Most people who experience panic attacks would describe themselves as feeling instantly out of control during panic. They primarily complain about losing control of their body: all of a sudden, physical symptoms come rushing into their awareness, and they feel overwhelmed.

Although panic seems to occur instantaneously, in actuality there are a number of events that tend to take place within our mind and body leading up to panic. If we could magically slow down this physical and mental process, we would typically find that a person's anxiety involves a number of stages. The tricky part is that some or all of these stages can take place outside your conscious awareness. And they can all take place in a matter of seconds. That's why panic can feel like such a surprise: we are not consciously aware of the stages we go through prior to a panic attack.

Several of these stages also serve to instruct the body on how to respond. For instance, let me explain to you one possible way stage one -- Anticipatory Anxiety -- could unfold. The panic cycle begins as you consider approaching a feared situation. Quickly your mind recalls your past failures to handle similar situations. In the last example, Donna, while sitting at home, considered entering a grocery store. That thought reminded her of how she had experienced panic attacks previously in grocery stores.

Here is the first of four important pieces of information. When we become mentally involved with a past event, our body tends to respond to that experience as though the event were happening RIGHT NOW. All of us have had this experience. For instance, you might flip through the pages of your wedding album and begin to feel some of the same excitement and joy you felt that day. Or perhaps on another day someone mentions the death of a person he was close to. You are reminded of the death of someone you love, and you begin to feel sad again. Similarly, as Donna recalls her last panic episode, she unconsciously retrieves the feelings of that day as though it were today: anxiety.

So, first we contemplate facing our feared situation. That reminds us of our past failures. Since we are now recalling that we handle such situations poorly, we next begin to question our coping abilities. "Can I really handle this? What if I panic again?" These kinds of questions send a special message to the body.

And here is a second important piece of information. Unconsciously we answer these rhetorical questions: "No, based on my past performance I don't think I can handle it. If I panic I will totally lose control." These unconscious statements give this instruction to the body: "guard against the worst possible outcome."

Simultaneously we can mentally visualize ourselves failing to cope with the situation, even though we may not consciously "see" the image. In our example, Donna pulls up to the store and imagines what it might be like if she "lost control." Later, while filling her cart, she imagines how long it might take to go through the checkout line. And each time, her body responded to that image.

Here is the third important piece of information. Just as our body responds to memories of the past, it will respond to images of the future as though the future were occurring now. If our image is of ourselves coping poorly, the mind instructs the body to "protect against failure."

What about the body? Exactly how does it respond to these messages?

Our bodies have been trained for millions of years to respond to emergencies. Ours is a finely honed response that answers with a moment's notice to the instruction, "This is an emergency." It responds the same way every time to any event that the mind calls an emergency.

Here is the fourth important piece of information in this step. Within the panic cycle, it is not the body that responds incorrectly. The body responds perfectly to an exaggerated message from the mind. It is not the body that needs fixing, it is our thoughts, our images, our negative interpretation of our experiences that we must correct in order to gain control of panic. If we never told ourselves, in essence, "I'll lose control in that situation," then we would not be flipping on that unconscious emergency switch so often.

In summary, here is the unconscious communication taking place between the mind and the body during the anticipatory anxiety stage. The mind considers approaching a feared situation. That thought process stimulates a memory of a past difficulty. At the moment the mind creates an image of that old trauma, it simultaneously instructs the physical body to "respond as though past difficulties are occurring NOW." Using this information about the past, the mind now begins to question your ability to cope with this event. ("Can I handle this?") These questions lead to an instant instruction to the body: "Guard against any of these worst possible outcomes." Moments later the mind conjures up pictures of you failing to handle the upcoming event (consider them brief glimpses that don't register in your conscious mind). A strong message is sent to the body: "Protect against failure!"

In other words, your mind says to your body: "The danger is NOW. Guard me! Protect me!" This is one reason why you begin to feel all those physical symptoms "out of the clear blue": most all of the messages the mind sends the body before that moment are unconscious, "silent" ones.

In stage 2 -- the panic attack -- these messages are no longer silent, but their effects are the same. You notice those physical sensations that the body is producing, such as a rapid heartbeat. Then you become afraid of them and unconsciously instruct the body to protect you. The body begins to change its chemistry in order to guard against the emergency. Yet, since this is not a true physical crisis, you can't properly use the body's power effectively. You notice an increase in physical symptoms instead. This creates a self-reinforcing cycle during the panic attack.

Let's look a little more closely at this physiology that is often misunderstood during panic. The table below lists many of the physical changes that take place when we flip on that emergency switch. (Technically we are stimulating hormones that engage the sympathetic branch of the autonomic nervous system.) All those changes assist the body in responding to an actual crisis. For instance, the eyes dilate to improve vision, the heart rate increases to circulate blood more quickly to vital organs, respiration increases to provide increased oxygen to the rapidly circulating blood, the muscles tense in the arms and legs in order to move quickly and precisely.

The Body's Emergency Response blood sugar level increases

eyes dilate

sweat glands perspire

heart rate increases

mouth becomes dry

muscles tense

blood decreases in arms and legs and pools in head and trunk

These are normal, healthy, lifesaving changes in the body's physiology. And when there is an actual emergency we hardly notice these changes; we pay attention to the crisis, instead. However, since this is the "pseudo-emergency" of panic and not a real one, two problems develop.

First, we become stuck focusing on our fearful thoughts and our physical sensations instead of taking action to solve the problem. Since we are not expressing our body's energy directly, our tension and anxiety continue to build.

The second problem has to do with our breathing. During an emergency, our breathing rate and pattern change. Instead of breathing slowly and gently from our lower lungs, we begin to breathe rapidly and shallowly from our upper lungs. This shift not only increases the amount of oxygen into our bloodstream but it quickly "blows off" an increasing amount of carbon dioxide. In a physical emergency we are producing excess carbon dioxide, so this breathing rate is essential. However, when we are not physically exerting ourselves, it produces the phenomenon called hyperventilation by discharging too much carbon dioxide.

During the anticipatory anxiety and the panic attack stages of the panic cycle, hyperventilation can produce most of the uncomfortable sensations that we notice, as listed in this next table. This is another important piece of information: simply by changing how we breathe during panic-provoking times we can significantly reduce our uncomfortable symptoms. However, our breathing is dictated in part by our current thoughts and the images we are currently focusing on, so we must also change our thinking and imagery.

Possible Symptoms During Hyperventilation irregular heart rate

dizziness, lightheadedness

shortness of breath

"asthma"

choking sensations

lump in throat

difficulty swallowing

heartburn chest pain

blurred vision

numbness or tingling of mouth, hand, feet

muscle pains or spasms

shaking

nausea

fatigue, weakness

confusion, inability to concentrate

Summary

Before you can learn to gain control over panic, you must first believe that you have the ability to take control. Many people feel helplessly out-of-control, experiencing panic as something that rushes over them from out of the blue. The truth is that many of the early stages of the panic cycle take place outside conscious awareness. In this step you learned what these typical stages are. By first identifying these stages, we can begin to design a self-help plan that accounts for the entire cycle of panic not just those stages we consciously notice during panic. As you continue exploring this self-help program, here are some important ideas to keep in mind:

Our body properly responds to the messages sent to it by the mind. If we label a situation as dangerous, and then begin to approach that situation, the body will secrete hormones that prepare us physically for crisis. Even if the situation appears relatively safe, if the mind interprets it as unsafe, the body responds to that message. If we become mentally involved with thoughts of a past event, the body may respond as though that event were taking place now. When we question whether we can handle a fearful situation, we tend to unconsciously predict failure. Our body responds to our fearful thought by becoming tense and on guard. If we visualize ourselves failing to cope with a future event, our body will tend to respond as though we are currently in that event. Within the panic cycle, the body is responding appropriately to unnecessarily alarming messages sent by the mind. By changing our images, our thoughts and our predictions about our ability to cope, we can control our physical symptoms. When we become anxious, our rate and pattern of breathing change. These changes can produce hyperventilation that may cause many of the uncomfortable physical symptoms during panic. By changing the way we breathe we can reduce all of those uncomfortable symptoms.

Don't Panic, Chapter 7. The Anatomy of Panic Don't Panic, Chapter 8. Who's in Control? Don't Panic, Chapter 9. Why the Body Reacts