What You Can Change _. And What You Can't - Martin E. Seligman [30]
I am, incidentally, no puritan about drugs or about quick fixes, so when I advise you against their use—as I do here—it is not out of priggishness. If you crave quick and temporary relief from acute anxiety, either alcohol or minor tranquilizers, taken in small amounts and only occasionally, will do the job. They are, however, a distant second-best to progressive relaxation and meditation, which are each worth trying before you seek out psychotherapy or in conjunction with therapy. Unlike tranquilizers and alcohol, neither of these techniques is likely to do you any harm.6
The Right Treatment
ANXIETY SUMMARY TABLE*
I urge you to weigh your everyday anxiety. If it is not intense, or if it is moderate and not irrational or paralyzing, live with it. Listen to its dictates and change your outer life, rather than your emotional life. If it is intense, or if it is moderate but irrational or paralyzing, act now to reduce it. In spite of its deep evolutionary roots, intense everyday anxiety is often changeable. Meditation and progressive relaxation practiced regularly can change it permanently.
But anxiety, when intense and unremitting, can be a sign of a disorder that requires exorcising rather than just acknowledgment. The next three chapters are about the three anxiety disorders we know the most about—panic, phobia, and obsession—and what is changeable and not changeable about them.
* Throughout this book, I will give my overall evaluation of both psychotherapy and drugs for each problem in The Right Treatment summary tables. I will use an upward and downward pointer system, where means the best and means the worst.
5
Catastrophic Thinking:
Panic
S. J. RACHMAN, one of the world’s leading clinical researchers and one of the founders of behavior therapy, was on the phone. He was proposing that I be the “discussant” at a conference about panic disorder sponsored by the National Institute of Mental Health (NIMH). This meeting would pit the established biological psychiatrists against the Young Turk cognitive therapists.
“Why even bother, Jack?” I responded. “Everyone knows that panic is a biological illness and that the only thing that works is drugs.”
“Don’t refuse so quickly, Marty. There is a breakthrough you haven’t yet heard about.”
Breakthrough was a word I had never heard Jack use before. Very British, he had recently immigrated to Canada from England, where he had run Europe’s premier anxiety clinic at the University of London’s Maudsley Hospital. Understatement and modesty are Jack’s strong suits.
“What’s the breakthrough?” I asked.
“If you come, you can find out.”
So I went.
I HAD KNOWN about and seen panic patients for many years, and had read the literature with mounting excitement during the 1980s. I knew that panic disorder is a frightening condition that consists of recurrent attacks, each much worse than anything experienced before. Without prior warning, you feel as if you are going to die. Here is a typical case history:
The first time Celia had a panic attack, she1 was working at McDonald’s. It was two days before her twentieth birthday. As she was handing a customer a Big Mac, she had the worst experience of her life. The earth seemed to open up beneath her. Her heart began to pound, she felt she was smothering, she broke into a flop sweat, and she was sure she was going to have a heart attack and die. After about twenty minutes of terror, the panic subsided. Trembling, she got in her