Category: mental illness

What recovery means

People who have recovered from addictions to alcohol and drugs are often very, very cautious with how they describe their recovery, and that’s for good reason: Relapses are, tragically, all too frequent.

It didn’t dawn on me until much, much later in my life that the same applies for people living with depression.

First, a look at some broad facts: According to one study, ” at least 50% of those who recover from a first episode of depression having one or more additional episodes in their lifetime, and approximately 80% of those with a history of two episodes having another recurrence.”

In other words, sadly, the more depressive episodes you have, the more likely you are to have another one in the future.

Making this personal: The worst depressive episode I’ve had in my life, and the most extended, was my freshman year of college.  Therapy and medication helped me learn to live again, but I had a pretty hard-core relapse my senior year, and then another one a little after grad school.  Periodic ups and downs followed, but I’d say those were the three worst “episodes” of my life, with the most dehabilitating consequences.  As I got older, the intensity of these episodes began to wane, as I became better at recognizing depression for what it was, coping with it’s symptoms and seeking additional help as appropriate.

That’s not to say they went away.  They didn’t.

I’m bringing this up to make a point: Recovery is not an end state.  It’s not a destination.  For most, it’s a journey.  For some, they’re lucky: One episode of mental illness, one bout with addiction, and they are done.  You lucky, lucky sons of…sigh, anyway….

For most who have ever suffered – depression, anxiety, addiction, whatever – a relapse could always be just around the corner.  This means that you can never let your guard down, because you’re never really, truly “done” with mental illness.

Is this a bad thing?  Well, I’d be a heck of a lot happier if I never had to worry about this again.  But the specific reason I am bringing this up is to remind people who suffer that recover is not the end state – it’s a perpetual one – and that relapses are okay.  They are part of the disease with which you suffer and not endemic of any internal weakness.  Recurrences shouldn’t be dealt with via self-flagellation and scolding – they should be treated as a natural flare up of a disorder that can be dehabilitating without treatment.  Don’t yell at yourself.  Don’t hate yourself.  And don’t think that your any recovery must be permanent or you are failing.

Recovery is a journey.  Not a destination.

Going meta: Observations and topics for the future

So the this blog is now a few months old and I wanted to take a second to note my experiences in writing it so far.  This is not the first blog I’ve ever run – it’s the third, I think – and there are, as you can imagine, a few things that make it stand out.

First, some comments about the audience for this blog, and this came as a surprise.  There aren’t quite as many people reading it as I had hoped.  That’s disappointing.  But, what is surprising is the level of engagement.  My posts here get more likes and comments than they ever did on any previous blog.  That’s surprising and interesting.  It tells me that the people who are interested in mental health are passionate about the topic and want to engage with it.

Second, a realization about the topics.  The most popular entries for this blog are, in order:

  1. What you should know if you love someone with depression
  2. A shameful disparity: Minorities and mental illness
  3. 4 ways to stop an anxiety attack
  4. Depression is more than feeling sad

What connects these entries?  Well…not a lot, actually.  Not that connections all four of them, anyway.  Numbers 1, 3 and 4 all provide some unique insight on mental illness.  #1 was far and away my most popular entry, and I think that’s because it’s something with which people can sympathize.  The lesson, for me, is that people seem to really be interested in entries that provide some level of up close examination for mental illness, and that is what I will continue to try to focus on.

With a few exceptions, the entries where I focus on more public policy aspects of mental illness are not as well read.

So, going forward, here are my plans for this blog:

  • Provide that unique insight: Without sounding too much like a self-aggrandizing schmuck, people – particularly those with some sort of mental illness – seem to truly appreciate this discussion – and I don’t just mean the blog.  I think others like hearing that there are people out there, like me, who are in recovery.  I will continue to blog about that topic, and try to make sure that people know there is hope, regardless of what sort of mental health disorder you suffer from.
  • Serve as a resource for families & friends: The most popular blog entry – one which discussed what family should know if they love someone with a mental illness – was an interesting lesson for me.  We constantly talk about people who suffer from a variety of diseases, but we don’t focus enough on the caregivers.  That’s something I’d like to explore more as the blog goes forward.
  • Explore the interaction between technology and mental illness:  I’m scared – really scared – about our over dependence on technology and social media.  I worry about how this may affect mental health.  I’ve written a little about the topic in the past, but I really think this is one that is going to blow up over time.
  • Discuss public policy and mental illness: I know, I know – I said above that those entries aren’t as popular.  That being said, they are still read and I think they serve a useful purpose.  Like it or not, mental illness is largely affected by public policy, a topic I am all too familiar with in my real job.  For both my readers – and for me – it’s something I am going to continue to focus on.
  • Promote my book: If you’ve made it this far, you get a secret – in the first half of 2018, I’ll have a fiction book published.  I’m not going to reveal too much of the details yet – don’t worry, I will! – but know that it is a young adult, sci-fi adventure – one that deals with mental health and living with depression and anxiety.  You can expect to hear more about this one later.

Now, all of that being said, a blog isn’t a blog without readers.  So, let me ask you, my friends – what can I answer for you?  What questions would you like to see this blog explore?  What topics are you interested in?

Let me know in the comments below – and thanks so much for reading!

 

Shhhhhhhh and listen

I have always found that, when depressed, one of the most difficult things for me to do is to shut up and actually listen to others.  This makes sense, of course: When you get depressed, you have a hard time escaping your own head.  After all, depression and rumination are linked; that is to say that when you are depressed, you are more likely to think about yourself.  Your problems.  Your issues.  Your concerns.  Doing so makes you more self-absorbed, which, in the case of many people (me for sure!), can make you feel incredibly guilty and like a burden to your loved ones.

I also want to tie this back to the current political environment in which we find ourselves.  Last week, I went on this FB rant:

tl;dr – I listened and learned something.

I find that there is a big connection with how self-centered I feel and how depressed I am, and that the more I focus on the needs of others, the better shape I’ll be in.  I suspect this feeling is universal – indeed, there is evidence to show that is the case.

On an intuitive level, this makes all the sense in the world.  Thinking of other people makes you more likely to get out of your own head, less likely to ruminate, and more likely to break the cycle of destructive thoughts that are bouncing around in your own brain.  It can be hard.  Really, really hard.  I remember my therapist once telling me that avoiding people and allowing yourself to retreat in to a corner is the absolute worst thing you can do when you are depressed.

He was right, as far as I am concerned.  I think trying to think of others and actively engage with other people when you are down can be next to impossible, given the mood of a depressed person.  That also makes it all the more important that you try and break through and change your focus…get out of your own head.

Now, this is all well and good, but it doesn’t answer the question…how you gonna do it?  How can you break that cycle and start engaging with other people well all you want to do is grab your iPad and dive into a blanket fort?

A few thoughts on that:

  • Most social interaction is casual and almost thoughtless – that is, it lacks conscious effort.  When you are down, you have to actively make yourself talk to someone else.  Get up.  Get out of the chair.  Go find the spouse you’ve been ignoring because you are trapped in your own head.  The kid you were letting watch too much TV.  Talk to them.  As them how they are doing.  Try to start a conversation and hook yourself in.  Make a conscious effort to do something real.
  • Can’t leave the house, or don’t want to?  Pick up the phone.  Don’t text!  No texting!  And don’t send a FB message!  Call someone…you know, like phones used to be used.  Start talking with a real voice.  Engage in that human connection that I think far too many of us have delegated to texting and messages.
  • Read a book.  Alright, this one is slightly different than the first two.  But, staring at your phone, mindlessly scrolling your way through your Facebook newsfeed, isn’t going to help yourself.  Instead, try to break the cycle by getting lost in someone else’s life.  See if you feel better on the other side.

There is more – so much more – but I want to hear from you.  How do you get out of your own head when you are depressed?  Let us know in the comments!

When depressed is caused by nothing at all

I have an interesting question for those of you out there who suffer from depression: What do you do when your depression is caused by nothing at all?

There are times – and I suspect that this is for everyone, not just folks who have depression problems – where I get depressed for no reason.  At least, none that I can think of.  I remember my therapist once telling me that there was always something lurking around in the back of my mind somewhere.  That depression is almost never caused by “nothing.”  I suspect that he is right, and that makes it even more frustrating.

I’d argue that this can often be worse than feeling miserable for reasons that you can identify.  Obviously, that depends on the reason you are down, but if there is a reason behind a depression or sadness issue…well, then you can actually deal with it.  When there’s no reason, it’s harder to grasp.  In instances like these, fighting depression is like pushing smoke.  It just can’t be done.

On instances like this, I come back to a conversation I had in a psychology class when I was in college:

glass-half-full.jpg

Ahh, yes, the glass half full.  But, this one comes with a different spin.

I once had a Muhlenberg professor describe mental illness as a combination of genetics and environmental factors.  This is a vast oversimplification, of course, but hear me out.  Let’s say that the water already in the glass is your genetic predisposition to depression.  Additional water gets poured in as a result of environmental factors and other stressors, and when the glass overflows, bam, you are depressed.

In this metaphor, people who aren’t predisposed to depression are less likely to be depressed, but that’s because they have less water in the glass to begin with.  Those people can still get depression, but it’s gonna take a heck of a lot more water (life stressors) to get them there.  For others who have a history of depression or a genetic predisposition, it only takes a little bit of water to get the glass overflowing.

I agree with my psychologist – it’s never really nothing.  It’s always something – maybe something you don’t want it to be, maybe something you are ashamed or embarrassed by, but there is usually something bouncing around in your head which is going to push you over the edge into a depressive funk.

So, here’s my advice: When it’s nothing at all – when you are depressed, but have no idea why, try to ask yourself what’s truly on your mind.  Work?  Family?  School?  As best you can, within your own head, ask yourself those questions.  Create a judgement free zone and allow your heart and your head to tell you what’s really up.  I hope this doesn’t come across as new-agey mumbo-jumbo, but as helpful advice.  Sometimes, the best way to get yourself feeling better is to ask yourself the right question – even if you don’t really want to know the answer.

I hope this is helpful, and as always, I’d love to hear your thoughts – for this one more than most!

An in-depth look at suicide statistics in the United States

Before you can truly solve a problem, you have to have a better idea of what that problem is.

In my policy-making career, I’ve taken a long look at suicide reduction.  I’ve come to the conclusion that there is no one-size fits all approach; different demographics require different solutions.  We know there are certain groups more likely to commit suicide, and those groups require different interventions.

First, here’s a look at what the American Foundation for Suicide Prevention has found.  The basic statistics are tragic:

  • Suicide is the 10th leading cause of death in the United States.
  • 44,193 Americans die by suicide.  That’s an increase of 25% since 1999.
  • For every completed suicide, there are 25 attempts (Note: Terminology matters – “committed” or “successful” suicide have negative connotations, and “completed” suicide is a much more appropriate term).

Now, this is a broad overview.  Let’s take a closer look at these numbers in-depth.

Gender

According to the CDC:

Males take their own lives at nearly four times the rate of females and represent 77.9% of all suicides.

One of the reasons for this: Men are more likely to attempt suicide via a firearm, which is much less survivable than other suicide methods.  This is also despite the fact that women attempt suicide three times as often as men.

Race

In most mental health related fields, it is members of the minority community who are on the wrong end of the statistics.  That being said, for race, the reverse is true: Whites have the highest suicide rates of any ethnicity, followed by American Indians.  African Americans, Hispanics and Asians are well behind.

More research certainly needs to be done in this realm, but at least one researcher suggests that, “White older men, however, may be less psychologically equipped to deal with the normal challenges of aging, likely because of their privilege up until late adulthood.”

Age

While suicides have been increasing across all age groups, those of middle age (45-64) have the highest rates of suicide, followed by those 85 or older.

What is particularly striking and tragic is where suicide falls in terms of leading causes of death.  It is the 3rd highest cause of death for those 10-14 and 2nd for those between the ages of 15-24 and 25-34.

Method – and gun ownership

49.8% of all completed suicides result from firearms, with suffocation (26.8%) and poisoning (18.4%) as the next most used method.  It is important to note that there is a strong link between gun ownership and suicides.  Suicide rates are higher in states where there are high levels of gun ownership, and lower where there are low rates of gun ownership:

The lesson? Many lives would likely be saved if people disposed of their firearms, kept them locked away, or stored them outside the home. Says HSPH Professor of Health Policy David Hemenway, the ICRC’s director: “Studies show that most attempters act on impulse, in moments of panic or despair. Once the acute feelings ease, 90 percent do not go on to die by suicide.”

But few can survive a gun blast. That’s why the ICRC’s Catherine Barber has launched Means Matter, a campaign that asks the public to help prevent suicide deaths by adopting practices and policies that keep guns out of the hands of vulnerable adults and children. For details, visit www.meansmatter.org.

As I hope this entry has demonstrated, “suicide” should not be viewed as a monolithic disease or condition.  It varies from person to person, group to group.  We have to treat is as such, and ensure that any treatment effort addresses the many various demographics that suffer from suicidal idealization or attempts.

The difference between being sad and being depressed

Here’s one that came up yesterday when I was just having a conversation yesterday: How can you tell this difference between being sad and having a diagnosable depression problem?

I mean, everyone gets sad at some point, duh.  Life has moments of pain.  But, what is the difference?  Because it is a crucial one – and it can be difficult to tell for people who are in recovery from depression or who have other mental health issues.

Now, in the course of writing this entry, not to my surprise, I discovered that there is a loooooooooot of other content on this topic.

An ABC news article on the subject summarizes it nicely:

Depression causes problems with regard to a person’s functioning. And the symptoms of depression typically last at least two weeks or longer. Sadness is one the of the symptoms of depression, but with depression you have more than just sadness.

You have other symptoms as well, and the diagnosis requires that you have not only sadness for two weeks or longer, but also some of these other associated symptoms that I was talking about earlier such as lost of interest, and inability to sleep at night, trouble with your weight and your appetite, as well as feeling guilty, having trouble concentrating, and having suicidal thoughts.

That’s a pretty succinct summary.

But….

Okay, I’ll bring in my own personal experience here, and note that it isn’t quite as black and white as this.

First, the above symptoms aren’t quite as clearcut as noted above.  Some hypotheticals:

  • I couldn’t sleep for a couple of nights in a row – is it just the coffee, or something more?
  • I haven’t enjoyed my video games for a week or so – do I need a new game, or am I starting to get depressed?
  • My weight has been off – is it the ice cream, or something worse?

More often than not, these symptoms don’t approach with the force of a tidal wave.  They start slow, and then get worse and worse.  In times when I’ve relapsed, I’ve looked back and thought, “Wow, that got bad…and I didn’t notice it before.”  It’s sort of like the frog and boiling water metaphor.  You feel fine one day, then turn around the next week, realize you have been really struggling, and didn’t even realize that you were in a bad place.

Early detection for depression – well, for anything, certainly – is absolutely critical.  Which is why this is an important question to be answered.  Am I sad, or is it something more?  Do I need to make an appointment with my therapist?  Adjust my medication?  What do I need to do right now to stop this from being getting worse?

I’d also say that this question is better answerable from an outside source.  At times where I have skidded into a depressive phase, more often than not, it’s been my wife who has noticed it and given me a gentle prodding or two about seeming off.  Others – family or friends – are often much better at telling when we are suffering than we are ourselves.

Here’s my point: Telling the difference between sadness and depression isn’t always easy.  It isn’t a flow-chart like exercise that lends itself to a simple interpretation.  It’s a complicated question – more complicated than it would appear, certainly – and can be even more complicated to answer.

As always, I welcome your thoughts and advice.  Any experiences with answering this question that you’d like to share?  Let us know in the comments below!

Reimagining Electroconvulsive Therapy

I had the pleasure of attending an event earlier this week in which another local elected official personally discussed his own experiences with anxiety, all in the name of an anti-stigma campaign by our local chapter of the National Alliance for Mental Illness.  One of the speakers at the press conference was a psychiatrist who discussed stigma surrounding mental illness, but he got a little bit more specific: He discussed ECT, or Electroconvulsive Therapy.

Electroconvulsive Therapy was once one of the cruelest treatments for mental illness imaginable.  It’s common use in American began in the 1950s and was largely brought into public view by the film One Flew Over the Cuckoo’s Nest.  It became a controversial treatment option, and with good reason: Patients were often treated against their will and with dangerously high doses.

That being said, that’s no longer the case.  Indeed, to say that the therapy has changed is an understatement.  From the Mayo Clinic:

Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses.

The article goes on to note that ECT is used when other treatment – medication and therapy – is less effective.

Is it still risky?  Sure, like any therapy, there is the potential for side effects, including confusion, memory loss and other complications.  That sounds bad, but most of those side effects are also temporary.  That, and let’s be honest: Can you find an effective drug without potentially problematic side effects at this point?  Nope.

How effective is ECT?  Well, according to this article from Psychiatric Times, very: 60-90% of people have a positive response.

If you’ve ever read this blog before, you know that the basic gist of my entire mental health crusade is anti-stigma oriented.  It didn’t really hit me until the press conference I attended how that stigma remains powerful when it comes to specific treatment modalities.  Multiple studies proved that ECT is an effective way of treating depression and mania that is otherwise treatment resistant, but older forms of its operation have convinced many people that it’s a terrifying and dangerous way of trying to rid yourself of depression.  Science has evolved to the point that this is no longer the case, and it is vitally important that we recognize this truth.

National Depression Screening Day

I’m a bit late on this, but October 5 was National Depression Screening Day.  The day itself, first created in 1990, is an effort to encourage people to determine if they are depressed and seek treatment for their illness.

Common depression screening tools

There are multiple depression screening tools available.  These tools, often available in online questionnaires, allow users to determine if may be suffering from depression.  Ideally, an appropriate screener will then link to resources which will enable a person to get help.

From what I have seen, the Patient Health Questionnaire (PHQ-9) is the most common tool to determine depression.  It’s brief – just nine questions – and allows for the user to easily determine if they are potentially suffering from depression.

There are, of course, many more depression screening tools, including:

  • Hamilton Depression Rating Scale (HDRS)
  • Beck Depression Inventory (BDI)
  • Patient Health Questionnaire (PHQ)
  • Major Depression Inventory (MDI)
  • Center for Epidemiologic Studies Depression Scale (CES-D)
  • Zung Self-Rating Depression Scale (SDS)
  • Geriatric Depression Scale (GDS)
  • Cornell Scale for Depression in Dementia (CSDD)

Does depression screening work?

There is evidence which shows that depression screening can make untreated individuals aware of their problems and encourage them to seek treatment.  Depression screening also appears to be relatively accurate, and its systemic use can make doctors more aware of depression with their patients.

The biggest benefit of depression screening

Depression screening is a useful, if flawed tool, which allows for an individual to determine if they are depressed.  That being said, depression screening increases awareness of depression.  It allows someone to determine if they may be suffering from depression, and seek help.  It also treats depression just like any other physical aliment – this, in turn, has the power of reducing stigma.

How to explain mental illness to your kids

Like the vast majority of parents, my children are the light of my lives.  My son, Auron, is six; my daughter, Ayla is four, turning five in November.  I won’t sit here and wax on and on about how much I love them – I don’t have that kind of time, and you probably don’t have that level of interest.  But, for the sake of this blog entry, please understand that they are one of my main reasons for living, my biggest source of joy and a constant fountain of entertainment, surprise and hilariousness.

So, I suspect many parents can sympathize: Having children when you have depression can add innumerable guilt and sadness to an already debilitating disorder.

When I think about depression in relation to my kids, I think of it from two angles.  First is how it will likely one day affect them.  There is no question that mental illness has a strong genetic component.  Also, as much as it pains me to admit it and as hard as I try to make it otherwise, I suspect that both of my kids will learn some of my behavior and internalize it. Even more unfortunate is that a major source of childhood trauma is having a parent with a mental health disorder, and an expanding body of research has shown that these Adverse Childhood Experiences, or ACEs, can have significant and detrimental effects on the life of a child.

One of the symptoms of depression is guilt, and lemme tell you, this entry is not helping.

Second is how my disorder affects their lives.  As much as I hate to admit it, depression and anxiety have affected my parenting skills.  There’s no doubt that there have been times where it has affected my mood, made me snappier or less willing to do things.  Kids can tell when you are worried or down.  They are like little sponges.  They just know when things are off, and they are far, far more intuitive than most people realize.

So, all of this leads me to the critical question of today’s blog entry: How do you talk to your kids about depression?

Obviously, the answer to this question depends on the age of your child.  The first time it ever came up for me was when my son was about four and happened to walk into the bathroom when I was taking my medication:

“Dad, what are you doing?”

“Taking my pills, buddy.”

“Oh.”  Pause.  “Are you sick?”

Me, internally: Crap.  

Followed by: “Well, Auron, you know how people sometimes get really sad?  Or really scared?”

“Yeah.”

“Well, Daddy sometimes gets really scared or sad for no reason.  These pills help make sure I don’t get too scared or too sad, and they make it easier for me to have a good day.”

“Oh.  I’m gonna go watch Bubble Guppies.”

At that age, I think that was a pretty good way to describe it: Simply, and by relating it to something they already understood.  As my kids have gotten older, I’ve expanded that conversation to talking about it to a stigma perspective.  Whenever we are trying to illustrate something that we think is silly (All boys are better than girls at sports by default, for example), we scream “THAT’S NONSENSE!”  I’ve used that frame to describe how some people don’t think it’s okay to get sad, or get scared, and to try to tell the kids that anyone who is sad or scared should see a Doctor, just like if they had a broken arm.  Do they understand it?  I think so.  I hope so, anyway!

As they get older, it is my hope that the way I have dealt with my mental illness – openly and honestly – will help them recognize the symptoms of it within themselves.  I never want my kids to think that whatever circumstances they may be born with are completely out of their control – I want them to know that they do have the ability to deal with whatever challenges they may face.

I cannot control the mental illness that I have anymore than I can control the weather.  But, just like dealing with a rainy day, I can bring an umbrella.  I can take care of myself by ensuring that I see my therapist when necessary, that I take my daily medication, that I recognize my mistakes and try to learn from them, and by practicing good coping skills.  In that way, I hope I can teach my kids a very critical lesson: You cannot always control the hand that you are dealt, but you can control how to react to it.

As always, I welcome your comments.  How have you dealt with your own mental illness when it comes to your kids?  What have you said – and what have you left unsaid?  Let us know below!

4 ways to stop an anxiety attack

I’ve had a particularly interesting internal debate – well, interesting to me, anyway – about which is worse, depression or anxiety.  I’ve repeatedly come to the conclusion that, at least with the way I have both, I’d rather have depression than anxiety.  Don’t get me wrong – both suck something fierce.  That being said, with depression, if it isn’t too severe, you can still function.  Anxiety, and particularly anxiety attacks makes doing basic tasks next to impossible.

College was the worst for me in that regards.  I would have periodic anxiety attacks, usually brought on by a particular situation.  I developed fears of set events – travelling in buses or planes, for example – that caused me to avoid travelling in general.  Therapy and medication helped get me through, but I still remember how traumatic those events were.  I remember not being able to travel on a bus with my coworkers because I was so, so scared of having an anxiety attack.  Or having a major one while traveling for work that almost caused me to run off of a plane.

Learning how to control my anxiety is what got me through those dark times, and learning how to stop an anxiety attack before it started – or at least how to stop one once it was underway – was immeasurably helpful.  Learning these skills gave me the confidence that I needed to believe that I could survive the worst anxiety attack, and that taught me how to live again.

With that, here’s a few techniques that I’ve successfully used in order to try and head off an anxiety attack before it started, and cool one down when it began.

Oh, and standard disclaimer: I’m not a Doctor or professional. I’m a guy with a blog.  Don’t let my random thoughts stop you from seeking professional, medical advice!

1) Pick a number.  Count to seven.  And keep going.  One of the things I found when I was at my worst was that the brain desperately needed a distraction.  I believe it was a therapist who first made this suggestion to me: Pick a task and run with it.  Pick a random number – 136.  Add 7.  And keep going.  This will, hopefully, distract your brain enough to stop the anxiety attack in its tracks.

2) Breathing Exercises.  There are a ton of variations on this, and there is also ample evidence that anxiety and depression can be ameliorated in the long run with proper breathing techniques.  When I was younger, I found this to be particularly effective, particularly when I first started suffering from anxiety attacks.  I would literally sit there in 8th grade homeroom and say to myself, “There is nothing else but your breath.  Take a deep breath.  Fill your chest as much as possible.  In through your nose and out through your mouth.”

For a more formal exercise, click here.

3) Pick an object.  Any object.  This is related to the first technique.  Getting yourself out of an anxiety attack often means changing the way that you are thinking in order to stop yourself from cycling through panic.  To that end, find an object.  It can be simple or complex.  Stare at that object.  Get lost in it’s texture and colors.  How does it look?  What does it do?  Is it moving?  What are it’s colors?  Rough or smooth? Ask yourself simple questions, and then allow those questions to become more complex.  Remember, the goal here is to get your mind to concentrate on anything other than the panic.

For me, when I was at my worst, the challenge with this was trying to get myself to concentrate on an object, because starting too long at something could make me feel worse.  If that’s the case for you, no problem!  If one object doesn’t work, try picking a different one.  Or, allow yourself to look away for a moment before coming back to the object in question, and starting the cycle over.

4) Call someone.  I found that conversations with others – people I trusted, who wouldn’t judge – could be helpful.  If you allow yourself to get lost in your own mind, you can get yourself into trouble.  To that end, talk to someone you trust and love.  Talk about the anxiety attack.  Talk about the weather.  Do whatever works for you, but just make sure that you can get out of your own head.

As always, these are just suggestions, just my thoughts.  Have better ones?  Let us know in the comments!