As you begin to observe your levels of fear (on the 0 to 10 scale), you will notice that those levels are not constant. Your anxiety, in fact, goes up and down. You may begin to notice that the fear goes up when you are concentrating more on your most frightening thoughts and bodily reactions.

It would be helpful to notice your level of panic, and also listen carefully to the messages you are sending your¬self about your symptoms. It may be very normal to have some level of tension in certain situations, like having to give a speech or getting on an airplane. However, the difference between feeling an anxiety level of 1 or 2 in some situations and a level 10 in others can be the result of your own thoughts. If you predict that a catastrophe will occur, or that you will be unable to cope, or that you will need to escape, your fearful feelings will intensify. Catastrophic thinking causes people with panic attacks to misinterpret anxiety symptoms as being dangerous.

Fortunately, there is another more rational voice always with you. By focusing on this reassuring voice, you can bring a level of 10 back down. We call this voice the “Rational You.” The Rational You “thinks” its way through life’s events evaluating the degrees of safety versus danger involved. It can reassure and comfort you when you are okay. What happens to this part of you in panic situations? It gets pushed aside when you focus on the anxiety sensations and misinterpret them as dangerous.

In order to strengthen the Rational You, examine the specific thoughts that increase your feelings of panic and deliberately try to develop alternate ways of thinking. This is called rational responding, or decatastrophizing.
For example, the thought, “I am going crazy” might be replaced with, “I am just experiencing physical symptoms. I have no reason to think I’m going crazy.” “I’m going to faint” could be replaced with, “I’ve never faint¬ed before and there is no evidence that I’m going to now.” Adding those soothing words and phrases that you have developed, such as “relax,” “it will pass,” “it’s just my heart beating — I’m not dying,” as well as slow, gentle breathing exercises will also help.

Carry your First Alert Card with your catastrophic predictions on one side and your rational responses on the other. Before entering a situation where you think panic might occur, read the card and focus on the rational response. When you are plagued with catastrophic thoughts, talk to yourself as objectively as you can. Do you have any evidence to support those thoughts that disaster might happen? Is there any other way you could view the situation? This exercise will usually allow you to see that you have been concentrating on the worst possible, but by no means the most likely, outcome.

You can also try what is called “here and now” focusing. Allow your awareness of panicky thoughts to recede and, instead, concentrate intently on what is around you. Pay attention to the colors, sights, smells, sounds, and tasks at hand. When panic thoughts intrude, use them as reminders to refocus your attention on the actual situation.

Stay focused on what you are feeling now — “I feel my heart beating,” for example, rather than “I am going to have a heart attack.” Stay attuned to the situation, rather than to your fear of what may be about to happen.

People who develop extreme fear reactions sometimes label every feeling they have as anxiety. This is another error in logic or judgment. See if you can identify feelings other than fear or anxiety when you are experiencing discomfort. Perhaps you’re excited, sad, lonely, angry, or disappointed. Ask yourself, “What would I be feeling right now if I weren’t feeling anxious?”

Another way to say this is, “What else am I feeling underneath my fear?” If those other uncomfortable feelings are due to something other than anxiety, you may be able to work on solving the other problems or accepting some of those feelings as normal parts of being alive.

Differentiating anxiety from fatigue, hunger, or your physical response to caffeine, heat, or humidity can reduce the potential of panic attacks. (This is called reattribution.) Some people are afraid to feel intense emotion and get anxious if they are very sad, angry, etc. The more you begin to identify and get comfortable with your entire range of emotions, the less scary and more manageable all your emotions will become.

Many of our irrational thoughts spring from basic beliefs about ourselves, especially, and about others as well. These beliefs usually come from childhood and are very deeply ingrained. If unexamined, these beliefs may cause you to dismiss or discount the Rational You.

Several studies—ranging from those conducted on people with normal anxiety in a laboratory, through uncontrolled studies of patients suffering from various kinds of Anxiety Disorders, to controlled studies of patients with Anxiety Disorders or depression—have shown that exercise decreases anxiety. In one uncontrolled study, agoraphobics were asked to run “at their best speed.” Running produced increased heart rate, rapid breathing, sweating, and, in some, trembling— all symptoms these patients associated with anxiety or panic. Having been given a physiologic experience of and explanation for these “panic” symptoms, they were asked to enter the situations they had been avoiding and did so without experiencing panic. It may be that all that the exercise contributed to treatment was a rationale that allowed these patients to perform effective exposure therapy.

Laboratory studies of both normal individuals and those with Generalized Anxiety Disorder who exercised vigorously on a treadmill showed that anxiety decreased substantially after exercise and remained decreased for three to five hours.

Several controlled studies of exercise used to treat mild to moderate depression have shown that anxiety measured on standard self-report questionnaires, as well as depression, decreased and remained at lower levels after exercise. Whether this was a direct effect on anxiety or a result of reduced depression was not clear.

Many questions arise regarding the kinds of anxiety that might benefit from treatment with exercise, the amount of exercise needed (in terms of frequency, intensity, and duration), and the likelihood of relapse when exercise is stopped. Not everyone can undertake an exercise program and not everyone would wish to do so. Exercise is clearly an experimental treatment of Anxiety Disorders at this time and cannot be prescribed with confidence for any specific disorder. Older people considering exercise should obtain clearance from their physician to check for risks of cardiovascular and other medical problems. Anyone beginning an exercise program should start gradually in order to lessen the likelihood of ordinary muscle and joint aches and pains that are so common in those taking up exercise for the first time or after a period of inactivity.