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Anticipatory Anxiety in Panic

For people with panic disorder, the panic attack is only part of their difficulty.  Rather the worry and anticipation of having a panic attack can be quite debilitating.   This worry leads to avoidance, which prevents a person from living a fulfilling life. The panic attack itself only lasts for a short period of time, but the anticipation of future attacks can often be with the person all the time.   The thought of having a panic attack consumes countless hours, but the actual panic attack is at its worse for only a few minutes. This anxiety/worry in clinical terms is referred to as anticipatory anxiety and can often be the most debilitating part of Panic Disorder.

To treat anticipatory anxiety, both the cognitive and behavioral techniques are implemented.   The thought of having a panic attack is examined to see whether worrying about it all the time is helping them in anyway. Thus, the person might come to a realization that no amount of worrying is helping them and it might be making his or her life miserable.  If a panic attack does occur then all the time spent worrying was completely useless.  If a panic attack does not occur, then all the worrying made the person miserable during that time. A person can ask him or herself whether it was really worth all the sacrifices and missed opportunities (i.e. social functions, work activities, family events, socializing with friends, family vacations, etc.)? How is life better by worrying?  So what is the purpose of worrying?  One answer is control.  People with panic often think that if they can predict how, when, and why the panic occurs, then we are somehow we are in control of it or can prevent it from happening. The problem with that logic is that panic cannot be controlled and the more you try to the worst it becomes.  The best way to gain control is by letting go of the control and accepting panic for what it is (a false alarm).

The examination of the thoughts is sometimes easier “said than done.”  The exposure to the feared bodily sensations is where the person learns that the symptoms are not as bad (and learn that he or she can handle the symptoms).  We liken it to watching a scary movie. Watching it once is quite scary, but watching it multiple times becomes boring.  The important factor in exposures is that the person does not practice safety seeking behaviors as they reinforce the idea that the symptoms are not manageable (basically, telling the person’s body that “I can’t handle it and I need to do something to protect myself”).