Rita Schulte: I’m a Licensed Professional Board Certified Counselor in the State of Virginia. I got my BS in Psychology and my Masters in Counseling from Liberty University in Lynchburg. I have a private practice here in Virginia with a couple of offices where I specialize in treating eating disorders, anxiety disorders, and depression disorders, as well as issues of grief and loss. I’m certified in critical instance and stress management; basically just completed a book which is currently in the publishing process. So I’m excited about that.
Getting ready to now start a podcast called Heartlines and a weekly devotional that’s going to be called Consider This. I’ve got two really exciting guests lined up for that show Dr. Don [Tradamer], excited about having him there, and Dr. Gina [Cabarera] from Remuda Ranch.
SPP: What promoted you to kind of go into psychology and to specialize in things like anxiety disorders and eating disorders, things like that?
Rita Schulte: Well I started an Undergraduate Degree in Psychology, took a few years off, and then got a degree in Interior Design and decided then to go back to school and finish my Psychology Undergraduate Degree, which led to me getting a Masters. Then I started a private practice and the anxiety disorders were interesting to me because I’d suffered with anxiety and panic for awhile. So that was interesting.
Then the eating disorders just kind of started being referred to me and I really was interested in that client population. So I started seeing a lot more patients and that makes a big bulk in my practice that will actually be the subject of my next book.
SPP: I don’t know if Jon mentioned it or not, but I have also dealt with some anxiety and panic disorder in the past. I know it makes you want to look into it and figure out what’s going on, because you really don’t have any idea.
Rita Schulte: Yeah.
SPP: Were you able to deal with it through your research and through learning more about it?
Rita Schulte: I basically went and got some counseling. There were just a lot of losses going on in my life, a lot of things were happening circumstantially. I went and got some counseling I actually went on medication for a period of time and was able to go off of it. So it interested me but I really hadn’t started my graduate work at that point so I didn’t really know a lot about it.
I think that’s one of the things that people really need to know is that panic disorders are really treatable things. Most people feel weird and guilty and so they don’t get help and they can go on for years without treating it. When a lot of it if you know about it knowledge is power, power is change. So I really want to educate my clients about panic and about anxiety. That helps to dissipate some of the fear right there.
There’s about 40 million people that suffer from panic disorder and anxiety disorders, often correlate with other things like depressive disorders. So it’s not uncommon for someone who has an anxiety disorder to have a mood disorder as well.
SPP: Can you explain to our listeners briefly what a panic disorder actually is?
Rita Schulte: Yeah. A panic disorder is one of the disorders in diagnostic statistical manual of mental disorders it’s cluster group of anxiety disorders, which include generalized anxiety disorder, panic disorder, with or without agoraphobia, excessive compulsive disorder which most people have heard of, excessive compulsive personality disorder, and then post traumatic stress disorder.
SPP: Why did these people develop panic disorders?
Rita Schulte: There’s really basically three reasons that people are prone or develop anxiety disorders. The first one is Genetic Predisposition. In other words, if there’s a history of anxiety or depressive disorders somewhere in your family chances are you may be predisposed to develop an anxiety disorder.
The second reason is going to be your Family History. Many people that have anxiety disorders grow up in environments in which they feel unsafe. Life’s unpredictable, the home is chaotic; perhaps they never learn to regulate their emotional responses to stress. Then some people grow up in homes where the parents are overprotective or the parents have anxiety disorders. This kind of unknowingly strengthens their sense of vulnerability or helplessness.
Then finally there’s the stress Vulnerability Component. I explain that to my clients like this, if you can imagine you have two buckets, we’ll call them stress buckets Bucket A and Bucket B. Bucket A is half full of water, Bucket B is three quarters full, but the water in those buckets represents the current life stressors that we all have. Now we introduce a rainstorm and those buckets then start filling up.
Now remember Bucket A is half full but it has enough requisite reservoir capacity in it to handle the stress, but remember Bucket B is already three quarters full so it lacks the requisite reservoir capacity to handle the additional stressors, and over time as more and more stress is added overflow occurs. That bucket is just going to start spilling all over the place. So basically your body’s going to take a hit physiologically, emotionally, everything. So if I’m already genetically predisposed to anxiety or panic it’s pretty easy to see what happens. Then over time the more I experience anxiety and panic the reinforced those responses become. That’s where people develop agoraphobia to the point where they won’t even go out of their house.
SPP: Can you explain what happens during a panic attack?
Rita Schulte: Basically what happens in a panic attack is your brain receives a stimulus then it interprets the meaning of that stimulus and it usually interprets that as danger. It selects the response and enlists the body to cooperate as needed. When all this happens chemicals begin being released through your bloodstream and your central nervous system, things like adrenaline and no adrenaline. We’ve all heard of that flight or fight response at times this fear response for us.
Okay let’s say you see a copperhead in your garden. A visual relay occurs to the prefrontal cortex of your brain. That’s the information processing center. That organizes information and sends a signal to your Limbic System which is the emotional center of your brain.
The Amygdala is a tiny little almond shaped group of nuclei deep within the medial temporal lobe and they’re activated and sent out a danger signal, and your body responds with flight, fight or freeze. When you see the snake your brain has made an interpretation of danger and your body cooperates with physiological changes like increased heart rate, pulse rate, your muscle tense, increased respiration or holding of the breath, you might get dry mouth, sweaty palms. This is a situation with an appropriate response to danger.
The problem with panic disorder sometimes is there isn’t a snake. The attack can be situation specific that I see a snake, but oftentimes the attack comes out of the blue. So you’re left wondering what the heck has happened to me. Your body overestimates a danger signal which no apparent visual clue, and that’s where folks get tripped up. They don’t have a clue as to why or when or what’s going on, which only serves to make it more fearful for them. We have to help people understand what’s really going on by evaluating their particular situation.
SPP: Do you find that a lot of your clients describe the feeling of having a heart attack?
Rita Schulte: Yes absolutely. In fact I had one person that had visited the ER five times thinking they were having a heart attack and nobody ever bothered to explain or educate them on panic.
SPP: When I first started work I had that same exact experience. I literally thought I was having a heart attack and ran to my boss’ office and was going to tell him to call 911. But as I was standing in his doorway I finally realized that I wasn’t dying that caused me to look into the whole panic disorder and anxiety attack thing.
Rita Schulte: Yeah and it can be very frightening. It’s very frightening for people. You don’t know how bad it can be until you’ve really experienced it and people have all different kinds of symptoms. I mean for me it was more almost like I was coming out of my own body. It’s very scary and what drives that fear is these chemicals that get a pulsating through your central nervous system in your bloodstream that are giving you these feelings. Once you know that that is in and of itself can calm you down.
SPP: That’s kind of how I went about it. Once I figured out that I really wasn’t dying and I kept telling myself that I was able to recognize when I as having a panic attack and kind of stave it off.
Rachel Schulte: Absolutely. So education is a big huge piece of it. The other thing that’s really important that I look for with people with anxiety or panic is what beliefs underline their fears? For example, let’s say you have a fear of flying you can get a panic attack just thinking about going to the airport.
I had a lady once that was just absolutely terrified and real panicked by just the thought of that. But what her thoughts were telling her, what her beliefs were, were if I get on a plane I know it’ll crash and I’ll die or if I’m claustrophobic and I fear being trapped on the plane I tell myself I won’t be able to get out. So this loss of control becomes huge for people who suffer with panic disorder. They attach a meaning to it that becomes catastrophic.
SPP: Say you have a panic attack for the first time and you feel like you’re on edge afterwards for awhile. What are the steps that you recommend people take to start dealing with it and eventually get over it? I guess that’s another question, is it possible to rid it from your life entirely?
Rita Schulte: I think it’s definitely possible. Again it goes back to family history, genetics, how much stress you’re under, those kinds of things, but panic is really something that people can manage and people can control. They need to be educated about it. If it’s really bad seeing a counselor would be something they should do. But what they can do in the immediate here and now is really learn about the breath because the breath is something that’s huge in terms of reducing the senses of panic.
Panic is driven by fear so what that does is it revs up our sympathetic nervous system. The breaks to that is our parasympathetic nervous system. So when we slow down our breath and learn to breathe diaphragmatically we’re actually kicking in our parasympathetic nervous system which calms us down. So when you notice, I mean and since both you guys have experienced panic, you might think back how is my breath? Usually our breath becomes shallow, short; sometimes we’re holding our breaths.
I have a client that when she just comes into the office we start laughing about it now because she’s catching herself doing it. So the breath is hugely important. Learning how to breathe and practicing that. I have my clients practicing it three or four times a day so that they’re so familiar with it that when they start feeling anxiety coming on it’s much easier to deal with it when it’s a one or a two than when it’s already a nine or a ten. So once I feel those physical sensations, the thoughts, the emotions I need to notice and pay attention to what’s going on in my physical body and begin to slow down that hyper arousal on my sympathetic nervous system by doing the breathing.
SPP: Now you’d also mentioned medication earlier. Do you think medication is the last option for panic disorder, the first option? When do you start talking to your clients about seeking medication to help them out?
Rita Schulte: Right. Well that’s a good question. It depends on how debilitating it is for them. For a lot of people I see they are in such a place where it is impairing their functioning and so at that point I would refer them to a psychiatrist for evaluation for medication. People can do it without medicine, they can do it I use cognitive behavioral therapy and exposure and response prevention to treat it. So in other words, by exposing people, see what do people do when they fear something? What are people that are phobic about getting on an airplane do? They don’t fly.
Look at John Madden he goes across country to all the games in a bus. So it’s easy to avoid the fear of situations but that’s actually the worst thing you can do for panic. It’s exposing people, gradually exposing them to the fear of situations or events and letting them realize that they’re not going to die; they’re not going to explode. It might feel uncomfortable but the more they do it and the more they expose themselves to it the more that anxiety is going to be manageable, the more they’ll learn to sit with uncomfortable emotions, then they’ll go away.
SPP: I know that most medication that is prescribed for things like anxiety and depression deals with the levels of serotonin in the brain. I read a book one time that said “In the future that will be dispelled as a myth that they’ll realize that that’s not true.” Is there a strong science backing that that actually is what happens you lack a level of serotonin in the brain?
Rita Schulte: Yeah but you know that’s a really good question because there’s a lot of really cool stuff going on with brain neurobiology, it’s a really hot topic right now. It’s getting us a lot more information on how these information processing system works in the brain. Is it serotonin and is a lack of dopamine, is it this is it that? So actually what I can tell you is that pet scans and spec scans that they’re using now, which are able to measure cerebral blood flow and indirectly look at brain activity or brain metabolism, are actually showing that people that are prone to anxiety and depressive disorders – that area I was talking about the Limbic System – will actually light up because those areas of the brain are really overworking.
So there’s got to be a link there. The jury’s out. Depending on who you read about, who’s article you’re reading is going to say “Well no this is the worst thing you’ve got to get off medicine. Oh no you’ve got to take medicine.” I tell people you need to do what’s best for you. When your quality of life is debilitating to the point where you’re not functioning or you’re not going out of your house because of panic disorder then you probably would want to consider taking some medication.
When I took medication I took it for eight months and then I went off of it and I was fine. So it doesn’t mean that you’re locked into taking it for the rest of your life. Some people might have to take it for the rest of their lives, but I think oftentimes some people get anxious about that oh my gosh what’s the medicine doing to me? Oh my gosh I’m going to have to be on this for the rest of my life.
So people with anxiety tend to think that way anyway and they get anxious about that whole piece. But I do think there’s some really exciting things going on neural biologically that we’re learning about the brain, about its neural pathways and how we literally have carved out neural pathways in our brain by the repetitive learning process of life. What we found out is the brain is very plastic so that’s really cool because it gives hope to healing for folks. You can actually retrain your brain and make new neural pathways, healthier neural pathways in your brain by learning some of these skills. So I think that offers people a lot of hope right there.
SPP: I wanted also to ask, and I know you do some work with eating disorders, and I wanted to kind of talk to you a little bit about that.
Rita Schulte: Sure.
SPP: What are the most common ones that you see and any advice that you could give to people suffering from them that might be listening?
Rita Schulte: I treat a lot of people. Well I have people that are anorexic, which means that they restrict food, people are bulimic which means they binge and purge, and compulsive overeaters. So I have the whole gamut in my practice. It’s a very interesting disorder in that there’s really a whole lot of layers to it depending on which one we’re talking about.
There’s also something in the DSM called eating disorder not otherwise specified. So in other words, you don’t meet the criteria for anorexia or bulimia but you’ve always had issues with food. I had a client like that and basically she’s walking a huge measure of freedom. There’s always been issues with food, I’m always on a diet, I’m always talking about my weight, I’m constantly ruminating about my body image. I have people with body image issues. So there’s just a whole lot tied into this whole idea of eating disorders.
SPP: Do you feel like those are usually solved or cured, or at least dealt with, through talking to someone through counseling as opposed to medication and things like that?
Rita Schulte: Anorexia there’s really no medication. Oftentimes the reason folks are given medication for those disorders is because of co morbid symptoms, meaning they would have an anxiety disorder or depressive disorder that we would treat. But eating disorder doesn’t go away because you put somebody on like a serotonin reuptake inhibitor. A lot of people end up having to go into treatment.
I work with Remuda Ranch which is an eating disorder facility in Arizona and here in Virginia, and sometimes people have to go to inpatient treatment facilities to deal with it. So if you know somebody or concerned about somebody that has an eating disorder definitely get them into counseling. Because I have a lot of young people, a lot of teens, and the earlier you get somebody into treatment the better the prognosis will be for them to get help.
SPP: I wanted to switch topics real quick with you and talk to you about the book that you’re publishing.
Rita Schulte: Okay.
SPP: Can you go ahead and give the listeners the name of the book? Just a brief synopsis of what the book’s going to be about.
Rita Schulte: Sure. The book is going to be entitled “Sifted as Wheat: Finding Hope and Healing for the Losses of Life” and it’s really about how the losses of our lives impact us at the heart level. Millions of people today struggle with the catastrophic effects of loss, I mean we just look around right now what’s going on in Egypt and war or terrorism, death, suicide. I just had a client in yesterday who was telling me about a 17-year-old boy who hung himself in his basement. Mental illnesses, economic failures. All of these things are affecting people’s hearts but most people aren’t paying attention to how they’re affecting their hearts. So it became for me a real issue of interest because in my clinical practice I started noticing that people suffering from a whole host of mental health disorders, whether it was an eating disorder, an anxiety disorder, a depressive disorder, they had at the core of the problem and unresolved or unidentified loss of some kind. Something that they had never put words to much less grieve and it was really keeping them stuck in their pain.
The book is about having people notice that, it’s about having people I coin the term “Abstract Loss”, which means most people equate loss with death, but loses can be very abstract. Shattered dreams, unmet expectations, loss of trust, loss of hope, even a loss of faith, all those are abstract losses. If you don’t identify those and then cover those and uncover the roadblocks that keep us from grieving and identifying them, sooner or later it seems like we hit a wall. So this book makes a strong case for why we need to focus on matters of the heart when dealing with the losses of our lives and what the long range benefits of doing so are.
Part of the book is focusing on unfinished business of loss and then helping people to kind of begin to think about reinvesting their life and their heart after loss, rekindling desire and passions that perhaps got buried on a stuck on a shelf for decades and nobody ever bothered to take it down and dust it off. The story isn’t finished in your life just because you’ve experienced wealth and so you need to start seeing a bigger picture of what life can be apart and aside from loss.
SPP: Awesome. Well I know I’m real interested to read this book when it comes out. Hopefully once it is published and printed you can send a couple of signed copies over to us to give to our listeners.
Rita Schulte: I’d be glad to.
SPP: Awesome.
Rita Schulte: I’d be glad to.
SPP: Well I wanted to thank you so much for being on the podcast today. Rita Schulte: Oh it was my privilege. Thank you for having me.