fear cycle as she realizes fear is nothing more than
just that. She realizes she can experience fear and yet still function - "No matter what, I can handle it".
No catastrophe has to result from fear, and that realization puts an end to fear - and the fear-of-fear.
Bree's story is an impressive tale of hopelessness that changed
to hopefulness and success, due to her thorough determination and motivation for recovery. After only a few sessions she was
expanding her comfort zone and progressively driving further and further away from home each week. After having avoided driving
freeways for 1& 1/2 years, only 4 months of therapy and she was back driving on freeways - her ultimate fear conquered.
What allowed this remarkable turnaround? Two factors: effective CBT, and most important
- her motivation. CBT can only be successful when the person in therapy is motivated, or is not resistant.
And there are 2 forms of resistance that need to be dealt with in effective CBT: process and outcome resistance.
Process resistance is the patient's resistance or lack of committment to complying with the "Process" of therapy, i.e. doing
the cognitive exercises and doing the in-session and out-of-session exposure exercises. Outcome resistance is the patient's
(usually subconscious) resistance to surrendering the fears and fearful avoidance. This occurs when the person believes that
keeping the fears and avoidance behaviors will help prevent the feared outcome from occurring. Identifying and challenging
this resistance is key to successful CBT, and is what is often missing from unskilled CBT practitioners. As Bree was so "fed
up" by the time she started therapy, it did not take alot of time nor work to help her recognize and then abandon her outcome
resistance. This is what constitutes motivation, the authentic motivation for change and recovery. Bree has been very successful
in her therapy as she has that kind of motivation, and will therefore continue to enjoy much success in the rest of her life
as well. Great work Bree!
Dr.
Stephen Pravel
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