Approaching avoided activities

When people have unexpected panic attacks, this means that there is nothing in particular in the environment that leads to a panic attack, no specific object or situation that they can try to avoid to prevent a panic attack. And what this means is that people who experience unexpected panic attacks often try to avoid experiencing any of the physical or bodily sensations that they associate with panic attacks, such as increased heart rate or shortness of breath.

So, what is the problem with this? Well, in addition to the fact that avoidance tends to not work in the long term, the major problem with trying to avoid these very common physical sensations is that so many different activities can make you out of breath or cause your heart rate to increase. Therefore, the only way to avoid these sensations is to severely limit your life.

Think about it: what kinds of things make your heart rate increase or cause you to be short of breath? Exercise? Walking up stairs? Seeing an exciting or scary movie? Eating or drinking something with caffeine? Having sex? And if your goal is to avoid these physical sensations, then that probably means that you need to avoid all of these activities, as well as many others. Basically, to avoid these sensations, you have to dramatically limit your life and avoid doing a ton of different activities—­some of which are enjoyable and others of which are very healthy. And that can have some major downsides for your quality of life.

So, let’s apply the acting opposite to fear skill to these unexpected panic attacks. The first step for this type of panic attack is to identify the physical or bodily sensations that you try to avoid, those sensations that you associate with the onset of a panic attack and that you do everything in your power not to experience. Take some time now to identify all of the bodily sensations that you try to avoid and write them down in the first column of exercise 8.3.

Next, for each of these sensations, identify the different activities that you fear could cause these sensations. Focus in particular on activities that you tend to avoid or do less of. Try to identify as many activities as possible and write them down in the second column.

Exercise 8.3 Indentify Avoided Activities in Panic Attacks

Next, use the information from the second column of this exercise to create a list of all the activities you try to avoid because they trigger panic symptoms. Write down all of those activities in the following table. Then, see if you can, once again, come up with some small, doable steps you can take to begin to engage in these activities. How can you begin to approach these activities? Think about all of the things you can do to get into contact with these activities, focusing on small steps you can take to act opposite to your fear. Write down these steps in the second column of exercise 8.4.

Exercise 8.4 Avoid Avoidance: Manage Avoidance of Activities in Unexpected Panic Attacks

Congratulations! Now that you have identified the steps you can take to approach these activities and address your avoidance, you are one step closer to breaking free of panic attacks and their hold on your life. This is a really big step. We know it can be difficult to break the cycle of avoidance, so even taking the time to identify what you can do to approach these activities can be really scary. And yet, this is also the first step on the road to recovery. The next step is to begin to make your way through this list, doing one thing at a time to approach these activities.