What is a Panic Attack and How Can CBT Help?

Everyone experiences anxiety, and sometimes high levels of anxiety, as a normal response to a dangerous or stressful situation. A panic attack is when you have a sudden and intense sense of overwhelming fear and your body experiences a rush of intense mental and physical symptoms which come on very quickly. Sometimes it can feel like there is no obvious trigger. 

Symptoms include a racing heartbeat, feeling faint, sweating, nausea, chest pain, shortness of breath, trembling, hot flushes, chills, shaky limbs, a choking sensation, dizziness, numbness or pins and needles, dry mouth, a need to go to the toilet, ringing in your ears, a feeling of dread or a fear of dying, a churning stomach, a tingling in your fingers and feeling like you’re not connected to your body.

A panic attack can be very frightening and distressing, both for the individual and anyone watching, but they’re not dangerous or life-threatening. Most panic attacks last between 5 and 20 minutes, but some people feel they can last longer.

What Happens During a Panic Attack?

Sometimes what triggers a panic attack is clear and sometimes it can feel like it’s happening out of the blue. When we feel triggered, we tend to automatically go into our mind and overthink the situation.

We may find ourselves doing things to keep ourselves safe, for example avoiding places where we’ve previously experienced a panic attack. These are called ‘safety behaviours’. In the short-term, they can be effective, but in the long-term avoidance can become an issue. Your world will start to get smaller and smaller, so what started as a solution becomes part of the problem.

When we’re panicking, we are anxious and it’s important to remember that anxiety distorts how we think. In CBT we call this having ‘hot thoughts’. Examples include thinking a heart palpitation is going to lead to a heart attack or that lack of breath is going to lead to fainting. When we’re calm, we have more logical, rational thoughts about a situation – ‘cold thoughts’.

How Can CBT Help?

Most of us will experience at least one panic attack in our lives at some point and some people will continue to have them. If they begin to impact your day-to-day life, for example if you start to avoid doing things in case you have a panic attack, then you should visit your GP and consider a course of Cognitive Behavioural Therapy. This has been found to be the most effective form of therapy for panic attacks.

When someone is struggling with panic attacks, the most common goal is to never experience any anxiety or feelings of panic again. Through CBT, you’ll begin to understand why anxiety is an important part of us. Instead of eradicating it, you’ll learn how to work with the experience differently.  

First, your CBT therapist will ask you to describe your thoughts, physical symptoms and coping strategies during a panic attack. Exploring your experiences is the first step to developing your individual treatment approach.

The aim of CBT treatment is to help you develop more cognitive flexibility in your thinking style. For example, instead of catastrophizing your physical symptoms, you’ll have a more factual understanding of them. This involves an element of education around what is happening physically and mentally.

CBT will help you learn how to tolerate the unpleasant physical symptoms, so they don’t distress you as much. You’ll learn the best coping style for when a panic attack happens because how we naturally respond in panic often contributes further to the symptoms. You’ll learn to meet panic with more curiosity, so you can assess if there’s actually any danger or not. You’ll learn to allow yourself to roll with the experience and that what you resist persists. Trying to fight the panic exacerbates the symptoms.

You will also be supported to go towards the triggers or fears in a graded way. This is called ‘exposure therapy’. To avoid feeling overwhelmed, you do this with lots of planning and support from your therapist. The goal is to retrain your anxious brain. You’ll learn that the triggers that have been causing you to panic such as going into shops, being in crowds, public speaking, enclosed spaces, heights etc are not actually dangerous.

Useful Links

The CBT Journal

Understanding and Managing Social Anxiety

Anxiety & Panic Attacks

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Sarah Rees

Sarah is a fully accredited Cognitive Behavioural Therapist and mental health writer delivering Modern Mental Health for you and with you in Mind. Sarah is the author of ‘The CBT Journal’ which helps you write for your wellbeing incorporating CBT techniques. For more information and to keep in touch have a look at sarahdrees.co.uk.