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 Q: I have been having anxiety attacks for some months now and have been to see my GP who feels I need some form of counselling. The attacks just seem to happen and last for only a few minutes at a time. They are a bit like asthma and my heart rate goes up and I sweat heavily. The attacks have been getting more frequent recently and lasting a bit longer.

I belong to a health club and go regularly. My husband and I also sail and ski every winter. We both like to eat healthily, but recently we have both started drinking more alcohol than I know is good for us.

My husband has a business which is not doing well and we owe a lot of money. We owe two terms school fees for our two children and are in arrears with our mortgage. He says everything will turn out alright, but I am not so sure. I came from a really poor family and I don't want to be like that again.

How can you help me?

What should I do?

A: From what you tell us, it is clear that you are suffering from stress and seem to need help in the formulation of successful coping strategies. If you do not adopt suitable methods of coping with your stressors, you are in danger of becoming ill from stress-related illness and then you will be unable to help your husband, your children, or yourself.

The essential feature of panic attacks is usually a sign that anxiety is getting out of control. The initial symptoms vary, but can include all of those which affect you : rapid heart beat, sweating and breathlessness. These attacks can sometimes be triggered by chemicals and drugs such as caffeine - found in tea, coffee and cola or they may be caused directly by stress. One important cause of panic attacks is the build up of anxiety over time. In your case, talking to you would tell us if you have an excessive intake of chemicals or caffeine. If this is discounted, and it seems likely that it will be, then it is assumed anxiety is the cause of the attacks.

For you, the best way to stop the panic attacks may be to stop the build up of anxiety. Your anxiety seems to stem from what you perceive as financial insecurity and to you this is a very real problem allowing the stressors to take control of your life. You might wish to consider confronting your problems and in doing this attempt to re-establish your control.

You need to sit down and talk things over with your husband as the problem is one for both of you. Try to discuss things in a non-accusatory, logical manner so that together you agree on the best way forward.

As you already live a healthy lifestyle and probably take aerobic exercise, you are part way towards relieving stress. Regular gentle exercise is one of the best ways of preventing panic attacks as it reduces muscle tension, reduces heart rate and reduces stress hormone levels. The prolonged aerobic exercise which you take causes production of endorphins, which produce feelings of euphoria and relaxation. The exercise you do should produce these feelings and reduce her stress, but this does not seem to be happening as your panic attacks are actually increasing. Professional opinion suggests at the very least it is important to take aerobic exercise daily for a minimum of 30 minutes each time. Your aerobic exercise may be insufficient in terms of frequency or time.

Paradoxically, your membership of this particular health club may cause you stress. You may feel that it is too expensive in your current financial state, and yet be unwilling to give it up because you fear loss of face and worry what your friends and acquaintances will say if you suddenly disappear. You may have to buy expensive and the very latest in leisure wear and equipment if you wish to conform to group norms and expectations, thus increasing your anxiety as to how you are going to afford to do so.

Again, you seem to be pre-occupied with the material things which money can buy as your lifestyle indicates a liking for expensive hobbies, i.e. dinghy sailing and skiing. The very fact at having two children at fee paying schools also mirrors this attitude and beliefs.

As we said before, you need to sit down and talk to your husband. You need to be open and honest with each other, and must start to prioritise. As your problems have finance as their origin, this could be the starting point. Have you considered a less expensive health and leisure club. You may well find that you are better able to carry out the exercise necessary to combat stress in a less expensive and less socially demanding club, or even exercise at home, perhaps with the view that this is simply a temporary measure until the financial problems are less pressing. As a couple, could you save money on your dinghy and expensive skiing holidays. Clearly, hard decisions and actions need to be made. There is also the possibility of selling your house and if you are not in the state of negative equity, using any residual value to either purchase a cheaper house or consider renting. As a couple you may also like to consider the expense of sending your two children to fee paying schools. It is possible you could use the excuse of moving house for placing your children in the maintained sector as opposed to the private sector, which may be less stressful to all concerned. You may wish to involve the children in discussion of finances and in these situations it is not unknown for the children to volunteer to move to a maintained school.

If you think you and your husband are drinking more than you should, then you need to do something about it. Resorting to increased alcohol consumption is the wrong way of coping and needs to be checked. Like caffeine, alcohol stimulates adrenaline secretion and produces the same problems of nervous tension, irritability and insomnia. Excess alcohol increases fatty deposits in the heart and decreases the immune function. Alcohol is toxic to bone marrow and inhibits the liver's ability to detoxify the body. Thus where liver function is impaired, toxins including hormones released during stress will continue to circulate. Problems associated with heavy drinking include 'the loss of jobs, cirrhosis of the liver, suicide, marriage breakdown, child abuse and accidents at home or work . So we seriously suggest you and your husband carefully monitor your drinking and confront your stressors rather than retreat from them.

It seems reasonable to suggest that you try some form of relaxation to help face up to the problem. It is also suggested that your husband could also benefit from practising relaxation techniques. It would be useful in combating stress, for you to practice relaxation techniques, by progressively contracting and relaxing the muscle groups in order to release the tensions in them. To evoke a feeling of mental calm and inner peace, you may like to try mental relaxation exercises. Autogenic training, which has been found to have a positive healing effect on people able to calm and relax themselves, could help you, but in order to induce the state of self-hypnosis, you would be advised to consult a person skilled in this technique. Underlying self-hypnosis, is the idea that when in a state of deep relaxation, the mind is freer to work and help the individual make changes more quickly than when not using the technique. You might like to try aromatherapy in order to relax. You could use this in a bath, which also could assist relaxation, or inhale the vapours from your chosen oils, or even apply the oils as a massage. Suitable oils for you to try would be : bergamot, jasmine and neroli to reduce tension and depression. You would be advised to seek further advice from a qualified aromatherapist should you show interest in taking the oils internally.

None of this is cheap, so don't allow yourself to go into more debt to do it. If people buy you presents, you could always ask for these sorts of things as gifts.

You could also profit from learning correct breathing techniques, which are recognised as playing a part in helping to reduce stress levels and its signs and symptoms. In your panic attacks, your breathing becomes so shallow and rapid, a condition known as hyperventilation, that you expel too much carbon dioxide. Practise your breathing to make it more efficient, so that hyperventilation during anxiety can be avoided by controlling the breathing. This reduces stress and leads to feelings of well-being. Your husband might also benefit from basic relaxation techniques, some form of physical exercise and autogenic training and possibly music therapy. Relaxation may change the natural and inevitable tendency to be drawn outwards to the happenings in the world around by redirecting the focus from external events to a concentration on what is happening inside. In doing this, then you and your husband may become sensitive to internal tensions and so be able to attempt to relieve them.

The whole point of your therapy is that you face up to your stressors and become able to deal with them in a positive way. This means that you will be re-establish control over the future and not continue to allow the events to control you as they currently do.

Some of the suggestions may, or may not, work for you. Remember you are the one who is best able to determine appropriate methods of coping with the stressors that currently affect you.

In summary, it is suggested that you and your husband :

* adopt a positive attitude towards stress; face up to it rather than remove it completely

* develop realistic expectations and set attainable goals

* stop worrying about the big things that may never happen, concentrate on the smaller things

* put things in perspective so that minor problems do not become sources of stress

* act for the present and have reasonable concern (but not worry about) future problems

* rest, sleep and vigorous exercise will help reduce stress

* be thankful for what you can do

In all this, try not to forget you are not on you own even though it can feel like it.Other members of your family may be able to offer support, talk to them and do keep in touch with your GP.

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