Panic Attacks and Self Monitoring

As with all posts that describe individual clients, materiel changes in descriptions are made to insure client confidentiality.

Kevin is a pleasant 16 year old junior in high school.  He began seeing me due to depression and anxiety a bit more than six months ago and has generally done well, not needing medications for either, though I admit it was close there for a while.  He's insightful, thoughtful and a very enjoyable kid to work with.  He's struggled a bit with some panic attacks that have been (understandably) frightening.  He's smart, but the depression and anxiety distracted his ability to keep the good grades he'd been used to last fall - he's not on the autistic spectrum.  He needed to pull his academics up, anticipating the coming focus on college applications and the importance of junior year grades in that process.  Pressure, but the kind that most kids tolerate.  Since the beginning of the year with a new semester, he has done very well with his academics.  

He came in and discussed another panic attack after a 4 month respite from them.  So we discussed what was going on around the time of the panic attack that might have triggered it.  He was quite clear and didn't hesitate - he had been having a bad day anyway, having not done well on a paper he had worked on and invested a lot of time in.  His friends and parents noticed he was a bit edgy but he couldn't really put his finger on the problem.  Then he was asked to go to the store by his mom to purchase an item for a recipe she was working on and needed right away.  It wasn't there.  She needed it.  He panicked. Shortness of breath, pounding chest, fears of death.  Another panic attack.

He managed this one pretty well.  He called his mom who was understanding and quickly helped him see that the priority was his emotional stability much more than the recipe she was making.  She encouraged him to just come home, reassuring him that the recipe was not that important.  With that, he was able to calm down more quickly then he has in the past.  He came home (while his mom went to another store, understanding, to her credit, that he was more overloaded than she had anticipated), and was soon fine, but perplexed about having had another panic attack after having been doing so well.

So Kevin and I began to talk about how self monitoring might be a useful tool in helping him see when and where he's vulnerable to panic attacks.  We reviewed past panic attacks and saw a couple of themes - when he feels pressure to meet the needs of others and when he's unhappy with himself.

He rightly asked: now that I know what the triggers might be, what do I do? Which led us to a discussion of self monitoring.

Self monitoring is one of those things that's easy to discuss and easier to advise, but not near as easy to do.  Despite that, Kevin has some important insights:  He knew he wasn't feeling good about his academic work either time he's had the panic attacks.  Last week it was a paper.  Then really tried to help his mom - he feared disappointing her when she needed him.  The  panic attack of 4 months ago had similar themes - his friends were desperate for him to join in an activity when he had schoolwork he needed to do in his weakest subject at a time his grades were slumping.  Again the themes of not feeling good about his academic performance connected to the pressure to please others.

Kevin's a good kid.  I can't say that he'll never have another panic attack, but he's aware, wanting to learn and seeing that there are times he's vulnerable to emotional distress.  I think that's a great start.