Understanding Panic

A panic attack is a sudden surge of intense fear which is accompanied by strong body feelings (such as your heart beating rapidly, or finding it hard to breathe) and catastrophic thoughts (such as thinking that you will lose control or die). Panic attacks feel terrifying, but they are not dangerous. People who worry about their panic, and who take steps to try to prevent the possibility of having more, are said to suffer from panic disorder.

It is thought that between 1 and 3 people out of every 100 will experience panic disorder every year and many more than that will have a panic attack at least once. Cognitive Behavioral Therapy (CBT) is an extremely effective treatment for panic disorder: about 80% of people with panic disorder who complete a course of CBT are panic-free at the end of treatment (Rees et al., 2016).

This guide is for people who are struggling with panic. It will help you to understand:

• What panic is.
• Why panic might not get better by itself.
• Treatments for panic.

• Scaffold knowledge. The guides are perfect during early stages of therapy to help your clients understand how their symptoms fit together and make sense.
• Reassure and encourage optimism. Many clients find it hugely reassuring to know there is a name for what they are experiencing, and that there are evidence-based psychological models and treatments specifically designed to help.
• De-mystify the therapy process. To increase your client’s knowledge of the therapy process and the ingredients that it is likely to involve. If you can help your clients to understand why an intervention is important (think exposure!), it can help encourage them to engage.
• Signposting. If you’re just seeing a client briefly for assessment, or you have a curious client who wants to know more, these resources can be a helpful part of guiding them to the right service.
• Waiting time not wasted time. When you’ve assessed someone but their treatment can’t begin right away, psychoeducation can help them learn about how therapy can help while they’re waiting.

• Case examples to help your clients relate to the condition, and to normalize their experiences.
• Jargon-free descriptions of symptoms, and descriptions of how they might affect your thoughts, feelings, and actions.
• A symptom questionnaire for screening assessment.
• An accessible cognitive-behavioral account of what keeps the problem going, or what stops it from getting better.
• A description of evidence-based treatments for that condition, including an overview of the ‘ingredients’ of a good cognitive behavioral approach.

• Rees, R., Stokes, G., Stansfield, C., Oliver, E., Kneale, D., & Thomas, J. (2016). Prevalence of mental health disorders in adult minority ethnic populations in England: a systematic review. Department of Health.
• Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627.
• Clark, D.M. and Salkovskis P. (2009). Cognitive Therapy for Panic Disorder: Manual for IAPT high intensity therapists. Retrieved from: https://web.archive.org/web/20190704101855/https://www.kss-ppn.nhs.uk/resources/publications/12-cognitive-therapy-for-panic-disorder-iapt-manual/file
• Fleet, R. P., Dupuis, G., Marchand, A., Burelle, D., Arsenault, A., & Beitman, B. D. (1996). Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition. The American Journal of Medicine, 101(4), 371-380.
• Schmidt, N. B., Zvolensky, M. J., & Maner, J. K. (2006). Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology. Journal of Psychiatric Research, 40(8), 691-699.
• Ehlers, A. (1993). Somatic symptoms and panic attacks: a retrospective study of learning experiences. Behaviour Research and Therapy, 31, 269-278.
• Cox, B. J. (1996). The nature and assessment of catastrophic thoughts in panic disorder. Behaviour Research and Therapy, 34(4), 363–374.
• Pompoli, A., Furukawa, T. A., Imai, H., Tajika, A., Efthimiou, O., & Salanti, G. (2016). Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta‐analysis. Cochrane Database of Systematic Reviews, (4).
• Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
• Salkovskis, P. M., Clark, D. M., & Gelder, M. G. (1996). Cognition-behaviour links in the persistence of panic. Behaviour Research and Therapy, 34(5-6), 453-458.
• Funayama, T., Furukawa, T. A., Nakano, Y., Noda, Y., Ogawa, S., Watanabe, N., ... & Noguchi, Y. (2013). In‐situation safety behaviors among patients with panic disorder: Descriptive and correlational study. Psychiatry and Clinical Neurosciences, 67(5), 332-339.
• Furukawa, T. A., Watanabe, N., & Churchill, R. (2007). Combined psychotherapy plus antidepressants for panic disorder with or without agoraphobia. Cochrane Database of Systematic Reviews, (1).
• National Institute for Health and Care Excellence (2011). Generalised anxiety disorder and panic disorder in adults: management. Retrieved from: https://www.nice.org.uk/guidance/cg113/resources/generalised-anxiety-disorder-and-panic-disorder-in-adults-management-pdf-35109387756997