I'm scared that my panic attacks are coming back

To set the stage, I had a huge problem with panic attacks a long, long time ago. I think it started around 2003. I was diagnosed when I went to seek emergency care. I thought I was having a heart attack. They said it was panic and I should have a chat with my psychiatrist before sending me home with 30 days of the intro dose of Xanax/alprazolam. I ended up doing better with Lorezapam, but that was a life saver. My psych didn't want me on it for too long for fear of dependence, so I also spoke with my therapist at the time, who was using the CBT methodology. Turns out that helped so much with my panic, that after 2 years of working with it, I had a good way of managing my attacks. I also learned what precipitates them, and could sort of plan ahead if I was going to be in a scary situation. I was at a point where I no longer met the diagnostic criteria according to the DSM-IV, which was current at that time. So, I moved on to a life that wasn't a cakewalk, but I had much fewer attacks, and I felt like I could handle them when they did happen.

I still have the occasional panic snowball, but it's more like once every 8 months, and there has to be a heck of a stressor, like having my hydration and electrolytes seriously imbalanced. I seem to be having them more frequently suddenly, and a tiny sprout of agoraphobia, in that I started to panic when I went to a demonstration with a lot of people and noise. I have been isolated in my room for about 15 months straight, and being around people was a challenge. My concern is that I have to re-learn the CBT skills to manage them, or I will end up in the psych detention facility again. If a panic attack gets out of control, I melt down. I'm crying and disoriented and every system in my body feels like it's in overdrive. I can't think straight, but I still know I'm not thinking straight. Usually it ends in 15 minutes. Max is 30.

I am not looking forward to having to use my skills again, but I'm grateful that I know I can do this. In writing this, I noticed that being anxious about oncoming anxiety is the very seed of a panic attack, at least for me.

I call it a snowball because it starts with noticing that I am upset. If I let it go, then I will be upset that I am upset, which will make me more upset, and so on until the whole system collapses. It's like putting a mirror in front of another mirror, except with fear instead of light. And I've been noticing more proto-panic that I have to consciously head off. It has generally taken the form of an internal dialog similar to this:
ME: "Uh-oh, it's starting. Should I engage my coping strategies?"
ALSO ME: "IDK it seems like that will backfire"
M: wtf do you mean?
A: Well, if I notice that we are applying a coping strategy, one of us will see that as a sign that things are going wrong and proceed to freak out.
M: Okay... so we should not do something that works because it might not work because it might make us think it's really scary to admit we're scared?
A: Now you are getting with the program...
M: I was being sarcastic and now I need a drink. FML

It should be noted that I have not actually had a drink for 3 years and change. It's one thing to crave a drink but another to give in to it. Just saying. Also booze is guaranteed to induce anxiety. There's a medical reason for that if you're curious.

I'm sorry it's been like this.

Is there any way you could do an end-run around your internal monologue?

For example, the reason why you'll start using your CBT skills again is because of how much you don't need them right now.

No. The problem with arguing with myself is that my crazy side is exactly as smart as my rational side. It was like this with substance abuse, too, in that I could come up with all these elaborate excuses for my drinking/smoking/vaping/snorting et al. Basically, I always had a reason, so nobody could get through to me that my strategy to just be drunk all the time wasn’t working.

My addiction therapist called it “hiding behind a wall of words.” I didn’t like hearing that. I was trying to hide something from myself, and he saw right through it. It is only comforting to pull back the curtain from the outside.

continuing on a new reply because the text editor is not cooperating…

So, what I can do is remind myself of the most important meditation experience instruction.


I guess I need to take the same advice I offer to others and forgive myself for losing my shit. It is just a break, I don’t have to be perfectly sane. How boring would that be, anyway?

What's triggering it?

Yes, this. And this is a weird, random thought which might only apply to myself, but when very bored and lonely it's possible the mind comes up with stuff it can process. But if one is not feeling so great, that stuff triggers a panic instead of an intellectual task.

Triggers are physical stress such as dehydration and/or uncomfortable interpersonal interactions.

According to my therapist, things come up for processing when the body is ready, regardless of how the brain feels about it. If you have heard of the book about the body keeps the score, it is an extension of that idea.

When the body has processed enough from a freeze state, it goes into fight/flight before self regulating, and that middle stage is prone to making me respond to a present stressor as if it was the one in the past.

I wonder if that’s why I am going from 1% to 100% on the anger scale over seemingly mild irritations. I left the “hospital” in a state of freeze. I have spent a lot of time frozen; I know it when I’m there.

In some sense, it might be good news that I am making progress in processing the trauma that I experienced there. It was not exactly water boarding that they did to me, but I was not able to get my needs met, and fight and fight were both stifled.

So I went into a state of freeze with a big helping of feeling very much younger. Being trapped in a place where the people who were supposed to be taking care of me were unsympathetic to my needs was a rude reminder of what I felt when dependent on my parents. God I’m f*king sad!

Sounds like your making progress we are here for you too and glad you got a good threapist

Hugs!!!!

Whst modalities does your therapist practice?

You have coping stragies now that you learned things will be able to get better

For the most part it is SE or Somatic Experiencing. We also use the terminology from IFS or internal family systems. IFS is a more fleshed out model of the inner child model.

I found the principles of IFS really helped me. Also I loved discovering a modality that described the way I split myself and write to myself which nornskised what I anyways do.