Understanding Panic Attacks and Panic Disorder

A panic attack is a sudden surge of intense fear or discomfort that reaches a peak within minutes and is accompanied by a cluster of distressing physical symptoms. These may include pounding heart or palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, tingling sensations, chills or hot flushes, and a feeling of unreality or detachment. During a panic attack, many people believe they are having a heart attack, losing their mind, or about to die. The experience is genuinely terrifying.

Panic disorder develops when panic attacks become recurrent and are followed by persistent worry about having further attacks or about the consequences of attacks (such as losing control, going mad, or dying). This worry leads to behavioural changes designed to avoid triggering further attacks, which may include avoiding places where attacks have occurred, avoiding physical exercise (because the physical sensations resemble anxiety), and avoiding caffeine, alcohol, or other substances.

Clark's cognitive model of panic, which forms the basis of the most effective treatment, proposes that panic attacks are maintained by the catastrophic misinterpretation of normal bodily sensations. A benign physical sensation (such as a slight increase in heart rate) is noticed and interpreted as a sign of imminent danger (for example, "My heart is pounding — I am having a heart attack"), which triggers further anxiety, which produces more physical symptoms, which are interpreted as further evidence of danger, creating a rapidly escalating vicious cycle.

The good news is that panic disorder responds extremely well to CBT. Treatment typically involves psychoeducation about the fight-or-flight response, identification and challenging of catastrophic misinterpretations, interoceptive exposure (deliberately inducing feared physical sensations in a safe environment to demonstrate that they are not dangerous), and graded exposure to avoided situations. Recovery rates with CBT for panic disorder are among the highest for any psychological intervention.