Understanding the Vicious Cycle of Panic

About a month or so ago, Dr. Kleiner wrote an excellent SharePost entitled, "Understanding Panic Attacks."   If you haven't read it, you might want to do so before continuing on with this SharePost.  Kr. Kleiner mentioned that we now understand that physical symptoms lead to increased anxiety which in turn leads to increased physical symptoms, in other words, anxiety feeds off of itself.  I would like to take a little time to discuss this "Vicious Cycle of Panic," in more depth because it is a critical concept to understand so that panic attacks can be prevented.

Panic  attacks are generally described as being "physically abrupt," or "out of the blue," or occur "without an apparent cause."  Indeed, many of my clients will make a comment something like, "One minute I was sitting on my sofa feeling fine, and the next minute I was having a panic attack."

While I agree panic attacks can develop very quickly and abruptly, I strongly believe that they develop from this feedback loop, or "vicious cycle."  Let me explain:

The Vicious Cycle of Panic always starts with stimuli or "triggers", which are either external (outside ourselves) or internal (within ourselves).   There are 8 broad categories of triggers, which I will discuss in depth in future SharePosts, but for now, just note that stimuli are wherever we are and cause the experience of a bodily sensation.

For example, where are you right now?  Are you sitting on a chair at your computer reading this post?  How does the chair feel?  Is it soft and comfortable or is it hard and uncomfortable?  Maybe it's somewhere in between, not especially soft or hard. Unless your chair is particularly uncomfortable, you probably were not thinking about how it felt until I asked you about it.  Also, most likely you do not have strong thoughts or feelings about how your body feels while sitting in your desk chair.  If this is true, then at this point you are probably wondering why I'm making such a big deal out of it. The chair is an example of an external stimulus that causes a body sensation when you sit on it.

In order for the Vicious Cycle to start, however, you must first notice the body sensation and have a negative interpretation of it.  If you have a neutral or positive interpretation of a body sensation, then you will not head towards a panic attack.  Let's look at some examples:

Many people I work with are uncomfortable sitting among large groups of people during an event such as a play, movie, church, or classroom. 

Joe* talked to me about sitting in a church service.  "I was sitting in the middle of the row and there were people on both sides and our arms were touching.  I started to sweat and soon I knew if I didn't get out of there I would panic."

The stimulus for Joe was sitting in close proximity to other people.  Their arms touching him is a stimulus. If it is a little warm in the room, that's another stimulus.  Sitting in close proximity to other people in a warm room will cause a body sensation that many of us would notice.  We might be hot, feel cramped or closed in, or uncomfortable in some other way. However, if we were not scared by this sensation or did not worry about having a panic attack, then nothing would happen, we'd just be hot and uncomfortable.