Panic attacks are single episodes of intense fear or discomfort that begin suddenly and reach a peak within minutes. Particularly common among those who suffer from anxiety (Schmidt, 2006), they are not dangerous, and do not by themselves indicate that treatment is required. Many people only experience a single panic attack in their lifetime, though experiencing one panic attack increases the probability of having another in the future. Physiological symptoms of panic include:
- Palpitations or a pounding heartbeat
- Sweating, trembling, or shaking
- Dry mouth, shortness of breath, or feelings of choking
- Chest pain or discomfort
- Hot flushes or cold chills
- Nausea, churning stomach, dizziness, or light-headedness
- Fear of dying, losing control, going crazy, or passing out
- Numbness or tingling sensations
Psychologist David Clark’s cognitive behavioral model of panic suggests that misinterpreting benign body symptoms as a threat leads to activation of the fight-or-flight system, which can in turn exacerbate the intensity of panic symptoms (Clark, 1986). This increased physiological arousal is interpreted as further evidence of impending catastrophe, leading to an upward spiral of panic.
Panic attacks can occur in different circumstances. Clark and Salkovskis (2009) identify three main types of panic attack:
- Those that follow a period elevated anxiety. Physiological sensations of the anxiety are misinterpreted, leading to panic (“I’m shaking > There must be something wrong”).
- Those that appear to happen unexpectedly. We all experience a wide range of body sensations throughout the day (e.g. feeling hot and sweaty if we run to catch a bus, feeling alert and twitchy after drinking coffee). When people who panic are unaware of the sequence of body sensations > misinterpretation > feelings of panic, it may feel to them as though the panic is occurring spontaneously.
- Nocturnal attacks. Waking from sleep in a state of panic is common in people who suffer from panic disorder. Some psychologists suspect that they can be triggered by conditioned reactions to internal physiological sensations.
Cognitive behavioral therapy for panic attacks and panic disorder seeks to address these catastrophic misinterpretations through psychoeducation about panic attacks, anxiety, and the fight-or-flight system. Other components of treatment include monitoring client symptoms, behavioral experiments, exposure to uncomfortable body sensations, decatastrophizing, and relapse prevention.
The What Is A Panic Attack? information handout demonstrates a typical escalation sequence for panic attacks. It is a client psychoeducation tool designed to explain how noticing and misinterpreting benign physical feelings can intensify into a panic attack. The design and language of this handout have been kept simple so that it can be used with a wide range of clients.
This is a Psychology Tools information handout. Suggested uses include:
- Client handout – a psychoeducation resource.
- Discussion point – to provoke a discussion and explore your client’s beliefs.
- Therapist learning tool – to improve your familiarity with a psychological construct.
- Supervision tool – to develop formulations and knowledge.
- Teaching resource – a learning tool during training.
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
- Clark, D. M., Salkovskis, P. M. (2009). Panic disorder: Manual for improving access to psychological therapy (IAPT) high intensity CBT therapists.
- 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.