Panic disorder is awful. It feels like your life is spiralling out of control.
But the good news is that you can get better.
Anxiety disorders are treatable in the vast majority of cases even though anxiety sufferers rarely believe they can get better.
How do I know? Because I used to have regular panic attacks. Sometimes the anxiety was so high that I could barely eat (partly because my intestines weren’t working properly and partly because of a fear of choking). I felt I was missing out a lot because my whole energy was spent on constant worries and fighting the panic attacks.
But I did get better and now I’ve been panic-free for over half a year. The prospect of another panic attack seems unrealistic.
I had the good fortune of coming across some excellent advice and coping strategies that worked for me. The strategy in this article was designed by psychologists to help people suffering from generalized anxiety disorder. It will teach you to overcome the habit of excessive worrying.
Although this method was created as a treatment for generalized anxiety disorder, it helped me overcome my panic disorder. The reason for that is that panic disorder is fuelled by the fear of having another panic attack. So if you stop worrying about having a panic attack, the anxiety and panic will go away.
Of course, it is easier to say than do, so you need an effective strategy to control your worries. This is exactly what this article provides.
When Does Worrying Become a Problem?
All people have some worrisome thoughts. Worry only becomes a problem when it seems uncontrollable and consumes most of your mental energy.
Worrying consists of two steps.
- A worrisome thought pops up.
- You dwell on the worry for prolonged periods of time.
It is important to acknowledge that you can’t control step 1. Minds process huge amounts of thoughts daily and you simply can’t control what pops into your mind.
However, you are in charge the dwelling part. You can simply choose not to give your negative thoughts the time and energy they need to convert into worries.
To give you an example. You may think: “What if I don’t succeed at this work project?” Then you start dwelling more on the thought: “If I fail at the project, I’m going to lose my job, and if I lose my job, I’m not going to be able to support my kids and we’ll end up on the street.”.
You can't control what pops into your mind
Positive and Negative Beliefs About Worrying
Positive beliefs about worrying make you think that worrying is helpful. Some of such beliefs may include:
- Worrying prepares you for the worst.
- Worrying solves problems.
- Worrying shows that you care.
- Worrying helps prevent bad things.
If you believe that worrying is helpful, you give your negative thoughts the attention they need to convert into worries. Inventing worst-case scenarios may make you feel prepared for the worst.
For instance, you may think: “What if I have a panic attack during this presentation? If I have a panic attack, I will forget everything and start shaking and I will make a fool out of myself in front of the whole class.”
This may give you a sense of control over the situation. You may feel prepared for the worst. In reality, however, this sort of thinking doesn’t offer any practical solutions. The positive beliefs about worrying aren’t helpful.
Negative beliefs about worrying include the following:
- Worrying will cause you physical or mental harm (anxiety will make you go ill or crazy).
- You can’t control your worrying and it’ll never stop.
Whereas the positive beliefs make you engage with bad thoughts, the negative beliefs make you suppress them. You fight anxiously the negative thoughts because you believe they can harm you.
This clearly doesn’t work. If you tell yourself not to think about a pink elephant, you’ll obviously think about a pink elephant. If you ban the negative thoughts from your head, they will return even stronger!
So how to break this circle? The key is to challenge your positive and negative beliefs about worrying.
Challenging the Belief That Worry Is Uncontrollable
You can’t stop worrying if you believe it’s beyond your control. So you should examine this belief to check if worry is indeed uncontrollable.
Grab a pen and a piece of paper for this exercise. Firstly, assess on a scale from 0-100% how much you believe that worrying is uncontrollable.
Next, we’ll take a closer look at the belief, considering evidence for and against it.
Divide your sheet of paper into two columns, one for evidence for and one for evidence against. These are the questions you may ask yourself to provide evidence for:
- What makes you think worrying is uncontrollable?
- What’s the evidence for your belief?
- Is the evidence for your belief good/solid/reliable?
- Is there another way you could view the evidence for your belief?
And this is a set of questions to provide evidence against the belief:
- Is there any evidence that goes against your belief?
- Has your worrying ever been disrupted/interrupted? Can distraction work in the short term? What does it tell you about uncontrollability?
- Does your worrying stop eventually? How can this be if it is uncontrollable? Shouldn’t it just go on forever if it can’t be controlled?
- Can you manipulate your worrying (decrease it, increase it)? Would this be possible if it was completely out of control?
- What strategies have you tried to control your worrying? Are they mostly forms of suppression, which only increase worrying?
- Is it possible that it is controllable, you just don’t know how to control it yet?
Write down any other ideas for and against your belief that you may have.
The next step is testing your belief. You will test the uncontrollability belief by using an effective method for worrying less.
As we have seen earlier, thought suppression doesn’t work. So instead you may try to postpone your negative thoughts.
Postponement consists in acknowledging and accepting a negative thought that pops into your mind and choosing not to engage with it at that moment. In contrast to thought suppression, you don’t ban the initial negative thought (which you can’t control).
Instead of dwelling on the thought immediately, you can come back to it later, during your thinking time. The steps to successful postponement are as follows:
- When a negative thought appears, acknowledge and accept it.
- Formulate the essence of the thought in a couple of words and jot it down (you can use a notebook or your phone).
- Shift your attention from the thought to the task at hand.
- If a worry comes back (which is very likely), repeat steps 1-3 (instead of writing it down again, you can put a tick next to it).
- Think about the worries you’ve collected during your thinking time.
I cannot stress enough the importance of being accepting of the initial thought – that’s the key difference between postponement and thought suppression. At the beginning, you may find it helpful to say clearly in your mind something along the lines: “I accept that I’m thinking about having a panic attack on the bus and I will come back to it during my thinking time.” It may sound ridiculous but it works.
Next important point – repetitive thoughts. When I first tried that technique, I was frustrated because some thoughts kept coming back. However, it doesn’t mean that postponement didn’t work. You need to remember that you can’t control what pops into your mind. So whether you need to postpone a thought fifty or a hundred times during the day as long as you don’t engage with it, the technique works.
And finally, the thinking time. The technique is called postponement because you do get to think about your worries eventually. Set a time, length of time and place and stick to them daily if possible. For instance, you may decide to have your thinking time at 6 pm, in your room, for 20 minutes.
During your thinking time, go through the negative thoughts you’ve collected during the day. You will notice that some of them don’t bother you anymore (maybe even a majority of them). Cross them out.
Categorize the rest of the negative thoughts into those that can be solved and those that can’t. An example of a solvable problem is “I have an essay due in two days and I haven’t done anything yet”. In this case, you should use problem-solving skills to tackle this worry (which is discussed in the “Problem Solving” section of this article).
Some worries can’t be solved. The thought “What if my friend dies in a terrorist attack” isn’t solvable. In this case, you should think of more helpful ways to frame the thought (which is discussed in the “Helpful Thinking” section of this article).
The great thing about postponement is that it bears fruit early on. My anxiety levels and panic attacks were down within the first 2-3 days of applying it. It also helps you spot recurring worries. I, for instance, worried a lot about being around people, which was a sign of social anxiety. This insight allowed me to tackle my social anxiety head-on. Click here for advice on social anxiety.
Try postponement for a week to see if you can challenge the uncontrollability belief. If you feel a bit more in control of your worries, it’s a success. Continue postponement beyond the initial 7-day period as the key strategy for getting better.
If it doesn’t work, make sure you’re not suppressing thoughts (i.e. that you are accepting of the initial thought that pops into your mind). Don’t shy away from the thinking time either.
Worry postponement is not thought suppression
Simply put, mindfulness is shifting attention to the present moment. Mindfulness is a great relaxation technique and will help you become better at worry postponement.
We will look at two mindfulness exercises – mundane task focusing and meditation. It’s best to practice both daily but I had amazing results doing only mundane task focusing, which you can do at no additional time investment to your daily routine.
Mundane task focusing is focusing your attention on the task at hand. Choose an activity you perform daily as an opportunity to practice mindfulness. It can be doing the dishes, cooking, cleaning up, taking a shower, or walking. I did task mundane focusing during my daily 20-minute walks to university and it had the additional benefit of helping me relax before classes.
When you perform a mechanical activity, your mind tends to wander off. When doing mundane task focusing, bring your attention back to the task at hand. Focus on sensory experiences.
During my mundane task focusing, I paid attention to the details of the buildings, what the people were doing, what I was hearing (the traffic, birds, rustling leaves?), then smells, if it was warm or cold.
Note that the exercise consists of bringing your attention back to the present moment but not anchoring it there forever. Minds wander off and you’ll have to bring your attention to the present moment many times – it’s perfectly OK. Become an observer during your mindfulness sessions and adopt a non-judgemental attitude.
To practice meditation, follow the following steps:
- Set a time and place for meditation (preferably, a quiet one).
- Adopt a relaxed posture and ask yourself what you are feeling now. What is your body like? Is it tense, relaxed? What are you thinking about? How are you feeling? Anxious? At ease? Record everything in a non-judgmental fashion for about 30 seconds – 1 minute.
- Focus your attention on the breath. Can you feel your belly moving up and down? If your mind wanders off, acknowledge the presence of thoughts and feelings and shift your attention back to the breath. Keep doing this for about 1-2 minutes.
- Now feel your whole body. If you have any strong feelings, just allow yourself to feel them. If your mind wanders off, gently bring it back. Spend 1-2 minutes doing that.
Perform both mundane task focusing and meditation daily, if you can. If not, perform at least one of these. Start off slowly, let’s say for 5 minutes each day. You can gradually extend this time until reaching your optimum.
If you feel frustrated during mindfulness practice, it may be that you are trying to suppress thoughts. Remember that you’re not trying to change any thoughts or sensations – let them be and shift your attention to the present.
With practice, you’ll notice that you’re becoming more and more skilled at mindfulness. Focusing on the present will become second nature to you.
Mindulfness is focusing your attention on the present moment
Challenging the Danger Belief
So far, you’ve hopefully been able to change the belief that worrying is out of your control. Now you should try to challenge the belief that anxiety is dangerous to your physical or mental health.
Again, grab a pen and paper to gather evidence for and against.
- What makes you feel that worrying is dangerous/harmful?
- What’s the evidence for your belief?
- Exactly how does worrying cause mental/physical harm?
- Is the evidence for your belief good/solid/reliable?
- Is there another way the evidence for your belief could be viewed?
- Is there any evidence that goes against your belief?
- How long have you been worried for? What specific physical or mental harm has resulted over this time?
- During a worry episode have you ever become ill or gone crazy?
- Are there explanations or greater risk factors for the illness you are concerned worrying will cause? (genetics, exercise, diet, lifestyle, smoking, alcohol)
- Have you ever ended up in hospital with a serious illness as a result of a panic attack?
- Have you ever gone crazy as a result of a panic attack?
- Have you ever fainted as a result of a panic attack even if you felt close to it? Do you know someone who did?
- Do you know someone who died as a result of a panic attack?
Health worries are extremely common among people who suffer from panic disorder. I managed to persuade myself once that I suffered from a neurodegenerative disease just because my muscles trembled slightly.
That said, you should consult any major physical symptoms with your doctor. But after checking that there is no underlying cause, worrying about the physical symptoms is not helpful, as it may also result in more worrying.
Postpone any health worries until you manage to change your danger belief or if you are waiting for a doctor’s appointment.
Anxiety can't harm you
Challenging Positive Beliefs
Positive beliefs about worrying are those that make you think that worrying is helpful. You may believe that worrying makes you prepared for the worst, that it motivates you or that it shows that you care.
You may challenge these beliefs by gathering evidence for and against them. It’s best to put pen to paper to do it, as it will help you think clearer.
- What makes you think worrying is helpful?
- What’s the evidence for your positive beliefs?
- Can you specifically describe how worrying helps?
- Is the evidence for your beliefs good/solid/reliable?
- Is there another way the evidence for your beliefs could be viewed?
- Is there any evidence that goes against your positive beliefs about worrying?
- What is the aim of worrying? Does worrying really achieve that aim? Can you achieve your aims without worrying? (i.e., problem-solving, taking action)
- Is it worrying that is helpful or something else? (i.e., problem-solving, taking action)
- What is the difference between worrying and problem-solving?
- Have there been situations where you haven’t worried, and things have still turned out okay?
- Have there been situations where you have worried, and that has actually made things worse?
- What are the disadvantages of worrying? How do these fit with being helpful?
Try another exercise. Think of your worries before some specific event. Write down the worst-case scenarios you came up with before the event. Then, write down what actually happened. Compare your predictions with the facts.
It is likely that your scenarios were nothing like the reality. If you can’t predict what will happen, how is worrying helpful in making you prepared?
Now you can try to put your belief to the test. Over a week, alternate days you don’t worry and days you worry a lot. For the days you don’t worry use your usual postponement technique. For the days you worry stop postponement and fall back on your old habits.
If your positive beliefs about worrying are true, on the worrying days you should be performing better.
However, chances are you performed equally good or better on the worry-free days. If it is so, how true is the belief that worrying is helpful?
Worry and problem-solving are not the same
Problem-solving and worrying are not the same – the former is about finding solutions to problems, the latter is about imagining scenarios that may never happen. When solving problems, always put pen to paper.
Problem-solving consists of a couple of steps:
- Define the problem at hand and make sure it’s something that can be solved in the hear-and-now. Write the problem down in a sentence or two.
- Storm your brain in search of possible solutions. Don’t worry about the quality of the solutions at this stage – let yourself be creative.
- Now, evaluate the solutions and cross out the least desirable ones. Next, order the remaining solutions from the best to the worst.
- List the advantages and disadvantages of the first 3-4 options.
- Decide on one or more plans (the remaining ones will be your backup plans). Write down all the details: who is going to implement it, when, and how.
- Implement the plan.
- Evaluate the implementation of the plan. Was the problem solved? Do you need another plan in place? If none of the solutions you’ve listed helped, go back to step 2.
Some worries can’t be solved. You may worry about losing your job without any reasonable grounds. In that case, you should find more helpful ways to frame the problem. Again, this is best done by putting pen to paper.
Remember that helpful thinking should be only done during your thinking time. Talking back to the thought as soon as it pops up may give it the attention it needs to convert into a persisting worry.
Here are the steps to tackle a worrisome thought:
- Write down what you are worrying about.
- Ask yourself what is your specific fear regarding the future. What do you predict is going to happen?
- How strongly do you believe it’s going to happen? Rate the intensity of the belief from 0%-100%.
- What emotions are you feeling? Anxiety? Fear? Sadness? Rate those emotions from 0%-100%.
- Ask yourself what’s the evidence for your prediction. Write it down.
- And what’s the evidence against your prediction?
- What’s the worst that could happen? And what specific steps could you take to cope?
- What’s the best that could happen?
- What is the most likely thing that will happen? You’ll find it is somewhere between the worst and the best scenario.
- What are the consequences of worrying about this? After having read the rest of the article, you hopefully think that worrying doesn’t achieve anything helpful.
- What is a more helpful way to view the situation? What advice would you give to a friend feeling this way?
- What would be a more balanced and helpful way to replace the worry?
- Re-rate how much you believe in the original prediction and how intense your emotions are.
If a worry doesn’t go away after one session of helpful thinking, keep postponing it and working through it during your thinking time.
To keep the benefits of the approach you should monitor your anxiety levels and be wary of warning signs –getting stuck in worry, feeling anxious, or getting panic attacks. Revisit the strategies in this article when necessary.
Make sure that you take care of yourself. Find time for relaxation, being with your family and friends, and doing physical exercise or pursuing a hobby. All those things will aid your general well-being.
The strategies in the article have been adapted from the brochure What? Me Worry!?!. As the authors state:
“The concepts and strategies in the modules have been developed from evidence based psychological practice, primarily Metacognitive Therapy (MCT). MCT is a type of psychotherapy developed by Professor Adrian Well’s at the University of Manchester. MCT is an extension of Cognitive-Behaviour Therapy (CBT) and is based on the theory that repetitive negative thinking, such as chronic worry in generalised anxiety, is a result of problematic metacognitions (i.e., beliefs about thinking) and behaviours. There is good scientific evidence to support that targeting metacognitions and behaviours in therapy can help many people to overcome generalised anxiety.”
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.