# When Panic Attacks

## Metadata
- Author: [[David D. Burns]]
- Full Title: When Panic Attacks
- Category: #books
## Highlights
- Cognitive Behavior Therapy (CBT), because you learn to change the negative thoughts, or “cognitions,” that cause the depression, as well as the self-defeating behavior patterns that keep you stuck. ([Location 116](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=116))
- Anxiety comes in many different forms. ([Location 167](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=167))
- Chronic Worrying. ([Location 168](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=168))
- Fears and Phobias. ([Location 170](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=170))
- Performance Anxiety. ([Location 171](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=171))
- Public Speaking Anxiety. ([Location 172](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=172))
- Shyness. ([Location 174](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=174))
- Panic Attacks. ([Location 177](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=177))
- Agoraphobia. ([Location 181](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=181))
- Obsessions and Compulsions. ([Location 183](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=183))
- Post-Traumatic Stress Disorder. ([Location 186](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=186))
- Concerns about Your Appearance (Body Dysmorphic Disorder). ([Location 188](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=188))
- Worries about Your Health (Hypochondriasis). ([Location 191](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=191))
- There are many theories about the causes of anxiety, but we’ll focus on four of them: ([Location 205](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=205))
- The Cognitive Model is based on the idea that negative thoughts cause anxiety. ([Location 206](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=206))
- The Exposure Model is based on the idea that avoidance is the cause of all anxiety. ([Location 210](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=210))
- The Hidden Emotion Model is based on the idea that niceness is the cause of all anxiety. People who are prone to anxiety are nearly always people-pleasers who fear conflict and negative feelings like anger. When you feel upset, you sweep your problems under the rug because you don’t want to upset anyone. You do this so quickly and automatically that you’re not even aware you’re doing it. Then your negative feelings resurface in disguised form, as anxiety, worries, fears, or feelings of panic. When you expose the hidden feelings and solve the problem that’s bugging you, often your anxiety will disappear. ([Location 214](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=214))
- The Biological Model is based on the idea that anxiety and depression result from a chemical imbalance in the brain and that you’ll have to take a pill to correct it. ([Location 219](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=219))
- Which theory is correct? According to the Cognitive Model, you’ll have to change the way you think. According to the Exposure Model, you’ll have to stop running and confront your fears. According to the Hidden Emotion Model, you’ll have to express your feelings. And according to the Biological Model, you’ll have to take a pill. ([Location 224](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=224))
- All four theories have their advocates. I believe that the first three theories are correct, and I use Cognitive Techniques, Exposure Techniques, and the Hidden Emotion Technique with every anxious person I treat. ([Location 227](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=227))
- I strongly prefer the new, drug-free treatment methods for anxiety and depression. In my experience, they’re far more effective, they work much faster, and they’re also superior in the long run because you’ll have the tools you need to overcome painful mood swings for the rest of your life. ([Location 229](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=229))
- The Cognitive Model is based on three simple ideas: You feel the way you think. When you’re anxious, you’re fooling yourself. Anxiety results from distorted, illogical thoughts. It’s a mental con. When you change the way you think, you can change the way you feel. ([Location 236](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=236))
- Cognitive Therapy* is based on the idea that each type of thought, or cognition, creates a certain kind of feeling. ([Location 250](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=250))
- When you feel anxious, worried, panicky, or afraid, you’re telling yourself that you’re in danger and that something terrible is about to happen. ([Location 262](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=262))
- Once you start to feel anxious, your negative thoughts and feelings begin to reinforce each other in a vicious cycle. ([Location 265](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=265))
- When you feel anxious, you’re telling yourself things that simply aren’t true. ([Location 269](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=269))
- Fortune-Telling. You tell yourself that something terrible is about to happen. For example, if you have the fear of heights and you’re at the top of a ladder, you’ll probably tell yourself, “This is really dangerous. I might fall! ([Location 277](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=277))
- Magnification. You exaggerate the danger in a situation. A man became anxious when he cut himself shaving because he told himself, “Oh, no! It’s really bleeding a lot! What if I have leukemia?” He couldn’t shake this fear from his mind and insisted his doctor check him out immediately. Of course, all the lab tests came back normal. ([Location 285](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=285))
- you can change the way you feel when you change the way you think. The moment you put the lie to your distorted thoughts, your fears will disappear. ([Location 294](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=294))
- Pleasing Others. I should always try to please you, even if I make myself miserable in the process. ([Location 387](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=387))
- Self-Blame. The problems in my relationships are bound to be my fault. ([Location 389](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=389))
- 17. Emotophobia. I should never feel sad, anxious, inadequate, jealous, or vulnerable. I should sweep my feelings under the rug and not upset anyone. ([Location 403](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=403))
- I call this the Acceptance Paradox. Although it’s a Cognitive Therapy technique, it’s also central to most spiritual traditions. For example, St. Paul was an early pillar of the Christian church. He suffered from a “thorn in the flesh.” Biblical scholars don’t know what this weakness was. Some have speculated that it might have been bipolar (manic-depressive) illness, sexual confusion, or stuttering. In desperation, St. Paul prayed to God to remove this thorn. But God ignored his prayers. Finally, the Holy Spirit came to St. Paul and said, “My grace is sufficient for you. For in your weakness, my strength is revealed more completely. ([Location 443](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=443))
- One of the things I really like about Cognitive Therapy is that it complements your spiritual beliefs. ([Location 458](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=458))
- No matter what your religious orientation might be, at the moment of recovery, you’ll suddenly see more deeply into your own spiritual roots. ([Location 458](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=458))
- The Exposure Model works differently. When you’re anxious, you’re always avoiding something that you fear. When you confront the monster you fear the most, you’ll defeat your fears. ([Location 470](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=470))
- I had stumbled across a technique known as Flooding. Instead of avoiding the thing you fear, you intentionally expose yourself to it and flood yourself with anxiety. You don’t fight the anxiety or try to control it, you just surrender to it. Eventually the anxiety burns itself out and you’re cured. ([Location 500](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=500))
- The Hidden Emotion Model is very different from the Cognitive Model and the Exposure Model. It’s based on the idea that “niceness” is the cause of all anxiety. In fact, I sometimes think of anxiety as the “niceness disease.” If you show me a hundred people who are anxious, I’ll show you a hundred of the nicest people you ever met! ([Location 507](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=507))
- When you’re anxious, you’re almost always avoiding a problem that’s bothering you, but you’re not aware of it. You push the problem out of conscious awareness because you want to be nice and don’t want to rock the boat or upset anyone. All of a sudden, you feel anxious and you’re not sure why. You may develop phobias or panic attacks or start obsessing about your family, your finances, or your health. Any type of anxiety can develop, but the dynamic is nearly always the same: You’re upset about something, but you don’t want to admit it. ([Location 515](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=515))
- When you express the feelings that you’ve been bottling up, often your anxiety will disappear. ([Location 522](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=522))
- So now you’ve learned about three powerful ways to defeat anxiety. Cognitive Techniques will help you put the lie to the negative thoughts and attitudes that make you feel anxious and depressed. Exposure Techniques will help you confront the monster that you’ve been avoiding. And the Hidden Emotion Technique will help you pinpoint any hidden conflicts or emotions that you’ve been ignoring and sweeping under the rug. ([Location 588](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=588))
- Anxiety can be frightening, but it’s not dangerous, and the prognosis for improvement is bright, regardless of your score. ([Location 647](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=647))
- Numerous published studies, as well as my own clinical experience, have underscored one important fact: Depressed and anxious individuals who don’t do self-help assignments between sessions usually don’t improve. ([Location 1217](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=1217))
- They have one foot in the water and the other foot on the shore. On the one hand, they desperately want to change their lives, but at the same time, they resist change. For each of us, the reasons for resisting change will be a little different. No matter what the problem is, you’ll always have to give up certain hidden benefits and pay a price if you want to change your life. ([Location 1249](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=1249))
- The Daily Mood Log is based on the idea that when you change the way you think, you can change the way you feel. You ([Location 1274](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=1274))
- If a positive thought is going to change the way you feel at the gut level, it has to fulfill two conditions: The Necessary Condition. The positive thought must be 100% true or nearly 100% true, or it won’t help. Rationalizations and half-truths won’t change the way you think and feel. The Sufficient Condition. The positive thought has to put the lie to the negative thought. Remember, when you change the way you think, you can change the way you feel. ([Location 1373](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=1373))
- There were several keys to her recovery. First, Marsha focused on one specific moment when she was feeling anxious. Second, ([Location 1401](https://readwise.io/to_kindle?action=open&asin=B000GCFVV0&location=1401))