Question: I need gastric bypass surgery. I am very obese and I want gastric bypass surgery. My sleep apnea is bad. My heart is a ticking time bomb. I have panic attacks and I am terrified of hospitals. I am 26 years old and I am also an alkie. I am 13 months sober. I weigh 395 pounds. I work at home and I get scared in public places. I am scared I going to have a heart attack one day soon unless I do the surgery. I think I damaged my heart with cocaine. My blood pressure is really bad. I need to do this but I can’t do it. I haven’t even talked to a doctor yet. If I am really tranquilized with Ativan or will I be OK and not get a panic attack. I am sober so I never take pills.

William Anderson Says...:

One step at a time. Make an appointment to see a doctor about the bypass surgery. At the same time, make an appointment to see a psychiatrist about the panic disorder. It doesn't make any sense to think or worry about anything else until you do these things. Make these appointments and do the best you can until the appointments, going to meetings and staying sober. After you have the appointments, if the path is still not clear, write back. You have a number of difficult issues, but all can be addressed and resolved if you just focus on the first step (in your case two) and forget about the rest until you complete those.

Question: I have been having a really hard time for the last few months with social anxiety and panic attacks. I have always been shy but this is something very different. My doctor is recommending a couple of different anti anxiety medications (I forget the names) but she said I would become dependent on them If I started using them and I wouldn’t be able to stop very suddenly. This really worried me, because I have had problems in the past with addiction. My doctor does not know of my past with addiction. I am not sure if I should tell her either. I am worried that if I tell her about my past she will be reluctant to prescribe me with certain medications and I want to be the one to decide what I should use based on the best available medical advice. Should I be very worried about using anxiety medications that have a risk of abuse if I have a history of addiction? Am I right in thinking that if I tell my doctor she may be reluctant to prescribe to me?

William Anderson Says...:

You need to change the way you work with your doctors.

First, you need to be straight with them. They need the right information in order to do their job, and you're not giving it to them. When they decide on what to do based on inaccurate or incomplete information, bad things can happen, even deaths.

If you can't be straight with your current doctor, get a new one and be absolutely straight. You are not there to impress anyone, least of all someone you hire to give you medical services. Find a doctor you can work with, and keep looking until you find one you like.

Second, in your case, you should be working with a specialist. You are describing two conditions that a lot of doctors in general practice are not prepared to treat expertly: anxiety disorders and addictions. Your addiction is in remission, but it still requires attention in the treatment. The anxiety disorders you describe are not the garden variety that the family doctor usually takes care of. The kind of specialist for these disorders is a psychiatrist. They are the experts with these things, and your doctor should be referring you to one. They have the necessary knowledge and experience regarding the conditions, the medications and the treatment protocols.

Thirdly, stop trying to be your own doctor. You are trying to decide which medications to take by doing your own research over the Internet and withholding information from your doctor? This is foolhardy. 

You can get these problems under control quickly and get on with creating a happy life, but it will take teamwork with medical experts, where you do your part and you let them do theirs.

Get to work today on lining up an appointment with a psychiatrist, and invite them into your confidence to get this problem solved ASAP. There is no need to stall and worry over it. You'll feel better as soon as the appointment is made. 

One more thing: Get it straight in your head whether you want to stay clean or start using again. It's not unusual for the dormant addiction to find it appealing to take an anti-anxiety med, especially when there is a good excuse. If that were the case, you couldn't tell the doctor about the addiction history, now could you? Don't let the addiction rear it's ugly head. Decide what you want and get going on it.

Question: I get panic attacks sometimes but my doctor says I do not have panic disorder. He recommended that I try biofeedback to learn to control my body at the onset of an attack and that by learning to relax my body as anxiety builds I’d be able to stop panic attacks before they really get started. Is biofeedback an effective treatment for panic? It sounds a little bit crazy, actually, but I will try anything that might work.

William Anderson Says...:

Panic attacks are episodes or "spells" of intense fear accompanied by a handful of uncomfortable symptoms like pounding heartbeat, sweating, trembling, nausea, dizziness, chest pain and more. It can feel like you're going crazy or dying. Your body goes out of control and there's nothing you can do about it.

Actually, biofeedback training can be helpful in learning how to manage panic attacks. The feedback you get from the machines helps you to learn how to control body functions that you are not usually in control of. Like the training we engage in to play a musical instrument or potty train, we become aware of information coming to our senses that we have not paid attention to, and with practice, we can develop skill sets that we didn't have before the training. You can get control of body functions that you may have believed were beyond your control.

However, I am confused by your reference to panic attacks, your doctor saying you don't have a panic disorder, and then the doctor recommending biofeedback to learn how to control your body at the onset of an attack. It sounds like you are, in fact, having real panic attacks, not just times of being anxious. Otherwise, he would not be talking about controlling your body at the onset of an attack.  

Make sure you have your condition diagnosed and treated by a doctor that specializes in treating anxiety disorders. That's a psychiatrist. Disorders that have panic attacks usually are best treated with both behavior therapy and medications, at least until you eliminate the occurences of the panic attacks and learn how to manage things so you don't have them anymore.

There is no mystery in modern psychiatry about how to successfully treat panic attacks and panic disorder. It's very treatable. Make sure you are looking into all available treatments. It sounds like you have only begun to learn about what you are having. With a little diligence, you'll have this problem well managed.  

Question: I am a successful founder of an internet startup (my profile here is "fake" sorry). I have been struggling with social anxiety. One of the many paranoias I live with daily is that everyone can tell I am uncomfortable. I guess you can call it a vicious cycle. I am behaving a lot more reserved (and sometimes hostile) towards people than is good for me. I particularly despise groups and their dynamics. (I can't even tell you why I feel that way.. I had loving parents and benefited from a great upbringing). A close friend of mine has suggested I try Acceptance & Commitment Therapy (ACT). Apparently ACT really helps with keeping anxieties in check over a long-term, but I do wonder whether a counselor can overcome the threshold of my mental defenses (I have a good BS detector). Isn't Cognitive Behavioral Therapy just another form of manipulation? Maybe I just don't like people and should learn to live with it, just improve my social skills (to better conceal my dislike of people). What do you suggest, will ACT change me and make me more sociable or can I achieve similar results by getting a simple job at Starbucks to learn better social skills?

William Anderson Says...:

It sounds like you may have studied more psychology than is good for you and not enough to have the whole picture. You need to stop trying to be your own doctor.

It's good to have a BS detector, but some great therapeutic techniques sound like BS until you've found that they work really well. I use traditional CBT in my practice and it has worked miracles for clients with all types of anxiety and mood problems. I think CBT is one of the most important and effective developments in life and emotions management, ever. It is not manipulation. I've read a bit about ACT, but I have no interest in reading further. It doesn't sound like CBT to me and it sounds like a lot of other ideas that have not worked well for my clients with mood and emotion problems. That's a highly personal evaluation of this experienced old therapist, and I'm sure you'll find others who think it's great.

I know you can experience wonderful relief from your discomfort with this problem. It is very common, and it is highly treatable. Doctors and therapists who treat these kinds of things help lots of people with it all the time and get good results. We see it every day. It is routine to be able to solve this with the right help.

I'd recommend that you make an appointment with a Licensed Therapist (LMHC,LCSW, Licensed Psychologist or Psychiatrist) who specializes in Anxiety Disorders and CBT. Try one. You can always try a different one if it doesn't feel right. After they get a better idea of what's happening, they may recommend a medication. Oftentimes, there is a physical basis for these symptoms you describe, and you may have to use both avenues of approach.

I hope you make an appointment asap. It would be a shame to continue to struggle with this when you could be feeling better in a matter of weeks.