In the last post, we discussed how some people are able to move past a panic attack experience, while others get stuck in the panic place. They begin to live in fear of their panic symptoms and their daily lives become consumed with attempts to prevent another panic attack. In these circumstances, an individual may have developed panic disorder. So, why does this happen? As a reminder, there are three reasons why someone transcends from having a simple panic attack to developing panic disorder: 1) Selective attention and hypervigilance; 2) Safety behaviors; and 3) Avoidance. This post is Part II of a three-part series. I will discuss how safety behaviors play a role in the development of panic disorder.
What are safety behaviors? Safety behaviors are a subtle form of avoidance. They are behavioral strategies that people use to prevent their feared catastrophe from happening. People use safety behaviors with ALL types of anxiety and anxiety-provoking situations. However, we will only discuss safety behaviors more commonly related to panic. Below are several examples of safety behaviors that people with panic use to reduce prevent catastrophic outcomes. With panic, the catastrophic outcomes vary but are commonly: a) the fear of dying by suffocating; b) the fear of dying by having a heart attack; c) the fear of “going crazy” or “losing control;” d) the fear of humiliating oneself in public.
• Bringing a family member or friend to places where they have had panic attacks in the past
• Taking or carrying around benzos or other anti-anxiety medication
• Decreasing their physical exertion, such as refraining from working out or climbing stairs more slowly
• Stand or sit close to the door at an event/party/movie in order to be able to exit suddenly if necessary
• Making sure they identify an exit sign and know where the nearest exit is
• In a grocery store, avoid going down aisles that are closest to the exit
• Checking pulse regularly
• Distract oneself- think of something else or keep very busy to not focus on it
What are the safety behaviors you use in an attempt to avoid your feared outcome from happening?
So, some of these behaviors don’t seem that bad. What is this a big deal?
Here is why: when we use safety behaviors, we are reducing our anxiety in the short-term but are increasing it in the long-term. This is because we never give ourselves the chance to learn that our feared catastrophes would likely not have happened, even if we never used the safety behaviors. We automatically attribute the non-catastrophe to the safety behavior itself (sub-consciously or consciously). Instead of saying, “Oh, I guess I was wrong. My rapid heartbeat and chest tightness didn’t mean I was having a heart attack,” they say, “It is a good thing I took the elevator instead of the stairs so I didn’t trigger a panic attack and give myself a heart attack.”
Safety behaviors can seem harmless but they most definitely contribute to ongoing panic attacks. In CBT, we target safety behaviors in treatment. We help clients understand the role of safety behaviors through cognitive restructuring techniques. Also, during exposure exercises, the therapist and client work together to help client refrain from using safety behaviors. This allows them to see the reality that safety behaviors don’t prevent their feared catastrophe. Their feared catastrophe was very unlikely to begin with.
