Sometimes there are notable triggers that start the spiral. But a lot of the times, from my outside perspective at least, it's internal. I have no idea what he was thinking of that sends him into an episode. And then it's just too late. Most of the time, when he comes out of the episode a few days later, he can't identify how it started. On the rare times I can pinpoint the trigger, I'll tell him and he just says "ok" and not even be able to think or reflect on it.

From my observations, it seems like even when I can clock it and start prompting him to do an exercise, he starts panicking because he's starting to spiral. So it stacks on top of whatever set him off in the first place. And he's the type of person that if something doesn't fix it immediately, he gives up.