Dear John,

Your experience coincides with my own, particularly in terms of the "fear of
fear" concealing anger. The trouble with cognitive approaches is that they
are essentially based on the idea of control, which in turn is probably what
the panic attack is about in the first place. Once the client accepts that
fear is a natural response either to their own strong feelings or to
external events the panic attacks become less severe. I would argue that
this is because the energy which is bound up in the state of panic (which is
a "held" state) is finding a way of discharging itself.

Yours


Geoff Lamb MSc.,  119 Lingfield Road East Grinstead West Sussex RH19 2EL
01342 315640 Mobile: 07949 153431 www.g.c.lamb.btinternet.co.uk/index.htm
----- Original Message -----
From: John Talbut/post.demon.co.uk <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, September 26, 2001 8:16 AM
Subject: Re: Panic attacks


> Hi Jo and all
> A notion that I have found clients find useful is the idea that panic
> attacks involve fear of fear.  Hence, if there is an initial sense of
> impending fear this triggers more fear which triggers more fear and so on.
>  It often can often be quite difficult to find out what the initial
trigger
> was, and also misleading since the main fear is of fear itself.  What we
> have is positive feedback which, as engineers know, can be triggered by
> next to nothing and leads to exaggerated effects.
> So part of my approach is to help clients to be less afraid of fear.  A
> reframing that some of my clients take to is "People pay good money to get
> as scared as you, going on scary rides at fun fares, bungee jumping etc.,
> and you are getting it for free!".
> Of course I emphasise that fear, along with other emotions, are completely
> normal parts of us and essential to the way in which we survive and have
> been successful as a species.
> Otherwise, I use bits from most approaches, exploring with the client what
> works for them.  Cognitive methods, reframing and reality checking, and
> behavioural approaches, physical relaxation techniques and familiarisation
> are well established in this field.  However, I have had a number of
> clients complaining about therapists who have taken a purely
> cognitive/behavioural approach and have clearly been insensitive to the
> underlying issues.
> Analytical approaches can help the client to learn about the origins of
> their fear and so let it go to some extent.  A fearful mother often seems
> to feature and I wonder about the effects of a mother's fear on a baby in
> the womb.
> Humanistic methods also seem effective some of the time.  The positive
view
> of the person and working on self-esteem can help.  Working with emotions
> can be very effective.  For instance getting the client to visualise a
time
> when they felt panic - what co-counsellors call the present time and
> literal description techniques.  Gently encouraging the client to describe
> slowly going up to the time of panic, only going as far as they want while
> letting them know they are safe - and safe to feel fear.  Sometimes I find
> that when the fear of fear is lifted what comes up is another emotion,
> particularly anger, and it may be that fear of that emotion is an
important
> element.
> Transpersonal methods, particularly meditation but also working with
subtle
> energies or prayer can also help.
> So try everything you know - the only right ways are the ones that work
for
> the client and each client will be different.  Let go of anything that
does
> not seem to be working - though it might work later.  Encourage the client
> to try different approaches - to attend workshops or training courses
using
> different methods and to see practitioners who may be skilled in
approaches
> that you are not.
> Best wishes
> John