The Domino Effect: From Panic Attack to Phobia

by Mark Sichel

A patient dealing with panic attacks talking to a therapist.

Panic attacks are usually a fearful response to internal feelings, wishes and ideas that we unconsciously feel will put us into danger. One of the major problems with panic attacks is that when people are unable to identify the internal source of their fear, they learn to associate the attack with an external situation. This is how a panic attack can turn into a phobia.

For example, John has a panic attack in the theatre while sitting in the balcony. He then associates his anxiety with theatres and balconies. John had a panic attack, and now has a phobia of theatres and balconies. Sally, who is an experienced and frequent flyer, has a panic attack one day during a turbulent flight, and becomes a phobic flyer.

John and Sally's experience is called anticipatory anxiety. When anticipatory anxiety becomes linked to a place, person, or a situation, the panic attack becomes a phobia. This is one reason why it's so important to deal quickly and effectively with your panic. Anything you might experience can become linked to panic in your mind, and you might respond by avoiding that situation to control the panic and prevent them from reoccurring.

The most important thing to understand is: Your panic attack has meaning. In each instance, try to understand what it was about the given external stimuli or events that triggered the internal fears that caused your panic attack. Sally learned that she needed to slow down, change her travel schedule, and devote more attention to herself and her family. It wasn't the flying that Sally was afraid of, being on the plane simply triggered her deep-seated internal fears that she was "abandoning" her family.

John was a creative and gifted college student studying psychology who wanted to be involved with the creative arts. Watching the show ignited for him a rage, helplessness and lack of control that he eventually channeled into a shift in his college studies to the arts. It wasn't the theatre that John was afraid of, being in the theatre simply triggered his internal fear that he would never pursue or realize his dreams.

Sally and John were able to examine their panic attacks and make changes in their lives that not only eliminated the panic attacks, but also made them happier overall.

Your panic attacks are a message from your unconscious. They are a symbolic representation of messages you need to give to yourself. Our psyches are purposeful and they're creative. Panic attacks are a message: we need to understand, express and face parts of ourselves that we don't necessarily like or understand. Even if the message is "right now I want to be a baby, take a break from adult life, and be cared for," it's a message we should heed.

Mark Sichel, LCSW is a psychotherapist in private practice in New York City and a Licensed Clinical Social Worker. Mark is the author of Healing from Family Rifts, a guide to mending even the most difficult family estrangements, and how to reconcile with yourself if your family rift cannot be healed. More information can be found at Visit the author's web site at

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