"Hypoglycemic" anxiety. The role of reinforcement in psychophysiological disorders.

One adult had panic attacks that always ended with eating. Doctors called it ‘hypoglycemic anxiety.’ The team used an ABAB design.

In baseline phases, the person ate right after panic. In treatment phases, staff delayed food 30 minutes and taught relaxation. They tracked heart rate and self-reported fear.

When eating no longer followed the panic, the attacks dropped fast. Heart rate and fear ratings fell in the first treatment phase and returned when food was allowed right away.

The second treatment phase showed the same drop, proving the link was learned, not low blood sugar.

Gaucher et al. (2020) also used differential reinforcement. They slowed autistic children’s fast talking with a DRL schedule. Both studies show you can change behavior by changing what follows it.

BURNSTEIN et al. (1964) found wheel-running reinforced rat drinking. Matthews et al. (1987) found eating reinforced human panic. Together they prove almost any event can be a reinforcer.

Sanders et al. (1989) showed caffeine itself, not just coffee taste, kept adults drinking. Likewise, A et al. showed food itself, not just taste, kept panic alive. Check what is really reinforcing before you treat.

If a client says ‘low blood sugar’ causes panic, test the contingency first. Delay the snack, teach a quick relaxation, and watch the numbers. You may fix the panic without any diet change.