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. How does one then decide to challenge one's irrational thinking or problem-solve, or try acceptance strategies? The seven questions that will help you guide your decision to choose one path over another to overcome anxiety are as follows: 

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 the 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 follows: 

• “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 invaluable to quell your catastrophic thinking about the severity of the 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 evidence supports 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, a 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 causing you to feel anxious or fearful. For example, an increase in heart rate may be due to several other factors, such as climbing up a flight of stairs. A person 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 a 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, and come up with the most realistic outcome for the situation you predicted as dangerous or awful. Ask yourself, “Given the current information, 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 successfully identify, challenge, and change irrational thoughts. You have had these thoughts for years; they will not change overnight.

Can I cope with the most realistic outcome?

Once you have arrived at the most realistic outcome, ask yourself if you can cope. Most people with anxiety disorders underestimate their ability to manage an anxiety-provoking situation. Coping involves both your internal and 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 is 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 include defining the problem, defining your goals in addressing the problem, brainstorming solutions, weighing the pros and cons for each solution, implementing the solution, and evaluating the effectiveness of the solution.

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. An example of such a situation would be a person who finds out that their loved one has a terminal illness. Acceptance means accepting the unwanted thoughts and feelings associated with a difficult situation without trying to avoid them, getting rid of them, dwelling on them, judging yourself, or acting upon them. Acceptance doesn't mean that you have accepted defeat or resigned to your fate; it means that you have stopped struggling with uncomfortable thoughts and feelings, allowing you to direct your life to something meaningful. Mindfulness-based strategies offer a way of acceptance to manage anxiety in such unfortunate situations where the usual control strategies (e.g., problem-solving or changing your thinking) may not work.

To learn more about evidence-based self-management techniques that are proven to work for depression, check out Dr. Duggal's Author Page.

HARPREET S. DUGGAL, MD, FAPA