I went to my GP at about the 2 year mark of agoraphobia. It was always a massive struggle to get there, but luckily I had a very kind and understanding one. But I was determined to get there and say “I want to get well. I want a psychiatrist that specialises in anxiety and agoraphobia.”
I was with a wonderful psychologist at the time, but it wasn’t helping my recovery. I had tried a psychiatrist before but it was a terrible experience – he didn’t have empathy or clear understanding and would just say to go out and do things. I never returned.
But, the psychiatrist my GP found – bit research and a bit luck – not only started a better understanding of agoraphobia and anxiety and set a path for my recovery, but he very much saved my life.
He would give me a little pad page of notes at the end of every session, sometimes with handouts to read, and I’ve kept every one in the critical first 12 months of recovery. I will add my recollections soon, but hope the below gives you a snap shot of what my recovery plan looked like.
Session 1
- Panic log – two panic attacks in week. Breathing issues and chest pains. Selling (family) home.
- To taper current medication.
- Start on new medication.
- Continue panic attacks re-education (Recommended End to Panic).
- Read introduction to anxiety program; specific techniques for anxiety control, thinking and anxiety
Session 2
- Better on new medication
- House sold
- More confident with new computer and typing
- Sister overseas for three months
- Read CT of Panic and vicious cycle.
- Homework:
- Panic log
- Note level of medication
- Draw own vicious cycle
- Read Thinking and Anxiety
- Going out with trusted people
- Lunch with family member
- What if – So what – Plan – Do it
What if / Next time / Panic beliefs - DISTRACTION
- Handout: Panic Disorders
Session 3
- Negative >> Danger
- Car is danger signal – House tasks – garden, type
- Focus away from body monitoring
- New house – good news
- Major fears
- Car travel is longer distance (than used to) – distraction > music – relax
- Home alone – Tasks – PLAN
- Major fears
- Driving (passenger) at night
- Before sleep:
- Visualisation
- Radio
- Reading
- YOU RESCUE YOU
- Reading End to Panic (good)
- Medication dose ok
- Being pushy with people
- Discussion: the new Megan “My future”
Session 4
- Panic attack after sister overseas – Spreading the rescue – the rescue – More distraction – Follow a plan
- Task:
- Start walking >> Goals >> DAILY
- Make notes
- Accept rising anxiety
- Symptom check list (bring next session)
- Meaning of fears – to read
Session 5
- Long weekend – mainly alone. Did use rescue plan.
- Managed palpitations without going to bed.
- Continue panic log.
- Walk 50 metres alone
- Met with family member and friend
- Coffee shop alone (PLAN) – Mum leaves for 20 mins.
- My plan (written on post-it-note to take with me)
- Buy drink
- Self talk I’m fine; nothing can happen; so what
- My plan (written on post-it-note to take with me)
- Distraction; breathing; magazine
- Mentally spell out each word
- Measure anxiety level
- Imagine DOING IT
- Write shopping list / Plan week
- Walks to increase distance.
Session 6
- Walks now 15mins, then 20 then 25 then 30 minutes
- Write out a cue card – reminder
- Panic attacks increase if PMS
- Review medication
- Only use past memories to problem solve
- Nauseated in morning – Get out of bed – Routine
- Positive visualisation / Expectation
- Later sessions – Trams to Chapel Street
- Activity (Exposure) (written out to take)
- Walk alone to the plaza and coffee shop
- Mum comes later
- On walk, use distraction
- Count parking meters both side of road
- Slow breathing via NOSE
Session 7
- Walks up to 25 mins. No major panics. Some anticipatory anxiety.
- To read Cognitive Aspects of Panic Disorder (handout)
- Plan each day – Tasks
- EXPECT TO IMPROVE
- Negative image à Overwhelmed by fear / Time frozen / Alone / Helpless
- Write down image then dispute – Evidence for and against – Self talk
- Discussion with Mum on self esteem
- Tram with Mum to Chapel Street.
- My plan (handwritten to take)
- Distraction: Look at scenery
- Reward: Go to shop and buy something
- My plan (handwritten to take)
Session 8
- Talk down the anxietiesThe K in AWAKE – Keep going
- Visualise the nice walk – before the walk
- Now in new home – NEW – STRANGE > Familiar
- Task:
- Back to Chapel Street by tram
- Sit apart ? Next time will be on different trams
- Homework: Drive (passenger) to airport and walk around. (Sister returned in month)
- Meditation classes
Session 9
- Meeting with Nana in city via tram (Doc needs report)
- PSP = Use past successes to solve problems
- Set out a plan to manage the fears
- Structure Problem Solving (PSP) handout
The best PLAN compared with Perfectionistic / Critical / Approval from others
Session 10
- Anticipation
- What if – Panic
- So what – Plan – Cope
- Wait for tension to reduce in time
- Note: Anxiety goes down (bell chart) (Anxiety over time)
- Expectation notes (Cognitive Aspects of Phobic Disorders)
- Homework: Visit Tullamarine airport on Saturday. (Sister back from OS soon)
Session 11
- Two trips to airport – Sister is back!
- Remember surprise trips – GO FOR IT
- Cue card – carry is bag
- Anticipation
- Anxieties à Negative
- Visualise a good outcome
- Positive
- Normal emotions (see chart: From Theory to Therapy) – Get off adrenaline rush – Symptoms
- Task: Tram to Myer (Melbourne City)
Session 12
- Meditation – dissociate reaction – Closed eyes continue – New experience
- Useful tasks around home – Valuable
- Vary the walk – new streets – write down the route
- Driving – build up – With sister or alone
- Tram via Victoria Street to Bourke Street Mall (Melbourne City)
Session 13 (with sister)
- Disorder explained (to sister)
- Facing the crowds – club for two hours
- First band in 18 months / Movies first time in 2 years
- Walking – varying routines
- Driving and to start right hand turns
- Tram to city alone / Meet sister 20 mins later
- Day trip to Venus Bay (holiday home)
Session 14
- Next time – Dance on the floor (band)
- Try and lock in date with girlfriends, e.g. get the tickets
- Increase driving – 15 to 20 minutes – Shop and coffee
- With sister
- Then alone
Session 15
- Driving
- Having problems
- Out of focus : Vision
- 2 years ago images of slumped over wheel
- False message – Safe driving image
- Task: Drive to shopping centre
- Visualise driving to the place
- Next year – Uni (?) or work
- Task: Chapel Street alone. Mum to follow next tram.
Session 16
- Set goals for next 12 months
- Driving – increase time, then move onto main road
- Plan for car problems – RACV / wait / shop. Get car checked.
- Hair dresser – Good news.
- Mistakes are human – forgive
- Place an ad – word processing
- Next session: Here by tram. Mobile phone = SAFE.
Session 17
CAME ALONE
Chest pain = Tight rib muscles, not death. Shown how to reproduce the pain.
- Walkman / Book.
- Looking at houses
- Tram to Whitehorse Road after last session – GOOD
- Today: Arrived by tram
- Anticipatory anxiety – Can be beaten
- Continue normal social life
- Driving – Increase
- Next session by TRAM
- Plan: Job resume
- Remember: Give yourself a small reward
Session 18
- Always have a plan for each trip
- Use deep breathing – helps throat tightness
- Change the need to find danger – Focus on nice/positive/useful projects – More self esteem
- Sister has new job
- Driving: Alone
- Short distance (shop)
- With sister – build up time
- Remember: Credit for improvement
- Task: Socialise / Have fun / New friends
- Recalls panic in cinema aged 18yo “I was dying”.
Session 19
- Nervous on the tram – butterflies
- New rules for self esteem
- Face the fear (bad relationship) – Let the fear pass and Megan remains
- Preparing a list of rules for relationships
- Continue driving
Session 20
- When depressed check the triggers
- Find the reason and this will help solve the problem
- Saturday: Bridge Road for 3 hours
- Homework: More driving
- Let fear pass – Megan left in tact.
Session 21
- After interview got chest pains and made assessment that could put up with tension in chest
- Credit each step
- Changing negative self talk – Always add hope to the outcome
- Spent weekend alone – No reassurance sought
- Homework: Movies by myself, using public transport ALONE
- Both Mum and sister to increase my driving – Bring report for Dr
- Do some work with driving negative images
- Before each drive, sit down and visualise a fair outcome
Session 22
- Course (3 days for 8 weeks) and driving to Box Hill – Go home a long way
- Driving:
- Focus on road – music / object – Visualise the route
- More time on the road – 10 – 20 – 30 mins
- Focus on Megan NOT other drivers
- Visualise fair outcome
- I am a good driver
- New route (e.g. Malvern Town Hall)
- I can cope / Me / Ask for help
Session 23
- Two interview – Job – Good news
- Plus drove to Brighton with sister
- Driving alone – more time
- For job – Be prepared – Visualise the interview
- Work: Selling Megan
- K = Keep going
Session 24
- Job group shifted location (Town Hall)
- Continue to set goals with driving
Remember sit back – Relax – Try again – Divide into steps – AWAKE
Beware of people using the “guilt trip”
- Task: Mum passenger and Megan drive to doctor rooms
- Plus use “one more street” – Driving
Session 25 (month later) (with mentor from job group – I drove)
- Driving to work daily – peak hour traffic
Front person in small office (6 people). Job group helped.
Improve self talk
- Visualise on Mondays: I can manage even with a panic attack
- Credit each day / each win.
Session 26 (few months later)
- Drove in alone – great news
- Two months into work – Keep going
- Drives to work – 20 mins.
- Three traffic jams – coped
- Driving home – Use deep breathing before
- Sit and wait – Drop anticipatory anxiety
- At red lights – relax
- Diffuse office issue – Self talk “they are in a bad mood”
Session 27 (few months later)
- Set a limit on the pace of the work
- “Their problem – not mine” and step back. Don’t accept any blame. Beware of personalising.
- Four and half months at the volatile and dramatic real estate (game).
- On phone – select the “close out” plan. Cue card.
- Make a list of the phobias left to sort out.
Session 28 (few months later)
- Six months at job – good news.
- Drove (here) – accept the minor symptoms
- Continue working on “trapped” in driving
- Hairdresser – drove alone – first time in four years
- Now doing advertising and deadline at work
- Prepare stress cards – stay about a year
- Reality test “drama queens” – what is the evidence -> For and against
Session 29 (few months later)
- Increased panic – increased chest pains
- Work – some politics à “float along”
- Three social events – anticipatory anxieties
- Driving – to continue
- Dry mouth – disaster link. Go back to sip/sip
Session 30 (few months later)
- Try new challenge regarding driving
- Job hunting – still likes relative around
- Driving home – Let go of work – Focus on tonight – Tell Mum a good/funny part of work
- Lunch in park/walk
Session 31 (Came with Mum)
- Noted drive few months earlier
- Panic attack- hyperventilation – Frozen arm
- Now walking to work / limited driving
- New flat. Lives alone. More panic.
- Can use extra medication.
- Driving to Mum takes 30 mins.
- Next time use deep breathing. Some pins and needles.
- Start the graded exposure with the car / after work / weekends
- Review in 4 weeks.
This is where the notes finish, but it’s far from the end of my recovery. As you can see, this last documented session I am going backwards – Mum has had to drive me. Recovery was a roller-coaster for me, something few people talk about. But I got there in the end. And, to answer your question: Yes, I still see this same doctor today. Not often, but he’s still my go-to, top up, anxiety guru and he wants to stay very much in the background of my success.