Panic refers to a sudden, intense fear that occurs abruptly. Such panic might lead to what is often termed a Panic Attack. In a panic attack, it’s common for two additional symptoms to occur. The first is an intense physical sensation, such as a fast-beating heart or shortness of breath. The second is extreme thoughts, often referred to as 'catastrophizing', accompanying thoughts like “I feel like I'm going to die” when a panic attack occurs.
Though a panic attack is itself very frightening and distressing, it is not actually dangerous. Nobody dies from a panic attack. Moreover, some people might experience just a single panic attack and never encounter panic again. However, others may suffer repeated panic attacks, worry about the potential occurrence of panic, and make various attempts to avoid it. In such cases, they can be ultimately diagnosed with panic disorder. What differentiates someone who experiences only one panic attack from someone who is diagnosed with panic disorder? Why do some people continue to have panic attacks? Cognitive psychologists have identified three habits that create, sustain, and worsen panic. Let’s examine each one.
Those who have experienced panic attacks often mistakenly interpret bodily sensations, which are medically harmless, as urgent signals of danger. For example, when their heart beats fast or breathing quickens, they might think, “I'm going to die” or “I’m going to faint”. Specifically, they might worry about a possible heart attack or about the sudden stopping of breath.
The problem is that such worries stimulate the sympathetic nervous system. When the sympathetic nervous system is stimulated, various hormones including adrenaline and cortisol are secreted, which do actually increase heart rate and frequency of breaths. This then results in more uncomfortable physical sensations, leading back to excessive worry. From this cycle alone, it is easy to understand why panic disorder might manifest in the form of an ‘attack’. It's because of this continuous, vicious cycle.
A panic attack is certainly a fear nobody wants to experience again. Think back to when you were in a state of panic. The world seems chaotic. Typically, after a terrible experience, people avoid repeating it. The same happens with panic. Some of those who have gone through panic pay close attention to even minor physical sensations, worrying “What if?”, “Surely not?”. Being overly sensitive to panic can with high likelihood trigger another attack due to the vicious cycle mentioned earlier. If the first case starts with a physical sensation that leads thoughts to amplify it into a cycle, the second case starts with thoughts that amplify the physical sensation.
People often engage in certain behaviors to avoid panic. Commonly, they steer clear of places where they’ve previously experienced panic attacks, like crowded areas, for instance. Some may walk a very long distance to avoid taking the bus, or for those who do not want to fly, they could go decades without traveling abroad even once. There are also those who, fearing that their breathing might become labored, choose not to exercise at all, or avoid consuming any coffee that could potentially cause their heart to race.
Such behaviors are referred to as 'safety behaviors'. These safety behaviors help to avoid situations that might lead to panic, and so they could be seen as having some short-term benefits. However, if safety behaviors become excessive, they can lead to increased sensitivity to panic. When a person steps even slightly outside of the ‘safe’ zone that safety behaviors have provided, they are likely to experience a panic attack.
To manage the acute symptoms of panic, medication may be necessary. To prevent panic from persisting and worsening, cognitive-behavioral therapy is needed. Cognitive-behavioral therapy is often cited as the most effective treatment for panic disorder because it targets these three elements precisely. The truth taught in cognitive-behavioral therapy is simple: The world is not as dangerous as we think. The negative emotions and sensations we experience are not that dangerous. Have you ever paused when feeling anxious with a racing heart, closed your eyes, and truly felt what it was like? Have you ever stayed with that sensation?
As you practice through cognitive-behavioral therapy, you will come to understand that the sensations in your body or the thoughts that arise in your mind are not as threatening as you might think. They too are merely something that one can willingly experience in this world.
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). Psychological therapies for panicdisorder with or without agoraphobia in adults: a network meta‐ analysis. Cochrane Database of Systematic Reviews, (4).
