Panic Disorder

Panic disorder is a mental health condition involving frequent, unexpected panic attacks (also known as anxiety attacks) when there is no real danger or apparent cause. A panic attack is a sudden episode of intense and overwhelming fear that can trigger severe mental and physical reactions such as an accelerated heart rate and a fear of losing control.

Many people will have just one or two panic attacks in their lifetimes, whereas with panic disorder the panic attack is not only more frequent and unexpected but also comes with a persistent worry about having another attack. There is also an avoidance of situations that may bring on another attack, such as going to places where panic attacks have occurred before, being in an enclosed space or in an unfamiliar situation.

Although panic attacks themselves are not dangerous, they can be frightening and significantly affect one’s quality of life. It's important to know treatment for panic attacks and panic disorder can be very effective. Before receiving a diagnosis of panic disorder persons experiencing frequent panic attacks should be evaluated by their physician to rule out any physical cause for the attacks.

The following are some common symptoms of panic:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating, trembling or shaking
  • Sensations of shortness of breath or smothering
  • A feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Feelings of unreality (derealization) or being detached from oneself (depersonalization)
  • Fear of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations
  • Chills or hot flushes

Common Compulsions in Panic Disorder

Avoidance of any situation or activity that may trigger panic including job, travel and social opportunities

Distraction to cope with anxiety-producing thoughts, feelings and sensations

Preparation/Planning by sitting near the exits when going out, bringing anti-anxiety medication, water, etc.,

Reassurance seeking: asking family and friends if they think they will be okay, going places only when with another person

Treatment for Panic Disorder

A number of CBT therapies are effective in treating panic. Psychoeducation helps clients understand the neurobiology of what causes panic, and cognitive restructuring helps clients identify ineffective patterns in thinking that can lead to or prolong panic and learn how to change their thinking to be more reasonable and skillful.

Acceptance and commitment therapy (ACT) and Mindfulness help clients learn to accept, not resist challenging thoughts and sensations by using breath to move through the discomfort, and also apply self-compassion during panic using a warm tone of voice towards themselves along with kind words of support, just as one would with a friend.

Interoceptive Exposure is a specific type of Exposure and Response Prevention for panic disorder that helps clients habituate to symptoms of panic such as heart palpitations, sweating, dizziness and hyperventilation. Like ERP for other anxiety disorders, interoceptive exposure is a collaborative, compassionate process between therapist and client to gradually bring about the symptoms the client is having so they become desensitized to them over time.

In addition to interoceptive exposure, standard ERP is practiced to eliminate the safety behaviors or compulsions clients are doing in an attempt to get certainty. These safety behaviors/compulsions serve to reinforce the Panic Cycle. Eliminating these behaviors gradually over time weakens panic and clients are able to once again live their lives freely, knowing if the panic symptoms do arise, they have the tools to handle it.