Episode 391: Panic Disorder & Caregiving for a TBI

Hello friends!

In today’s episode, we tackle two interesting questions that delve into the heart of mental and emotional challenges many of us face.

First, we explore the complex world of panic disorder through the eyes of a 24-year-old graduate student grappling with severe panic attacks. Their story illuminates the physical and psychological intensity of panic disorder, revealing how it transcends mere stress or anxiety to significantly disrupt daily life. We dissect the cycle of fear and avoidance intrinsic to panic disorder and discuss the critical importance of specialized care and therapy in navigating this condition.

Next, we turn our attention to the challenges faced by caregivers of individuals with dementia resulting from traumatic brain injuries (TBI). One listener shares the struggle of balancing caregiving with personal self-care, seeking resources and support to manage this demanding role. We offer guidance on finding online and in-person resources, emphasize the importance of self-care for caregivers, and encourage seeking professional help to ensure both the caregiver’s and the loved one’s needs are met.

As always, you can send your questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode391.

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Question 1:

Hello, first and foremost, I want to thank you for answering these questions and producing the podcast. It has become a tool I use to help process my anxiety and make sense of my feelings both at work and outside of the house.

I am a 24-year-old graduate student who works as a Graduate Assistant and intern at my future workplace. Over the past few months, I have developed a pretty nasty panic disorder. I used to be a very social person and enjoyed going places, but now I struggle to go to the grocery store or stay at work. I have tried everything I can think of, from therapy to medication, and nothing has made any significant progress. My panic attacks have become so physical that my vision shakes due to facial twitching, and it’s hard to move my body due to the strong tingling sensation and muscle rigidity. I have visited the doctor many times, and they have concluded that I am experiencing severe panic attacks to the point where my body is constantly tense, sore, and in a panic state. I can’t seem to get out of this hole no matter how hard I try, I am still trying different medications and continuing therapy. I am beginning to feel overwhelmed and defeated because I don’t know how long and how bad this will get. I don’t know what to do next.


Firstly, your experience underscores the severity of panic disorder, which goes beyond simple stress or anxiety. A panic attack isn’t just feeling overwhelmed; it’s an intense period of fear and discomfort, with symptoms like heart palpitations, sweating, and muscle rigidity. These symptoms are so physical and powerful that they significantly disrupt daily life.

Panic disorder involves not only the panic attacks themselves but also the constant worry about future attacks and their potential consequences. This fear can lead to a cycle where worrying about panic attacks actually triggers them. It sounds like this is what you’re experiencing, with your daily activities becoming increasingly limited due to this fear.

The connection between panic disorder and agoraphobia is important here. Agoraphobia is about the fear of being in situations where escape might be difficult or help wouldn’t be available if a panic attack occurs. This can lead to avoiding a wide range of situations, including places like stores or even staying at work, as you mentioned.

Finding the root cause of your panic disorder can be crucial. Sometimes, a specific event or series of events triggers the initial panic attack, setting off the pattern you’re now struggling with. Identifying this can help direct treatment efforts more effectively.

Your current approach, trying different medications and continuing with therapy, is on the right track. It’s also worth looking into more specialized care. For instance, seeing an endocrinologist could help rule out any hormonal issues contributing to your symptoms, and a psychiatrist could offer more tailored medication management. Similarly, making sure your therapist has a background in treating anxiety disorders can provide you with more targeted strategies to combat your panic disorder.

It’s understandable to feel overwhelmed and defeated, given the intensity of your panic attacks and their impact on your life. However, it’s important to remember that this doesn’t have to be a permanent state. With the right support and treatment approach, there is a path forward. Continuing to seek out and adjust your treatment, as you are doing, is key to finding what works best for you.

In summary, your efforts to manage and overcome your panic disorder, though challenging, are the right approach. Exploring the potential triggers, ensuring you’re receiving specialized care, and continuing with both medication and therapy are essential steps. There’s hope for improvement, and with persistence, you can regain control over your life.

Question 2:

Hello Dr Duff! Love the podcast and your books have been very helpful also!

Do you have any insight on online resources or advice for caregivers of people with dementia (in this case related to a TBI)? I am really struggling to take care of myself when my loved one needs extra care during waking hours? I try to stay up late or wake up early to get an hour of “me time” but often that translates to catching up on housework or other necessary chores, not really taking care of myself. I feel if there was an online support group or something scheduled I would be more likely to carve out time, rather than just saying “I’ll do self care time when I have a moment.” Any insight you have here would be awesome! Thank you!


Caring for a loved one with dementia, especially when it stems from a traumatic brain injury (TBI), is an incredibly challenging journey that many find themselves on. The person reaching out is looking for online resources or advice to navigate the complexities of caregiving while struggling to maintain their own well-being. They’re finding it difficult to carve out time for self-care, as moments that could be spent on personal rejuvenation instead go towards housework and other chores. They’re in search of an online support group or scheduled resource to help make self-care a priority rather than an afterthought.

In response, it’s acknowledged that the experience of caring for someone with TBI varies greatly, depending on the severity and location of the injury. TBIs can range from mild, like concussions, with symptoms that may quickly subside, to severe injuries from accidents that can drastically alter a person’s functioning and personality. Recovery from TBIs is most significant within the first year, with possibilities for continued progress, but at a slower pace. The challenges caregivers face can be immense, from managing basic care needs to dealing with potential behavioral and personality changes in their loved one.

For resources, caregiver.org is recommended for its comprehensive support offerings, including support groups, services by state, events, and classes tailored for caregivers. Books like “Caregiver’s Bible” by William Matteson, “Self-Compassion” by Kristin Neff, and “Dementia with Grace” by Vicky Noland Finch are suggested for further reading. Additionally, exploring social media profiles, YouTube channels, blogs, and online support groups can provide a wealth of information and community support.

It’s also encouraged to seek out in-person resources within the caregiver’s local area, which might include organizations like the Caregiver Wellness Center and the Brain Injury Center. These local resources often offer classes, support groups, and events specifically designed for caregivers, along with familiarity with local services that could be of help, such as adult daycare or respite care.

The importance of individual therapy is emphasized for caregivers, highlighting the need to focus on their own mental health and well-being. It’s acknowledged that while the desire to care for a loved one is noble, professional help may sometimes be necessary to provide the best care for both the caregiver and the individual with TBI. The cultural complexities surrounding caregiving and the potential need for assisted living facilities or professional care are also discussed, urging caregivers to consider what is sustainable and best for their unique situation.

In conclusion, the caregiver’s need for support and perspective is validated, with a reminder of the importance of self-care and the potential benefits of leveraging both online and in-person resources.

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