CBT to Manage Panic and Intrusive Thoughts

Reader’s Question

I’ve been dealing with mild anxiety my whole life. I’ve had a couple major panic attacks, one when I was 12 and the other at age 23. I was able to overcome those, but for some reason I’m experiencing some anxiety lately that feels very different. I’ve had to deal with numerous stressful issues (death, car accident, etc.) and in May I had to get an MRI in a closed machine. This triggered 5 panic attacks while on the machine. Ever since then I haven’t been the same. I’ve started having nightly panic attacks. My chronic anxiety is also at an all time high, constant worrying about stuff I didn’t worry about in the past, zero (AND I MEAN ZERO) stress tolerance, off and on depression, crying episodes, and the craziest intrusive thoughts you can imagine — including violent stuff towards family and even strangers walking down the street. These thoughts are very random and come out of the blue.

Can you please explain why people who suffer from anxiety suffer from this? I would think a lot of suffers have them but are to ashamed to express them. The ones I’ve had are very scary, and generally I’m one of the most quiet, shy, soft-spoken persons you’d ever know. Can you please tell me anything about these intrusive thoughts and why people have them? I’ve tried some meds but don’t believe in them. I believe they do more harm then good.

Our Clinical Psychologist’s Reply

Anxiety sometimes increases in intensity when it accompanies depression. And events high on the life stress scale (especially an injury, accident or death) can precipitate a depressive/anxious episode. Symptoms can become quite distressing and bizarre, including unwanted and intrusive thoughts of harm to self and/or others.

It’s also normal to have a good deal of anger and/or fearfulness with respect to the stressful events that have occurred. However, fear and anger also have the potential to fuel and intensify cycles of anxiety.

The good news is that the non-chemical therapy best suited to treat anxiety (cognitive-behavioral therapy or CBT) is also the non-chemical treatment of choice for depression. A mental health professional who specializes in this type of therapy and in the treatment of anxiety and depression would be the best person to consult. Sometimes, medication is recommended as an adjunctive or temporary intervention. But CBT principles and techniques have more than proven their value and effectiveness in dealing with anxiety and depression.

Even before you see someone, you can begin working on cognitions that inadvertently fuel heightened anxiety and the more bizarre symptoms. When you find yourself talking (even self-talking) about “zero” stress tolerance and “every night panics,” try changing the words slightly (even if you don’t really believe in what you’re saying when you change the words) to less extreme words such as “much reduced” stress tolerance and “anxious nights.” Ratcheting-down the pitch of your anger, fear, and distress can go a long way toward breaking the ever-escalating cycle of anxiety and the distressing symptoms that sometimes accompany it.