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Panic Attacks: When, Where, & Why?
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David Carbonell, Ph.D.
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Aug 31, 2005 19:20 PDT
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THE ANXIETY COACH®
Helping People Thrive in an Anxious World
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Volume 6, Issue 8
IN THIS ISSUE
Dr. Carbonell writes about the rules which govern when,
where, and why people have recurrent panic attacks.
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INDEX
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1. Dave's Note
2. Panic Attacks: When, Where, & Why?
3. About The Anxiety Coach®
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Dave's Note
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August 31, 2005
Dear Reader,
By the time you receive this, my family and I will have moved
back to Chicago. We are probably unpacking boxes at this very
moment.
So this month's article is a reprint of an article that first
appeared in July, 2001.
I have an update on the schedule of my workshops for professional
therapists. The panic disorder workshop will not take place in
Wisconsin in January, 2006, as previously announced. Instead,
I will be in Wichita, Kansas on January 26, and Kansas City,
Missouri on January 27. These workshops will also be offered
in Washington State in late 2005: December 1 in Everett, and
December 2 in Bellevue.
The Wisconsin workshops will be rescheduled at some future date.
Watch this space for registration details.
See you next month!
Dave Carbonell
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Rules Behind Recurrent Panic Attacks:
When, Where, & Why?
by
David A. Carbonell, Ph.D.
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Perhaps the most difficult and disheartening aspect of
panic disorder is that you can have recurrent panic attacks
at unpredictable times and places.
The first full-blown panic attack a person experiences
generally comes "out of the blue", with no forewarning or
anticipation. No one suspects a first panic attack, and
so no one has any worry or anticipation about it ahead of
time.
But thereafter, people commonly experience recurrent panic
attacks in a variety of situations. And this leads them
to worry about the possibility of additional attacks.
People often feel confused and disturbed by the variety
of situations in which they experience panic attacks. It
often seems random and irrational to them, and that's how
clients frequently describe it to me when they first come
to my office. And they tend to fear that, since the attacks
seem so illogical, they won't be able to overcome this
problem.
If that were actually the case, that panic attacks occurred
at random, that would make the task of recovery much more
difficult.
But the fact is that, for most people, there are rules which
govern where and when they will experience recurrent panic
attacks. It may seem random and irrational, but there is a
logical set of rules which tells us where and when most
recurrent attacks will occur.
It will help you in your recovery efforts to know what the
rules are, so that you can be better prepared to work with
them.
Recurrent panic attacks are likely to occur:
1. in situations that remind you of your first attack. If
you had your first panic attack in a large grocery store,
you will probably have some fears about going back to that
particular store. But, for many people, it won't stop
there. You may find that you become uneasy about going to
other large grocery stores as well. This fear may spread
to other types of stores, for instance, large department
stores and malls. You might begin to avoid these stores.
Or you might still go, but change your pattern of shopping.
Instead of getting all your groceries at one time, you
might shop frequently, only getting a few items each time
so you can leave quickly. Or you might start shopping real
late at night when very few people are there, so you can
hurry through your shopping. Or you might arrange to go
with a support person, and come to believe that you can't
shop on your own any longer.
There are other ways in which people have recurrent panic
attacks which are reminiscent of their first attack.
Sometimes it involves such coincidental factors as the time
of day, or the kind of weather, that accompanied their first
attack.
2. in situations that you see as a "trap". I don't mean
the usual definition of a trap, which involves someone or
something forcibly confining you with the intent to harm or
kill you. People with panic attacks usually define "trap"
more broadly, to include any situation from which they
can't leave as quickly, quietly, or invisibly as they may
wish. Thus, a supermarket line can seem like a trap, as
can a divided highway, a red light, and the middle section
of a church pew. Note that you can actually leave all
these situations. They really aren't traps. But you might
have to wait, or ask someone to move. It's pretty easy for
people with panic disorder to forget that they have the
option to leave, and therefore feel more anxious.
3. in "leisure time activities and situations". People
tend to panic in situations in which they're bored or just
killing time. Examples of this include watching a dull
movie; waiting in a restaurant while your companion lingers
over yet another cup of coffe; or sitting in a doctor's
waiting room. It also includes activities that don't
really engage your mind because you can do them without
much thinking, like driving or taking a shower. People
tend to panic when they're not really occupied with
anything, and their mind has time to wonder. People don't
tend to panic when they're really involved in something.
4. The last rule is a special case of Rule 3. People don't
tend to panic when "the chips are down". I've worked with
firemen who have panic attacks. Do you know when they tend
to panic? Not during a fire when they're actually in danger,
no. They tend to panic when they've been been at the station
for a long time without a fire, playing too much pinochle!
If the fire bell does ring, the panic attack stops
immediately!
In the same way, when someone's child falls down and breaks
a nose or an arm, that's not when mom or dad tend to panic.
Instead, they typically take care of business, get their
child treated at the ER, and don't start to feel panicky
until after their child is safely home again. That's when
they start to think of all kinds of "what if...?" situations
and may panic - not during the actual crisis, but afterwards!
So these are the rules that govern recurrent panic attacks.
Don't just take my word for it. Use the panic diary
(www.anxietycoach.com/pan6.htm) to help you observe and
understand the internal logic of your panic attacks, and see
how that compares to what I've described here.
I hope this helps you see that the experience of recurrent
panic attacks is not a random or mysterious process. Rather,
it follows logical and consistent rules, even though they
lead you to illogical fears. Understanding these rules can
help you move from confusion to coping - from being stuck
on the "why?" questions to working with the more useful
questions of "what's happening?" and "how can I respond to
it?".
There are many problems you can overcome without
understanding them, but Panic Disorder is not one of them.
You can help yourself recover by better understanding how panic
works, and learning different ways to manage your symptoms.
For more ideas about how to cope with panic attacks, take a
look at the articles on my website at:
www.anxietycoach.com/panic.htm
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THE ANXIETY COACH®
++++++++++++++++++++++
The Anxiety Coach® is a publication of the Anxiety
Treatment Center, Ltd. The Center is a small group of
clinical psychologists who specialize in the treatment of
anxiety problems. The Center has offices in Chicago and
several nearby suburbs.
Dr. Carbonell, a licensed psychologist, is the founder and
director of the Anxiety Treatment Center.
The information contained in this publication is not a
substitute for consultation with healthcare professionals.
Each individual's health concerns should be evaluated by a
qualified professional.
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SUBSCRIPTION INFORMATION
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If you would like to see past issues of our newsletter,
you will find them in the archive at:
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To unsubscribe, follow the link at the very end of this
newsletter.
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CONTACT INFORMATION
++++++++++++++++++++++
David A. Carbonell, Ph.D.
Anxiety Treatment Center, Ltd.
E-mail: dire-@anxietycoach.com
Web: http://www.anxietycoach.com
1340 Remington Road, Suite D
Schaumburg, IL 60173
847.605.0453
© 2005, Anxiety Treatment Center, Ltd.
All rights reserved.
Anxiety Coach® is a registered mark of Anxiety Treatment
Center, Ltd.
Distribution Rights: The above material is copyrighted,
but you may retransmit or distribute it to whomever you
wish as long as not a single word is changed, added or
deleted, including the contact information. However, you
may not copy it to a web site without prior permission.
Reprint permission will be freely granted, upon request,
to periodicals and non-profit educational and service
organizations.
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