EVENT: I need to attend a meeting. I am anxious because last time I had a panic attack during a meeting.

EMOTIONS: apprehension, worry, dread

DISTRESS RATING: 7—feeling distressed, less in control

THOUGHTS: “I'm going to have a panic attack again. What will everyone think? I can't handle this. I'm so weak.”

CAN YOU IDENTIFY THE IRRATIONAL THINKING IN THIS EXAMPLE? There are at least 3 irrational beliefs.

HOW CAN YOU CHANGE THE THINKING? What is another way of thinking about the situation that won't cause the feelings of being apprehension, worry, and dread?

ANSWER:

Irrational Beliefs:
1) Generalizing. Due to a previous panic attack in a meeting, this man has expectations that he will have a panic attack again. And because he believes that, he is setting himself up for another panic attack. The belief is already creating apprehension and dread which means that he is caught up in the anxiety cycle of thoughts creating symptoms creating worse thoughts creating worse symptoms. By the time he attends the meeting (if he attends) he is likely to have escalated to a full-blown panic attack. However, in this case, it is a self-fulfilling prophecy created by his expectation.

In reality, however, just because he had a panic attack previously in a meeting doesn't mean he will have one again. The other circumstances could have been different. Maybe it was a particularly stressful meeting. Or, sometimes, even the environmental circumstances such as the temperature of the room can activate anxiety symptoms. In addition, by recognizing his anxiety and learning to do something about it, he is changing the situation.

2) Mind-Reading of Others. He is concerned about what others may think of him if he has a panic attack. There are two issues to address here. One is that most people don't pay that close of attention to others. Secondly, why should it matter what others think?

The first issue needs to be addressed by recognizing he isn't the center of attention. Unless, of course, he is the one standing in front of everyone giving a talk (and even then many people aren't paying that close of attention). He also needs to recognize that his anxiety symptoms are more noticeable to himself than they are to others--most of the symptoms are internal. Finally, even if people notice the symptoms, they are more likely to attribute them to something else such as believing that he's not feeling well.

The concern about what others think is a self-esteem issue. He is allowing the external to determine how he feels about himself. It is more important for him to have a positive view of himself because that is what he will convey to others. Other people's impressions often conform to what we present to them. This means the more he accepts the anxiety as just some annoyance that happens and not as a personal flaw, other people are more likely to view it that way as well.

3) Negative Labeling of Self. As just indicated above, he needs to think of the anxiety in a different way and not label himself so harshly. Anxiety is a normal emotion. It is a message that we feel threatened in some way. Of course, he is likely to be thinking "I'm weak because I shouldn't feel so threatened in a meeting." However, instead of putting this demand on himself, it would be better to examine how he feels threatened and address it using his self-talk. Just demanding to not feel something is only more likely to make the anxiety more insistant. But listening to the message of the anxiety and then having a plan of action can help manage it better.

How Can This Thinking Be Changed?
"Just because I panicked before doesn't mean I will again. Besides, it wasn't the end of the world--most people didn't notice and those that did only expressed concerned. I don't need to be so hard on myself. I have a problem with anxiety--it doesn't make me weak. Also, I have been learning some ways to calm myself that I can put into practice during this meeting."