Summary

Panic attacks are common psychological experiences characterized by intense physical and emotional symptoms, often triggered by perceived threats or subtle stimuli, and can be effectively treated with Cognitive Behavioral Therapy (CBT) and medication.

Abstract

Panic attacks are a prevalent phenomenon affecting approximately one in five people in the United States, as indicated by the National Comorbidity Survey Replication. These episodes are marked by a combination of physical symptoms like shortness of breath and chest pain, as well as profound emotional distress, leading individuals to believe they are in mortal danger. Cognitive psychology, particularly Clark's model from 1986, outlines four components of panic attacks: identifiable triggers (which may or may not be present), activation of the fight-flight response, misinterpretation of bodily sensations, and safety behaviors that can inadvertently perpetuate the cycle of panic. Despite their terrifying nature, panic attacks are highly treatable, with CBT showing recovery rates of up to 93%.

Opinions

The article suggests that panic attacks can be triggered by both clear and subtle stimuli, emphasizing that the perception of threat is subjective and can be influenced by internal thoughts and sensations.
The fight-flight response is portrayed as an overprotective mechanism that can be activated in the absence of real danger, leading to unnecessary stress on the body.
Misinterpretation of bodily sensations during a panic attack can result in a catastrophic misinterpretation, where individuals believe they are experiencing life-threatening events.
Safety behaviors, such as selective attention to physical symptoms and avoidance of certain situations, are seen as counterproductive, potentially reinforcing the panic cycle rather than alleviating it.
The article holds a positive view on the treatability of panic attacks, highlighting the effectiveness of CBT and medication in managing and overcoming this condition.

Panic attacks, explained.

Breaking down panic attacks and understanding their mechanisms

People who have suffered from panic attacks will know what it’s like to experience sheer terror. It is a psychological phenomenon that causes a powerful effect on the body. The DSM-V (the Diagnostic and Statistical Manual of Mental Disorders) indicates that panic attacks are characterized by a range of physical symptoms, such as shortness of breath, chest pain, shaking, and feeling faint. If that weren’t enough, panic attacks are also accompanied by intense emotional experiences, where people will truly believe that they are dying or losing their mind.

If this sounds like a horrendous experience that only strikes the unlucky few — think again. Panic attacks are actually pretty common. Findings from the National Comorbidity Survey Replication suggest that around 1 in 5 US citizens will experience a panic attack in their lifetime. Luckily, research has made incredible strides to understanding the whys, hows, and whens of panic attacks.

Cognitive psychology has presented one of the most comprehensive and evidence-based models of panic (see Clark, 1986), which breaks it down into four distinct components.

The trigger

Panic attacks are sometimes preceded by clear, identifiable triggers. This trigger does not have to present an actual threat to life (e.g. being held at gunpoint) to elicit a panic attack — being placed in a situation that creates intense fear, such as public speaking, is sufficient.

However, many people will report that their panic attack was out-of-the-blue and completely unexpected. So, what’s happening in these cases? According to psychologists, these “uncued” panic attacks are triggered by much more subtle internal or external stimuli. These might take the form of thoughts (like anxious predictions that something bad will happen), or bodily sensations (like your heart beating faster when you are nervous, or your noticing pain in some part of your body).

2. Activation of fight-flight response

Whatever the trigger, what is crucial is that the brain perceives that it is under threat, which activates the “fight or flight response”. A cascade of hormonal signals are then sent around the body to prepare you to fight, run away as fast as you can, or if all else fails — play dead.

Photo credit to @chrissabor via Unsplash

This then instigates a whole host of physiological changes, which might lead to an accelerated heart rate, increased alertness, heavy breathing, and butterflies in the stomach. Each of these responses is unique evolutionary adaptations so that you have the best chance of survival when something dangerous comes your way.

Think of your fight-flight response as your over-protective lioness mother. Any whiff of danger, and she’s ready to take someone’s arm off. Unfortunately, what this means in real terms is that our fight-flight response gets triggered even when we are not actually in any danger. That is a lot to put your body through for a false alarm, but better safe than sorry, right?

3. Misinterpretation of bodily sensations

Another handy adaptation of the fight-flight response is that it is an unconscious process, which allows us to react to threat quickly. This is great in situations where there is real danger, as you definitely would not be able to dodge any punches if you had to spend time thinking about it.

However, when our fight-flight system misfires (false alarm), what happens is that we have all these intense physical reactions, but without any observable explanation for them. Imagine sitting on the subway and out of nowhere, your heart starts racing and you break into a cold sweat. Scary, no?

Without an understanding of what is happening to our bodies and minds, people make what psychologists have termed a catastrophic misinterpretation. They interpret their anxiety symptoms as signs of immediate danger to their life or safety. For example, heart palpitations may be interpreted as “I am having a heart attack”. Racing thoughts? “I am losing my mind”. Dizziness? “I am going to collapse”. This then feeds the fight-flight response further, which leads to bodily and psychological symptoms to intensify. Handy.

4. Safety behaviors

Individuals who have suffered from panic attacks may engage in a range of behaviors that they feel might keep themselves safe. Unfortunately, these sometimes have the unintended effect of creating a feedback loop that maintains the cycle of panic. This means people may not resolve their panic attacks or experience them more frequently.

Consider the example of a person who misinterprets their accelerated heart rate as a sign that they are having a heart attack. They begin to pay more attention to their heartbeat (this is known as selective attention), checking in more frequently, so that they can respond quickly if anything seems unusual. However, this will then mean they start to notice many more subtle irregularities in their heartbeat or even pick up things that aren’t really there — things that wouldn’t have happened if they weren’t monitoring. This could then increase the probability that a panic attack is triggered.

Another common safety behavior is avoidance. If you know that you had your last panic attack in a crowd, why not avoid crowds in the future? Well, what this is teaching the body is that crowds are something to be feared, while removing your opportunity to learn that you can be in a crowd without something bad happening.

It is important to note, that whilst panic attacks are genuinely frightening for those affected, they are one of the mental health difficulties which respond best to treatment. Research shows that panic can be treated effectively with both Cognitive Behavioral Therapy (CBT) and medication. Studies have shown recovery rates of up to 93% with CBT, with similar promising results from medications. If panic is something that you are struggling with, please do remember that help is out there.