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People may be predisposed to experience panic because of a sensitive 
temperament, high levels of stress that sensitize nerves, emotional 
disorders (social phobia, obsessions, and depression), a hyperactive 
imagination, or a perfectionist personality. The actual first episode or 
trigger incident will be caused by a surge of adrenaline due to one of three 
things:

• A tense situation: conflicts with people, giving a speech, dealing with 
  painful memories, being in a place where a person feels trapped, or 
  a recent death—“What if I die like my aunt Mary did three weeks 
  ago?”

• A conditioned reaction to certain triggers that bypasses thinking 
  processes—A young girl had a near-drowning experience. A year 
  later, in a submarine ride, she had her first panic attack.

• A nonthreatening physical condition that causes unexplained 
  symptoms (dizziness, nausea, blurred vision, sweating, shaking, 
  faintness, rapid breathing, palpitations, or hot flashes) that are not 
  fear, but feel like fear.

Once the first panic attack happens, it can quickly develop a life of its own. 
People begin to think, “What was that? Is it going to happen again? Do I 
have some terrible illness? Am I having a nervous breakdown? What if 
people notice me?” Negative thoughts that flash through the mind almost 
below the level of awareness can trigger subsequent incidents until they 
start happening with increasing regularity.

A woman with high standards was physically stressed from a miscarriage. 
She first became panic-stricken while grocery shopping in the aisle of baby 
products. Later, she began having anxiety attacks anywhere in the store, 
and then, even when driving past the store—just because these cues were 
associated with her first attack.

TWO ADDITIONAL PROBLEMS

When panic is not understood as a part of anxiety, episodes can increase 
in intensity due to two additional problems. Once these are recognized, 
they can be eliminated by learning coping strategies.

Coping Stategies

Symptom

To Cope

Feeling unreal or depersonalized is due to racing thoughts. Brain waves can cycle very rapidly in situations that require “quick thinking.” When thinking is converted into action people have a sense of being in charge. If the source of danger in unclear, thinking has no place to go and people feel “trapped “ in their heads. Poor memory, indecision and loss of confidence come from a mind over crowded with brooding. Little energy is available for making decisions or remembering routine details. These symptoms can be worse in the morning when blood sugar is low. You may have gone to bed the night before hoping to wake up a new person and then despair at being your same old self. People begin to wonder, “Will I ever be normal again?”

Think: Racing fearful thoughts will not “drive you crazy.” Act: Refocusing on your  surroundings or even on troubling  sensations will help you feel more  real and connected to yourself. Relabel unreal feelings as a natural  consequence of brooding. Think: “I am not losing my mind.” As you learn to manage symptoms,  thinking will become clearer and  confidence will return. Be easy on  yourself and appreciate little  accomplishments. Act: You may need anti-depressant  medication to “jump start” your  system if you have become with- drawn and have little motivation to  do anything, Relabel symptoms as the natural  consequence of brooding and early  morning blues.

THE VICIOUS CYCLE OF PANIC

Even when stresses, depression, tense situations, or a temporary physical 
condition have passed, people can continue to have panic just because 
they fear it will happen. This is the fear of fear. People become afraid of 
their own bodily reactions—“I’ve been doing pretty well lately, I wonder if 
panic will come back.” “What if I really do have a nervous breakdown this 
time?” “What if people can tell that I am perspiring?” This aggravates 
predisposing factors of temperament, emotional disorders, and personality 
traits and creates on-going stress that produces the vicious cycle of panic.

BREAKING THE CYCLE

The steps of recovery from panic can restore peace with calming swiftness 
and make each link in the “vicious” cycle an opportunity for change:

• Reattribute predisposing factors to minor physical conditions (ear or 
  thyroid problems, PMS, allergies, low blood sugar, anemia, high 
  blood pressure) and unrecognized emotional problems 
  (temperament, stress, overactive imagination, perfectionism, 
  depression, social phobia, obsessions) that are little cause for 
  concern once they have been treated and/or identified.

• Relabel troubling “symptoms” as a surge of adrenaline. This 
  eliminates fears of dying, going insane or making a fool of yourself. 
  People who have anxiety are overly concerned with reality while 
  people who become psychotic are out of touch with reality. They may 
  think they are Jesus, hear voices or speak in a way that makes no 
  sense. Although people with anxiety can have vivid imaginations, 
  they know who, what and where they are.

• Retrain yourself not to react to anxiety triggers and negative 
  thoughts by refocusing on pleasant activities or facing, flooding and 
  floating past the worst sensations of panic.

• Revalue panic episodes as opportunities to practice coping with and 
  minimizing symptoms.

• Expose yourself to difficult situations to increase your comfort zone 
  as panic attacks reduce in frequency. Friends and family can help 
  until you can face triggers alone.

• Get additional help if needed to reduce stress from conflicts or 
  painful memories..

• Reread information on panic disorder at the first sign of reoccurrence 
  of symptoms or after intense episodes of anxiety.