Has anxiety left you immobilized?

My patient, Annie* waited weeks to tell me about it. Then, with tears in her eyes and a shaky voice, she revealed that she thought she might be going crazy. "I have this thing that happens where I don't hear what people are saying. I know they are talking but I just zone out and I feel like I'm not real. They're not real. Time kind of seems to stop, but goes too fast, all at the same time." Assessment revealed that Annie had these experiences during moments of panic due to her intense social anxiety. Depersonalization (feeling detached from one's mind or body) and its related experience, derealization (feeling detached from one's surroundings) are often some of the most disturbing symptoms of Panic Disorder. Many who experience these believe they are losing their minds, and that belief makes anxiety even stronger. In Annie's case, the phenomenon seemed so crazy to her she was afraid to even mention it to me. Depersonalization and derealization can occur in other mental illnesses, such as Dissociative Disorders and PTSD. It is important to get a good assessment and diagnosis by a trained mental health professional. However, the feeling Annie expressed is very common in Panic Attacks. These intense bursts of anxiety carry numerous symptoms including increased heartrate, breathlessness, mind racing, and shakiness, to name just a few. It is estimated that 10%-20% of people will experience panic in their lifetime. And for some, derealization is a part of that picture. There are many tools in the CBT (Cognitive Behavioral Therapy) toolbox, but one of the most important ones is knowledge . Knowing what panic is, and what it isn't, is a key to regaining one's calm. Once the sympathetic nervous (Fight-or-Flight) system is engaged, a number of mental/emotional and physical symptoms are set in motion. These vary by individuals, but can include hyperventilation, increased heartrate, shakiness, even a sensation that the environment is getting too bright. But these are all explainable when you consider that the purpose of this system is to ready you to defend yourself from a threat. The body is primed to run, fight or hide , causing changes in respiration, heartrate, even pupil dilation. The sympathetic nervous system also tends to sharpen focus on these "lifesaving" tasks, while blurring focus on extraneous stimuli. This is likely why Annie couldn't focus on a conversation and felt zoned out. Knowing this is a physiological protective mechanism, rather than the beginnings of schizophrenia, helped Annie to overcome her anxiety. I hope her story helps to encourage others to reveal this symptom in therapy sooner rather than later, so healing can begin. *Annie is a pseudonym. Name changed, along with identifying details, to protect patient confidentiality.