This article is mainly written for the professional treating anxiety panic attack via hypnosis, biofeedback, psychotherapy, psychiatry… However, the sufferer may use the information to guide his/her therapist.

Based on a stress management model, the technique is different than generally associated with main stream stress management training. Let me clarify. It is often assumed that a stress management model is synonymous with body awareness techniques that utilize inward focus. The other technique is outward focus initially used by Lacy, a psychologist. It is the one most effective for all anxiety/panic attacks. It likewise is effective for all other maladies, but because it is less defined, it is generally only used in more advanced training and left out of the protocols for initial training sessions.

In this article I want to focus mainly on the why's that contribute to one developing anxiety issues as opposed to some other stress related issue such as ulcers or colitis--not that some individuals don't develop both.

Generally anxiety/panic/agoraphobia is found in those who
· Have less than healthy eating habits or
· Are taking medications that contribute to panic and anxiety as a side effect.

Most are in the first category and it's contributed to a high sugar or refined food diet. They generally drink caffeinated beverages and eat lots of snack foods. If they were to correct their eating habits in advance, they would never develop of anxiety panic attack for anxiety is simply a hormonal response to large blood sugar changes. However, once the pattern of anxiety has generalized or developed into panic and agoraphobia, then simply changing eating habits usually isn't enough because the mind has begun a conditioning process-more later.

And likewise the same conditioning process affects the second group for even once the meds causing anxiety are stopped, the symptoms continue.

But the main question is, "Why do anxiety panic attack sufferers develop Anxiety and others who likewise are hypoglycemic develop muscle pains and aches, or hypertension, ulcers, colitis…?

The answer is in one's personality. Effective treatment of an anxiety sufferer requires that the therapist understands the personality that contributes to the development of anxiety.

I first began working with anxiety clients in the late 70's under the supervision of two psychologists for the World Health Medical Dental Center in the World Trade Center, NYC. Dr. Joyce Brothers was one of the consultants. I asked my superiors for advice in how to work with anxiety sufferers. My main treatment modalities were biofeedback and hypnosis. I asked them for the protocol that they wanted used and was told something similar to, "Anxiety patients are basically babies. They use anxiety generally for secondary rewards. We don't expect you'll have much success. Simply teach them body awareness techniques and hold their hands. They are generally an irresponsible group of patients."

I was too young to dispute what I was told and accepted it as truth. Needless to say, I didn't have very much success hand holding and most clients came three or four sessions at most and then stopped coming-they could never get their muscles to relax with biofeedback, much less their breathing.

Two years later I opened the Biofeedback Center of NJ in Middletown, NJ and after about four years of poor results-only 30% improvement (no better than placebo)--with anxiety/panic attack clients I hired a psychotherapist to work with them. My thinking was that it must be something deep rooted causing the problem and I wasn't qualified to do therapy nor did I want to.

After another five years we evaluated her success and even though the clients came for many more sessions than they did with me-she was better at hand-holding-the results were no better. The only consolation was that I wasn't the one seeing the clients-I could focus on clients with stress related health issues that brought me much greater success rates.

One Saturday afternoon I received a phone call from our psychologist who was doing an intake with a new client-I'll call her Jane. He informed me that Jane wanted biofeedback for her panic/agoraphobia and nothing else. She was dictating her treatment. She and her husband drove some distance and they very much wanted to start immediately and refused psychotherapy as he recommended.

It was his opinion that her high motivation and expectation would be instrumental (pun intended) in biofeedback working. Reluctantly I agreed to see Jane and her husband hoping to convince them that psychotherapy was the route to go.

She made it clear she wanted nothing to do with psychotherapy and it was biofeedback or nothing. I didn't waste much time trying to convince her re psychotherapy. Instead after twenty minutes of getting to know her, I began her with basic "close your eyes inward focus breathing exercises," and observed her go into a panic attack within minutes. She opened her eyes. She and her husband were quite apologetic, paid their fees, and left quite abruptly.

Personality? I'll jump ahead and share with you what I leaned about personality. First it was easy for me to see Jane as the classic attention getting irresponsible secondary reward getting individual-a no brainer so to speak which was a total erroneous assumption as were all clients suffering from anxiety that I had ever seen.

Contrary to what I was told and learned to believe, anxiety sufferers are Type A perfectionist individuals. They are totally responsible (in some or many areas of their lives) and don't use symptoms for secondary reward (even though it appears that way). They need to be right. You might ask, "Who doesn't?" Contrary to most of us who like to be right, they really need to be right. In fact it's this universal need to be right of anxiety sufferers that makes waking hypnosis work. They are the kind of person you would want to have as an employee-minus the anxiety which may totally incapacitate them. In fact it's their high sense of responsibility that works against them in contributing to development of anxiety issues whereas someone suffering from hypertension is also a type A individual, but be more of a driven, less patient person than the responsible one who develops anxiety.

Although there are many more issues such as diet, handling disappointments, the general adaptation syndrome... this is the first program of its kind that takes personality factors in consideration. A survey of the participants indicated an 80% success rate in overcoming anxiety panic attack and agoraphobia.