RELABELING SYMPTOMS OF
"Brief Therapy Client Handouts", Kate Cohn-Posey
Anyone who has experienced panic or anxiety
knows that while an attack is happening, it
seems to last forever. Although most episodes
endure for less than three minutes, an attack
can be prolonged for hours or days by imagining
that you are dying, going crazy, or making a
fool of yourself. However, the body’s natural
calming mechanism will always cause the most
intense symptoms of panic to pass.
are nothing more than the body’s natural
reaction to a surge of adrenaline. This is the
hormone that responds to danger, low blood
sugar, and stimulants. It prepares the body for
action by increasing blood flow and tensing
muscles. When adrenaline effects are experienced
without the presence of clear danger, they can
be frightening and less easily dissipated. To be
convinced of how normally your body is reacting,
you need to fully understand the “adrenaline
connection” between sensations and panic.
The Adrenaline Connection
Check any symptoms you experience and
study related coping strategies.
Increased blood flow:
pounding, racing heart results from a
surge of adrenaline that causes
stronger, more rapid contractions to
increase blood flow. The heart
compensates for quick, forceful beats by
taking a pause, creating the sensation
of thumping, or “missing beats.”
Palpitations are a natural reaction to
aerobic exercise, infection, exhaustion,
caffeine, cigarettes, and troubling
Think: The heart
muscle is very strong and cannot burst.
A “nervous heart” is still in control
and will always return to its normal
Act: Consult a
physician to rule out any physical
problems: high blood pressure, mitral
valve prolapse, menopause,
hyperthyroidism, low blood sugar,
anemia, or a heart condition.
palpitations as anxiety if physical
problems have been ruled out.
flashes and sensations of “heating up”
result from blood rushing to the center
of the body due to increased heart
action. To compensate, perspiration
helps cool off the body. Coldness in
hands and feet may result from blood
rushing toward the center of the body.
“Overheating” is a good aerobic
exercise. It is identical to what occurs
during heavy exercise.
Relabel changes in
body temperature accompanying
palpitations as a side effect of an
adrenaline rush and increased heart
Chest pain that feels like a pinprick or
stitch is caused when chest wall muscles
become tense. Sharp pain is felt when
the lungs expand during inhalation. Deep
breaths can be difficult until
discomfort passes. A narrowing of
arteries causes heart disease.
Trouble breathing can happen when tense
chest muscles do not allow enough room
for lungs to expand. To compensate, some
people take large gulps of air or start
breathing fast. Trouble breathing can
also result from obesity, pregnancy,
colds, asthma, and emphysema.
Act: Have your
doctor rule out heart problems,
particularly if you have dull pain or
pressure in the center of the chest that
radiates to the neck, jaw, or left arm.
Relabel pain as
“chest wall pain” due to stress once
heart disease is ruled out.
problems due to anxiety are no different
from having trouble catching your breath
after heavy exercise. It is impossible
to stop breathing—just try holding your
as the result of tense chest muscles if
physical problems aren’t present.
Hyperventilation happens when too much
oxygen collects in the lungs due to
rapid breathing and washes out carbon
Giddiness, Tingling, or Numbness can be
caused by oxygen collecting in the lungs
due to rapid breathing. Physical
conditions of anemia and carpal tunnel
syndrome can also cause light-headedness
Act: Breath into a
paper bag to inhale carbon dioxide if
too much oxygen is causing
Act: See your
doctor if symptoms occur at times other
than during rapid breathing.
and numbness that accompanies troubled
breathing as the result of too much
oxygen from rapid breathing.
Shakiness is the body’s way of releasing
muscle tension. It often happens after
lifting heavy objects. Trembling can
also be caused by hyperthyroidism and
low blood sugar.
Feeling faint happens when blood flows
away from the brain to “feed” tired
Think: Shaking can
be a way to express joy, as the Shakers
and other religious groups did.
Act: Unlock knees
and let arms hang loosely so they can
tremble freely. This allows shaking to
pass more quickly.
Act: Slow down to
let any faintness pass. Put your head
between your knees to return blood to
your brain if necessary.
Difficulty swallowing can also feel like
a “lump in the throat” or choking.
Act: Try chewing a
cracker without swallowing.
Dizziness, disorientation, and floating
feelings happen when jaw tension puts
pressure on the inner ear. The same
symptoms occur when the inner ear is
stressed on amusement park rides. Fluid
retention from colds, allergies, and
thyroid problems can also strain the
Nausea, diarrhea, and blurred vision
happen when pressure on the inner ear
irritates nerves to the stomach and
eyes. Discomfort from fluorescent
lighting, cloudy days, loud noises, and
freeway driving can stress nerve endings
and also aggravate inner ear problems.
Act: Notice how
far your jaw can drop with your mouth
closed when you’re not upset. Clenching
and letting go of your jaw can help
during panic. Give symptoms time to
pass. See your doctor for possible inner
as inner ear pressure.
Act: Relaxing your
jaw may help blurred vision or nausea
pass more quickly. Without rushing, you
can find a restroom. If you tell
yourself it is okay to vomit, nausea
Relabel symptoms that happen
during anxiety as irritation of stomach
and eye muscles.
THE SECOND FEAR OF PANIC
happens when concern over the above symptoms
triggers further adrenaline release that causes
a desire to flee. It is experienced in the mind
rather than in the body. There is a sense of
urgency, with thoughts such as, “I have to get
to a place of safety” or, “I have to get outside
and get some air.” Panic comes in a wave and
must pass as adrenaline dissipates throughout
the body. What you are feeling is annoying,
unsettling, and possibly painful, but it is not
harmful! People do not die or “go crazy” from
panic. Relabel panic as the fear of fear that
inevitably happens before you learn to manage
is the fear of not being in complete control of
physical and mental faculties.
Generalized anxiety is the fear of not meeting
others’ expectations or handling
responsibilities, such as paying bills or
keeping a job.