• 27 Oct
    Shiva Raman Pandey

    Understanding Panic Attacks

    Understanding Panic Attacks

    A panic attack is sudden sensation of heavy and difficult breathing along with a pattern of other sensations that can last for several minutes. Panic attacks may occur independently, as a part of Panic disorder, or as a part of other disorders. The DSM criteria for panic disorder are as follows:

    • Recurrent and unexpected (panic attacks)
    • There is a pattern (expected Panic attacks)
    • Many PA within minutes
    • Four of the following should happen for it to be called a panic attack:
    • Palpitations/heart pounding
    • Increased heart rate
    • Sweating
    • Trembling/shaking
    • Shortness of breath
    • Choking sensation
    • Chest pain/discomfort
    • Nausea/abdominal distress
    • Sometimes can this can also be accompanied by:
    • An abrupt surge of intense fear/discomfort that peaks
    • Dizziness, light headedness
    • Chills/hot flushes
    • Numbness/tingling sensation
    • Depersonalization/derealization (losing one’s sense of self and feeling cut off from reality)
    • Fear of losing control
    • Fear of dying
    • At least 1 attack should be followed by 1 month of –
    • Persistent worry about having another Panic attack and its’ consequences
    • Maladaptive changes in behavior to avoid having a panic attack: Patients Often worry that they will have to lose control, will be judged by others for having a Panic Disorder. Therefore, they exhibit avoiding behaviours to tackle this.

    Nocturnal PAs or panic attacks during the night are quite common. PA’s usually occur in rare episodes but the symptoms often resurface and very few people have full remission. The first time it happens is usually around the 20s. Inquiring about the childhood can help understand the trigger, it could be a cardiac arrest, exposure to emotional and sexual abuse, or a mental health issue.

    There is almost always a trigger, a stressful event that put the person into an exertion-like state. However, there are also some personality types that seem to go with this: mainly fearful, anxious and controlling personality types.

    People with these personality types are more likely to worry about controlling one’s body and its reactions. This makes them worry too much when they are not able to control it. Therefore, each time the body’s responses are slightly elevated also, the person misinterprets it as a cardiac arrest or a panic attack and this makes them actually have a panic attack.

    However, the good news is that panic attacks are highly manageable. There are definite cues within the body that seem to make people think they are having a panic attack, and that actually leads to a panic attack. In psychotherapy, sensitivity to these cues can be reduced with training and relaxation. Alongside, the therapist also starts to work on thoughts and feelings related to Panic attacks and how they affect work and relationships. With time, the trigger may be identified and worked through. Medications (anti-anxiety or/and anti-depression) can help to curb some of the symptoms.

    Therefore, help is available if you or someone else you know has panic attacks. Never hesitate to take help.


    Responses 1

    • jyoti sharma
      jyoti sharma   Dec 24, 2015 04:11 PM

      I am 28 year old female. I experienced my first panic attack when I was a senior in high school. I started to work out and lost weight but being at home always makes me feel pressure and stress. At times I don't know what to do. I've taken many medications but citalopram has been more effective.

  • 27 Oct
    eWellness Expert

    Let's discuss About Mental Health

    mental health

    Is it only weak people who seek psychotherapy?

    Will you be completely out of control if you had one?

    Does having a mental health disorder make you ‘mad’?

    Are you wondering what it means to have a mental health disorder?

    Are these illness contagious or will someone get them by talking to you?

    These and many other questions would probably be in your mind. We answer a few of them for you below:


    Causes of Psychological Problems:

    Mental Health disorders are caused by your biological make-up as it interacts with your social environment (economic, social class, safety, violence, access to development etc) as well as your psychological make-up ( shaped by your thoughts, feelings, how you were bought up, strengths, life experiences etc).

    Therefore, as you can see, there are many factors that can act as risk and protective factors for mental health. This means that pills alone cannot solve the problem.

    Although they can help control neurotransmitter imbalance, the rest of the work on psychological and social levels happens in various kinds of therapy. Further, relapse and dependence is quite likely in medication, whereas therapy helps build skills and is empowering.

    Stigma begins and ends at home. We as a society are a long way from where we should be. We don’t spend enough on both prevention and treatment of mental health disorders.

    Our social circumstances and experiences like poverty, abuse and violence make it much more likely for us to have a disorder. But you can take the first step, and empathetically accept and love someone in your family or friends’ circle who has a mental health condition. 

    What not to do

    Don’t throw around words related to psychiatric condition. Terms like ‘I’m so depressed’ and ‘Are you retarded?’ as figures of speech are very insulting to people who do live with these conditions and undermines their struggles. It is the equivalents of saying you have AIDS when all you have is a cold. We need to start respecting people with mental health conditions because they didn’t cause it to happen, it is society and social conditions which make them vulnerable.

    How to help?

    One in four people in the world suffer from a mental health disorder, and we have to all join hands to prevent and treat mental health disorders with respect and care.

    The one thing that makes human stand apart from other species is our ability for compassion, love and care. It is about time we used these very qualities with each other, especially for those among us having a troubling time, as they need it the most.

    Image source:

    Responses 1

  • 17 Jan
    Shiva Raman Pandey

    If you wait, you will get more

    delaying gratification

    You may not have heard of a man called Walter Mischell, but he has something very important to say about you. In perhaps what was the cutest experiment in psychology, he conducted the ‘marshmellow test’ with children. A child was left in a room with marshmellows. The child was then told that the researcher had to leave the room for a few minutes, but not before giving the child a simple choice: If the child waited until the researcher returned, she could have two marshmallows. If the child simply couldn’t wait, she could ring a bell and the researcher would come back immediately, but she would only be allowed one marshmallow.


    This tested the will-power of the children. This obviously applies to food and our ability to indulge in our cravings, but it can be extended to life as well. When our will-power fails, the cool system of our mind, which reasons that ‘If I wait, I will get more later’ is overrun by the hot system which just simply wants to indulge and not think.


    The same children with whom the experiment was conducted, were later also analysed as adults for self-control tasks. It showed that children who had poor control in childhood, continued to have bad control in adulthood as well. For those with better control, the frontal cortex of the brain, where decisions are made, was more active (cool system), and for those with less control the ventral stratium (that part which produces rewards and desires) was more active. This is the hot system. Therefore, there is a definite neurobiological basis to our urges.


    Researchers found that people with better control do better on achievement tests of schools and college, have lasting relationships, better health and better stress management skills. Delaying gratification then, is a part of a person that can have many good outcomes.

    Delaying gratification

    So if you are a predominantly hot systems person, how do you become more of a cool system? This is an area still under research, but what seems to help are the following tips:

    Distract: If you can distract enough for the initial urge to go, you may be able to reason with yourself later. So, a good ability to distract can help you delay gratification.

    Delay by seconds: This seems to work even for serious OCD issues. Try delaying your urge by seconds. So tell yourself that you will have the cookie 5 seconds or 10 seconds later, and then slowly, increase the seconds till you have enough time-gap to reason with yourself.

    Self-talk: Have a dialogue with yourself. ‘Why do I want to do this? I felt so guilty the last time. I definitely do not want to feel that way again. Let’s see if I can push my urge to indulge by half a day’. This sort of dialogue is important to make sure that you are not functioning from your hot system.

    Image source

  • 22 Oct
    Shiva Raman Pandey

    Overcoming Social Phobia or Social Anxiety

    Overcoming Social Phobia or Social Anxiety


    Social anxiety or phobia is felt by many people. Social anxiety is not just stage-fright, although stage fright may be a part of it.

    What is social anxiety?

    • Basically, the person feels high level of unease when they are on display in front of people in any social situation – this also mean gathering of friends and family too.

    Effect of social anxiety on person’s life:

    • Dating and relationships become difficult for them.
    • They are viewed as shy and backward.
    • Miss out opportunities to grow out of their fear.
    • They may hold jobs much below their capacity out of this fear.

     Causes of social phobia:

    Social phobia has many causes. By and large, research suggests that the fear is learnt. The upbringing of the child could be such that his or her parents never encouraged or acknowledged them, and were harshly critical, and so the self-esteem is very low. There could also have been one or more severely embarrassing social situations that could have triggered such intense fear of social situations.

    Attributions, or the reasons we believe are behind events, tend to add to this fallacy. A confident person would see an embarrassing situation as a one-off, or a learning experience and make the best of it. A person with low self-esteem would attribute it to their own fault, and would think that they are right in thinking that they cannot do anything at all, thus making it a self-fulfilling prophecy.

    Can social anxiety or phobia be cured?

    The answer is yes. Not only with social anxiety but also with other anxiety disorders, there is some amount of fear of social situations, and therapists provide ‘social skills training’ to get over this fear. In this, detailed effort is made to unconditioned the fear of social situations, to understand accurately what facial expressions mean, how to start and maintain a conversation, how to make a compliment, an argument and so on. Since there is a high eagerness to make their situation better, clients do find the training very helpful.

    The therapists may even work on a client’s absolute thoughts, such as ‘I must excel at everything I do’ which is an unrealistic thought that put pressure on the person and increases anxiety. These thoughts are disputed and replaced by healthier thoughts. Slowly, clients start to do their disputations on their own, and feel much lighter and less anxious with these healthy thoughts.

    Since social anxiety can occur with other issues like panic disorder, generalized anxiety disorder, agoraphobia and depression, sometimes medication may be suggested to reduce the intensity of the concerns. This helps to bring the person to a level where he or she can work on their thoughts and social skills.

    If you or someone you meet or know seems to go through these concerns, please do not dismiss these and ask them to ‘buck up’. If it were that easy, they would have done it already. They need help and the sooner they get it, the faster they get it, the better they could use the help and resolve these concerns.

     Image source : (http://www.ianwalshaw.com/selby-hypnotherapy-hypnosis-hypnoband-yorkshire/hypnotherapy-helped-problem/social-anxiety/)

    Responses 1

  • 22 Oct
    Shiva Raman Pandey

    Understanding PTSD

    PTSD or Post-Traumatic Stress Disorder, is a variety of linked symptoms that people experience after living or going through intense trauma.

    Understanding PTSD

    Image source: (https://bradfordhealth.com/ptsd/)

    According to DSM V, the following criteria are necessary to diagnose PTSD:
    ⦁ Actual/threatened death, injury, sexual violence
    – Direct experience
    – Witnessing the event
    – Find out that it happened to a close family member
    – Experiencing the aversive details of the traumatic event repeatedly (cops hear abusive stories again & again) - This is not applicable to children below 6 years of age.
    • Doesn’t apply to seeing it on TV
    Any 1 needed of these is needed to fulfill criteria number 1.
    ⦁ Intrusive Symptoms after trauma (Same for children < 6 PRESCHOOL SUBTYPE)
    • Recurrent, involuntary, distressing memories (play themes in children > 6)
    • Distressing dreams with traumatic themes (children, frightening theme. May not be able to say the theme)
    • Dissociative reactions (flashbacks)
    Feels/acts (sensory, emotional, behavioral) as if the event is happening again – extreme can be loss of awareness of surroundings
    ( Children enact through play)
    • Distress when exposed to the traumatic cue
    – External cues – reminders
    – Internal cues- similar bodily signs during trauma
    • Physiological reactions to internal/external cues
    Any 1 needed of these is needed to fulfill criteria number 2
    ⦁ Persistent Avoidance of Stimuli (Same for children < 6)

    • Avoidance/efforts to avoid distressing memories/thoughts/feelings of trauma

    • Avoidance/efforts to avoid

    – External reminders – people, places, situations
    – Arouse distressing memories

    ⦁ Negative alterations of Cognitions/Mood

    • Inability to remember important aspects of the traumatic event

    – Due to dissociative amnesia – not brain injury/drug

    • Persistent & exaggerated negative beliefs about self & world

    – I’m bad

    – No one can be trusted

    – I’m permanently damaged

    • Persistent distorted cognitions

    – Cause & consequences

    – High self-blame

    • Persistent negative emotional state

    – Fear, anger, horror, guilt, shame

    • Diminished interest in activities

    • Detachment/estrangement from others

    • Inability to experience positive emotions

    Negative alterations of Cognitions/Mood

    ⦁ Alteration in Arousal & Reactivity (Same for children < 6)

    ⦁ Irritable behavior, angry outbursts

    – Without provocation

    – Verbal, physical aggression towards people/objects

    ⦁ Reckless, self-destructive behavior –

    ⦁ substances, (para)suicidality

    • Hypervigilance

    • Exaggerated startled response

    • Trouble concentrating

    • Sleep disturbance.

    These symptoms should persist for more than 6 months. It will show in children slightly differently, but will definitely be recognizable. Sometimes, there may be a delayed onset. That is, the display of PTSD symptoms may occur months after the actual trauma gets over.
    If you feel that you or someone you know maybe going through one or more of the symptoms, it is important and urgent to seek care. The disturbance you see in behaviour is much lesser than the disturbance that the person may be going through within. A history of known trauma is a big red flag here.
    PTSD is treatable. Medications and psychotherapy can help the person reduce the symptoms as well as work through the trauma and feel better. Care and help is available if you or someone you know has PTSD. Use it today.


    Responses 1