I have had them out of the blue, and I have had them via trigger. Most occur with a trigger, but some don't. They "out of the blue" type are the most frightening. I have trained myself to know what it is and sort of try to laugh at it. I say...oh, here we go again, just breath and laugh at this because it will all be over in a few min. anyhow (well, the worst of it is over quickly). I guess i try to lean into them now and I attempt to enjoy them if that makes any sense. I have had two in the past two years that were not manageable with this line of thinking though. Those, I just had to get to a place where I was alone and ride it out. One of the bad ones happened at an amusement park in a crowd so tight I think I ended up pushing people (accidentally and without active awareness) just to get out of the crowded space. It sucked, but it passed and I was back enjoying rides with my family within 20 or 30 min. I just try to roll with the punches now. I hope you are ok.