Episode 45 -- August 15, 2020

Anxiety and substance use disorders often go hand in hand. We have sought refuge from stress and anxiety by numbing ourselves and even hiding by blacking out. What happens during a pandemic, when things are unknown and scary? Let's look to Embracing the Fear: Learning to Manage Anxiety & Panic Attacks, a book in Hazelden Publishing's portfolio that talks about agoraphobia, the most common and most debilitating of anxiety disorders. Some of us have thought of agoraphobia as a fear of the outside. But Judith Bemis and Amr Barrada tell us about it in more relatable terms, as a "fear of fear," or more specifically, a fear of being trapped and unable to get help. When we get stuck in a cycle of panicking, then avoiding the things that make us panic, our world gets smaller and smaller. We become afraid of leaving where we're safe. Does this sound familiar during this time of distancing and quarantine? Does this sound familiar in our recovery? What can we learn from agoraphobia, anxiety, and panic? How does our fear serve us? Bemis and Barrada will tell us how we can let go so we can grow.

It has been edited for brevity.

Often we do not feel in charge of our lives. We feel helpless and do not assert ourselves in our relationships; we fail to establish boundaries and express our needs. Our self-esteem often depends on how we think other people judge us. To feel good about ourselves or to be accepted, we constantly seek the approval of others. Our low self-esteem and lack of self-confidence keep us from taking risks; we often feel stuck.

In many cases, life has become a treadmill that is moving faster than we can handle. Feeling pressured, we have a difficult time slowing down or taking time for ourselves. We continually tell ourselves that we have to hurry through various tasks, even the simplest ones. Is it any wonder that life has become unmanageable and that anxiety and panic have become a way of life?

ANXIETY DISORDERS AND ALCOHOL
People suffering from anxiety disorders in general, appear to use chemicals, especially alcohol, to relieve their symptoms.

A person may begin with the belief that drinking alcohol can alleviate anxiety, which leads to actually drinking, which leads to increased anxiety, which leads to further alcohol consumption. It may be that the more anxious people become, the more alcohol they feel they need to consume to alleviate their anxiety. And this reinforces their belief that alcohol reduces anxiety.

Another study reports that between 10 and 40 percent of alcoholics have a panic-related anxiety disorder, and that about 10 to 20 percent of people suffering from an anxiety disorder abuse either alcohol or other drugs. One interesting finding this study makes is that the majority of people who suffer from both alcoholism and an anxiety problem say that the anxiety problem came before the alcohol problem. A similar earlier study also found that anxiety disorders usually preceded alcoholism: 59 percent of the participants with anxiety disorders reported using alcohol as a means of coping with anxiety. This stresses the primacy of anxiety in many cases of alcoholism.

From these and similar studies it is tempting to conclude that excessive use of alcohol and other substances has a harmful effect on anxiety-related problems.

GAINING A NEW PERSPECTIVE
It is difficult for us to think that there's anything positive about an anxiety disorder. It feels so debilitating that we can perceive it only as an indication of abnormalcy and dysfunction.

First, anxiety is essentially a normal response to stress. Once this is accepted, even intense or persistent anxiety--and yes, even panic attacks--can be seen as serving a useful function in our lives (although we are unlikely to see this function when we are persistently being overwhelmed by anxiety). Can you imagine finding yourself in a life-threatening situation and not experiencing an intense anxiety reaction?

The usual response to this argument is that the fears of those who suffer from anxiety disorders are not experienced in life-threatening situations, that their fears are irrational and serve no useful function. Such is the perspective of someone suffering from agoraphobia. But let's look at it from another perspective. Agoraphobic fears have almost nothing to do with situations that are life-threatening; the situations do not pose a threat to our health or personal safety. A simple look at the kinds of situations that are typically feared by agoraphobics reveals that the threat posed is an?emotional?one; specifically, we feel threatened with a loss of self-esteem. When entering a feared situation, such as a shopping mall, most of our thoughts are focused on whether or not we will cope well--whether we will have uncomfortable feelings or "abnormal" thoughts, or engage in shameful behaviors that will compromise our self-esteem. The catastrophic thoughts of a typical agoraphobic? (What if I panic? What if I faint? What if I lose control and scream?) essentially involve fears of loss of self-esteem. What we are really saying is? I had better not behave this way, for such behavior is disgraceful and humiliating. Even thoughts of having a heart attack or a stroke, or of dying, can be related to our sense of self-worth, since being alive and healthy are inextricably linked with how we value ourselves.

The gist is that the shame-based quality of our fears can alert us to their usefulness, to the emotional meanings represented by our fears. For example, if we have a panic attack while shopping at a mall or driving on the freeway, our response may be one of extreme mystery: we see such reactions as meaningless or as signs of personal defectiveness. However, the panic attack can serve as an important signal to alert us that difficult issues in our lives are in pressing need of attention, and that perhaps the time has come to start taking risks to bring about important changes.

We hate our problem with a passion; we hate our fears, our avoidance behaviors, our catastrophic thoughts, and our dependency on other people to help us do the simplest things. The problem is so complex and causes so much grief that we are unlikely to see any merit in our fears and anxiety. However, as our journey in recovery begins and we start to make sense of what is happening to us, as we become more and more accepting of our problem, and as we learn to become more mobile and independent, the problem becomes less and less threatening and at some point can even be seen as a friend. In recovery, we often reach a point at which we are better off than we've ever been in our entire lives.

WHAT IS RECOVERY?
It is difficult for those of us who suffer from panic or chronic anxiety to believe that life could ever again be normal, especially if we have struggled with anxiety problems for a long time. But it is possible. The problem is that we often try to get better by using the same strategies that helped cause the problem: shaming ourselves, being intolerant of our thoughts and feelings, and trying hard to be perfect.

Typically, those of us who suffer from anxiety problems have extremely unrealistic expectations of ourselves. So it is natural for us to view our recovery with similar unrealistic expectations: we want a perfect recovery as soon as possible. The more perfect we insist our recovery should be, however, and the more we try to hurry it, the more disappointed we are likely to become in our efforts to get well.

Since anxiety problems become entrenched in our daily lives, and since our self-talk is an indelible part of how we think and how we cope with various aspects of our lives, it is likely that very little will change at first. Recovery takes time, and the more time we give ourselves, the more stable and long-lasting our recovery will be. Finding shortcuts seems like a good idea but usually leaves us open to more setbacks. James Kavanaugh, in his book Search, encourages his readers to "play the long game." If ever there were a need for playing the long game, it's in recovering from an anxiety disorder. But taking a long view of recovery will not be easy for us, since we already feel that life is passing us by.

When we develop a permissive attitude about our panic attacks, when we're able to let go of our fear of them, they lose their power and occur less and less often, until we no longer find ourselves waiting for that next wave of panic from out of the blue. As we gain more confidence and take more risks, we focus less and less on our anxiety and panic attacks. We no longer need to label ourselves "agoraphobic," (or use any other label, for that matter). We can now see ourselves as normal people; the anxiety or agoraphobia becomes an inconsequential part of our total self-image.

Recovery does not mean we'll never feel anxious again; no one can expect to be completely anxiety-free. But the anxiety will diminish and become much more manageable. The more we lower our expectations for a perfect recovery, the stronger a recovery we can actually bring about. The more time we give ourselves, the sooner we will recover. Such paradoxes are difficult to accept and understand. At first, they seem neither logical nor helpful. As you read this book, however, the many paradoxes of the recovery process will become more understandable. This understanding will make the recovery process easier.

Recovery means more than being free of panic or anxiety; it also means personal growth and awareness. In recovery, we look back and realize that we have made it through a very difficult time. This realization leaves us with a feeling of great accomplishment. We gain valuable insights and learn coping skills that can change our lives.

© 1994 by Judith Bemis and Amr Barrada
All rights reserved.