A Few Charms (Banner)

A Few Charms (Banner)

Friday, 24 March 2017

Prescription for panic: ice, ice baby

Have you ever wondered why people splash water on their face? Actually, I myself have never really thought about it before, but they do it all the time on TV and in the movies. Turns out there is a really good reason for this - and the more extreme version called "ice diving" - and it helps if you are upset, angry, worried, or embarrassed, even if you practice forms of self-harm, like cutting.

"Ice diving" is one of the best ways to get out of 911, whether you're feeling anxious or having a panic attack, you're frustrated or angry, or you're feeling disgusted with yourself or feeling full of shame and speaking harshly to yourself.

The Frozen snowflake (and polar bear) charms on my
"Beat the Winter Blues" bracelet
Maybe the reason I've never tried splashing water on my face is because I am a girl and I wouldn't want to "ruin my makeup." But last Wednesday was a make-up free day (as are most days, if I'm being perfectly honest) so I gave it a try. Even better, I went ice diving. And it rescued me!

(Since I've already assigned a meaning to the polar bear charm, I use the snowflake charm from the Disney movie "Frozen" to represent this effective strategy.)

The reason I needed this rescue strategy last week was because my "threat system" (aka the fight-or-flight response) had kicked in. As I explained in an earlier post, "there are only three emotions when you are in 911: anger, fear, and shame." and I was feeling them all.

When I opened the mail last week there was a letter to my husband from the Canadian Revenue Agency (CRA) saying that he owed over $2000 in taxes and I started to panic. I have this memory of the RCMP (Royal Canadian Mounted Police) coming to our home when I was a child and arresting my father for not paying his taxes. Or... maybe it was for not paying for parking tickets. Or... maybe they just came to yell at him and didn't cart him away! Or... maybe it never happened at all. But it sure feels real! Arguments about money were frequent and explosive issues in our home, so they trigger very strong reactions in me. This letter also triggered some shame. Although we have overcome some major financial hurtles and are debt-free, I am not contributing much to our financial situation at the moment.

Shame (here in polar bear style) is one of the 911 emotions.
I knew that there had been some issues with my husband's taxes and he had recently filed some paperwork, so he had asked me to open the mail if anything came from CRA, expecting to find out what his tax refund would be. What a surprise to find out that it was NOT a refund after all! (I have come to see that surprise frequently pushes me into panic.) So, trying not to over-react, I splashed some cold water on my face, and called my husband at work. In the past, my fight-or-flight response would have me fighting with my husband or I would be so overcome with emotions I'd be crying hysterically, but we actually had a reasonable conversation. Sure enough, when he called the CRA the next day he discovered that his new paperwork had not been processed yet - crisis averted. And my urge to respond to those intense emotions, and potentially cause harm to our relationship, also averted.

As soon as I hung up the phone it rang (another surprise!). It was a call from a woman from Desjardin Financial, the company that had looked after my mother's retirement income. Apparently there was a life insurance policy that I hadn't been aware of (surprise!) and they would be sending a cheque to both my brother and I - nine years after she died! Now most people would be happy to hear news of a sudden windfall (a happy surprise!), but I was suddenly flooded with a sense of shame and instantly felt my face get flushed. I started asking the woman questions about how this happened and why were they just finding out now. I also asked myself questions: How had I missed this? What did I do wrong? I was saying things to myself like, "I was a terrible daughter." You know, beating myself up and should-ing all over myself. And I had a VERY strong urge to binge. Ice diving to the rescue!

Both self-harm and problematic eating, like bingeing and purging, can be ways of managing distressing emotions. Intense emotions frequently lead to these urges, behaviour urges that are hard to resist. One of the most important things I have learned about dealing with intense emotions like panic, anger, and shame is "Distress Tolerance." The goal of distress tolerance is to figure out how to tolerate the distress of intense emotions without doing something that is harmful to ourselves or others, or doing something to harm our relationships. In other words the goal is to not make the situation worse. Ice diving can provide instant results and stop you from doing something that is harmful to yourself or others.

The Most Important T.I.P.

When I first met with Dr. Mercer, the psychiatrist at the Shared Care Mental Health Team, back in the Spring of 2014, she gave me this tip for managing my panic attacks - and the way to remember it is the acronym T.I.P. We discussed this in the Day Hospital program I attended in the Fall of 2014, but I learned even more about it in the "Working with Emotions" program I completed just over a year ago in the Fall of 2015.

Although the "Frozen" snowflake charm is perfect for my "Beat the Winter Blues" bracelet, I actually wear it all year round, in different bracelet combinations, because this strategy is, for me, one of the most effective rescue techniques whenever I get into 911.

The Frozen snowflake in the centre of  my bangle.
The T in T.I.P. stands for "temperature change," in other words, change the temperature of your body. Some people find a warm bath, a hot shower, or even putting their feet in warm or very hot water, can help ease the discomfort of anxiety or panic, but most people get their best results from the cold, in particular, "ice diving" (instructions and explanations to follow).

The I represents "intense exercise." This is an effective way to calm a body that is revved up by stress and intense emotions. It allows you to relieve muscle tension and burn off the "stress hormones" adrenaline and cortisol, as well as producing a release of endorphins, the "feel-good" hormones. Do some push-ups, do jumping jacks, run up and down the stairs, or put on some music and dance.

The P represents "paced breathing" and/or "progressive relaxation." Learning how to control your breath, by doing diaphragmatic breathing or counting the length of your breaths, can help reverse the symptoms of fight-or-flight, slowing down your heart rate and racing thoughts. Learning meditation teaches you how to use your breath to calm you down. Learning progressive muscle relaxation also changes the bodily sensations of the stress response.

The Stress Response

To understand how this T.I.P. works, you need to understand the stress response, what happens physiologically when your body responds to a perceived threat, which we can refer to as being in 911.

The reality is we have not really evolved very much from our caveman days, at least physiologically. If you were a caveman (or woman) who sees a threat, like a scary animal, let's just call it a sabre-tooth tiger, you would need to either fight or flee. Your body will immediately kick into fight-or-flight. Regardless of whether you fight or flee, your body needs to prepare for that physical exertion. All of these changes in our bodies can be evident when we have a panic attack; see if you recognise some of them.

If you were going to run from, or battle, that sabre-tooth tiger (I'm still undecided as to which would be best), then your body needs to increase your breathing rate to ensure you get enough oxygen to your working heart and muscles. For me this is the most obvious bodily sensation during a panic attack. I'm breathing really fast, taking shallow breaths, can't get any air into my lungs, can't catch my breath, and feel like I'm being suffocated. Of course being short of breath makes me panic and worsens the panic attack.

Look how much the Pandora charm resembles the snowflake from the Disney movie.
When the fight-or-flight response kicks in, your heart rate also increases in order to make sure that you are getting enough blood flow to your heart and muscles, which will be working extra hard to fight, or flee. Some people with anxiety or panic attacks have racing heart rates, tightness in their chest, and even feel like - and fear - that they are having a heart attack.

Making sure that you have enough blood flow to your heart, brain and muscles also leads to a redistribution of your blood supply. Your blood is diverted away from the non-essential body functions like digestion, which may lead to nausea. Your body may even want to empty the digestive system or the bladder. My mother always had to go to the bathroom when she was nervous; it was particularly annoying when she had Alzheimer's and couldn't remember that she'd just gone! But, as always, I digress.

The blood is diverted to more essential functions like the brain and heart as well as the muscles you will use to fight or flee. Your working muscles will create a lot of heat, a by-product of making energy. In order to dissipate that heat, blood is diverted closer to your skin to make sure you can cool yourself off, which means you may feel flushed and you may sweat.

Any of this sound familiar? Fear is something you can feel and many people with anxiety or panic report symptoms like shortness of breath, muscle tension, chest pain, racing heart or heart palpitations, excessive sweating, sweaty palms, and nausea.

Elsa and her signature snowflake from "Frozen"
If you, the brave caveman or daring cavewoman, while in the process of fleeing from the sabre-tooth tiger, fall into a frozen lake, everything changes; your body changes priorities. The threat to your life now is to keep you from dying of hypothermia. Forget about the sabre-tooth tiger. You need to survive being immersed in freezing water. Your body will stop the stress response. You can trick your body into thinking you have fallen into a frozen lake and reverse those uncomfortable physiological responses of the fight-or-flight system by ice diving.

Instructions for Ice Diving:

Fill a sink (or a bowl large enough for your whole face) with ice cubes and water. When the water is really cold, lean forward, hold your breath, and plunge your face into the ice water. Hold it there for as long as you can, up to 30 seconds (or at least 5-10 seconds). Come up for a breath and repeat. Repeat as often as needed until your intense urges have passed and the intense emotions have settled.

Since there are usually dirty dishes in our kitchen sink, and the ice cubes and freezer are not near our upstairs bathroom sink, I grab a large plastic bowl from the kitchen cupboard, empty a tray of ice cubes into it and then fill it with cold water. And dive in.

If you're not in a place where you can literally dive face-first into cold water, or don't want to wear the Speedo as in the photo above, you can trick your body into eliciting the "mammalian dive reflex."

Mammalian Dive Reflex

This is a physiological response to diving into cold water. The body's "prime directive" (to quote Star Trek) is to keep the brain functioning, ensuring that it is getting sufficient fuel and oxygen. When aquatic mammals, like seals, otters and muskrats, dive under cold water their bodies adjust to allow them to hold their breath longer under water without coming up for a breath, essentially helping them tolerate low oxygen levels. To conserve oxygen, the heart rate slows significantly (called bradycardia) and the blood vessels in the limbs constrict (called peripheral vasoconstriction). The blood shifts from the limbs (and less vital organs) to the chest, concentrating the blood flow between the lungs, heart and brain. It is similar to the slowing down of the metabolism during hibernation or protective hypothermia (the response to falling in that frozen lake).

This reflex is very effective for aquatic mammals but this primitive neural reflex still exists in humans and can provide instant and powerful results just by holding your breath and chilling your face.

Anxiety and Panic Attacks

The stress responses, those physiological changes in our bodies when we are in the fight-or-flight system, are all a result of the sympathetic nervous system. The sympathetic nervous system is one of our autonomic nervous systems, the ones that are (surprise surprise!) automatic and act without our conscious control. We have another autonomic system called the parasympathetic nervous system. It is the one that calms you down and it often referred to as "rest and digest." When we are trying to manage intense emotions the trick is to switch off the sympathetic nervous system and switch on the parasympathetic system, and the most effective way to do this is by controlling the vagus nerve. We don't have direct control over this system but we can stimulate the vagus nerve with the diving reflex.

The diving reflex is the most powerful autonomic reflex known. It instantly slows your heart rate and changes the distribution of your blood. It can get you out of an anxiety attack or panic attack in seconds.

You can also stimulate the vagus nerve through something called the Valsalva maneuver. "Bearing down," as one does when trying to empty the bowel or push out a baby, creates an increase in blood pressure in the chest. There are receptors in the heart which respond by stimulating the vagus nerve, lowering the heart rate to counter the high blood pressure.

I was surprised when I saw these tricks being used on the American TV show "Code Black," set in an emergency room in Los Angeles. The Emergency Room doctor resorted to the dive reflex when he couldn't lower his patient's racing heart rate. He put an ice pack over her eyes and told her to hold her breath and "bear down." Not that you should believe everything you see on television, but if it rescues this patient it can rescue you too.
Screenshot from the emergency room on "Code Black"

Do not use the dive reflex or Valsalva maneuver if you have a heart condition or anorexia!

So when you're having an anxiety or panic attack, channel your inner dolphin (or polar bear) by "diving" into cold. Hold your breath and submerge your face in ice water or hold cold packs on your face, or even a cold wet towel. Make sure to get the forehead and the area around the nose, as well as the eye socket and under the eye. These are the areas that will stimulate that vagus nerve.

In addition to putting ice on your face there are a few other tricks that can help.

Do you know why first aid responders at races like marathons will put ice in the groin and arm pits of people with heat stroke? It's because large blood vessels lie close to the skin surface (that's why we sweat there) and ice in those areas is an efficient way to cool off the body. Take a cold shower and aim the stream of cold water at your arm pits and groin.

Remember your physical education teacher (or your mom) telling you that you lose most of your heat through your head? That's why you pour water on your head if you're running a race and why you need a hat when winter camping (yes, we do that in Canada). In a cold shower I find letting the cold water hit my head makes a big difference.

Why do you think we have physical symptoms like the flush of embarrassment or shame? Or have a red face in the heat of anger? Or have sweaty palms when we're nervous? It is because there is efficient heat transfer there - they help cool us off when the fight-or-flight response kicks in. Recent research indicates that the blood vessels in the cheeks, palms of the hands, and soles of the feet do not contract when they come in contact with cold. You can take advantage of this and continue to cool the blood by applying cold water or ice to these areas - like using your hands to splash cold water on your face!

Have you ever thought about why you put perfume on your neck, behind your ears and at your wrists? It's because the blood vessels are near the surface in these areas, which means they are warmer, which evaporates the alcohol in perfume and amplifies the aroma. Those superficial blood vessels also allow you to take your pulse at the wrist and neck (called "pulse points"). You can calm yourself down by cooling yourself off in these places. I find that if my hands are cold it helps calm me to simply place my fingers behind my ears, or use my cold fingers to massage my eye area and forehead.

I made these felt snowflake Christmas tree ornaments for a Christmas gift exchange last year.
We have discussed the application of acute (short-term) cold as a rescue technique, but on a regular (long-term) basis you can also stimulate your parasympathetic nervous system (the vagus nerve) through singing, yoga, tai chi, meditation, prayer (particularly the repetitive recitation of the rosary), deep slow breathing, positive social interactions, laughter, exercise, and massage (including foot rubs). The best way to strengthen the parasympathetic nervous system is by controlling your breath.

I'm thinking that singing (breath control) and dancing (intense exercise) to "Ice, Ice Baby" might be the best way to remember this TIP:

To rescue yourself from panic or other intense emotions or behaviour urges, use ice, ice baby.

You Tube video of "Ice, Ice Baby" (by Vanilla Ice), performed on the TV show "Glee"

"Ice, Ice Baby:" putting it into practice
  1. Freeze an almost-full bottle of water and carry it with you. Freeze it with the top off so it won't burst in the freezer.
  2. Fill a water bottle with ice cubes and carry it with you. I always have a water bottle or two with me and I have an extra bottle with just ice. Ice cubes will melt quickly if they are in water but will stay frozen quite a long time in a bottle by themselves. I can then add ice cubes to my water bottle to make it colder and roll it on my face.
  3. Carry in your purse or knapsack a soft first aid ice pack from the freezer; wrap it in tea towels to help it stay cold longer.
  4. Carry an "instant ice pack," the kind you squeeze to activate; they are surprisingly inexpensive.
  5. In winter, carry a zipper-top plastic bag that you can fill with snow; it shapes nicely to the contours of your face.
  6. Bring a face cloth and pour cold water onto it. Even better put an ice cube IN the wet cloth and then rub it on your face, neck, behind your ears and on your wrists.
The centrepiece on my bangle is the Frozen snowflake
worn with my chalcedony "Serenity" bracelet
and blue chalcedony Mii bracelets

Millions of people in North America and around the world practice self-harm, including cutting, burning, hair-pulling, or hitting, as well as bingeing and purging, or abusing alcohol or pain killers. It seems that there are some people who specifically associate pain with the feeling of euphoria we get when the pain is relieved. This can become a way of relieving emotional pain or intense emotions. Cutting and other forms of self-mutilation can cause the body to release natural painkillers called endorphins. These painkillers can make a person feel better physically and emotionally, at least for a short amount of time. The reward provided by the relief reinforces the behaviour, making it difficult to stop the very strong urges. The goal is to find another way to relieve the pain without causing physical harm.

"Ice, Ice Baby:" putting it into practice
  1. Ice diving will release endorphins and will give you the same high as cutting or other forms of self-harm, minus the harm.
  2. Jump in a cold shower - with your clothes on if you need to! Not only will it elicit the diving reflex, especially when you let the cold water hit your face, but it will also distract you and delay acting on your urge long enough that the urge to cut or self-harm may pass.
  3. Squeeze ice cubes in your hands as long as you can. The cold causes pain in your hands, and then the subsequent desired pain relief, but is not dangerous or harmful.
  4. Put ice directly on your skin, where you would normally cut or burn yourself. It can give you a strong painful sensation, and may even leave a red mark afterwards, but not a permanent mark.

Next time you are anxious about a presentation, get an upsetting phone call, or panic about your taxes, use ice, ice baby. You could also wash your hands and let the cold water run on your hands and wrists. At the very least, splash cold water on your face. Make-up be damned!

How I stack my "Beat the Winter Blues" bracelet

Related Posts:

Advice on managing anxiety - from a turtle! - a story about my very first charm, on the very first day of my recovery from my eating disorder, and one of the most important reminders when I'm in fight-or-flight and have the urge to binge. You can also learn how to correctly do diaphragmatic breathing - it is probably the opposite of what you always thought it was!

The turtle part two: advice for anxious parents - a story about how heart-breaking it is when you see your children struggle, with strategies we used for helping our son with intense emotions like anger and anxiety. You can also read one of the best pieces of parenting advice I've come across - it's from a turtle!

When your brain and body scream 911 - a story about my introduction to the idea of "wise mind"  and the "threat system" (or 911) and the reason for my intense emotions. You'll also see an overview of the types of therapy that have made a huge difference for my mental health.

Will he always love me? My explanation of panic attacks - a story about the origins of schema-focused therapy. A rather long post but my explanation of panic attacks and my behaviour urges when I'm having a panic attack.

Friday, 17 March 2017

Enjoy your cheer - it comes but once a year! A reflection on St. Patrick's Day

A few years ago I decided to start a new tradition with my family for St. Patrick's Day. I wanted to make traditional Irish soda bread - and my reward for my efforts would be the retired silver clover charm for my True Colours bracelet.

But on the evening of St. Patty's Day, my husband and I were arguing (God-only-knows what we were arguing about), and my son was whining and saying, "Can't we make something else?" (you know, the way they draaaaaaw out the end of the last worrrrrrrd). I just got annoyed and said, "Fine! Forget it!" and went to my room to sulk! I needed to give myself a time-out.

With my emotional state already ramped up by the argument, I was overwhelmed with my feelings of frustration with the kids, and on the verge of having a panic attack. At that time I hadn't really learned about distress tolerance or emotion regulation, but at least I removed myself from the situation until I could calm down. Not long after, my daughter came upstairs and said, "Mommy, can we still make the bread?" She always reminds me to be resilient. She must also be lucky because she found three four-leaf clover before she was ten!

Taylor has always been quite shy, and she is often cautious when given the chance to try something new. There have been so many times when I have said to her, "Don't miss out. You may not get this opportunity again." That night, on St. Patrick's Day, I needed to say this to myself.

When you struggle with depression or anxiety, it is often the things we say to ourselves, rather than the things others say or do, that creates the overwhelming emotions that we experience. So I said to myself, "Don't miss out on this opportunity to make these memories with the kids. St. Patrick's Day only comes once a year!" I knew that if I didn't do this I was going to be really mad at myself! I also didn't want to let this ruin the whole evening. So I pulled it together. The kids each made a loaf of soda bread (with just a little direction from me). And we had some tasty Irish soda bread with dinner, to celebrate our Irish heritage. Now it's an annual tradition and the clover charm is an important reminder.

On a four-leaf clover, according to tradition, the first leaf represents hope, the second represents faith, and the third, love - the fourth is for luck. But for me this little four-leaf clover will also represent something else. It will remind me that there are things that only happen once a year, or only once ever, so "Don't miss out." I try to remember to be in the moment. To make memories. And to cherish those "unforgettable moments."

Our traditional Irish soda bread

I just realized that the Pandora four-leaf clover charm looks a lot like the cross you score into the top of the round loaf of bread! To read the traditional reason for the cross you can check out my baking blog Leonard Family Favourites, and see what my kids scored into the top of their first loaves of bread. This year the charm has the added congratulations to myself for completing the blog post about Irish soda bread in time for St. Patrick's Day. I wanted to do it in memory of my late Uncle Gordon Bingham, because the reason I started the blog was to share favourite family recipes with Gordon's children, and my youngest cousins, Alyson and James Bingham. I was pleased, thanks to Aunt Edna, that I was able to include a photo of Gordon as a teenager with his family, not long after they left Ireland and immigrated to Australia. You'll find recipes for three versions of the bread and some photos of how we like to eat it. You won't believe how quick and easy it is to have warm homemade bread, fresh from the oven. Our picky eater Taylor even likes it!

A bracelet made just for St. Patrick's Day this year.
On my Essence bracelet the "prosperity" charm provides a focal point.
I have been reminded that not all of my readers know the names of every charm Pandora ever produced (as I do) so I thought I would list the names of the charms on this new bracelet I made just for St. Patrick's Day; clockwise from the top: birds of a feather; love, hope and faith; moss; clover; leaf spacer; green fascinating murano; tree of life; fireworks (or starburst) clip; wildflower murano; roses spacer; celebration; unicorn dangle; world peace; roses spacer; wildflower murano; fireworks clip; wise owl; green fascinating murano; leaf spacer; cathedral ceiling; family tree; sun, moon and stars; and elemental flow clip.

In case you're wondering why I have the unicorn dangle on my St. Patrick's Day bracelet, it's because of this favourite song from my childhood, sung by a Canadian group of Irish immigrants; they called themselves The Irish Rovers. Their first hit "The Unicorn" was from a song originally written and recorded by Shel Silverstein, author of the famous book "The Giving Tree." The Irish Rovers TV show was a staple in my home while I was growing up. When I think "Irish," this song about the unicorns always comes to mind.

You Tube video of "The Unicorn" by The Irish Rovers with lyrics

Related Posts:

A little girl and an egg remind me to celebrate - a story about an interesting observation about my daughter and the insight it taught me.

When your brain and body scream 911 - a story about my introduction to the idea of "wise mind"  and the "threat system," and the reason for intense emotions.

Will he always love me? My explanation of panic attacks - a story about the origins of schema-focused therapy. A rather long post but my explanation of panic attacks.

Managing emotions means learning to surf - a story about emotions coming from the fight-or-flight response, and managing intense emotions by learning to "ride the wave."

Wednesday, 1 March 2017

Will he always love me? My explanation of panic attacks.

Originally published December 2014
have panic attacks. I've had them since my father died over three years ago. And yesterday I had one of my worst. The majority of them seem to happen when my husband and I argue. Yes, we argue - mostly about child-rearing practices. Yes, we argue in front of the kids. And Yes, we continue to work on our communication, and try to model good conflict-resolution skills. But, having said that, finding a cure for the arguments isn't really the issue. The issue is changing how I respond to these situations. It only seems to happen when I realize that my husband is angry, or he outwardly expresses his anger or frustration with the situation, and typically that only happens when I criticize him. That's the tipping point for me.

The everlasting love charm between the letter and the red glass murano

When we argue in the car and I have a panic attack (my husband is the driver), I want to open the door and jump out of the car! Or pull the steering wheel and drive us all into the ditch, or off a bridge, or into a pole! And if we argue in the bedroom and I have a panic attack, I want to open the window and jump out! I don't, of course. But in the moment I cannot for the life of me think of anything else to do except escape. My brain is screaming, "Danger! ESCAPE!"

This may sound shocking to many! Dangerous even! But please be assured that I have discussed this with psychiatrists, and I am not suicidal. I am not a danger to my family. I just have panic attacks; well, also depression and anxiety, and an eating disorder, in recovery. But still it's just a panic attack, not suicidal ideation; I don't want to die, I just want to escape.

If you've been following my stories you know that just over a month ago I finished a six-week full-day intensive treatment program for anxiety and depression; it's referred to as Day Hospital. And the staff there don't think I'm a risk to myself, or others; I suppose they wouldn't have discharged if they had.

My "Always and Forever" bracelet with Mr. and Mrs. Penguin

Before I did the program, this "Everlasting Love" charm was my talisman. As I shared in an earlier Marriage Monday postMr. and Mrs. Penguin (spotty head and smooth head respectively) remind me of the affirmation, "I love him and he loves me." If we have an argument and those words weren't enough reassurance to calm me down, I would spin this little heart charm around and say, "He will always love me." You'd think that after 20 years of marriage I might start to believe it! But I don't.

At first I didn't know why I had these panic attacks. Then I realized that they coincided with my father's death. I wondered why there was a connection. Had I previously thought of my parents as an escape route if I had an argument? Was there a cushion there, to catch me if my husband did abandon me, and now it was gone? But my parents had never been an escape route for me. First of all, I haven't lived in the same city as them since high school, although my mother moved here when she couldn't live on her own anymore. But even before she moved here she was using a walker - and she was blind. And my father had a hard enough time taking care of himself, let alone support me; he was never reliable and certainly never there to catch me. In my imagination, there are some couples who, when they fight, can walk out, and go to their parents' home. I don't know if couples actually do this, or even if it's a good idea, but I always wished I could run away and that my parents would be there for me. But they weren't.

I also wondered if my husband's anger was triggering a response. My father was a pretty passive person and didn't show much emotion, but there were a few incidents in my life where I was truly afraid of his anger. One time, when I was very young, my father pushed my mother and she fell to the floor. My little brother was there and I stood in front of my mother and my brother to protect them from my dad. Many years later, when this came out in therapy, my mother told me that wasn't really what happened - she had in fact tripped. But regardless, it was a little late then; I had always lived with that memory, and that fear. Another time, my father flew into a rage and chased me up to my room. I can't recall what precipitated that, but I remember getting to my room and barricading the door while he pounded on it. I suppose it could be an issue of me being afraid of my husband. But I'm not.
Me with my father in our front yard

While I was in Day Hospital I slowly started to learn WHY I have panic attacks. I have abandonment issues. I know that sounds cliche, but we were learning about these underlying patterns in our lives and the root causes of those. I need to understand why I am the way I am, before I can make change.

One of the tools that the Day Hospital used extensively was Jeffery Young's book, "Reinventing Your Life: The Breakthrough Program to End Negative Behaviour and Feel Great Again," co-authored with Janet S. Klosko. Young found that he had many patients where Cognitive Behavioural Therapy (CBT) didn't work; just changing their thoughts and behaviours was not enough. These people had chronic self-defeating personality problems, psychological problems like depression and anxiety, and recurring patterns in their lives. CBT was not sufficient to change these lifelong patterns. So Young and his colleagues developed what he calls the "lifetrap approach," which combines cognitive and behavioural techniques with psychoanalytic and experiential techniques.

Young explains what he calls lifetraps: "A lifetrap is a pattern that starts in childhood and reverberates throughout life... Lifetraps determine how we think, feel, act and relate to others. They trigger strong feelings such as anger, sadness and anxiety."

The technical term for a lifetrap is a schema. "Schemas," as Young describes them, "are deeply entrenched beliefs about ourselves and the world, learned early in life. These schemas are central to our sense of self." Young's approach is called schema-based therapy because it addresses not just the symptoms (depression, anxiety, panic attacks, addictions, eating disorders, etc.) but also these underlying schemas, or controlling beliefs.

I have learned CBT in the past, the techniques for catching your thoughts, to identifying the cognitive errors, challenging the thoughts, and replacing those distorted thoughts. But I always had the impression that if I just worked hard at this and changed my thinking, I would be fine! And since I wasn't fine, I assumed I wasn't doing it correctly, and I was beating myself up. But in doing an assessment upon entering Day Hospital I learned that CBT is often not enough and that one of my core lifetraps is abandonment. Yes, I have other lifetraps as well but this one is having the greatest impact on my life at the moment.

The real issue is that I felt abandoned by both of my parents, at different times, for different reasons. The most powerful triggers for abandonment are illness, separation, divorce and death, and of course they had both abandoned me one last time; they both died within three years of each other. And before that I was slowing losing my mother to Alzheimer's Disease. But not all triggers are so obvious; they can be very subtle. 

When a lifetrap is triggered we are flooded with negative feelings - sadness, shame, anxiety and anger. And we can learn to run away from those feelings, because the feelings are too hard to face - hence the eating disorder. But in Day Hospital I learned that anything that feels "disconnected" can trigger the lifetrap. So when my husband and I argue, if there is any remote indication that my husband is going to "abandon" me, I panic.

One of the things a child needs to thrive is basic safety. A child who feels safe can relax and trust. Without this, a child, and later an adult, live in "fight or flight" mode, sometimes called the 911 emotion system. This describes me perfectly: "People who were abused or abandoned as children...[feel] there is nowhere they feel safe. They feel that at any moment something terrible might happen - someone they love might hurt them or leave them. They feel vulnerable and fragile. It takes very little to disrupt their equilibrium. Their moods are intense and erratic, and they are impulsive and self-destructive." Yup, that is me, in a nut shell.

In looking through the list of examples of "destructive early environments," there were a few that applied to me. The first was that "your parents fought all the time and you were caught in the middle." Another one was in relation to my father: "You became enmeshed with a parent and were expected to act as a substitute spouse." There was also a wide swing in my family between being "overprotected" and "parents not setting appropriate limits."

Each lifetrap has an understandable origin in childhood. Abandonment is one of the lifetraps related to a lack of safety or security in your childhood family. The abandonment lifetrap is the feeling that the people you love will leave you, and you will end up emotionally isolated forever, without emotional support, connection, strength, direction, or protection.

There are a number of possible origins of the abandonment lifetrap, and I will try to explain the ones that I think most likely apply to me. In most cases abandonment starts early, because it often takes place before a child can talk. This makes it difficult to identify and verbalize as an adult, but I will do my best.

The first origin of abandonment is that your mother was separated from you for a long period of time when you were a child, or you were raised by nannies.

One of the origins of abandonment is the absence of one person who consistently serves as a maternal figure. A child needs the stable presence of one caregiver, particularly during the first years. It doesn't have to be a parent, but if there is constant turnover it causes disruption. My mother wrote some memories for my brother and I, and from that I can piece together what life was like in my first few months and years.

Me at eight months having a bath in the enamel basin

When my mother was married at the age of 36, it was 1963. I was born a little more than a year later and she expected that, like most women of the day, she would stay at home and be a mother and homemaker. But it was the busy time for my father's photography studio, leading up to Christmas. So my mother brought me, as a newborn, to the studio so she could help my father. She'd leave me in a car bed and put me "somewhere in the studio," while she ran errands for Dad - and hoped to get back in time to nurse me. She said I was an easy baby and "didn't seem to mind the wear and tear of being dragged off to the office every day." They did that until after Christmas; I would be two months old by that time. It hadn't taken long for my mother, being in the studio every day, to realize that my father was not going to be able to support this new family on the profits from his studio. That she would have to go back to work.

In 1964 there was no maternity leave for new mothers. Fortunately my mother had been successful in her young career working as a scientist at the National Research Council. When I was two months old she got part-time work doing research at Fisheries. At the end of the three-month contract she got a full-time job in the Biochemistry Department at Dalhousie University, first in paediatric research and then in the Med School, and worked there until my brother was born three years later.

From how my mother tells it, she had a very difficult time finding a caregiver to come to our home. The babysitter she did find had a child in the first year she was there. Mom later told me that she felt that the sitter had been neglectful, that she brought her own child and ignored me. When the sitter got pregnant again she decided not to continue working and Mom was on the hunt for a sitter again.

With no luck finding someone to come to our home, Mom eventually found a daycare program. At the same time she approached an older woman, a neighbour, who said she might be interested in babysitting. It was decided that since I loved the daycare I would go there a few days a week, and have a few days a week with Mrs. Scott. She was probably the first consistent and attentive caregiver I had and some of my fondest memories were with Mrs. Scott. After she moved away I wrote letters to her for years, probably until I was in university. It was very touching for me that Mrs. Scott's son was the minister at my mother's church and presided over her memorial service.

Another origin of the abandonment lifetrap is that you lost the attention of a parent when a brother or sister was born.

When I was three years old my mother entered the hospital to deliver my younger brother Thomas. My mother had antibodies to my brother's blood (called Rh factor) so she had to deliver early. The surgery was scheduled just before Chritsmas. My father would be busy at the studio during the holiday rush again, so my mother had made arrangements with a number of different people to babysit, and had them scheduled for days and evenings. 

After my mom went to the hospital, my Aunt Mary, my father's older sister, asked my Dad and I for dinner, and then asked me if I wanted to stay with her for Christmas. Of course I said, "Yes." I've mentioned before that she was my favourite aunt and her husband performed our wedding service. My mother and I talked about this many years later and we both agreed that Aunt Mary, having known her brother for a long time, probably knew that I wouldn't get cared for very well at home, alone with my father.

Me, three-years-old, at Christmas with my Aunt Mary on the right

My brother had a blood transfusion immediately after delivery and Mom didn't see him for two days. Other mothers had their babies brought to them so they could nurse but not Mom; she said it was hard to adjust to that, but even harder to go home and leave him there! Thomas had half-a-dozen blood transfusions in his first week, and had to stay in the hospital for a full month, even though mom was discharged after ten days.

My mom was home with me then, but every day she would call my dad at the studio and say, "I need to go to the hospital now to see this baby!" Dad would rush home and stay with me while Mom went to the hospital (they only had one car and being a child they couldn't bring me to the maternity hospital). Every day she could see Thomas, but only through a window, and she wasn't able to touch him. She could see that he was getting stronger every day, and slowly his jaundiced colour was disappearing. Being a mother now, I can only imagine how painful it must be to have a newborn baby and not have him with you! What kind of effect would that have on you?

Even though baby Thomas was home after a month, his iron was still low; at the end of two months he needed another blood transfusion. At that time, when Thomas was two months old, Mom went back to work and there was a new babysitter. Mom wrote about this time, "She wasn't the greatest babysitter in the world , unfortunately. She liked Thomas better than she liked Sheila, and also brought a nine-year old granddaughter with her on a number of occasions when this little girl was not in school. She didn't bring any toys, which meant Sheila had to share without a reciprocal arrangement, and that just wasn't very satisfactory. Anyway, she didn't last long." And the search for a caregiver began anew.

When Thomas was about ten months old my mother hired Mrs. Chaddock who was with us until I was thirteen. Mom was pleased because she would take us for walks, whereas previous sitters had apparently watch soap operas most of the day. And my brother then had a consistent caregiver.

Another origin of the abandonment lifetrap, especially significant for me, is that your parents fought so much that you worried the family would fall apart.

hated when my parents fought. And they fought a lot. Usually about finances. I think. In the morning I could hear them arguing down in the kitchen. In the evening I could hear them arguing in bed - my bedroom was next to theirs. I wanted so badly to go and fix it! At one point I found my mother literally banging her head against a cupboard door. I now understand that she was just fed up, but It scared me that the person who was supposed to give me strength was so vulnerable. And then there were the times when the arguing got so bad that one of my parents would get in the car and drive away. It scared me SO much! And I usually ended up yelling at the parent who was still there, blaming them driving the other person to escape - and abandon me.
I lived in fear that my parents would get a divorce. If they divorced I would lose one of them. I suppose I knew that we would have to go with Mom, because she was the only person with an income. But I also felt it was my job to take care of my Dad; I was his emotional spouse. How could I do that if I lived with my mom? When I look back at that, from the position of an adult and a parent, I can only imagine the conflict that must have created in my head! So it became my mission, to prevent my parents from separating.

When my mother was 64 she lost her sight. She couldn't work anymore or drive. And she had to move out of our family home to an apartment that had bus access. My father refused to leave the family home. They separated - after being married for over 25 years. And I had an nervous breakdown, or what they now call a Major Depressive Episode. Their marriage had ended, and I had failed at my life's mission. And I got therapy for the depression and my eating disorder.

It has not gone unnoticed that the arguing with Mike seems to reflect what was so destructive to me as a child; unfortunately, this is what happens with lifetraps, we repeat these patterns, and it makes it very difficult to change them.

As Young explained in his book, a child needs a secure, stable family environment, where parents are predictably available, and physically and emotionally there for the child. My parents' marriage was not a stable base of support for our family. My mother was busy putting food on the table, as well as taking night classes, doing volunteer work, sewing, knitting, reading, etc. And my father was unpredictable. He made promises he never kept, and made plans that were never fulfilled. It was a constant cycle of hope, and then despair. Neither of my parents knew how to support me emotionally, mostly as a result of things that happened in their childhoods. I know that they did the best they could, with what they knew, at that time. But that doesn't change the fact that they were not able to be there for me in the way that I needed.

So where do I go from here?

In the first chapter of his book, Young explains the process of change, "The lifetrap approach involves continually confronting ourselves."  And promises to, "show you how to recognize [lifetraps], how to understand their origins, and how to change them." He adds, "We will teach you how to track your lifetraps as they play themselves out in your life, and how to counter them repeatedly until these patterns loosen their grip on you." I have my work cut out for me; first of all, learning not to overreact, and secondly, working on mindfulness, emotion regulation, and distress tolerance.

When I left the Day Hospital program, I asked the staff (social worker, occupational therapist and psychiatrist) what I needed in terms of therapy or a therapist once I was discharged. All three of them said I needed to find a therapist who wasn't married to one form of therapy, supporting Young's contention: "I have come to believe that integrating the best components of several therapies is far more effective than any one alone."

One important piece of advice from Young's chapter on abandonment, one that is particularly relevant for me was, "When you find a partner who is stable and committed, trust him/her. Believe that he/she is there for you forever, and will not leave." The staff also suggested that, in the midst of our busy lives, that we make time to check in with each other nightly, to maintain that connection.

This photo, that I keep on my dresser, is Mike on our wedding day, twenty years ago

There is no reason for me to be afraid that Mike is going to abandon me. He is one of the most reliable, dependable, loyal and honest people you could ever meet. He has seen me through recovery from my eating disorder - twice. He was there when I went off work on stress leave. He was there when I was suicidal, and he was never sure what he would find when he got home from work. He was there, at my side, doing full-time parenting, for the first eight months after our twins were born. He was there when I was thrown into parenting my aging mother. He was there when we had to pay off a massive debt. He was there when each of my parents died and all the grief, anger and sadness that followed. He was there when I was so ill that I was practically bed-ridden for two years. And he is still here even when I'm not functioning at full capacity. He has not left.

I am so tempted to write, "He has not left YET." But I am going to trust that "he will always love me," and remember why I have the everlasting love charm.

Now Mike knows that when I have a panic attack it's not really about him. There is no rational fear that he will leave me, just an emotional trigger. He just needs to give me a hug and remind me, "I'm right here. I'm not going anywhere."

Of course we avoid hugging when he is driving. Instead he puts his hand on my knee, to reassure me.