7 Questions That Will Help You Overcome Anxiety, Fear and Panic

Anxiety, fear and panic are associated with irrational thoughts involving themes of threat or danger. These irrational thoughts take the form of “if” or “what if” beliefs. For example, a person who is afraid of heights may think, “If I am on the elevator alone and it gets stuck, no one will be able to save me,” or a person with panic disorder may believe, “If my heart beats too fast, it means that I am probably having a heart attack.” The “if” and “what if” thinking in anxiety disorders is a byproduct of your irrational thought patterns, including magnification, catastrophizing, overgeneralizing, and “should” and “must statements.” Sometimes anxiety is a result of genuine problems or situations that have no solutions. The seven questions that you ask yourself to overcome anxiety are as below:

1. What is the likelihood of this happening?
2. What is the evidence supporting my prediction?
3. What are some other ways to look at this based on facts?
4. Based on facts, what can happen most realistically?
5. Can I cope with the most realistic outcome?
6. If this is a genuine problem, can I problem-solve?
7. Is it time to accept?

What is the likelihood of this happening?

Individuals with anxiety or panic overestimate the probability of a threat or a bad outcome in a particular situation. Overestimating the probability involves irrational thought patterns of overgeneralizing (e.g., if it has happened one time over past several hundreds of times, it can happen again), jumping to conclusion (e.g., it will happen despite no evidence to support it or evidence to the contrary), or “should”/“must” statements (e.g., it will happen because you have a rigid rule about it). For example, a person with panic disorder may feel that they will faint, if they feel dizzy. However, they may have never fainted before during a panic attack, but their irrational thinking makes them overestimate the probability of fainting. Another common irrational thought in people with panic disorder is that they will have a heart attack if their heart is beating quickly, even though they may not have any history or risk factors of heart disease and their faster heart rate could be explained by several alternative explanations such as doing physical work, drinking coffee, or just being excited.

Other questions you can ask yourself to challenge this faulty overestimation are as below:

• “What are the odds of this happening?”
• “Realistically, how likely is this situation going to happen?”
• “How often has this happened to me in the past?”
• “How often have I seen this happen to others?”
• “Am I overestimating the likelihood of this situation to happen?”

What is the evidence supporting my prediction?

This question is particularly helpful to quell your catastrophic thinking about the severity of consequences of a situation. In catastrophic thinking, you believe that a particular outcome will be unmanageable and at the same time underestimate your ability to manage the outcome. Related irrational thought processes are “awfulizing” and “I-can’t-stand-it-it is.” Examples of catastrophic statements include the following:

• “If I have a panic attack in a movie theater, it would be a disaster.”
• “It would be absolutely terrible to faint.”
• “I couldn’t manage if I were to panic on an airplane.”
• “If I lose my job, it would be a complete disaster.”
• “I must do everything I can to avoid experiencing a panic attack or else something horrible will happen.”
• “I would not be able to manage if I were to have a panic attack at work.”
• “If I have a panic attack, I would not be able to cope.”

One of the most important ways to challenge your catastrophic thinking is to look for evidence to support your worst-case scenario prediction. It is easier to identify irrational thoughts if you change the “what if” statement to a definite statement. For example, “What if the elevator runs out of air?” would be reframed as, “The elevator is going to run out of air.” Then ask yourself, “What is the evidence supporting my prediction?” 

Other questions that you can ask yourself are as below:

• “Am I predicting that a particular situation will be more catastrophic or unmanageable than it actually is?”
• “Do I know for sure if my prediction will come true?”
• “If I have made similar predictions in the past, how often have they come true?”
• “Do I have any proof that this situation is as dangerous as it appears?”
• “Will I still think about this situation a month, 6 months, year, or five years from now?”
• “When I think that I would not be able to cope, what does ‘not be able to cope’ mean?”
• “Have I ever actually lost control before?”
• “Based on my past experience, what is the worst thing that will happen?”
• “What does my past experience tell me about the likelihood of this happening? 
• “Am I underestimating my ability to cope with this situation?”

What are some other ways to look at this based on facts?

Another strategy that complements the previous approaches to challenge your underlying irrational anxious thoughts is to find more plausible explanations for the situation, thought, body sensations, or image that is causing you to feel anxious or fearful. For example, increase in heart rate may be due to several other factors such as climbing up a flight of stairs. A person who is anxious about making a presentation may arrive at another way to look at this if they tell themselves that people don’t care about how one appears during a presentation. Similarly, a person worrying about their spouse being half-hour late coming home from work can alternatively interpret this as their spouse either leaving work late or being stuck in traffic. It is not unusual for individuals with anxiety to jump to conclusions and arrive at the most fearful scenarios to explain an uncomfortable situation while ignoring the most common possibilities that may explain that situation. 

Based on facts, what can happen most realistically?

The next step in your effort to change your irrational anxious thinking is to pause, assimilate all the information you have gathered so far, and come up with the most realistic outcome for the situation that you predicted as dangerous or awful. Ask yourself, “Given the information I have now, what is the most realistic outcome in this situation?” If you are still convinced that the worst-case scenario is the only plausible outcome, then either you may have to dig deeper to challenge the anxious thoughts or you may have some underlying rigid assumptions or negative core beliefs (e.g., all dogs are dangerous or no one likes me). In addition, it takes practice and repetition to be able to successfully identify, challenge, and change irrational thoughts. You have had these thoughts for years and they are not going to change overnight. 

Can I cope with the most realistic outcome?

Once you have arrived at the most realistic outcome, ask yourself if you are able to cope with it. Most people with anxiety disorders underestimate their ability to manage an anxiety-provoking situation. Coping not only involves your internal resources, but also external resources such as getting help from friends, family, or support group members, and seeking advice from healthcare professionals. Ask yourself:

• “How have I coped with this before?” 
• "What other resources are available to me to cope with this situation?" 

If this a genuine problem, can I problem-solve?

Genuine problems such as not being able to pay your bills on time or not knowing how to go about furthering your education can also lead to anxiety and are best addressed by problem-solving and not by cognitive techniques such as challenging your irrational thoughts. The problem-solving steps are described next:

• Define the problem in clear and specific behavioral terms, i.e., what specific behavior needs to be addressed or changed. You will be able to generate better solutions for a specific problem such as, “I have been postponing paying my bills for last two weeks and feel overwhelmed whenever I try to do that” versus the vague problem, “I can’t get anything done.” To get the specifics of a problem, describe it in terms of: Who? What? When? Where? Why? and How?
• Define your goals in addressing the problem – what is your desired outcome? Goals are often stated beginning with the phrase, “How can I …?”
• Brainstorm possible solutions to the problem. When brainstorming solutions, generate as many solutions as possible, don’t analyze or judge the possible solutions at this stage.
• Weigh pros and cons for each solution.
• Pick one solution and implement it. Sometimes a combination of solutions may work better as they complement each other.
• Evaluate the effectiveness and make changes to your approach, if needed.

Is it time to accept?

At other times, there may not be a solution to your problem that is contributing to your anxiety and you may have to switch to an acceptance mode. For example, a person who finds out that their loved one has a terminal illness. Mindfulness-based strategies offer a way of acceptance to manage anxiety related to these situations. 

These strategies have been excerpted from the book The Complete Guide to Self-Management of Depression: Practical and Proven Methods.

HARPREET S. DUGGAL, MD, FAPA