Medical Cannabis

Cannabis and Medicine

Why would I think of using Medical Cannabis?

Medical cannabis, or CBD oil, is not a first line treatment. As per the Royal Australian College of General Practitioners guidelines, “medicinal cannabis products should only be considered when all first line, conventional options have been tried.”

So, if you have a medical condition of more than 3 months duration and conventional medications have not proved effective for you or the side effects have outweighed the benefits or you wish to stop using ‘community acquired’ cannabis. Then it may be worth having a detailed discussion of the potential benefits and downside of medicinal cannabis with one of our doctors.

Who prescribes Cannabis at the Wholistic Medical Centre?

Cannabis (CBD) can only be prescribed by a Doctor through an individual application on your behalf to the Therapeutic Goods Authority – Special Access Scheme TGA SAS.

At the Wholistic Medical Centre, Dr Nick Bassal is registered with the Therapeutic Goods Authority – Special Access Scheme (TGA SAS) to prescribe Cannabis.

The Wholistic Medical Centre Difference

We differ from other clinics who prescribe cannabis, at the Wholistic Medical Centre we will consult with you from a holistic perspective. Cannabis is not just another drug, herb or magic bullet, we view it as an adjunct to holistic health care. So, where appropriate we can also discuss nutritional medicine, exercise, sleep and psychological support. It may also be useful to incorporate Chinese herbs relevant to your condition to improve outcomes. The above adjuncts will potentially have the effect of improving health outcomes, reducing the dose of cannabis you need and hence reduce the monthly cost and any potential side effects.

The Consultation Processes

For the initial appointment (which can be in person or via video) you will need to have relevant information such as medical history, letters from your GP or specialists. If Cannabis is indicated, the Wholistic Medical Centre doctor will make a formal online application to the TGA on your behalf. Note that your name is not revealed. We only need your initials and date of birth.

You will be notified once we receive the approval from the TGA.  You will be asked to make an appointment to discuss the specific medication and starting dose and things to look for. Your doctor will write a prescription and send/give that to you, along with the approval documentation. We will also endeavour to find a specific pharmacy near you that will provide you with the medication.

Follow up appointments are advised initially fortnightly to establish the correct dose and then monthly for the first 6 months to monitor progress and thereafter every 3-6 months as advised to obtain repeat scripts.

If you would like to discuss further, please make an appointment. Call 02 9211 3811 or make an online booking via our website.

What is the cost involved?

The fees below apply to Medical Cannabis consultations with  Dr Nicholas Bassal:

Initial consultation- You will not be out of pocket any more than $199 with Dr Nicholas Bassal. This is for the initial phone or video consultation (this includes the time taken for the Doctor to complete the TGA SAS application on your behalf).

The fee may be different if the consultation is in person, or on video, who you see and how long the consultation is, this is due to different Medicare item numbers that are charged. However, your out of pocket cost will remain at a maximum of $199.

Follow up consultations : $99 (out of pocket)

If you wish to gain from mindfulness-based psychotherapy, in addition to the cannabis, to assist in your holistic treatment, then a follow up consultation will be required with Dr Nicholas Bassal.

As Cannabis has been used in Traditional Chinese Medicine (TCM) for millennia, usually in conjunction with other herbs, TCM practitioners already know which Chinese herbs to use to boost the benefit of cannabis. Each case however needs to be individualised according to their TCM presentation. If that is of interest to you, then make a consultation with Tanya Newton our highly experienced TCM herbal practitioner.

In the unlikely event that your application is declined, unfortunately the initial consultation fee is not refundable

The cost of the medical Cannabis appropriate for you varies depending on the exact product recommended (CBD:THC ratio, supply company and pharmacy). The cost can vary between approximately $200-$400 monthly.

Note- Currently cannabis products are not on the PBS (Pharmaceutical Benefits Scheme), so there is no government subsidy. So, all the costs of the cannabis products as supplied by the pharmacy are privately paid for.

If you want to find out if cannabis might help you. Please call 02 9211 3811 for an appointment.

The Ancient History of Cannabis in Medicine

Cannabis is a form of herbal medicine and has been used for over 5,000 years in many parts of the world. The medical benefits of cannabis were documented by Emperor Shen-Nung in China in 2737BC. Cannabis has been considered one of the 50 fundamental herbs in Traditional Chinese Medicine and its use has been continually documented in Chinese medicine for ~1800 years. In the modern era the seeds, known in TCM as huomaren 火麻仁, are listed in the Chinese Medicine Pharmacopeia.

Read more on Cannabis in Chinese Medicine

The Ebers Papyrus (c. 1550 BCE) from Ancient Egypt describes medical cannabis.

Surviving texts from ancient India confirm that cannabis’ psychoactive properties were recognized, and doctors used it for treating a variety of illnesses and ailments, including insomnia, headaches, gastrointestinal disorders, and pain, including during childbirth.

The Ancient Greeks used cannabis to dress wounds and sores on their horses, and in humans.

In the medieval Islamic world, Arabic physicians made use of cannabis for its diureticantiemeticantiepilepticanti-inflammatoryanalgesic and antipyretic properties from the 8th to 18th centuries.

Modern History of Cannabis

An Irish physician, William Brooke O’Shaughnessy, is credited with introducing cannabis to Western medicine. O’Shaughnessy discovered cannabis in the 1830s while living abroad in India, where he conducted numerous experiments investigating the drug’s medical utility (noting in particular its analgesic and anticonvulsant effects). He returned to England with a supply of cannabis in 1842, (Queen Victoria even used it for period pain) gradually its use spread through Europe and the United States. Cannabis was entered into the United States Pharmacopeia in 1850 and used legally until US prohibition in 1937

Cannabis began to attract renewed interest as medicine in the 1970s and 1980s, in particular due to its use by cancer and AIDS patients who reported relief the effects of chemotherapy and wasting syndrome. In 1996, California became the first U.S. state to legalize medical cannabis in defiance of federal law. In 2001, Canada became the first country to adopt a system regulating the medical use of cannabis.

Our Body’s Own Cannabis

In 1992 it was discovered that our body produces its own cannabis like neurotransmitters and has receptors for them. (similar to the discovery of our natural endorphins). So, it was named the endo cannabinoid system (ECS).

The ECS modulates different body systems to help achieve homeostasis. It is involved in many functions including inflammation, pain, sleep, appetite, digestion, metabolism, cardiovascular function, bone development, reproduction, immune function, mood, memory and cognitive processes.

The Endo-Cannabinoid System (ECS)

We have two natural endocannabinoids – anandamide (from the Sanskrit word, “ananda” meaning bliss; similar structure to THC) and 2- AG (similar structure to CBD) and it was also discovered that there were two types of cannabinoid receptors – CB1 and CB2.

Most of the receptors are CB1 receptors and located in the central nervous system (CNS) which includes the brain (cognitive functions, memory) – e.g. hypothalamus, amygdala, hippocampus, basal ganglia, cerebellum, cerebral cortex. And peripheral nervous system (PNS) all the nerves connected to our muscles and organs.

CB2 receptors are in the immune system and gut (immune function, pain and inflammation).

CBD and THC are chemically similar to our own naturally produced cannabinoids- hence they can interact with our CB1 and CB2 receptors.

Chemistry of Cannabis

CBD oil

Many people are familiar with two of the well-known chemicals found in medicinal cannabis- CBD (cannabidiol) and THC (delta 9 tetrahydrocannabinol).

Cannabinoids can be classified into three categories:

  •      Endocannabinoids– natural produced in the body
  •       Phyto cannabinoids– from plants
  •       Synthetic cannabinoids– pharmaceutical products

The cannabis plant has over 500 chemicals which can be grouped as cannabinoids, terpenes and flavonoids.  There are approx. 140 cannabinoids of which CBD and THC are the most well-known and researched. However, the terpenes and flavonoids have their own beneficial actions and also work synergistically with the cannabinoids- this is known as the entourage effect. Which is why we prefer whole plant extract.  The main variety of the cannabis plant is Cannabis sativa. Hemp is a strain of Cannabis sativa and has been bred to have lower concentrations of THC and higher concentrations of cannabidiol (CBD), which decreases or eliminates its psychoactive effects.  Hemp has been used for centuries for its fibre for making cloth, paper and ropes. Marijuana the other strain of Cannabis sativa which has been bred to have higher concentrations of THC and is the strain commonly used recreationally.

Medicinal uses of CBD and THC

CBD – this is the non-psychoactive component that has many beneficial properties including:

  •      anti-inflammatory
  •       anti-epileptic
  •       anxiolytic
  •       analgesic
  •       anti-emetic
  •       anti-psychotic

CBD is thought to inhibit the enzyme that breaks down anandamide (one of the two natural cannabinoids in the body) and stimulates the production of 2-AG (the second naturally occurring cannabinoid).

THC – produces the psychoactive effects (“high”) that cannabis is known for. However, it also has many other benefits including:

  •      analgesic
  •       anti-spasmodic
  •       improving appetite
  •       anti-inflammatory
  •       anti-emetic
  •       anti-spasticity

THC binds to CB1 receptors in the central and peripheral nervous system whereas CBD binds very weakly to CB1. It has been found that when THC is combined with CBD, this helps to reduce the THC’s psychoactive side effects. Phyto cannabinoids can also bind to other receptor sites apart from CBD 1 and 2. e.g. CBD is an agonist (enhancer) for the serotonin receptor.

CBD and THC can be used alone on in various formulations depending on individual circumstances and medical conditions.

In Australia in November 2016, THC became a Schedule 8 classification (controlled drugs – like morphine) and CBD became a Schedule 4 classification (prescription only medicine – like antibiotics, strong painkillers) by the TGA (Therapeutic Goods Administration).

Which medical conditions is Medical Cannabis (CBD) useful for?

  • Chronic non cancer pain (CNCP)
  • Chemotherapy induced nausea and vomiting (CINV)
  • Cancer pain
  • Epilepsy
  • Multiple Sclerosis
  • Inflammatory bowel disease
  • Autism
  • Endometriosis
  • Fibromyalgia
  • Migraine
  • Anxiety/Depression
  • Chronic insomnia
  • PTSD
  • Parkinson’s disease
  • Alzheimer’s disease
  • Sleep disturbance associated with Obstructive sleep apnoea (OSA)

Who cannot use Cannabis (CBD)?

CBM is generally contraindicated in:

  •      Unstable cardiopulmonary disease
  •       Cardiovascular risk factors
  •      Pregnancy and breast feeding.
  •       Active mood disorder, a history of psychotic disorder, schizophrenia.
  •       Hypersensitivity to cannabis products

Caution is required in:

  •       Patients < 25 years old. Cannabis can be used with careful monitoring in children/young adults with certain conditions like epilepsy (e.g. Dravet syndrome- drug resistant epilepsy) or autism.
  •       Kidney/liver impairment
  •       History of substance abuse
  •       Previous or family history of mental illness e.g. schizophrenia.
  •       Patients with risk of fall e.g. frail elderly patients.

Drug interactions – caution if taking these medications

  •       Blood thinning agents e.g. warfarin.
  •       Drugs/herbs that are also metabolised by CP450.
  •       Sedatives and analgesics- alcohol, benzodiazepines, anti-depressants, anti-epileptics

What are the side effects of Cannabis?

The most common side effects are dry mouth, dizziness, disorientation, confusion, drowsiness, fatigue and anxiety.

Less commonly, people may also experience increased heart rate, impaired reaction times, fatigue, nausea, diarrhoea, vomiting and depression.

These effects are dose related and completely reversable.

That’s why we use the principle of “start low and go slow”.  Each patient will be started at an low dose, with any dose changes done gradually and closely monitored especially in the initial phase. Once on a stable dose, the frequency of follow up visits can be less frequent. The aim is to be on a dose that provides maximum benefit with minimal side effects. Each patient will be different.

Forms of Medical Cannabis

The oil is the most commonly used method for administering medical cannabis. The whole plant extract is mixed with a food grade oil (e.g. olive, canola). A dropper is used to place the oil under the tongue, it is absorbed within a minute.

Taste is generally not an issue. Capsules containing the oil are also available.

There are other methods like using a vaporiser or inhalation and creams/patches, but these are not currently approved in Australia.

Absorption of Cannabis

When taken as an oil (most common form of medical cannabis) under the tongue, and not swallowed, Cannabis is absorbed directly into the blood stream and has medium bioavailability. The effects can be felt in 30min to 90min and last about 4-8 hrs.

When Cannabis (CBD) is ingested, (added to food) it goes through the digestive tract, has lower bioavailability and is slower to act. Effects can be felt in 30min to 2 hours and last 3-6 hours.

By contrast smoking ‘community acquired’ cannabis (not recommended) provides high bioavailability and acts within a few minutes with a duration of 3 to 4 hours. The dose delivered by smoking is highly variable depending on the strain, potency of the plant, how it has been grown and dried. Generally smoking can deliver a dose of about 250mg to 1000mg of THC this of course hinges on initial quantity and how many people are sharing.

Can I drive?

CBD is less likely to impair driving than THC; however, there can still be very small amounts of THC in a CBD only product. So, until Mobile Drug Testing legislation allows for minimal levels of medicinal THC (like alcohol), it is not advised to drive even though your driving may not impaired.


If you want to find out if cannabis might help you, please call 02 9211 3811 for an appointment with

Dr Nicholas Bassal


Many of the WHolistic Medical Centre practitioners use traditional and western herbal medicine

Where are we up to with medicinal cannabis?


Is it legal?    

Medical practitioners in Australia can legally prescribe medicinal cannabis through regulated pathways such as the Special Access Scheme Category B and the Authorised Prescriber Scheme. These pathways are typically used by doctors for unapproved medicines.

Dr Vicki Kotsirilos, Victorian GP and Integrative Medicine Practitioner, became Australia’s first authorised GP prescriber of medicinal cannabis in May 2018. She said recently that GPs currently have ‘a large demand’ for knowledge about the use of medicinal cannabis. Dr Kotsirilos says there is a lack of knowledge about the clinical usage of medicinal cannabis which stems from a lack of formal education and upskilling available to GPs.

‘We need regular top-ups of education because the science actually changes every day and there’s new studies that come out all the time,’ she said. ‘Because it is a plant medicine, it’s not part of our curriculum, so all the learning is self-taught.’

 What is it currently prescribed for?

The main medical conditions for which medicinal cannabis is prescribed in Australia to date are:

  • chronic non-cancer pain
  • epilepsy
  • multiple sclerosis
  • palliative care including cancer pain management
  • cancer-related nausea and vomiting.

Is it available at Wholistic Medical Centre?

We are very fortunate that Dr Nick Bassal, who had already begun upskilling in the use of medicinal cannabis, has been invited to participate in a conference in Montreal, Canada, taking place as this newsletter goes to ‘print’. So, watch this space if you believe that you have a need for medicinal cannabis.

Medical cannabis for period pain? Would you like to have your say?

Development of a clinical trial on medicinal cannabis for primary dysmenorrhoea: Co-Design.’

Researchers from NICM Health Research Institute would like to invite women who suffer from ‘primary dysmenorrhoea’, that is period pain not due to endometriosis or adenomyosis, to participate in an on-line focus group to have your say in how clinical trials should be designed to be relevant and well-structured. Read the participant information at

Or ask our wonderful Reception Team at the Wholistic Medical Centre for more details.

Is the standard medical test for thyroid function sufficient?

Thyroid problems – living beyond “normal”

The thyroid gland is an extremely important gland which regulates a number of complex hormonal reactions. Because of the complexity of its inter-reactions it is readily poorly diagnosed.

As an Integrative GP, I see patients on a regular basis who have been misdiagnosed or inadequately treated for thyroid problems. Thyroid function, its’ diagnosis and treatment are areas in which I have a particular interest.

The standard medical test for assessing thyroid function is to test the levels of the Thyroid Stimulating Hormone (TSH) in the blood – however this test alone is not sufficient. Patients who have apparently ‘normal’ levels of TSH can in fact have significant thyroid problems and are therefore commonly misdiagnosed.

Misdiagnosis can lead to the distressing situation where a patient is told that their thyroid function is normal when in fact it is the cause of many of their symptoms. In these cases, a patient can find themselves on the merry-go-round of being referred off to all sorts of specialists and being put on any number of drugs for symptomatic relief (eg. anti-depressants for mood disorders, statins for high cholesterol, contraceptive pill for period problems) when the real cause is right there waiting to be discovered – if only the correct tests are performed – and interpreted correctly.

Once the correct hormonal tests are performed and the genuine underlying causes determined, an effective treatment regimen can be put in place. This can give a long-lasting benefit and a whole new lease on life to people who have needlessly suffered for, sometimes, many years.

This article explains the complexities of the thyroid and its hormonal relationships in a way that is designed to be straight forward enough for a non-medical person to understand and to enable anyone to take a more proactive role in their health management.

Introduction to the Thyroid

The thyroid gland is a butterfly-shaped gland in the neck, weighing less than an ounce. Its name coming from “thyros” – meaning “shield like”.

The thyroid gland is an extremely important endocrine gland in the body. It can be viewed like a ‘spark plug’ that initiates a number of vital functions, and also like a thermostat that then regulates those functions. If the ‘spark plug’ function isn’t working properly then some vital functions won’t be turned on sufficiently. If the ‘thermostat’ function is not working, then some vital functions will be either over-stimulated or under-stimulated. For effective treatment to be applied it is essential that we understand exactly how the thyroid is malfunctioning.

The vital functions that the thyroid has control over include cellular metabolism, temperature regulation, growth and development (especially foetal, and early childhood), fat breakdown, neurotransmitters in the brain and gut function.

Why talk about the thyroid gland?

Thyroid conditions are extremely common. They occur in women 10 times more often than in men and can be undiagnosed or misdiagnosed leading to years of ineffective treatment and loss of quality of life.

Of those that are diagnosed, some are not effectively managed. This can occur because the underlying causes of thyroid dysfunction are not sufficiently looked at, the interpretation of results is not sufficiently accurate or because the treatment options given may not be the best for that individual.


The most common symptoms of an under-functioning thyroid are fatigue, dry skin, low mood and constipation. However, because the thyroid gland controls so many functions, there can be a wide variety of symptoms. This somewhat explains how some of the misdiagnoses happen.

Other symptoms include, but are not limited to – cold hands and feet, irregular heart rate, swollen legs/ankles, puffy face, low body temperature, morning headaches, needing more sleep than usual, low heart rate, long recovery period after exercise or illness, poor immunity and recurrent infections, low libido, feeling of fullness in throat, sore throat, transient neck pain, menstrual problems, infertility, recurrent miscarriage, gut symptoms including ‘irritable bowel syndrome’ (IBS), constipation and bloating, brain fog, memory problems, goitre- neck lump, soft, weak pulse, puffiness around the eyes or face, enlarged tongue (macroglossia), voice hoarseness, slowed speech and slowed movements.

And, of course in an over-functioning thyroid, the symptoms may be the opposite. The gland may even go from under- to over-functioning.

How the thyroid gland works

It all starts in the brain and then cascades throughout the entire body! The hypothalamus gland in the brain secretes Thyrotropin-Releasing Hormone (TRH) which stimulates the pituitary gland (also in the brain) to secrete Thyroid Stimulating Hormone (TSH). TSH then stimulates the production of Thyroid Hormone T4 from the thyroid gland.

T4 itself is inactive and needs to be converted to Thyroid Hormone, T3. T3 is the main active thyroid hormone.  It is T3 that does most of the work.

The conversion from T4 to T3 is done mainly outside the thyroid gland, including in the gut and the kidneys. Indeed 20% of thyroid hormones are generated via gut bacteria.

There are many factors that are needed for the conversion from T4 to T3 to happen. The main nutrients required include iodine, selenium, magnesium, zinc, iron, B vitamins (especially B2,B3,B6) and vitamin D. The main factors that can interfere with the conversion of T4 to T3 include stress, heavy metals, plastics and other endocrine disruptors, also other halogen chemicals including fluoride and chlorine.

If any part of the cascade of hormones from the brain down through the thyroid to the gut and kidneys is disrupted or incomplete, or if nutrients levels are insufficient, or if negative influences are too high – then the eventual production of T3 can be inhibited.

We can already see why simply testing for TSH can be inadequate as a diagnostic tool if the problem lies further down the chain,  if the problem lies in the gut  or if the problems lies in nutrition or in the presence of too many negative influencers such as stress or chemical exposure.

The pitfalls of thyroid management

TSH is the standard thyroid test that is measured.

Tests for levels of T3 and T4 are only carried out if TSH levels fall outside of ‘normal laboratory ranges’. The problem is further exacerbated by the fact that ‘normal laboratory ranges’ are generally too wide to be sufficiently sensitive to subtle variations in TSH. TSH can also be suppressed by cortisol (stress) and other illness, making it even more challenging to interpret thyroid function if we rely on TSH alone.

There is ample research showing that T3 levels are the most predictive marker of effective thyroid function – not TSH.

Even when T3 and T4 levels are tested, the interpretation of those results is very important. Again, the acceptable ‘laboratory range’ is wide and it may be that the T3 and T4 levels lie just within the ‘normal’ range but are a good way away from being optimal.

The optimal levels of T4 are 16-18pmol/L and T3 5-6pmol/L whereas the ‘laboratory ranges’ will accept readings that are significantly lower than these optimal values. This is very common and is often referred to as ‘subclinical’ hypothyroidism whereby the patient has clinical symptoms, but all the test values fall within the ‘normal’ range.

Hashimoto’s Disease

Hashimoto’s disease is an autoimmune condition of the thyroid and many patients with an underactive thyroid actually have Hashimoto’s. Diagnosing Hashimoto’s syndrome requires antibody testing which isn’t routinely done, so patients often remain undiagnosed. In still other cases, patients can be Hashimoto’s sero-negative.

The Often Overlooked role of the Gut

The critical link between the gut and the thyroid includes the following factors:

  • 20% of thyroid hormones are made in the gut by bacteria
  • Inflammatory gut conditions, leaky gut and autoimmune conditions of the gut are toxic to thyroid function

A good long-term solution to an underactive thyroid must therefore include a full assessment of the diet and implementation of a nutritional plan that will underpin any drug program.

But thyroxine is given for under-active thyroid shouldn’t that fix the problem?

Thyroxine is the drug that is equivalent to T4. Sometimes taking Thyroxine is sufficient and it helps to alleviate the symptoms of an underactive thyroid.

Sometimes taking Thyroxine is not sufficient.

If there are issues with the conversion of T4 to T3 due to nutrient deficiencies, stress or toxins, then giving Thyroxine isn’t necessarily the solution. The roadblock that is preventing the conversion of T4 to T3 will also prevent the conversion of Thyroxine to T3. So, in those cases, taking thyroxine will not be very helpful. In those cases we need to investigate further and apply treatments that will genuinely work.

In some cases taking Thyroxine can actually make the situation worse!! This happens because the body can interpret high levels of emotional, chemical or nutritional stress in a way that converts T4 into a hormone called reverse T3 (RT3). RT3 actively works to shut down the thyroid gland – exactly the opposite of what is required! In these cases the more Thyroxine that a patient takes, the more RT3 that is produced and the less active the thyroid may become.

So, thyroxine has its limitations. The answer once again is appropriate testing, excellent analysis and coming to a diagnosis that pinpoints at exactly which part of the hormone cascade the problem is occurring.

Management of thyroid problems

Every person with thyroid problems is different. However, there are some common principles that apply to everyone, and then specific elements that pertain to the individual and to that individual’s specific thyroid condition.

In every case lifestyle factors need to be addressed.  A healthy nutritious diet, appropriate exercise – not too little and not too much, sleep (it IS medicine!), stress management strategies, relaxation and fostering positive relationships. These are the foundations of recovery.

Supporting the adrenal and nervous system is critical. Functional and Integrative GPs like myself as well as some other practitioners at the Wholistic Medical Centre are trained in prescribing supplements and herbal medicines that can be used to help support the gut, liver, thyroid and adrenals.


Thinking of an underactive thyroid in simple terms, and trying to apply a single approach to what is a very complex situation will mostly lead to failure.

The good news is that when time is taken to fully understand a patient’s history, when a full suite of relevant pathology tests is run, and when a skilled analysis of all of the data is carried out, it is possible to achieve life changing results for many patients.

I hope this article provides the many thyroid sufferers with information that they can take into conversations that they are having with their medical teams.

I am very happy to respond to email enquiries and of course I am available for consultations both face to face in my rooms and also on Skype/Zoom for those that don’t live in Sydney.

Holistic medicinal practices can help reduce stress

Panic attacks and traumatic stress may be helped with mindfulness psychotherapy

Stress blog pic






Panic attacks and traumatic stress may be helped with mindfulness psychotherapy

Sally* is a 50 year old woman who came to see me in Surry Hills after a month of having severe panic attacks. These started first thing in the morning. She experienced shortness of breath, tightness in her chest, racing heart, trembling hands and legs, nervous sensations in the belly, irregular breathing and a sense of suffocation and impending doom. Often there would be no trigger for these panic symptoms. They would be intense for around 30 mins then would persist in varying degrees all throughout the day.

These panic feelings were impacting her ability to work effectively and maintain a social life. Sally often thought during these panic attacks that she was “going crazy” and perhaps there was “something deeply wrong with her”.

Ordinarily, Sally was a highly competent, robust individual who had never really experienced any severe anxiety or panic symptoms. However, she had just been through a major life change – she had relocated to Sydney from overseas after leaving a highly traumatic and abusive relationship. This relationship involved experiences of feeling a combination of complete overwhelm, helplessness and fear. One of the coping strategies she had adopted was to “keep going and push through” with a focus on action- oriented outcomes.

There was also a past history of accumulated grief from her recent mother’s and her late husband’s deaths, which she admitted was still unprocessed within her. She was holding traumatic stress in her body.

Sally was interested in helping herself as much as she could. Although she came to see me as a GP, she did not want to use medication unless it was absolutely necessary; she preferred to turn to mindfulness psychotherapy to help her.

Mindfulness psychotherapy may be healing

Through our weekly sessions together, she learnt how to use mindfulness to slow things down and observe her internal experiences without getting completely hijacked by them. She learnt to build and discover resources within her body and mind that helped her panic symptoms. By understanding and learning how to calm her internal world Sally felt empowered to then begin processing and integrating her previous ‘undigested’ memories and feelings.

This process allowed her to make sense of what has been senseless before and to regard the feelings in her body as useful information rather than something to be avoided.

Sally now experiences significantly less anxiety. More importantly when the waves of anxiety do arise, Sally now can work with her internal states, rather than let them escalate into full-blown panic as it had before. Mindfulness psychotherapy has allowed her to witness her thoughts and feeling and get a gauge on how they impact on her body. By working directly with and navigating the information held within her body, Sally now draws upon “safe” places, both inside and outside the body to regulate her arousal and bring her back into the present moment.

She reports feeling less reactive and acting less automatically and can now make decisions based on choice.

How does mindfulness psychotherapy help panic attacks and traumatic stress?

Sally’s panic attacks were a reflection of traumatic stress stored and held within the body. As a whole, our bodies are highly intelligent systems, equipped for stress and even trauma. When there is a perceived threat, our bodies will instinctually activate our “flight/fight/freeze” mode to take action and respond to danger. This then leads to a complex biochemical cascade within our bodies that orients us for survival.

Ordinarily, we can usually cope with great stress for a period of time as long as it is temporary and/or we can make sense of what has happened to us. However, when we are faced with trauma, this survival response becomes frozen and our bodies are unable to discharge all the pent up energy. We keep re-living what has happened, even when there is no obvious threat – it’s like a bad tape that keeps playing over and over again, without an option to pause or stop. So by using mindfulness to slow down, we begin to examine more carefully what is happening and to take in new information that would otherwise have never been noticed or would have been dismissed. We learn to develop a new language for reporting on our own internal experiences and finally begin to get to know intimately our emotions, thoughts and beliefs that held us captive for so long.

* Name has been changed

This case study is for educational purposes only. Results may vary due to individual circumstances.

Dr Marie PaekGeneral Medical Practice, Mindfulness Psychotherapy

For more information see:

What does this nausea in my stomach and tightness in my chest mean

“What does this nausea in my stomach and tightness in my chest mean? ”

What does this nausea in my stomach and tightness in my chest mean

Chest tightness can stop a person from breathing deeply


Michelle* was in her late 40’s when she first came to the Wholistic Medical Centre. For the previous five years she had an upset stomach, felt nauseous every day, had some bloating after meals with bouts of diarrhoea alternating with constipation. She had been advised to reduce grains, dairy products, sugar and caffeine. She followed that advice and lost 11.5 kilos. The abdominal discomfort reduced a little but did not disappear.
In the previous few months Michelle also noticed a discomfort in her chest. It was so tight that it stopped her from breathing deeply and even prevented her singing. Given that she was a singer, this had become quite a serious limitation. Further medical investigations revealed no abnormalities in her digestive or respiratory systems.

Michelle felt that she couldn’t do anymore with her diet or medication and she suspected that there might be an underlying emotional problem that was behind all her symptoms. She chose to work with a mindfulness based psychotherapy approach.

During her first session, she was guided to study her experience of tightness in the chest/throat and tightness in her abdomen. As she did this, in mindfulness, it became apparent that she had felt exactly the same feeling many times before. It felt like a strong fear. When asked to trace her earliest memory of that, she vividly remembered that at 13 she was made to sing at family functions and experienced ridicule from her cousins. In order to cope, she remembers tightening up her diaphragm and ignoring her feelings of shame and fear.
She was directed to imagine going to help her 13 year-old self: to appear in the family room and to go to her 13 year-old self in a kind and comforting way; to let her know she doesn’t have to sing if she doesn’t want to and to tell her cousins to sing themselves or to be quiet. Staying with that imagined new scene gradually produced a relaxation of the throat and abdominal contractions.

Those muscles relaxed all by themselves, as a new possibility was introduced: ‘I don’t have to go along with my family’.
Subsequent sessions revealed that feelings of fear were constant during her early home life. Sometimes after school, she would stay in the driveway outside her house, too afraid to go inside, because she did not know what she would walk into. Her father could be drunk and yelling abuse. Her mother could be either withdrawn or panic stricken.
Since her childhood she had learnt to ignore her fear and tighten her body in order not to feel it and keep going.

Over the next 5 sessions Michelle was able to go towards her ‘exiled’ feelings – they were allowed to come into her awareness and she was able to take care of them in a soothing way.
An important realisation was that she was so used to being fearful that she had concluded an existential belief of ‘I fear therefore I am’. In fact not feeling full of fear felt strange and empty, even though feeling free of fear was what she was seeking.
Once Michelle began noticing that belief in action she slowly began ‘digesting’ a new possibility of ‘I can live without fear’. This did feel strange and took some getting used to, especially as the fear would bounce back by itself. She would have to feel it and let it pass over and over again. Over 3-4 weeks the previous habitual states of fear and physical contractions gradually lessened, the abdominal tension stopped and her singing voice gradually found an open channel.
A new way of being in the world was now becoming a real possibility!

The notion that feelings are ‘exiled’ from day-to-day awareness is fascinating. Our nervous system learns to actually shut out the unpleasant experiences from our consciousness for the purpose of getting through it. When there are no other choices and no support this is a useful ability to have had at the time.
However the underlying feelings persist in the body and the conclusions that were made based on those past events continue to influence current life. Conclusions like: ‘life is scary’; ‘I’m not quite good enough’; ‘nobody is interested in what I feel’; ‘having emotions means I have a mental health problem’ and so on, place profound limitations on our lives.
The use of mindfulness in psychotherapy allows an exploration into the emotional memories without re-traumatizing and without intellectualizing. The original pain is accessed and new more soothing experiences can be introduced. These new experiences allow new conclusions which are far less limiting than the previous ones.
In this precise and gradual way Michelle released her pattern of holding tension in her abdomen, chest and throat. She felt more at ease and confident within herself and as a bonus she became less angry with her children and more loving to her partner.


*Name and details have been changed. Results obtained by one person does not mean the same  can be expected by another. Each person has different life experiences and circumstances which will influence responses.

Dr Nick BassalGeneral Medical Practice, Mindfulness-Based Psychotherapy – Wholistic Medical Centre