Chapter 7 - The Panic Cycle

Question 1

There are rules which govern where and when they will experience recurrent panic attacks. There is a logical set of rules that tell us where and when most recurrent attacks will occur.

Answer 1

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Question 2

You can use these rules to identify the situations and activities you need to include in your exposure practice.

Answer 2

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Question 3

Recurrent panic attacks are likely to occur:

Answer 3

1. In situations that remind you of your first attack.
2. In situations that you see as a “trap”
3. In Leisure-time activities and situations
4. When there i no emergency

Question 4

What situations or activities remind you of your first attack?

Answer 4

1. Having no water nearby

Question 5

TRAPs are usually any situation from which they can’t leave as quickly, quietly, and invisibly as they may wish.

Question 6

What situations or activities do you think of as “traps”?

Answer 6

1. Malls
2. Movies theaters
3. Outdoors in general

Question 7

During what leisure-time situations or activities do you get anxious because your mind is idle?

Answer 7

1. Work
2. Being outside

Question 8

The experience of recurrent panic attacks is not a random or mysterious process. Rather, it follows logical and consistent principles, even though they may lead to illogical fears.

Answer 8

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Question 9

The better you understand the process and pattern of an individual panic attack, how physical sensations, thoughtsm emotions, and behaviors interact to produce panic, the more ableyou will be to observe it, accept it, and wait for it to end without getting caught up in the turmoil it offers.

Answer 9

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Question 10

PANIC ATTACKS ARE CYCLICAL. IT ALWAYS FOLLOWS THE SAME PREDICTABLE PATTERN.

Question 11

Many people with panic attacks don’t realize that there is a pattern, and this makes their task of recovery much harder. They focus on the illogical or “irrational” aspects of the fears and fail to notice what a predictable pattern a panic attack follows.

Answer 11

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Question 12

They say things lie “It doesn’t make any sense…it’s irrational,” and give up on finding any logical pattern to the attacks. Naturally, this leads them to feel discouraged, because if they can’t understand something, how can they change it? But, while it’s true that the fears of a panic attack are exaggerated and unrealistic, the pattern a panic attack takes is predictable and regular. The symptoms often change over time, but the pattern remains the same.

Answer 12

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Question 13

A panic attack is a circular process and can be seen as starting at one of several points on the panic cycle.

Question 14

Recall a recent panic attack you experienced-one that you remember reasonably well, a strong one that scared you. What event (anxiety symptom) did you notice first.

Answer 14

Tunnel Vision
Rapid heart beat

Question 15

An external “CUE” triggers the attack

Question 16

Example: You drive toward an intersection wanting to make a left turn. You see a massive amount of traffic. You feel a lump develop in your throat, followed by a difficulty in breathing. THe traffic jam is the “cue”; the physical symptoms are the event.

Answer 16

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Question 17

In the same attack you recalled above, did an external cue trigget the event in you? If so, what was it?

Answer 17

Distance to point B
Blazing hot temperature

Question 18

Most often, “CUES” will fill you with thoughts about them, quick interpretations of what it means to you, and these will produce physical and emotional responses in you.

Question 19

THESE THOUGHTS ARE LARGELY BEYOND YOUR VOLUNTARY CONTROL. If you are afraid of that cue, you will have thoughts and mental images as soon as you see one. You may not consciously remember the thoughts, but they’ll be there.

Question 20

Sometimes you will see cues that immediately mobilize your FIGHT OR FLIGHT response without ever producing a thought.

Question 22

The CUE triggers the precipitating event of a panic attack.

Question 23

THE CYCLE OF A PANIC ATTACK

Answer 23

1. Cue
   - The first symptom to appear, which can belong to any one of the four categories: A. Physical Symptoms B. Thoughts C. Emotions D. Behavior
2. Reflex Reaction (additional symptoms)
   - The rapid repetition of the initial symptom, and the appearance of other kinds of symptoms
3. Interpretive Reaction
   - The part of the attack where your thoughts interpret the symptoms in unrealistic and extreme ways, and predict terrible outcomes for you
4. Panic Attack
   - When the flood of symptoms reached a peak, and you fear an imminent catastrophe
5. Panic Attack Ends
   - Even though you fear it won’t end, it always does, regardless of what you do
6. Relief
   - The feeling of having “dodge a bullet”
7. Anticipatory Stage
   - The “what if” thoughts that suggest future trouble, and lay the groundwork for the next attack

Question 24

It’s possible to have a panic attach without a cue

Question 25

As you become more “stuck” with the panic disorder, you will find that you no longer need an external cue to trigger a panic attack. It’s often sufficient to just think of something you find threatening, or feel an unwelcome emotion like anger, and those thoughts and emotions serve as the cue.

Question 26

In any event, the cue is less important than what is happening inside of you

Question 27

The EVENT is simply a panic symptom, the first one that comes to your attention as you start experiencing the first signs of a panic attack.

Question 28

During the second phase, the REFLEX REACTION, in a way that seems automatic and reflexive, you experience more of the first symptom you already experienced as the event.

Answer 28

Like a landslide triggered by one rock falling down a slope, you start having more symptoms as well.

Question 29

Many, but not all, of these additional symptoms are actually caused by your reaction to the event. For instance, if you start to feel short of breath, you may tense up in ways that make your breathing even more labored…and the labored breathing will then begin to produce other symptoms, such as feeling dizzy or lightheaded.

Question 30

In the same panic attack you described above, what reflex reaction (additional symptoms) was brought on by the initial event?

Answer 30

Screaming
Shaking legs
Blurry vision
Despreration

Question 31

The Reflex Reaction is also called “the second wave” and is usually felt worse than the first.

Question 32

This wavve of additional symptoms occurs in response to the interaction between the reflex reacion and the next part of the cycle, the INTERPRETIVE REACTION

Answer 32

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Question 33

The INTERPRETIVE REACTION is the part of the panic attack where you tell yourself what the symtpoms mean for you. Consciously or Unconsciously, you decide what the symptoms of the event and reflex reaction mean. You make an interpretation of those symptoms.

Question 34

Most of the time, this interpretation will be some form of this thought: “Uh Oh.. I’m in trouble.”

Question 35

In the same panic attack you described above, what interpretive reaction (thoughts about your symptoms) was brought on by the event and your reflex reaction to it?

Answer 35

1. I’m going to die.
2. My vision is going blurry
3. I am going to get a heat strole
4. I am to weak to make it back home
5. My legs are shaking uncontrollably.. I am going to collapse and not make it home
6. No one nearby to help me/support me

Question 36

The REFLEX REACTION and the INTERPRETATIVE REACTION stages inmteract and affect each other. It is a two way street. The interpretations of danger and illness lead to more physical symptoms, and the physical symptoms give rise to more scary interpretations.

Question 37

The INTERPRETATIVE REACTION is usually an anticipation of doom.

Question 38

Eg…

A person might see an airplane overhead and picture himself on board a plane, having a panic attack, and acting like a crazy person.

That’s an INTERPRETATIVE REACTION.

All that really happened is that he saw an airplane.

But in response, he experienced some involuntary thoguhts that reflect his fear. When he instinctively resists these thoughts, he produces more reflex reaction symtptoms-muscular tension, labored breathing, and so on. That in turn leads to an even more catastrophic interpretative reacion (“On No! It’s happening again!”) and thus keeps the cycle moving along.

If nothing else intervenes, these two reactions escalate and fuel each other, creating more fear-and fear of fear-and culminating in the peak of the panic attack

Question 39

Hom many times have you had a panic attack and thoguht: “What if it never ends?” This kind of thought makes the panic attack feel worse if you don’t have the right answer.

The right answer is: “THE PANIC ATTACK WILL END!”

Question 40

The panic attack with end because all panic attacks end. It’s not up to me to end the attack. This panic attack will end regardless of what I do. Whether I do everything the best way possible to calm me down, or the worst way possible to get myself more agitated, the panic attack will end. It is not my job to end the attack. My only job is to make myself as comfortable as possible while waiting for the attack to end.

Answer 40

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Question 41

Have you had any attacks that did not end?

Take a few minutes to consider the answer above, and compare it to your own history and experience.

Is it true for you?

If no, this answer is not true because:

Question 42

In the same panic attack you described above, what positive emotions did you experience after the attack?

Answer 42

• I was just glad I made it back into my home safe, but confused because of how that panic attack happened. Usually after major panic attacks like that one, I would feel “high”. I would feel very energetic. I would feel like a brand new person. I would feel like I am on top of the world. But oddly, not for the one mentioned above. I just felt glad to be safe, along with confused.

Question 43

What negative emotions did you feel.

Answer 43

• Refering to the panic attack mentioned above, the negative emotions I felt were fear of what just happened. I was not expecting to have such a massive panic attack so close to home. I was very confused. From that day forward, I started to fear going to that park and being out in the sun in general.
• Refering to other major panic attacks, the negative emotion(s) I felt were mainly embarrassment.

Question 44

The ANTICIPATION STAGE is where you start dreading the next appearance of panic, or panic symptoms, and hoping that they don’t return. ONCE YOU’VE STARTED WORRYING ABOUT A SYMPTOM OR SITUATION, IT’S EASY TO PRODUCE ANOTHER EVENT, AND YOU’RE OFF AGAIN, INTO THE VICIOUS, REPETATIVE CYCLE OF PANIC.

Question 45

Panic atatcks can start on several places on the cycle.

Question 46

How does the panic cycle described in this chapter compare to your experience of panic? Are there any important differences?

Answer 46

The panic cycle is a perfect example of what I’ve experienced during my panic attacks.

Question 47

Does the panic cycle describe your experience reasonably well?

Answer 47

Yes. Perfectly

Question 48

If you are satisfied that the PANIC CYCLE is a reasonable description of the way you experience panic attacks, then you can use it to figure out how you can BREAK THE PANIC CYCLE.

First, answer these questions:

1. At a time when you were experiencing a panic, have you ever been interrupted by a surprise visit from a good friend, an important phone call, or some other unexpected event that demanded you attention?
2. Did you later remember that you had been starting to panic, and realize that the panic attack simply ended when you were interrupted?

Use the following questions if you have experienced the above

3. I was _____ doing _____. I noticed the following symptom(s) that made me think I was starting to panic:
4. Then, the following unexpectid event occured:
5. the result of this interruption was:

Answer 48

1. No
2. No
3. -
4. -
5. -

Question 49

People claim to notice that sometimes when they get distracted from panic, it fades more quickly. This often leads people to think along the lines: “If I dont think about it, I won’t panic.” So they try to distract themselves from panic by avoiding the subject entirely, in hope that by so doing, they can protect themselves from panic.

Unfortunately, THIS CAN CAUSE YOU A LOT OF TROUBLE.

Question 50

It’s certainly true that, under certain circumstances, a distraction can interrupt and stop a panic attack. But the kind of distraction that can help you most is distraction that comes from an outside source-the kind that results from somebody else doing something that distracts you. The problem is you cannot count on a distraction being available whenever you want one.

Question 51

People often try to distract themselves. This does not work as well, because you know why you’re trying to distract yourself, and from what.

Question 52

For the next ten seconds, do not think about and elephant. What happened?

Question 53

There are real limitations to how useful distraction can be as a strategy for coping with panic. The more deliberately you try to use it-the more consciously you choose to distract youself-the less likely it is to work. (There are even more reasons why not to rely on distraction)

Question 54

The idea behind distraction is that, if you don’t think about panic, you won’t panic. This often leads people to assume that thinking about panic is enough to cause a panic attack. It’s not that simple. Such an assumption can mislead you.

Question 55

Have you even pulled out a medication when you were feeling panicky and felt better just by looking at it?

Answer 55

Yes

Question 56

Have you taken a medication (or any source ((food, water, etc)) ) and gotten instant relief as soom as you took one, even before it could actually take effect?

Answer 56

Yes

Question 57

If you haven’t use these medications (sources), have you ever started having a panic attack and then your “self person” arrived, or called you on your cellular phone, and you started to feel better because of it?

Answer 57

No

Question 58

Have you ever started to panic and found that it ended as you pulled out some writted material about panic, such as this book or your own written observations?

Answer 58

No

Question 59

People often start to feel better even when the have not been distracted from the panic. They see their source of comfort as an example. They’re thinking about the panic rather than being distracted from it-and yet they feel better. That is because they are not thinking about the panic in a particular way. Their VIEWPOINT has changed. They’re thinking about the panic from an OBSERVER’s point of view rather than a victim’s. And by thinking about it in a more realistic, less catastrophic way, they are no longer engaging in phobic self talk.

Question 60

What is self talk?

Answer 60

Self talk is simply the process of thinking to yourself, abnout the world and your place in it. We do this all day, every day of the year. We all leared to do it in a similar way, even though we don;t remember the process because we were too young.

Question 61

One of the most important characteristics of self talk is that it’s subliminal. In other words, you hear it as a background sound, without paying much attention to it. BECAUSE YOU DON’T PAY MUCH ATTENTION TO IT, IT HAS MORE INFLUENCE WITH YOU, BECAUSE YOU DON’T NOTICE WHAT YOU’RE TELLING YOURSELF, AND THEREFORE DON’T USUALLY CHALLENGE OR ANALYZE IT.

Answer 61

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Question 62

Even when you’re not paying attention to your self talk, your body WILL STILL “GET THE MESSAGE”.

Question 63

Your body WILL repond as if a self talk is true, even when it isn’t. This can cause you lots of trouble when your self talk is negative and unrealistic.

Question 64

IMAGINE A LEMON (An example of how self talk can affect you)

Close your eyes and imagine holding a lemon in your hands. Feel the two different ends of the lemon. Feel the texture of the skin of the lemon. Hoke the lemon under your nose and smell it. Cut the lemon open and smell it again. Taste the juice that gets on your fingers.

If you’re like most people, you don’t have to do too much of this before you notice some extra saliva in your mouth. That’s produced just by thinking about the lemon. Simply picturing it in your mind is enough to get your body to produce some extra saliva to help digest it.

Question 65

What we think about and isualize in our minds can have effects on what we actually experience physically. Our thoughts and self talk are not just idle chatter. They can, and do, influence our physical experience.

Question 66

Phobic self talk ot the kind of thinking and talking to oneself that sets the stage for panic attacks. It’s full of suggestions and innuendoes, some subtle and some not so subtle, which are continually offering a subliminal influence to keep the person in a state of anticipatory panic, It has three characteristics:

1. It’s unrealistic
2. It’s negative
3. It’s persistent

Question 67

Phobic self talk comes into play at two key parts of the panic cycle: The INTERPRETIVE REACTION and the ANTICIPATORY STAGE.

THESE ARE THE TWO PARTS OF THE CYCLE WHERE YOU CAN BENEFIT THE MOST FROM OBSERVING AND WORKING WITH YOUR THOUGHTS.

Question 68

Phobic self talk in the INTERPRETIVE REACTION consists principally of misinterpretting discomfort for danger. It’s here, for instance, when you feel dizzy or lightheaded, that you might hear yourself thinknig it means you’re about to faint, when it really means that you’re breathing too short or shallow, or maybe holding your breath.

It’s also here that you might feel tightness or pressure in your chest and hear yourself thinking that it means a heart attack, when it really means that you’ve tightened up your chest muscles with shallow breathing.

Question 69

What are some of the misinterpretatios you hear in your thoughts in the interpretive stage of a panic cycle?

Answer 69

• I’m going to die
• I’m going to faint
• I’m going to have a heart attack
• I need to get home
• I need water
• I’m going to get s heat stroke

Question 70

Phobic self talk in the ANTICIPATORY STAGE consists mostly of “what if” messages about terrible thingks you imagine might happen to you, such as:

• What if I have a heart attack?
• What if I faint?
• What if I freak out?

This is often called ANTICIPATORY WORRY.

Question 71

There is a simple formula for ANTICIPATORY WORRY, and it goins like this:

Say “what if.” Then fill in the blank with something terrible. Most people with panic and phobias think this way a lot. How about you?

What are some of the “what if” thoughts you notice in your self talk before, or during, a panic attack?

Answer 71

• What if I faint
• What if I die
• What if I have illness
• What if I have a panic attack
• What if I go crazy

Question 72

Negative and unrealistic self talks are sometimes subliminal and automatic. They create in you an anxious mood without your understanding where it comes from.

Sometimes the thoughts are loud and obvious, and you become embroiled in an argument with them, or you struggle to distract yourself from them.

Question 73

Every time I see (or visit) 1. ___________, I think of the time I panicked at 2. ___________. That’s when I started feeling 3. ___________ and became afraid that I was about to 4. ___________. When I remember that now, I find myself thinking, “what if 5. ___________?”

6. Add some more

Answer 73

1. Outside
2. The park
3. Horrified
4. Faint, Die, have a heart attack, have a heat stroke.
5. I was not wearing that massive black jacket in the summer and carrying a bottle of water with me.
6. I was feeling slight panic attacks prior the major one mentioned, but I was letting them slide thinking I was under control of my panic attacks. I was not at all expecting such a massive one to hit me out of no where. I admit my body was telilng me to return home, but I thoguht I would fight it. It made thing way worse. I was scared for my life.

Question 74

Your body is an innocent, naive being. It’s going to respond to whatever it hears as if it were true, regardless of how true or false it actually is. You body will produce almost as much saliva for an imaginatory lemon as for a real one. It will produce the same fear on a roller coaster that it would if you fell of a roof.

Question 75

When your body hears insinuations about disaster, what’s it going to do? Is it liable to remain cool, calm and collected, knowing that it’s just hearing the empty threats and false predictions of the anticipatory stage of the panic cycle…or not?

Question 76

Thinking back to the panic attack you were describing in the exersices earlier in the chapter, what did your body experience?

Answer 76

My body experienced a rapid heart beat, blurry vision, uncontrollable shaking legs, etc..

Question 77

If you find yourself in the same circumstances in the future, do you imagine that your body will experience the same sensations? Why or why not?

Answer 77

Yes. Every time I still try to take my kids to the park or just walk around my complex, I can feel the beginning stages starting to show themselves. So I calmly avoid actually persuing those activities any further and go back home. It’s a bad habit I’m fighting against at the moment.

Question 78

When you talk to yourself about catastrophic consequences, it’s only natural that your body is going to trigger its emergency responses and flood you with adrenaline, speed up your heart rate, and make you feel like fleeing, That would be great if there really were an emergency, because it would give you the energy and motiviation you need to protect yourself. But since there’s no real danger to run from, it’s only going to make you feel worse.

Question 79

People often underestimate the power of their mind to create panic attacks and think of them as a purely bioligical phenominon. “Aren’t they due to a chemical imbalance?” Certainly there are chemical aspects to a panic attack, because we are literally made of chemicals. It’s also true that the use of certain chemicals in panic medications can often help people.

But the “Chemical Imbalance” emplanation overlooks some of the most important aspects of chronic panic disorder.

Question 80

Write does two situations in which you think you’re almost guaranteed to have a panic attack.

Answer 80

1. Being outside (Going for a bike ride, drive, walk, etc..)
2. Having nothing to eat/drink

Question 81

Now write does two situations in which you would be extremely unlikely to have a panic attack.

Answer 81

1. At a relatives house.
2. I have a meal and water with me (and it’s not sunny)

Question 82

WELCOME CHANGES

Once you learn how to get the practice you need, and actually get that practice, you will notice some changes appear in your life:

• You’ll notice that the average severity of your panic attacks become less and less
• You’ll notice thta the average length of time in between panic attacks become longer and longer
• You’ll notice that the average duration of a panic attack becomes shorter and shorter
• You’ll notice that your use of avoidance and other “self-protective” methods gruadually declines
• And your fear of fear will gruadually diminish
• And finally, when you lose your fear of the attacks, that’s when they fade away

Question 83

You can learn how to talk to yourself differently and send the chemicals a message that all is well

Question 84

What I’ve called the EVENT stage deserves a different name. It’s an INVITATION to a panic atatck, not a command.

Depending on how you respond the the INVITATION, you may or may not “go to the party”.

If you take the phobic self talk seriously, and get into a struggle to make it go away, you’re probably “going to the party.”
If you recognize the phobic self talk for the trash talking it is, and observe these thoughts without getting ebroiled in the struggle, you’re probably going to skip it.

Question 85

When you don’t talk to youreslf in a negative, scary, and unrealistic way and when you don’t struggle to protect yourself, you generally don’t panic. Instead, you cope and exit the cycle.

Question 85

> :( When you take your phobic self talk at face value and struggle to protect yourself, you’re likely to panic. Your body will respond to the phobic self talk as if it were true, even if it’s not.

Question 85

As essential ingredient to panic attacks is the unrealistic, scary, misinterpretation of what’s going on around you, and especially within you.

Question 86

If you could find some other way to change the scary self talk, you’d have a better, more reliable way of preventing panic. That means you’d get over panic attacks. All you have to do is get rid of the phobic self talk and you’ll get rid of the panic.

Question 87

When you suspect that your life or sanity is on the line, you need something other than positive self talk to help you. Nothing anybody else might say will be enough. You need to tell yourself something you know to be true from your own personal experience. When you hear that wuestion “what if I have a panic attack?” the only answer sufficiently powerful to help you calm down will be something like “that’s okay, if I panic here I’ll do the same thing I did the last time. That worked pretty well.

Question 88

Your own reminder that you know how to interrupt a panic attack is the only thing that will be strong enough to regularly put the panic attack to rest. And there’s only one way to het that. You need practice coping with panic. That’s the catch.

Question 89

You need practice in coping with the sensations of panic-gradual, progressive practice that will help you determine for yourself over time that you are safe. As you come to believe you can cope, from your own practice, you will begin to talk yourself out of the attacks.

Question 90

You would probably prefer to find a method that helps you recover without ever again feeling the sensations of panic. Who wouldn’t? Yet this is just another way panic tricks you. WHILE YOU ARE WAITING FOR A NEW MIRACLE DRUG TO BE INVENTED, OR FOR THE PANIC DISORDER TO DISAPEAR ON ITS OWN, THE PANIC IS BECOMING A MORE DEEPLY INGRAINED HABIT IN YOUR LIFE.

Question 91

It’s like learning self-defense. If you went to a self-defense class and took copious notes and observed carefully but never participated in the practice sparring, you wouldn’t learn much self-defense. You certainly wouldn’t develop any confidence in your self-defense abilities. To develop self-defense skills, and confidence in those skills, you would literally need to practice fighting with the other students and the instructor.

Question 91

The moethod that’s been shown to be most effective for panic attacks and phobias is called “EXPOSURE THERAPY”-that is, exposure to panic so that you can practice resonding to it. This will enable you to develop a new answer to the question, “what id I have a panic attack?” The answer that will work will be some variation of “I’ll fo what I did the last time I panicked. That seemed to work pretty well”.

Question 92

To develop your panic coping skills, and your confidence in them, you literally need to practice WITH panic.