Simple Ways to Tame Anxiety
May 3, 2011
Volume 11, Issue 5
This month's issue of Anxiety Coach® answers a reader's question about coffee and alcohol. Is it necessary to abstain from these substances in order to achieve recovery from panic disorder?
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Coffee & Alcohol:
A reader writes:
Their Relationship to Panic
Are moderate amounts of coffee and alcohol detrimental to recovering from panic disorder? I know that they both contribute to anxiety, but both of these items are ingrained deeply into society. I do enjoy a morning cup of coffee, and on weekends I like to go to social events where alcohol is usually present (going to a karaoke bar with friends, cookouts, etc).
Since developing Panic Disorder, I am sensitive to both of these drugs. Coffee and alcohol both cause anxiety symptoms, though they have lead to only a few panic attacks.
So what is your opinion, if I am trying to put Panic Disorder into remission, do I need to quit coffee and alcohol or just moderate them?
The Short Answer
No, you don't need to quit them. A cup of coffee a day is not an unreasonable amount for most people. A couple of alcoholic drinks at weekend parties is not generally a problem either, but you need to make sure you don't use alcohol to soothe your anxiety.
Read on for the full length answer.
The Key Consideration
Panic Disorder is a problem of avoidance and excessive protection. A good treatment or self help program will guide you to accept and work with the symptoms rather than avoid them, because avoidance and protection generally makes the problem worse. For a thorough discussion of this point, take a look at my article on the
Most people will not need to abstain from caffeinated and alcoholic beverages in order to achieve recovery. However, you should consider how your use of these beverages can interact with your panic attacks.
Caffeine is a stimulant. It's a natural component of coffee, tea, and chocolate, and is added to most sodas and energy drinks. Many people find that it increases anxiety, and for some it can be a trigger to a panic attack.
Some people consume such large amounts of daily caffeine that it interferes with their sleep and/or promotes ongoing anxiety. For these people, and those with unusually high sensitivity to the effects of caffeine, it would be advisable to abstain, or at least to gradually reduce your usage to low levels.
However, I don't think that eliminating coffee is a necessary, or even desirable, part of the treatment for most people with Panic Disorder. Avoiding coffee that you otherwise enjoy, in the hopes of avoiding panic attacks, isn't any different than avoiding the grocery store, or highway driving, or any other cue to a panic attack.
The treatment for Panic Disorder is not removing or avoiding the triggers to panic. It's about learning
how to respond to panic attacks so well that you lose your fear of them. When you lose your fear of panic attacks, that's when they tend to fade out of the picture. That's how progressive exposure works.
If you have so much trouble with panic attacks that you're limiting your activities, then reducing your intake of coffee and other caffeinated beverages may be a reasonable temporary step to help you get started on a recovery plan. However, at some point I think it would be reasonable to re-introduce coffee in your life, perhaps a cup a day.
The practice you get with the anxiety symptoms produced by the coffee can be part of your exposure training. When I work with patients using progressive exposure for panic attacks, we usually include coffee as one of the triggers to work with.
Many people use alcoholic beverages to medicate against anxiety. The fearful flier who always stops at an airport bar, the salesman who stops at a neighborhood tavern before pitching a new client, the shy person who has a few drinks prior to a party - these are all people who use alcohol to self medicate.
The use of alcohol to resist the feelings of anxiety is a problem. It relies on avoidance and protection, both of which cause more problems than they solve. And alcohol is quite addictive. Some studies suggest that more than 50% of people with an anxiety disorder are also having problems with substance abuse.
There's another concern. Alcohol can reduce anxiety levels while it is still being assimilated into your system, but can also increase anxiety levels as it wears off and you feel a "hangover effect". A person who drank to rid himself of anxiety at a Saturday night party may find himself having a panic attack on Sunday as he experiences a hangover effect.
This might lead him to reach for another drink, or a xanax. That's a bad pattern.
For this reason, I usually suggest two guidelines for Panic Disorder patients with respect to alcohol.
1. Abstain from drinking immediately prior to, or during, your experience of panic triggers. So the salesman who gets nervous before a cold call on a prospective client can have a few beers on the weekend with his friends, but not before his anxiety provoking calls.
2. Drink occasionally, but not regularly. This means don't drink every day; don't drink in habitual ways, times, and places.
Of course, if a person shows signs of having trouble with the use of alcohol, we will usually want to consider a more restrictive set of guidelines.
See you next month!
Dave Carbonell, Ph.D.
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Survey About the Internet
A colleague of mine is conducting research into the effects of finding information about your therapist on the Internet. It consists of answering some survey questions. If you're interested,
here for details.