The Genesis of Panic by R. Clark Vinson, LCSW Phobia Center of Dallas/Ft. Worth 817-461-6184
	Panic attacks result when a person misinterprets the reason for certain bodily sensations. The sensations which are misinterpreted are usually those which are involved in normal anxiety (for example, heart palpitations, breathlessness, dizziness, etc.).  The person believes these sensations to be much more threatening than they really are.  Examples would be a healthy man thinking heart palpitations are the beginnings of a heart attack, a woman thinking that a shaky feeling means she is about to faint or fall down, or a man driving a car thinking that the intense feelings he is having mean he is about to lose control of himself and the car.  Since the sensations that are misinterpreted are usually those caused by anxiety, becoming afraid of them only makes them more intense (fear and anxiety are different levels of the same body mechanism, the fight- or-flight response).  When the person experiences these sensations becoming more intense, he or she becomes more afraid ("my heart attack is getting worse") which makes the sensations even more intense, increasing the fear in a quickly escalating spiral that results in the greatest amount of fear you can have, namely, a panic attack. A panic attack occurs when: (1) a person has a particular bodily sensation such as a racing heartbeat, chest pain, a choking sensation, dizziness, etc.; (2) thinks that the sensation means that he or she will suffer in some way (die, faint, lose control, be humiliated); (3) becomes afraid of the sensation and thereby causes it to intensify, which (4) leads to more thinking of horrible consequences in a vicious circle that rapidly results in panic. After the first panic attack people often develop a new fear.  They become afraid of having another panic attack.     Since a panic attack is simply an intense fear response, becoming afraid of panic means a person has become afraid of fear.  When this develops, any sensation similar to past panic attacks (such as a rapid heart beat or becoming light headed) is misinterpreted as the potential onset of another panic attack.  Since panic is simply intense anxiety, normal anxiety is usually misinterpreted as the potential onset of another panic attack, particularly if it occurs in an "unsafe” place such as while driving or in places where quick exit is difficult or embarrassing.   This reinforces the belief that panic attacks are spontaneous and outside of one's control. Many people have read or been told that panic attacks are the result of a malfunction in body chemistry.  It is important to be absolutely clear about this issue.  Panic is not the direct result of some uncontrollable change in body chemistry.  It is the result of a particular chain of thinking.   Overcoming panic attacks is difficult if you hold on to the incorrect belief that panic is the result of something going on in your body that is out of your control.  This belief is often inadvertently encouraged by well meaning health professionals who have reviewed a particular series of research articles that have been widely publicized in the popular press.  This research found that certain chemicals and bodily sensations lead to panic attacks in people who have a history of having such attacks but rarely in people who have never before panicked. The chemicals that these researchers found would lead to panic were sodium lactate (a chemical naturally produced by the body) and caffeine.  The bodily sensations that they found would lead to panic were those feelings produced through voluntary hyperventilation and through inhaling carbon dioxide (which will produce sensations similar to those you might get breathing into a paper bag). The researchers concluded that when some people drink caffeine or when their bodies produce lactic acid, or when these people hyperventilate or breath carbon dioxide (things that will cause abnormal, and therefore, noticeable) bodily sensations, these things produce panic.  Since these things rarely caused panic in people with no history of panic attacks, the researchers assumed that people who have panic attacks have a chemical makeup that sets them up to have the attacks.  They are often told they have a “chemical imbalance." The logical conclusion of this diagnosis is that panic attacks are only controllable by taking drugs that will balance one's chemicals.  However, more recent research noted that these previous studies did not take into account that people with a history of panic attacks are usually highly sensitive to any sensation that might signal the onset of another attack.  Therefore, if you artificially stimulate any sensation that reminds them of a panic attack it will often lead them to think they are going to panic.  As noted earlier, if they think they are going to panic, this is enough to cause most of these people to actually panic.  In other words, the sensation can arise from any source, but it is the misinterpretation of the sensation that is the problem, not the sensation itself.  If people with a history of panic attacks believe the sensations are harmless, they will have the sensations without panicking.  It is the beliefs they hold about the sensation that really causes panic, because fear, no matter how intense, will not cause death, fainting, losing control, going crazy, acting weird, choking, vomiting, inability to breathe or anything except discomfort. There seems to be two major kinds of panic attacks; those that follow a period of heightened anxiety and those that seem to come "out of the blue." Panic Attacks That Follow A Period Of Heightened Anxiety Two distinct types of attack can be found in this category. In the first, the heightened anxiety which comes before the attack is the result of fearing an attack and worrying about it.  This is often the case when phobics experience an attack in a situation (such as a supermarket) where they have previously panicked.  Upon (or before) entering such a situation they tend to become anxious in anticipation of a further attack, then start to focus on their body, notice an unpleasant body sensation, misinterpret this as evidence of an upcoming attack and thereby activate the vicious circle which produces an attack.   In the second type of attack that follows a period of heightened anxiety, the anxiety that comes before an attack may have nothing to do with anticipating a panic attack.  It may come from other sources.  For example, a person may become tense and anxious as a result of an argument with his  spouse, notice his bodily reaction to the argument (fast heart rate, etc.), totally misinterpret these sensations as the onset of an attack or of something dangerous happening to his body, and then panic. Panic Attacks That Come "Out Of The Blue" The trigger for this type of panic attack often seems to be exercise, drinking coffee or some other harmless event such as suddenly getting up from sitting.  While these events are  harmless they often trigger bodily sensations that the person fears. Emotions such as anger or excitement can lead to a rapid heart rate, standing suddenly can cause dizziness, drinking coffee can lead to heart palpitations.  Once the bodily sensation is noticed it is incorrectly interpreted as a sign that something harmful is about to happen and panic results.  Events happen so quickly in these situations that the phobic often fails to notice the bodily sensation which triggers the misinterpretation (the thinking) which triggers the attack.  The person mistakenly concludes that the attack just came "out of the blue. What all this means is that the misinterpretation of the normal bodily sensations of anxiety always is involved in the vicious circle which leads to panic attacks.  Therefore, one of the most important ways of overcoming panic is to learn how to interpret bodily sensations correctly. Where does this problem come from if it is not a "chemical imbalance" as many of us mistakenly have been led to believe? First, there is evidence that some part of this problem comes from the genes vou got from your parents.  People are different in the way their bodies react to stress.  Some people are likely to have more of a physical reaction to stress than others and their metabolism may respond differently.  However, not everybody who inherits the tendency for panic (and that may be everybody) actually ends up having panic attacks.  The reason is that everyone grows up in a different environment.  The way we react in fearful situations is mostly determined by how we learned to act as we were growing up.  For example, if your parents taught you that it was normal to be afraid, that you could deal with fear by accepting it and deciding how best to deal with it, you probably would not be reading this paper now because you would not be phobic even though you have a genetic tendency for panic. The fact that panic results mostly from learned behavior and thinking brings out a very important point.  Panic attacks and phobias are not mental illnesses, disorders, or sickness of any kind.  They are normal responses of your body to situations you interpret to be very threatening.  If you really believe you are about to die, go crazy, or be humiliated, then being frightened is a reasonable response.  People who have panic attacks are mentally sound.  They have no "weak constitution," nor are they wimps, or timid.  Most of them have amazing courage in that they continue to function even in the face of overwhelming fear.  If a person really believes he is  going crazy or about to die or lose control of himself, it takes a "force of will" that is incredible just to carry on day to day.  One of the things we work to change is the attitude there is something "wrong" with you if you are phobic.   There is nothing wrong with you.  Panic is something you find uncomfortable.  It is something with which you have to cope that some people do not experience.  These things are true, but that does not make you less than other people, only different.  You can learn how to control your fear so you can do anything that anyone else can do and be comfortable while doing it. Another important point relates to this fact that phobias are not illnesses - you will not be cured.   You have to be sick to be cured.  What you will have to do is to work harder than other (non- phobic) people to control your anxiety.  That may seem unfortunate, but in some ways it is fortunate.  You will probably have much better health overall because you will learn to reduce your stress.  It has become very clear in the last 20 years that people are more likely to get diseases when stressed and that constant high levels of stress lead to some major health problems like heart attack and ulcers.  You are also likely to be less irritable, easier to be around, accomplish more, be more creative, more satisfied with yourself, and in general, have more fun if you are more relaxed. What caused my very first panic attack?  It couldn't have been the result of anticipating a panic attack since I had never before panicked.  How could it be anything except a spontaneous chemical change in my body?  These are questions asked by most sufferers of panic attacks. First, people who have panic attacks usually have a style of thinking that is very likely to provoke heightened anxiety.  For example, they often are unsatisfied with whatever level of achievement they have accomplished, believing that they need to do more, work harder, be better, be "successful,"never idle, always pushing ahead, etc.  They tend to be more self critical because of this style of thinking so that even when they are doing well they think they could always being doing better.  Also, phobics seem to chronically compare themselves with others who they think are doing better.  What happens is that they set up a lifestyle in which they can seldom rest because they are never satisfied they have done enough to justify slowing down.   Even if they take time off they think they should be doing something productive or they feel guilty for resting. People with this type of thinking are likely to have a nagging feeling that they are "wasting” time whenever they slow down.  They often have a vague sense that they are going to suffer in some way if they do not keep pushing.  What happens is that they keep themselves anxious almost all the time.  In fact, it usually gets to the point that it feels normal for them to be anxious!  They feel uncomfortable any other way because they feel they cannot get enough done if they slow down. They usually take stimulants (coffee, tea, soft drinks, cigarettes) to get themselves going and to keep themselves going well past the natural limits of their bodies.  Worst of all, they seldom give their bodies a break because they feel very uncomfortable if they ever slow down!  What we have then is a panic attack waiting to happen. Here is how it might occur.  A man who is very stressed from constantly pushing himself has an extra load of stress because he is taking a vacation.  During the vacation he breaks from his normal routine, eating at different hours, eating different foods, staying up later, traveling long distances, and doing many things he may normally consider "wasting time."  He becomes more active than usual visiting vacation sites or possibly doing more around the home.  His stress level, which most people think is going to be lowered during a vacation, is rising.  He goes back to work, again completely changing his routine of the last two weeks, and during a lunch break he decides to run by the bank.  He gets into a long lunch-hour line and while impatiently waiting begins to notice that his breathing is labored and that he is feeling light headed.  The next thing he knows he is panicked and fleeing the bank. What happened? Well, the heightened anxiety during the past weeks (added to a normally anxious lifestyle) resulted in a natural increase in body metabolism.  His heart rate increased, as well as his rate of breathing.  However, he may not have noticed this until he slowed down a bit as he would when waiting in a line.  Then, because of his impatience, he caused his body to speed up even more.  This still would not cause panic unless he thought the sensations he felt from the increased metabolism were dangerous.  For example, this person had the typically worrisome thought of "What if I'm about to pass out while standing in the middle of this crowded bank?" Even that thought would not cause panic unless he also added, "That would be horribly humiliating!" That thought caused a sudden rush of fear, he misinterpreted that rush of fear as more evidence that, yes indeed, he was about to pass out.  That caused more fear, etc., in the vicious circle that led to panic. Now we have a whole new ball game.  The person is likely to have more attacks since people do little to reduce their stress after the first attack and much to increase it.  They may quit drinking coffee or something like that, but usually they push themselves even harder to "control" this fear.  And they punish themselves for having it in the first place.  Their self-criticism reaches new heights, particularly as the attacks begin to limit their ability to overachieve.  Of course, they are doing just the things that are likely to make the situation worse.  Now they have become truly phobic.   ________________________________________________________________________                 The treatment program at the Phobia Center of Dallas/Ft. Worth is based upon sound research and proven methods.  It is likely to be slower, more methodical than any treatment you may have had before.  However, you will learn more and learn it better.  Our goal is that you do not have to have therapy for this problem in the future. Some people will see major changes in their comfort very soon, particularly if they have never had therapy before.  There is a saying among therapists that "the worse the problem, the greater the change."  If you have been very bad off and have never had any relief you may seem to have a miracle recovery at first.  However,  real control takes more work and is not as rapid.   Compared to the relatively easy "miracle" recovery you may experience initially, all that work may seem unnecessary.  But without all the work people are usually back for more therapy eventually.   For those of you who have had therapy before, the changes may not be so dramatic, but they will be more permanent. Even though our treatment is brief compared to most types of therapy, we will take our time and learn how to deal with this problem once and for all. This treatment will require some work from you and it is important for you to keep up with the assignments in order for you to derive the maximum benefit from your time and money.  We will make the work as manageable and fun as possible and most of it will be extremely rewarding.   The ultimate reward is finally to be in control of panic, or, in a word, freedom. This material is copyrighted and is intended only for the personal use of individuals. Dissemination of this material without the express, written consent of the author, R. Clark Vinson, is prohibited.