Herbal Health – information on herbal medicine

Sold as Restoril, temazepam is especially appropriate for people whose insomnia takes the form of middle-of-the-night awakenings, because its half-life of about ten hours means the drug stays effective throughout the period of sleep. On a temporary basis some people may be able to take a temazepam pill as needed after a nighttime awakening to help facilitate a return to sleep, with only a relatively small risk that the sedative effects will persist into the morning. However, the drug is absorbed slowly in the gastrointestinal tract; some people thus find it ineffective in helping them fall asleep unless taken an hour or two before bedtime. Temazepam does prevent nighttime awakenings, and it improves the duration and subjective quality of sleep. Some physicians may also use temazepam to treat cases of nocturnal myoclonus or restless legs, although this is not an approved indication for the drug.
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So much for ordinary everyday stress, but what about extraordinary stress. This is like a hammer hitting an apple. We do not expect much of this stress in our lifetime, but when it comes, even if we are coconuts, we cannot help feeling the impact of the stress.

Loss of loved ones, loss of possessions, tragedies of any kind, or any events of similar magnitude are extraordinary and we are expected to feel the stress badly and most of us will be hurt. The normal biological and psychological reaction to stress as outlined earlier still applies, but is of much greater magnitude and lasts much longer. We call this grief reaction.

When we are hit with a stress hammer, there are two phases: the injury phase and the healing phase:

Injury phase. During the injury phase, we feel the pain. This pain can be in our head as headache or in our chest not unlike a heart attack. Of course, the pain is hurting most of all in the mind. It is a normal defence mechanism of the body to protect the psyche, and the immediate reaction is denial. What has happened is not true, we hope we are dreaming. There is a sense of disbelief: ‘Can somebody tell me this is not true’. This is a form of protection for us from the sudden shock of the extraordinary stress.

Healing phase. The healing phase starts when the body begins to react. We are angry at what has happened; we may be angry at ourselves or angry at the one we have lost. The biological reaction sets us on a chain of tension, anxiety, and depression all mixed up, until we feel exhausted. We are at battle stations all the time, but there is really no enemy. The enemy is ourselves. Some of us feel guilty and question whether there was anything we did wrong that may have led to this loss. We may cry and feel tired and exhausted. This may go on for days.

We need to let this energy out Hysterical crying and weeping is common. Sharing this locked up energy with someone is sometimes useful; just talking about it, airing our thoughts can be helpful. Some like taking long walks, some like rearranging and cleaning out their desks, or just doing something that may be purposeful but relaxing.

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Of course it is excessive pain which we desire to control, and which is the central subject of this study. A great number of different factors may combine to make pain excessive. Some of these are organic, depending upon the nerves concerned and their connections in the central nervous system; others are psychological and depend on our general mental health, as well as the particular significance which the pain has for us, both consciously and unconsciously. Constitutional factors also come into it. Some people are undoubtedly more sensitive to pain than others.

Some parts of our body are more copiously supplied with pain nerves than other parts. Any swelling due to inflammation is much more painful in a rigid tissue than in a soft tissue. This is so because pressure develops more easily in a rigid tissue. Thus an abscess at the apex of a tooth, or under the fingernail, is very painful, whereas a similar infection in the soft tissue under the skin causes relatively little pain.

If pain is coupled with distress, it quickly becomes excessive. It can be excessive, also, if it is associated with guilt, which often acts to prolong pain. The presence of a mild psychological depression makes the pain from some organic cause more severe, and tends to make the pain persist after the organic cause has ceased to operate. In fact, unrecognized depressive illness is one of the commonest causes of persistent pain for which no adequate organic cause can be found.

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Meditation is an integral part of Eastern religions and forms the basis of some Christian traditions. This gives rise to the many myths surrounding meditation. As a consequence some people are unsure of meditation and are concerned about practising it. Therefore it is important for these issues to be discussed. If we have doubts about meditation because of our religious background, we need to speak to our minister or priest and be guided by our own feelings of what is right for us.

Meditation is like so many of the other Eastern techniques and disciplines we have adopted, such as various martial arts, tai chi and yoga. In India the word ‘yoga’ is a generic name for a multitude of meditation disciplines. The word ‘yoga’ was originally defined as ‘the way to go’, but more recently it has been defined simply as ‘union’.

We associate yoga with the practice of gentle physical and breathing exercises. This form of yoga is derived from a very strict meditation discipline called ‘hatha yoga’. The West has adapted hatha yoga to its needs by stripping it of all its religious and ascetic practices. This form of yoga is now an accepted part of our Western lifestyle.

Other forms of meditation from the Eastern traditions have also been adapted. The comprehensive and intricate visualisations of various deities have been replaced with images of beaches or forests, the devotional ‘gazing’ has been replaced with flowers or candles, and the sacred mantras have been replaced with everyday words.

There is nothing mysterious in these techniques. The strict adherence and disciplines required for their religious and philosophical aspects have been stripped away, leaving their bare essence, techniques for relaxation. Learning to meditate does not mean we have to change our religion, our lifestyle or our diet. The only thing which will change will be our response to stress and anxiety.

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Many people were, and still are, being given a graded exposure program as treatment for their agoraphobia. Along with medication this may be the only other form of treatment people have received. Graded exposure does not cover the many strategies used in CBT and is simply exposure to situations and/ or places we avoid.

The question many people with panic disorder/agoraphobia ask is, ‘exposure to what’? Many graded exposure programs treat the avoidance behaviour in panic disorder as though it was the situation or place which triggered the attack. Much to their confusion, people who have panic disorders without any form of avoidance behaviour have been, or are given, a graded exposure program.

The rationale behind graded exposure programs is that when people put themselves into avoided situations/or places and stay in that situation or place, then the anxiety and/or panic attack will peak and slowly ebb away. In other words the person will habituate to the anxiety and panic attack in that situation or place. As many people say, even though the panic attack does subside, if they are not directly frightened of the situation/or place why would the anxiety ‘ebb away’ when it has never done so before.

Trying to correct avoidance behaviour without working on the cause means limited success, which can be destroyed by the next panic attack.

Most of these programs insist people stay in the situation or place until the anxiety and panic attack subsides and this is also one of the main complaints from people with panic disorder. It seems illogical to stay in a city mall (or any other place) for hours on end in an effort to reduce anxiety. Many are chronically anxious day-in, day-out, and are also experiencing ongoing panic attacks. As people say, if they were going to habituate to the anxiety and the panic attacks they would have already done so, irrespective of where they were.

To compound the issue and the confusion, many panic disorder clients are asked to list their secondary fears and a graded exposure program is built around them. In some cases the list of fears included specific fears which pre-dated the attacks and have no bearing on the disorder, yet they are incorporated or become the main feature of the exposure program. This little known but crucial fact has also been noted by researchers. One such study showed, ‘half the simple (specific) phobias in panic disorder had childhood onset and half had onset associated with the onset of panic disorder’ (Argyle et al. 1990).

The new categories of panic attacks demonstrate quite clearly the spontaneous panic attack is triggered by internal cues not external ones. In panic disorder, treatment needs to be aimed at these internal cues.

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The third category of avoidance behaviour is not known or realised by almost anyone who does not have the disorder. It is the avoidance of situations and/or places because of feeling generally unwell most of the time.

As well as suffering the symptoms of anxiety and panic attacks, our level of overall fitness deteriorates rapidly. We begin to experience a general sense of feeling unwell. Some people compare this to ongoing ‘flu-like’ symptoms. We are also continually exhausted, as the anxiety and panic attacks consume all our energy. Going out, going to work or doing the normal day-to-day things around the house mean not only trying to keep the anxiety and panic attacks at bay, but also trying to overcome the feeling of being unwell and the all-consuming fatigue.

Alcohol

The use of alcohol is another control and some people will go on to develop an alcohol dependence. Both men and women use it, although it appears to be the major control used by men.

Many people with the disorders feel it is more socially acceptable to have an alcohol problem than to admit to having an anxiety disorder. The symptoms of a hangover can also perpetuate the anxiety. We misinterpret these symptoms as a warning” of an impending panic attack, so we have another drink in an effort to control it.

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Part of the overall problem in understanding the severity of the disorders lies in the word ‘anxiety’. Everyone has been anxious at one time or another, and it is through our own experience of anxiety that we judge those who experience anxiety disorders.

Our own anxiety may not have affected us to any great extent. If it did we were able to do something about it, or it passed of its own accord and was no longer a problem. We have extreme difficulty in accepting that a person with an anxiety disorder experiences anything different from our own anxiety. So it is quite natural for us to say or think ‘pull yourself together’, or to ignore that there really is a problem.

There is a marked difference between the ‘normal’ experience of anxiety and that of an anxiety disorder. People cannot ‘pull themselves together’, because they do not know what is wrong with them. They do not recognise the symptoms as anxiety. If it was purely the experience of anxiety, people would recognise it and they would be able to address the problem. It is this difference which is highlighted by the fact that even now, some health professionals are still unable to recognise, let alone, diagnose or treat these disorders.

The symptoms of anxiety can be quite varied, with any number of symptoms being experienced at the same time. The most common ones are a rapid or pounding heartbeat,

‘missed’ heartbeats, chest pain, an inability to take a deep breath, a feeling that breathing will stop altogether, choking sensation, dizziness, giddiness, feeling faint, nausea, pins and needles, diarrhoea, trembling hands and/or legs, dry mouth, sweating, fatigue, loss of concentration, loss of libido. Dissociative symptoms can include depersonalisation, derealisation, visual disturbances such as intolerance to light, stationary objects appearing to move, tunnel vision and/or audio disturbances, where everyday noise seems louder than normal.

For many people with an anxiety disorder the symptoms are their constant companion. Not just for a few minutes or hours at a time, but ongoing sometimes for months or years. To confuse the issue further, people can experience different symptoms and sensations in their anxiety and panic attacks (Arthur-Jjnes 1994).

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