The mall wasn’t open yet and the door was still locked. Laughing, I realized that I’d never had this problem before. I’m never early for anything.

“If you don’t like Celexa, you don’t have to continue taking it,” my doctor said. Yeah, I thought. I’ve heard that story before.

“I think you’d feel much better if you tried some medication other than Xanax,” he said. His concern was genuine. “Instead of treating your panic as it happens, we should try to prevent it.”

(If you missed the first three parts of this story, click here, then here , and then here.)

The scene: a small road off of a two-lane state highway in the woods. The cell phone coverage: first none, then a single bar. My panic state: full blown.

I was laying down in my car, following the EMT-in-training’s instructions to avoid sitting up or moving around, and I was scared nearly to death. I shook, I gasped for air, and I palpitated.

I hated every single second that slowly and dreadfully crawled by. No matter how hard I tried, I couldn’t even conjure up the energy or the clarity of mind to reach for my Ten Rules for Coping With Panic worksheet that lives in my wallet. I was in the middle of nowhere, I was stuck, and I couldn’t escape without help. Not only was I about to receive medical help, but I’d had to call my husband and ask him to drive 40 miles to be with me.

Ugh. Failure.

The word kept repeating in my head: failure failure failure.

Maybe I am having a legitimate medical problem instead of a panic attack. Maybe there’s a problem with my heart or my blood pressure. Maybe there’s a problem with my brain. Did I have a stroke? Maybe I’m having a stroke RIGHT NOW OH GOD WHAT THE HELL.

When your limbs are shaking uncontrollably, the gas pedal is a nightmare to control. My car heaved in fits and starts, thanks to my spasmodic right foot, but I didn’t make it far before I started to feel very cold and prickly.

Twenty minutes in: rocking out to Modest Mouse and eating a peanut butter cup. Thirty minutes into the drive: nausea, a racing heart, and a vivid expectation of death.

I wanted to re-frame a breakdown into a breakthrough.

I can’t panic now, I thought. I want to pay this parking ticket. I have a hair cut appointment in a half hour. Then, I need to grade some more papers. I’ve got shit to do. Don’t panic. Don’t panic. Don’t panic.

As an adult, I definitely understand the logic of how small things sound like big things at night.

It’s the Contrast Principle in effect: during the day, there are so many sounds in nature that we’re unlikely to hear a tiny mouse scurrying near our feet. But at night, with its absence of light, dull orchestra of crickets, and an imagination open wide, tiny sounds get amplified by our minds.

As we learned in my last blog post, in a tent full of scared eleven-year-old Girl Scouts at summer camp, a field mouse scurrying through the leaves = a big hungry bear searching for a late-night snack. At the right (or, well, wrong) thoughts and a tiny mouse becomes a big bear.

It doesn’t necessarily need to be dark outside for our mind to amplify the wrong message. When anxious, small things sound like big things. When sick, small things sound like big things. When depressed. When overwhelmed. When tired.

I mean, think about it: when’s the last time something small — say, washing a load of dishes — seemed like a gargantuan task? Maybe it was yesterday when your nerves were already abuzz thanks to your colicky little one screaming her head off.