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Relapses: When Panic comes back

Many people who experience repeated panic attacks will go through periods--usually months but sometimes years long--during which they are panic attack free. The dread of leaving the house or being in crowded places dissipates almost completely. They can go anywhere and it feels wonderfully like the Panic Disorder is gone for good. This could happen spontaneously or after a brief stint of treatment. But then life stressors begin to put cracks in a person's sense of wellbeing, and the stomach-churning worry and fear of uncertainty returns, followed by panic attacks. What has generally happened in this temporary remission of panic is that a person has concluded, often unconsciously, that he or she is safe from panic attacks because the probability of having a panic attack is low. It's like having the thought, "Well, if I do have a panic attack, I will surely die from it, but it seems like I'm not likely to have a panic attack anyway, so I guess I can go about my life normally."

The reason this is a temporary remission versus a long term mastery of panic is that the underlying fear of panic attacks is still firmly in place, so the person is vulnerable to a return of the symptoms. In particular, almost every panicker has what's called a focal fear, or one core dread at the heart of their whole fear structure. Usually focal fears are very physical, such as "A panic attack will cause me to have a deadly heart attack" or "My heart will stop during a panic attack," or "I will suffocate and I will die instantly." When the underlying fear structure, with the focal fear at its core, is still in place, panic attacks will always return over time.

The goal of exposure-based CBT treatment for panic attacks is to expose the underlying fear structure so that the former panicker, with a therapist's guidance, can reinterpret the panic sensations more realistically, realizing that they do not mean what they feel like they mean: they are uncomfortable, but not dangerous. The focal fear is a lie.

Being truly unafraid of panic symptoms, rather than just temporarily thinking that panic attacks are unlikely to happen, is the pathway to real, lasting remission of panic attacks. I hope everyone out there who experiences them has the opportunity to get there.

(This post written with help by Dr. Elke Zuercher-White's workbook An End to Panic: Breakthrough Techniques for Overcoming Panic Disorder. Photo Credit: Jack Dykinga, U.S. Dept. of Agriculture)
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