Learning to manage anxiety: lessons from a dog named Ben - Part 2. By: Maura Matarese, M.A. LMHC, R.Y.T.

Please read part 1 on www.mauramatarese.com before part 2.

I consulted his veterinarian, and we both agreed that Ben needed medication. We bantered back and forth about which class of medication would be best for him. I wanted him on a small dose of Benzodiazepines, and she wanted him on an SSRI (selective serotonin reuptake inhibitor). She then consulted a doggy behaviorist who recommended Alprazolam (Xanax) and Reconcile (Puppy Prozac) together. 
The Alprazolam would be short term, as it takes a few weeks for Prozac to
work. She warned that I needed to stay home with Ben the first day he tried the
Xanax because some dogs have what's called a "paradoxical" reaction
to it, making them more anxious and irritable. So that's what I did. And he seemed to be able to tolerate the Xanax. But by the third day, I noticed something: when the Xanax wore off, he seemed worse. He was more growly and irritable. And as this continued, I wondered if he needed more?

I thought back to my training in biological basis of behavior and psychopharmacology and remembered some basics about neuro chemistry and the brain. When people (and dogs for that matter) are traumatized, certain parts of the brain kick into high gear in order to survive. This is called "fight or flight" a necessary survival mechanism of the sympathetic nervous system. Sometimes, one traumatic event is all it takes for the brain to get stuck in overdrive even when it doesn't have to be, because the memory of the event is so powerful. And because parts of the brain are working "too hard" eventually some very
important neurotransmitters become depleted. Neurotransmitters are chemical
messengers that tell the brain what to do. Some are excitatory, like dopamine
and Adrenalin (which is actually a hormone), and some are inhibitory, like GABA
and Serotonin. Excitatory messengers do exactly what you'd think they'd do, and
cause us to move quicker, and on the flip side, inhibitory messengers help us
to slow down. For optimal functioning, we need a balance of both messengers as
some times we need to move quickly, and at other times, slowly. As stated
previously, traumatized and or anxious people are often "stuck” moving too
quickly, which manifests in symptoms such as: shortness of breath, hyper
vigilance, startle response, racing thoughts, irritability, and even panic.
Sound familiar? They need the "slow down" messengers to come along so
that they can feel normal. Benzodiazepines which mimic GABA in the brain which do just that, but there's one problem.  When the brain thinks it has enough GABA, it won't produce anymore. So when the medication starts to wear off, people can have increased anxiety, and often want to take more medication -a prelude to the addictive cycle.  And taking more fosters dependency. Taking
Benzodiazepines is not always a "bad" thing, as we don't want people
to suffer.  However people who struggle with addictive disorders are more vulnerable to abusing them, hence the negative consequences of this can outweigh the positive ones. Knowing that there are other and equally effective ways to manage anxiety, I thought it best to discontinue Ben’s Xanax. I called his Ben’s vet, and we both agreed to stop the Xanax and wait for the Prozac to take effect. I kept all my fingers and toes crossed.

SSRI's work a little differently than Benzodiazepines. They allow for more serotonin to be available in the brain which indirectly allows the brain to produce more GABA. It's a complicated process, one that takes longer to work. In some cases it can take up to six weeks for an SSRI to be effective. And although there are some initial side effects that generally go away, SSRI's don't have the negative side effects that Benzodiazepines have, such as increased anxiety and irritability. Also, they are non habit forming. In time, they can actually reset the brain to "normal functioning" and some people can successfully come off of them. However keep in mind that genetics play a crucial role in determining this, as for some, their brains just don't make enough "feel good" chemicals to function without suffering. But I digress.

Three weeks to the day after starting the reconcile (puppy Prozac), I noticed a few things. Ben seemed calmer. When I'd pick him up from the sitter at night, he was happy to see me, not flailing and wailing with excitement for ten plus minutes before he could relax. Then I went grocery shopping. Before reconcile, he'd try to come out of the car with me, and when he couldn't - he would plant his paws on my car's dashboard - hyper vigilant till I returned. Now, he knows I'm leaving, and just sits in the front seat and waits. He's less growly around people, and when he barks at people unnecessarily, he's easily redirected. But the biggest change - and this blew me away – is what happens we get ready to leave the house. I make him wait as I walk out the door first then tell him to come, and he does! Prior to the reconcile, the second he knew we were leaving, his excitement would overwhelm him, and he'd plough right over me. Making a dog wait before walking out the door is a behavioral technique designed to slowly teach dogs how to hold their anxiety, and at the same time, remind them who the boss is. I was convinced that he would NEVER be able to do this, and within a short period of time, he was. I am hopeful, that in time, he will learn to feel okay being home alone. But time is the operative word here.

Learning how to manage pain, sadness, discomfort, and anxiety takes time. It doesn't happen instantly or within a day, a week, or a month. It happens when it happens, and will happen if we follow a simple recipe: practice, practice, practice. With proper support, appropriate medication, good self care, patience and consistent effort, you will see changes - take it from Ben who's a trauma survivor. He still has a long way to go, but I believe that someday, and I don't know when
that day will be, he will do more than just survive. He will thrive! What
happened to him can't be undone, but his memory of it will be less powerful as
his brain creates newer, happier memories. He needs to feel some discomfort in order to learn, and will learn as he slowly gets exposed to what he fears. In time, his fear will dissipate.

It is said that "the journey of a thousand miles begins with one step", and it is also said that growth is not linear. We often take "two steps forward and one step back". All that really matters though is that we keep moving forward. The pace is not so important. Challenging, especially when we want things now! But NOW is when it does happen, little by little.  NOW is when we practice, over and over again.

People often ask me about my dog, and how he got his name.  Ben, who
is sleeping by my side as I write this, was already named when I adopted him.
Sometimes my friends call him Benji, as like me they grew up having seen the
television series “Benji”. I did a Google search about the series, and wouldn't
you know that "Benji" was also a shelter dog who represents “hope, the will to survive, and eternal optimism". That feels like such an eerie coincidence, don’t you think?

I'm sure that Ben will have many more life lessons to teach me, but I believe fate sent me an obvious lesson here about medications and managing trauma and anxiety. And even though he's a dog, he's not so different from us people. He has a limbic brain just like we do which allows him to have feelings and form attachments. But what he doesn't have is a neo cortex, which would allow him to understand what's happening, and make decisions about what to do. Fortunately, you do have that part of the brain. And this is a good thing, because as you learn to mange anxiety and other uncomfortable feelings, you can understand how the whole process works. This means that you can do so much more then Ben!  It is my hope, that you do just that!

Sat Nam.

Maura Matarese is a psychotherapist and yoga instructor. To lear more about Maura, visit her website at www.mauramatarese.com.