Hilton Garden Inn, Center City Philadelphia

I promptly arranged a second meeting with the manager at the Hilton Garden Inn. Weathering out some more social phobia and responsibility stress, I kept reminding myself that the task was almost completed. The manager and I reviewed our agreement. When all seemed in order, I gave them my credit information, signed the papers and wrote a check for a down-payment. The manager gave me copies of our agreement and we wished each other a good day.

The final step was simply letting Angie know that we definitely had a conference venue. I was looking forward to putting the stressful venue task behind me so that I could take a break and calm down. Returning home, I quickly began to send an e-mail to Angie. That's when I realized that my phone line was dead! I could not make calls or dial-in to the Internet! I wasn't completely surprised. There had been a number of brief phone outages recently, but service usually returned after a few hours. Perhaps the outages were due to maintenance work in the area? I tried not to get worked up over the issue because I really needed to relax at this point. I simply waited to see if my phone service would return that evening.

Part 2 - Telephone Torments

I needed to tell Angie that I had managed to secure a venue. She needed to hear from me before other conference preparations could proceed. However, my phone service, along with my dial-in Internet access, had been out all evening and there was no sign of it returning when I awoke the next morning. I was starting to get upset. I didn't need the added stress of being cut off from the world at a time like this. I simply had to find a pay-phone to contact the phone company and get word to Angie.

Finding a public pay-phone can be difficult these days. The popularity of mobile cell phones has decreased the demand for public phones. Consequently, the once ubiquitous pay-phone has become an endangered species. Within my neighborhood, pay-phones have slowly been disappearing and only half of those remaining seem to work anymore. This is a problem for me because I simply can't afford a cell phone on my tight budget. As I left my house to search for a functioning pay-phone, I wasn't sure if this search would be any easier than finding a mythical yeti.

My neighborhood, a few miles North of Center City

I felt fortunate to find a pay-phone at a small shopping center only five blocks from home. However, my sense of good fortune faded a bit when I got a closer look at this pay-phone. The phone had been abused, vandalized and was notably grimy. My imagination suggested several unpleasant visions of the phone's recent history. The poor thing seemed molested by unhygienic people with explosive head colds, violent tempers and a need to carve strange words into things. Most people would have felt somewhat germ phobic about touching this phone even without an anxiety disorder. Still, I really needed to use the cursed thing. After a cautious pause, I lifted the handset from the receiver. My ear had to make contact with the handset because the volume was very faint and there was noise from nearby street traffic. I used my other hand to dial a phone number, making my sense of contamination even more complete.

Using this pay-phone soon proved even more problematic. My first attempt to call the phone company's toll-free repair line resulted in the unhelpful message, "This call cannot be completed as dialed, please hang up and try again." I promptly tried again and again. Sometimes I used coins and sometimes not. I tried dialing the toll-free number with the recommended 1-800, then just 800, then just the number like a local call. All the permutations kept resulting in the same annoying message. I then decided to contact the operator for assistance.

"Operator speaking." replied a voice.

"I seem to be having trouble dialing a number."

"What number are you trying to call?"

"Ah, 1-800-"

The operator promptly interrupted, "You can not dial a 1-800 number from this phone."

"I can't?" I replied with a sense of surprise and injustice.

"No Sir, you can't."

"But I'm trying to contact the local phone company about my home phone not working."

"You will have to use a different number."

"All the numbers for the phone company are 1-800 numbers. How am I supposed to contact them?"

"You will have to find another phone."

"Can you tell me where I might find another phone?"

"I wouldn't know that Sir."

Contacting the phone company was becoming a form of unguided exposure therapy. I struggled to think of where I might find a phone that would allow me to dial a 1-800 number. Being reclusive and social phobic, I didn't know my neighbors well and felt awkward about asking to use their phone. I began wandering the neighborhood trying to find another pay-phone operated by a different company. I then noticed a local family deli shop where I had sometimes bought food. Swallowing a measure of social anxiety, I entered the shop and explained my dilemma. They kindly let me use their phone.

My first call from behind the deli counter reached the phone company. Slowly, I navigated the phone menu. The automated system asked for my home phone number and automatically confirmed that my line wasn't working. A machine voice then announced that a phone technician would be available to check my phone in four days. I pressed the appropriate buttons to confirm the appointment and acknowledge that, under certain conditions, I may be responsible for paying a repair fee. I felt some relief having scheduled a repair and I thanked the nice people of the deli for letting me use their phone.

Four more days felt too long a wait to contact Angie. I wasn't going to ask the nice deli people if I could use their phone for a long-distance call, so I returned to the pay-phone from Hell. Making an international call from this pay-phone seemed out of the question. However, I could phone my friend Jay and ask him to send a brief e-mail to Angie for me. All Angie needed to know was that we now officially had a venue for the conference and that I would be incommunicado until my phone service was restored. Jay kindly agreed to send this e-mail for me. I then returned home and decontaminated myself with a thorough shower.

My telecommunications nightmare was only beginning. A technician would eventually come to my house and seem to fix my phone line, but a short time later I would lose my phone service again. Confronting social phobia, I ended up bothering my neighbor several times to contact the phone company before eventually finding a pay-phone that allowed 1-800 numbers (a mere twelve blocks from home). When I could reach actual people at the phone company, I emphasized that I had health problems and truly needed reliable phone service. My mention of health problems sometimes brought the technicians over more quickly, but each repair was soon followed by another loss of service. Adding to the chaos, each repair involved a different technician who each expressed a different explanation for my phone problems. I wondered if anyone knew what was happening? Would I ever have reliable phone service again?

The telephone fiasco lasted for two whole months! Loss of phone service can be a serious matter for anyone with a severe anxiety disorder. Emergency services, counseling hot-lines, support groups, friends, family, as well as therapist, doctor and pharmacy all become much less accessible. People with anxiety disorders often become reclusive and socially isolated, so loss of phone service can make such isolation even more intense. Furthermore, anxiety is often modulated by our perceptions of control and predictability, both of which are affected by a dysfunctional line of communication. The addition of phone stress to my existing stress of panic disorder and the conference proved a bit much for me. There were a number of days where I felt too physically ill and disoriented to do anything at all.

Recovering from my phone misadventure took a while. Even after reliable service was finally restored, the previous two months of failed fixes had conditioned me to expect further problems. There was no way of knowing if my phone troubles were truly resolved other than the passage of time. Each day that the phone continued to work brought a little more reassurance. After a few weeks, I started to feel reasonably comfortable with my phone service again.

The tulips that Philip and Christie gave me during
last year's conference trip bloom in my tiny garden

Part 3 - Speeches and Screams

Finding a keynote speaker was taking longer than expected. Of course, venue issues and telecommunication turmoil had played significant roles in this delay. However, my approach to finding a keynote speaker was also a factor. One by one, I started contacting the most respected experts on panic whose work I was familiar with. This ambitious approach meant that I was contacting people with busy schedules and big responsibilities. Not surprisingly, each person politely declined on account of schedule conflicts. The effort was not without some consolation however. Amongst the declines were requests that I contact the respected experts next year.

A resolution to the keynote dilemma was not clear to me by July. With only three months until the conference, I was starting to feel awkward about asking anyone to conjure up a keynote on such short notice. I was wondering if maybe we should just skip the keynote this year? Angie was quite busy at the time with other equally important conference matters, so she didn't have much time to offer further suggestions. Then, terrorist bombings in London compelled me to check on a number of friends and conference members in the UK. Simultaneously, in the US, my stepfather ended up in hospital for a few days. I put the keynote question aside for a short time.

Panic attacks are a common enough occurrence in my life that I'm not in the habit of mentioning most of them. For the most part, these attacks disable me for several hours and seem best managed by CBT techniques and a couple milligrams of alprazolam. On August 5, however, I was hit by a notably severe attack. As the attack began, I immediately placed a milligram of alprazolam under my tongue, started pacing about my small house and tried to distract myself any way I could. As my ability to stand started to falter, I knelt down upon the floor and took a second milligram. Most of my attacks level off by this point, but not this one. I clutched at the couch and desperately tried to reassure myself as awful somatic sensations raced about my body. When strength and control of my muscles started to fade, I took a third milligram. Minutes later, pseudoparalysis set in and I could do nothing more than writhe on the floor with useless limbs, now mute and my mind drowning in more horror than I know how to describe. I can't be sure, but I think the worst of the attack lasted about an hour. Once my limbs started to function again, I took a half milligram more. The attack continued to fade and I climbed up onto my couch. A sense of relief slowly crept into my body and, exhausted, I feel asleep for about ten hours.

Another distraction arose on August 10. I suddenly noticed water leakage from an old window which was making a wall damp. Feeling stressed and short on funds, I wasn't sure how to address the issue. As often happens with anxiety disorders, I was already stressed out by my condition and it didn't take much more stress to cloud my mind and overwhelm me. Ironically, I noticed a report in the local news about home repair assistance for people with low incomes. I managed to jot down the phone number and promptly tried to inquire. For several days, my attempts to call only resulted in an automated response that their message system was full. I was eventually able to leave a message and hoped for the best. A month would pass before they returned my call.

My role in the conference became busy again in September. Since I had been unable to find a keynote speaker, Angie felt that one of us should speak instead. She gave me a choice between giving the keynote speech or the welcome address. This choice caught me a bit off guard. I was very uncomfortable about doing any public speaking this year and had clearly told her this many months ago. However, I also felt responsible for this situation and didn't want Angie to feel overburdened. With some anxious reluctance, I agreed to give the welcome address as this seemed the easier choice.

The low income home assistance people finally returned my call. However, this call was mainly to forward me to another number for my specific neighborhood. I promptly called the other number and, after answering some preliminary questions, they seemed optimistic about my case. An appointment was scheduled for me to visit their nearby office a month later. I was told to expect a letter in the mail which would list the papers I should bring when applying for assistance.

The last month before a conference always feels very intense to me. Wild variations of anxiety and the random ambush of panic attacks are the norm for me, but these become harder to work around with shorter periods of time. Like guessing coin tosses, you can be pretty confident about guessing right half the time with many tosses, but such statistical confidence diminishes with fewer and fewer tosses. During these last four weeks, my cumulative functional time might amount to three weeks or just one week. The best way to manage such uncertainty was to stay focused on priorities, complete preparations as soon as possible and make good use of CBT techniques. Slowly and methodically I made progress with the welcome address and some other assorted details.

My appointment to discuss low income home repair assistance came on October 10. After filling out some paperwork, I met with a case worker. I was soon told that my Social Security income was just enough to disqualify me. Health related expenses played no role in their formula, simply gross income. They seemed sympathetic and acknowledged that my case was falling through the cracks. They had no suggestions of what I should do next. As if to make me feel better, they pointed out that the wait for assistance was a year, so I was probably better off trying to find help elsewhere. Seeing no point in getting upset over all this, I politely thanked them for their time and left.

I felt notably tense during the last week before the conference. My most significant shortfall was that I became too stressed out to produce the program booklets, so other conference members had to complete that task. Yet, there remained a number of other items that needed to be printed and copied. The fact that my computer's printer stopped working was not helpful, but I was able to take files on 3-1/2 inch disk to a shop downtown where I printed originals and made numerous copies. Fortunately, my welcome address was in fairly good shape by then.

The last evening before the conference wasn't too bad. Everything seemed pretty much taken care of or under control. I was as prepared as I could possibly be and felt good about having accomplished so much under difficult circumstances. Being well prepared and emotionally fatigued, my anticipatory anxiety was surprisingly low. I surrendered myself to a sense of inevitability and got to sleep by a reasonable hour.

Part 4 - The Conference (Day 1)

October 15 was the first day of the conference. The day began reasonably well. I woke on time and got myself together without too much fuss. Between a little OCD and forgetting that the trains ran less frequently on weekends, I fell a little bit behind schedule. Nonetheless, I arrived at the venue in time to add papers to the conference packages and help out with the morning's preparations. Other members of our organizing committee did a fine job preparing the digital projection equipment, helping posters set up and handing out the conference packages. As people started filtering in, I took some extra alprazolam to keep calm and reviewed my welcome address notes.

Mr. Daryush Abbasi talking with presenters

Angie approached me shortly before the conference started. After asking how I felt, she explained that our chairpersons were unable to attend and asked if I felt up to being a chairperson myself. This was another one of those anxiogenic surprises where I thought, "You want me to do WHAT?!" I had never been a chairperson before. Mainly this involved monitoring the time used by presenters and politely letting them know when their time was running short or over. Furthermore, it meant that I would be stepping up to the podium throughout the conference to introduce people. This is by no means an easy task for a typically social phobic person like myself. I'm sure Angie felt this would be therapeutic for me and she offered to do this herself if I felt the challenge was too great. Strangely, though, I found myself agreeing to do this. The moment had the flavor of "In for a penny, in for a pound." Someone had to chair and I felt obliged to be supportive. Besides, my sense of adventure makes it hard for me to turn down a good novel opportunity. Despite some anxious and awkward moments, I would manage this task reasonably well throughout the conference.

The moment finally came to begin the conference. When Angie gave me a nod, I clutched my notes and stepped up to the podium. Speaking into the microphone, I mentioned that it seemed time to get started. Soon, all the eyes in the room were upon me. I wished everyone a good morning and they replied with pleasant smiles. I then began the welcome address.

I would like to begin by welcoming everyone to The 3rd International Conference on Psychophysiology of Panic Attacks.

This conference series originated from some collaborative research at the University of Westminster. In the 1990s, Dr. Angie Stones, Dr. David Perry, Dr. David Groome and Dr. J. J. Masani were working together to better understand the psychological and biological aspects of panic attacks. Dr. Stones came to feel that this specific, yet complex, subject deserved wider attention and, with the support of her colleagues, she organized our first international conference in 2003.

From the beginning, these conferences have brought together a variety of scientific and cultural perspectives of panic attacks. Presentations have addressed issues ranging from physiology and psychology to alternative and spiritual views. The presenters, themselves, have included researchers, clinical practitioners and even a few patients.

Personally, I feel this is an exciting time to be discussing the subject of panic attacks. Research has revealed much new information in recent decades, yet there are still many important and fundamental questions to be answered. As someone familiar with the history of this topic, I can't think of a more interesting and dramatic time to study panic attacks.

Everyone involved in these conferences deserves much credit. The members of our scientific advisory committee have reviewed many abstracts; namely, Dr. David Groome, Dr. David Perry and Dr. Angie Stones. Credit is also due to the members of our organizing committee with special thanks to Mr. Daryush Abbasi who has been extremely supportive during all three conferences. I want to thank our presenters for all the effort they have put into sharing their presentations with us. I also want to thank everyone attending this year for joining us and demonstrating their interest in panic attacks. Furthermore, my thanks to Global Egg Donation Resources and Avon for their help and sponsorship.

Minus brief coffee breaks, the morning presentations included:

• Angie Stones, Ph.D., "Keynote," International Events/GEDR.

• Eileen Wollburg, cand.-psych., "Psychophysiological Responses of Panic and Tense Patients to a Hyperventilation Test," Stanford University, US.

• Eda Gorbis, "Using Interoceptive Exposure to Treat Panic Attacks Comorbid with other Anxiety Disorders," Westwood Institute for Anxiety Disorders, Inc., US.

• Janet Nestor, MA LPC, "An Energy and Somatic Psychotherapy to Balance the Autonomic Nervous System", Center of Well-Being, US.

Afternoon presentations included:

• Marie Thompson, "The Experience of Living with Panic Disorder: The Carer's Experience", Beyondblue: The National Depression Initiative, Australia.

• E. Mark Stern, EdD ABPP, "Restless Legs: Panic With No Place to Go", US.

• Daniel J. Benor, M.D., "WHEE - the Wholistic Hybrid of EMDR and EFT: For Stress, Pain and Allergies", WholisticHealingResearch.com, US.

Discussion at coffee counter

I'm not sure if any groups formed for dinner that evening. As with lunch, closing the salon took just long enough for me to miss any groups that might have formed. This was not entirely a bad thing as I had to carefully pace my activity and allow time to calm down. So, I simply took the train home, relaxed and got to sleep by an early hour.

Part 5 - The Conference (Day 2)

Sunday morning started well. Despite some OCD, I managed to leave the house on time. Walking down the streets of my neighborhood, I was suddenly passed by a number of fast moving police cars with screaming sirens. A few blocks further, I found about half a dozen police vehicles gathered outside a house responding to some incident. I couldn't tell what the incident was about and soon continued on my way. After a brief train ride, I was in Center City and entered the hotel. Like the day before, I took some extra alprazolam to help me stay calm and was soon introducing our next presenter.

Minus coffee breaks, the morning presentations included:

• Angela Neal-Barnett, Ph.D., "Sister Circles: Treating Panic Attacks in African American Women", Kent State University, US.

• David Ellard, "Developing a Self-management Approach for Anxiety Disorders: The Evidence and a Way Forward?", University of Coventry, UK.

• Shannon Stirman and Melissa Hunt, "A Cognitive Theory of Panic Disorder During Pregnancy", University of Pennsylvania, US.

• Kirsten Flaten, MA spec.ed., MA psychology, "A Little Safer, A Little Happier", Mental Health Services for Children and Youth, Norway.

Discussion at poster tables

Daryush and I hung around to close the salon. We double checked to make sure everything had been packed up before asking hotel staff to lock the room. I wished Daryush well. Then I went for a stroll around the city to pass the time until dinner.

Ms. Flaten, Ms. Anisman, Ms. Connolly and I rendezvoused in the hotel lobby at 7:00 PM. Following a recommendation, we walked a few blocks in the refreshing evening air to a continental restaurant on Walnut Street called Portofino. The prices were a bit higher than I expected and I felt a bit underdressed, but the food was good and we enjoyed each other's company. I was hit by an anxiety surge in the middle of dinner and almost excused myself to step outside for a little while. All the excitement of the conference was starting to catch up with me. After breaking into a mild sweat, I decided that I might be Okay if I simply stopped eating. Nonetheless, we took our time and the evening went well.

We wished each other good-bye after returning to the hotel lobby. Following a train ride and nighttime walk through my neighborhood streets, I arrived home at 10:30 PM. The whole conference experience was already feeling more like a dream than a real memory. I think the dreamlike quality comes from these events being notably different from my usual life and a sense of surprise over how far I managed to test my limits for a couple of days. Otherwise, I mainly felt a mixture of happiness and exhaustion.

Part 6 - Exhausted Epilogue

I can never emphasize enough how exhausting an anxiety disorder can be. I guess my favorite analogy is holding up books with outstretched arms. The books may not feel heavy at first and the exercise seems trivial over a short period. Gradually, however, the books feel heavier and heavier until even a small strain becomes overwhelming through its persistence. Living with an anxiety disorder is often a similar strain. Such disorders, alone, can wear people down. Once worn down, other forms of stress which should be minor or mundane can easily become overwhelming.

Panic disorder and various recent events had left me exhausted after the conference. I experienced a heightened degree of cognitive dysfunction. In other words, my ability to think clearly, solve problems, plan and make decisions was notably diminished. Also, I was just too easily overstimulated by noise, social interaction and the like. I simply needed to keep my life simple and quiet for a while.

Assembly of the conference proceedings progressed in a slow and leisurely fashion. The relaxed pace was a necessity for me, yet it also seemed helpful to our presenters as well. Likewise, writing of this personal account became a sluggish project stretched out over months. Some days I spent hours simply writing a single paragraph. The slow pace could feel frustrating at times, but I knew this wasn't a time to pressure myself. I wrote when I could and I felt no grief over taking breaks lasting a day or more.

The last few months of the year are often a time for social gatherings. I was invited to family events and friendly parties, but I had to turn down the vast majority of these opportunities. One case where I tried was the Thanksgiving holiday with family in New York. Getting there normally involves about five or six hours on four different trains. I've made this trip many times before and thought I could handle it this time. However, the stimulation of noise and crowds quickly got the better of me. Before I had left Philadelphia, a surge of anxiety accompanied by sweating and shaking had compelled me to abort this attempt and quickly return home. I wouldn't be able to do much travel or socializing for the remainder of the year.

This January marks my 15th year with panic disorder. It was on January 10, 1991, that I suddenly started to have mysterious attacks of a seizure-like nature and seriously began to wonder if I was dying. Back then, even excellent doctors and therapists had difficulty diagnosing my condition, to say nothing of treating it. It seemed strange to suffer so much and effectively be told that I would have to accept it. Of course, the intense and frequent suffering of panic disorder was beyond acceptance and this strongly motivated me to speak out in any way I could.

A lot has changed since the early and mid 1990s. Thanks to the efforts of many people, anxiety disorders are better recognized and better treated than ever before. I have great appreciation for the ongoing work of researchers, the further education of clinicians and the people who make conferences possible. I also greatly appreciate the role of the Internet and my fellow patients who share support and information like never before in the history of our disorders. Finally, I have mixed appreciation for the pharmaceutical industry, disability support and government agencies that play important roles, yet often fail to help and protect patients as much as they should. There remains much need for further improvement on many fronts, but the progress I've witnessed so far encourages my optimism.