Doug, panic attacks can pretty much come at anytime. (Some people get them in their sleep.) I mean, for some people, just to think for even a few seconds about their physical symptoms can bring on an attack. But, more than likely, a full blown panic attack doesn't normally happen unless you start "catastophizing" your physical symptoms.
This is why the distracting techniques really work, i.e., as soon as you start thinking about your physical symptoms FORCE your mind to CONCENTRATE on something else - count the tiles on the wall, think of fruits beginning with a, b, c, etc. - and if your mind goes back to your physical symptoms FORCE it back onto your distracting technique. This is what brings that panic down.
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