Break the Cycle of Panic

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BREAKING THE VICIOUS CYCLE OF PANIC
From "Brief Therapy Client Handouts", Kate Cohn-Posey

People may be predisposed to experience panic because of a sensitive temperament, high levels of stress that sensitize nerves, emotional disorders (social phobia, obsessions, and depression), a hyperactive imagination, or a perfectionist personality. The actual first episode or trigger incident will be caused by a surge of adrenaline due to one of three things:

• A tense situation: conflicts with people, giving a speech, dealing with painful memories, being in a place where a person feels trapped, or a recent death—“What if I die like my aunt Mary did three weeks ago?”

• A conditioned reaction to certain triggers that bypasses thinking processes—A young girl had a near-drowning experience. A year later, in a submarine ride, she had her first panic attack.

• A nonthreatening physical condition that causes unexplained symptoms (dizziness, nausea, blurred vision, sweating, shaking, faintness, rapid breathing, palpitations, or hot flashes) that are not fear, but feel like fear.

Once the first panic attack happens, it can quickly develop a life of its own. People begin to think, “What was that? Is it going to happen again? Do I have some terrible illness? Am I having a nervous breakdown? What if people notice me?” Negative thoughts that flash through the mind almost below the level of awareness can trigger subsequent incidents until they start happening with increasing regularity.

A woman with high standards was physically stressed from a miscarriage. She first became panic-stricken while grocery shopping in the aisle of baby products. Later, she began having anxiety attacks anywhere in the store, and then, even when driving past the store—just because these cues were associated with her first attack.

TWO ADDITIONAL PROBLEMS

When panic is not understood as a part of anxiety, episodes can increase in intensity due to two additional problems. Once these are recognized, they can be eliminated by learning coping strategies.

Coping Strategies
Symptom	To Cope
Feeling unreal or depersonalized is due to racing thoughts. Brain waves can cycle very rapidly in situations that require “quick thinking.” When thinking is converted into action people have a sense of being in charge. If the source of danger in unclear, thinking has no place to go and people feel “trapped “ in their heads.	Think: Racing fearful thoughts will not “drive you crazy.” Act: Refocusing on your surroundings or even on troubling sensations will help you feel more real and connected to yourself. Relabel unreal feelings as a natural consequence of brooding.
Poor memory, indecision and loss of confidence come from a mind over crowded with brooding. Little energy is available for making decisions or remembering routine details. These symptoms can be worse in the morning when blood sugar is low. You may have gone to bed the night before hoping to wake up a new person and then despair at being your same old self. People begin to wonder, “Will I ever be normal again?”	Think: “I am not losing my mind.” As you learn to manage symptoms, thinking will become clearer and confidence will return. Be easy on yourself and appreciate little accomplishments. Act: You may need anti-depressant medication to “jump start” your system if you have become with-drawn and have little motivation to do anything, Relabel symptoms as the natural consequence of brooding and early morning blues.

The Vicious Cycle of Panic

Even when stresses, depression, tense situations, or a temporary physical condition have passed, people can continue to have panic just because they fear it will happen. This is the fear of fear. People become afraid of their own bodily reactions—“I’ve been doing pretty well lately, I wonder if panic will come back.” “What if I really do have a nervous breakdown this time?” “What if people can tell that I am perspiring?” This aggravates predisposing factors of temperament, emotional disorders, and personality traits and creates on-going stress that produces the vicious cycle of panic. See page 5.15 of the book.

Breaking the Cycle

The steps of recovery from panic can restore peace with calming swiftness and make each link in the “vicious” cycle an opportunity for change:

• Reattribute predisposing factors to minor physical conditions (ear or thyroid problems, PMS, allergies, low blood sugar, anemia, high blood pressure) and unrecognized emotional problems (temperament, stress, overactive imagination, perfectionism, depression, social phobia, obsessions) that are little cause for concern once they have been treated and/or identified.

• Relabel troubling “symptoms” as a surge of adrenaline. This eliminates fears of dying, going insane or making a fool of yourself. People who have anxiety are overly concerned with reality while people who become psychotic are out of touch with reality. They may think they are Jesus, hear voices or speak in a way that makes no sense. Although people with anxiety can have vivid imaginations, they know who, what and where they are.

• Retrain yourself not to react to anxiety triggers and negative thoughts by refocusing on pleasant activities or facing, flooding and floating past the worst sensations of panic.

• Revalue panic episodes as opportunities to practice coping with and minimizing symptoms.

• Expose yourself to difficult situations to increase your comfort zone as panic attacks reduce in frequency. Friends and family can help until you can face triggers alone.

• Get additional help if needed to reduce stress from conflicts or painful memories..

• Reread information on panic disorder at the first sign of reoccurrence of symptoms or after intense episodes of anxiety.

National Institute of Mental Health's Anxiety Hotline-1-888-826-9438