It is a common experience of psychotherapists that a client with panic disorder would not go for professional help after she or he had his first "panic attack". Most clients only recognize the physical symptoms and think of some sort of virus infection, heart problems or other possible somatic reasons. Some of them might call a doctor and ask for a complete physical exam.

But usually the panic attack will reoccur. This can cause very typical changes of behaviour and attitudes of the client.

"Triple A"

• Avoidance

  Very often a person should try to "identify" possible influences of the environment or any activities that seem to trigger (cause) the onset of the anxiety. Typical examples could be riding in a bus or train, being in elevators or shopping-centers, having an unaccompanied walk in the city. Clients very often have a fear "to lose control", to be alone and without any possible help by someone else. The clients try to avoid these situations, which seem to be "dangerous" or cause severe discomfort for them. Sometimes they use a little "help" to find good excuses not to face these triggers of their anxiety or might ask someone to come with them ("just to feel safe").

  Temporarily the fear might be less severe for the person, if the specific situation is avoided. But it does not keep the attacks from happening.

• Anticipatory anxiety

  Once clients recognize that the panic attacks could happen again without control they are very much concerned about any future anxiety symptoms. Now the anxiety is already triggered by merely thinking about the possibility of having another panic attack. This causes additional stress and tension in the patients.

  Many clients try to change their behavior in a very restrictive way and try to do everything to decrease the risk of further attacks.

• Agoraphobia

  Often occurs in combination with panic disorders (but also without those). Agoraphobia is the fear of being in places or situations from which "escape" would be impossible or difficult (embarrassing). Many people are concerned about the loss of control or are frightened by merely thinking of a sudden loss of consciousness without any help. They try to stay at home or in "safe" places and may only dare to leave home accompanied by someone.