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.
When I asked Joe what was going through his mind as he sat between the two people he stated, "When I noticed I was sweating I started to think, "Here we go again, I'm going to panic." In other words, he had a negative interpretation of his sweating. Joe is well on his way into the Vicious Cycle of Panic. He had the stimulus (sitting in close proximity to two people in a warm room), the bodily sensation (sweating), and the negative interpretation of the bodily sensation (Here we go again, I'm going to panic).
Negative interpretations often lead into a string of "what if..." thoughts, which for Joe were, "What if I faint?," and "What if I have to get up and leave and everyone stares at me?" What if thoughts tend to turn into catastrophic thoughts, such as, "I will faint in front of everyone." As the intensity of thoughts progress, then the intensity of the physical sensations increases, feeding off of each other which can result in a panic attack.
It is true that this can all happen very, very quickly. However, if you start to become more aware of your reaction to the stimuli around you, you can become more sensitive to your escalating anxiety. As you become more sensitive to when your anxiety is escalating, then you will be more equipped to do something about it before it spirals into a panic attack.
In other words, while panic attacks appear to come out of the blue, once you start to closely examine them, you will often find clues as to what triggered the panic attack. Once you understand triggers, you can learn to prevent panic attacks.
As a first step, start to rate your anxiety on a scale of 0-10. 0 is completely calm and relaxed, and a 10 is a panic attack. Where would you rate yourself right now? Anything from 0-4 is ok, but when you are at a 5-7 it's time to intervene before your anxiety escalates into a panic attack. Start taking your anxiety "temperature" multiple times per day and make a note what you are doing when your anxiety is low, and what you are doing when it is high. For now, look for trends. I'd encourage you to keep a log of your anxiety temperature for a few weeks, and take it into your therapy session if you are in therapy.
In my next few SharePosts I'll go into depth about the broad categories of triggers so that you can start to hunt for what your triggers are.
Dr. Jennifer Fee
*Names and details are always changed in my client examples in order to protect confidentiality