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What Keeps Panic Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, they provide an easy way for clients to understand at a glance why their disorders persist, and how they might be interrupted. What Keeps Panic Going? is designed to help clients experiencing panic attacks and panic disorder understand more about their condition.

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A PDF of the resource, theoretical background, suggested therapist questions and prompts.

Client version

A PDF of the resource plus client-friendly instructions where appropriate.

Editable version (PPT)

An editable Microsoft PowerPoint version of the resource.

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Languages this resource is available in

  • Bulgarian
  • Chinese (Simplified)
  • English (GB)
  • English (US)
  • Greek
  • Italian
  • Polish

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Introduction & Theoretical Background

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. Some people might just have a single panic attack and not experience any more. 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. 


Research studies have shown that Cognitive Behavioral Therapy (CBT) is probably the most effective treatment for panic disorder (Pompoli et al, 2016). CBT therapists work a bit like firefighters: while the fire is burning they aren’t very interested in what caused it, but are more focused on what is keeping it going. This is because if they can work out what keeps the problem going, they can treat it by ‘removing the fuel’ and interrupting this maintaining cycle. 


In 1986, psychologist David Clark identified key components that are thought to explain why some people keep suffering from panic attacks. The What Keeps Panic Going? information handout describes these factors, which maintain panic attacks and panic disorder. It illustrates these maintaining factors in a vicious flower format in which each ‘petal’ represents a separate maintenance cycle. Helping clients to understand more about the cognitive model of panic is an essential part of cognitive therapy for panic. Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences of panic.

Therapist Guidance

“One interesting way of thinking about panic is to look at why, for some people, it does not get better by itself. This handout shows some of the most common reasons why some people’s panic persists. I wonder if we could look at it together and think about whether it describes what is happening for you?”

References And Further Reading

  • Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
  • Pompoli, A., Furukawa, T. A., Imai, H., Tajika, A., Efthimiou, O., & Salanti, G. (2016). Psy- chological therapies for panic disorder with or without agoraphobia in adults: a network meta‐ analysis. Cochrane Database of Systematic Reviews, (4).