PAW final resized - anxietycoach.com

1 7Th e Panic Cy cleAfter a pers on has had a first panic attac k, he will usuallybe su spicio us and fe ar -ful of the situationin whic hhe had that first attac k. Apersonwho had afir st pani cattackin a movietheat er is pro bably not going to go bac k and see that particularmovie , or go back to that particulartheater,an yt im e so , it usually doesn tstop the re. Peopleus ually find that the antic -ipatoryanxiety,and oft en the attacksthem selv es, sp read to other situ atio ns andcircum stance leads pe ople to fear that their lives are spinning out of control. Peopleoften de scribeth eir fear as irrat io nal and ran dom . Th e ent ire prob lem se ems soillogi cal to them that they don t see how it can be solve th at were actuallythe case, that panic attacksoc curre d at random, it wouldmake the task of reco very much more diffic ult.

2 But the fac t is that, for most peo -ple , the re are rules whichgovernwherean d when they will experience recurrentpanic may seem randomand ir rational,but there is a logicalset of rule sthat tel l us whe re and when most recu rrent attackswill occ wi ll hel p you in your recove ry eff orts to know what the rules are, so th at youcan be better preparedto wo rk with them. You can also use these rules to iden tifythe situat ions and ac tivi ties you nee d to includ e in your exp osure currentpanic attacksare likely to oc cur you had your firs t panic attackin a large grocer y store, for ex amp le, youwill probablyhave som e fears about going back to that partic ular store and, if it spart of a chain,about goi ng to other stores in the , fo r many peo ple, itwon tsto pther e.

3 You may find that you becomeune asy ab ou tgoin gto other largegroce ry stores as well. This fe ar may spre ad to other types of stores,for instan ce,large department stores and malls, even tho ugh you v e never had an attack ther mightavoid thes e stores , or you mightstill go but ch ange your patternofshop pin g in ways designedto avoid a pan ic s also com mon to associatepanic with the time of da y,orth ekind of weather, that accom paniedthe firs tattac activitiesremindyouof yourfirstattack? trap. Whe n a personwith panic di sorde r talks abou t a trap , they usuall y me anany situationfr om whic h they can t leave as quic kly , qu ietly, and inv isibly as theymay wish.

4 They reon the loo kout for su ch situations not only becau se havingbeen se ns itized by the firs t pani c attackth ey natu rally want to avoid re currences,but also be cause they want to feel sure that they can leave any time they be co meanxious,withoutany one no tici ng and askingabo ut it. A supermarket line canseem like a trap, as can a dividedhighway,a red light, and the mid dle sectionofa churc h pew or mo vi e activitiesdoyouthink of as traps ? le tend to panic in situationsin which th ey re bore d or just this inc lu de wa tchin g a dull movie,waitingin a restaurant whi leyour companionlingersover yet anothercu p of coffe e, an d sit tin g in a doctor swai tin g also includeactivitiesthat don t really en gage your min dbecauseyou can do them withoutmuc h th inkin g, su ch as drivingor takin g ashow er.

5 Goin g to bed and waitingto fall aslee p is anoth er situationthat gives alot of leisure-timesi tuationsoractivitiesdo yougetanxiousbecauseyourmindis id le? is relatedto nu mber 3 not to panic w hen th e chipsar e do wn. Fire men who have panic attacksalm ost never have them duri ng a fir ewhen th ey re actua lly in dang er. Instead,th ey tend to pan ic wh en th ey ve been atthe stationfor along tim ewith out afire, playingtoo muc hpinoc hle. If the fire bel ldoes ring, the pani c attackstops nts rarely panic when th eirchi ld fall s down and breaksa nose or an ar m. Ins tead, th ey typ icall y tak e care ofbusi ness, get their chi ld tre ated at the ER, an ddon t star tto feel pan icky until aftertheir child is safe ly home aga experienceof rec ur rent panic at tack s is not a randomor mysteriouspro ce ss.

6 Rather,it follo ws logicaland consistentprin ciples,even thoughthey maylead to illogicalfe ars. Understandingthese ru les can help you mov e fro m confu -si on to derstandingthe PanicCycleLet s take a closer look at an in div idual panic better yo u unde rstan dthe processand patt ern of an in div idual panic attack,how physic al sensations,thoughts,emotio ns, and behaviorsinter act to produce panic, the more able youwi ll be to ob serve it , acceptit, and wait fo r it to end witho ut gettingcaugh t up inthe turm oil it of PANICATTACKSWORKBOOKThe first thin g to notice,even beforewe consider the in div idual par ts, is thatthe panic attackis cycl ical . This is a big advantage. Why ? Because it al ways fol -lo ws th e same , predictab le lem that keep s ch angi ng, that neve r fol -lo ws the sa me patt ern twice,is a very dif ficult pro blem to solv e.

7 A problemthatfo llow s the same pat tern tim e and again is mu ch eas ier to pe ople with panic attacksdon t realizethat there is a patter n, an d thismake s their task of rec ove ry mu ch harder . Th ey focus on the illogic al or i rra -ti onal aspectsof the fears and fail to noticewhat a predictable pat tern a panicattackfol say thin gs like It doesn tmake an y s ir rational, and give upon findingany logicalpatternto the attac ks . Natur al ly, this le ad s them to feel dis -co ura ged, becauseif they can t understand something,how can they changeit?But, while it s true that the fears of a panic attack are exaggerated and unre alistic,the patterna panic attacktakes is pre dictableand symptoms oftenchangeov er time, but the patternremainsthe diag ram on page 78depic ts the stagesof a pani c panic attackis a ci rcularpro ces s and can be seen as star ting at one of se v-eral pointson th e pani c cy cl e.

8 Fo r our pur po ses, let s pres ume it star ts with whatI labele d the , I mean an anxietysym pto m. The attackthus beginswi th an intern al event,not somethingthat takes place ou tside of recentpanic attackyouexper ienced one thatyouremember rea-sonablywell,a strong oneth at event(anxietysy mptom)didyounoticefirst?Ho wev er , you will note on the di agramthat there is often an exter nalcuethat triggers the instance, as you drive tow ard an intersectionwhereyouwant to turn left, yo u see a great big tr affic jam , an d you feel a lump developinyour thro at, followedby a di ffi culty in e tr affic jam is the cue; thephysi cal symptomsare the thesameattackyourecalledabove,didanexter nal cuetriggertheeventin you?

9 If so,whatwasit?THEPANICCYCLE77 How does a cue such as the trafficjam tr igger a changein you r bod y? Mostoften it will fill you wi th tho ug hts abo ut the trafficjam , quic k interp reta tio ns ofwhat it meansto you , and these wi ll produ ce physicaland emot ional responsesin you. These thou ghts are largelybeyondyo ur can t willyourselfnot to have them. If you reafraid of traffic jam s (or dogs, or wh atever),Iassureyo u that you wi ll have thoughts and ment al im ages as soo n as you see may not con sciou sl y rememberthe thou gh ts, but they llbe th ere. Som etimes,you ll see a cue that appe ars to immediatelymobilizeyour fightor flight respon se withoutever pr oducinga t eith er way, th e cu e trigge rs thepre cipitatingevent of a pani c s possibleto have panic attacksbo th with, and without, a cue.

10 Peop le withpanic disorderhave probably experiencedit both ways, havinghad attackswithand withoutan observablecue. As you becomemo re stu ck with the panic dis -order, yo u will find that yo u no longerneed an ex ternalcu e to tr igger a s ofte n suffici ent to just think of som eth ing you find threatening, or feelan unw el come emotion like anger,and those th oughtsand emotionsserve as the78 PANICATTACKSWORKBOOKThe PanicCycl :the first symptomto ap pear,whichcan belong to an y oneof the four cat egories:a. physicalsensationsb. thoughtsc. emotionsd. behaviorsReflexReaction:the rapidrepetiti on of the initialsymptom,and the appearanceof otherki nds of symptomsInterpretiveReaction:the partof the attackwhere yourthoughtsinterpretthe symptomsinunrealistican d extreme wa ys, andpredictterr ibl e outcomesfor youPanicAttack:whenthe fl ood of symptomsrea chesa peak,and you fear animminentcatastrophePanicAtt ac k Ends:eventho ug h you fea r it won tend,it alwaysdoes,regardless of whatyou doRelief:the fe elin g of having dodgeda bul le t Ant icipatorySt age.