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Panic Disorder; The Phobia of Bodily Sensations

by Dr. Blumberg on November 14, 2010

*After the first attack strike, panic disorder patients become sensitized to natural normal bodily sensations of adrenaline.  See the list of common sensitized bodily symptoms below;

A List of the Top Ten Sensitized Bodily Sensations

1)      Heart pounding

2)      Shortness of breath

3)      Lightheadedness

4)      Weakness

5)      Rubbery legs

6)      Numbness and tingling in the hands and feet

7)      Dry mouth

8)      Lump in the throat

9)      Chest pressure

10)    Head pressure

Don’t be alarmed if you do not see your symptoms on the above list.  I have catalogued well over 60 panic attack bodily symptoms in my Encyclopedia of Symptom Checklist. Use the Comment Form below to share your particular panic attack symptom profile with me.

Even after you break the false link between your panic attack symptom (heart pounding) and your false catastrophic thought (heart attack), a residual fear of the bodily symptoms e.g. heart pounding sensation itself remains.

How Do You Remove the “Fear of Fear”?

The History of the “Fear of Fear” Concept

Dr. Claire Weekes, a pioneer in the field of panic disorder, originated the idea of “Fear of Fear” in her famous work “Hope and Help for Your Nerves.” She encourages “floating with the bodily symptoms.”  Dr. Joseph Wolpe, in his breakthrough classic, “The Practice of Behavior Therapy”, applied his systematic desensitization model for phobias to the bodily sensations of panic disorder.  He saw the bodily sensation as fear stimuli no different than the fear of a dog. You would then develop a heart pounding phobia.  The unique aspect of panic disorder is that when you fear your bodily symptom, heart pounding, the heart pounding symptom intensifies.  When you show fear reactions to a dog, the dog does not instantaneously grow bigger with sharper teeth right before your very eyes!  Claire Weekes calls this vicious cycle “Fear-Adrenaline-Fear.”

The basic principle of Wolpe’s Fear Reduction Model is gradually approaching the fearful stimuli, heart pounding and creating a calming counter response (counter conditioning) to diminish the fear reaction to heart pounding.

Dr. David Barlow’s Interoceptive Exposure Procedure

Dr. David Barlow, a renowned clinical psychologist and researcher at Boston University’s Center for Anxiety and Related Disorders (CARD), popularized the procedure he terms Interoceptive Exposure. In chapter 10 of his book with Dr. Michelle Craske, “Mastery of Your Anxiety and Panic”, the doctors outline a series of exercises designed to produce the very bodily sensations you fear most.  For example, if your primary feared symptom is dizziness, the exposure exercise might be spinning in a chair to produce the dizzy feeling.  The most critical component in these exercises, is your reaction to the production of the dizzy feeling.  If you run, distract yourself and try to eliminate the feared dizzy feeling, you sensitized yourself further to the dizzy feeling. Your panic attacks can worsen. I find extensive preparation in facing the physical feeling of panic attacks without the secondary fear reaction is necessary for a positive therapeutic effect.  Also, these exposure exercises must be executed repeatedly over time to lessen the fear of the bodily symptoms.  We call this principle “repeated exposure to habituation.”

Furthermore, many of my panic attack patients have shown no fear reaction to the simulation of panic attack symptoms through exercises in the office.  The knowledge that a specific exercise caused the panic attack-like symptom was enough to remove any fear of symptoms like heart pounding and dizziness.

panicLINK’s Approach to Removing the “Fear of Fear.”

The Use of Naturally Occurring Panic Attack Symptoms for Bodily Desensitization

Over the span of three decades of clinical practice, I developed a Six Step takeControl Training method designed to gradually reduce the fear of normal bodily sensations.  At the beginning of training, panic attack sufferers, often, naturally experience panic attack symptoms in the office. These natural in-office panic attack symptom productions offer ripe opportunities to practice feeling the panic attack symptoms without fear.  By tracking panic attacks with the panicLINK log, circumstances that reliable trigger panic attack symptoms outside the office are also uncovered.

The Panic Attack Symptom Orientation Scale

Next, panic disorder patients evaluate their Panic Attack Symptom Orientation using a Symptom Orientation Scale. The scale ranges from -10, which indicates “I dread my symptom” to =+10, which indicates “I love my panic attack symptom.”

Panic Attack Symptom Encounter Readiness Assessment

Next Symptom Encounter Readiness is evaluated through anticipation of experiencing a panic attack symptom in a specific panic triggering situation. My panic attack patients are already dreadfully imagining a terrifying panic attack symptom encounter.  This anticipatory exercise provides a rich opportunity to rehearse a powerful Six  Step Method of taking control of panic attacks in advance of a the panic attack symptom encounter. Through repeated in-office rehearsal, all the incorrect reactions and misunderstandings are cleared up prior to positive symptom practice encounters outside the office. Finally, specific audio instructions are recorded in an audio program designed for daily home practice.

Preview the Complete panicLINK Program

The exact 12 Session Four Phase multimedia (4 learning components for each session) panicLINK Program I personally delivered to over 6000 panic patients in my Boston office is now available for review at the home page of

*This educational information should be used in consultation with your doctor to confirm a diagnosis and to review available treatments for panic disorder.

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