EVENT: I want to attend my friend's wedding but I will have to fly. I'm afraid of flying because I have been having panic attacks and I'm afraid of having one while flying. I know flying is safe and I'm not afraid of that. I'm afraid of feeling trapped, panicking, and not having any help.

EMOTIONS: apprehension, embarrassment, terrified

DISTRESS RATING: 9—feeling desperate

THOUGHTS: “What if I have a panic attack while flying? I can't leave and I will feel trapped which will make my anxiety worse. I will feel out-of-control. What will people think of me?”

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 apprehension, embarrassment, and terror?

ANSWER:

Irrational Beliefs:
1) Catastrophizing. When a person has "what ifs" they are predicting a future outcome that may or may not happen. However, the "what if" itself may actually increase the likelihood of anxiety which in this case could cause a panic attack. This type of "what if" can create a self-fulfilling prophecy in which the catastrophic event (a panic attack) is caused by the worry itself. The belief increases anxiety which increases the likelihood of panic, thus fulfilling the prediction.

However, the opposite can also be true. The more that a person believes he or she can handle having a panic, the less likely it will occur. With catastrophic thoughts of this type it is important to recognize that your thoughts can impact whether you have a panic or not.

Catastropic thoughts are not about something that is happening right now. They are assumptions about the future: predicting a future possibility. The mindful focus on the present can reduce the anxiety about future events. By focusing on what can be done in the present, the anxiety can be reduced.

2) Mind-Reading Others. The belief that other people will think a certain way is an assumption. In this case, the assumption is that other people will have critical thoughts. There are two ways to combat this thinking. One is to recognize that the assumption may not be accurate and the second is to challenge the idea that it matters.

In this situation, for instance, most people know people who have a fear of flying. So, if others have any thoughts about a person having a panic attack while flying, they are most likely to attribute it to a fear of flying. Some people, then, are likely to act by trying to comfort and reassure whereas others may not even notice because they are focused on something else.

Of course, some people may have critical thoughts. But if they do, what does it matter? Usually, if people are critical, it is only a demonstration of their own lack of empathy and concern for others. Why be concerned about what such people think?

3) Emotional Reasoning. Based upon the thought "What will people think of me?" this person is making an assumption that feeling out-of-control means losing control. Those are two very different things. Emotional reasoning is the belief that what you feel is true. In this situation, it is the belief "If I FEEL out-of-control, I will BE out-of-control." However, that is not always the case. In fact, for the majority of people with anxiety, and even panic, their anxiety is not evident to other people. What this means is that they can't possibly be out-of-control if other people do not notice anything unusual.

The other issue in this situation is that even if a person is out-of-control, what is likely to happen? Most likely the flight attendant will recognize the person is anxious and do something to help.

How Can This Thinking Be Changed?
"Maybe I'll have a panic attack. Maybe I won't. However, what I do know is that the more I worry about having a panic, the more likely it will occur. Instead, I'll focus on using my anxiety management skills. I can focus on practicing and preparing myself before I fly. Also, I know most people are unlikely to be critical of me just for being anxious while flying. That is not such a terrible thing in the whole scheme of things. If I do get anxious, I know I can handle it. I have before. Just because I feel out-of-control, doesn't mean I am out-of-control. The worst case is that I will be uncomfortable for a while."