UNDERSTANDING PANIC ATTACKS
By David Hennessy, Clinical Psychologist
Understanding panic attacks involves looking at what they are, how fear and bodily sensations can interact, and when medical or psychological assessment is useful. An attack can feel overwhelming, but there are ways to understand the pattern and seek support.
This article explains possible contributors, panic attacks versus panic disorder and general care options. For a closer description of sensations and lived experience, read What Do Panic Attacks Feel Like?.
A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes. It can involve a racing heart, breathlessness, dizziness and frightening thoughts. Our companion article What Do Panic Attacks Feel Like? explores these experiences in more detail.
Panic attacks can occur without panic disorder and alongside other psychological difficulties. Medical conditions, medicines and substances can also produce similar symptoms, so identifying panic requires attention to the individual health context.
One influential cognitive model proposes that panic can escalate when ordinary or anxiety-related bodily sensations are interpreted as signs of catastrophe, such as believing that a racing heart means a heart attack or dizziness means imminent collapse [1]. Modern reviews continue to support important parts of this model while recognising that panic is influenced by multiple biological, cognitive and contextual processes [2].
The sensations are real. What may become inaccurate is the meaning attached to them. Fear then increases arousal, which can intensify the sensations and create a self-reinforcing cycle.
A panic attack is a single episode. Panic disorder is diagnosed when a person has recurrent unexpected panic attacks and then develops at least one month of persistent concern about additional attacks or makes significant changes in behaviour because of them. Avoidance may become a major part of the problem, particularly when a person begins avoiding exercise, driving, public transport, crowds, shopping centres or situations where escape feels difficult.
Some panic attacks seem to come “out of the blue”. Others occur in particular situations or after bodily sensations are noticed. Contributing factors can include stress, sleep deprivation, caffeine or stimulant use, illness, medication effects, hormonal changes, trauma-related cues, and learned fear of particular sensations or situations.
There is rarely one universal explanation. The important question is what pattern is operating for the individual person.
Panic symptoms can overlap with physical conditions involving the heart, lungs, endocrine system, vestibular system and other areas of health [3]. New, severe, unusual or changing symptoms should not automatically be labelled as panic.
Medical assessment is particularly important when symptoms are occurring for the first time, differ from a person’s usual pattern, involve collapse or significant injury, or occur alongside relevant medical risk factors. If you have chest pain and think you may be having a heart attack, severe difficulty breathing, collapse or another medical emergency, call 000.
When panic is already underway, the aim is usually not to force the sensations to disappear immediately. Fighting the sensations can sometimes add another layer of fear. It may be more helpful to recognise the experience as a surge of alarm, orient to the present environment, allow breathing to settle naturally, and remind yourself that intense sensations can rise and fall.
For someone with a known panic pattern, reducing frantic checking, repeated reassurance seeking or immediate escape can also be useful over time. However, these ideas are not a substitute for medical assessment when symptoms are new or uncertain.
Cognitive behavioural therapy has a strong evidence base for panic disorder and is recommended in major clinical guidelines [4,5]. Treatment often includes psychoeducation, examining catastrophic interpretations of bodily sensations, reducing safety behaviours, interoceptive exposure to feared sensations, and gradual situational exposure where avoidance has developed.
A 2023 network meta-analysis found that individual, group and guided self-help CBT formats can all be effective for panic disorder, although confidence in the evidence varies across delivery formats [5]. A 2024 review also found substantial continuing support for the cognitive theory of panic, while identifying areas where the model needs refinement [2].
It may be worth seeking psychological support when panic attacks are recurring, fear of another attack is taking up a lot of mental space, avoidance is increasing, or daily activities are becoming restricted.
Psychological therapy does not require a person to be certain that they have panic disorder. Assessment can help distinguish panic from other anxiety presentations, trauma-related responses, health anxiety, stress reactions, substance-related symptoms or problems that require medical review.
Yes. A panic attack can occur in many contexts. Panic disorder is a broader pattern involving recurrent unexpected attacks plus persistent concern or behavioural change related to further attacks.
Yes. Some people experience nocturnal panic attacks that wake them from sleep. Other sleep and medical conditions can also cause nighttime symptoms, so assessment may be useful when the cause is unclear.
Yes. Several medical conditions can produce symptoms such as palpitations, breathlessness, dizziness or chest discomfort. New or unexplained symptoms should be assessed rather than automatically attributed to anxiety.
Yes. Evidence-based treatments can substantially reduce panic symptoms and panic-related avoidance for many people. Improvement varies between individuals and often develops through repeated practice rather than one dramatic change.
Explore the sensations, frightening thoughts and feelings of unreality that people may experience during panic, and how these can vary.
Learn about psychological assessment and evidence-based treatment options for panic attacks and panic-related avoidance.
Explore broader information and support pathways for anxiety-related difficulties.
Read about evidence-based psychological approaches used in therapy.
Further resource: NICE guideline: Generalised anxiety disorder and panic disorder in adults.
This page provides general educational information and does not replace individual medical or psychological assessment. Panic-like symptoms can have different causes. Care is tailored to your health, circumstances, preferences and the impact on daily life.
If panic attacks, fear of panic or avoidance are affecting your everyday life, psychological assessment can help clarify the pattern and whether therapy may be useful.
Hennessy Clinical Psychology provides appointments for adolescents and adults at Varsity Lakes on the Gold Coast and by secure telehealth across Australia.