Conquering Your Panic, Anxiety, and Phobias
online conference transcript

Dr. Granoff is an expert in the treatment of anxiety, panic and phobias. Author of the book "Help, I think I'm Dying. Panic Attacks, Anxiety and Phobias", and the video "Panic Attacks and Phobias Conquered".

Dr. Abbot Lee Granoff: Guest speaker

David: HealthyPlace.com moderator.

The people in green are audience members.

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. The topic of tonight's conference is: "Conquering Your Panic, Anxiety, and Phobias." We have a wonderful guest: Abbot Lee Granoff, M.D., board certified psychiatrist and a nationally known expert in the treatment of anxiety, panic, and phobias. During the approximately 30 years he's been in practice, he has successfully treated thousands who suffer from panic attacks and phobias. Dr. Granoff has written a book entitled "Help, I Think I'm Dying. Panic Attacks, Anxiety and Phobias." He also has a video: "Panic Attacks and Phobias Conquered" in which patients share their stories and how, through proper treatment, they were able to overcome these debilitating disorders.

Good Evening, Dr. Granoff and welcome to HealthyPlace.com. Thank you for agreeing to be our guest. To make sure everyone is on the same page tonight, can you please define "anxiety, panic and phobia" for us? Then we'll get to the tougher questions.

Dr. Granoff: Anxiety is a generalized feeling of discomfort. Panic is an attack of sheer terror as in the 'flight or fight reaction. Phobia is an unrealistic fear.

David: Since we've all experienced panic attacks in our lives at some time or another, how do you know when it's time to seek professional treatment?

Dr. Granoff: Only people who have experienced life threatening experiences or have Panic Disorder have experienced panic attacks. There are many who have experienced neither.

David: I think what many people tonight want to know is; is there a cure for severe anxiety and panic disorder? And if so, what is it?

Dr. Granoff: You first have to understand what panic attacks are and why they occur, then one can find a cure.

Panic attacks are a chemical imbalance in the brain which has a genetic predisposition. When stress gets too high, it kicks the part of the brain that causes fight or flight into a panic attack.

David: What are the most effective ways to deal with it?

Dr. Granoff: My book and video go into this in detail. Understanding it is the first step. The next step is to get medication to rebalance the brain chemistry.

David: And we'll get into the medications in a minute. First, some audience questions:

sunrize: Do you feel it is possible to overcome these phobias without medication? I have a fear of medication.

Dr. Granoff: I have treated many patients who have medication phobia. This makes them harder to treat because medications are most often needed to get a decent result.

David: What are the most effective medications on the market today? And how much relief should one expect from taking a medication?

Dr. Granoff: The benzodiazepine tranquilizers such as Xanax, Klonopin or Atavin are the most effective medications available. You get full relief when taking these medications. And taken appropriately, there should be no side-effects. You should feel normal.

Arden: Have you ever heard of the natural supplement SAM-e and, if so, is it helpful for panic?

Dr. Granoff: All herbal remedies are not FDA regulated so anyone could make any claim they want about them. There is no standard dosage and a list of side-effects is not necessary nor medication interaction. Therefore, while some of these herbal remedies may seem to have some positive effect, I remain skeptical.

David: Besides anti-anxiety medications, what other forms of treatment would be effective in dealing with anxiety and panic disorders?

Dr. Granoff: Panic attacks characteristically come and go, so there are many supposed claims of treatment that don't pan out in the long run. Desensitization can be effective but usually requires medications first so a person can feel comfortable in a phobic situation. Some techniques that are used in place of medication include deep, slow diaphragmatic breathing, snapping a rubber band on your wrist, concentrating on relaxing. All of these techniques take your mind off the acute panic.

trayc: Does hypnosis help panic and anxiety disorders?

Dr. Granoff: No. Not in my experience.

DottieCom1: Is it common for people with this disorder to be on medications for a lifetime? It is the main thing that has helped me.

Dr. Granoff: Yes. Since this is a genetic disorder and we can't fix the gene, the illness usually remains for a lifetime. One has to view panic disorder in the same way as any other chronic illness, such as diabetes, asthma, high blood pressure, etc.

David: So, just to make sure I understand; panic disorder can never be cured, only "managed". Is that correct?

Dr. Granoff: That is correct.

KRYS: I have been treating mine with herbs and vitamins. Do you believe in the use of homeopathic techniques the same as you would a prescription.

Dr. Granoff: No. There is no scientific validity to homeopathic techniques. But if it works for you, do it.

David: We've been discussing anxiety and panic. I want to touch on phobias for a minute. How is a phobia different than panic disorder and what are the treatments for that?

Dr. Granoff: Phobias usually result from having panic attacks. These begin to occur in places where a patient has experienced a panic attack in the past. They become sensitized to the panic provoking situation, which increases anxiety and stress causing another panic attack to occur. The person will then become phobic to that situation, and experience anticipatory anxiety when approaching that situation again. They then become phobic to that situation and will ultimately avoid it.

David: Is exposure therapy, repeated exposure to the situation that causes the phobia, the best means of treatment?

Dr. Granoff: Usually not. Some people will respond to that, however, most people will become panicky in the situation and this will make them more phobic of it. The recent show on 48 hours showed exposure therapy as a new and wonderful treatment for panic disorder. They had spoken to me and had a copy of my book and video, and while they knew my treatment was much more cost-effective and clinically effective, they went with exposure therapy because my technique doesn't make for "good" TV.

David: So, what is the best treatment then for phobias?

Dr. Granoff: One has to get the panic attacks under control with medication, then have the person de-condition themselves through exposure therapy. This is much more effective than exposure without medication.

David: Here are some more audience questions, Dr. Granoff:

cherub30: How can a person who experiences these attacks, not keep repeating the problems that triggers them?

Dr. Granoff: It's not about repeating the problem, it's about repeating the situation without experiencing a panic attack. The benzodiazepine tranquilizer mimics a chemical the brain produces on its own. The genetic disorder kicks in when there is more stress present exceeding the amount of chemical the person can produce on their own.

Martha: Can improper breathing ( i.e. hyperventilation) actually stave off an attack or at least minimize the attack while it is happening?

Dr Granoff: No. Slow breathing is better. When you hyperventilate, you blow off carbon-dioxide and cause tingling and numbness and your extremities, face and head. That is a symptom of a panic attack.

kathy53: What can you use for anxiety attacks if Paxil, Zoloft or Celexa have no effect.

Dr Granoff: They all have an effect. But the antidepressant medications have a secondary effect on anxiety, where as the benzodiazepines have a primary effect. The main concern with the benzodiazepine is addiction, memory loss, and sedation. However, 98% of people using the benzodiazepine use them appropriately even for a life time and do not become addicted. 2% abuse these medicines while abusing alcohol and street drugs at the same time. Sedation and memory loss are dose related if these side effects occur, lowering the dose gets rid of them. The antidepressants, including Paxil, Zoloft, Celexa and Imipramine, etc., have side-effects which often cause insomnia, weight gain, and sexual dysfunction. For me, it's a no-brainer to chose the most effective and least problematic medication, the benzodiazepine tranquilizers. These are safe and effective to use for a lifetime, if necessary. Also, the drug companies are marketing the antidepressants with lots of dollars because they make lots of dollars on them. The benzodiazepine tranquilizer generic is much less costly.

David: That's a good thing to know.

sassy: I have a lot of trouble with racing thoughts, a lot of daydreaming and stuff. I can't seem to stay focused on anything, always feel frustrated and confused. Feels like I am losing grip here. Can you tell me what that is all about?

Raven1: I have had anxiety attacks for 15 years and nothing has helped me at all. In fact, I tried taking Zoloft and it made me very sick. I'm now taking St. John's Wart. I have been through mounds of therapy, been to many doctors and I feel like I'm never going to pull through and be able to live on my own. I'm almost 18 and need to be helped before it's too late. What can I take that won't make me sick?

Dr. Granoff: The benzodiazepine tranquilizers prescribed by a knowledgeable psychiatrist. Your general practitioner is not qualified to treat this.

David: And that's a good point, Dr. Granoff makes. It's important to go to a specialist, one who knows how to treat anxiety, panic and phobias. Not your general practitioner.

Dr. Granoff: A psychiatrist is the only M.D. who specializes in mental health and is the only mental health practitioner who is a M.D.

David: Dr., we are getting quite a few questions on exactly what is your technique for effectively treating anxiety and panic? Could you be somewhat detailed?

Dr. Granoff: That's impossible to do in this forum. My book and video explain this in detail.

David: Here is the link to purchase Dr. Granoff's book: Help, I think I'm Dying. Panic Attacks, Anxiety and Phobias. I also believe Dr. Granoff's book is available at the major bookstores. Is that right Dr. Granoff?

Dr. Granoff: Yes. The video can be purchased on my website.

Smoochie: Is Paxil a good antidepressant for anxiety and panic attacks?

Dr. Granoff: In 30% of cases, Paxil and medications like it make the panic and anxiety worse. In 30 %, it has no effect and in 30%, it seems to help. The antidepressants, like Paxil, usually help when the person has both panic and depression and the depression is the primary illness with panic as the secondary illness. And Paxil often causes weight gain, insomnia and sexual dysfunction.

vick b: Would therapy help at all? And when will the non-addictive drugs for anxiety come out?

Dr. Granoff: The marketing department of the Paxil drug company doesn't want you to know this because they won't sell as many pills. And yes, therapy in combination with medications is the best form of treatment.

David: For the audience: I'd be interested in very short comments on how you effectively dealt with your panic, anxiety, or phobia. Here are some audience responses "on what's worked for you":

wintersky29: changing the way you think, from negative to positive, that's how I deal with it.

Raven1: I have tried exposure therapy for my separation anxiety and it only makes me want to kill myself and more depressed.

cookie4: Paxil made mine worse, switched 5 different times before finding one that works

kristi7: For me, a sufferer for 20 years now, I never had medications other than Ativan for a funeral. I used relaxation techniques and Attacking Anxiety program cognitive behavioral therapy (CBT).

Dr. Granoff: CBT therapy means thinking therapy and understanding your condition and your body's response to it.

Martha: I've read that exercise acts in the same way as uptake inhibitors, is this true?

Dr. Granoff: While exercise can reduce some stress, it is not going to reduce enough to make a difference.

Hemlock: This is very interesting, I had anxiety that was unreal over surgery and I'm on Paxil.

Eileen: Paxil gave me a new lease on life after 24 years of total fear and misery!!

trayc: What about Buspar?

Dr. Granoff: Buspar is not effective for panic attacks.

blusky: I only have problems driving alone but can go places with people without panic.

kristi7: Is there a test to prove the chemical imbalance?

Dr. Granoff: Not for the general public, for research only.

David: A lot of the things we are talking about tonight have been around for awhile. Do you know of anything new coming online?

Dr. Granoff: Nothing that I know of. However, with the deciphering of the genetic code we will one day find the gene or genes that produce panic. Once found, cures will be found to fix the gene.

David: Just to jump back for a second Dr. Granoff, is there a reliable test available to check for brain chemical imbalance. I mean, can I go to my psychiatrist and have this done today?

Dr. Granoff: No. The diagnosis is made by taking a thorough history. This is outlined in my book.

diana1: I have stopped taking Paxil-30mg, cold turkey, and had what was referred to by my therapist as "brain firings". It is a sensation somewhat like hitting your funnybone, but in your head for a split second. Is this normal?

Dr. Granoff: You were experiencing withdrawal from the Paxil. This should stop after 4 or 5 weeks. If it doesn't, it is a return of anxiety symptoms, which can be better treated by using the benzodiazepines (Xanax, Ativan, Klonopin, etc.)

jeansing: Is there research being done at this time for finding genes for Panic?

Dr. Granoff: Not that I'm aware of. There are a lot of genes to find for a lot of diseases. It will be placed on the list and hopefully found soon.

panickymommy: Why is it that driving is so hard for me? I cannot drive in places where there is nowhere to pull over; for example, in construction areas or down narrow roads. This is ruining my life!

Dr. Granoff: Most phobias occur in situations where escape is difficult or would prove embarrassing. For instance, driving on an expressway, in a tunnel, over a bridge, in the left turn lane, sitting in a dental chair, standing in a checkout line at the grocery store or sitting in church, a restaurant or movie.

David: What would be an effective way to get some relief from that?

Dr. Granoff: Getting appropriate treatment from a qualified psychiatrist.

figa: Can agoraphobia ever be cured? And if I start exposing myself to my fears, like eating, etc., will my anxiety start to drop, or will I have to take medication? I have lost 14 pounds in two weeks and cannot eat or sleep well.

Dr. Granoff: Medications are usually necessary and effective and safe.

David: Here's a question about "social phobia", or what many call "shyness":

z3bmw: Hi, have you ever treated a person who talked freely at home but wouldn't talk in public?

Dr. Granoff: Yes. I would have to know the cause of the attacks. Counselors, social workers, psychologists, and your family doctor will tell you to exercise, provide relaxation training and supportive therapy. While that might help some--a qualified psychiatrist will help most

David: Here's the link to our journalers in the anxiety-panic community who keep online diaries of their experiences. You can read them and post your comments on their bulletin boards. It's one of the most popular portions of the HealthyPlace.com site. We also have an anxiety chatroom here to discuss your anixety, panic, phobias issues and concerns. Here's another agoraphobia question:

Aussiegirl: I started having Panic Attacks three months ago. Everything was fine before that. The last time I had a panic attack, I ended up screaming and lost control. Since then, I have developed agoraphobia. How can I help myself if I can't leave the house? I couldn't even get to a therapist.

Dr. Granoff: First, get my book and video to understand your condition and how it should be treated. Then, find a qualified psychiatrist to treat it, perhaps by phone at first.

David: Dr. Granoff, I want to thank you for being our guest tonight. You've been helpful and given us more insight into the causes and treatments of anxiety, panic and phobias.

Dr. Granoff: It's been my pleasure.

David: I also want to thank everyone in the audience for coming. We have a large number of people who are chatting regularly in the anxiety chatroom, so I hope everyone in the audience will feel free to visit anytime. I think it's important to support each other and pass along information on what does and doesn't work.

Again, here's the link to Dr. Granoff's book, and this one takes you to his site, where you can also get his book and video. If you haven't already, click on this link and register for the mail list so you can keep up with what's happening in the anxiety community. I also want everyone to know, my address is: info@healthyplace.com. If you have a guest or conference topic idea, please pass it along.

Good night everyone and thank you for participating tonight.

POSTSCRIPT TO CONFERENCE:

Following the conference, Dr. Granoff answered this question regarding medications vs. cognitive behaviorial therapy to treat anxiety disorders:

Caroline: The anxiety and panic conference on HealthyPlace.com a few days ago seemed to indicate that you feel that medication is the only way to go and that anxiety disorders are life long conditions only to be managed not cured.

Vast numbers of people have overcome their anxiety problems without the use of drugs. CBT is recognised as the best treatment for anxiety disorders. I personally found the conference made people feel worse. Although you may have been well intentioned, many people I have spoken to felt the same.

The following is an excerpt from Christopher McCullough's book "Nobody's victim".

Biomedical approaches to treatment similarly employ the disease metaphor. They tend to cast blame on "biochemical imbalance", an approach that rests on extremely shaky assumptions. Psychobiological research attempts to establish causal relationships between biochemistry and emotion.

Because certain medications taken by certain patients make them feel better, researches conclude that the drug corrects the chemical imbalance that was causing the misery. This is like claiming that since you feel more relaxed after drinking gin, it's evidence that you were gin-dificient.

Such research sounds serious and important. A presentation at a recent conference of the Anxiety Disorders Association of America was entitled "Increased Regional Blood Flow and Benzodiazepine Receptor Density in Right Prefrontal Cortex in Patients with Panic Disorder." Interestingly, however, many patients recover from panic and anxiety using nonmedical treatments such as behaviour modification, breathing, or divorce without doing anything to their "receptor densities".

Dr. Granoff: "Vast numbers of people" may get temporary relief from anxiety using only CBT. About 60% of people studied get temporary relief from placebo. In my experience, having treated thousands of people, often the relief from only CBT is partial and temporary. Sometimes it has a longer lasting effect.

Medical research shows that panic disorder is usually lifelong. Some people can have one or an episode of panic attacks never having any others. Some people have their first episode with minimal or no relief for decades. For most people, it is a recurring illness which waxes and wanes throughout life. The longer the study, the larger the number of people who experience a relapse.

CBT only is promoted mostly by psychologists, social workers or counselors. These mental health professionals cannot prescribe medications, whereas psychiatrists can prescribe medications and do CBT. You have to be able to read the medical literature with a critical eye and recognize the biases of the researchers.

A combination of CBT and medications is the most effective treatment. I tend to stress medications as my bias because too many people are misinformed about their safety and effectiveness. They become fearful that the medical/pharmaceutical industry is taking them on a royal ride for economics. I certainly use CBT in my treatment along with medications.

My book and video explain why panic attacks occur (stress), causing the genetic predisposition to kick in, causing the brain chemistry to flip out of balance and how the medications and stress reduction of any kind (including CBT) rebalance the chemistry. Although no gene has yet to be identified to cause panic attacks, the genetic link is clear.

In medicine, especially in psychiatry, there is more than one way to skin a cat. Human behavior is exceptionally complex and varied. Hanging upside down by your toes might work to cure panic attacks in one person. If that works for that one person, I can't argue with it. I would suggest they continue hanging. Likewise, CBT might work for some people. If it does go with it.

Realize if you still experience the pain of panic while using CBT, like Kim Bassinger did while getting her academy award in the HBO panic show, there are medications that can offer relief.

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