THE FEAR OF FEAR

Panic attacks and panic disorder are a type of anxiety that may have started out from an actual situational experience: getting sick when you were little, being extremely embarrassed by a seemingly innocuous situation, or being stuck somewhere briefly. After that experience you may find yourself avoiding similar situations for fear that the panic will happen again.

Panic and full-blown panic attacks are so unbelievably unpleasant and uncomfortable that we will do pretty much anything to try and avoid having them again.

This may sound a bit like trauma and we could certainly identify the triggering event as traumatic, however it differs from trauma in that the primary symptom of panic disorder is the fear that the panic attack will happen again.

Someone may have a legitimate negative experience (e.g. nearly passing out on a crowded subway), but unlike PTSD, the subsequent anxiety symptoms are not about the memory of the incident. Rather, it is the fear that they will lose control in public that causes them to avoid going back on the subway. This avoidance of anything stressful causes a fear of panic or activation symptoms, which in turn triggers additional anxiety and panic.

AN INTENSE, OVERWHELMING FEAR OF SOMETHING VERY SPECIFIC

Phobias are very similar to panic disorder, though they are specific to a feared trigger. Common phobias include the fear of driving, fear of flying, fear of vomiting, or the fear of dogs.  

EXPOSURE THERAPY

The most effective way to challenge the combination of physical panic symptoms plus behavioral avoidance is to engage in exposure therapy that is specifically tailored to the client’s symptoms. When treating panic I usually work to help expose patients first to the physical bodily sensations associated with panic attacks (interoceptive symptoms) and later the thoughts, activities, and environments that are avoided due to fear of experiencing panic in everyday life. 

I treat phobias just like panic, using exposure therapy that focuses on bodily sensations, thoughts, and the avoided everyday experiences.

This may include:

• Exposures in session (e.g. watching videos or viewing images)

• In-session in vivo exposures (e.g. going on exposure “field trips” together)

• Imaginal exposures (e.g. using imagery in-session to talk through a triggering experience)

• Exposure homework (e.g. engaging in various out-of-session exposures on your own) in between sessions

Exposure therapy for panic disorder and specific phobias typically takes about 10-12 weeks.