panic attacks can come from out of the blue for no apparent reason at times when you're
not expecting them in today's video i'm going to be talking about why this happens
and why panic attacks continue to happen
hi everyone in today's video i'm going to be talking about panic attacks and why panic attacks
can seem to come from completely out of the blue for no apparent reason at times when you're not
expecting them but before i get into that just a couple of disclaimers to go over i am a registered
psychologist in the province of british columbia canada and this video is for informational
purposes only it is not intended as a substitute or replacement for advice from your doctor or
mental health professional now with those things out of the way let's talk about panic attacks
now in a previous video i've talked about a model for uh what happens in a panic attack it's called
the fear of fear model of panic and i strongly encourage you to take a look at that video because
this video won't make a lot of sense without understanding the fear of fear model of panic
but essentially what happens in a panic attack is that a person experiences uh some physical
sensations of anxiety and when they notice these physical sensations of anxiety they experience
what we call the uh-oh reaction or they have a a bunch of uh-oh thoughts uh what if i'm having
a heart attack what if i'm having a stroke what if i'm going crazy those types of things
now these thoughts can be really scary and so what happens when a person starts thinking these things
is they become really anxious they hurry up or tense up to either get out of the situation or
prepare themselves for what's happening and the more anxious they get the more they're hurrying
up or tensing up the more that increases the physical sensations of anxiety and the cycle
continues and this is the fear of fear model of panic essentially panic attacks are caused by a
catastrophic misinterpretation of normal body sensations so um that's what occurs in a panic
attack but what can happen in panic disorder is that a person can have repetitive and repeated
out of the blue panic attacks panic attacks that seem to come from out of nowhere for no reason
and because they're happening so unexpectedly it can become really really scary and a person can
become really apprehensive or fearful of when the next panic attack is going to happen and that's
sort of what happens in panic disorder is that it's almost like the person develops a phobia of
having another panic attack so what i want to talk about is two features that tend to perpetuate
panic disorder two features that tend to keep panic attacks happening over and over again
and the first of these is something we call anxious apprehension essentially
when a person is having repeated panic attacks when a person has panic disorder
they become really fearful and really anxious of when the next panic attack
is going to happen so the way i like to explain it it's almost like the person has
uh like a time bomb set inside of them except the timer is set to random so they don't know
when the timer is going to go off they don't know when the time bomb is going to occur and so
what is really common in panic disorder is that people get really really good
at scanning their bodies for any signs of a panic attack so sir a person becomes really
really in tuned with what's happening inside their body so they're more likely to notice when
their heart starts to flutter a bit or when their breathing changes or when they're feeling
a little bit lightheaded so for most people we may not even recognize that that's happening
but for a person with panic disorder they are highly in tuned with what's going on in their
body the metaphor i like to use to explain this is to imagine that i'm heading out for a walk and
just as i'm about to leave my front door to go on the walk i hear on the radio that it's squirrel
season and squirrels are out and they're foraging for nuts i don't think much of it maybe it's a
slow news day and i go out on my walk now as i'm going on my walk i'm walking through the forest
off in the distance i hear some leaves rustling what am i likely to think it is well
i'm likely to think it's swirls and so i get these warm and fuzzy commune with nature
feelings and i i go on my way thinking about the cute squirrels getting their nuts
but same scenario imagine that just as i'm about to leave my front door to go onto my walk
i hear on the radio that there is a mountain lion in my neighborhood and they're warning people to
be really really cautious because this mountain lion has attacked a number of people now imagine
how that's going to change how i approach my walk as i'm walking through the forest i'm
more likely to be scanning for any signs of that mountain lion so i'm much more likely to be aware
and to recognize and hear when those leaves are rustling in the distance and when i hear those
leaves rustling in the distance what am i likely to think it is i'm likely to think
it's a mountain lion and how am i likely to feel really scared i fear that i'm going to be attacked
it's the exact same situation i'm walking down a path in the forest and in the first scenario
i feel these warm fuzzy commune with nature feelings in the second scenario i feel terrified
this is kind of what it's like for a person with panic disorder whereas someone without
panic disorder can feel these physical sensations of anxiety and may not care too much about it
may not think it's epic of a deal or they may not even be aware of the physical sensations
whereas someone with panic disorder is hyper aware and is much more likely to notice these physical
sensations and when they notice the physical sensations they're much more likely to then
become anxious about them because they interpret the physical sensations as dangerous just like
the person in the second scenario interprets that the leaves rustling are a mountain lion
and so you have a couple of things that are happening here for a person with panic disorder
is that they're constantly scanning their body for physical sensations of a potential panic attack
but because they're so anxious about having another panic attack they're more likely to
experience some of these physical sensations a person because they're anxious about having
a panic attack is more likely to be tense their heart rate is more likely to sort of change or
flutter they may just be more highly tuned and highly anxious because they're overall fearful
of a panic attack and so you have these two things working together one i'm scanning my body for any
signs of danger and secondly i'm more likely to experience some of these physical sensations
because i'm anxious about having the physical sensations now the thing is our bodies are
constantly in a state of flux they're constantly changing and fluctuating if it's warm outside
and i go into my office where it's cool and air conditioned there are going to be changes to my
body's physiology my heart rate is going to change my respiration rate's going to change the amount
of blood flow to the surface of my skin is going to change and these are all perfectly natural
as a way of my body maintaining homeostasis if i uh run to go catch the bus that i'm oh that i've
almost missed and i get onto that bus it's going to lead to changes in heart rate respiration rate
sweating our bodies are constantly fluctuating now the thing is we can't possibly be aware
of every single thing every single factor that may be contributing to our body's fluctuations
and so my heart rate may increase because i had a cup of coffee
two hours ago and the caffeine's finally kicked in and so my heartbeat is beating a little bit faster
now i can't possibly be aware that my heartbeat is beating faster because i
had a cup of coffee two hours ago and so if i just notice my heart beating faster
it becomes easy for me to think uh oh especially if i have a history of panic or panic attacks
so the body is constantly in fluctuation but because i'm so anxious about having a panic attack
i'm scanning my body i'm more likely to notice those fluctuations and i'm more likely to enter
that fear of fear cycle so that's the first big maintaining factor in panic disorder it's
this anxious apprehension it's this fear of when the next panic attack is going to occur
the second factor that tends to cause panic attacks to occur over and over again is avoidance
now avoidance can take a couple of different forms avoidance can take the form of avoiding
situations or places or activities that may bring on these physical sensations or where i'm fearful
that i might have a panic attack so if i'm fearful that i might lose control while i'm driving
i might avoid driving or avoid driving on highways or avoid driving in situations
where i wouldn't be able to sort of pull over and get help i may avoid situations where i may not be
able to get help if i were to have a panic attack and and wouldn't be able to get help right away so
i may avoid uh hiking or being far away from my home i may avoid activities such as
exercising or i may avoid drinking coffee or having alcohol because
these activities and the substances may bring on some of the physical sensations
of anxiety and so i don't want that to happen and so i avoid it
people can really focus on avoiding the physical sensations themselves like i said people will
avoid drinking coffee they'll avoid exercise they'll avoid things like really strong emotions
so a person may try to avoid getting too worked up getting too anxious getting too excited because
they're fearful that if they get too excited their heart might start racing and it may trigger
a panic attack so this avoidance can take the form of avoiding the physical sensations themselves
but also avoiding situations that might bring on the physical sensations or situations in which if
i had a panic attack it would be really bad now the problem with avoidance is that well there's
a couple of problems with avoidance the first is that it makes a person's world a lot smaller the
more i avoid the more i tend to have to avoid and so i become very limited in terms of what
i can do if i can't drive long distances or if i can't drive on the highway or or if i'm no longer
able to play sports that i enjoy doing because i don't want to get my heart racing too much
i may really like coffee but i'm avoiding drinking coffee because uh i'm afraid of how it will make
me feel so this avoidance can make my world a lot smaller but the second factor that avoidance can
the second issue that avoidance can cause is that it can perpetuate these panic attacks
because what a person's doing when they're avoiding the reason why a person's avoiding is
because they're afraid of the physical sensations that these activities or these substances
might bring on and so by avoiding anything that might get my heart rate increasing
by avoiding anything that might make me short of breath what i'm telling myself is
those physical sensations are dangerous they're threatening and so i should avoid them because
if they do happen something bad could happen so by avoiding these physical sensations
the implicit message that i'm giving myself is that the physical sensations
in and of themselves are dangerous and there's something wrong with these physical sensations
and so that way whenever these physical sensations come up of course i'm going to feel anxious about
them because i've been trying to avoid them and the reason i've been trying to avoid them
is because i feel that they're dangerous so it becomes this cycle where i'm avoiding because i
fear that they're dangerous but i fear that they're dangerous because i'm avoiding them
so this avoidance can really drive this anxiety and the more i avoid the more anxious i get
about the physical sensation and the more anxious i get about the physical sensations
the more likely i am to experience the physical sensations and because of that apprehen after
that anxious apprehension i talked about earlier i'm more likely to notice the physical sensations
and there you go that's how i keep entering these anxiety and panic events
so uh the anxious apprehension and the avoidance work together to keep the panic attacks going
because what they're doing is they're they're reinforcing this idea
that these physical sensations are dangerous and so whenever i get those physical sensations
regardless of what caused them i could have those physical sensations like i said
because i walk inside to an air-conditioned room from outside where it's hot and i may
experience some of these physical sensations it's not dangerous it's not threatening but i
notice the physical sensations and i think uh oh and i enter the panic attack cycle
so uh anxious apprehension and avoidance the two factors that can
drive and perpetuate and maintain panic attacks in panic disorder in an upcoming video i'll be
talking about uh ways in which we treat panic disorder how we use this fear of fear model
and how we use our understanding of anxious apprehension and avoidance to really begin to
challenge and and treat and address these panic attacks so i'd love to hear your thoughts and
ideas about this any questions you might have so please leave me some comments in the
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so thank you for making it all the way to the end of this video and i will see you in the next one