204 ASSESSMENT AND INTERVENTION STRATEGIES
cL i e nT: No, I’m stuck.
Th e r a p i sT: Have you ever noticed whether there is anything you can do that reduces the
suffocation feelings? For example, what happens to the feelings if you get distracted
or are busy at work?
cL i e nT: Well, on a couple of occasions when I started to get the feeling of not catching
my breath and then I got real busy at work, I somehow forgot about it and the feel-
ings went away.
Th e r a p i sT: Okay, so maybe distraction can cause a reduction in suffocation feelings. Is
there anything that seems to make the feelings worse?
cL i e nT: My worst panic attacks have been when I’m driving alone in the car along a
remote, unfamiliar highway. I seem to become really preoccupied with my physical
state.
Th e r a p i sT: Is there any chance, then, that focusing on breathing sensations makes the
suffocation feelings worse?
cL i e nT: It is possible.
Th e r a p i sT: So let’s write this down as the fourth evidence against the anxious thought:
“Suffocation feelings are worse when I focus on my breathing and least when I
am distracted.” Does that sound like a condition that could lead to death? Do you
suppose doctors warn people not to focus on their breathing because it might cause
them to suffocate or if they have breathing problems, just distract themselves? Does
this sound like a cure for emphysema?
cL i e nT: No, obviously not. But I suppose it is consistent with anxiety as the cause of
suffocation feelings. This is what my doctors have been telling me.
Th e r a p i sT: Okay, so let’s rerate your anxious thought “I will suffocate alone and die.”
Based on the evidence (and not on your feelings), what is the likelihood that you
will die from suffocation?
cL i e nT: Well, I suppose it is much less than 90% but it is certainly not zero. I’ll say
20%.
Th e r a p i sT: And based solely on the evidence, how serious is the likely outcome of your
suffocation feelings?
cL i e nT: Again, it’s probably not 100% because death is highly unlikely. I guess the
seriousness is about 60%.
Th e r a p i sT: What this tells us is that you tend to overestimate the probability and sever-
ity of threat (“I’ll die from suffocation”) when you are anxious. However, when
you focus on the evidence (and not on your feelings) you realize the threat is much
less severe. We know that making exaggerated threat estimates makes anxiety
worse and when a person sees the threat more realistically, her anxiety declines.
So, one way to reduce your anxiety is to correct your exaggerated anxious thoughts
by reminding yourself of all the evidence against the thought and then rerating its
probability and severity. After you do this a few times using Appendix 6.2 as a
guide you’ll become skilled at correcting your anxious thinking.
cL i e nT: That sounds fine but when I’m really anxious I can’t think straight.