Panic Attacks

Panic is the most extreme form of anxiety. It’s the body’s strongest fear reaction. Let’s consider an example of what panic might feel like:

“For me, panic is a terrifying experience. I feel like I’m losing control in a very extreme way and I feel disconnected from reality. My heart pounds really hard, I feel like I can’t get my breath, and there’s an overwhelming feeling that things are closing in on me. It started 5 years ago, when I had just graduated from college and started a new job. I was sitting in a work seminar in a hotel and it came out of the blue. I felt like I was dying. In between panic attacks there is this dread that it’s going to happen again. I’m afraid to go back to where I’ve had an attack. Unless I get help, there soon won’t be anywhere where I can go and feel safe from panic.”

Panic is characterized by sudden attacks of terror, usually with a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.


People having panic attacks sometimes believe they are having heart attacks, losing their minds, or on the verge of death. They can’t predict when or where an attack will occur, and between episodes many worry intensely and dread the next attack.

Panic attacks can occur at any time, even during sleep. An attack is overwhelming anxiety that comes on quickly, and usually peaks within 5 to 10 minutes. Panic attacks affect about 5 percent of Quebec adults and are twice as common in women as men. Panic attacks often begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder. The tendency to develop panic attacks appears to be partly inherited.

People who have panic attacks can become very disabled by their condition and are encouraged to seek treatment before they start to avoid situations or places where attacks have occurred. For example, if a panic attack happened in an elevator, someone with panic may develop a fear of elevators that could affect the choice of a job or an apartment, or limit where that person can get medical help or see their family or friends.

Some people’s lives become so restricted that they avoid necessary activities, such as grocery shopping or driving to work. Many become housebound or are able to confront a feared situation only when accompanied by a family member or other trusted person.

People with panic may sometimes go from doctor to doctor for years and visit the emergency room repeatedly (often believing they have a heart condition) before someone correctly diagnoses their condition. This is unfortunate, because panic is one of the most treatable of all the clinical anxiety disorders, responding in most cases to certain kinds of cognitive-behavioural psychotherapy or medication, which help change thinking patterns that lead to fear and anxiety.

How is Panic treated?

Psychologists and other mental health professionals usually treat panic in the context of an anxiety disorder (usually panic disorder or social phobia). The disorder may revolve mainly around panic attacks (and debilitating fear of them), or may be socially determined, in which case the social situations that trigger the attacks are also treated. The best supported treatment for panic attacks is cognitive-behavioural therapy (CBT).

For example, CBT can help people who panic learn that their panic attacks are not really heart attacks, or that social situations that trigger panic can be successfully managed. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.


One effective CBT treatment for panic is the The Albany Panic Control Treatment (PCT) for panic disorder. PCT was originally developed at Albany by psychologists David H. Barlow, Ph.D. and Michelle G. Craske, Ph.D. The helpfulness of this treatment has been documented in a consensus conference sponsored by the U.S. National Institute of Mental Health on treatments of panic disorder, where this treatment, along with certain medications, was recommended as the treatment of choice for panic disorder.

PCT is rooted in a CBT perspective and is intended to help correct distressing and erroneous thinking about panic attacks. PCT uses a technique known as Interoceptive Exposure (IE)– this involves having patients repeatedly trigger feared sensations (e.g., shortness or breath, heart palpitations, dizziness) as a means of reducing the fear of those sensations. IE exercises such as hyperventilation, chair spinning, and breathing through a straw have been demonstrated effective in the treatment of panic attacks and panic disorder, both as part of a broader cognitive-behavioral program and as a stand-alone intervention. For example, IE helps correct misguided ideas patients may have about hyperventilalation. IE gives patients in-depth information regarding the physiology of panic attacks. CBT techniques are used to teach patients to identify and modify erroneous thinking about panic and its triggers. Breathing retaining is provided to decrease the over-breathing that occurs during panic. Repeated exposure to feared mental cues for panic (i.e., fear of fear responses) reduces fear reactions to panic. If the patient also avoids panic situations, real-life exposure to feared and avoided situations is practiced to weaken associations between those situations and panic. Homework assignments are also used: with the therapist’s help, patients monitor anxiety and panic with the goal of replacing avoidance with facing and overcoming the patient’s fears.

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