I have two suggestions, one for when you wake up after a really frightening dream, and another for longer-term prevention of panic attacks in this situation. When you wake up after one of these bad dreams, immediately try to remind yourself where you are in space and time. When we feel anxiety or fear, parts of the brain (especially one called the amygdala) are activated. When this happens, it’s easier to lose touch with your current time and space. By reorienting yourself in reality (versus the place and time of the dream), you force your brain to shift you out of fear. Therapists call this “grounding yourself in the present.” Talk to yourself out loud and describe what you see — your bedroom, your sleeping partner, your cat. Remind yourself that you are a certain age, living in a certain place. For example, you might say, “I am in my bedroom at 4317 Chestnut Street. I see the striped comforter on my bed and feel it with my hands [rub it at the same time]. I see my cat Garbanzo [pat him if possible], and on that table is the book I am reading for my book club.” While this may seem silly, you’re actually using your senses to reorient yourself from the dream, and what it might represent, to the present. Looking at your current space gives you visual reorientation. Talking allows you to hear your own input, and touching things gives you a tactile sense of the present. If an object around you has a specific pleasant scent that you relate to in the present, you can also use your sense of smell. For example, a vanilla candle that you keep by the bed or the fabric softener on your sheets can work. Turn the lights on, but leave them low so you can see clearly enough to get good visual input and fully realize where you are. Avoid turning them on too brightly, however, because that may make it more difficult to go back to sleep. Your brain could react to the light by beginning a chemical reaction signaling that it’s morning. For prevention of this problem in the future, look for a licensed psychotherapist who is trained in eye movement desensitization and reprocessing (EMDR). In EMDR, you are taught information-processing techniques that allow you to connect the fearful images from your dreams to more adaptive information that you already hold elsewhere in your memory. You can read more about EMDR and learn how to find a therapist trained in this technique at http://www.emdr.com/. Q2. Can anxiety or panic attacks bring on memory loss? Is it common, and if so, how long does it last? — Suzie, Ohio People with severe anxiety often report trouble concentrating, which in turn can affect memory adversely. If the memory loss is severe, however, there may be another physical or mental problem, so it would be best to discuss this further with your therapist or treating physician. Q3. I just returned from a year long deployment in Iraq. I’ve been home now for one full day. I was having bad dreams while on the deployment. Now that I am back at home in my comfort zone, I am having more intense dreams — ones where I wake up scared and confused. Should I be worried about this? Is it something that will go away? — Clifford, Tennessee What you describe, Clifford, is a very common reaction to having been in a war zone, a situation most of us can’t even imagine. You had to be on guard and highly vigilant at all times. You constantly had to engage the fight-or-flight response, a stress reaction that is essential for physical survival. In essence, your brain and body did not have time to process the information, images, and emotions you experienced while at war since your body needed all its resources to ensure survival. Now that you are in a safe place where you do not have to be constantly on guard, your brain and body are processing what happened. It is a normal part of healing and should subside over time. However, about 25 percent of veterans do develop post-traumatic stress disorder (PTSD), a type of anxiety disorder wherein the body has a difficult time turning off the stress response. While most people who have nightmares do not develop PTSD, repeated nightmares can be a symptom. Research shows that early intervention helps decrease the intensity of symptoms, and that there are effective ways to help your brain process traumatic events more quickly so you suffer less. If you are still experiencing intensely negative and disorienting dreams after a month, I’d recommend a brief course of Eye Movement Desensitization and Reprocessing (EMDR). With this treatment, you are taught information-processing techniques that allow you to connect negative aspects of the trauma (like a specific image of the event) with adaptive information that you already hold elsewhere in your memory. The therapy should be done in the office of a licensed mental health practitioner, requires no medications, and is much shorter than most other therapies for trauma. You can read more about EMDR and learn how to find a therapist well trained in these techniques at the web page of the EMDR Institute. Learn more in the Everyday Health Anxiety Disorders Center.
