Breaking the panic cycle with psychological support

Panic disorder involves intense physical and mental episodes of anxiety and fear. When learning to overcome panic, it’s important to understand it. Dr Isobel Horn is a leading clinical psychologist who has helped many patients with targeting their safety behaviours and catastrophic thinking. In this article, she helps you to understand panic and highlights how your panic attacks can be treated successfully.

‘So, first of all, let me assert my firm belief that the only thing we have to fear is...fear itself —‘ Franklin D. Roosevelt, 1933.

What happens when we panic?

In a panic state, you experience strong bodily symptoms which scare you a lot. You don’t understand the cause of these uncomfortable sensations and you believe they will lead somewhere bad if allowed to continue. So, you usually work out ways not to experience them - either through avoidance or by doing special things to protect yourself. But the natural response to protect through avoidance is a large part of the problem. So too is the catastrophic thinking.

These are the targets of change and panic disorder is quickly and easily treated using a talking therapy and action-based approach.

The panic attack

Panic attacks are intense, sudden and very unpleasant episodes involving the body and mind. They appear to come out of nowhere, but when we study panic episodes, we usually find some kind of trigger which was interpreted as threatening. For example, you enter a situation where you previously had a panic attack and you start to worry you will have another one. Or you experience an internal physical sensation like the heart beating fast or a feeling of tightness and you think, ‘Oh no, it’s happening again’.

When you interpret a trigger as threatening, you start to feel uncomfortable and you experience an increase in physical symptoms of anxiety. The mind notices this happening and misinterprets the experience as harmful, ‘Yes. Something bad or unwanted is going to happen to me now’. Anxiety and body symptoms increase further and begin to feel very unpleasant. You are now in a vicious cycle where thoughts, fear and body sensations feed each other and escalate quickly into a panic state.

Component one - catastrophic thinking drives the panic cycle

Specific beliefs about what bad thing is going to happen vary amongst individuals. Beliefs range from fearing unpleasant and embarrassing outcomes to believing that death is imminent. Here are some examples:

• ‘I’m about to faint/fall/vomit/collapse’
• ‘I’m having a stroke/a heart attack’
• ‘I’m going to stop breathing/choke’
• ‘I’m about to lose control and act weird in front of other people’

Physical symptoms can also be interpreted to mean that something bad is going to happen to your health in the future. For example, ‘Maybe I’m not going to die right now, but this chest pain might be a sign of heart disease and if it gets any worse, then things are going to get serious for me’. Treatment helps you to start explaining these symptoms to yourself differently, so you can have more reasonable thoughts about the causes and consequences of your symptoms. Alternative thoughts support you rather than scare you.

Component two - safety behaviours

It is only natural that when you believe yourself to be in danger, you try to protect yourself. Safety behaviours are things you do to cope with both physical sensations and catastrophic predictions. They consist of things you stop doing (avoiding) and things you actively do to prevent the feared ‘catastrophe’ from occurring.

Hypervigilance is one such behaviour. This means repeatedly scanning the body and checking for frightening sensations. But focusing on the body this way means you are more likely to notice sensations you would not even be aware of if your mind was elsewhere. So it’s not a helpful behaviour because the mind uses these sensations as evidence that something serious is about to occur. This heightens anxiety and keeps the panic cycle going.

Avoidance of specific activities, bodily sensations and situations are widespread in panic disorder. While avoidance provides some temporary relief, it maintains the panic cycle in a few ways. Take breathlessness as an example, but you could substitute any symptom. Say you develop a fear of feeling breathless. You believe it indicates some underlying health condition connected with your heart, so you start to avoid strenuous activity and any time you happen to feel out of breath you stop and slow down. You believe this keeps you safe, but if it is medically confirmed that you don’t have a heart condition, then strenuous activity and breathlessness are not dangerous to you anyway.

Avoidance stops you overcoming your panic problem because:

• you lose opportunities to learn to cope with discomfort and build confidence
• you don’t get to challenge the catastrophic thinking or learn that the danger is not real
• it can exacerbate the symptom itself (you avoid exercise —> you lose fitness level —> you become breathless more easily).

Treatment encourages you to take actions which are the opposite of avoidance and to gradually drop your safety behaviours. Disproving catastrophic thinking and learning you can cope are the benefits. Symptoms appear less and fade away. This is sometimes challenging but we start slowly and we plan the targets together.

In conclusion

Having a panic attack does not mean you are seriously mentally ill or in imminent physical danger. It is our mental and behavioural response to bodily symptoms that keep the panic cycle going. Treatment targets and changes your ideas about the causes of these symptoms and fears about what will happen once they have started. Your panic attacks can be treated successfully in a relatively short period and it is definitely worth doing the work.

If you’re struggling with fears and anxieties, do ask for confidential support. Dr Isobel Horn can help you treat them - click here to learn more and to get in touch with her.