Guide
A panic attack is a wave of intense fear that rises within a few minutes, with strong sensations: a pounding heart, shortness of breath, dizziness, trembling, a feeling of losing control. It is very frightening, but in a healthy person it isn’t dangerous.
The panic circle
It usually starts with an ordinary sensation. If it is interpreted as a sign of disaster (“a heart attack”, “I’m going mad”), fear rises, and fear increases the sensations, which confirm the fear. This circle is what turns a sensation into an attack.
A little theory · According to David Clark’s model, a panic attack arises from a catastrophic interpretation of normal bodily sensations: “my heart is racing, I’m having a heart attack”. That interpretation increases fear, which increases the sensations, and the circle takes off (Clark, 1986).
Why it comes back
To protect ourselves, we avoid places or sensations (exercise, coffee, public transport) and use safety behaviours (sitting down, staying near the exit). They bring relief, but stop us discovering that the sensations pass on their own.
A little theory · Safety behaviours (sitting down, holding on, always carrying a pill, going with someone) prevent you from discovering that the disaster doesn’t come: we put having “survived” down to the precaution. Reducing them is part of treatment (Salkovskis et al., 1996).
A little theory · In a large controlled trial, CBT was as effective as an antidepressant for panic disorder, and its effects held up better once treatment had ended (Barlow et al., 2000).
What helps
- Understanding your own circle.
- Testing your interpretations, for example by deliberately bringing on the sensations with a psychologist.
- Gradually reducing avoidance.
CBT for panic disorder is one of the most effective psychological treatments. If the symptoms are new or unusual, see a doctor first.
Worksheets to practise
- 68 · The panic cycle · Understanding how a sensation turns into a panic attack
- 69 · Bringing on the sensations on purpose · Learning that the sensations of anxiety are not dangerous (interoceptive exposure)
- 15 · Slow breathing · Slow breathing to accompany anxiety
- 08 · The map of my avoidances · Spotting avoidance and safety behaviours
- 09 · The ladder of small steps · Building a gradual exposure plan
Sources
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
Clark, D. A. & Beck, A. T. (2010). Cognitive Therapy of Anxiety Disorders: Science and Practice. Guilford.
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.
Barlow, D. H., Gorman, J. M., Shear, M. K. & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 283(19), 2529-2536.
These worksheets do not replace therapy. If you are in distress or having suicidal thoughts, call your local emergency number (112 in Europe; 3114 in France, free, 24/7).
