Panic and Fear Management by Keith “Buster” Torkelson, MS

 

Contents

• Requirements
• List Current Quarter Worries (Concerns & Complaints)
• FYI - Panic attacks and panic disorder
• Why do I panic?
• Sleep and Panic
• More Things That Make Me Anxious
• Rest & Sleep Ability
• Fear of Getting Hit by A Train (Pretty much resolved)
• Lived Experience
• Impulse, Frenzy and Proximity
• Cardiac patients with panic disorder: defense mechanisms’ score
• FYI – Figure - For Definition of Terms
• Psychology Defense Levels
• Terminology
• Dis-adaptive Defenses = Maladaptive Defenses
• Progress and Control Efforts – Features – For a Respite Adventure
• A Bit of Charting
• Timeline of a Panic Attack
• Panic Attack Factors
• Picture of First Responders
• Table – Panic Checklist (Us)
• Panic & Anxiety – Includes Assessment Results
• Unmanageable Feelings
• Chronic Stressors
• Table – Chronicling a Panic Attack
• Adapting to Panic
• Defense mechanisms
• Summary of Maladaptive Defenses (Scorecards follow)
• Dis-adaptive Defenses Survey for Fear Management (DDS-FM)
• Weight of Defense Mechanisms in Anxiety Intensity and Other Psychopathological Symptoms
• Comorbidity
• Definition of Frenzy
• Panic Intensity Scale (PIS)
• Complex Questions Centered on Panic and Panic Attacks
• Syno-Terms for Frenzy

List Current Quarter Worries (Concerns & Complaints)

 

• ADHD
• Advanced Planning
• Ambulation
• Car
• Car Insurance
• Choking to Death
• Confidence
• COPD
• Dementia
• Dental
• Driving Alertness
• Falling
• Hard Death
• Memory
• Not enough time
• Ophthalmologist
• Panic
• Physical Fitness
• Property Disposition
• Rent a Shared Roommate
• Smoking
• SNT
• Walking

 

FYI - Panic attacks and panic disorder

https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021
Why do I panic?

Feeling panicky often happens when your brain activates its natural "fight-or-flight" survival response, even when there is no real physical danger.

Common Causes of Panicky Feelings

The Fight-or-Flight Response:

Your brain's alarm system (the amygdala) releases adrenaline and stress hormones, which cause a racing heart, shallow breathing, sweating, or dizziness.

Accumulated Stress:

Chronic pressure from work, family responsibilities, financial strain, or major life changes can over-stimulate your nervous system.

Physical Triggers:

Sleep deprivation, too much caffeine, alcohol use, skipped meals, or rapid changes in blood sugar can mimic or trigger panic.

Medical Conditions:

Thyroid imbalances, asthma, or heart irregularities can cause physical sensations that feel like panic.

Interoceptive Sensitivity:

Being overly sensitive to normal body changes (like a slightly fast heart rate) can trick your brain into thinking you are in danger, starting a fear cycle.

Panic Disorder or Anxiety:

Repeated, unexpected panic attacks or constant worry about having another attack may point to an underlying condition. You can read more via the Mayo Clinic or the NHS.

Quick Ways to Calm down Right Now

Regulate Your Breathing:

Inhale slowly through your nose for 3 seconds, hold for 2 seconds, and exhale slowly for 3 seconds.

Ground Yourself:

Look around and name 5 concrete things in your room (like a plant, a chair, or a cup) to pull your focus away from racing thoughts.

Use a Reassuring Mantra:

Remind yourself:

“This is just anxiety, and it will pass.”

Step Away from Stimulants:

Drink water and avoid coffee, energy drinks, or alcohol.

Sleep and Panic

Less sleep is strongly and positively correlated to panic and anxiety. Clinical studies consistently show that sleep deprivation lowers your physiological "panic threshold," making you much more vulnerable to acute panic responses and panic attacks. The connection between sleep loss and panic relies on a specific biological chain reaction:

Amygdala Hyperactivity:

When you are sleep-deprived, the amygdala—the brain's emotional and fear processing center—becomes highly overactive. It begins misinterpreting normal bodily sensations or minor stressors as major threats.

Prefrontal Cortex "Offline":

The prefrontal cortex is the rational part of the brain that normally regulates and calms down the amygdala. Sleep loss drastically reduces its activity. Without this "brake" system, feelings of anxiety can rapidly escalate into full-blown panic.

Cortisol and Stress Spikes:

Missing sleep causes an uptick in stress hormones like cortisol and triggers your sympathetic nervous system (the fight-or-flight response). This leaves you in a state of physical hypervigilance before your day even starts.

Symptom Overlap:

Sleep deprivation causes physical symptoms like heart palpitations, dizziness, and shortness of breath. Because a tired brain struggles with rational thinking, you are much more likely to misinterpret these physical symptoms as a medical emergency (like a heart attack), which can directly trigger a panic attack.

This relationship is bidirectional, creating a vicious cycle: a bad night of sleep triggers next-day panic, and the dread or physical experience of a panic attack makes it incredibly difficult to fall asleep the following night.

 

FYI – II - Are you asking out of scientific curiosity, or are you personally experiencing daytime or nighttime panic attacks? If the latter, let me know if you would like some evidence-based strategies to help break the sleep-panic cycle.

 

Case-notes

Includes some case-notes on frenzy, anxiety, panic and sleep

 

More Things That Make Me Anxious

• Appointments
• Dentist
• Disposition of my belongings
• Dr. RBB (psychiatrist) and sleep medication
• Dr. RBB in general
• EOL considerations
• Fear of Hospitalization
• Gaps in medication
• Getting lost
• Knowing my belongings with not survive me
• New Shared Roommate interferes with Sleep, Peace and Harmony
• Risk of falling
• The car
• Thinking about Car Accidents
• Thinking about sleeping
• Trips

 

Things That Fatigue Me - Work Done

https://clozapinerx4ecstasy.blogspot.com/2024/09/fatigue-and-avoidance-recovery-planning.html

 

STR Timeline [STAYED]

 

Dis-adaptive Defenses Survey for Fear Management (DDS-FM)

While there is no specific, widely recognized "Dis-adaptive Defenses Survey for Fear Management," several established psychological assessments can be used to measure maladaptive (dis-adaptive) coping styles and defense mechanisms related to fear. These surveys examine cognitive patterns and behaviors that can worsen anxiety and prevent effective fear management.

 

Rest & Sleep Ability

Rest and sleep are essential for your overall health, improving cognitive function, emotional well-being, and physical health by enabling the brain and body to repair and regenerate. Good sleep hygiene includes maintaining a consistent sleep schedule, creating a restful environment, and limiting caffeine and screens before bed. Prioritizing quality rest can boost memory, attention, and mood, while also supporting physical healing and a stronger immune system. 

 

In House > Metadata >
Airport Notes – Contains Mini-STR – Los Altos Trip (2019)
07_Overnight_Adventure_Respite_19080301_Records

 

Development Stream

Fear of Getting Hit by A Train (Pretty much resolved)

A fear of getting hit by a train is known as Siderodromophobia or can be a symptom of Dystychiphobia (fear of accidents). This fear can be treated with professional therapies like Cognitive Behavioral Therapy (CBT), exposure therapy, and Virtual Reality Exposure Therapy (VRET), and sometimes with medication. Causes can range from direct trauma or witnessing an accident to anxieties about safety and potential train malfunctions. 

 

Lived Experience

My onset of illness back in 1989 involved fear of trains.  I was living alone at Ivy Towne apartment in Davis and an overwhelming impulse (frenzy) hit me to get hit by the train on the track adjacent to where I lived.  I was hospitalized for the first time and after about 6 months I bounced right back.  By fall of 1989 I was back at it in Veterinary School. Yet, many issues with intentional sleep deprivation still continued so I was still at risk of re-hospitalization.

 

Impulse, Frenzy and Proximity

My risk factors are: Fall, Road Kill, Train, Bus, Poor Matching Roommate, Interference with Sleep, Continuity of Medications, and Gravity

 

San Jose (Los Altos) Trip - Hyper-vigilance & Airport Security

Hypervigilance is a state of excessive and abnormal alertness to potential threats, a common symptom of trauma-related conditions like post-traumatic stress disorder (PTSD). Airport security, with its unpredictable procedures, crowds, and physical searches, can trigger a hypervigilant response, creating a highly stressful and overwhelming experience for some travelers.

 

FYI – Reference [Must copy and paste research gate links]
Assess Panic Disorder
Cardiac patients with panic disorder: defense mechanisms’ score
https://www.researchgate.net/figure/Cardiac-patients-with-panic-disorder-defense-mechanisms-score-DSQ_tbl3_50285731

FYI – Figure - For Definition of Terms

https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.718440/full

Psychology Defense Levels

In psychology, defense mechanisms are automatic, unconscious mental processes that protect the ego from anxiety, internal conflicts, and stressful emotions. George Vaillant categorized defense mechanisms into a hierarchical ladder based on maturity and adaptiveness:

1. Pathological / Psychotic Level

Characteristics:

High distortion of reality, complete avoidance of facts, and low psychological maturity.

Examples:

Denial: Refusing to accept real events or facts because they are too painful to process.

Delusional Projection / Distortion:

Misinterpreting external reality in a grossly bizarre way.

2. Immature Level

Characteristics:

Seen commonly in adolescence or severe personality distress; involves moderate reality distortion and difficulty handling interpersonal or emotional conflicts.

Examples:

Acting Out:

Expressing unconscious emotional conflict through actions rather than words or reflection.

Projection: Attributing one's own unacceptable thoughts or feelings onto someone else.

Hypochondriasis / Somatization:

Converting emotional distress into physical complaints or health worries.

Passive-Aggression:

Indirectly expressing hostility or resistance.

3. Neurotic Level

Characteristics:

Typical of middle-range adaptiveness; manages internal conflicts by altering feelings or awareness rather than completely breaking from reality.

Examples:

Repression:

Unconsciously blocking painful thoughts or memories from awareness.

Displacement:

Redirecting an impulse or emotion from a dangerous target to a safer substitute (e.g., yelling at a partner after a bad day at work).

Intellectualization:

Using heavy logic and abstract thinking to detach from emotional pain.

Reaction Formation:

Behaving in a way that is the exact opposite of one's true, uncomfortable feelings.

Rationalization:

Creating logical excuses or justifications for unacceptable behavior.

4. Mature / High-Adaptive Level

Characteristics:

The highest tier of emotional maturity; allows individuals to face reality directly while constructively integrating emotions, logic, and social values.

Examples:

Sublimation:

Channeling unacceptable or intense impulses (like aggression or anger) into productive, socially valuable activities (like art or exercise).

Altruism:

Handling emotional conflict by dedicating service and generosity to others.

Suppression:

Consciously (rather than unconsciously) deciding to push aside a disturbing thought or urge to deal with it later.

Humor:

Finding the ironic or lighthearted side of a stressful situation without denying its reality.

Learn more about these concepts on Wikipedia's Defense Mechanism Guide or explore clinical breakdowns on Verywell Mind.

 

FYI – II - Would you like to explore specific examples of how a particular defense mechanism operates, or look at how they are addressed in psychotherapy?

 

Terminology

Positive Psychology
Defense Mechanism
Adaptative Defenses
Dis-Adaptive Defenses
Maladaptive Defences

 

Positive Psychology

Positive psychology is the scientific study of factors that allow individuals and communities to thrive, focusing on strengths, positive emotions, and virtuous behaviors instead of solely on mental illness. It is built on three core pillars: Positive experiences, positive individual traits like gratitude and resilience, and positive institutions that foster flourishing. The goal is to enhance quality of life and help people lead meaningful and fulfilling lives by cultivating their best selves and improving their overall well-being. 

Affiliation

The individual deals with emotional conflicts, or internal or external stressors, by turning to others for help or support. By affiliating with others, the individual can express him or herself, confide problems, and feel less alone or isolated with a conflict or problem. Oct 15, 2021

Altruism

By using altruism, the individual receives some partial gratification either vicariously or as a response from others. The subject is usually aware to some extent that his or her own needs or feelings underlie altruistic actions.

 

Anticipation

Anticipation as a defense mechanism is the realistic planning for future discomfort and learning ways to mitigate this discomfort. Using humor to express negative thoughts and feelings, rather than speaking about them directly.

Reaction formation

Reaction formation is a defense mechanism in which people express the opposite of their true feelings, sometimes to an exaggerated extent. For instance, a man who feels insecure about his masculinity might act overly aggressive.

Humor

Humor, the capacity to express or perceive what's funny, is both a source of entertainment and a means of coping with difficult or awkward situations and stressful events. Although it provokes laughter, humor can be serious business. From its most lighthearted forms to its more absurd ones, humor can play an instrumental role in forming social bonds, releasing tension, or attracting a mate.

Psychology Direction to Work - What is the direction of work?

In psychology and organizational behavior, the "direction of work" typically refers to the trajectory, focus, and flow of goal-oriented effort.

Sublimation

Transforming one's anxiety or emotions into pursuits considered by societal or cultural norms to be more useful. This defense mechanism may be present in someone who channels their aggression and energy into playing sports. May 22, 2023

Suppression

Consciously choosing to block ideas or impulses that are undesirable, as opposed to repression, a subconscious process. This defense mechanism may be present in someone who has intrusive thoughts about a traumatic event but pushes these thoughts out of their mind.

 

Adaptive defense mechanisms: Function and Transcendence
National Institutes of Health (NIH)
https://pubmed.ncbi.nlm.nih.gov/24677248/
By JA Metzger · 2014 · Cited by 79 – Abstract Only - Abstract

This article reviews the high-adaptive (mature) defense mechanisms, along with case material illustrating each. These defenses are described in terms of not only the specific means by which they serve to ward off anxiety and manage conflict, but also how they often transcend their role as defenses by contributing to the creation of new "products" of value, such as new meanings, perspectives, modes of relating, and works of art or science. This report also discusses the implications of the use of adaptive defenses, especially humor, in the context of psychotherapy.

Keywords: adaptive defense mechanisms; humor; mature defense mechanisms; meaning making; sublimation.

 

Dis-adaptive Defenses = Maladaptive Defenses

Key Word = Unconscious

Undoing

Undoing is a defense mechanism in which a person tries to cancel out or remove an unhealthy, destructive or otherwise threatening thought or action by engaging in contrary behavior. For example, after thinking about being violent with someone, one would then be overly nice or accommodating to them.

Isolation

Isolation is the state of feeling alone and without friends or help. Many deaf people have feelings of isolation and loneliness. He also talked briefly about the isolation he endured while in captivity. Synonyms: separation, withdrawal, loneliness, segregation

Social Isolation

A state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts, and they are deficient in fulfilling and quality relationships.

Consumption

Consumption is also described as the satisfaction of not only human needs but also their desires and wants, especially in the current westernized societies.

Splitting

Splitting is a defense mechanism that makes people and situations seem all or nothing, good or bad, with no integration of nuanced or conflicting aspects of a person or situation. Splitting first emerges in toddlerhood when a loving child (“Good Mommy!”) told “no” transforms into a hating one (“Bad Mommy!”). Jul 11, 2025

Acting out

In the psychology of defense mechanisms and self-control, acting out is the performance of an action considered bad or anti-social. They indirectly express emotions through behavior rather than words. These actions are often used to cope with uncomfortable emotions or to relieve tension.

Fantasy

The word fantasy is most often referred to as a term in psychology as a "mental apprehension of an object of perception; the faculty by which this is performed" and further as "the fact or habit of deluding oneself by imaginary perceptions or reminiscences" or "a day-dream arising from conscious or unconscious wishes ...

Idealization

Idealization is a psychological or mental process of attributing overly positive qualities to another person or thing. It's a way of coping with anxiety in which an object or person of ambivalence is viewed as perfect, or as having exaggerated positive qualities. Mar 6, 2025

Projective identification

Projective identification occurs when the target of projection identifies with and expresses the feelings projected onto them. This represents a deeper stage of the distortions raised by projection, one that often occurs in relationships.

Inhibition

inhibition, in psychology, conscious or unconscious constraint or curtailment of a process or behaviour, especially of impulses or desires.

Denial

Denial is the conscious refusal to perceive that painful facts exist. For example, in denying the reality of a loved one's terminal diagnosis, an individual can escape intolerable thoughts, feelings, or events.

Passive Aggression

While passive-aggressive behavior can be hard to pin down, experts agree on the most common signs, which include refusing to discuss concerns openly and directly, avoiding responsibility, and being deliberately inefficient. The passively aggressive person often leaves a job undone or “almost” complete.

Projection

In psychology, psychoanalysis, and psychotherapy, projection is the mental process in which an individual attributes their own internal thoughts, beliefs, emotions, experiences, and personality traits to another person or group.

Aid rejection

In psychology, "aid rejection" can refer to a person's unwillingness to accept help or support, even when needed, which is often rooted in internal factors like a resistance to change, fear of dependency, or low self-worth. It can also refer to Rejection Sensitivity, a psychological phenomenon where individuals have an intense emotional reaction to any perceived rejection, criticism, or disapproval. Managing rejection involves acknowledging and processing emotions, reframing the experience to find alternative explanations, practicing self-compassion, and engaging in self-care and positive social connections to build resilience.

Regression

Regression is a defense mechanism in which people seem to return to an earlier developmental stage. This tends to occur around periods of stress—for example, an overwhelmed child may revert to bedwetting or thumb-sucking. Regression may arise from a desire to reduce anxiety and feel psychologically safe.

Somatization

Somatisation is generally defined as the tendency to experience psychological distress in the form of somatic symptoms and to seek medical help for these symptoms, which may be initiated and/or perpetuated by emotional responses such as anxiety and depression.

Omnipotence

The concept of omnipotence refers to a primitive fantasy, a mechanism of defense, and a pathological psychic structure. Omnipotence and its derivative defensive operation, omnipotent control, are highly prevalent in borderline personality organization.

 

Progress and Control Efforts – Features – For a Respite Adventure

A Bit of Charting

20190403-W: 215pm Crash Appointment with RBB
2012-2017 BSL | 2018-2026 (Present) RBB

HX – RBB did not defend our Clozapine Determination position. Medication Management Error. Said no to our request for a medication change without hearing it. Total 6 appointments so far and we find ourselves repeating ourselves. Sustains approval about Lorazepam. Messing with the BSL/Torkelson system (2012-2017). As of 2019 seven years no hospitalization. Taking into consideration his other patients such as Road Kill Dave we give him 3.5 Quick Stars.

 

20190611-TU: M6ONA – Motel 6 Overnight Adventure. Sustain anti-panic measures.  Rely on the “Dad Light for protection”.  Decrease violent TV. Stop coffee at 645pm. Have cold pill ready. 7p routine titration. Dad Light left on yet change to different fixture. Outcome – Anxiety Minor. Little panic.

 

20191127-W: Update - Control Effort – Family Respite in Redondo
Associated Document
08_LS_LA_Respite_19092601_Register V2026
Stop coffee @ 5pm. Rely on “Dad Light” for protection. Choice, AC/Heat decision for noise or no noise. 7pm routine titration. Bothersome COPD.

Timeline of a Panic Attack

A typical panic attack reaches its peak intensity within 10 minutes and completely resolves within 20 to 30 minutes, though residual fatigue can linger for hours.

The 5 Stages of a Panic Attack Timeline

1. Trigger / Prodromal (Seconds to Minutes): Subtle body signals, restlessness, or a quiet sense of dread before the attack officially launches.

2. Escalation (1 to 3 Minutes): Physical symptoms amplify rapidly; heart rate spikes, breathing quickens, and an intense urge to flee sets in.

3. Peak (5 to 10 Minutes): The most intense phase. It features a racing heart, chest tightness, shortness of breath, shaking, and terrifying fears of dying, losing control, or derealization (feeling detached from reality).

4. De-escalation (10 to 30 Minutes): Adrenaline begins to burn off. The heart rate slows, breathing deepens, and the acute physical storm starts to recede.

5. Recovery (Several Hours): The body returns to baseline, leaving behind physical exhaustion, shakiness, confusion, or emotional rawness.

If you or someone you know is dealing with frequent episodes, I can share grounding exercises to help during the peak or outline treatment options like CBT. Let me know what you need.

Our conditions are associated with Sleep, Bed Quality, Peace, Harmony, Happiness, and Respite

 

Anxiety

Our anxiety feeds chronic fatigue and fatigue worsens anxiety

Define Panic - Revisited

Panic Disorder is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.

 

Panic Attack Factors

Factors that may increase the risk of developing panic attacks or panic disorder include:

 

• A traumatic event such as serious accident
• A traumatic event, such as sexual assault
• Drinking Alcohol
• Excessive caffeine intake
• Family history of panic attacks
• Family history of panic disorder
• History of childhood physical abuse
• History of sexual abuse
• Major changes in your life such as a divorce
• Major life change such as an addition of a baby
• Major life stress such as the death of a loved one
• Major life stress such serious illness of a loved one
• Smoking Cigarettes

 

Lived Experience – Shanks Truck Stop (Circa 2023)

Picture of First Responders

Table – Panic Checklist (Us)

First Addressed – 20190620-TH: Last Addressed: 20261029-TH:

Panic & Anxiety – Includes Assessment Results

Panic – Anxiety

An anxiety attack, people may feel fearful, apprehensive, may feel their heart racing or feel short of breath, but it's very short lived, and when the stressor goes away, so does the anxiety attack. Panic attack on the other hand doesn't come in reaction to a stressor. It's unprovoked and unpredictable. Apr 15, 2008

Define Panic

A sudden feeling of acute and disabling anxiety. Sudden uncontrollable fear or anxiety, often causing wildly unthinking behavior. E.g. "She hit him in panic"

How does a panic attack feel?

For doctors to diagnose a panic attack, they look for at least four of the following signs: sweating, trembling, shortness of breath, a choking sensation, chest pain, nausea, dizziness, fear of losing your mind, fear of dying, feeling hot or cold, numbness or tingling, a racing heart (heart palpitations), and feeling ... Aug 3, 2018

Panic Attack

A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. May 4, 2018

Anxiety

Anxiety attacks can last anywhere between a few moments to 30 or more minutes. Even though anxiety attacks eventually end, it's common for the symptoms and after effects of an anxiety attack to linger for hours or even days, depending upon the severity of the attack and the level of stress your body is under.

What causes anxiety?

Stress around work or school can lead to an anxiety disorder. Anxiety disorders have a complicated network of causes, including: Environmental factors: Elements in the environment around an individual can increase anxiety. Oct 25, 2018

Unmanageable Feelings

Sudden, uncontrollable fear or anxiety that leads to impulsive behavior is known as panic or a panic attack. This condition is often a symptom of panic disorder, a type of anxiety disorder, which involves recurring, unexpected episodes of intense fear with physical and mental symptoms like a pounding heart, sweating, shortness of breath, and a feeling of impending doom.

 

Related to trip by Plane (2019) – Synonyms for Panic

Anxiety Mitigation Score 16 Items (AMS)

An anxiety attack, people may feel
 
Fearful
Apprehensive
Heart racing
Feel short of breath
But it's very short lived
 
And when the stressor goes away
So does the anxiety attack.
 
Panic attack on the other hand doesn't come in reaction to a stressor. It's unprovoked and unpredictable. Apr 15, 2008
 

A key characteristic of panic attacks is that they are sudden, intense episodes of fear that occur without warning and without a clear trigger, unlike a typical anxiety attack which is a prolonged response to a specific stressor. These attacks manifest with severe physical and psychological symptoms, such as a racing heart, shortness of breath, and a feeling of losing control, and typically resolve within a few minutes.

Chronic Stressors

A chronic stressor is an ongoing, persistent, or recurring condition or situation that forces the body and mind to remain in a state of prolonged tension without a quick resolution.

Common Types of Chronic Stressors

Work & Financial Strain: Job insecurity, high-pressure roles, or long-term money problems.

Caregiving & Relationships:

Caring for a chronically ill family member or dealing with ongoing family or marital conflict.

Environmental & Social Factors:

Living in high-crime neighborhoods, facing chronic discrimination, or dealing with poverty.

Health Issues:

Living with long-term pain, diabetes, or other persistent medical conditions.

Health Impacts

Physiological Wear and Tear:

Keeps the hypothalamic-pituitary-adrenal (HPA) axis activated, flooding the body with cortisol and adrenaline.

Organ Systems:

Increases the risk of high blood pressure, heart disease, stroke, weakened immunity, and digestive problems.

Mental Health: Contributes to anxiety, major depressive disorder, burnout, and memory or focus difficulties.

Management Strategies

Lifestyle Adjustments:

Prioritize 7 to 8 hours of sleep, regular physical activity, and balanced nutrition.

Relaxation & Mindfulness:

Use deep breathing, meditation, or yoga to calm the nervous system.

Professional Support:

Engage in cognitive behavioral therapy (CBT) or talk to a healthcare provider if symptoms persist. Learn more about symptoms and management through the Mayo Clinic Stress Guide.

Table – Chronicling a Panic Attack

20190115-TU-ON Panic Episode – Including Stressors

Adapting to Panic

I used to have panic attacks quite often yet by 2019 I had improved.  My panic attacks were limited to when I was alone on respite.  I usually stay at Motel 6 where at time it can be rough.  So to reduce anxiety I would stay in the room as much as possible.  When I lay down to sleep is when the attack would hit.  I waited powerless for the Big Fat Foot (Thing greater than us) to hit in a manner that I would expire. From 3/19/2019 (W) – 3/22/19 (F) I went on respite and made a few changes: I was on better medication, I kept what I call the “Dad Light” on all night, I built off of prior successes and I made sure to eat one good meal per day. From 6/11/2019 (TU) – 6/14/2019 (F) I went on respite to my friend’s house in Fallbrook California.  He has a little house separate from the main house.  I get to stay in the little house free.  The peaceful and un-risky environment made all the difference I didn’t panic at all.

 

Defense mechanisms in cardiovascular disease patients with and without panic disorder.
http://www.medigraphic.com/pdfs/salmen/sam-2010/sam103b.pdf
By BPR Martínez - ‎2010 - ‎3, mayo-junio 2010. Artículo original. Salud Mental 2010;33:219-227

2025 - Adaptive Defenses - First Addressed: 20190613-TH:

Adaptive Defense	2025 0909 TU-RT SW-Solo	Example/Definition
Affiliation	1.00	The state or relation of being closely associated or affiliated with a particular person, group, party, company, etc.
Altruism	1.00	The belief in or practice of disinterested and selfless concern for the well-being of others.
Anticipation	0.75	An emotion involving pleasure or anxiety in considering or awaiting an expected event. Anticipatory emotions include fear, anxiety, hope, and trust. When the anticipated event fails to occur, it results in disappointment or relief.
Reaction formation	0.75	A psychological defense mechanism where a person expresses feelings or behaves in a way that is the opposite of their true, unacceptable unconscious impulses or emotions
Humor	0.50	Humor is the tendency of experiences to provoke laughter and amusement, often arising from recognition of the comic, absurd, or incongruous aspects of a situation. It is a complex human trait with significant psychological, social, and physical effects. The perception of humor varies from person to person, and several theories attempt to explain why we find things funny.
Direction to work	1.00	Based on psychological principles, finding a career direction involves a structured process of self-assessment, exploration, and planning to align your work with your skills, interests, and values. This approach goes beyond simply finding a job by focusing on your deeper needs for purpose and meaning
Sublimation	1.00	A defense mechanism in psychoanalytic theory that involves transforming unacceptable or harmful impulses, thoughts, or emotions into socially acceptable and constructive behaviors
Suppression	0.75	Prevent the development, action, or expression of (a feeling, impulse, idea, etc.); restrain.
CALC	=6.75/8
Adaptive Defense Score 8 Items =	84%	High Scores are Favorable

Table – Managing a Panic Attack
Dis-adaptive Defenses Survey for Fear Management (DDS-FM)
Mal-adaptive Defense Survey
First Addressed: 20190613-TH:

##	Maladaptive Defense	2025 0909 TU-RT SW-Solo	Note
01	Acting out	0.25	Misbehave, especially when unhappy or stressed
02	Aid rejection	0.25	The dismissing or refusing of a proposal, idea, etc.
03	Consumption	0.25	Wasting - the using up of a resource.
04	Denial	0.25	The action of declaring something to be untrue.
05	Fantasy	0.50	The faculty or activity of imagining things, especially things that are impossible or improbable.
06	Idealization	0.00	The action of regarding or representing something as perfect or better than in reality
07	Inhibition	0.25	A feeling that makes one self-conscious and unable to act in a relaxed and natural way. A voluntary or involuntary restraint on the direct expression of an instinct.
08	Isolation	0.00	The process or fact of isolating or being isolated.
09	Omnipotence	0.00	The quality of having unlimited or very great power.
10	Passive aggression	0.25	Medical Definition of passive-aggressive Being, marked by, or displaying behavior characterized by expression of negative feelings, resentment, and aggression in an unassertive way (as through procrastination, stubbornness, and unwillingness to communicate) a passive-aggressive personality.
	Part A	=2.00/10	(LSF)

##	Maladaptive Defense	2025 0909 TU-RT SW-Solo	Note
11	Projection	0.00	A defense mechanism where an individual unconsciously attributes their own unacceptable thoughts, feelings, or traits to another person to avoid dealing with them themselves
12	Projective identification	0.00	A psychoanalytic concept and unconscious defense mechanism where a person projects unacceptable qualities, feelings, or thoughts onto another person
13	Regression	0.25	A return to a former or less developed state.
14	Social isolation	0.00	Social isolation is a state of complete or near-complete lack of contact between an individual and society. It differs from loneliness.
15	Somatization	0.50	The expression of psychological stress through physical symptoms, such as pain, fatigue, or gastrointestinal issues, that are real but disproportionate to any underlying medical condition
16	Splitting	0.00	A psychological defense mechanism and cognitive distortion where a person perceives people, objects, or situations as either entirely good or entirely bad, without any middle ground or ability to integrate conflicting qualities
17 (7)	Undoing	0.25	The act of reversing or annulling a decision or action, and the cause of someone's failure or destruction
	Part B	=1.00/7

Weight of Defense Mechanisms in Anxiety Intensity and Other Psychopathological Symptoms

Defense mechanisms hold significant weight in determining the intensity of anxiety and the severity of broader psychopathological symptoms. Rather than just being passive side effects of distress, an individual's specific profile of unconscious defenses acts as a psychological mediator. It determines whether temporary stress resolves into a healthy adaptation or escalates into clinical anxiety, depression, or somatic disorders.

The Defensive Hierarchy and Mental Health

According to modern psychodynamic frameworks like the Defense Mechanisms Rating Scale (DMRS), defense mechanisms are organized hierarchically based on how much they distort reality and how successfully they handle anxiety. Extensive cross-cultural research demonstrates a direct correlation between these levels and psychopathology:

1. Influence on Anxiety Intensity

Anxiety is the primary signal that a person’s psychological equilibrium is threatened. The "weight" of defense mechanisms determines how that signal is handled:

The Cycle of Immature Defenses: When someone relies on primitive defenses like projection (attributing their own unacceptable fears to others) or denial (refusing to accept reality), they do not process the root cause of the anxiety. While this provides immediate, short-term relief, it severely increases long-term anxiety intensity. The underlying conflict remains unresolved, meaning the mind must expend even more psychic energy to keep it buried, causing chronic generalized anxiety and panic attacks.

The Buffering Effect of Mature Defenses: Conversely, conscious or highly mature defenses like suppression (choosing to set a worry aside until it can be dealt with) or sublimation (channeling anxiety into art or physical fitness) successfully diffuse anxiety intensity. They allow the individual to experience stressful realities without suffering a complete collapse of emotional regulation.

2. Connection to Other Psychopathological Symptoms

Large-scale clinical studies—including data tracked across international populations—demonstrate that defensive profiles serve as powerful predictors for specific mental health conditions:

Depression: Recent network analyses show that immature depressive defenses (such as passive aggression and help-rejecting complaining) are heavily interconnected with depressive symptom severity. These defenses turn unexpressed internal conflicts inward, fueling feelings of worthlessness, hopelessness, and lethargy.

Personality Disorders: Chronic, rigid reliance on highly distorted defenses—specifically splitting (viewing things/people as entirely good or entirely bad) and projective identification—is a defining architectural feature of severe psychopathology, particularly Borderline Personality Disorder (BPD).

Somatic Symptoms: When emotional conflicts are completely blocked from conscious awareness via repression or conversion, the unaddressed psychological tension frequently manifests physically. Individuals heavily utilizing these defenses show significantly higher rates of somatic distress (unexplained bodily pain, chronic fatigue, gastrointestinal issues).

Clinical Implications

Because the weight of these mechanisms is so profound, modern psychological interventions focus heavily on defensive restructuring. Therapeutic modalities like psychoanalytic psychotherapy and Cognitive Behavioral Therapy (CBT) work by bringing immature, unconscious defenses to light. By helping individuals graduate from primitive protections to mature coping strategies, the overall baseline intensity of both anxiety and broader psychopathological symptoms can be systematically reduced.

 

FYI – II - If you are exploring this for a specific project or practical reason, let me know if you would like me to: Focus on a specific psychopathological disorder (e.g., OCD, PTSD, or Depression). Detail how specific therapies work to shift defenses from immature to mature. Provide details on the psychometric tools (like the DMRS-SR-30) used to measure these weights in research.

 
Fantasy – E.g. "his research had moved into the realm of fantasy"

 

Synonyms for Fantasy

• Creativity
• Daydreaming
• Fancy
• Imagination
• Invention
• Make-Believe
• Originality
• Reverie
• Speculation
• Vision

 

Cardiac patients with panic disorder: Comorbidity

 

• Agoraphobia
• Generalized anxiety
• Major depression
• Mental disorder
• Social phobia
• Specific phobia

 

Comorbidity

Comorbidity—the presence of two or more disorders in the same person at the same time—is exceptionally common between Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD).

Major Depression and Anxiety (General)

High Overlap:

Roughly 60% of people with major depression will experience an anxiety disorder at some point in their lives, and about 60% of people with an anxiety disorder experience symptoms of depression.

National Statistics:

In the U.S. National Comorbidity Survey, about 56.8% of individuals with MDD also meet the criteria for an anxiety disorder.

Shared Roots:

Both conditions often stem from overlapping biological mechanisms, similar genetic vulnerabilities, and high sensitivity to stress.

Generalized Anxiety Disorder (GAD) and Major Depression

Strong Association:

Around 59% to 80% of individuals diagnosed with GAD also meet the criteria for MDD during their lifetime.

Most Common Pair:

Comorbid MDD and GAD represent the single most frequent combination of a mood disorder and an anxiety disorder.

Symptom Overlap:

Both conditions share several physical and emotional symptoms, such as chronic fatigue, sleep disturbances, restlessness, and difficulty concentrating.

Comorbid Major Depression and Generalized Anxiety

Increased Severity:

Having both MDD and GAD together leads to more severe symptoms, a higher degree of functional and social impairment, slower recovery rates, and a lower quality of life than having either condition alone.

Diagnostic & Clinical Recognition:

Because the symptoms heavily overlap, clinicians often use specialized screening tools (such as the PHQ or PRIME-MD) to identify both conditions.

Treatment Approaches:

First-line treatments typically include selective serotonin reuptake inhibitors (SSRIs) like sertraline or paroxetine, often combined with evidence-based psychotherapy such as cognitive behavioral therapy (CBT).

Definition of Frenzy

"Frenzy" describes a state of uncontrolled excitement, wild activity, or violent mental agitation, which can range from a temporary bout of delirium to a burst of energetic or even terrifying action. As a noun, it refers to a spell of this mental derangement or a frantic outburst of feeling and activity. As a verb, it means to make someone frantic or drive them into a frenzy.

 

Frenzy - Key Aspects of the Definition – Modified Frenzy Intensity Scale (FIS)

Which is worse anxiety, panic or frenzy?

When evaluating anxiety, panic, and frenzy, a panic attack is generally considered the most acute and intense experience. A frenzy is not a formal mental health diagnosis, but rather a descriptor for a state of uncontrolled behavior that can accompany conditions like mania.

 

Anxiety

Anxiety is a common emotional response to stress that can range from mild to severe. Unlike a panic attack, anxiety symptoms build gradually over a longer period.

Onset and duration:

Gradual onset that can last for hours, days, or months.

Trigger:

Typically linked to a specific stressor, such as an upcoming deadline or a relationship issue.

Symptoms:

Apprehension, worry, restlessness, irritability, and muscle tension.

Intensity:

Can be disruptive but is generally less severe than a panic attack.

 

Panic attack

A panic attack is a sudden, intense episode of fear that triggers a severe physical and psychological "fight-or-flight" response. It is often mistaken for a heart attack due to the intensity of its symptoms.

Onset and duration:

Sudden and abrupt, with symptoms peaking within minutes. An attack typically lasts less than 30 minutes but can take hours to fully subside.

Trigger:

Can occur without any clear trigger, even during sleep.

Symptoms:

Heart palpitations, chest pain, shortness of breath, dizziness, and a feeling of unreality or detachment. Many people feel a sense of impending doom or that they are going to die or lose control.

Intensity: The most extreme form of anxiety, with symptoms that are more intense than a typical anxious episode.

 

Frenzy (Mania)

"Frenzy" is a descriptive term for wild, uncontrolled, and sometimes violent behavior that can be associated with the high energy of a manic episode. Mania is a symptom of bipolar disorder and is not considered a form of anxiety.

Fear driven frenzy

The phrase "fear-driven frenzy" describes a state of intense, widespread panic or chaotic activity triggered by deep-seated anxiety, threat, or apprehension.

Panic Intensity Scale (PIS)

Panic Disorder Severity Scale – Self Report Form (PDF)

Several of the following questions refer to panic attacks and limited symptom attacks. For this questionnaire we define a panic attack as a sudden rush of fear or discomfort accompanied by at least 4 of the symptoms listed below. In order to qualify as a sudden rush, the symptoms must peak within 10 minutes. Episodes like panic attacks but having fewer than 4 of the listed Symptoms are called limited symptom attacks. Here are the symptoms to count:

 

Scored: 20261012-M:
Symptoms of Activation

Complex Questions Centered on Panic and Panic Attacks

1. How many panic and limited symptoms attacks did you have during the week?

 

2. If you had any panic attacks during the past week, how distressing (uncomfortable, frightening) were they while they were happening? (If you had more than one, give an average rating. If you didn’t have any panic attacks but did have limited symptom attacks, answer for the limited symptom attacks.)

 

3. During the past week, how much have you worried or felt anxious about when your next panic attack would  occur or about fears related to the attacks (for example, that they could mean you have physical or mental  health problems or could cause you social embarrassment)?

 

4. During the past week were there any places or situations (e.g., public transportation, movie theaters, crowds, bridges, tunnels, shopping malls, being alone) you avoided, or felt afraid of (uncomfortable in, wanted to avoid or leave), because of fear of having a panic attack? Are there any other situations that you would have avoided or been afraid of if they had come up during the week, for the same reason? If yes to either question, please rate your level of fear and avoidance this past week.

 

5. During the past week, were there any activities (e.g., physical exertion, sexual relations, taking a hot shower or bath, drinking coffee, watching an exciting or scary movie) that you avoided, or felt afraid of (uncomfortable doing, wanted to avoid or stop), because they caused physical sensations like those you feel during panic attacks or that you were afraid might trigger a panic attack? Are there any other activities that you would have avoided or been afraid of if they had come up during the week for that reason? If yes to either question, please rate your level of fear and avoidance of those activities this past week.

 

6. During the past week, how much did the above symptoms altogether (panic and limited symptom attacks, worry about attacks, and fear of situations and activities because of attacks) interfere with your ability to work or carry out your responsibilities at home? (If your work or home responsibilities were less than usual this past week, answer how you think you would have done if the responsibilities had been usual.)

 

7. During the past week, how much did panic and limited symptom attacks, worry about attacks and fear of situations and activities because of attacks interfere with your social life? (If you didn’t have many opportunities to socialize this past week, answer how you think you would have done if you did have opportunities.)

Define Frenzy - Revisited

Frenzy is described as a state or period of uncontrolled excitement or wild behavior. "Doreen worked herself into a frenzy of rage"

 

Syno-Terms for Frenzy

 

Agitation, Bout & Delirium

Agitation and delirium are distinct but often connected, with agitation being a behavior and delirium being a state of acute brain dysfunction characterized by confusion and a rapid change in mental status, which often includes agitation. Delirium is a medical emergency that can present with hyperactive (agitated, aggressive), hypoactive (sluggish, withdrawn), or mixed symptoms. Identifying the cause of the delirium, which could be illness, infection, or medication, is crucial and requires immediate medical attention to prevent severe outcomes.

Dementedness, Derangement & Distraction

Dementedness, derangement, and distraction are related but distinct concepts involving a departure from normal mental functioning. The terms vary in severity and clinical relevance, with "dementedness" and "derangement" often referencing a serious state of mental disturbance, while "distraction" refers to a more common and temporary lapse in attention.

Fit, Hysteria & Insanity

Fit, Hysteria & Insanity is likely a phrase or title referring to the historical relationship between mental health concepts. In the late 19th and early 20th centuries, "fit," "hysteria," and "insanity" were intertwined terms, especially in the field of psychiatry. A doctor named F.W. Edridge-Green discussed the "Relation of Hysteria to Insanity" in 1904, highlighting how many distinct conditions were grouped under "hysteria" and were thought to be closely related to insanity.

Madness, Mania & Outburst

While related, madness, mania, and outburst refer to distinct concepts in both everyday language and clinical psychology. "Madness" is an outdated, non-clinical term for severe mental illness, while "mania" is a specific mood state associated with bipolar disorder. An "outburst" is a sudden and temporary expression of emotion that can occur in any individual, but may be more extreme or frequent during a manic episode.

Paroxysm, Seizure & Spasm

"Paroxysmal" describes a symptom's sudden, episodic nature, while a seizure is a specific type of event characterized by abnormal, excessive, and synchronized brain activity. A spasm is a sudden, involuntary muscle contraction or twitch, which can be a component of certain paroxysmal events or seizures, like epileptic spasms.

Tumult & Turmoil

"Tumult" refers to a sudden, noisy, and confused disturbance, often from a large crowd, or an internal mental or emotional disorder. "Turmoil" describes a more prolonged state of great confusion, uncertainty, and disturbance. While "tumult" can describe the chaotic event itself, "turmoil" describes the general condition of disorder and agitation that may include various tumults.