The Cycle of Panic in Social Anxiety Disorder

Panic attacks may come on suddenly.

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If you suffer from social anxiety disorder (SAD) you might have experienced what is known as a panic attack.

A panic attack is a period of intense fear accompanied by symptoms such as a racing heart, shortness of breath or dizziness. When people who have SAD experience panic attacks they are generally triggered by social or performance situations. To understand why panic happens, it is helpful to look at the cyclical pattern of events that leads to panic.

Initial Feelings

Imagine that you are sitting in a meeting at work. Although the situation might seem harmless, being in a position where you have to speak in front of others or voice your opinion might make you feel a little uneasy. The situation is known as the "cue" and is what triggers the first stage of the panic cycle.

As you sit in the meeting, perhaps you notice your heart starting to beat a little fast. Maybe you have a thought such as "I have something to add to what is being said, but I am afraid of what the others will think." You might even find yourself starting to breathe a little bit more rapidly and shallower than you normally would.

Interpretation of Sensations

As you notice the sensations in your body, you start to experience even more symptoms.

Your interpretation of what is happening contributes to the escalation of your symptoms of panic.

As your heart beats even faster and hands begin to shake, you wonder if anyone else in the room has noticed your anxiety. These thoughts fuel even more symptoms of panic.

Escalation of Panic Symptoms

If you are called upon to speak in the meeting, or if your name is on the agenda to present during the meeting, your symptoms might escalate to the point of a full-blown panic attack.

During the panic attack, you might experience things like a racing heart, shortness of breath, shaking hands, dry mouth and feelings of impending doom.

As you look around the room you are sure everyone must notice your anxiety and be thinking badly of you. You may even think you're having a heart attack, which then worsens your symptoms.

Anticipatory Worry

After you finish speaking or after the meeting ends, you probably feel exhausted and drained. You might feel relieved that the episode is over, but also worry about similar situations in the future.

You will probably ask yourself questions like, "How will I cope with our next meeting?" or, "Will I fall apart if I have to speak in front of the group again?" These types of thoughts about being unable to cope and worrying about future situations set up the anticipatory stage of the panic cycle.

Coping With Panic

During the anticipatory stage of panic, you start to worry about future events and situations where you might experience similar symptoms. You remember how you could not cope in the past when you had to present in a meeting, and wonder how you will ever get through it again. The anticipatory stage continues until the next triggering situation.

Although it might seem like it is impossible to escape the cycle of panic symptoms, there are effective treatment methods that address the negative thought patterns that keep the cycle going.

It is not the situation that triggers the reaction in your body; it is the thoughts that you have about the situation. Treatment methods such as cognitive-behavioral therapy (CBT) can help you to learn better ways to talk to yourself so that panic can be avoided.

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  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author; 2013.
  • Carbonell D. The panic attacks workbook: A guided program for beating the panic trick. Berkeley, CA: Ulysses Press; 2004.

By Arlin Cuncic
Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety."