A lot has happened in the three weeks since my last post. I took the Clonazepam, as prescribed, for one week. It helped to bring down my overall anxiety and also decreased the frequency and intensity of the panic attacks. At this point in time, I was experiencing them approximately five to six days per week. They caused notable fear and distress and were significantly impacting my day to day living.

Following the direction of my psychiatrist, I began to taper the Clonazepam the following week. My anxiety and panic symptoms increased slightly, but remained manageable. For the past week, off the Clonazepam, my anxiety and panic symptoms/attacks increased. I do not want to go back on the Clonazepam, as I have a history of benzodiazepine misuse that contributed to an inpatient hospitalization.

So, where is my therapist in all of this? My therapist was on vacation during the first week; this I was aware of. Unfortunately, he had an unexpected medical complication that kept him out of the office for an additional two weeks. This, I was not prepared for. I needed a treatment plan for my panic attacks and I needed it now.

I was spending every waking moment analyzing all body sensations. Pain in my chest… I must be having a heart attack. Slight dizziness… I must have a brain tumor. Pause in my breathing pattern… I’m going to faint and never wake up again. Thankfully, my therapist e-mailed me some recommended strategies and scheduled an appointment for this past Monday. I used some approved strategies including diaphragmatic breathing and occasionally agreeing with intrusive thoughts. However, I also used some that were discouraged, such as analyzing, checking and reassurance seeking from myself and my husband. I did anything to try and stave off the impending panic attacks.

Finally! Monday arrived and I met with my therapist, virtually, to devise a plan for treatment. He immediately recommended interoceptive exposures. Intero… what?!?! According to the American Psychological Association (APA), interoceptive exposures involve deliberately bringing on physical sensations that are harmless, yet feared. My interoceptive exposures include the following: 1. Step-Ups (60 secs), 2. Rapid Breathing (60 secs), 3. Head Shaking (30 secs), 4. Head Between Legs (30 secs), 5. Straw Breathing (60 secs), 6. All-Over Muscle Tension (60 secs), 7. Spinning (60 secs) and 8. Breath Holding (30 secs). I immediately told Damon that I could not do any of these exposures at home; I was so fearful of the activities inducing a panic attack. He asked that I identify the two that would cause the least amount of anxiety. I chose Step-Ups and All-Over Muscle Tension. So we started right then and there.

Instructions: 1. Do one exercise per day; repeat that exercise five times, 2. After each repetition, rate your fear or dislike of the symptoms produced from 0-10, and 3. If the fifth fear or dislike rating is 2 or less, you may move to the next exercise on the following day. If it is a 3 or more, repeat the same exercise the following day. So, here I sit; third day of interoceptive exposures. For the most part, I have avoided the exposures in fear. I have the all-over muscle tension rated at a 2 and the step-ups at a 3. In the coming days, I have set a goal of completing 3-5 step-ups exposures, in hopes of lowering my fear/dislike rating to 2 or less. I anxiously await my, in office, therapy appointment this upcoming Monday. The plan is to tackle the higher feared interoceptive exposures, like straw breathing… wish me luck.


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