DIALOGUE number 6 – The impact of panic disorder on the rest of your life

In this dialogue Julie had been worried about the impact that panic disorder was having on her life in general – on her relationships with family and friends and so on. I could tell that she felt that she had a ‘deeper’ problem that still needed to be ‘fixed’ apart from the panic

Jthat’s very important. too.. .. after every major panic attack .. i feel like ending my life… seriously… i know i don’t have guts to do that.. but the thought is very sadly serious

even today i felt that for some time

i just hate that so much

it is living in a prison.. i feel like just being free of that horrible sensation.. and all the

things it stops me from doing.

R – but u are ok now?

Jso its very important to tell people about how to handle life in spite of panic..

because that is going to affect the panic too


but i am ok

R – yes

Ji know .. handicapped or whatever Melanie still needs me..

R – but that is precisely why CBT makes it so important that people do

EXPOSURE practice

Jso that thought made me come out of the depression

R – CBT doesn’t just tell people how to ‘cope’ with panic

that’s not necessary


R – if i told you how to ‘cope’ today u would still be in panic

this is important

Jit is very important to tell people how to get out of the guilt


R – Yes – but it can be helpful if people see that the feelings of guilt are another

symptom of having panic disorder


R – a symptom

common – normal

if u give it importance by discussing it

then u are into more thoughts that are u this person or that

its just a normal response everyone has to panic

nothing more

Julie: yes

R – its vital to keep focussed on panic as a mistake of body sensations

nothing else

all else is ‘effect’ of that

emotions don’t cause panic

nor does guilt or depression

we are simply reacting with fear to very unpleasant sensations

Misinterpretation and catastrophisation

that’s it

Jbut the obstacles that it creates for the people and yourself in leading the day normally is so HUGE .. that it does become a HUGE social and psychological problem.. and it does create relapses … almost like any addiction.

R – it DOES if the panic disorder is untreated

but you are working through the panic now

all else will resolve once you overcome the fear of panic

depression is a secondary disorder with panic very often

but CBT doesn’t work on the depression first

because it is only due to the panic and will resolve once panic is fixed

Ji think the practice and rehabilitation both are necessary together? … you are

helping me in both ways.. so its helping me..

R – yes – but that is different

Jis it not a bad cycle?

R – when I help u with the PANIC – i never talk about your life

Jit constantly blocks you from leading a normal day … then again faced with all the same problems.. and then panic.. of would things ever be ok

R – it is separate from the panic



R – panic is TOTALLY separate from life stress in the way it works

Jwhen one panics.. all those thoughts keep coming in mind


R – yes but to work out each thought about your life would make it WORSE

because in PANIC u cant think logically


R – u leave that to one side and deal with the SYMPTOMS

then once it has calmed down u may feel fine ANYWAY

because fear is gone

if u still have unresolved issues in your life then ok – deal with them separately

but don’t mix them into panic practice

Jbut so many people around you are affected by it.. every day

R – all the more reason to just stop the PANIC

Jso there is not a moment of relaxation


R – do u see this?

are u confused about what to work on

ALL u should work on – regarding the actual panic attacks – is the cycle of fear

don’t think – “I panic because of .. or..”

THAT causes MORE anxiety

Jfor example today it’s susan’s birthday  … so now that i am in panic

should i go or should i not go.. if i go feel panic there .. their party will get disturbed..

if i don’t go.. i don’t do something that i am expected to do.. and melanie’s going

there also depends upon my going.. and for me its a horrible experience anyway… so

living completely stops.. ..

R – panic is NOT dangerous


R – exactly

u are ADDING anticipatory anxiety

that is a SYMPTOM

Jso its panic , crying , panic , crying for me.. when its this bad.

R – that’s because u aren’t taking practice seriously enough

u aren’t going through the practice every time u think of it all

u are analysing

rather than practicing

when panic thoughts arise u should PRACTICE with them

Jyes… how to deal with people who are there around you .. the situations around you and still practice

R – let go – relax stomach – etc


R – but that’s the thing

there is only ONE way

Jwhen the symptoms are a little bearable.. then all the tension and thoughts come back.

R – to practice through it



R – I was the same

that’s why i got stuck with it so long

i want u to see something RIGHT NOW

are u listening

Jwhen one panics one feels so stupid and clumsy .. because of the fear .. and then feel its necessary to carry forward the image of being ‘stupid’ .. or people will think you were ‘acting ‘ when in panic.. its subconscious.. but it happens..


R – this would NOT happen very much longer if you took the exposure practice seriously if you MADE yourself feel panic EVERY DAY

to practice through it

but you aren’t doing that

so u only practice on panic when it pops up now and then

which is very small exposures

too far apart

Jyes i will

R – so your learning is weakened

can u see this?


R – can u see if u FORCED yourself to go through this every day to small degrees

u WOULD HAVE TO learn something

u would be FORCED to memorise the practice statements

can u see how vital that IS

u have gone out yes – but you hardly ever panic because you stay ‘safe’

Jso many variables are at work. .. yes i know.. i am just trying to see the obstacles that come in the way of exposure and practice

R – so the big bad panic is still a fear for you

Jhow to stick to the decision..

R – u come back from exposure and say – “it was so great – i didn’t panic”

Jhow to have discipline

R – and that was a wasted exposure

Jall these things are important to address

R – yes

Jas the panic does break your will so badly

R – that’s why CBT is SO effective


R – because exposure is a big part of the treatment and exposure is THE most effective treatment for panic

Jmy brain feels tired today .. still feeling jittery . .. words are looking blur now.

R – practice NOW on that


R – let go all over

let your stomach relax

breathe properly

feel feet on floor

come back into room

Jsitting on the floor


R – lol


listen to sounds


its ok

u are in NO danger at all

it’s JUST feelings


R – that’s all

it only ever WILL be just feelings

its just fight or flight

Ji am able to immediately tune when you say it.. but i cannot say it myself.

R – and guess why


Jbecause i am constantly adding second fear

R – but what else

in answer to your statement

WHY cant u say it yourself

Jmy mind not working right now

R – ok – if u practiced on actual anxiety everyday for two weeks

do u think u would know the practice better


i will do exposure every day

R – we have only really done proper practice a few times in two months


R – not much chance of u being an expert


R – that’s why the longer u spread it out the longer u HAVE panic


i will do a crash course

R – its a simple equation


R – the more practice you put in the faster you recover

Jand wont i get so exhausted doing it and die?

R – Practice where u faced SOME real anxiety


Ji am so tired today

feel so sick

R – ok

but that’s ok

i am tired too

VERY tired


R – I also get days when i feel sick – it doesn’t mean anything ‘bad’


R – keep that in mind


R – everyone feels all this at some time or other

Ji will do practice

R –  don’t build it up

not today


R – u have done it for today


R – although keep practicing on how u feel


R – write out the flashcard


R – good

then EVERY time your script writing mind kicks in

read that instead


R – let panic happen

its ok


R – its ok if it has affected your life

so what

that’s just life

why add worry more to that


R – just get back to practice


R – now is now

get on with it


R – tell Julie to shut up


Jthank you so much


R – imagine Melanie was going through this


R – and u KNEW that practice would clear it if she did it diligently

Jnever – she wont

R – but she went on and on about how it ruins her life

Jdon’t even want to imagine that

R – lol



R – its just an analogy

Ji know .. i will ask her to shut up and do practice


i know

R – good

so go do the practice


J yes

thank YOU

R – when u catch yourself ‘wandering’ off into catastrophe-land

bring it back to PRACTICE

Jthank you. .. ok

R – ok chat later

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