The endless chase
The vicious circle down into oblivion
Getting out of a vicious circle always includes...
THE ENDLESS CHASE
"I'm not good enough" is a completely erroneous belief with no sound basis.
Yet believing that has set Barbara off on a chase that is endless and mostly fruitless. Though it works at times, just like any addiction or poor behavior might, that occasional "reinforcement" does not mean that it works over the long term.
Yes, a cat can chase it's tail, but it is seldom a fruitful activity.
THE VICIOUS CIRCLE DOWN INTO OBLIVION
Feeling she is not good enough leads her to needing validation and approval from others, which in turn leads to her social anxiety, which in turn leads to her panic attacks and hyperventilation, which in turn leads to her shying away from social interaction, which in turn leads to her feeling lonely, which in turn leads to her feeling miserable.
Her hyperventilation leads to depleting her physical and mental resources, which leads to several days of recuperating, which leads to feeling bad about blowing that time and to feeling bad that she is the victim of the hyperventilation, this all leads to her being in a low state of resourcefulness, which leads to her not making good decisions (as it would do with anyone), which leads to her criticizing herself for not making good decisions....
And then she disapproves of herself, which leads to her focusing on that instead of on loving herself and doing things that would make her feel good (such as Soothing/Nurturing Oneself), then she doesn't realize that she could fill her own needs and not be needy, which leads her to being more susceptible to seeking approval from others, violating the principle of control. And because she doesn't take care of fulfilling herself, she concentrates on "what's wrong" and thinks from a "loss" mentality, rather than seeing what there is to be grateful for.
GETTING OUT OF A VICIOUS CIRCLE ALWAYS INCLUDES...
Getting out of a vicious circle always includes doing a step that gets own outside the vicious circle. (Duh!)
The point here is that we can get out of the vicious circle by intervening at any point.
Look at the chaining of thought circles above and pick out any point in the causal chain/circle.
Changing the belief that she is not good enough is the obvious and most effective point since it is the beginning of the causal chain. This is discussed in Cause And Effect.