Ask Panic to Make it More

To work on any anxiety disorder, work on your anxiety about anxiety. Consider the following case: A client is having several panic attacks per day. Like most panic attacks, they come on quickly, peak within ten minutes, then begin to subside. His immediate fear is that panic will cause a heart attack, ending his life. We talk about how many panic attacks he’s had so far this year, which is hundreds. We talk about how many heart attacks he’s had, which is zero. We agree that if he was going to have a heart attack, he would have already. The fact that it hasn’t happened means that he’s not going to have a heart attack on the next panic attack. Every panic attack proves that.

With Panic Attacks, Rationality is Not Enough

So far, our discussion is eminently rational. The assumption is that rationality should guide one’s emotions. On the value of rationality we totally agree. As such, the client should change his interpretation of his body signals. Rather than be suckered into fear, he should intercept the anxiety before it reaches panic proportions. I ask the client try to remember, as the anxiety begins to grow, that the fear of a heart attack is really a catastrophic thought. “I am going to have a panic attack” is a catastrophic thought.

The client says he already does this, and that while it does help, in that it reduces the anxiety, the anxiety does not go away. I suggest that it’s a matter of where he wants to put his faith. He can put faith in what he and I know to be true, backed up by his own experience with hundreds of panic attacks: He is not going to die with a heart attack on the next attack. Or, the client can give in or fuse with his catastrophic thought: “I am dying.” He agrees, but goes on to say that when the anxiety is escalating, any logical-rational perspective goes out the window. I picture him in my mind at a crossroads, faced with escalating panic, trying to hold onto rationality, and all while his interpretation of his body signals is telling him to “be afraid, be very afraid.”

Cognitive Distancing

I again explain the concept of cognitive fusion, that the catastrophic thoughts become more compelling as the anxiety grows more intense. We’ve talked about cognitive distancing many times already. That’s where the client steps outside of the experience, watching the symptoms and watching his own thoughts, feelings, and behaviors. By doing so, they gain some distance from the symptoms, gain some objectivity, and facilitate exposure. “Oh my hand is trembling now, isn’t that interesting. Look at the thoughts I’m having…wow…and the fear is there in the corner of my mind, and how tempted i am to fuse with it…wow…” The client says he is already practicing cognitive distancing, at least until the anxiety builds and builds, reaching the point, he says, that he’d do anything to get away from that terrifying feeling.

So what’s sustaining the client’s anxiety? Why does he continue to have one to two panic attacks per day?

Anxiety about Anxiety

We talk about anxiety about anxiety. He understands that in order to recover, he has to change his relationship with anxiety from dread to acceptance. There’s just one catch: From the client’s perspective, he is practicing acceptance of the symptoms already, and changing his interpretation of his body signals, and practicing cognitive distancing to facilitate exposure, and it’s not working. Yes, it’s helping, but the panic is not going away.

So I explain that there’s a nuance here that gives us some insight into the real meaning of acceptance. Acceptance is not resignation and it’s not a reluctant surrender to the inevitability of an attack. Moreover, acceptance cannot be practiced in order to make panic attacks go away. Anything practiced to make anxiety go away is resistance. That resistance is just a continuation of anxiety about anxiety, a fake acceptance. I explain that as long as his acceptance is in service to anxiety about anxiety, panic symptoms will hang on. They may wax and wane, but it’s unlikely they’ll go away, because the underlying cause of the disorder is not being treated. Anxiety about anxiety is the cause.

Acceptance: Asking Panic to Make it More

The agenda of acceptance is to be okay with the symptoms, whatever they are. If they are nonexistent, that’s okay. If symptoms arise, that’s okay, too. That’s the opposite of anxiety about anxiety, where the symptoms are your enemy, and your enemy must be banished, where anxiety is what you must not feel.

Acceptance is made a little easier when you understand that just because symptoms appear doesn’t mean there’s anything to be frightened about. In fact, there is nothing to be frightened about, no external threat—no comet about to strike the earth and end civilization. Anxiety about anxiety is just a psychological state, not a tangible thing or physical weapon. As one of the symptoms, you may feel arousal escalating in your body, and that’s okay, too. Just because your body says there’s a threat, doesn’t mean there actually is one. In short, don’t believe everything you feel.

To prove that anxiety is just an idea, I suggest that clients ask anxiety to make it more, If that seems absurd, that’s because it is. Anxiety is not a thing and cannot be asked, it’s just your own construct. Asking anxiety to do anything is as silly as asking pink to suddenly turn blue. Nevertheless, the question is good at uncovering little pockets of resistance deep in the psyche. If you’re reluctant to ask this question, it may indicate that anxiety about anxiety is still at work. Moreover, it indicates that you are externalizing your anxiety as a thing. Only then can it be regarded as your enemy. Anxiety is just a construct, and as such, it has only the power that you give to it.