What is Panic Disorder?

Panic Disorder is an anxiety disorder that occurs when someone experiences recurrent, spontaneous, unexpected, and untriggered panic attacks. This leads to preoccupation with and fear of experiencing another attack. Panic attacks occur when there is an intense physical surge of symptoms that quickly reach their peak, usually in a few minutes. A panic attack can be felt very differently from one person to another. A combination of the following symptoms is typically experienced during a panic attack:

  • Heart palpitations, pounding heart, or accelerated heart rate
  • Sweating/perspiration
  • Trembling or shaking
  • Sensations of shortness of breath or feeling smothered
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizziness, unsteadiness, light-headedness, or faintness
  • Chills or feeling over-heated
  • Numbness or tingling sensations
  • Feelings of depersonalization (unreality)
  • Feelings of derealization (being detached from oneself)
  • Fear of losing control or “going crazy”
  • Fear of death or dying
  • Sense of impending doom or danger

At least one of these panic attacks is followed by one month or more of persistent concern or worry about having another attack and/or a significant change in behavioral pattern (typically avoidance of certain places or situations).

Panic attacks can be viewed as a “false alarm” related to a fight-or-flight response to a mis-perceived threat. Fight-or-flight is a natural human reaction that prepares us to defend ourselves or flee the situation. When someone becomes hyperaware of their body’s sensations, they may interpret a sensation as a threat when there’s not one.

Panic disorder affects 2-3% of Americans and is affects women roughly twice as frequently as it affects men. The onset of Panic Disorder typically occurs in adulthood, but can also affect children and teens.

What is Agoraphobia?

Agoraphobia occurs when someone persistently avoids situations in which they might become embarrassed or have difficulty escaping. This is often the result of fear of having a panic attack in public. This can manifest in fear of using public transportation (such as planes, buses, trains), being in open spaces (such as parking lots, malls, or stadiums), being in enclosed spaces (such as elevators, stores, or cars), being in crowds or standing in line, or even being outside the home alone.

Panic Disorder can be present with or without Agoraphobia, but these disorders commonly present together. When they occur together, Agoraphobia usually develops following an adverse experience, such as having a panic attack in one of these places/situations in which the person feels trapped, embarrassed, or fearful. Over time, avoidance of these situations and places reinforces one’s fear, leading to further avoidance.

How are Panic Disorder and Agoraphobia treated?

People with Panic Disorder often present to emergency departments or their physician’s office due to their uncomfortable physical sensations (often fearing that they are suffering from a heart attack). While it is important to rule out any physical cause for these symptoms, repeated trips to the ER and doctor visits can also reinforce the symptoms. Instead, it is important to receive appropriate mental health treatment for Panic Disorder and Agoraphobia.

Treatment for Panic Disorder and Agoraphobia typically includes of a combination of medication and psychotherapy. Medications commonly used to treat Panic Disorder and Agoraphobia include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), beta blockers, and benzodiazepines. SSRIs and SNRIs are a category of antidepressants that are also useful in treating anxiety disorders such as Panic Disorder and Agoraphobia. Beta blockers can be used to help control some of the physical symptoms of panic attacks such as a rapid heart rate. Benzodiazepines are useful to provide temporary relief of acute anxiety symptoms. These medications can be very helpful, but they should be used with caution due to their potential for dependence. Benzodiazepines can also interfere with the ability to habituate or learn that situations are safe. Only your health care provider should determine whether these medications are appropriate for use and you should not discontinue any medications without consulting with your provider.

Cognitive-Behavioral Therapy (CBT) is an evidence-based type of psychotherapy that is helpful in treating Panic Disorder and Agoraphobia. This therapy helps people to change their behavior and their way of thinking. Various CBT techniques are useful in treatment of these anxiety disorders. Interoceptive exposures involve purposely provoking uncomfortable physical sensations (heart pounding, shortness of breath, dizziness) to desensitize oneself to them. This should be done with the guidance of a trained mental health professional to ensure that it is done correctly. Similarly, gradually limiting avoidance of circumstances and places (such as driving or going into stores) that are typically avoided allows someone to become comfortable and gain confidence in these situations. Breathing and relaxation exercises can help to lower someone’s overall level of anxiety to prevent them from having a panic attack. And finally challenging faulty beliefs, such shifting from thinking “I’m in danger” to “my body is telling me that I’m in danger, but I’m actually safe” can be helpful in lowering related anxiety. Other helpful interventions include biofeedback and mindfulness. Additional lifestyle changes such as reducing one’s intake of caffeine, sugar, nicotine, regular exercise and sleep, and limiting checking vital signs can be helpful in lowering anxiety.

If you believe that you or someone you know is suffering from Panic Disorder and/or Agoraphobia, it is important to seek the help of a mental health provider. These disorders can become debilitating without proper treatment but can become manageable if properly treated.

by Jennifer B. Wilcox, PsyD
Staff Psychologist, Lindner Center of HOPE



by: Ronald Freudenberg, Jr., MA, LPCC-S
Outpatient Therapist, Lindner Center of HOPE

Anxiety can take many forms.  Anxiety is also one of the most common reasons one might seek out mental health treatment.  In this blog, we will explore some of the most frequently occurring anxiety disorders, as well as panic attacks, which can be part of a Panic Disorder (but do not have to be, as will be discussed later).  We will also look at effective strategies for preventing, treating, and managing anxiety disorders and symptoms of anxiety.

Regardless of how anxiety may present for one person, the various anxiety disorders all have at least one thing in common…fear.  Whether it is described as worry, nervousness, feeling “on edge,” or something else, the basic emotion of anxiety is fear.  We all experience some anxiety sometimes, and in fact, you may have heard that a little bit of anxiety can be a good thing from time to time.  It serves a protective purpose when it tells us to avoid people, things, or situations which could be dangerous.  Anxiety can also help us by keeping us on our toes and motivating us to perform well under pressure, such as when pulling an all-nighter before an exam, giving a big presentation at work, or playing in the championship game.  Yet, as with any negative emotion, anxiety can become problematic when it becomes too frequent, too intense, lasts for too long, or interferes with our lives and our ability to function well, as can happen in the context of the following types of anxiety disorders.

Types of Anxiety Disorders

Adjustment Disorder

Sometimes, one may feel excessively stressed or anxious about a certain thing or things in one’s life.  People often describe this as “situational”, and the clinical term is an Adjustment Disorder with Anxiety.  (It can also present with depression, or other emotional/behavioral responses.)  An example might be if one would experience something stressful like the loss of a job.  Of course, most people would likely feel some anxiety about this.  However, an adjustment disorder is thought of as when one’s response is out of proportion with what may be typically expected.  With this type of anxiety, once the stressor has resolved, so will the anxiety.  So, when that same individual lands a new job, he/she/they will feel better, simply put.

Generalized Anxiety Disorder

Generalized Anxiety Disorder is very much like it sounds.  This is when a person feels generally anxious, worried, and nervous much of the time (more than half of their days) about any number of different subjects.  In order to meet criteria for the diagnosis, one must experience this type of anxiety for at least six months, find it difficult to control the worry, and present with at least some of the following additional symptoms: restlessness, trouble concentrating, irritability, muscle tension, sleep difficulties, and/or trouble concentrating.  Although every person is unique, classically, a person with GAD may tend toward long-term anxiousness, worry excessively about many things (such as finances, family, work, health, world events, etc.), and lay awake in bed at night doing so.


Specific Phobias are another type of anxiety disorder in which a person experiences strong fear and anxiety about a specific thing (object or situation), and actively avoids that thing or endures exposure to it with intense discomfort.  In this writer’s experience it is relatively rare for this to be a person’s main reason for seeking treatment, at least in outpatient settings.  Perhaps that may be because many anxiety-provoking subjects can be pretty easy to avoid.  (When was the last time you unexpectedly came across a snake?)

Social Anxiety Disorder

An exception to anxiety that is easily avoided, is Social Phobia, also known as Social Anxiety Disorder.  Social Phobia exists when the source of a person’s fear is social or performance situations in which one may feel subject to scrutiny or judgment by others.  Social anxiety may arise when one feels uncomfortable mingling with new people at a party, walking through halls of (seemingly) glaring eyes at school, or giving a speech.  From an evolutionary perspective, if anxiety helps us to avoid dangerous things which threaten our survival, being ostracized from one’s tribe and forced to try to survive alone in the wilderness is near the top of that list.  With this in mind, it is little wonder that public speaking is often cited as people’s number one fear.






Panic Disorder and Attacks

Finally, let us explore the issue of panic.  So, what is a panic attack? Panic Attacks, according to the DSM-5, occur when a person experiences an “abrupt surge” of anxiety which reaches a peak within minutes and includes (at least four of) the following symptoms.

Symptoms of Panic Disorder and Attacks

  • Racing/pounding heart
  • Sweating
  • Shaking
  • Shortness of breath
  • Choking sensations
  • Chest pain
  • Nausea
  • Dizziness or feeling light-headed
  • Chills or heat sensations
  • Numbness/tingling
  • Feeling of unreality or detachment from one’s self
  • Fear of losing control, “going crazy,” or dying

When one develops a fear of having additional panic attacks and exhibits maladaptive behaviors designed to avoid or limit the likelihood of them, this is called a Panic Disorder.  Further, if one’s fear and avoidance includes public situations away from home, open or enclosed crowded spaces from which it would be difficult to escape should panic-like symptoms arise, that is called Agoraphobia (which may, but does not have to, co-occur with Panic Disorder).  Also, according to the most recent edition of the DSM, panic attacks are now thought to be a feature which may occur in the context of a spectrum of other mental health disorders, substance use disorders, and some medical conditions.

Treatment of Anxiety, including Treatment for Panic Disorder and Attacks

When it comes to treatment of anxiety, it is unrealistic for one to expect to live out the rest of their days, anxiety-free.  One can no more be “cured” from anxiety, than from happiness, sadness, or anger.  These are basic human emotions, and there are reasons why we have them.  However, the good news is that anxiety symptoms, whether mild or debilitating, can be effectively prevented, treated and managed, usually by a multi-faceted approach.

How to Manage Anxiety, including Managing Panic Disorder and Attacks

Medications can often be a very helpful part of a person’s treatment plan.  Antidepressants, such as SSRIs, and some SNRIs, are commonly used to treat ongoing symptoms of anxiety, while benzodiazepines (such as Xanax, Klonopin, Valium, or Ativan) are sometimes used on a shorter-term or as-needed basis to alleviate acute anxiety or panic.  (Caution is usually advised with the latter due to their addictive potential.)  Some antihistamines, beta-blockers, and anticonvulsants have been shown to be helpful for anxiety as well.

Various forms of talk therapy can be beneficial by providing a safe, supportive experience in which a person can process fears and learn to implement rational coping thoughts to overcome them.  Therapy can also assist one to form new behaviors to mitigate symptoms of anxiety.  Regardless of the specific therapy used, a common element is learning to approach, rather than avoid, that which causes one’s anxiety.  Anxiety and fear lead to avoidance by definition, while summoning the courage to face and overcome our fears cuts them down to size (this is commonly referred to as “exposure”).  Cognitive-Behavioral Therapies (CBT), Dialectical Behavioral Therapy (DBT, as well as Radically Open DBT), and mindfulness-based psychotherapies are common effective treatment approaches.  Mindfulness can help one learn to be in and accept the present, increasing one’s capacity to tolerate feelings of discomfort while reducing anxious thoughts about the future.

Treating and Managing Panic Disorder and Attacks

In the case of panic attacks, it is advised to first rule-out any medical causes of the symptoms which can mimic other medical issues, specifically heart disease.  If another person is present during a panic attack, they provide support and reassurance, helping the person to talk through it or asking what they need that may be helpful.  In addition to medication, there are other helpful strategies for panic symptoms.

Strategies for Managing Symptoms of Panic Disorder and Attacks

  • Breathing or relaxation exercises
  • Physical exercise
  • Mindfulness/grounding exercises (such as a sensory check-in)

Coping Skills for Anxiety, including Panic Disorder and Attacks

Therapy can also help a person develop effective coping skills for preventing and managing anxiety.  These may vary depending on personal preferences, but can include increasing social supports, problem-solving for stressors, journaling, exploring spirituality, exercise/movement, etc.  Practicing healthy self-care habits (such as getting regular exercise and restful sleep, managing health conditions, and minimizing/avoiding alcohol, caffeine and other drugs) and generally trying to live a balanced lifestyle can simultaneously help to reduce the stress one may experience in life, while increasing one’s ability to effectively cope with anxiety.

Summary:  Anxiety is a common human experience, but persistent and debilitating anxiety, is often what causes people to seek treatment. There are a variety of types of anxiety. Panic or Panic Attacks are among the types of anxiety. Learn what are panic attacks, symptoms and causes and treatments for panic attacks and other anxiety disorders.

Learn more about panic attacks and anxiety.

OCD is a common disorder and affects 1 in 40 people, it is also the 3rd most common psychiatric condition. This disorder can be very tricky and tries to tell lies to keep people trapped in anxiety. Below are the 10 common tricks it tries to use to keep the anxiety lingering as well as how to combat them.

The most common trick is OCD trying to convince you that “this time it is not OCD.” It is important to educate patients how to spot the difference and it’s helpful to emphasize that OCD tends to feel like an emergency and needs to be attended to immediately. One way to treat this lie is to do the “public service announcement” test which is basically challenging the patient to call the radio and request to make a public service announcement to warn people about their fear (i.e., please inform everyone they should not wipe less than 20 times when going to the bathroom, it is not safe to do less than this). This strategy helps them test out their belief and helps them realize they need to accept uncertainty but increase willingness to bet that is OCD and not give in to the compulsion.

The second most common trick is that OCD convinces you that “only crazy, bad, dangerous people have these thoughts.” It is important to teach patients that the content of one’s thoughts is the maker of “crazy, bad, dangerous.” Also educating patients that everyone has intrusive thoughts and how we cannot control our thoughts helps normalize this.

The third most common trick is “if only I knew why I had these thoughts I could stop my OCD.” Many patients have found the why, but actually only have recovered once applying evidence-based CBT skills. Teaching patients that finding the why will not solve their OCD is important.

The fourth most common trick is thinking “you’ll never beat me (OCD), so don’t even bother trying.” Teaching patients that short-term comfort will only lead to worse OCD and more discomfort overall, but short-term discomfort will actually lead to a more free and comfortable life is important for this trick.

The fifth most common trick is to convince you that you must control your thoughts. Teaching patients it is impossible to control their thoughts will be helpful for beating this trick. The more you try to control them the worse they get. Having patients use meditation like leaves on a stream to allow them to practice observing their thoughts is helpful for this.

The sixth most common trick is trying to convince you that compulsions must be done perfectly. To combat this helping the patient complete the compulsions imperfectly is helpful, such as changing the language of compulsions, or changing the preferred hand to complete the compulsion.

The seventh most common trick is convincing you that rituals will help give you the comfort of certainty. This is a common trick and one that patients spend a lot of time trying to obtain. Teaching patients that there is never certainty in anything is key here. Helping the patient see all the ways they are able to tolerate uncertainty in other areas of their life is helpful: while driving, while eating, when going to bed, going to the grocery store, etc.

The eight most common trick is that you will feel better with reassurance. Helping them reduce reassurances is helpful here, which can be done by tracking reassurances and reducing them by 20% each day to week.

The ninth most common trick is thinking you have a great responsibility to keep everyone safe. One cool technique for this trick is to have patients actually try to make something happen to you by thinking “I hope you break leg tomorrow” or “I hope you get a flat tire on your way home.” This helps the patient see that they don’t actually have control over things.

Finally, the tenth most common trick is thinking” if you don’t do this ritual, something bad will happen to you or your family.” To combat this last trick it can be helpful to change the way you do the ritual as mentioned previously, and to also purposefully wish for bad things to happen, which directly targets the fear.


By Angela Couch, RN, MSN, PMHNP-BC

Psychiatric Nurse Practitioner, Lindner Center of HOPE

Anxiety is a common symptom. Anxiety is a part of everyone’s lives, we have all experienced it to one degree or another. Believe it not, anxiety serves some useful purposes. Anxiety can help give you the drive to make a change, or complete task on time.Anxiety can activate the fight or flight instinct, in a “potentially” dangerous situation, giving you the drive to get out of there, or do something to prevent harm. Anxiety can occur when you are enduring multiple stressors, or there is uncertainty, and it’s not entirely unexpected.

For instance, say you hear layoffs are coming in the company, and you’re not sure if your department will be affected. You may experience physical symptoms of anxiety (which could include racing heart, nervous stomach, sweating, tremor, nausea, shortness of breath, and more), and you might also experience worry. COVID-19…yup, that can cause some anxiety, or worry, too! Situational anxiety is a part of life, and often can be managed by rational self-talk, problem-solving, and various positive self-care strategies. (For more on that, see some of our other recent blog articles, for lots of helpful ideas!) So how do we know when the anxiety is more than just “normal” or to be expected, and when to seek help?

According to the National Comorbidity Study Replication, about 19.1% of U.S. adults will have had an anxiety disorder in the past year, and 31.1% experience an anxiety disorder in their lifetime. In other words, it’s pretty common! There are various types of anxiety disorders, and most have an underlying common thread– difficulty in accepting uncertainty in some form. So how do you know if you may need to seek further assessment or help for anxiety, if it’s really so common? If everyone gets it, is it really a problem that requires treatment? The answer is yes, it might. Some symptoms that may indicate problematic anxiety include:

* Feeling “paralyzed” by fear.

* Anxiety is causing you to avoid things you used to be able to do without anxiety, or things that are important to you (this could include social activities, leaving your house, going to your job, driving, engaging in spiritual activities, etc.).

* You have difficulty staying present “in the moment”, which may repeatedly distract you from attending to conversations, being able to complete work or school tasks because of lack of focus.

* You are having difficulty with sleep or eating due to excessive worry or anxiety.

Anxiety is causing significant physical symptoms.

* You cannot determine a cause for the anxiety and the symptoms are persistent or very bothersome.

* You worry about “everything” or “all the time”.

* The anxiety/worry you are experiencing about situations seem excessive.

* You need to engage in compulsive or repetitive behaviors, or do things in a certain way, in order to avoid significant anxiety/worry.

* Anxiety is causing you to turn to self-medication with alcohol or substances.

So you’ve determined you should seek help, now what? Psychotherapy can be helpful for anxiety, and is a very important component of treatment. Psychotherapy may include several modalities such as cognitive behavioral therapy, addressing faulty beliefs contributing to anxiety, psychoeducation about anxiety and worry, problem-solving, exercise and wellness activities/lifestyle changes, addressing sleep hygiene, skills for time management and stress reduction, or exposure therapy, just to name a few.

How do you know if psychotherapy is enough to manage the symptoms? Medication can be a helpful component in treatment of anxiety, particularly if symptoms are not improving with other psychotherapeutic interventions mentioned above. Medications alone are rarely enough to treat anxiety disorders adequately. Medication can often make it easier to engage in meaningful psychotherapy, to make those helpful lifestyle changes, or try new ways of coping with the anxiety/worry. If you are experiencing suicidal thinking or significant depression, medication should be a consideration. If the anxiety symptoms are preventing you from being able to work or do other essential tasks, medication may be indicated. If your therapist suggests a medication consultation, you should consider it.

The important things to remember are, everyone has some anxiety, not all anxiety is bad, and when anxiety does become problematic or excessive, there are evidence-based treatments to help, so don’t be afraid to reach out for help!

Quarantine.Isolation . Lockdown.

Who could have ever predicted that these words – so often associated with scary movies or rare, brief safety emergencies – would become so commonplace in our social language? The terms, themselves, being so casually thrown around that we’ve nearly become numb to their actual magnitude? The concept of loneliness is a broad one: certainly, this can describe distance or literal, geographical separation from others; however, it is also quite possible to experience loneliness while physically surrounded by people. This often arises in response to feeling misunderstood or “different” from those around us, or through a belief that we are truly alone in our struggles and suffering.


When in this state of mind, it’s easy to inadvertently fall into self-destructive patterns and habits that further worsen the depth of isolation we experience. This tends to be easier to “catch” in the “normal” world – someone is missing days at work or school, not showing up to family events, skipping appointments. However, in the midst of the COVID19 pandemic, this has become more difficult to identify, both in ourselves and in family members or friends. In this strange new reality, maladaptive coping might present through symptoms of depression:

– Withdrawing from others by declining phone calls or choosing not to respond to text messages
– Staying in bed during times when you’re not sleeping or physically in need of rest
– Deferring school assignments or work deadlines in favor of binging on Netflix series for extended periods of time
– Not leaving the house for fresh air when weather permits
– Declining hygiene practices and decreased attention to nutritional needs and physical activity
– Self-medicating through alcohol or drug use

In contrast, some individuals experience severe levels of anxiety when facing loneliness or isolation. Those with pre-existing obsessive-compulsive disorder, anxiety or impulse-control disorders, eating disorders, or traits of perfectionism may attempt to cope with isolation by trying to gain a sense of control over specific aspects of their lives. This could present as:

– Excessive cleaning, organizing, list-making in the home without clear need to do so
– Catastrophic thought processes with over-indulgence in news reports and social media
– Difficulty sleeping or resting due to racing thoughts
– Flare-ups of previous OCD rituals or disordered eating patterns
– Difficulty concentrating on school assignments or work due to preoccupation with above concerns

One of my favorite, go-to methods for combating these negative impulses is an emotion regulation technique called “opposite action,” a concept originating from the skill sets taught in dialectical behavioral therapy (DBT). This technique forces us to identify our emotion and the urges or impulses that go along with it, and to assess their degree of helpfulness or harmfulness by challenging them with facts. If found to be irrational or maladaptive, then we aim to implement the opposite of our emotion-driven impulse. We actually implement opposite action frequently through our lives without necessarily naming it as such. By identifying the technique, though, we
can consciously choose to use this skill when our level of motivation to change is low. Consider this example
(modified content courtesy of PsychPoint.com):

STEP ONE: Identify the emotion you’re looking to change. You’re really anxious about leaving home to go
on vacation.
STEP TWO: Identify the urges/impulses associated with the emotion. You actively avoid booking the
vacation by burying yourself in work and household tasks to subconsciously convince yourself that you simply
do not have the time to take a vacation.
STEP THREE: Assess whether the urge or behavior fits the facts of the situation. You have plenty of unused
vacation time and recognize that your year-end productivity will not be negatively impacted by taking the break.
You’ve taken vacations before and your family has benefited from the escape each time.
STEP FOUR: If the emotion and behavior does not fit the situation, then apply the opposite action.
Create a manageable schedule / timetable to take the steps necessary to search for and secure the logistics
required for booking the trip.
STEP FIVE: Experience the opposite emotion. Experience the excitement involved with planning activities
and excursions or buying a new outfit for the occasion. Go on the trip and enjoy the time with your family while
allowing others at work to keep things running smoothly until you return.

Used consistently, opposite action can help us to change our emotional response to stressors over time. It’s
important, though, to commit to the technique so that you can experience the full benefits of taking control of
your mood and behaviors rather than allowing them to be in control of you.

For a quick video explanation of opposite action, view the following:

If you’re experiencing the above symptoms associated with loneliness and have tried methods for self-help
without benefit, or if you’ve been previously diagnosed with a psychiatric illness or substance use disorder
that has begun to flare up in the midst of these extraordinary times, please know that psychiatric treatment
providers are still open, available, and ready to help you through this – at all levels of care.

Clinicians at the Lindner Center of HOPE are seeing patients every day through Telehealth, with options for
telephone or video sessions for both therapy and medication management. Additionally, our services are open
for emergency intake assessments and inpatient hospitalization, partial hospitalization, intensive outpatient,
residential, and treatment for substance use disorders.

If you or a loved one could benefit from professional help, call the Lindner Center of HOPE at 513-536-
4673 to start the conversation and take the next steps toward healing.

Lindner Center of HOPE , Psychiatric Mental-Health Nurse Practitioner

En esta oportunidad quiero compartir con ustedes el articulo que escribimos en mi Grupo de estudio Psicoanalisis de Cara a lo Social integrado por Manuel Llorens, Alicia Leisse, Carmen Elena Dos Reis, Claudia Alvarez, Yone Alvarez y esta servidora.  Nos reunimos de forma “virtual” cada 15 dias para discutir trabajos y temas de corte psicoanalitico y tambien social. Somos todos venezolanos conectados desde el exilio o desde la emigracion elegida.  Espero que les resulte de utilidad en estos tiempos de incertidumbre…


Una de las anécdotas que ha circulado ampliamente en medio de la pandemia es de la antropóloga Margaret Mead cuando un estudiante le preguntó que cuál era, a su juicio, el hallazgo que evidenciaba el comienzo de la cultura. Esperando escuchar algo como potes de arcilla o cabezas de flechas, el estudiante se sorprendió al escuchar “un fémur roto que fue curado”.

La pandemia ha servido para subrayar la íntima conexión de la humanidad entera. La manera en que los hábitos alimenticios, los sistemas de gobierno, los medios cada vez más veloces de transporte, y hasta nuestra manera de saludarnos, influyen en el curso de un virus que ha detenido todo el planeta. El coronavirus ha puesto de rodillas el poderío humano: paralizó el comercio, las olimpiadas, los aeropuertos, las protestas públicas y más.

Sumado a las consecuencias de la salud de los contagiados, los sistemas sanitarios, la economía mundial y las adaptaciones a la vida cotidiana que ha exigido la pandemia, ha habido un repunte a nivel mundial de trastornos de ansiedad. Por ende se les pregunta a los profesionales de la salud mental: ¿cómo se lidia con las angustias que todo esto despierta?

Circulan muchas recomendaciones, ideas, gestos salvadores, actos creativos que dan cuenta de que, en lugares geográficos con mayor piso de respuesta social, los daños ciertamente están, pero el músculo creativo se reinventa al servicio del otro y de uno con el otro y del sí mismo. Muchas de las recomendaciones, útiles  sin duda, se anclan en el terreno de las acciones concretas y conscientes que podemos incluir en nuestras rutinas para sobrellevar la angustia, el tedio, la pérdida o el conflicto que desata las medidas de protección que han alterado nuestras vidas.

Creemos, sin embargo, que puede ser útil tomar un paso al costado y escucharnos desde otro lugar. Hay por lo menos dos elementos fuera de las prescripciones más concretas que valen la pena considerar. El primero, es que la pandemia nos ha colocado de manera dramática frente a la vulnerabilidad humana. Ante esto, algunos han querido continuar como si nada, como los presidentes de Brasil y México, besucones desafiantes, que parecerían estar en negación de los riesgos que implica el COVID-19. Lo cierto, es que desde el Príncipe Carlos hasta los plebeyos estamos expuestos. La omnipotencia no está resultando buena consejera.

A la vulnerabilidad se le suma una gran cuota de incertidumbre. Nuestros parámetros de control han sido trastocados. Hay recomendaciones que nos pueden ayudar a sobrellevar el día a día, pero inevitablemente necesitamos escuchar y articular el temor que surge. El miedo, lo sabemos, pero se nos olvida, es una alerta que necesita ser atendida, para poder prepararnos para lidiar con una amenaza. Lidiar con el miedo sin negarlo, pero sin quedar sobrepasado por el desespero, es parte de la tarea.

La escucha y el esfuerzo por darle palabra a nuestro mundo interno, es parte de una solución que lidia con la incertidumbre sin pretender tener las respuestas de antemano. Una de las maneras en que la psicoterapia psicoanalítica ha sido descrita es como una “conversación con la incertidumbre”. La gran verdad, es que ni los expertos tienen la respuesta completa de las dimensiones del problema ni de su solución. Lo más probable es que tengamos que hablar y escucharnos para descifrarlo en conjunto.

Lo que estamos diciendo, y que lleva al segundo elemento, es que el problema tiene que ver con la interdependencia humana, y su solución, probablemente también. Una de las medidas preventivas curiosamente se ha llamado “distanciamiento social”, cuando lo que necesitamos es distanciamiento físico, pero no social. Tanto por el proceso de concebir soluciones a un problema de dimensión sistémica, como por el funcionamiento biológico individual: la conexión humana es esencial. Sabemos que el sistema de defensa inmunológico está íntimamente relacionado con la vinculación interpersonal, la soledad nos hace más propensos a enfermar.

Nos estamos quedando en casa, aunque parezca paradójico, como gesto de profundo reconocimiento del otro. Nos quedamos en casa, para cuidar a los demás tanto como a nosotros mismos. Nos quedamos en casa, porque el bienestar del otro es indispensable para el bienestar nuestro. Visto así, nuestro encierro no es aislamiento. Las redes de solidaridad, para estar atentos a las personas de nuestro vecindario que no se pueden valer por sí mismas, el comunicar nuestra preocupación por el otro, el pedir ayuda, la música en los balcones o los aplausos a los operarios de salud, son gestos indispensables de conexión humana, necesarios para mantenernos sanos y cuerdos.

No olvidemos finalmente que los riesgos y las desventajas tienden a multiplicarse, por lo que, aquellos que vienen arrastrando desventajas, están ahora en una situación multiplicada de riesgo. Los que tienen alguna situación previa de vulnerabilidad, por edad, por salud, por pobreza, por red de apoyo limitada, están mucho más expuestos y haremos bien en pensar en el problema priorizando las necesidades de aquéllos que la van a sufrir más.

La cuarentena es un alto obligatorio que puede ayudar a hacer un parado en una vida que no deja de exigir apresuramiento, un llamado a abrir espacios para la reflexión, para recalibrar nuestras prioridades y para hacernos más conscientes de nuestra interdependencia, nuestra necesidad del otro, fomentar nuestra capacidad de construir la cultura en los términos que propuso Margaret Mead.



Margot Brandi, MD,
Sibcy House, Medical Director

Paul R. Crosby, MD

Lindner Center of HOPE, Chief Clinical and Operating Officer, Psychiatrist

4075 Old Western Row Rd.

Mason, OH 45040


Most of us are weeks into the significant life changes caused by the novel coronavirus.  Even as we work to adjust to our new normal, there continues to be changing instructions and sometimes confusing and frightening information to process.  Daily, we are being asked to make sacrifices and critically important decisions for the safety and welfare of our family and our communities.  It is important during this crisis to remember to monitor and maintain our own mental wellness.

Some tips to manage the stress of today’s circumstances include avoiding excess exposure to media, including social media, taking care of yourself through exercise, eating healthy foods, getting enough sleep, and talking to friends and family.  Cultivating a practice of mindfulness and gratitude is another evidence-based way of improving wellness and alleviating stress-related mental health symptoms.  For people new to the idea of meditation and to those with more experience, there are many apps, such as Headspace www.headspace.com, to guide the process.  Also, even though social distancing is necessary during these times, seek out safe ways to stay connected with others.  The American Psychological Association, The National Alliance on Mental Illness, and Mental Health America are advocacy organizations that have a wealth of information about supporting your mental wellbeing during this crisis. www.apa.org  www.nami.org www.mhanational.org

With most students out of school and engaged in some combination of home-based and online learning, the situation is understandably stressful for both children and parents.  It can be hard to know where to start; but, try and establish a regular routine.  Children (and most adults) are reassured by structure and predictability.  Try to keep in mind that children learn from watching and listening to the adults around them.  They will be very interested in how you respond to news about the coronavirus outbreak.  Let children know that there are lots of people helping the people affected by the coronavirus outbreak.  This is a good opportunity to show children that when something scary or bad happens, there are people to help. Try to create an open and supportive environment where children know they can ask questions.  It is also important to remember that most children may be more interested in playing games, reading books, and other physical and recreational activities than discussing current events or following the news about what is happening across the country or elsewhere in the world.  The American Academy of Child and Adolescent Psychiatry’s website is an excellent resource with advice to help families help the children in their lives through the pandemic.  www.aacap.org

When there are many changes and uncertainties that are beyond our control, heightened stress and anxiety are normal feelings.  A time of crisis can also be a trigger for the onset or reoccurrence of mental health symptoms.  If anxiety and/or stress related feelings are causing you significant discomfort or are interfering with relationships, work, or other areas of your life, it may be time to seek help from a mental health professional.  Other symptoms to look for include:

  • Behaving, thinking, or feeling in ways that are out of character
  • Withdrawing from social contacts
  • Lack of interest in things that would normally bring joy
  • Becoming consistently irritable
  • A change in sleep patterns
  • Changes in eating habits and/or weight
  • Increased use of intoxicating substances

It is essential to remember that mental health services are still available during the COVID-19 crisis.  For individuals already receiving mental health and/or substance use disorder treatment services, it is important to continue with these services during this difficult time.  To follow social distancing guidelines, outpatient services for mental health assessment and treatment are being offered virtually via a simple phone call or one of several easy-to-use, secure video conferencing apps.  When needed, in-person services are still being offered with added health and safety measures to keep patients and staff safe throughout their treatment.

Similar to adults, children who become overly preoccupied with concerns about the coronavirus outbreak should be evaluated by a trained and qualified mental health professional.  Other signs that a child is struggling and may need additional help include ongoing sleep disturbances, intrusive thoughts or worries, recurring fears about illness or death.  If you notice similar symptoms or other behaviors, thoughts, or feelings that seem out of character for your child, seek a consultation with a pediatric mental health professional.  For help finding such a provider, your child’s pediatrician, family physician, or school counselor are good places to seek a referral.

Unfortunately, stigma about mental illness remains the key reason that people do not access care.  It is important to know that more than 50 percent of the population will suffer from a diagnosable mental illness at some point in their life and about 20 percent every year.  Only a small fraction of these individuals ever seek treatment.  One way to start breaking the stigma is to start talking about mental illnesses as a part of normal conversation, similar to how we may discuss illnesses like diabetes or high blood pressure.  Mental illnesses are common, biological illnesses that tend to respond very well to treatments that are typically very safe.  The goal of mental health treatment is to get back to feeling completely like yourself again.  In most cases, treatment is highly effective and allows individuals to function to their full potential.

When it comes to mental health, we need to start treating ourselves more gently.  We also need to extend that compassion to those around us.  We may be social-distancing but we are all in this together.  As, together, we work to fight off this pandemic and take up the challenge of recovering from it, kindness to ourselves and others has never been more important.

If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others call:

  • 911
  • Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)
  • The National Suicide Prevention Line: 800-273-8255




by: Tracy S. Cummings, MD, Psychiatrist, Lindner Center of HOPE

The outbreak of coronavirus disease 2019 (COVID-19) may be stressful for people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. Coping with stress will make you, the people you care about, and your community stronger.

Everyone reacts differently to stressful situations.  How you respond to the outbreak can depend on your background, the things that make you different from other people, and the community you live in.

People who may respond more strongly to the stress of a crisis include

  • Older people and people with chronic diseases who are at higher risk for COVID-19
  • Children and teens
  • People who are helping with the response to COVID-19, like doctors and other health care providers, or first responders
  • People who have mental health conditions including problems with substance use

If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others call

  • 911
  • Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)

Stress during an infectious disease outbreak can include

  • Fear and worry about your own health and the health of your loved ones
  • Changes in sleep or eating patterns
  • Difficulty sleeping or concentrating
  • Worsening of chronic health problems
  • Increased use of alcohol, tobacco, or other drugs

People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms.

Things you can do to support yourself

  • Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.
  • Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
  • Make time to unwind. Try to do some other activities you enjoy.
  • Connect with others. Talk with people you trust about your concerns and how you are feeling.


By Nicole Bosse, PsyD
Lindner Center of HOPE, Staff Psychologist

What is panic disorder? Panic disorder consists of recurrent unexpected panic attacks, specifically a spike of intense anxiety
or discomfort that reaches a peak in minutes that is followed by four or more of the following symptoms: racing heart/palpitations, sweating, trembling/shaking, shortness of breath, feelings of choking, chest pain or discomfort, nausea, dizziness, chills or heat sensations, numbness or tingling in the hands or feet, derealization, fear of losing control or going crazy, and fear of dying. This has to occur in combination with fear and worry about having additional attacks, and a significant change in behavior related to the attacks, such as avoiding situations or activities that might bring on panic.

When treating panic disorder, it is treated mostly from a cognitive behavioral approach. The cognitive piece targets the person’s misappraisals about the panic. Individuals with panic disorder tend to overestimate the likelihood of panic occurrence, underestimate one’s ability to cope with panic, and exaggerate the negative consequences of panic attacks.

By helping the individual to identify the misappraisals and working on challenging them, individuals are less fused with their thoughts and can start to think differently about things rather than buy into their thoughts as facts.

The behavioral piece of the approach involves exposure therapy, specifically exposure to what situations they avoid, but also interoceptive exposures. Interoceptive exposures involve gradually exposing oneself to the physical sensations of the panic attack that are feared. Working with a therapist to identify the exposures that rank from low to high is important. Once this is identified, the patient and therapist work from the least distressing to the most distressing. The following are some examples of possible interoceptive exposures:

* Running in Place

* Holding breath

* Head shaking (side to side)

* Spinning in a chair

* Mirror staring

* All over muscle tensing

* Straw breathing

* Over breathing

* Head between legs

The therapist and the individual work to complete just one of these exposures, five times during the day for about 30-60 seconds. This is done repeatedly every day until the person habituates to that sensation before moving on to the next exercise.


Another exposure idea that is sometimes used is pretending to actually have a panic attack in a public area. This strategy is brought in when the person’s fear centers around the social consequences of having a panic attack, such as not wanting others to crowd around them or being embarrassed. For example, I have suggested that individual’s go to a store and practice sitting down somewhere to pretend they are dizzy or cannot catch their breath. This is a great strategy for teaching the person that what they typically fear in that situation is not as bad as they make it out in their mind. It actually usually ends up being pretty uneventful.


Exposures for the avoidance of situations is a little more specific for the person and their unique avoidances. Some common examples of avoidance that I have come across are the following: avoiding caffeine, avoiding intense exercise that increases their heart rate, avoiding being in a car, avoiding driving, avoiding going into stores, avoiding traveling far distances from one’s house, avoiding going places alone, avoiding going places without safety items (i.e., water, benzodiazepine, food, etc.), and avoiding places where the amount of time being there is uncertain (i.e., waiting in lines, sitting down at a restaurant, etc.)

Once the individual’s unique avoidances are identified, the therapist and individual work to create another hierarchy, ranking from low to high distress. For example, if someone avoids going certain distances from their house, some exposures could consist of walking down the street and gradually increasing the distance. A similar strategy could also be used for driving, gradually increasing the distance of driving from a person’s house. Similarly, for line waiting, the individual could practice waiting in lines and gradually increase the amount of time they wait in line, working up to actually waiting in the entire line and being uncertain of when it when it will end.

As you can see by the above described therapy, the main component is facing what the individual fears and letting the body learn that their anxiety will decrease without having to escape the situation. Panic disorder is a very treatable disorder, especially when engaging the correct therapy for it and when combined with the appropriate medication.



Trevor Steinhauser’s struggle with mental illness began at an early age, but thanks to receiving early help and support for his symptoms, Trevor is feeling better and is now four years sober.

Trevor and Tracy Cummings, MD, Medical Director of Inpatient and Partial Hospital Program Services at Lindner Center of HOPE, spoke with Local 12’s Liz Bonis about mental illness warning signs to watch for in children, such as anxiety and panic attacks.

Trevor credits the Lindner Center of HOPE for helping him overcome his own issues with mental illness and substance abuse. By employing a team approach and giving him a voice in his own treatment, Trevor says the Center was the first to help him learn coping skills for lifelong problems, such as depression and anxiety.

According to Dr. Cummings, behaviors that lead to addiction often present in a person’s youth.

“The reality is that, in any given year, one in five of us are experiencing mental illness. About half of those cases started before age 14, so a lot of people have been having symptoms for a long time. They’ve just figured out ways to either adapt to those or not talk about those,” Dr. Cummings said.

Lindner Center of HOPE has a comprehensive program that treats both substance abuse and co-occurring mental health disorders. Learn more about our Intensive Outpatient program here.



Watch the full story from Trevor and Dr. Cummings’ sit down with Liz Bonis interview on local12.com