(bright music) - [Announcer] Major support for this program was provided by Nancy and Nyle Maxwell.

Emerson.

Kathy and Charlie Izard.

Additional support was provided by Amanda Jensen and Scott Bonneau.

Amado DeHoyos.

Georgetown Health Foundation.

Kristen and John Nelson.

(bright music continues) And by... And also by... For more information and a full list of funders, please visit us at howarewetoday.com or aptonline.org.

The information provided in this program is for general educational purposes only, and is not intended to constitute medical advice.

This is not a replacement for therapy and does not constitute therapeutic services or a therapeutic relationship.

For personalized medical guidance, or in the case of an emergency, please contact a healthcare provider.

(bright music) (bright music continues) (switch clicking) (gentle music) - Oh, hey.

How are we today?

Hope you're warm wherever you're at, because I am turning into a popsicle in my own apartment.

But hey, who doesn't love a snow day?

And I love my favorite ski suit when I'm outside and it's snowing.

That's life, though.

It'll throw you curve balls, or snowballs.

Like when your heater goes out, which can leave you feeling a bit frozen.

Not just because you're chilly, but because it can be easy getting caught up worrying, "What if it happens again?"

Which, of course, leads to its own brand of perpetual anxiety, which greatly affects your happiness.

(knocking at door) Ah, hey, Mariel, what's up?

- Hey bud, can I use your washer and dryer?

Mine's busted, and holy!

It is colder than a landlord's heart in here!

- Well, my heater is busted and I put a call down to maintenance I don't even know how long ago, and nobody picked up.

- You know, I put a call in, too, and I haven't heard from them.

That's super weird.

- Heard from who?

- Maintenance Mike.

- Mike?

- Yeah, Maintenance Mike.

You don't know him?

Super outgoing, really fun.

Really great guy, great at his job.

- I don't think I've ever seen him, but I tell you, if he doesn't show up in a few minutes, I'm starting a bonfire in my living room.

- Can we use this shirt as some kindle, maybe?

- What's wrong with that shirt?

- Really?

- It's my comfy shirt, that's, it's my happy time place!

It puts me in a summertime mood, which I really wish I was in today.

(jaunty music) Holy mackerel!

- Turkey, actually.

Uh, mind if I use your oven?

- Sure, Barb, but you know it's not Friendsgiving, right?

- I like turkey.

'Sides, who says you could only cook turkey once a year?

Though it does feel like November in here.

What's going on?

- Heater's out.

- Washer's out?

- Oven's busted, isn't it?

- Yeah.

- Man, this Maintenance Mike guy doesn't really seem to be good at maintenancing anything.

- You guys haven't seen Mike, either?

- Nope.

Is he always like this?

- No, he's pretty professional and, like, really good at his job, so I'm not sure what's going on.

- Yeah, it's honestly a little concerning.

- Yeah.

(knocking at door) - There he is!

- Maintenance Mike!

(Mike groaning) - Good to see ya!

- Hey, guys, sorry for the delay!

- Mike, I take it.

I appreciate it.

Clearly, though, we have a lot of things going on right now.

- Oh, yeah!

Well, you're telling me.

Okie-dokie!

I'll take a look at the heater first and then I'll get on to the rest.

- Honestly, you might want to start with Mariel's washer, because yikes.

- Hey!

(Mike laughing) - Sounds good.

Well, you know what, that'll probably only take a couple seconds.

Probably just a loose bolt or something.

I, I, just need my wrench!

Oh.

I'm sorry, I, I think I left my wrench in the truck.

Um, I'm really sorry, you guys.

I'll just run downstairs and get it.

I'll be just a couple minutes.

- Is the elevator broken?

'Cause I took it this morning to go get coffee.

- No!

No, elevator's fine.

(pensive music) - Wouldn't the elevator be easier?

- Faster?

- I mean, yeah, but I mean, I'm good.

(laughs) - Wait, is that why maintenance has been so slow?

Have you been taking the stairs this whole time?

- Ah... - Is everything all right?

(Mike sighing) - All right.

There was a, there was an incident.

I, I had, had a, a panic attack on, on the elevator.

I, I never had one of those before, and it was really pretty terrifying.

- Gosh, I'm so sorry, Mike.

That must have been really scary.

- Yeah, that's terrifying.

I'm so sorry.

- Um, can we ask what happened?

- Yeah, like, are you just kind of uncomfortable in tight spaces?

- Did you get stuck in there?

- (sighs) Well, you know, that, that's the most frustrating part, is I, I have no idea what triggered it.

It just kind of happened.

- Hey, Mike.

Why don't you take this?

- Oh!

- Let's work on fixing the heater, and then you can tell us all about it, yeah?

- Okay.

(bright music) (wrench rattling) (Mike groaning) (metal squealing) (drumroll rumbling) - Ah, there we go!

(bright music) All right.

Thanks for the helping hand.

It'll, it'll take a little bit for it to warm up your place, but it's working again.

- Oh, thank goodness!

- You're the man, Mike.

- Thanks, Mike.

Guys, why don't we go huddle up next to the campfire, yeah?

- Hmm!

- Yeah.

- Yeah, come on!

(exhales) Well, to begin, you know, everything started off normal.

(saucy music) I was doing a, a quick fix on the elevator panel one night.

Nothing to it, really.

Everything was fine.

I had a typical day.

There was nothing out of the ordinary.

I even remember being in a good mood.

(saucy music continues) And then, something happened when I was working.

(music fades) It just, it just started, I was, I was instantly, like, dizzy and lightheaded out of nowhere.

Just, just a surreal, almost out-of-body experience.

But not, not in a good way.

My legs started to tingle and I could feel myself collapsing inward.

I never felt anything like that, and... (machinery humming) (eerie music) I couldn't breathe.

And when I tried to, it was just tighter and tighter, and, and then... (Mike crashing) I can't even remember how, but I ended up on the floor.

Felt like I was suffocating, like the world was getting smaller and tunnel-visioned, and my heart was, was pounding so hard.

I, I, I honestly felt like I was gonna die.

(eerie music continues) (Mike grunting) And then I, I, I finally crawled out and just laid there.

And I don't even know how long, because, 'cause the weirdest part about it is that even though I can remember the panic that I felt, I, I can't remember hardly anything else about it.

(eerie music continues) So, I, I called 911, 'cause I didn't know if I was having a heart attack or a stroke, or, or what, you know?

I just, I just knew I was, I was just really scared.

I haven't told anyone because it's embarrassing, you know?

I mean, it's, it sounds pathetic that you, you, you know, freaking out over nothing.

- Mike, that is not pathetic, not at all.

- I mean, it's always okay to get things checked out, especially when it's new or different.

It's better to be safe, right?

- Yeah.

- And now that you know, maybe it won't feel as scary if it happens again.

- But see, that's part of the problem, you know?

I mean, since, since I don't know what happened or what triggered it, it, it's kind of given me this weird case of elevator phobia.

- Elevator phobia?

- Yeah.

So, I've been avoiding elevators altogether in the hopes that the feeling will go away, but it's not working.

(eerie music) 'Cause every time I get near it, I get this little trickle of dread.

(elevator door creaking) It starts to build, and it feels like that beginning of the panic attack again.

(eerie music continues) And just thinking about being inside the elevator carries with it its own sort of anxiety.

It's turned into this monster in my head.

My brain morphed it into existence.

I mean, I know my mind is, is playing tricks on me and the, you know, the monster's not real, and the best thing is to just breathe deep and be calm and try not to think about it.

But, like... (eerie music continues) Even when I think I've forgotten it, it finds a way to kind of come crawling back in.

(heartbeat pounding) (eerie music continues) All I can do is pray it doesn't happen again.

So, that's why I've been so slow.

I'm sorry you guys are suffering 'cause of my elevator phobia.

- Well, I don't mean to be rude at all, and I'm not a doctor, guys, but I don't know if elevator phobia is a real thing or what.

- I mean, I, I checked it out online.

You know, good old self-diagnosis.

I mean, it's either that or it's post-traumatic stress disorder.

- Can you get PTSD if something dangerous didn't actually happen in there?

- I don't know.

- Well, I think I know somebody who might know.

- Dr.

Erin?

- Yeah, I figured we needed her today, so, texted her a while back, and... (bright music) - Hey, everyone!

- Should be here any minute.

- Why is it so freezing in here?

- (sighs) It's a long story, Doc.

Head on over.

(bright music) Okay, so we caught Doc up on Mike's situation, and she's gonna give us a lowdown.

But it's important to remember that Doc isn't actually Mike's provider.

She can merely offer advice, not diagnosis or treatment options.

Ready to learn s'mores?

Okay, let's go.

- Mike, I'm so sorry that you're going through this.

Having a panic attack, especially for the first time, can be a really scary ordeal.

It's really good that you're able to recognize the feelings that are coming up, especially those physiological feelings, like shortness of breath or tunnel vision, those things that can come with fear, especially when it's presenting like panic.

- Yeah, I mean I, I would definitely say that fear and panic is what I'm feeling with all this.

- One of the first things that we typically wanna do when something like that shows up is try to figure out why it's happening, right?

Like, why is my body feeling this way?

What's going on?

You said that you didn't really know where it came from, that just, all of a sudden, this sort of popped up, right?

It's one of the most frustrating things with panic attacks, is they can sort of just pop up out of nowhere.

But, you know, while we're trying to figure out what's going on, there's a couple things we can rule out in the meantime.

So, you mentioned PTSD, but the thing with PTSD is that, usually, there's a really clear traumatic event or series of events that triggers the fear.

PTSD can present with flashbacks that can feel like or even include panic attacks, but it's usually the trauma that's the cause of the fear.

With panic attacks, however, usually, those can just kind of come up out of nowhere.

- So, if it's not PTSD, why is Mike continuing to have panic attacks?

- That's a really good question, because they can feel kind of similar.

But basically, panic attacks are so painful, so scary, and so aversive that our body essentially says, "Wow, I literally never wanna feel that way ever again."

Then, we start to sort of fear, fear.

We start to look for ways to avoid ever having another panic attack, and we can get caught in this really tricky cycle.

- I mean, that makes sense for me.

So, so then, it's just panic.

- Well, it's not just panic.

Many people would argue that panic attacks are some of the most painful experiences they've ever had.

It's really important that we validate that because it can be so easy to dismiss if, in the back of your head, you're thinking, "Nothing really happened."

But something did happen.

You had an experience that involved extraordinary fear.

The truth is, whether you're drowning in the ocean or in a puddle, it's an equally unfun feeling.

Fear is fear, after all, no matter the trigger.

- If fear is fear, then how is this not phobia?

I mean, he's been avoiding the elevator because he's so afraid of it.

- That's a really good question, and sometimes, it's kind of tricky to tease it apart.

But essentially, we can think about it this way.

If it was a phobia, the fear would be specifically of the elevator, whereas this is more a fear of having a panic attack that just happened to happen in an elevator.

- Well, I guess now I just gotta avoid the, the triggers that could cause a panic attack.

So, I guess all stairs for me.

(laughs) - We need our stuff fixed a little faster than just stairs, Mike.

- Yeah.

(Barbara laughing) - And here's the thing with that, though.

That's a totally logical thought, and it makes sense, because panic attacks, again, are so aversive that we think, "I wanna avoid ever having one, so I wanna avoid anything that could trigger one."

But unfortunately, as you're kind of seeing right now, that's not really working, is it?

- No.

- But usually, that is the first thing that people wanna do, is they wanna avoid anything that could make them feel like they're having a panic attack or feel similar to how they felt when they were having a panic attack.

Like, for example, sometimes people even avoid tight-fitting clothing, just depending on whatever symptom of the panic attack was the most painful.

The thing with fear is that it triggers our fight-or-flight response, and then our bodies go into this unconscious, really instinctual mode in answer.

The problem is, if there isn't actually a direct threat, then our alarm system can get overactive, and then we go into fight-or-flight mode when we don't actually need to.

Remember that the key here is that when we feel fear, the normal response is to wanna avoid.

- I mean, that makes sense.

Of course we would wanna avoid things that are scary to us.

- Yeah, like when you cover your eyes during horror movies that aren't that scary.

- I know, I'm agreeing here, Mariel!

- I do the same thing.

It makes complete sense to wanna avoid a threat.

We can sort of think about it this way.

Fear is the fear of a direct or immediate threat, whereas anxiety is a fear of a perceived threat or a could-be threat.

"What if there's a threat?"

But most of the time, the threat isn't actually happening, or the anxiety is tricking your body into thinking that whatever is happening, you can't handle, which isn't true.

The key here is that the more we avoid a thought, the more power the thought has.

The more we avoid a situation, the scarier the situation can be.

Avoidance grows fear.

Sort of like when you do something new for the first time, it feels scary and uncertain, like, what's gonna happen?

But then, the second time, it's easier.

But the new scary thing is always gonna be new and scary unless we do it.

Sometimes the best treatment for anxiety is really taking the power away from the thought by facing it.

- Wait, I think I know this one.

It's exposure therapy, right, facing that fear head-on?

- Bonus points for Barbara!

(Barbara laughing) Exposure therapy can be a really effective tool, but it's probably not something you wanna do without professional support.

In fact, why don't we go practice now, Mike, if you're up for it, and we can do it together?

- Uh, uh.

All right, might as well give it a shot, right?

- Yeah, and we're gonna be right there with you.

- Okay.

- Yeah, we're here for you, buddy, no matter what.

- Okay.

- But what is it exactly we're doing?

- We're gonna go face some fears.

Tyler, do you have a flashlight?

- Hmm.

I do.

- Grab it.

- Shall we?

- Shall we.

- Onward!

(bright music) - All right, so, for this next part, what I want you to do is grab a flashlight or two, or just use the light on your phone.

But if you don't have either, just bring your attention.

I'll explain here momentarily.

All right, guys, got 'em.

Let's go!

- Okay, so we're gonna do a skill here that's not about getting away from the fear.

We can't really do that.

This one is just about noticing it in a way that's gonna be helpful.

And it's not actually an exposure per se.

It's really more of a getting started tool.

This one specifically is from acceptance and commitment therapy.

Hand me the flashlights, and then you go turn off the lights.

- Okay.

(soft music) (switches clicking) - (exhales) Okay.

Mike, go ahead and follow along with me.

Turn on your flashlight.

Put it on the elevator.

When the lights are down, we really hyper-focus on the bad thing.

It's like it's all that we see.

We're really focused on it and we can even fixate on it.

But when we pull back a little bit and maybe look left or right, we start to realize that there's more in the room than just the elevator.

Now, what we want to do is turn the flashlight away, don't think about it, don't look at the elevator.

But unfortunately, that doesn't actually work.

In fact, when we try not to think about something, our brain ends up thinking about it more.

So, instead, what we wanna do is acknowledge that it's there.

Acknowledge the fear, acknowledge all the emotions that are showing up in relation to the object or the situation or the thought.

But also, acknowledge that it's not everything.

It's one piece of a whole bunch of other things in the room.

It's not about ignoring it.

It's more about diffusion, letting the scary thing exist without being in charge.

We can let our pain show up without being the sole focus.

- Pain?

What kind of pain?

- Any kind of pain.

You can do this with chronic pain, physical pain, or really, any emotional pain, any thought or feeling that is really causing you heartache.

- So, we should do this when we start to feel pain or fear panic?

- Yeah, so much of therapy is about changing our relationship to the thoughts and feelings that show up.

We can't always stop the fear from showing up here, but what we can do is change how we respond to it.

And really, this is about choosing ways to respond that are gonna be helpful instead of doing things that don't help so much, like reassurance-seeking.

- Reassurance-seeking, what's that?

- Exactly what it sounds like.

Reassuring yourself that you won't have another panic attack.

Unfortunately, we can't actually guarantee that, right?

What we can guarantee is that, whatever happens, we know that you can handle.

- [Mike] So, my fear is real, but so is everything else in my life.

- Yeah, exactly.

Your thoughts, your feelings, your values, your beliefs, your relationships.

Everything else exists also.

This feeling is just one feeling in my body and in my world right now.

And the flashlight can really help us to see our pain in the greater context of our lives.

(all murmuring) - Wow.

- That's pretty deep, Doc.

But more importantly, Mike, how do you feel?

- Well, uh, okay?

I mean, I still feel a little uneasy, but it's, it's manageable.

- I'm so glad that it feels manageable.

It makes sense that it feels uneasy, still, though.

This is a really new, kind of weird way to think about our thoughts and feelings.

But the fact that you were able to do this at all and really face it is a really good first step.

- And I think that deserves a reward.

Uh, Mike, you like hot chocolate?

- I, I do like hot chocolate.

- Hey!

- Yeah!

And in fact, with our hot chocolate, I have another skill that we could do that might also be helpful.

- Ooh, what about some marshmallows?

- Yeah, I got you covered there.

- Thank you very much.

- Okay, so we're gonna do a grounding exercise that involves mindfulness to get us out of our minds and into our environment in a way that's calming.

There's a number of different grounding exercises you can do.

This is one of my favorites, and it's called Find 10.

(bright music) (bubbles popping) So, just like with the flashlight, this is gonna help us bring our awareness and our attention to our environment in a way that will help us figure out what we wanna do with our thoughts and feelings that are showing up.

So, Mike, what I want you to do is, from where you're standing, don't move.

Just look around and find 10 things that are red.

Just call them out.

- Just me?

- Mm-hmm.

- Okay, uh, that pot.

- One.

- So, yeah, this is basically all that we're doing, playing I Spy with colors.

And it doesn't have to be 10, by the way.

It can be five, it can be three.

And it doesn't even have to be colors.

It could be objects or shapes.

And I know it sounds cheesy and very simplistic, and you're probably sitting there, thinking, "Tyler, do you really just want me to look for colors?"

Yeah, I do.

(laughs) That's all I want you to do.

So, here we go.

I want you to find five yellow things in my apartment.

Ready?

Go.

(bright music) (bright music continues) And that's it.

That's all we're doing.

Giving our brains a little break, allowing it to focus on a really easy task so it can draw focus away from tension or stress or panic.

- This red part of my, my mug.

- Nine.

- And, uh, ah!

And that trolley!

- 10.

- Ha-ha!

- Perfect!

That's Find 10.

- Wow.

You know what?

I, I can't, I can't thank you guys enough.

I mean, I know I, I kinda lost my tools today, but I feel like I got some new important ones.

I really appreciate it.

And it's a good thing, too, 'cause I still owe you guys some maintenance.

- Perfect, because I am very hungry and this turkey needs a-cookin'.

- Okay, me next.

Dr.

Erin, you mind grabbing my laundry?

- Oh, yeah.

- It's kinda stinky, so I don't know.

You wanna come help me do some more Find 10 at my place?

- Sure.

- All right.

- Yeah.

Tyler, wait a minute.

Are you wearing one of those fish shirts?

- Yeah, actually, it's my favorite one.

- Dude, that's brutal.

- What?

Oh, come on!

Really?

Barb.

- I kinda like it.

- Hey, sea?

Sea, guys, like- - That, that fish has some red on it.

- There you go, yes.

- That's 11.

- Yeah, get it?

Sea, like ocean, like swi, that was a good one, guys, don't be so crabby!

(bright music) It's amazing how quick the seasons can change when we stop and do a little maintenance on ourselves, isn't it?

Noticing when we have those pesky feelings showing up and practice grounding ourselves.

Whether it's one of our activities or one of your own, we can begin to weather those storms and make them just a little drizzle.

So, until then, take heart and take care.

Hey, I'm not trying to do this on porpoise!

(laughs) Oh, I'm floundering.

Ho, that is fishy.

I gotta get out of this thing.

My goodness.

(upbeat music) (upbeat music continues) (upbeat music) - [Announcer] Major support for this program was provided by Nancy and Nyle Maxwell.

Emerson.

Kathy and Charlie Izard.

Additional support was provided by Amanda Jensen and Scott Bonneau, Amado DeHoyos, Georgetown Health Foundation, Kristen and John Nelson.

And by... (upbeat music continues) And also by... For more information and a full list of funders, please visit us at howarewetoday.com or aptonline.org.

(soft music) (bright music) (stirring music)