Preventing Panic Attacks: The… | Counseling | Therapy

Preventing Panic Attacks: The Anxiety Scale

Shannon Oliver-O'Neil , LCSW — Therapist, director of intern program, director of rhode island office

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Preventing Panic Attacks: Anxiety Scale

Many people with anxiety can describe exactly what a panic attack feels like. Your heart feels like it’s racing a million beats per minute, you can’t get enough air, you get sweaty or nauseated. You know you would do whatever it takes to avoid having a panic attack. But many people have trouble accurately identifying the warning signs of a panic attacks early enough that there is still time to prevent the panic attack from happening. The following exercise can help you do exactly that.

Create a Scale

Take a piece of 8.5”x11” paper and draw a line down the middle vertically. Put a “10” at the top of the line and a “1” at the bottom, then fill in the rest of the numbers so that you have a scale from 1-10 in the middle of your paper. Label the left side of the paper “memories”, and the right side “symptoms”


Think about one of the worst panic attacks you’ve ever had. In the memory column next to number 10, write a brief descriptor. For example “panic attack in 2015, at mom’s house, when we were supposed to go to church.” Just enough information to remind you about the memory.

Then go all the way down to number 1. Think about one of the most calming memories you have. Write a brief descriptor of where and when you were, and what was happening.

Go back to number 5. Using your Number 10 and Number 1 memories as anchors, think about a specific time where you felt about halfway between your worst panic attack and your calmest moment. Write a brief descriptor of where and when you were, and what was happening.

Do this for the rest of the numbers on your anxiety scale.


Following the same order as you filled in your memories, write down as many physical symptoms as you can remember for each number. Focus on your heart; your breath, muscle tension especially in your hands, neck and shoulders; nausea or bowel movements; body temperature; your ability to focus and the speed of your thoughts; any repetitive movements or activities (ring twisting, pacing, foot jiggling, etc); changes in appetite; changes in vision; and any feelings that pop up or change in their intensity. Many people, for example, find that irritation or anger can be present during or immediately prior to a panic attack.

Use as much detail as you can while filling out symptoms for each spot on your anxiety scale.


  • What “tells” do you tend to have when you’re feeling panicky or anxious?
  • Which numbers were easy to fill in? Which were difficult? What does this tell you about when you tend to “tune in” to anxious feelings?
  • Looking at the symptoms you listed, what number is usually “the point of no return”? I.e. once you hit this level of anxiety, it’s almost inevitable that you will have a panic attack?
  • At which point on the scale do you typically notice that you’re feeling anxious? How close is this to “the point of no return?”

Put it to Use

Remember that it’s likely you’ll experience another panic attack at some point in your life- no matter how well we take care of ourselves, we can’t control for all variables. Remember too that having a panic attack, while unpleasant, is not the end of the world. You can’t die from having a panic attack, even if it feels that way sometimes. The Anxiety Scale is meant to help you manage and prevent panic attacks to increase your quality of life and decrease the impact they have on your job, school or relationships.

Set an alarm for 9am, 12pm and 6pm

When the alarm goes off, check in with yourself to see where on your anxiety scale you fall. Keep a little log with the level of your anxiety, and any physical symptoms. Being able to notice anxious feelings before you reach the point of no return is key to managing panic attacks. Make a habit of noticing when your anxiety level exceeds a “3”, and utilizing one of your coping tools. By doing so, you can get in the habit of soothing yourself and managing your anxiety levels before it’s too late.

If you don’t have any coping tools, or have trouble putting the Anxiety Scale to use, make an appointment with a therapist today.

At TCFG you can schedule directly online with a therapist. If you prefer talking to a therapist first, you may call (215) 922-LOVE (5683) ext 100 to be connected with our intake department. Lastly, you can call our Director, “Alex” Caroline Robboy, CAS, MSW, LCSW at (267) 324–9564 to discuss your particular situation. For your convenience, we have six physical therapy offices and can also provide counseling and therapy virtually.

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Some of the ways anxiety can be helpful:

Anxiety, despite being often associated with negative emotions and discomfort, can serve as a natural and adaptive response that can have some beneficial aspects. While excessive or chronic anxiety can be detrimental to one's well-being, moderate levels of anxiety can have certain functional and motivational effects. Here are a few ways in which anxiety might be helpful:

  1. Enhanced Alertness and Focus: Anxiety triggers the body's "fight or flight" response, which can increase alertness and focus. In situations where heightened attention is required, such as during exams or public speaking, a moderate level of anxiety can help individuals perform better by enhancing their concentration.
  2. Motivation and Productivity: Mild anxiety can motivate individuals to take action and complete tasks. It can create a sense of urgency and push individuals to overcome procrastination, leading to increased productivity.
  3. Risk Assessment: Anxiety can prompt individuals to consider potential risks and consequences before making decisions. It encourages a more cautious and thoughtful approach to choices, which can be valuable in certain situations.
  4. Problem Solving: Anxiety can drive individuals to anticipate potential challenges and think about solutions in advance. This can be particularly useful in planning and preparation.
  5. Adaptation to Threats: Anxiety is a natural response to threat, and its purpose is to help individuals respond effectively to danger. In situations where there is a real threat, anxiety can prompt individuals to take protective actions.
  6. Improved Performance Under Pressure: A moderate level of anxiety can enhance performance in situations that require quick thinking and response. It can sharpen reflexes and decision-making abilities.
  7. Increased Awareness of Surroundings: Anxiety can heighten sensory awareness, helping individuals become more attuned to their environment. This can be beneficial in situations where being vigilant is important, such as in crowded places.
  8. Avoidance of Harm: Anxiety can help individuals avoid situations that might be genuinely dangerous or harmful. It serves as a protective mechanism that encourages individuals to stay away from potential threats.
  9. Empathy and Compassion: Experiencing anxiety oneself can foster empathy and compassion for others who are going through similar feelings. This can lead to a greater understanding and willingness to support others.
  10. Personal Growth: Overcoming anxious situations can lead to personal growth and increased resilience. Successfully navigating anxiety-inducing situations can build confidence and a sense of accomplishment.

It's important to note that the positive aspects of anxiety are typically associated with mild levels of anxiety that are within the normal range. Excessive or chronic anxiety, on the other hand, can interfere with daily functioning, lead to distress, and contribute to mental health disorders. If anxiety becomes overwhelming or starts to interfere with your well-being and daily life, seeking support from mental health professionals is recommended. Therapies like cognitive-behavioral therapy (CBT) can help individuals manage and cope with anxiety in healthy ways.

How too much anxiety can harm you? Experiencing too much anxiety, especially when it becomes excessive, chronic, or overwhelming, can have a range of negative effects on your overall well-being, mental health, and physical health. Here are some ways in which excessive anxiety can be harmful:

  1. Impaired Mental Health:
    • Generalized Anxiety Disorder (GAD): Excessive anxiety can lead to the development of GAD, a mental health disorder characterized by persistent and uncontrollable worry about various aspects of life.
    • Panic Disorder: Chronic anxiety can contribute to panic attacks and the development of panic disorder, which involves recurring episodes of intense fear and physical symptoms.
    • Other Anxiety Disorders: Excessive anxiety can contribute to the development of specific phobias, social anxiety disorder, and other anxiety-related conditions.
  2. Physical Health Effects:
    • Cardiovascular Issues: Chronic anxiety can contribute to high blood pressure, increased heart rate, and a higher risk of heart disease.
    • Gastrointestinal Problems: Excessive anxiety can lead to digestive issues, including stomachaches, nausea, and irritable bowel syndrome (IBS).
    • Immune System Suppression: Prolonged anxiety can weaken the immune system, making the body more susceptible to infections and illnesses.
    • Sleep Disturbances: Anxiety can disrupt sleep patterns, leading to insomnia and poor quality sleep.
    • Muscle Tension and Pain: Anxiety can cause muscle tension, leading to headaches, backaches, and other physical discomforts.
    • Respiratory Problems: Anxiety can lead to hyperventilation and shallow breathing, contributing to feelings of breathlessness and dizziness.
  3. Impact on Daily Life:
    • Interference with Daily Activities: Excessive anxiety can make it difficult to focus, concentrate, and perform daily tasks effectively.
    • Reduced Quality of Life: Chronic anxiety can diminish your overall quality of life by limiting your ability to engage in enjoyable activities and pursue your goals.
  4. Relationship Strain:
    • Social Isolation: Severe anxiety can lead to social withdrawal and isolation as individuals may avoid situations that trigger anxiety.
    • Relationship Conflicts: Excessive anxiety can strain relationships due to irritability, mood swings, and communication difficulties.
  5. Negative Thought Patterns:
    • Rumination: Chronic anxiety often leads to rumination—repetitive, negative thought patterns that can contribute to depression and a sense of hopelessness.
    • Catastrophic Thinking: Anxiety can cause individuals to magnify potential threats and overestimate the likelihood of negative outcomes.
  6. Risk of Co-Existing Disorders:
    • Depression: Excessive anxiety can increase the risk of developing depression or exacerbate existing depressive symptoms.
    • Substance Abuse: Some individuals may turn to substances like alcohol or drugs as a way to cope with their overwhelming anxiety.
  7. Limited Opportunities for Growth:
    • Avoidance Behaviors: Chronic anxiety can lead to avoidance of anxiety-provoking situations, limiting opportunities for personal growth and achievement.
  8. Compromised Self-Esteem:
    • Self-Criticism: Anxiety often fuels self-critical thoughts and feelings of inadequacy, impacting self-esteem and self-worth.

Seeking help from mental health professionals is important if you're experiencing excessive anxiety. Therapy, such as cognitive-behavioral therapy (CBT) and mindfulness-based approaches, can be effective in managing anxiety and developing healthy coping strategies. In some cases, medication may also be recommended. Addressing anxiety early can prevent its negative impact on various aspects of your life and promote your overall well-being.

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