Helpful thinking for Panic Disorder

Realistic thinking for Panic Attacks in Panic Disorder with or without Agoraphobia

For individuals experiencing panic attacks, it is important that they learn how to identify and challenge scary thoughts, as it is these very thoughts that can trigger and fuel physical feelings of panic. This is a two-step process, beginning with step one, identifying your worry thoughts. To do this, you can ask yourself: what am I afraid will happen during a panic attack?.  Examples include: “I will faint,”  “It will go on forever,” “I’ll embarrass myself,” “I’ll have a heart attack,” or “I’ll die.”  To become more aware of your specific fears, try to identify your thoughts (and write them down) whenever you feel anxious or feel an urge to avoid or escape a situation. You can use a paper and pen, or consider typing notes into a smart phone, or on a computer or tablet. Repeat this exercise for a week or so.

In step two, after identifying your fear thoughts, you will begin to examine and challenge their accuracy. Thoughts related to panic attacks can be grouped into 2 categories:

  1. Overestimating: This happens when we believe that something highly unlikely is about to happen; for example, when we believe that we will faint or die as a result of a panic attack. This type of thinking is usually related to physical fears (such as fainting and hurting oneself, having a heart attack, going crazy, or dying)
  2. Catastrophizing: This is when we imagine the worst possible thing is about to happen and that we will not be able to cope. For example: “I’ll embarrass myself and everyone will laugh” or “I’ll freak out and no one will help.”  This type of thinking is often related to social concerns (such as embarrassing oneself).

 

To help you figure out whether you are overestimating or catastrophizing, ask yourself the following questions:

  • What would be so bad about that? 
  • What would that lead to? 
  • What would happen then? 

Example:
What do I fear will happen when I have a panic attack? I won’t be able to breathe.
What would happen then? I would die. (Example of OVERESTIMATING)
Example:
What do I fear will happen when I have a panic attack? I’ll get very scared.
What would be so bad about feeling scared? I would get so scared I would pass out.
What would be so bad about that? Other people would notice.

What would happen then? They might laugh or think something is seriously wrong with me. (Example of CATASTROPHIZING).

Challenging "overestimating": First, it is important to realize that your thoughts are guesses about what will happen, not actual facts. Next, evaluate the evidence for or against your thoughts. Individuals with panic disorder often confuse a possibility with a probability (for example, just because it can happen, doesn’t mean that it likely will).

Here are some questions to ask yourself:

  • How many times have I had this thought during a panic attack?
  • How many times has it actually happened?
  • Next time I have this thought, how likely is it that it will really happen?

It is helpful to realize that some of the things you fear are VERY unlikely to occur. Even
though you have had this thought many times, it has not come true.

Example:
What do I fear will happen? When I’m having a panic attack, I am afraid I won’t be able to breathe or that I’ll die.
How many times have I had this thought when I am having a panic attack? A lot!
How many times has it actually happened? Never. Even when it feels like I am going to die, nothing bad has happened. However, what if THIS is the time it happens?
How many times have I had that thought? Many times.
How many times has it actually happened? Never
.
How likely is it that it will really happen? The chances of something bad happen are extremely small. It's important to remind myself of that when I am having a panic attack.

Challenging "catastrophizing": To challenge catastrophic thinking, ask yourself to imagine the worst and then figure out how you would cope.  Here are some questions to ask yourself:

  • What’s the worst that can happen?
  • How bad is it REALLY?
  • Is it a hassle or a horror?
  • Will it make a difference in my life in a week or year from now?
  • What could I do to cope if it did happen?
  • Have I been embarrassed in the past? How did it turn out? Did it make a
  • difference?

It is important to understand that some of the things you fear are more of a hassle than a horror, and that there are things you can do to cope with the situation.

Example:
What do I fear will happen? I will have a panic attack at work.
What would be so bad about that? I might pass out and my co-workers will notice.
What’s the worst that could happen? Everyone will look at me. I would be so embarrassed I would just freeze.
How bad is it really? Well, it would be very embarrassing to “lose it” at work.
Is it a hassle or a horror? It wouldn’t feel very good, but I guess it’s more of a hassle than a major horror.
Will it make a difference in my life in a week or year from now? In a week people may still remember that I had an attack but in a year from now it’s unlikely that anyone will remember.
How could I cope if it did happen? I could excuse myself and go to the bathroom.
Have I been embarrassed in the past? Yes, I tripped on the stairs at work.
How has that turned out? Did it make a difference? I felt uncomfortable around my co-workers for a few days. It didn’t really make a difference in my life. I don’t think anyone remembers.
So, how bad is it to embarrass myself? It doesn’t feel good, but it’s not that bad.

You can challenge your worrisome thinking whenever you feel anxious or feel an urge to avoid or escape a situation. Writing it down helps!

For more information on identifying and challenge scary thoughts see Helpful Thinking.