Archive for the ‘Coffee’ Category

Hey, Obama!

Thursday, May 21st, 2009
Obama Shut the Hell Up!
Obama Shut the Hell Up!

We are tired of hearing you day after day as the mainstream news media makes you into some kind of demigod.

While we realize you are Hitler reincarnated.
Day after day holding news conferences.
Providing US with the Obama version of
The Ultimate Solution!

Panic Disorder—Behavioral Treatment

Thursday, January 29th, 2009


This is generic advice and may not be suitable for you individually.  Please see your health care provider to determine what is best for you.


The basic behavioral approach to treat panic disorder from a behaviorist point of view is quite simple and very effective.  In general, having the client “self-monitor” reduces the incidence of panic attacks by approximately 50%.  Here’s how I do it:


We start out with having the client keep a “panic log.”  We want to achieve a “baseline” number of panic attacks so that we have a yard stick against which we can measure our progress.  This is observable and enumerable (one can count the number of panic attacks.) and from this initial data, we can compare the results of our interventions. 


However, just having the client keep such a log and observe themselves is an intervention in & of itself.  Just from this homework assignment we often see a reduction in the occurrence of panic attacks and the development of insight into managing one’s self in order to diminish the occurrence and severity of panic attacks.


The client’s assignment includes keeping specific data about the date and time of each panic attack, logging the antecedents (what occurred just before the onset) and the consequences (what was the resolution), the quality (symptoms) and quantity (duration).  The more details we assign the client to track and write down, the better the results.


From this we obtain a baseline, that is, the initial rate of panic attacks prior to beginning treatment.  Remember, exercises in self-observation tend to become interventions in & of themselves.  Therefore, we often see an improvement in the first week; however, sometimes, especially when fueled by personality traits & features, there may be an exacerbation in panic attacks.


Furthermore, I also do an intake assessment of what the client has done to do to resolve his or her panic attacks that has not worked and how much caffeine the client ingests.  I have seen a correlation in clinical practice as almost half of my clients who complained of panic attacks had comorbid problems with caffeine. 


Acceptance and Commitment Therapy (ACT) has much to offer those who suffer from Panic Disorder.  See my earlier blog postings and archived shows.



Caffeine & Panic Attacks: Causation Versus Correlation

Friday, January 16th, 2009


A while back a friend of mine commented after one of my shows that even though he thought that I had a point with caffeine “causing” panic attacks he said he wasn’t going to stop drinking coffee. My friend missed my point completely and demonstrated an error common among psychologists themselves.


First, I never said that caffeine “caused” panic attacks or panic disorder. What I said was in treating clients who presented complaining about having panic attacks I observed that approximately half of them had a problem with caffeine. Some appeared to be addicted to caffeinated beverages and a telltale sign of their addiction was when they suffered a dull headache, a withdrawal symptom, when they didn’t have their coffee or other beverage of choice.


Second, the context of my comments was that we were pretty much invincible and could our abuse are bodies with almost any substances until the age of approximately 19.  Thereafter, we learn that we needed to take much better care of ourselves and this was usually “inspired” by a rude awakening.


Third, my concern was that the current generation of super caffeinated beverages contain so much more caffeine than anything my generation was exposed to when we were growing up or when I was treating people clinically for panic disorder, that I am extremely concerned regarding the outcome for the current generation which indulges in such overly stimulating beverages.


I also mentioned that ‘drinking strong beverages’ was not recommended by Joseph Smith of The Latter-Day Church of Jesus Christ. Joseph Smith seemed to know and his recommendations to his followers that they abstain from drinking coffee and tea as well as alcohol seem wise.


I never said that caffeine or coffee “caused” panic attacks but I must apologize to my audience for the confusion. What I needed to convey was that there was an observed correlation that is a positive correspondence between the use of caffeine or coffee in some subjects with panic disorder in my clinical practice.


In those cases what I typically did was had the person keep an additional log. Aside from the usual detailed log of panic attacks, I assigned them the task of keeping a log regarding their intake of caffeinated beverages. We wanted to see what might happen when they ceased drinking coffee. Some of these clients were drinking a lot of coffee. And when they stop drinking “cold turkey” they often experienced typical “withdrawal” or “discontinuation effects.” Often these consisted of some sort of headache and general discomfort but sometimes there was an increase in panic attacks and generalized anxiety.  And sometimes we found that their anxiety and panic attacks decreased!


When we found that either of those were the case, we adopted a program of behaviorally tapering off the use of caffeinated beverages. We did this with the goal of ceasing the use of all caffeinated products for a period of approximately 3 weeks during which we would determine if that might have an impact upon their symptoms of panic and anxiety.


Just as in the discontinuation of psychotropic medications, since caffeine is a psychoactive drug, I never rushed my patients in their discontinuation of caffeine/coffee. We always stepped down slowly and backed off from the use of the “drug” slowly. This is exactly what I recommend to anyone seeking to discontinuation psychiatric medications. There is no reason to rush it and there is no sense risking discomfort, such as with the sudden discontinuation of SSRI medications such as Prozac or fluoxetine.


A lot of folks when they hear such a presentation, including psychologists, jump (wrongly) to the conclusion that this implies causation. That is nonsense. It is utter nonsense. It is sheer hogwash. All we can do is say that we observe the two events or sequeluae occurring in conjunction. Unless we have a true experimental design with random assignments, we can never make the hard fast conclusion that caffeine causes panic attacks, most certainly not for all people, across all time and all situations.


Hence, I observed that the excessive use of caffeine/coffee actually increased certain clients’ propensities to experience panic attacks. In a sense one might say that caffeine lowered the panic threshold thereby allowing the individual to experience greater panic attacks.  I hope this clears the matter up regarding applied psychology.


Correlation means we observe a relationship and I need no be positive.  For instance, as we reduce X we see an increase in Y which indicates a “negative correlation.”  Stay tuned for more on this in the future.