The Domino Effect - From Panic Attack to Phobia

by Mark Sichel, LCSW

As we saw in The Fight or Flight Response, panic attacks are usually a fearful response to internal feelings, wishes and ideas that we unconsciously feel will put us into danger. One of the major problems with panic attacks is that when people are unable to identify the internal source of their fear, they learn to associate the attack with an external situation. This is how a panic attack can turn into a phobia.

For example, John* has a panic attack in the theatre while sitting in the balcony. He then associates his anxiety with theatres and balconies. John had a panic attack, and now has a phobia of theatres and balconies. Sally, who is an experienced and frequent flyer, has a panic attack one day during a turbulent flight, and becomes a phobic flyer.

John and Sally's experience is called anticipatory anxiety. When anticipatory anxiety becomes linked to a place, person, or a situation, the panic attack becomes a phobia. This is one reason why it's so important to deal quickly and effectively with your panic. Anything you might experience can become linked to panic in your mind, and you might respond by avoiding that situation to control the panic and prevent them from reoccurring.

The most important thing to understand is: Your panic attack has meaning. In each instance, try to understand what it was about the given external stimuli or events that triggered the internal fears that caused your panic attack.

Sally learned that she needed to slow down, change her travel schedule, and devote more attention to herself and her family. It wasn't the flying that Sally was afraid of, being on the plane simply triggered her deep-seated internal fears that she was "abandoning" her family.

John was a creative and gifted college student studying psychology who wanted to be involved with the creative arts. Watching the show ignited for him a rage, helplessness and lack of control that he eventually channeled into a shift in his college studies to the arts. It wasn't the theatre that John was afraid of, being in the theatre simply triggered his internal fear that he would never pursue or realize his dreams.

Sally and John were able to examine their panic attacks and make changes in their lives that not only eliminated the panic attacks, but also made them happier overall.

Your panic attacks are a message from your unconscious. They are a symbolic representation of messages you need to give to yourself. Our psyches are purposeful and they're creative. Panic attacks are a message: we need to understand, express and face parts of ourselves that we don't necessarily like or understand. Even if the message is "right now I want to be a baby, take a break from adult life, and be cared for," it's a message we should heed.

Below are a series of messages which, if unheard, could very well lead to panic attacks. Check off those that you feel could apply to you, and save your submission page in your logbook:

I want to be a baby. I need a break from responsibility.
I want to be taken care of.
I feel trapped. I want out.
I feel suffocated. Let me breathe.
I feel isolated. I need support.
I am afraid I will be hurt. Please protect me.
I am afraid I will fall apart.
I feel out of control.
I fear for my physical safety.
I am angry. I am afraid to express it.
I am afraid of failing. I need some help.
I don't know what I'm doing. I need guidance.
I am afraid of being a burden. I need autonomy.
I am afraid my dream will pass me by. I need to take action.
I am afraid of missing out on things. I need to get involved.
I am afraid I'm not taking care of the important things. I need to re-prioritize.

If you would prefer not to complete the interactive exercise at this time, continue the Panic Disorder lessons by reading Healthy Regression.

If you would like to start at the beginning of the Panic Disorder lessons, please read What to Expect When You are Diagnosed with a Panic Disorder.

*The names of all clients have been changed to protect their identities.


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