PANIC FREE: Eliminate Anxiety/Panic Attacks
without Drugs and Take Control of Your Life

by Lynne Freeman, Ph.D., Arden Books, Sherman Oaks, California, 1999, 190 pages, $13.95
Reviewed by Sherry Bortnick, M.A.
     If the 1990s have been accurately described as the "Age of Anxiety," as Dr. Lynne Freeman tells us in the preface to her new book, perhaps the next millennium will be the beginning of a new era for anxiety disorder sufferers. In the past decade, many books have been written on this topic yet Freeman's PANIC FREE: Eliminate Anxiety/Panic Attacks Without Drugs and Take Control of Your Life is an excellent, hands-on, user-friendly addition to this field. Like many previous authors on panic disorder, Freeman has experienced the terror of panic attacks herself and this has undoubtedly contributed to her enlightening and expansive exploration of alternatives to living with that fear.
     While many of the commonly known biological origins of anxiety and panic disorder symptoms are identified, such as mitral valve prolapse, hyperthyroidism, and hypoglycemia, other physical problems or reactions, which play a similar role, are addressed as well. Some persons with panic disorder, for example, may find that glaring sunlight or bright indoor lights (such as those in supermarkets or shopping malls) may help trigger a panic attack. This is known as photophobia, and wearing sunglasses may reduce the risk of an attack. Crowd noise, bright displays or other aggressive stimuli may also contribute to panic attacks in these situations.
     For many individuals with panic disorder, allergic reactions to food can bring on a panic attack. Candida albicans, a specific type of yeast infection, can intensify anxiety. Allergic reactions to environmental pollutants, such as carbon monoxide, which mimic the physical symptoms of anxiety (i.e., increased heart rate, dizziness, blurred vision), can provoke a panic attack in panic-prone individuals. The significant message Freeman conveys to her readers is that the fear of the feelings of a panic attack can make the attacks recur. And, most importantly, people with panic disorder have "no clear-cut way to distinguish between real and seeming anxieties."
     Since anxiety disorders create complications in the lives of those who have them, and affect those who share their lives, the chapter on "Special Issues" will be most helpful. It addresses the risks and benefits of disclosing the disorder to other adults, employers, and particularly, to children. Parents who have an anxiety disorder will appreciate the suggested guidelines to help determine how and what to tell children — and when.
     Adults with panic disorder, Freeman tells us, are "18 times more likely to have attempted suicide or to have thought about it than adults with no other mental illness." But the primary message emphasized throughout is: you can overcome your fear. Successive chapters offer a range of techniques and methods for dealing with anxiety, which are referred to appropriately as "tools."
     Breathing exercises, relaxation exercises, cognitive-behavioral techniques, and visualization are among the "tools" emphasized. They are clearly explained and can be practically applied. Breathing exercises are important because the panic disorder sufferer often under-breathes, even when in a resting state. 		A progressive relaxation exercise is a combination of visualization and breathing, with the goal of achieving a calm state of mind. Several cognitive-behavioral approaches are described. One such approach is called the IST: IDENTIFY, STOP and TRANSFORM your thoughts. With this method, the person identified the negative self-statement — i.e., "I can't. I'll get a panic attack." — tells themselves to stop this thought and then transforms that thought into a positive one: "I can do this even if I get anxious."
     Freeman suggests that one can feel as thought the fear itself is like a "ferocious beast" which thrives on an individual's power. To demystify this "beast," she has developed an "animation visualization" in which the person gets into a relaxed state, chooses a character they imagine to be ominous, and turns that character into a cartoon. The cartoon character, which represents anxiety, can then be employed in various scenarios. One that she uses the most often, the "anger as power" visualization, addresses the issue of anger her clients express once they realize the impact their anxiety disorder has had on their friendships, jobs or marriages. After getting in a relaxed state, using animation visualization to initiate a dialogue with this cartoon figure, she encourages people to direct their anger at this monster. The "animation visualization" and the "anger as power" help to discharge the anger.
     Probably the two greatest fears of anxiety disorder sufferers are the fear of dying and the fear of insanity. Panic Free examines these, with suggestions for dealing with these fears, but it covers several other fears (dizziness, choking, vomiting, claustrophobia, feeling "trapped" in the presence of others, anxiety while walking, the urge to run home, freeway driving, and social anxiety) as well. A full chapter is devoted to generalized anxiety disorder and depression, and the difference between panic disorder and generalized anxiety disorder (GAD) is clarified (with GAD, the anxiety is "free floating"). Freeman discusses the prevalence of depression in people who have GAD, the seriousness of the disease, ways to identify symptoms and the importance of seeking professional assistance.
     Common medications used to treat anxiety (and/or depression) are identified and explained. Possible alternative approaches, including acupuncture, homeopathy and herbs are also briefly mentioned, with a warning that an extensive medical evaluation is essential before exploring these options. Freeman makes it very clear that these alternative approaches are in no way to be used to the exclusion of psychotherapy. Whether one takes medication or not, the methods discussed in Panic Free offer anxiety sufferers options and hope. This is a well-written book, with many very clear instructions, making it a good choice both for those with an anxiety disorder and for the mental health professionals who are working with them.

Sherry Bortnick, M.A., is a freelance writer living in Rockville, Maryland.