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The Blog of John Gibson, PhD

Is the Anticipation of a Panic Attack Worse Than the Panic Itself?

Maybe. At the very least, for many sufferers it’s almost as bad.

When it comes to positive events, anticipation can be a good thing. If we’re anticipating an exciting vacation, say, or a cherished holiday or other event, the tension of the waiting itself can enhance our enjoyment (especially if we are adept at
savoring).

But what if it's a negative event? Panic attacks cause people to feel deeply afraid. The sufferer experiences the emotion of intense fear, not to mention disconcerting symptoms like shortness of breath, rapid heartbeat, or tingling in the extremities (and more). Fortunately, panic attacks are typically short-lived phenomenon. They pass. The sufferer’s physiology goes back to baseline.

Well, not quite. Because in the back of the sufferer's mind there is this terrible, worrying question:
When will the next one occur?

The panic sufferer often becomes hyper-vigilant to the prospect of another attack. The first attack was so aversive that it’s as if the sufferer must constantly be on guard for the possibility of another, lest he or she be caught unaware. A portion of the sufferer’s attention is devoted to keeping a close eye on the body’s sensations, scanning and searching for any sensation, pain, or symptom that might foretell a panic attack.

Unfortunately, the more the sufferer cues into sensations of the body the more keyed up he or she becomes, thereby increasing the chances of another attack. This hyper-vigilance simply revs up the nervous system and once the body is on high alert it doesn’t take much to trigger an attack. And if (when) one finally does occur, it's as if the sufferer tries to become even more vigilant that before. As you might imagine, this creates a vicious cycle. Conversely, sometimes the panic attacks themselves subside, either through treatment or the natural course of things, but the anticipatory anxiety remains. For many sufferers, living with anticipatory anxiety is almost as bad as tolerating the attacks themselves.

I think of panic disorder as having three overlapping components. The panic attack itself, the anticipatory anxiety, and the
avoidance of situations that might trigger an attack. Sometimes in treatment we need to break the disorder down and work on each component separately.

And yes, panic attacks can definitely be treated. It takes persistence, patience, and a willingness to examine your mindset (thoughts, beliefs, feelings, fears). Even with complicating factors (e.g., over-reliance on alcohol, a well-establish pattern of behavioral avoidance, health issues, or over-reliance of anti-anxiety medications) real gains can almost always be made.

Fear doesn't have to win.

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