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Panic Attacks: What They Are and How To Overcome Them

cognitive behavioral therapy

If you’ve ever experienced a panic attack, one thing is for certain: you never want to have one again. However, it’s not as easy as saying ‘wow, I’m never going to do that again.’ Panic attacks are a bit mysterious in their nature which can make them even more tormenting for those who experience them.

Not knowing why it occurred, what symptoms or bodily sensations lead up to a panic attack, and what happens during one can actually make them worse, leading to a downward spiral. Luckily, many mental health experts have outlined just about everything science currently knows. So, let’s learn about them.

Overcome panic attacksWhat Are Panic Attacks?

Panic attacks are different for everybody including what causes them, how you feel during one, and how you treat your relationship with them. Broadly, panic attacks revolve around a sudden feeling of intense anxiety and impending doom that can occur almost instantaneously [1].

During a panic attack there are many abnormal physical sensations such as breathlessness, palpitations, chest pain, choking, dizziness, tingling, hot/cold flashes, sweating, faintness and trembling. If you have had any combinations of these along with feeling like you are in danger or the world is coming to an end, we can consider it a panic attack.

Panic Disorder

Experiencing a panic attack is not an anomaly, and in fact, panic disorder affects up to 5% of the population. Statistically speaking, in a room of 100 people, 5 of them are likely to have this disorder. Keep this in mind when you think that you are the only one suffering from panic attacks; you are not alone.

Panic disorder means that instead of a one-time experience, the attacks are recurrent. This is also accompanied by anxiety about future panic attacks, phobic avoidance (staying away from places you fear will trigger a panic attack), or really any other change in behavior due to the attacks [2]. If you haven’t noticed, the criteria are fairly broad which shows how much it can vary from person to person.

Having this condition is often accompanied by other psychological disorders such as bipolar disorder, depression, general anxiety disorder and so on. In general, being in a poor state of mental health puts you much more at risk for panic attacks and panic disorder.

What Causes Panic Attacks?

This leads us to think about what exactly causes panic attacks. There are a number of things that can cause them and there are likely many more triggers that we aren’t even aware of, so I will go over some of the most common.

Trauma

Many people experience panic attacks as the result of early-life trauma and PTSD. We become afraid that whatever caused the trauma will occur again. When we enter a situation that we believe will cause that traumatic event to happen again, a panic attack may be triggered [2].

Stress and Anxiety

Another common cause is having an overbearing amount of stress and anxiety in day-to-day life which can lead to a mental breakdown or attack. Related to this, the amount to which someone is sensitive to anxiety can alter the occurrence of attacks [2]. Someone who has developed an anxiety disorder may be much more sensitive to anxiety and experience more panic attacks.

feeling unsafeFeeling Unsafe

Panic attacks most often happen outside of the home in a place that we feel is unsafe. This is exacerbated by loud noises and entrapment that might be experienced on a plane or bus. We may also feel unsafe in situations where we are being judged such as in a job evaluation [3]. Changes in bodily sensations (sudden warmth, heart rate increase, etc) may also be misinterpreted as ‘unsafe’ to your body and could lead to an attack.

Health Factors

Interestingly, having parents with panic disorder also makes you much more likely to experience this yourself [2]. Some other general lifestyle and health-related risk factors include stimulant/substance abuse, smoking, hypothyroidism, respiratory difficulty and hearing loss.

Trouble Assessing Threats

The main psychological reason underlying why we get panic attacks is that our brains have trouble assessing true threats [4]. This is especially true if the attack arises from a source of trauma but can also occur from fears out of the blue as well. Our brains determine that something poses a direct threat and we are in danger, setting off our fight-or-flight response.

However, the problem is unsolvable in the moment, resulting in a rush of anxiety that leads to a panic/anxiety attack [3]. Aside from being unsolvable, it is also unlikely that the situation we are in poses any real danger. Most panic attacks arise from either misinterpreting our environment or bodily sensations as a threat to our safety.

Fear of Future Panic Attacks

Unfortunately, simply having a panic attack can make you more susceptible to future panic attacks. It can be such a terrible experience, especially if it happens in a public place, that attacks themselves become what you’re afraid of instead of the initial trigger. This is called a fear of fear [2], where you become afraid of the anxiety that causes panic attacks.

Ways To Overcome Panic Attacks

Now that we know a bit about panic attacks and their causes, let’s get to the most important part: overcoming them. They can seem to creep up anytime, leaving you without control, but rest assured that there are ways that you can limit their occurrence or possibly eliminate them completely.

Consistent practice of various panic control therapies has been shown to be 70-80% effective and can last for up to two years [3]. With that said, if you suffer from panic attacks or panic disorder you should try to remain vigilant with your therapy and not test how long it will last.

you can stop panic attacks

It’s Necessary

Gaining the ability to stop panic attacks is crucial not only because of their inconvenience and unpleasant nature but also because how you react to them can make other parts of your mental health suffer as well. If you start changing your habits and avoiding situations that may cause an attack, you will likely become more and more isolated which could lead to heightened anxiety and other problems such as depression. This will only make your condition worse.

The best option to gain control is to work with a good mental health expert and have them walk you through therapy, but that is not always an option. Because of this, I will summarize (in no particular order) what the experts believe to be the best ways to stop panic attacks in a way that you can implement on your own.

Therapeutic Options

There are typically three routes you can take: therapy alone, medication alone, or a combination of the two. The question of whether or not to medicate to reduce anxiety and panic attacks should be taken seriously. Medications DO have some value in therapy especially if anxiety is blocking you from even attempting therapy.

Studies have shown that taking medication alone will help to stop panic attacks and reduce anxiety, but the patients never actually solved the underlying issues and there was a high risk of negative side effects or abusive behavior relating to the drugs [2].

“pharmacological treatments have short-term effects, and improvements do not persist after the end of the therapy. On the other hand, therapy has a long-term effect”

A combination of therapy and medication was shown to work best to help individuals lower anxiety and then overcome the underlying problems causing their panic attacks. However, after the risk of abuse and side effects of the drugs are factored in, some experts in mental health concluded that strict therapy led to the best outcomes [2].

Unfortunately though, taking a drug to overcome the problem is the ‘easiest’ route and is what most people follow, at least in the USA.

“Although the nature of the evidence [for behavioral therapy] is robust, such approaches are underused in the USA, compared with drug treatment”

So, now that we know that therapy is the best option, what do we mean by therapy?

cognitive behavioral therapy

Cognitive Behavioral Therapy

The most popular form of therapy for overcoming panic attacks and anxiety in general is cognitive behavioral therapy (CBT). CBT focuses on reversing misunderstandings (false interpretations of threat) you may have about your environment along with changing how you act in environments that seem ‘unsafe’ [5].

“CBT is the most widely studied and validated psychotherapeutic treatment for panic disorder”

Education About Panic Attacks

The actual therapy is very in-depth, so for time’s sake, I will give a general outline and let you decide if it is appealing enough to do more research on the how-to. The first step for CBT is educating yourself about panic attacks including what happens to your body and mind and what causes them [2]. This education includes correcting misconceptions about fear (how unlikely it is to occur) and correcting distortions you may have in how you think about them.

Controlling Behavior and Emotions

The next step is controlling how you act and think in situations when you are prone to panic attacks. One of the main techniques is becoming more present and gaining control of your body. This is done through attentional focus training where you try to gain the ability to focus on your surroundings as objects rather than abstract fears. For example, if you hear a loud noise on a bus, you just acknowledge that a loud noise occurred and move on rather than think about all of the terrible things that may have caused the noise.

Another purpose of CBT is to allow you to view your thoughts objectively and acknowledge the presence of negative thoughts, but don’t allow them to control you. You will also focus on how the negative thoughts affect you, thinking about advantages and disadvantages of keeping those thoughts. Often times you will realize that the negative thoughts harm you much more than they help.

In addition to this, you are encouraged to think objectively about bodily sensations that may have previously pushed you into a panic attack. For example, an increase in heart rate happens naturally many times throughout the day and doesn’t mean you will have a heart attack.

[Head here for a more detailed explanation of CBT along with how to implement it in your daily life.]

Fear Exposure Therapy

Sometimes you may not know what causes panic attacks, but if you can pinpoint the source, fear exposure therapy has been shown to be an effective option. In our minds, we have deeply rooted fear networks that tell us what we are afraid of and how to act. This occurs even if we know it is irrational [6].

Because of this, if we want to reduce panic attacks, the fear networks must be restructured. Experts in psychology have laid out the groundwork for doing this through exposure techniques. Facing your fears is no easy task and in the beginning it will likely be difficult, but with time and consistency, you will be able to overcome it.

“We have found that patients with comorbid panic attacks are generally successful in quickly reducing their fear”

Peaceful

Education About Your Fear

In order to reduce fear, two conditions must be met. The first is that you must become educated about your fear and begin to think about it in a way that is different than when you were afraid. Learn as much about your fear as possible so that when you experience it again there will be as few surprises as possible. This is much easier with the power of the internet where you can read and watch almost anything.

View the fear from all angles including how you think about it and the chances that your perceived negative outcome will occur. In reality, most of the things we are afraid of will never actually harm us and hopefully, you will come to that conclusion through learning. As a part of this process, try to watch videos of people interacting calmly around your fear or in the situation that you fear. Keep what you learned in your tool belt for the next step of the process.

Facing Your Fear

The second condition is that you must become more familiar with your fear in person, starting small and then working up to facing your fear. Thankfully, this part isn’t very technical but remember to stay safe. You don’t want to try facing your fear in its entirety right off the bat because failure means that your fear will only be strengthened.

Instead, take small steps logical steps that lead up to facing your fear. For example, if you’re afraid of being with large groups of people, start by hanging out with a couple friends. Do this a few times until you’re comfortable in that situation and then go a bit bigger, but not too much bigger.

Maybe hang out with a couple friends and a few of their friends that you aren’t as acquainted with. Repeat this building up over and over until you are to the point where you are facing initial fear. In the beginning, this would’ve seemed impossible, but now it is just another step like all the others you have conquered. Not all types of fear are this straightforward, but just try your best to implement the basic outline of the therapy.

Throughout the process, one of the best ways to remain calm is to practice breathing with your diaphragm. It may seem trivial, but this can have an enormous impact on taking you out of the fight-or-flight state of mind and into the calm. Briefly, breathing with your diaphragm means that instead of inhaling with chest muscles (how many of us breathe normally), you use your diaphragm and fill your lungs around your abdomen. I like to take about 4 seconds on my inhale, pause, and then 4 seconds on the exhale, repeating this cycle until I feel calm.

[Read more about how to face your fears and how to breathe with your diaphragm.]

Other Practical Ways To Reduce Panic Attacks

While CBT and fear exposure therapy were the two methods written about the most in the primary literature, there are also many other steps that can be taken to overcome panic attacks. Since panic attacks include a sudden onset of heavy anxiety and may also be caused by anxiety, techniques that reduce anxiety will only help us out.

journalinJournaling

One of my favorite methods for reducing anxiety is journaling. Again, this method has been deeply researched and proven to help with anxiety. Here is a compilation of what has been shown to work.

Before you begin writing, think about something that makes you happy for as long as you like. Then, write about some troubling thoughts you may be having, but try to incorporate how the negative experience could benefit you. This may be difficult, but it is almost always possible to see some sort of silver lining.

In addition to this, take some time to write about a few things you are grateful for and why. I also like to write about goals and track progress. Completing goals is ultra-fulfilling and just makes you feel good. Doing this on a blank sheet of paper works, but if you want to check out a guided journal we made for reducing anxiety that is explained in more depth, head here.

[Check out an in-depth article on journaling]

Mindfulness Meditation

We saw earlier that a main focus of CBT is viewing thoughts objectively which also serves as a large part of mindfulness meditation. Meditation is also completely free and easy to implement if you have a few minutes of spare time. To do this, sit in a stable, comfortable position, keeping a clear mind and trying to remain in the present moment.

Once you feel that you have control of your thoughts, begin to notice your surroundings and any thoughts that come into your mind. Think about everything objectively and try not to think about the past or future. This has been shown by many studies to work wonders for reducing anxiety.

[Here is some more depth info on the effect meditation has on anxiety]

Conclusion

If you suffer from panic attacks, it might seem like you are alone without control. However, we now know that neither of those are true. Many people experience panic attacks and mental health experts have found ways for us to overcome them. Once again, if you have access to a therapist, take that option. If you are taking any type of medication, keep taking it and discuss your alternative options with a healthcare professional.

The methods listed above are some of the best according to the scientific literature, but I’m sure that there are many more that could work for you as well. The most important thing is that you have to be willing to try and practice consistently if you truly want to overcome your panic attacks.

 

References

[1] Clark, D. M. (1986). A cognitive model of panic. Behavior Research and Therapy, 24, 461−470.
[2] Byrne, Peter Roy, et al. “Panic Disorder.” The Lancet, vol. 368, no. 9149, Sept. 2006, pp. 1023–1032., doi:10.1016/s0140-6736(05)74897-2.
[3] Craske, Michelle G., and David H. Barlow. “Mastery of Your Anxiety and Panic: Therapist Guide.” Oxford University Press, 2006, doi:10.1093/med:psych/9780195311402.001.0001.
[4] Ehlers, Anke, et al. “Selective Processing of Threat Cues in Subjects with Panic Attacks.” Cognition & Emotion, vol. 2, no. 3, 1988, pp. 201–219., doi:10.1080/02699938808410924.
[5] Fava, Leonardo, and John Morton. “Causal Modeling of Panic Disorder Theories.” Clinical Psychology Review, vol. 29, no. 7, 2009, pp. 623–637., doi:10.1016/j.cpr.2009.08.002.
[6] Falsetti, S.A., & Resnick, H.S. (2000). Cognitive-behavioral treatment for PTSD with panic attacks. Journal of Contemporary Psychotherapy, 30, 163–179.
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Defeat Fear by Facing It

When fear comes into our lives, we can either face it and overcome it or pretend it doesn’t exist through avoidance. The former allows us to maintain all regular activities while at the same time strengthens our confidence for the next time a fearful situation arises. However, the latter limits the scope of what we are able to accomplish and weakens us for any future adverse situations.

airplaneCrippling fear can be extremely disabling, reducing your ability to function which will inevitably lead to a decrease in your quality of life. For example, maybe you experienced heavy turbulence while on an airplane; in that moment you truly worried that you might go down in a fiery wreck. This led to other thoughts about airplanes such as the height you are flying at, the absurd amount of mechanical errors that could occur, and how hard it must be to land especially if it is windy. These thoughts ruminate in your mind and manifest as a sort of monster that comes out whenever the thought of an airplane pops into your mind.

Now there is no way that you can ride a plane without experiencing a panic attack or debilitating anxiety so it seems easier to avoid the situation altogether. However, this decision makes any long-distance travel out of the picture. This is fine if you enjoy long road trips or don’t mind isolation, but more than likely it will have vast undesired effects on your life. This could include never being able to travel to dream destinations overseas, not being able to see loved ones who live far away, missing job opportunities that require travel and many more.

False interpretations of fear

When in a worrisome state, we are most likely falsely interpreting something in our environment as being a threat [1]. This activates our sympathetic nervous system, more commonly known as a “fight-or-flight” state. We try to escape to avoid getting injured, and what easier way is there to escape than avoiding the situation altogether? The main issue here is a constant anxious feeling that arises from knowing our fear still exists along with the regret of missing out important parts of life because of our avoidance. The constant worry about non-existent threats forces us into living our lives as a sort of illusion.

FearWhatever your fear may be, the result of avoiding them will almost certainly have more drastic consequences than the reason you are avoiding the fear in the first place. Facing your fears head on is no easy task, but it is crucial to conquering them. Exposure therapy may seem like you are just using brute force to solve the problem and while it may not be easy, it remains as one of the most effective strategies you can use to reduce fear.

There is a lot of practical information buried in the scientific primary literature regarding specific techniques and practices regarding exposure therapy. Some of the most useful that I will describe come from two papers, one authored by Falsetti and Resnick and the other by Foa and Kozak. While many of these methods can be practiced at home, if your fear is too overpowering don’t hesitate to see a trained therapist to help you overcome them.

Using exposure therapy to overcome fear

Of the many aspects involved in conquering fear, two stand out as the most important. The first is that relevant information must be presented about the fear to give you a better understanding of what it is you’re are trying to overcome. Then, you must create a new relationship with the fear and integrate it into your existing fear structure. In other words, you must become acquainted with your fear and realize that facing it will not harm you. The first part focuses on making steps towards breaking through the barrier that your fear has constructed. This sets you up for the second part which involves a realization that you can conquer your fears using exposure techniques.

Learning about your fear

The first step to overcoming fear might seem a bit obvious, but many miss it. You must learn about your fear before you face it. By educating yourself, you can see the thing you fear from all angles which eliminates as many surprises as possible. Objective information also helps diminish the power you have attributed to your fear through constant rumination. Throughout the process, pick your top three fears and make a diary of all your findings and new things you have learned.

You need to learn facts and statistics about whatever is causing your fear. This is made much easier with the internet. Going back to our airplane example, the first step would be to search for general facts about how planes take off, gets to altitude, maintains altitude, lands, etc. Watch videos of airplane operation including sounds that you might hear and sights that are to be expected. Get as many insights as possible so that you won’t get thrown into a downward spiral (pun intended) when you feel a jolt or unexpected noises the next time you embark on a flight.

Try to learn as much as you possibly can about the background and then move into statistics. Statistics don’t always help, but they do allow us to achieve a baseline understanding of how irrational our fears may be. Thousands of flights are completed successfully every day with almost no incidence of failure.

Expanding to other types of fear

While airplanes serve as a straightforward example, there are many other types of fear that may not have such a clear way of learning about them. For example, let’s say you suffer from social anxiety and you’re afraid of going to dinner in large groups. You may not know exactly what you’re afraid of. For these types, do your best to determine what it is. After examining your thoughts, you may find that the fear of others judging you is the root cause of your anxiety in a group setting. For this, there aren’t really statistics to help you out.

friends.jpgIn this example, change your research to focus on the location and place you will be meeting along with who will be there. Maybe determine a few people that you can rely on throughout the experience to give you comfort. It is also helpful to search for other articles outlining the underlying causes for your specific fear so that you can better understand why you are feeling the way you are. For the statistics part, just think about the likelihood of your fear occurring. More often than not, most people aren’t going to spend the whole night judging you and you probably won’t spill your drink all over yourself. Whatever it may be, think about how unlikely it is to happen.

How is this fear affecting you?

Once you have a grasp on some of the background information, it’s time to switch over to thinking about how holding onto the fear is affecting your everyday life. Write down the advantages and disadvantages of holding onto your beliefs, focusing on the disadvantages. Hopefully, you will see that the disadvantages far outweigh the advantages. This should encourage you to move towards overcoming the fear after you see the consequences of remaining a victim.

Avoiding going out to eat with large groups of people will mean you never have to worry about people thinking negatively of you, which is an advantage. However, staying away from these types of gatherings means that you will become more isolated, miss out on important events, and miss opportunities to make relationships with new people. The disadvantages will hurt you much more in the long run, so you might as well take the steps necessary to overcome that fear.

Exposure therapy and tips for success  

It’s very difficult to successfully overcome fear without having exposure to it. Because of this, many mental health experts have written about effective exposure therapy practices in the primary literature. I will go over some of the most helpful aspects of the therapy that I think anyone can implement to start chipping away at the mountain your fear has become.

Other-side.jpgIn short, exposure therapy focuses on having you do things that you are afraid of so that you will get used to them. Using the same three fears from above, pick the one that you are least afraid of and would like to resume. This will hopefully allow you to build confidence in your ability to face your larger fears. Don’t worry though, the experts make sure that you work up to your fear so that you won’t ever be overwhelmed.

Start small

The worst thing that can happen is to jump off the deep end with your fear and fail, making you more afraid than you were in the first place. Because of this, we are going to start small to get you more acquainted with what the fearful activity feels like. Pick an activity that is related to your fear and feasible to do without failure, doing it a few times until you get comfortable with it. With our group social anxiety example, it would be a good idea to start off small by just getting coffee with a friend. It may be uncomfortable at first but knowing that it will get better makes it a bit more doable at first.

Building up

You will eventually become comfortable with the smaller activity that you chose which will be very encouraging. However, there is still more work to do before achieving your end goal of being free from fear. It’s time to pick a larger activity that pushes closer to your actual fear. This could possibly be going to lunch with a few close friends. Again, do this until you feel comfortable. Keep pushing farther and farther using the same technique.

In addition to the building up phase, visualization of your fear has been shown to be successful as well. This is a bit like meditating on your fear. The exercise won’t be particularly pleasurable, but it will help you along your journey to overcome your fear. Focus on visualizing what you are afraid of including specific aspects that are particularly frightful. Block out at least 25 minutes for this. Watching videos of people calmly interacting with what you are afraid of has been shown to be effective and can serve as a part of your visualization. Like all of the treatment, doing this often and consistently will yield the best results. Another benefit of visualization is that it can be done often and anywhere.

[To learn how meditation can help with anxiety, read more here.]

Facing your fear

This is the part of exposure therapy that we have been building up to. By now, this is just another step like all the others. You should have worked up to something in the build-up phase that is not far behind what your fear may be. Facing the actual fear may be a daunting task, but with the confidence you have built from the previous training it is something you can accomplish. The first time will be the hardest, but as you do it more and more it will become easier, even to the point where you are comfortable with it. You can now resume the activity and avoid the disadvantages that came from not facing your fear.

This method of overcoming fears is synonymous with watching a scary movie but much more practical and beneficial in your daily life. Imagine flipping the channel to a particularly scary and disturbing movie. You watch it for a while but decide it is too fear-inducing so you change the channel (avoidance). Yet, despite changing the channel, the scenes from the movie are still in the back of your mind where they will stay unless you intervene. If you change the channel back, the scary movie will still be there waiting for you.

canyonNow, if you force yourself to watch the whole movie and then repeat it a few times, the horror will likely fade and the movie may even become boring. The same happens with fearful and traumatic experiences. Ignoring it is like changing the channel; you have avoided the exact cause in the moment, but the fear remains. Fear exposure therapy allows you to habituate the fear and the experience becomes less frightful.

Tips for success

Breathing with your diaphragm

When we acquire an acute fear of something, our body and mind are most likely misinterpreting a threat that in reality won’t harm us. We instinctively go into “fight-or-flight” mode, activating the sympathetic nervous system. This activation works great if we are in the jungle being chased by a tiger, but in our everyday lives it can make things difficult.

Luckily, we can manage our bodies response through a few different techniques, one of which is diaphragmatic breathing. Put a bit more simply, this is what people mean when they say to ‘take slow, deep breaths’. However, more detail than that is needed to calm yourself effectively. Although breathing deeply and slowly will help to calm you down, it doesn’t quite capture all that can be done to when you are afraid and experience anxiety.

The title ‘diaphragmatic breathing’ encapsulates what you are actually doing, which is using your diaphragm to do the work of breathing. In other words, using your abdominal muscles rather than chest muscles to fill your lungs with air. This method of breathing holds a few other benefits such as strengthening your diaphragm, decreasing the effort needed to breathe, slowing heart rate, and decreasing your body’s demand for oxygen [2]. It also helps us transition from the sympathetic fight-or-flight state to a parasympathetic calm state.

How to breathe with your diaphragm

It is best to practice this at home before you embark on your fear exposure journey. Start by laying on your back with your knees slightly bent and head supported. Place one hand on your chest and another just below your ribcage so that you can feel where the inhaled air is being stored. Then, breathe in slowly through your nose using your abs to do the work. Instead of pushing out your chest as you breathe, your belly should push out against your lower hand. Try to not allow your chest to move which can be felt by the upper hand [2].

Breathing

When you exhale, use the muscles in your belly. Your lower hand should move down as air exits and your upper hand should remain still. This may be a bit difficult at first since most of us naturally breathe with our chest muscles and have underdeveloped muscles that control the diaphragm. Practice 3-5 times per day for about five minutes at a time. Then move to sitting and standing once you feel more comfortable with the technique.

It is best to follow some sort of cadence when you are doing the breathing. For me, I like slowly counting to 4 on the inhale, pause, slowly counting to 4 on the exhale, pausing again and then repeating. Whenever you feel anxiety and fear coming on, start breathing using this technique to help calm yourself. While diaphragmatic breathing can be used all day, it is hard to always be mindful of how you are taking in air.

More tips: Journaling practices

Writing has already been done as a crucial step throughout the process, but there are additional in-depth techniques that may be helpful. Broadly, write about the event or situation that causes your fear including what happened and why you are still afraid of it. More specifically, write down the emotions you feel around the fear and think about how it is just a memory and not an event that is reoccurring or one that will reoccur.

diaryIdentify which parts of the experience caused the most pain and trauma through your writing. As a part of this, identify distortions in your perceptions of your fear that were found through research. Allow yourself to let go of some self-blame that often occurs as trauma. It’s hard to accept this as a reality, but sometimes bad things do randomly happen to good people. Blaming yourself or others may just be a coping mechanism to make you feel safe, but again, sometimes negative events do happen randomly and likely won’t occur again. With that said, write about how you can prevent events that cause the fear or trauma from happening in the future as well. Both of these are meant to empower you over your fear.

Read what you have written daily and continue writing with this method as many times as you like. The more you do it, the more helpful it will be. Your first writing therapy session will likely be the most difficult, but like the scary movie example above, it will become easier and help you better understand your fear every time you do it. Although what happened may have been random, there is a reason and you are not completely helpless.

[If you’re interested in the benefits journaling can have for general anxiety, check out Journaling for Anxiety.]

Utilize thought restructuring 

Thought restructuring is a practice that branches from cognitive behavioral therapy. In short, the purpose is to restructure your thinking patterns to allow you the ability to view your fearful thoughts objectively. When you do this, you gain the ability to realize that what you are afraid of doesn’t warrant the fear you have attributed to it. Instead of restating how to go about thought restructuring, it would be more useful to head here to read an in-depth article about it on our blog.

Other useful info about exposure therapy

Depending on your fear, the time it takes to overcome it will vary along with the difficulty. If it doesn’t work at first, the worst thing you can do for your wellbeing is give up. Go at it again in a safe manner, using as many techniques as possible to stay relaxed throughout the process. Also, as you do this try to weaken the link in your mind between the activity or situation and perceived harm. If you constantly have thoughts running through your mind that you will be harmed, you will stay in fight-or-flight mode which makes it almost impossible to reduce your fear.

While mental health experts have shown that exposure therapy can help many conquer their fears and achieve a higher quality of life, it won’t work for everybody depending on the type and severity of your specific fear. The above technique is great if you are comfortable with doing the training on your own or don’t have access to a therapist, but I would recommend seeing a therapist if you have the ability. With that said, I believe that with persistence you will be able to find success in reducing your fear and living the life you desire.

Have any experiences with thought restructuring? Comment Below!

If you know someone who could benefit from this article, please share it with them.

[1] Borkovec, T.D. (2002). Life in the future versus life in the present. Clinical Psychology: Science and Practice, 9, 76–80
[2] Clevland clinic diaphragm breathing.
[3] Falsetti, S.A., & Resnick, H.S. (2000). Cognitive-behavioral treatment for PTSD with panic attacks. Journal of Contemporary Psychotherapy, 30, 163–179.
[4] Emotional processing. Foa, Edna B., and Michael J. Kozak. “Emotional Processing of Fear: Exposure to Corrective Information.” Psychological Bulletin, vol. 99, no. 1, 1986, pp. 20–35., doi:10.1037//0033-2909.99.1.20.

 

 

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Restructure Your Thoughts to Overvome Fear

Fears in everyday life can range from minor disturbances that we breeze past to crippling events that cause us to avoid certain situations completely. For example, imagine riding a public bus. Everything seems normal at first, but you then see someone cough and realize how close you are to them. What if they have tuberculosis? Could you catch it? You then notice the driver runs over the curb while driving. The driver surely isn’t competent and the trip will inevitably lead to a rollover accident at some point. In the meantime, you smell something that vaguely resembles smoke. You decide that you no longer need to worry about the rollover because the bus is going to start on fire before that happens with you trapped inside, perishing to a fiery demise.

busBecause of that experience and the fears that arose, it would be much easier to just skip riding the bus altogether, right? The fear is avoided and the problem is solved, but now you have just extremely limited your range of travel and exposure to the outside world. We can see through this story that the fears experienced on the bus are a bit irrational and are very unlikely to happen, despite how real they felt.

What really happened?

Let’s look at an alternate scenario. The person coughing? They simply swallowed a gulp of water down the wrong pipe and are completely healthy. The driver was forced to hit the curb in an attempt to avoid a near collision with another vehicle. Their competence was actually the thing keeping you safe. Oh, and the smell of smoke? The wind changed when you were at a stoplight, pushing some of the exhaust through an open window behind you.

Unfortunately, when we have a fear, our minds often take it the foreseen consequences to level 10. Conjuring the worst-case scenario is a protective mechanism that we have evolved throughout time to keep us safe. Imagine when our ancestors traveling in the jungle. If a twig snaps, you better be ready for a tiger to leap at you even though it was probably just a squirrel (do they have squirrels in the jungle?) hopping to a different tree because it was scared of you. When these fears manifest in our everyday lives, they can take control of our minds, making it difficult to tell our minds to ease up a bit.

How do we begin controlling our fears?

Luckily, this is something that experts in psychology have been deeply invested in. Below, I will detail some of the best information I found in the scientific literature to restructure your fear networks. The methods largely pull from some cognitive behavioral therapy (CBT) techniques discussed by Wells and Papageorgiou in a paper they wrote in 2004 along with a few other scholarly articles. Before the methods, it is important to say that if you have access to a therapist who can walk you through CBT, definitely take that route. However, many people don’t have the time or means to access this resource or may be afraid to go to a therapist. If you are in any of these categories, read on. If not, you may still find added benefit from a different point of view, so read on as well.

For most of us, fear comes from having trouble assessing true threats coupled with poor coping mechanisms for when this happens. Because of this, we may have lingering negative thoughts that can affect our lives on a daily basis. We may ruminate about these thoughts and hold onto the fear which will inevitably decrease our state of mental health and quality of life in general. To solve this, here are some techniques from mental health experts to decrease your fear through cognitive restructuring.

Educate yourself about the fear at hand

One of the biggest components that can cultivate fear is the unknown. Going back to the bus example, you probably didn’t know how unlikely it is to come across someone with tuberculosis or even how it is spread for that matter. Furthermore, your bus route only follows residential streets, so unless something catastrophic happened it would be practically impossible for the bus to roll over. Also, do you even know what a bus on fire smells like?

More fearCorrecting misconceptions we have about our fear is the first step to overcoming it [1]. Referring back to the example, when we think about it rationally, the distortions in the thought process become much more clear, showing us that the fear we have is actually very unlikely to occur. However, holding onto the fear will end up harming us much more than it will help us. Once we realize this, we can begin to overcome fear.

“negative thoughts are seen merely as events in the mind that should be treated as objects, and efforts should be devoted to changing one’s relationship with them”

Correcting misconceptions about the fear

Write down your top fears and begin to make a list of what makes you afraid of them. With the bus, being afraid of coughing comes from a fear that you could contract a disease that would severely diminish your quality of life. The rollover is scary because it could lead to serious injury.

Then, write down the advantages and disadvantages of holding onto that fear. An advantage would be self-preservation for the one in a gazillion chance that the negative outcome occurs. Don’t get me wrong, self-preservation is great! Well, except when it comes to disadvantages having consequences that also impact your life negatively, which is what you were trying to avoid in the first place. Think about the disadvantages of not confronting your fear. Not being able to travel outside of walking distance because you are unwilling to take public transportation will have a direct effect on your life. Completing basic errands, socializing, and finding any enjoyment outside of the home will become much more difficult. Ultimately, you will realize that dwelling on and giving in to your fear will not help you.

Once this is done, come back to the possibilities of each advantage or disadvantage occurring and write them down. Sure, you could contract a disease, have a rollover accident or be trapped in a fiery abyss, but are those likely in the slightest sense? No. Statistics don’t make the fear go away, but they can help to establish a baseline of objective thinking. Then write about the likelihood that avoiding your fear will harm you. More often than not, avoidance will impact your life immediately. Since the goal is to overcome the fear, it is ok to be a bit biased towards the negative impacts, though you may not need to be. Review this writing at least once daily and contemplate it.

Enhancing control over thinking

memoryWouldn’t it be great to have control in the moment and not take your assumptions about the fear to the extreme? With attentional training, this may be possible. If it doesn’t completely allow you to take control of your thinking, it will at least help. The main overview of the training is to allow you to keep your thinking in the present. It helps you think about your thoughts more objectively rather than extrapolate what you are sensing to an immediate reaction to fear which leads to the negative consequences you wrote down from the previous exercise. Obtaining a high amount of control won’t happen overnight. In a clinical setting, a therapist will guide patients through the training a couple days a week for many weeks. If you stay consistent and truly put in an effort, you too can acquire some of the benefits and control how you handle fear

Training your mind

The initial training is a bit abstract and has some deep similarities to mindfulness meditation, though it is more applied. To begin, find a comfortable place in your home and focus intensely on individual sounds, sights, smells and bodily sensations. Begin by focusing on a specific sound for a few minutes. If there is ticking from a clock, focus on that sound and try your hardest to not stray. If you do, that is ok, simply bring your attention back to the ticking.

“attentional training, which promotes external focus, can eliminate fear” -Adrian Wells

Once you have done this, switch your attention to looking at something, using the same intensity. Examine every part of the object. If it is a clock, notice the shape of the clock and the markings. Watch the movement of the hands. Take in all of the different colors. Again, for about three minutes the only thoughts in your mind should be of how the clock looks. Follow this same technique for smells. For bodily sensations, focus on each of your limbs one at a time. Notice anything you feel and how the feelings change. Imagine that there is a heavy weight attached to each limb and then imagine it being removed. Then, imagine that each limb suddenly becomes warm. Spend about a minute on each leg and each arm.

Try to pick different sources to focus on for each different training session. You will notice yourself becoming better and better at maintaining your focus. As stated earlier, this may take some time, but consistent training will pay off. After you feel yourself become more proficient, add about 3 minutes at the end (if you don’t have time, shave a minute off of the longer focus periods) where you rapidly change your focus between different sources. Quickly switch from sound to sound, still focusing intently on each [4]. Try to divide this time evenly between sounds, sights, and bodily sensations. Skip smells as it may be difficult to differentiate between them.

crowd.jpgIncreasing the difficulty

Once you’ve mastered this part of your training, go to a safe, public place and follow the same routine. Pick a place with more distractions to raise the difficulty. In today’s world, our attention spans are becoming shorter and shorter. This hurts us when it comes to fear because instead of being able to focus on and objectively analyze individual thoughts, we bounce from negative moment to negative moment. Not only does this cause the fear to linger in our minds, but it also increases our anxiety about the situation.

Another helpful technique is to utilize mental imaging. Think about an image such as a tree and examine it just as you would with the sights from above. Notice everything about the image and maintain this for a few minutes, bringing yourself back to the image if your mind wanders. You may begin this whenever you feel comfortable but eventually, this should become a main staple of your training.

Once you feel comfortable with mental imaging, shift the focus from images to thoughts using the same process. Instead of trying to process the thoughts that come into your mind, just observe them sort of like the objects from earlier in your training. Maybe examine how that thought makes you feel without letting yourself bring emotions into it. Explore the thought like you explored different parts of the clock. Instead of consciously picking a specific thought, allow your mind to wander and see what thoughts come into your mind.

Connecting the training to your thoughts

While it may not seem directly evident, the point of this attentional training is to increase your ability to be in the present moment and notice your feelings more objectively. When you notice the early negative thoughts arising from your fear, just observe them as you did the sights, sounds, smells, and bodily sensations earlier. Thinking “I am afraid of X” turns into “I am having thoughts about being afraid of X”. When this happens, you are no longer controlled by the emotions that would’ve followed before the training. You have the ability to monitor the thoughts and decide what to do with them. With this, you can think rationally and apply the list of disadvantages and the consequences of those disadvantages to hopefully change your mind about the nature of the fear and its importance.

banAnother method that has been found to be helpful with your newly acquired attentional control is to implement a “fearful thought ban”. Again, this one won’t be easy, but it has been shown to help. You can probably guess what it is from the title. The ban essentially means that when a fearful thought arises, you won’t try to understand it, find a coping mechanism, or fix it like you normally would before. Instead, you observe them like discussed earlier and tell yourself the reasons that you don’t need to be afraid. To enhance the benefits this can yield, make a log of when fearful thoughts come up in a journal and also write down how successful you were at overcoming them and what helped/didn’t help.

By doing this, you are further altering the cognitive fear networks, telling the mind to objectively engage in negative thoughts without simply covering them up or avoiding them. In order to conquer your fears, it is important to emphasize the confrontation of fearful thoughts. Otherwise, they will always remain in the back of your mind subconsciously. Another overarching goal of this process is to realize that you can actively modify your thoughts and beliefs rather than being a slave to them. The idea that you can’t change your thoughts or the way you think is common among people but erroneous. This is compounded by the fact that often there isn’t a path to change thought processes, but this training changes the game.

“patients believe erroneously that rumination is uncontrollable”

Overview of the process

  1. Educate yourself:

    Determine your top fears and write them down in a journal format. Then, ponder the advantages and disadvantages of holding onto that fear. Write down the positive and negative impacts that ruminating and acting upon the fear will yield. Then, think about the likelihood of each advantage or disadvantage actually occurring and write that down as well, acknowledging that the disadvantages are far more likely to occur. Look over this list at least once a day.

  2. Enhance your ability to remain in the present:

    Begin to train your ability to control your thoughts and remain in the present moment. In your home, intensely focus on and examine a sight, sound, smell and bodily sensation. If your attention strays, just bring yourself back into the exercise. Try to spend about 3 minutes per day on each category. Once you become better at this, add an additional 3 minutes at the end where you rapidly switch between sources of focus while maintaining the same intensity. To increase the difficulty and further your training, practice this in a safe, public space with more distractions.

  3. Practice monitoring your thoughts:

    Now that you have increased your ability to think objectively and stay in the present moment for an extended period, it’s time to move inside your mind. Using the same sort of process as before, create a mental image and focus on examining it for a few minutes, noticing distinct features and how it changes. Once adept at this, shift the focus from images to thoughts that enter your mind. Spend a couple minutes observing a single thought in your mind. Examine the features just as you did with mental imaging: notice you are having it, where it came from, how it makes you feel all without emotion or analyzing the thought itself.

  4. Implement a “fearful thought ban”:

    Now that you have trained yourself to view thoughts objectively and can notice their features, it’s time to begin reducing your fear. The fearful thought ban means that whenever a fearful thought comes to mind, simply take notice of it and realize that it is there rather than freaking out and trying to cope or cover it up. Instead of thinking “I am afraid of X right now. What should I do?”, you will now think “I am having thoughts about being afraid of X. Why am I having a fearful thought in this situation? Is the thought justified? How is acting on this thought going to hurt me more than benefit me? Ok, I no longer need this thought and can continue with my day”. Make a journal entry every time a fearful thought comes into your mind, detailing what it arose from and how successful you were with not falling to it. This ban brings all the training together and puts it to work.

Final thoughts

While these techniques are supported by psychological experts and real-world examples of success, they may not work for everyone. Because of this, it may be useful to try multiple different techniques to tackle your fear and anxiety. This goes without saying, but if you are on any medications or participate in a program with a therapist, don’t discontinue treatment unless you have discussed it with a medical professional. While I have spent many hours researching these techniques, I myself am not a mental health expert. My intent is simply to convey the information put out by experts in the scientific literature in practical and understandable.

By training yourself to think objectively about your thoughts, you can begin to chip away at the underlying cognitive framework that causes you to hold onto fears. You will begin to see them as irrational and unneeded, causing more damage than benefit. Fear itself can be scary when there is not a clear way to manage and reduce it. Through consistent and proper implementation of these techniques, hopefully you too can find the fear reducing benefit that many others have. Once you start, you will finally be on the path to conquering your fears.

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References:
[1] Byrne, Peter Roy, et al. “Panic Disorder.” The Lancet, vol. 368, no. 9149, Sept. 2006, pp. 1023–1032., doi:10.1016/s0140-6736(05)74897-2.
[2] Ehlers, Anke, et al. “Selective Processing of Threat Cues in Subjects with Panic Attacks.” Cognition & Emotion, vol. 2, no. 3, 1988, pp. 201–219., doi:10.1080/02699938808410924.
[3] Wells, A., & Papageorgiou, C. (2004). Metacognitive therapy for depressive rumination. In C. Papageorgiou & A. Wells (Eds.), Depressive rumination; Nature, theory, and treatment (pp. 259–273). West Sussex, England: Wiley
[4] Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21, 273–280.