Stop Anxiety and Panic Attacks

by Jennifer Lee

  An example of a rumination thought process might go like this:

  I’m so tired; I don’t want to get out of bed. Why am I always so tired? No one else seems to have this problem. It’s my depression again. It must be back. It seems to be getting worse. Why am I like this? I must have been born this way. No one else I know has this problem. And it never seems to get better. I’m going to have this depression until the day I die. All I can do is lie here and hope it goes away. Which it never will.

  And so forth. We can see from this example the way in which depressive thoughts often trap people into experiencing the very thing they are afraid will happen. What begins in this example as a very normal experience that nearly everyone in the world goes through sometimes – the experience of being tired in the morning and not wanting to get out of bed – is used to fuel a downward spiral of depressive thoughts.

  Panic attacks, as we have seen, operate in much the same way (except, if depressive rumination spirals down, metaphorically speaking, panic thoughts seem to spiral up – into greater and greater intensities). Oftentimes, panic attacks begin from mild feelings of anxiety that are a normal part of life. Many people feel discomfort before public speaking or going to a party with strangers, for example. To feel anxious about these things is normal and not a sign of any mental disturbance. Panic attacks build on these ordinary feelings to trigger a fear of panic. The sense that one might have a panic attack – and that one is prone to panic attacks – often turn this very fear into a reality.

  Let us examine a few other examples of hypothetical panic thought processes to see how this is so.

  3.) Social anxiety – or Social Phobia

  As mentioned above, some degree of anxiety or trepidation about meeting new people, speaking in front of others, etc. is a normal part of life. Indeed, social anxiety may be becoming more prevalent in our society, due to the rise of social media and the fact that most people maintain multiple public personas or public “selves.” If social anxiety stems from a fear of being “on display,” or a sense that one might be judged, ridiculed, humiliated, or shamed in front of others, then it is no small wonder that the feeling may be increasing in a society in which so many of us are literally “on [computer] displays” all the time.

  For this reason, many contemporary psychologists believe that excessive worry about and overthinking of social interactions is one of the key drivers of psychological distress in the modern era.

  That said, social anxiety comes in degrees, and when it is blocking you from engaging in social interactions in which you would otherwise like to participate, that is a good sign your anxiety may have crossed the line into becoming an outright psychological disorder.

  A panic attack thought process linked to social anxiety might take a form like this:

  I don’t want to go to this party. If I do, I might have a panic attack. It would be so embarrassing. Everyone would think I was a freak. I’d have to explain. I might panic so bad during the attack that I throw up in front of everyone. That would be so humiliating. I have to bring along my Xanax. But how will I be able to take it in time, if I start panicking? How do I know it will act fast enough to stop the panic attack? What if I take it and it makes me sick? Then I’d throw up in front of everybody! What if I throw it up before it has a chance to start working? Then I’d have to deal with the embarrassment of throwing up at a party, and I would still be panicking, and the Xanax wouldn’t work. I might be panicking forever. Who’s to say I would ever stop? Why should I?

  As we saw in the author’s own experience, described in Chapter 1, fear of losing control over one’s bodily responses is often associated with social anxiety. One may be afraid that one will be unable to prevent oneself from throwing up or that one will lose control of one’s bowels or other digestive functions in front of others. Finally, fear of fainting, of passing out, or of going unconscious is another manifestation of the fear of losing control of one’s body and thereby “embarrassing” oneself in front of others.

  If one starts to associate this danger with panicking specifically – that is to say, if one starts to be afraid of panic itself because it might lead one to lose control of one’s bodily responses, then the fear of panic can often bring on panic itself.

  Some important things to remember when one is experiencing social anxiety of this sort include:

  Your panic is not visible to others. While it is happening inside you, a panic attack often feels like it is the most important thing in the world. That does not mean, however, that anyone else can see it. Just remember that panic does not have the power to change your behavior or make you do things you don’t want to do. Many people who experience panic attacks report that no one ever notices that it is happening to them.

  Panic is not associated with loss of bodily control. Panic will not force you to lose muscle control of your bowels, force you to pass gas in inappropriate situations, force you to vomit, etc. It is true that when and where we vomit is often not really in our control, which is why it can be a frightening thing for people with panic disorder and social anxiety. In technical terms, vomiting is part of the autonomic nervous system, which means the part of our bodily responses that operate as reflexes, without conscious thought. (Other bodily responses that are part of the autonomic system include breathing, the heart-beat, sneezing, the gag reflex, passing out, etc.) For this very reason, however, vomiting essentially “just happens.” While it may be slightly socially embarrassing, it is not preceded by a long build-up of anxiety in which one worries about the possibility that one might throw up. If you struggle with a fear of vomiting, just think back to the last time you actually did vomit, and ask yourself: did it happen at a time when you were particularly afraid you might vomit or did it happen when you were hardly thinking about the possibility? Chances are it was the latter.

  Remember that other people are not as focused on you as you are on yourself. People with social anxiety are hyper-attuned to their own behavior and responses. Just remember that no one else is paying that kind of close attention and scrutiny to you. One exercise that people have found helpful in dealing with social anxiety is to attempt to focus one’s attention on the other people in the room. Scrutinize the minute details of their appearance and behavior. Once you are thinking about them, you will stop thinking so much about your own role in the situation.

  If you did throw up or pass out in front of other people, it might not be as scary as you imagined it would be. With a great many of the fears that people endure, it is often the case that anticipatory anxiety is far worse than the fear they experience at the moment (this is the “Samuel Butler principle” again). Many people who suffer from extreme fears of the possibility of vomiting often describe having almost no fear reaction at all on the rare occasions when they do actually throw up (because of course they don’t – they are too busy throwing up!). So too, if people really faint or pass out, this will be a process beyond their control, and they will not be conscious of any discomfort or embarrassment while it is happening. Finally, most people in social situations don’t actually respond in the ways we fear they will, even if we do have a bodily response we can’t control. When someone throws up or passes out around us, most of us respond with sympathy, trying to help the person who is sick and contacting health professionals to make sure they get the help they need. We do not stand around passing judgment.

  4.) Claustrophobia – or Fear of Enclosed Spaces

  Sometimes claustrophobia may be associated with a specific kind of enclosed space – such as an airplane, a subway car, or an elevator. In other instances, a person may be afraid of finding themselves in any of these places or other, similarly enclosed spaces.

  From the outside, such fears can often appear to people as “irrational.” Those who do not experience anxiety disorders themselves will often try to “talk people out of it.” They may remind the person with anxiety that flying is actually the safest way to travel; that the accident rate on elevators is extremely low and
that modern elevators have fail-safe mechanisms build into them which would prevent the elevator car from ever falling or losing control for long distances. They may ask: when was the last time you ever heard of someone being hurt on the subway? They may remind people of all the millions of people who commute to work every single day and back on the subway and who are never harmed.

  All of these things are true. What the person making these arguments needs to understand, however, is that panic attacks do not follow an “irrational” structure. They often follow a logical structure, in which each fear follows directly from the one that preceded it. Moreover, people with anxiety are often not afraid only that they will be harmed directly by entering one of the enclosed spaces they fear. They are also afraid of what their own emotional reaction may be once they are in that enclosed space, and of what it may cause them to do.

  Someone who is afraid of subway cars, for example, may understand at an intellectual level that other people ride subway cars every day without being harmed and that the chances of being hurt on the subway are very low. They may be afraid, though, that once they are on the subway, they will panic and lose control of their emotions, and that this may lead them to jump out of the subway at the wrong time, fail to notice an oncoming train, etc.

  Understanding these thought processes can help us respond with greater empathy when we encounter someone struggling with feelings of claustrophobia.

  5.) Agoraphobia – or Fear of Open, Public Spaces

  As the opposite of claustrophobia, agoraphobia is the fear of open, public spaces (the word comes from the Greek term agora, referring to the area at the center of the ancient Greek polis, or city-state, in which assemblies and other public business were conducted). Paradoxically, however, many people who suffer from claustrophobia may also experience agoraphobia in certain circumstances.

  As with claustrophobia above, many people who do not suffer from this fear may find it hard to relate to or empathize with. Why would open spaces be scary? And how could someone who dislikes closed spaces be no less afraid of open, public ones?

  Once again, however, it is important to understand that a person experiencing an agoraphobic panic response is often motivated by a thought process that presents itself to them as fully rational and logical. People are often not afraid of the open space itself, but of what they fear may happen to them within it.

  Here is an example of an agoraphobic thought process that might underlie a panic attack in a public area or an open space – perhaps while a person is walking someplace outdoors:

  I’m fairly far from home out here. If I had a panic attack out here, it would be a really long time before I could get home. If the panic attack was really bad, I’m not sure how I’d get myself home at all. I’m not sure I could walk that far. How long would I be stuck out here? Would anyone find me? I have to make sure I brought my Xanax with me. Yes, I did, good. What if it doesn’t work this time… And so on.

  6.) Separation anxiety

  This is one form of anxiety disorder that is most prevalent among children and is associated with a particular stage of developmental psychology. As most experts in child psychology have long recognized, children go through a crucial stage of bonding with adult caregivers in their lives, which has been described as the attachment phase. As early developmental psychologist Erik Erikson put it, this is the stage of a child’s life in which they need to develop a sense of “basic trust.” Having this sense of basic trust is crucial to all later stages of development that children – and adults – undergo.

  Separation anxiety reflects an excessive fear of the loss of attachment that reflects the instability of the “basic trust” that children are ideally in the process of developing. Oftentimes, a child will experience an intense fear of even short periods of separation from their adult caregivers. As with all anxiety disorders, this excessive fear is not necessarily related to any external event. Some anxiety is simply caused by specific personality traits or chemical imbalances that are unique to each person, and which cannot be “blamed” on any outside action or occurrence.

  In other cases, however, separation anxiety has been found to be triggered by actual events that interrupt the development of a child’s healthy sense of “basic trust.” Sometimes, these events involve actual periods of involuntary separation from a child’s adult caregivers, which breaks the bonds of attachment that a child is forming at the very developmental stage at which these bonds are most vulnerable and most essential to the child’s healthy psychological growth.

  For this reason, many childcare experts regard public policies that result in the separation of children from their adult caregivers as particularly heinous abuses of human rights. Such policies include the practice of separating immigrant children from their parents that occurred at the U.S.-Mexico border during the spring and summer of 2018, as well as practices in many immigration detentions and prison facilities in the United States that result in the temporary removal of newborn children from their mothers while their mothers are in confinement.

  Good to know: The “Logic” of Panic and Anxiety

  Children and adults respond very differently to anxiety, and as a result, recognizing the symptoms of anxiety or panic disorder in each age group will require looking for different things. Children often respond to separation anxiety and similar disorders through abrupt behavior changes or outbursts that are not consciously examined.

  Adults, by contrast, often report just the opposite. For adults, as we have seen, anxiety and panic take the form of highly “logical” thought processes that unfold in a graded series of stages. These stages escalate or “cascade” into increasingly frightening thoughts – often very rapidly. Many people with anxiety, depression, or kindred syndromes report feeling as if they were “thinking too much,” and over-thinking their lives. As we saw in the case of Sassoon’s soldier, it was “ugly thoughts” that he believed were the source of his doom.

  An older term for this kind of thought process is ratiocination. In medieval and early modern literature, writers tended to associate anxiety and depression with one another, placing both under the heading of the generalized disorder melancholy. Moreover, writers from these earlier periods also associated melancholy with ratiocination, meaning orderly and logical processes of thought. What is strange about this is that anxiety and depression are also a form of mental illness, and therefore tend to be seen as quintessentially irrational and illogical.

  The 19th Scottish poet James Thomson – the author of one of the most profound works of literature ever penned on the topic of depression and anxiety, called “The City of Dreadful Night” – captures the paradox of this situation perfectly:

  They are the most rational and yet insane: ⁠

  And outward madness not to be controlled;

  A perfect reason in the central brain,

  Which has no power, but sitteth wan and cold,

  And sees the madness, and foresees as plainly

  The ruin in its path, and trieth vainly ⁠

  To cheat itself, refusing to behold.

  Expressing a similar thought, the great poet Sor Juana Inés de la Cruz – a cloistered nun who lived and wrote in Mexico during the 1600s – once addressed a poem to “Melancholy Thought.” In the poem, she argues with her own melancholy, expressing the wish that she could stop overthinking her problems. To use our contemporary language, Sor Juana is expressing the hope that she might be able to stop ruminating. She writes:

  "Let my understanding at times/allow me rest a while,/ and let my wits not always be/ opposed to my own advantage/ [...] Oh, if there were only a school/or seminary where they taught/ classes in how not to know/ as they teach classes in knowing." (Translation by Edith Grossman).

  Toward the end of Thomson’s poem, likewise, he refers to a classic sketch by the German Renaissance artist and printmaker Albrecht Dürer, which depicts a seated figure who represents Melancholy embodied. Thomson notes that the character in Dürer’s painting is surrounded
by compasses and other instruments of “logical” deductive thought – otherwise known as ratiocination.

  This shows once again that, as “irrational” as panic and anxiety may seem to people who have not suffered from these conditions, they have been linked throughout history – by those who have experienced them – to processes of logical thought.

  Melancholia I by Albrecht Dürer. Source: Wikimedia Commons. This image is in the public domain.

  ***

  We have seen throughout this chapter, that some of the ways in which a simple thought process can often provoke and undergird a full-scale panic attack. In Chapter 6 of this book, we will discuss some methods you can use to manage and overcome these panic attacks – and their associated thought processes – even in the moment when they are happening.

  An important first step before applying these methods, however, is simply to learn how to recognize a panic attack for what it is. This can go a long way in itself toward helping you to calm down and manage your panic response.

  After all, we’ve seen throughout the examples in this chapter that panic often doesn’t present itself to our minds as what it is. It disguises itself. It appears first to us as simply a “logical” consequence of another fear. Therefore, the first few times we panic, we do not think we are experiencing a new physical reaction we have never undergone before, we simply think that we have “realized” something frightening about the world or about our own lack of safety within it that we never noticed before.