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Panic attacks (anxiety attacks) can be debilitating but there is something you can do to prevent anxiety from ruling your life.

By Dr. David Thomas

 

If you, or someone you know, suffers from anxiety, then you understand just how debilitating and downright paralyzing panic can be.  But there is much you can do, without being heavily medicated, to alleviate panic from your life.

What is Cognitive Behavioral Therapy (CBT)?

Are There Variations of CBT? What is REBT?

How Does CBT and REBT Provide Relief & Help?
Using CBT/REBT to Overcome Depression, Anxiety
The First Steps to Managing Anger
Listen to Your Self-Talk to Overcome Your Anger
How CBT/REBT Can Help For Anxiety & Panic
How to Think Differently So You Feel Better
Recommended CBT & REBT Self-Help Books

First of all, understand that anxiety is one of the Four Blocks to Happiness that motivates individuals to seek out counseling.  It, along with depression, are the most common emotional disturbances that counselors see people for in the U.S. today (including in my own practice).  

The other two Blocks, anger and guilt, are also experienced en masse, but with far less frequency.  Panic is an intense anxiety.  Much like Major Depression is an intense depression. 

 

Many years ago, a colleague of mine had a perspective on anxiety that I hadn’t heard before and I have since incorporated into my own teaching and counseling.  She explained it by its relevance in evolution. 

 

In the prehistoric years, when our species was in its infancy, man actually “needed” anxiety to survive, or more accurately the symptoms of anxiety.  The dangers our predecessors were faced with (like the Saber-Tooth Tiger) evoked these symptoms and helped man to avoid harm’s way.  My colleague used the Saber-Tooth Tiger for her example and I will do the same here. 

 

These tigers were flesh eaters and preferred their game alive.  In order for man to avoid extinction, they would need to fight or flee.  These behaviors could only be accomplished if adrenalin were produced in the body quickly and in abundance.

 

The sensation of wanting to strike out or run away are two common symptoms of anxiety; still useful under certain conditions, but generally maladaptive in most anxiety provoking situations.

Our ancestors would often experience stomach ailments triggering vomiting or loose bowels.  These conditions are generally not perceived by the Saber-Tooth Tiger (or our associates today) as evoking odors of freshness and desirability (“…geez, what died”). 

 

Today, these symptoms continue to be common ailments associated with anxiety.  Hypothetically, these warning signs helped then, but are not so useful now if you are attempting to drive over bridges, shop at the mall, or deliver a speech (some of our modern day Saber-Tooth Tigers). 

 

Often clients will report being “paralyzed” when experiencing anxiety or panic.  This catatonic state may have been just what man needed in order to be undetected in the bush, avoiding harm’s way once again. 

 

And finally, if you talk to enough people who have experienced debilitating anxiety, they will often be unable to describe the events coinciding with the feeling of anxiety. This disassociation may, or may not have been my first choice in primitive times, but psychologically speaking, the moment of doom may not have been cognitively experienced.   

 

Anyone who has experienced the type of anxiety described above can relate to some of the symptoms.  Therefore, we would have to infer that our species has maintained these symptoms for survival purposes and therefore our tendency to become anxious is truly couched in our biology. 

 

 

Fortunately, we do not have Saber-Tooth Tigers any longer.  Now our perceived dangers exist in the form of air travel, driving over bridges, being around groups of people. Or they may be fear of losing's one job, of dying or disease, of going bankrupt, "losing it all," or other future events, or even things like speaking in front of groups, being around insects, reptiles, and many other stimuli that give host to our anxiety. 

 

The range of symptoms associated with anxiety varies.  Often an individual will experience anxiety, and it will be uncomfortable, but tolerable.  Other times, the occurrence is perceived by the person as being “truly” unbearable and the thought of ever experiencing it again as unimaginable. 

 

Because the person believes the anxiety is so “awful” he or she will superstitiously attach evoking power to the stimuli that occasioned the dreaded feeling.  The result is often debilitating because the person will design their life (if they can) in such a way to avoid encountering the stimulus that they mistakenly believe will bring on the frightful feeling.

The person believes the stimulus causes the feeling and they absolutely could not bear experiencing the terror again.  Associated fear often results in ideas of going crazy, passing out and being embarrassed, not being able to escape or simply not being able to cope.

 

The person unwisely puts himself in an approach-avoidance that reinforces the idea that the experience of anxiety truly is unbearable and can not be tolerated.  The practice of avoiding then negatively reinforces the idea that the bridge, staying home alone, or shopping in the mall, etc. causes the feeling.  It can become debilitating and often negatively affects not just the person, but family members or friends.  Panic is born and begins to dictate many of the person’s behavior going forward.  It is an overwhelming fear that can truly affect many facets of one’s life. 

 

Now I will make a statement that may sound trite but is absolutely the truth, “it is all in your head.”

 

Your feelings are real, but they are not created by a virus, or events in your life, but simply they are created by the thoughts you have about yourself, others, or life conditions.  Remember my statement earlier, there are no modern day Saber Tooth Tigers.  Real dangers do exist though and we had better practice caution in some of our practices, but bridges, staying alone at home, giving a presentation, shopping in public areas, or seeing a snake does not have causation power unless you give it power.

 

If it were true that the sight or thought of a bridge causes one to become panicky, then everyone who encountered bridges in their travels would have to respond the same way.  The person truly feels panic, but the creator of the emotion is their thinking.  And by changing the thinking, the panic will go away.  Not magically, but through changing one’s thoughts.

 

Panic tends to be much more intense than anxiety, but a lot of anxiety is created leading up to panic responses and the person is so scared of having another panic “attack” that their anxiety will trigger it. 

 

 

Panic can not be experienced unless one is focused on the future.  Therefore, all panic, like anxiety, is future related.  What If becomes the beginning of the sentence and from there, the person will exaggerate how bad it would be to experience the event.  In panic, it is always the experience itself--the anxiety symptoms.  A mountain is made out of a mole hill. 

 

Let’s take a look at the world through a person’s eyes who is experiencing anxiety.

And to do this, I want to talk about phrases called “awfulizing or catastrophizing.”

 

When we awfulize we tend to view a life event, not on continuum, but as the worst thing that could happen, not just bad, but more than bad, more than 100% bad.  “And it should not be.”  Two irrational ideas, first a rating of more than 100% is scientifically an exaggeration.  100% is a maximum amount so if a person views it as more than 100%, their reference needs to be lowered and the current event placed in its slot. 

 

My mentor and creator of Rational Emotive Behavior Therapy (REBT), Albert Ellis, uses this as an example.  I have a Catastrophe Scale, and everything on this scale is bad.  It goes from zero to 100.  100 representing the worse possible thing that you believe can happen (real or imagined). 

 

You may divide it into increments of tens if you like (10, 20, 30, etc.).  Where on this scale would you put Being Tortured to Death?  Most people would rate it a solid 100.  Now I say to you that I Am Going to Torture you to Death, but Sloooowwwwer.  Now, where would you put this?  Again most people say 100.  But, 100 is already taken up, so you have to lower the first example to 99, and place this one in the 100 slot.

 

And I could give you more and more examples, possibly lowering the original torture rating below 90.  Now are these events bad?  Of course!  But not off the scale. 

 

Now we then add this statement, And it Should not Be.”

 

Logically speaking, if the event occurred, then it should have occurred based upon science.  Everything that exists in our world, should exist, because it does.  There are always pre-events or antecedents which make reality just that, reality.  You may not like the reality, but that has zero to do with its existence. 

 

So 1, we exaggerate its rating and take it off the scale and 2, we state that what just happened, be different than it is.  “Reality should not be reality.”  It is really kind of funny, because if it shouldn’t be reality, what could it possibly be?  The answer, Fiction, Magic, Make-Believe! (All in your head.)

 

Another way we can Awfulize or Catastrophize is to take low level events which normally we would rate below 50 and escalate them to high level ratings.  I also call this tendency awfulizing.  It may not be rating the event 100 plus but it does exaggerate the placement on the scale. 

 

So to review, we start with a What If (WI), and we add an Awful (Aw) with a Demand component.  Let’s talk about this for a moment.

 

Demands are words we say to ourselves that are absolute in their meaning.  We want to avoid these words because they place absolute requests on ourselves, others, and the world around us. These words include: should, ought, must, have-to, got-to, need-to, insist, expect to.

 

Now the final piece to Anxiety is ICSI, which simply means I Can’t Stand It!  Without mincing words, an incredibly “stupid” statement!  As you are saying you can’t deal with it What ARE you in fact doing? Yes, dealing with it! You may not be doing as well as you’d like and you may not be feeling well, but you ARE STANDING IT!  Fact, not Fiction. 

 

To sum up this “formula” for Anxiety:

 

Anxiety = WI + Aw +D + ICSI

[WHAT if…that would be AWFUL…it SHOULDN’T be that way…I can’t stand it]

 

Now what is the difference between Anxiety and Panic?  Not much, except you experience the severe anxiety (Panic), then you begin awfulizing about experiencing it again.  You become hypersensitive to the possibility of experiencing the feeling again, resulting in an increase of anxiety (What If-ing) the panic comes back. 

 

A person becomes fearful that the panic response will return, which increases the possibility that it does and driving the person “crazy” thinking about it.  Virtually everything is manipulated to insure that the person does not have to put themselves into a position to experience the panic.

 

The slight sensation indicating the onset of nervousness or anxiety becomes the breeding ground for panic.  The person believes they will not cope and every time they experience the panic, it reinforces this belief because the person often solicits family and friends to assist.  “I can not do this alone, see, I’m a wreck!”

 

They mistakenly allow the feelings they have be the proof that the situation or stimulus causes the feelings and they can not cope.  They have difficulty realizing that it is “all in their head.”  If they will instead tell themselves something different, more rational, the feelings will slowly go away.  Force themselves to stay in difficult situations, and the anxious feelings become less intense. 

 

Work hard and practice and panic disappears.  Is it easy? I don’t think so.  Can you learn to get rid of panic?  Absolutely!  Are you “nuts?”  No, just human!  Just like the rest of us Fallible Human Beings!  Remember, its part of your heredity, but let’s work on changing our evolution too.  There are no Saber Tooth Tigers! 

 

Dr. Thomas is a Licensed Mental Health Counselor with Whitford-Thomas Group in Tampa, FL.  He has been counseling people to feel better for over 25 years.

 




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