From one panic attack to a phobic disorder: what people with panic and phobias have in common
“The cave you fear to enter holds the treasure you seek.”
Do you suffer from panic attacks or high anxiety?
Did you know that this can be effectively treated with Brief Strategic Therapy (BST), a model that has shown over 30 years of clinical effectiveness in the treatment of phobias and panic attacks, often in a relatively brief period of time?
The single panic attack
A panic attack is usually characterised by a sudden peak of intense anxiety, where the person experiences sensations such as feeling they are going to die, lose control of their body, faint, or “go crazy”.
It is an extremely strong and distressing experience, often leading to significant fear and avoidance. Over time, the initial fear of the panic attack itself can shift and become the fear of having another panic attack.
While anyone can experience a panic attack, there are certain patterns commonly seen in people who go on to develop a panic disorder.
The key issue is often not the first panic attack itself, but what the person does in response to it afterwards. These are typically the main “attempted solutions”:
In some cases, the first panic attack is linked to a specific trigger — a place, object, situation, or bodily sensation. In other cases, no clear trigger can be identified.
The traps of the panic attack
After this first experience, when a trigger is recognised, for example leaving home, being in enclosed spaces, or speaking in front of others, the person begins to avoid these situations in order to prevent another panic attack.
In other situations, when avoidance is not possible, another strategy is used: help request and reassurance or the presence of others. This may involve asking someone to accompany them or help them face the situation, so that they do not have to face it alone.
When neither avoidance nor reassurance is possible, the person is left with only one option: trying to control their bodily reactions in order to prevent the panic from escalating. This includes attempts to slow the heart rate, reduce palpitations, control breathing, manage sweating, or ease chest tightness, along with internal instructions such as “calm down”, “breathe”, or “stay in control”.
These three strategies — avoidance, reassurance-seeking, and control — are the attempted solutions, or psychological traps, that are put in place in an effort to manage the initial fear, but which ultimately maintain it or worsen it.
I will explain why they do not help in the long term.
Why these solutions don't work.
Each act of avoidance confirms the perceived danger of the situation and reinforces the sense of incapacity. The more incapable a person feels, the more fear they experience when facing the situation again, and the more likely they are to avoid it. As Fernando Pessoa wrote, “We carry within us the wounds of the battles we avoided.”
Similarly, each request for help reinforces the belief of not being able to cope alone, producing the same effect: increased fear and decreased confidence over time.
The obsessive component is linked to attempts to control bodily functions. In trying to stop the escalation of anxiety and its physical symptoms, the paradox emerges: the more control is exerted, the more control seems to be lost.
Like someone carefully carrying out a fine, precise job — and another person constantly poking them, interrupting, checking, and interfering every few seconds, each attempt to control the body during anxiety ends up disrupting its natural balance rather than restoring it. The more interruptions there are, the harder it becomes to complete the task properly.
Paul Watzlawick described what he called the “be spontaneous” paradox: the idea that the more we try to force something that should happen naturally and spontaneously, the less natural it becomes. In other words, when we consciously try to control a process that works best automatically — such as calming down, sleeping, relaxing, or “not feeling anxious” — the effort itself often interferes with the very thing we are trying to achieve.
From the panic attack to a phobic or anxiety disorder
All of this reflects what happens when these attempted solutions are repeatedly used. The result is typically increased anxiety, a stronger sense of incapacity, and greater avoidance. Over time, this is how the problem becomes stabilised and develops into a disorder.
This is, in fact, the mechanism through which a proper phobic-obsessive disorder is developed.
In other words, the problem is often not the panic itself, nor the original trigger or first symptom, but the way the person responds to it afterwards — the attempted solutions that unintentionally perpetuate it and gradually transform it into something more structured, persistent, and limiting.
This is why looking for the original cause, or for what triggered the first symptom or sign of the problem, is often less relevant than understanding the traps that have developed afterwards and are now maintaining the disorder.
Avoidance, help-seeking, and attempts to control bodily reactions are understandable responses, but they function as attempted solutions that, instead of resolving the problem, keep it alive and often create an additional layer of difficulty on top of the original fear.
The way through
Interrupting this progression from isolated panic attacks to a structured phobic or obsessive pattern requires stopping the mechanisms that maintain it.
Brief Strategic Therapy offers a well-established and highly effective protocol for treating panic attacks and phobic-obsessive disorders in a relatively short period of time.
If this feels familiar, it may be a sign that you’re caught in a cycle that can be understood and changed, rather than something you simply have to manage alone. If you’d like support in breaking this pattern, feel free to reach out.
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