Baseer Maroof, LCSW · Raleigh, NC · Adults 21+
Panic
The heart pounds, the air feels thin, and your brain shouts “emergency.” Here’s what a panic attack actually is, and how the spiral gets broken.
In short
- A panic attack is a sudden surge of intense fear that peaks within minutes, with body symptoms like a pounding heart, breathlessness or dizziness.
- Panic disorder is when attacks keep coming out of the blue and you spend at least a month worried about the next one, or reorganize your life around avoiding them.
- The engine is reading normal body sensations as a catastrophe. Change the read and the spiral runs out of fuel.
- CBT for panic is the first-line treatment. It includes bringing on the sensations on purpose (interoceptive exposure).
Panic attacks vs panic disorder
Paraphrased.
A panic attack
An abrupt surge of intense fear or discomfort that peaks within minutes, with at least 4 of 13 symptoms: pounding heart, sweating, trembling, shortness of breath, choking feeling, chest pain, nausea, dizziness, chills or heat, numbness or tingling, feeling unreal or detached, fear of losing control, fear of dying. (StatPearls Panic)
Panic disorder
Repeated unexpected attacks, plus at least a month of persistent worry about more attacks or what they mean, or changes in behaviour to avoid them. An occasional attack before a big presentation isn’t panic disorder.
How common
2.7% of U.S. adults in a given year, 4.7% in a lifetime. Women 3.8%, men 1.6%. Of those with it, 44.8% had serious impairment. (NIMH)
Check once
If you’ve never had chest pain, fainting or palpitations checked, see a doctor once to rule out a medical cause. After that, repeated ER visits and checking tend to feed the cycle.
The spiral
The panic spiral
Pick a sensation, then switch between the two readings. Tap a step or press Play.
The sensation:
How you read it:
Based on Clark’s cognitive model of panic (1986).
Breaking it
Learn the body
Adrenaline explains every sensation on the list. Knowing exactly why your heart pounds or your hands tingle takes the mystery, and a lot of the threat, out of it.
Bring the sensations on purpose
Interoceptive exposure: spin in a chair, run stairs, breathe through a thin straw, shake your head. You learn the sensations are uncomfortable and not dangerous. Panic example ladder →
Drop the safety behaviours
Water bottle, sitting by the exit, a “just in case” pill, never driving alone. Each one quietly says “you were in danger.”
Don’t fight the surge
Trying to force it down usually adds fuel. Let it peak and pass. It always does.
Treatment
CBT first
NICE recommends CBT for panic disorder, about 7–14 hours in total, usually weekly sessions finished within four months. (NICE CG113)
Not benzodiazepines
NICE says benzodiazepines shouldn’t be used to treat panic disorder because long-term outcomes are worse. Antidepressants are the medication it recommends for the long term. In 2020 the FDA updated its boxed warning on benzodiazepine misuse, dependence and withdrawal. (NICE CG113; FDA 2020)
Medication
If you’re already on a benzodiazepine, talk to your prescriber before changing anything. Stopping suddenly can be dangerous.
Sources
All sources, linked6 references⌄
- StatPearls. Panic Disorder. NCBI Bookshelf NBK430973. www.ncbi.nlm.nih.gov/books/NBK430973/
- National Institute of Mental Health. Panic Disorder (NCS-R statistics). www.nimh.nih.gov/health/statistics/panic-disorder
- Clark DM (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470. pubmed.ncbi.nlm.nih.gov/3741311/
- Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. pmc.ncbi.nlm.nih.gov/articles/PMC4114726/
- NICE (2011, updated 2020). Generalised anxiety disorder and panic disorder in adults: management (CG113). www.nice.org.uk/guidance/cg113/chapter/Recommendations
- U.S. FDA (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
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