Panic Disorder patients hold beliefs about their ability to respond to the panic experience. Based on their belief system of control over panic, patients are divided into two separate categories: those with an external locus of panic control and those with an internal locus of panic control. Patients with an external locus of control accept as true that the way in which they will react during a panic attack depends on the presence of external help. For example, they think it is necessary to be accompanied by a person of confidence or to establish immediate communication with their therapists in order to control a panic attack. They do not believe that they have the ability to reinstate a state of calmness by themselves (external locus of control).
Patients with an internal locus of control have learned to believe that there is always some form of action they can undertake to help themselves during the course of a panic experience. They may not have discovered yet what the most effective action might be but nevertheless they locate this action within the power of their organism. For instance, they feel less worried about letting other people know that they have been diagnosed with panic disorder. This is because they know that they can actually exercise enough influence over what other people think of them (internal locus of control). Therefore, they do not believe that their social image is threatened by such a revelation.
Patients with an external locus of control and patients with an internal locus of control employ very different psychological mechanisms to protect themselves against panic and anxiety in general: the former feel helpless in themselves (external locus of control). The latter try to do something by themselves (internal locus of control). It is these psychological profiles that determine which patient will successfully negotiate panic disorder and which patient will develop chronic panic disorder.
For the successful treatment of panic disorder and for preventing both the painful experience of relapse and the introduction of the chronicity of the problem, therapeutic protocols should reinforce the progressive substitution of external loci of anxiety control with internal loci of anxiety control. This should extend to areas beyond the symptoms of panic disorder, since the patients’ belief system of locus of control extends to anxiety areas beyond the symptomatology of panic disorder. Patients are more responsive to this therapeutic possibility after the reduction of the acute symptomatology.