Our expert says:
PSYCHIATRIST: The situation you describe is something I hear about fairly often. Public speaking is recognised as being stressful for almost all people and you probably felt a degree of anxiety,pressure and expectations of your performance and contribution to that board meeting when you had your first panic attack so it did occur under stress. What then happened is that you developed an anticipatory anxiety of having a recurrence of such a terrible experience which made you more anxious for your next presentation to the board. The so-called "fear of the fear". Your anxiety has now started generalising to other situations such as talking to the boss, someone in authority, so this is also a situation where you may feel you are being assessed,scrutinised or judged.
If you are already in therapy, you will know that avoiding the situation only worsens your anxiety. The avoidance acts as a short-term reward because you escape the board meeting that morning but as you say this makes the next meeting even more difficult to face up to.It sounds as though your fear of having panic attacks could even have a detrimental effect on your career advancement.
Are you having cognitive behavioural therapy(CBT) with your therapist bcause this is the type of therapy you need for panic disorder? If your therapist does not specialise in CBT, ask for a referral to one who does.
I also recomend that you ask your psychologist or GP to refer you to a psychiatrist who would start treatment with an appropriate SSRI anti-depressant.Remember, anti-depressants are also anti-panic/anti-anxiety medications. I think you need maintenance treatment, not just a pill before you go into a meeting, as your anxiety is spreading to other situations. You also don't want to reach a point where you become fearful that you can't face any performance situation without a pill on hand.
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