Part 1
Anxiety and Panic Disorders

About 20 million Americans suffer from one of a variety of anxiety disorders, which includes: generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, and post-traumatic stress disorder (PTSD). This article will focus on panic disorder (including agoraphobia) and generalized anxiety disorder.

There is a very fine line between what is a “disorder” and what is a conflict, or a problem in living or lifestyle that makes us anxious. I am not a big fan of the “pathologizing of America .” What is now called “social anxiety disorder,” used to be called “being shy.” There is a big difference between saying to oneself, “I feel anxious” and”“I have an anxiety disorder.” When people are convinced that they “have” an anxiety disorder, they tend to look outside themselves for answers, tend to look for medical solutions (or alternative medical solutions), and they tend to shy away from ongoing personal inquiry as well as using “tools of responsibility and accountability” such as diet, exercise, meditation, mental imagery, yoga, and the like.

There are several schools of thought about anxiety disorders:

1. They are disorders of brain chemistry.

2. They are caused by unresolved psychological conflict.

3. They are cognitive disorders, disorders of thinking.

4. They are a natural part of the ebb and flow of dealing with life's highs and lows and daily stresses.

5. There are some people whose anxiety is truly an existential crisis. They have reached a point in life where they are asking themselves,'“What is the meaning of my life?” “Does my life have any meaning, and if so, what is it, and how can I discover it?” An existential crisis should not be dismissed or belittled. While most people whom I treat for anxiety are not in the middle of an existential crisis, some are.

A doctor's job is to help alleviate suffering. His job is not “to be right.” So, the most productive approach is to look at the 5 possible causes of anxiety, and see which ones are the most likely causes in each person.

Panic Disorder and Agoraphobia

Approximately 4 million Americans, or 5% of the adult population, suffer from panic disorder. The difference between “feeling anxious” and having panic disorder is gigantic. This is no ordinary state of anxiety, worry, or fear. A panic attack is one of the most emotionally devastating experiences a person can have. It is important to understand that worry, anxiety, fear, and panic are different. A panic attack is not the same as just having a lot of anxiety. It is an overwhelming, terrifying experience in which one thinks he may die.

Panic attacks are characterized by a racing or pounding heartbeat, tingling in the extremities, terror, fear of losing control, fear of going crazy, chest pain, a sense of heaviness in the chest, chills, trembling, muscle twitching, sweaty palms, and fear that one is dying. People who suffer from panic attacks have thoughts like: “I think I'm going crazy, “I'm having a heart attack,” “I can't breathe,” and”“I am totally losing control.”

The first time a person has a panic attack, he has no idea what is going on, and is likely to head to the nearest emergency room, where he will be evaluated for a myocardial infarction (heart attack). Even after multiple panic attacks, multiple trips to ER's, and multiple reassurances by doctors that their heart is normal, it takes awhile before people really believe that, during a panic attack, they are not dying. The feeing of impending doom is so overwhelming during a panic attack that “reason” and intellect don't make much of an impact.

Unless, the condition is correctly diagnosed, panic disorder will progress in a fairly predictable way. People will have attacks that occur unpredictably, and over time, they become frightened of the “next” attack and withdraw to their “safe zones,” usually their home, avoiding many public places. People with panic disorder become most afraid of places where they potentially have “limited ability to quickly escape,” such as large stores, tunnels, elevators, and driving over bridges. When panic has progressed to the point where one's life starts to constrict, the condition is called “agoraphobia.” Initially, the term “agoraphobia” meant, “fear of open spaces.” The term is now used to explain how panic disorder begins to constrain one's life. Panic disorder progresses to agoraphobia in about one third of those with panic disorder.

There are 3 main components of agoraphobia:

1. Repeated panic attacks.

2. Anxiety about when and where the next attack will occur. This anxiety, called “anticipatory anxiety,” grows and grows, often taking over a person's life.

3. Avoidance of anything or anyplace that one associates with panic attacks, followed by a retreat to one's sense of safety (usually home).

If one has a specific phobia, such as fear of heights or snakes, one can usually choose to avoid contact with heights or snakes. With the panic attacks associated with agoraphobia, there really is no safe place away from home that, if you avoided, would eliminate the attacks.

Psychiatry has generally looked at panic disorders, including agoraphobia, through the “disease model,” which is to say that it is believed to entirely be a problem with brain chemistry. But it's not that simple.

One patient of mine (I'll call him John) illustrates the complexity. He was referred to me by another doctor, who knew about the severity of John's life stresses, but had not seen how one major life stress had truly started the panic attacks. John was in the middle of a divorce, an ugly divorce in which a lot of money was at stake. John just wanted out, and had offered to literally give his wife 100% of his assets. John is an exceptional plastic surgeon, and he had the confidence that he could start over and be successful. However, his wife refused to accept his offer to “take everything,” which put John in a box from which he could not escape.

John was caught in the bureaucracy of a slow-moving legal system, which for about a year would not let him resolve the case, no matter what terms he offered. Once he began to believe that he could not escape the marriage, even by relinquishing 100% of his assets, he began to have panic attacks. His panic is just like what you've already read about. He was in emergency rooms countless times, certain that he was having a heart attack, even after being reassured that he was not.

It was most helpful for John when I explained what I believed to be happening. I thought that the panic attacks were an expression of feeling totally trapped. For this high-powered doctor, having no sense of control just about drove him crazy. Actually, a person with panic attacks is not going crazy at all. He just thinks he is. Once he clearly saw the connection of the panic attacks and the genuine trapped situation he was in, he felt better. His panic attacks did not simply disappear, but he felt better. What was also immensely helpful was that I was able to explain, in detail, what a heart attack is, what it feels like, what the EKG (electrocardiogram) looks like, what blood tests reveal, etc. I explained several things that “look like” panic attacks, and made clear distinctions between all of them. Being a plastic surgeon did not make him an expert in psychiatry or cardiology. This clarity did begin to lift his previously unshakable belief that he was dying, or that the attacks were going to kill him.

To jump ahead, suddenly the legal system turned in John's favor, the divorce went through, a settlement was reached, and he was a free man. No amount of therapy of any kind could have replaced the healing power of being relieved of the prison of his marriage.

The biology of a panic attack originates from fight-or-flight physiology, in which one's life is truly in danger, and in which adrenaline pours into the blood stream, making one's heart pump harder and faster, preparing the muscles for fighting or running. In a true, life-and-death situation, fight-or-flight physiology will lead us to take actions that are usually life-saving. In the animal kingdom, during an attack, where there is predator and prey, fight-or-flight physiology turns on. The result of the adrenaline rush is that the animal is either killed, or fends off the predator and successfully runs for its life. The biology of survival runs its course in a matter of minutes, after which one's system returns to a calm baseline. In panic disorder, our body responds as if our life is in constant danger, and our nervous system gets caught in a cycle of re-experiencing an overwhelming sense of danger and impending death. The biology explains the physical manifestations, but does not explain all the reasons that trigger the panic attack in the first place. John is a good example of that.

In working with fear and anxiety, we have to differentiate panic disorder from generalized anxiety disorder (GAD). GAD affects 3 – 4% of the population, or about 4 million Americans. People with GAD worry constantly. Most of the time they are negatively consumed with the future and are dwelling on “what ifs.” Feelings of dread and worry dominate their lives. They cannot turn off their minds or the vicious cycle they are in. It is true that our thoughts powerfully affect our lives. Not only do our thoughts create our emotions, they create our reality. “Worry” is negative imagery. It is a state in which we are incessantly visualizing negative outcomes. Our thoughts act like magnets, attracting whatever we intensely focus on. The more you focus on success, the more likely it is that success will manifest in your life. The more you think about and visualize negative outcomes, the more those negative outcomes, people, and situations will pop up in your life. So, a vicious cycle is created in which the inability to turn off a mind that is endlessly ruminating on “what ifs” results in some of those “what ifs” coming to pass.

People with generalized anxiety disorder become depressed, for their anxiety is like a constant tormentor. Over time, anxiety and depression will come and go, co-exist, and both will be part of the experience of GAD. However, those of you with GAD do not suffer from panic attacks. GAD and panic disorder are two distinct entities. And both of these are different from “real fear” and from periodic worry. Almost all of us worry to some extent, but it does not rule our lives.

At a fundamental level, anxious, worried people are pessimists, who do not feel lucky and don't believe in a “friendly” universe in which everything happens for a reason — a universe in which ultimately,—“everything works out.” While optimism may not be entirely “realistic,” it is an attitude that leads to a healthier and happier life.

In the next issue, we will examine a host of treatments for anxiety and panic disorder, and help map out the strategy that is best for each person.

David Gersten, M.D. practices Nutritional Medicine, Integrative Psychiatry, and Interactive Guided Imagery out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health, amino acids, and nutritional therapy at


Dear Louise

Dear Louise,

I've been reading your books for a few years, but I didn't really “get it” until fairly recently. Last month I took a meditation course and shortly after I began practicing I started to feel a bit different, so I kept going and meditating daily. I started to feel the presence of my inner child, and when I would hold my 20-month-old daughter, I'd feel my own inner child being held and loved along with her. I read your book LIFE! and started to tell myself that I love myself constantly. I started to practice forgiveness, and my thoughts have been changing for the positive.

I expected to go through a glorious transformation and had my arms wide open for the rush of abundance that I believed would come through. Instead of any of that happening, I started to get sick—a plethora of illnesses attacking my head. First I grew a small pea-sized ball of infection from a root-canal tooth. Then I got the flu. Then I got strep throat, which spread through my jaw and into my ear. Now I have a cold and a nasal drip that is nonstop (as well as a lot of headaches). And then last night in bed, my husband broke the news to me that we're almost broke, and he's terrified.

My question to you is, although I know and believe with my whole heart that this is me doing this to myself, is this just a bump on the road, or a cleansing of old beliefs and anxieties (in reference to my minor illnesses)? Help!

C.K., Canada

Dear C.K.,

This is definitely a bump on the road. Sometimes when we begin to clear our consciousness and change our thinking, we stir up a big mess. Think of the turkey pan after Thanksgiving dinner. There's all this baked grease, so we fill the pan with hot, soapy water and set it out to soak. Then we begin to scrape the pan, and boy, do we have a mess. However, if we keep scrubbing, we'll soon have a nice clean pan.

This is where you are now. However, keep going, keep meditating, and keep doing your affirmations. The mess will clear, and life will be better than ever. Use the powerful affirmation below. And if your husband is willing to say the affirmation, too, the situation will clear even quicker!

All is well. Everything is working out for my highest good. Out of this situation only good will come. We are safe.


Dear Louise,

Three years ago when my twin sister died of alcohol poisoning, I intuitively knew she was in trouble and was calling me; however, I didn't go to her because I was angry at her for continually drinking, and there was nothing I could do to help her. I felt really frustrated. I was also studying for a very important exam for my job that I had to take the following day. She died that night alone, and I haven't been able to get rid of the guilt that I should've been there for her. I could've helped her, and I let her down.

I have terrible muscle pain and severe arthritis in my neck, shoulders, upper and lower back and feet. I was wondering if this pain could be related to that experience and my feelings of guilt. If so, are there any affirmations you can recommend?

M.D., New Zealand

Dear M.D.,

“Shoulds” will get you in trouble every time. You must release that guilt. First of all, you need to acknowledge that you're very angry at your sister for drinking so much and for killing herself in this way. You did not kill your sister! She really wanted to go. Of course you have pain, because guilt always looks for punishment, and punishment creates pain. You might look into therapy to help you release this guilt.

Also, talk to your sister, ask her for help. She doesn't want to see you suffer in this way, ask her to help you release this. Being a twin, she'll know exactly what advice will soothe you. Also, please join a “grief counseling” group by calling 1-818- 907-9600, or go online to .


Dear Louise,

My dog recently passed away, and I thought I would be okay with it, but I'm actually very sad. What can I do to ease my pain about this? He was my companion for a long time, and I really miss him.

K.K., Los Angeles

Dear K.K.,

Our animals give us so much unconditional love, and it's heartbreaking when they leave. There's a homeopathic remedy that soothes grief. It's called Star of Bethlehem and can be purchased at any health-food store. Just a few drops under your tongue several times a day will bring relief.

Grief is a normal emotion. Allow yourself to go through it in your own way. Also, talk to your pet and ask him to help dissolve the pain. Know that you'll be united in a twinkling of an eye when you leave the planet. There are many puppies in shelters just waiting for a good home. In time, that might be right for you.

Affirm: I remember the past with joy and love.

Louise L. Hay is a metaphysical teacher and the bestselling author of numerous books, including You Can Heal Your Life , Empowering Women, and I Can Do It! . Subscribe to the Louise Hay Newsletter! Call for a Free Issue: (800) 654-5126. Questions for Louise? Write to: Dear Louise Column, c/o Hay House, Inc., P.O. Box 5100, Carlsbad, CA 92018-5100 (letters may be edited for length and clarity). Visit Louise and Hay House at: or