A panic attack or panic disorder is when you regularly have sudden attacks of panic or fear. Panic is the most severe form of anxiety and people living with panic disorder produce very real, physical symptoms, from rapid increase in heartbeat to tightening of the chest.
Everyone experiences feelings of anxiety and panic at certain times. It’s a natural response to stressful or dangerous situations. But someone with panic disorder has feelings of anxiety, stress and panic regularly which seem to occur any tme, often for no apparent reason. You may start to avoid certain situations because you fear they’ll trigger more attacks. This can create a cycle of living “in fear of fear”.
Counselling and medication are the most common treatments for panic. They demonstrate strong evidence of effectiveness in helping people address and overcome this disorder.
A panic attack can occur suddenly without warning, and for what appears to be no logical reason. Panic attack symptoms can be frightening, particularly if they appear to come from out of nowhere. Alongside feelings of anxiety, a host of other symptoms can accompany an attack such as:
Most panic attacks last for around 5 to 20 minutes. In certain situations, the shock of the physical symptoms can make people fear they are having a heart attack. However, it is important to note that the symptoms of a racing heartbeat and shortness of breath during a panic attack will not cause a heart attack.
People with panic disorder tend to experience general feelings of worry and anxiety in their daily life. They can experience panic attacks on a regular basis. The number of attacks you have will depend on how severe your condition is. Some people have attacks once or twice a month, while others have them several times a week. As with many mental health conditions, the exact cause of panic disorder isn’t fully understood.
“I feel like myself again. I’ve learnt to recognise my achievements and control my feelings of anxiety, which has helped me to regain my confidence and given me the motivation to try lots of new things…Things that previously filled me with panic are now a positive challenge…”
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Counselling and psychotherapy can help people to address panic in a number of ways including understanding and managing panic symptoms, overcoming panic attacks and reducing panic frequency. In fact, it is not uncommon for people to be free of unexpected panic altogether by the end of a course of treatment. These therapies also help people develop the skills needed to feel confident in coping should a panic attack occur again in the future.
CBT (Cognitive Behavioural Therapy) is considered one of the most effective psychotherapies for dealing with panic disorder and panic attacks. According to this model, people who suffer from panic disorder often have distorted ways of thinking that they are not aware of and these thoughts bring on a cycle of fear. By recognising and reshaping these thought patterns, people can take control over their panic. Relaxation training and exposure might also be used to help an individual overcome the problem, and homework assignments such as journals or breathing exercises are typically part of the programme. Weekly sessions of CBT for panic, over a period of 7 to 14 weeks, are recommended by the UK National Institute for Care and Excellence (NICE).
Psychotherapy can help people understand the roots of panic attacks, which do not have an obvious connection with here and now stimuli. By exploring areas in people’s past such as childhood experiences, early personal difficulties or past relationships the underlying causes that contribute to your panic can be uncovered and dealt with. This helps remove the issues that are often out of awareness but powerfully fuel the physiology which gives rise to panic. Blocked feelings such as anger, low self-esteem or shame can also be factors which exacerbate anxiety. Psychotherapy can help you uncover these issues and correct them, so they no longer contribute to fuelling panic.
There are some medications that can help control the physical symptoms that accompany panic disorder, but medication is rarely used alone to treat the problem.
If you and your doctor think it might be helpful, you may be prescribed:
Antidepressants can take 2 to 4 weeks before they start to work, and up to 8 weeks to work fully.
Keep taking your medicines, even if you feel they’re not working, and only stop taking them if your GP advises you to do so.
You should never attempt to stop taking antidepressants on your own as this can result in severe withdrawal symptoms.
In certain cases, when panic symptoms are severe or exacerbated by other conditions such as depression, some people find a combination of medication and counselling can be more helpful. Once the severe physiological symptoms have abated and the individual feels more in control, it is possible to move towards reducing or eventually stopping medication. Again you should never reduce or stop taking medication suddenly or without proper medical supervision.
Alongside medication and/or counselling the options listed below can assist people in coping with or reducing panic disorder symptoms.
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This page was written by Maggie Morrow (MSc, BSc, Adv Dip, UKCP) and medically reviewed in August 2021.