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Panic
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Understanding

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Understanding Panic

Introduction

A panic attack is a sudden surge of intense fear which is accompanied by strong body
feelings (such as your heart beating rapidly, or finding it hard to breathe) and catastrophic
thoughts (such as thinking that you will lose control or die). Panic attacks feel terrifying,
but they are not dangerous. People who worry about their panic, and who take steps to try
to prevent the possibility of having more, are said to suffer from panic disorder.

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It is thought that between 1 and 3 people out of every 100 will experience panic disorder

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every year [1, 2] and many more than that will have a panic attack at least once. Cognitive

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Behavioral Therapy (CBT) is an extremely effective treatment for panic disorder: about 80%

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of people with panic disorder who complete a course of CBT are panic-free at the end of
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treatment [3].

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This guide is for people who are struggling with panic. It will help you to understand:
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• What panic is.

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• Why panic might not get better by itself.

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• Treatments for panic.

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Understanding Panic

What are panic attacks and panic disorder?

A panic attack is an episode of intense fear that sometimes comes out of the blue (for no
apparent reason). It typically reaches a peak within minutes, and involves feeling strong
feelings in your body and your mind.
Surge of
Difficulty breathing or intense fear or Palpitations or
shortness of breath discomfort

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pounding heart beat

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Dry mouth Sweating

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Trembling or
Numbness or
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shaking
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tingling sensations

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Symptoms
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Fear of losing Feeling that the
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control, going
Panic world isn’t real, or
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Attack
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that you aren’t a
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crazy, or passing
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Fear of dying Feelings of choking

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Feeling dizzy,
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lightheaded, or faint
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Chest pain or discomfort

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Nausea or churning Hot flushes or cold

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stomach chills
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Understanding Panic

Some people might just have a one-off panic attack and not experience any more. Panic
disorder is when you experience a panic attack and then worry and take steps to prevent
the possibility of having another. A helpful way of thinking about panic is to break down
how it makes you think, feel, and act.

How you might think How you might feel How you might act
• Thoughts that something • A feeling of impending doom • Try to escape.
terrible is about to happen. • Anxious • Take protective action to help
• Thoughts that you are going to • Afraid you to manage (e.g. carry a

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die. • Terrified bottle of water, sit down).

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• Thoughts that you have to • Scared • Avoid situations where you
escape right now. • Worried have panicked before, or where

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• Thoughts that you are • Short of breath you might panic.

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suffocating. • Heart racing • Stay vigilant for signs that could

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• Thoughts that you are losing • Sweating indicate the onset of a panic
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control. • Shaking attack.

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• Unreal

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Understanding Panic

What is it like to have panic attacks?

Ted’s fear that he would pass out

I had my first panic attack during a stressful time in my life. I had been rushing to get a job
completed at work so that I could leave on time to visit my mother in hospital. I got stuck
in traffic on the way to the hospital and worried that I would miss the visiting hours. At
the hospital, I suddenly began to feel lightheaded and felt like I couldn’t breathe properly.

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A huge wave of fear came over me. I noticed myself getting hot and sweaty, and thought I
might pass out. I had to leave the hospital and take deep breaths of fresh air until I calmed

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down. It all only lasted a few minutes but it had felt like forever. My Mom got better and

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was allowed to go home, but I experienced more panic attacks over the next few months.

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Each time they would come completely out of the blue, and I felt an overwhelming sensation

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of dread and fear. I could feel my heart race and my throat getting tight. I worried that I

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wouldn’t be able to get enough air and would pass out, and only felt better when I got out
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in the open. I tried to manage by avoiding crowds and anywhere busy, and I took to doing
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my shopping at night when there were fewer people.
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Alicia’s fear that she would have a heart attack

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I had never had a panic attack before and so when it happened I was just terrified. I had
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been unwell for a week with a cold, but was feeling a bit better and had arranged to meet
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some friends. We met in a cafe and I started to feel really hot. My heart started pounding
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in my chest and I thought I was having a heart attack. I was terrified. My friends looked
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really worried, which made me more worried. They took me to the emergency room where
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the doctors hooked me up to an ECG and monitored my heart. They told me they didn’t
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think anything was seriously wrong and sent me home.

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After that I kept worrying about it happening again. I felt scared about going far from
home – I wanted to always be near to a hospital. I started doing less and less, and found it
difficult to leave home and take some time off work. I would monitor my heart rate using
my fitness watch, and was careful to not exert myself.

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Understanding Panic

Have I had a panic attack?

Have you ever been in a situation where you felt very afraid, and where you felt:

Palpitations, pounding heart, or accelerated heart rate ☐ Yes ☐ No

Sweating ☐ Yes ☐ No

Trembling or shaking ☐ Yes ☐ No

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Sensations of shortness of breath or smothering ☐ Yes ☐ No

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Feeling of choking ☐ Yes ☐ No

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Chest pain or discomfort ☐ Yes ☐ No
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Nausea or abdominal distress ☐ Yes ☐ No

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Feeling dizzy, unsteady, lightheaded, or faint ☐ Yes ☐ No
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Chills or heat sensations

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Paresthesias (numbness or tingling sensations) ☐ Yes ☐ No

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Derealization (feelings of unreality) or depersonalization ☐ Yes ☐ No

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(being detached from oneself )

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Fear of losing control or going crazy ☐ Yes ☐ No

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Fear of dying ☐ Yes ☐ No

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If you ticked ‘Yes’ to at least four of the symptoms then it is likely that you have had a panic
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attack.
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Remember that panic attacks are very common, and are not dangerous. Having a panic
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attack does not mean that there is anything wrong with you, and you do not necessarily
need to seek treatment unless you find yourself worrying about having more panic attacks
to such a degree that it is interfering with your life.

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Understanding Panic

Do I have panic disorder?

A diagnosis of panic disorder should only be made by a mental health professional.

However, answering the screening questions below can give you an idea of whether a pro-
fessional assessment might be helpful.

If you have had a panic attack before, have you:

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Felt anxious, worried, or nervous about having more panic ☐ Yes ☐ No
attacks?

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Had thoughts of bad things happening because of panic ☐ Yes ☐ No
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attacks? (e.g. losing control, dying, going crazy)

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Avoided situations where you worried that panic attacks ☐ Yes ☐ No

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might occur?
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Left situations early because of panic attacks? ☐ Yes ☐ No

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Spent a lot of time preparing for, or procrastinating about, ☐ Yes ☐ No

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situations where panic attacks might occur?

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Distracted yourself to avoid thinking about panic attacks? ☐ Yes ☐ No

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Needed help to cope with panic attacks? (e.g. medication, ☐ Yes ☐ No

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alcohol, other people)

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If you answered ‘Yes’ to a lot of these questions then you may be suffering from panic
disorder. You might find it helpful to speak to your general practitioner, or a mental health
professional about how you are feeling.

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Understanding Panic

What is happening in my body and mind when I

have a panic attack?

The symptoms of a panic attack feel so strong and overwhelming that many people actually
go to the hospital emergency department because they think they are dying. Research
studies show that about 1 in 4 patients who present to hospital with chest pain are actually
having panic attacks [4]! But what are your body and mind actually doing when you have

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a panic attack? To understand this, we need to know a bit more about how your body and

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mind are designed.

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Your Stone Age brain pl

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Modern humans originated in Africa within the past 200,000 years. Life could be hard,
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and many people died young. You would have lived in a small group and would know most
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of the people in your tribe. Being part of a group meant safety in numbers. Dangers or
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threats in those times included:

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Cold Hunger Other people Dangerous Being excluded

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animals from your group

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Our brains haven’t changed much since the Stone Age. They are well designed to detect
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these kinds of real-world threats. We still have much of the same programming that
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developed to help our ancestors to survive in those times. This programming makes it easy
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for us to feel afraid and respond to danger by:

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Freezing, hiding, Running away Fighting or acting

and ‘playing dead’ (taking flight) aggressively
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Understanding Panic

Psychologists call this the fight or flight response. Being programmed to respond in these
ways helped your ancestors to survive danger by prompting them act quickly and automat-
ically when danger was near. We all still have the same programming, and we all have the
urge to react automatically in these ways when we sense a danger.

Modern downsides of your Stone Age brain

Your Stone Age brain is incredibly well evolved for detecting threats and setting off your

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fight or flight response. However, it comes with a couple of downsides:

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• Better safe than sorry. Your brain operates on the better safe than sorry principle. It would

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rather set off ten ‘false alarms’ than miss one real danger. This means that we are prone
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to suddenly feeling afraid, even when there is no real danger.

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• Reality vs. imagination. Your brain isn’t very good at telling the difference between real
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threats in the world vs. imagined threats that you are just thinking about. Sometimes it
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will set off the fight or flight response for imagined threats.
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Understanding Panic

How your body responds to threat

Once a threat has been detected your fight or flight system will become active. One part
of this is your emotions – the feeling of fear is hard to ignore. Your body also starts getting
ready for action:

Changes to vision Thoughts racing

Vision can become acute so that Quicker thinking helps us to evaluate
more attention can be paid to danger and make rapid decisions.
danger. You might notice ‘tunnel It can be very difficult to concentrate
vision’, or vision becoming ‘sharper’. on anything apart from the danger

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(or escape routes) when the fight or
flight response is active.

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Dry mouth
Dizzy or lightheaded

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The mouth is part of the digestive
system. Digestion shuts down during If we don’t exercise (e.g. run away

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dangerous situations as energy is pl or fight) to use up the extra oxygen
diverted towards the muscles. then we can quickly start to feel

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dizzy or lightheaded.

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Heart beats faster Breathing becomes

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A faster heartbeat feeds more blood quicker and shallower

Quicker breathing takes in more
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to the muscles and enhances your ith
ability to run away or fight. oxygen to power the muscles.
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This makes the body more able to

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fight or run away.
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Adrenal glands
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release epinephrine Bladder urgency

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The epinephrine quickly signals Muscles in the bladder

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other parts of the body to get sometimes relax in response

ready to respond to danger.
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to extreme stress.
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Nausea and ‘butterflies’ in

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the stomach Palms become sweaty

When in danger the body sweats
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Blood is diverted away from the

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to keep cool. A cool machine is an

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digestive system which can lead to

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efficient machine, so sweating makes

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feelings of nausea or ‘butterflies’.

the body more likely to survive a
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dangerous event.
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Hands get cold Muscles tense

Blood vessels in the skin contract to Muscles all over the body tense in
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force blood towards major muscle order to get you ready to run away
groups. or fight. Muscles may also shake
or tremble, particularly if you stay
still, as a way of staying ‘ready for
action’.

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Understanding Panic

What happens when I have a panic attack?

Your brain is incredibly well evolved for detecting threats. Almost too well evolved: it
operates on the better safe than sorry principle and would rather set off ten ‘false alarms’
than miss one real danger. Worse, it isn’t very good at telling the difference between real
threats in the world versus imagined threats that you are just thinking about. It is easy for
the alarm to be set off mistakenly.

A panic attack is when your threat system has a ‘false alarm’ and detects a threat when

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there is none. It can do this automatically – without your conscious help – and it will set
off your fight or flight response. If you experience any of the body symptoms of fight and

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flight for seemingly no reason, it can feel very frightening.

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Panic symptoms can be made worse by the thoughts you have about them. You try to

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make sense of the panic symptoms (“why are they happening?”, “what do they mean?”) but
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the catastrophic answers you come up with can make things seem even more frightening
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(“I’m having a heart attack”, “I’m losing control”). Your brain reacts to these catastrophic
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thoughts as additional threats, and your fight or flight response is triggered even more
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forcefully.
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Panic escalates
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Have more
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catastrophizing
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Notice even thoughts

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symptoms
Fight or flight
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system activated
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Feel afraid

Misinterpret the
physical feeling
Notice a as a danger
physical (catastrophize)
feeling

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Understanding Panic

Why am I suffering from panic now?

Panic attacks are just the result of your fight or flight response being activated at the wrong
time, but why are some people more prone than others to suffering from panic? There is
no single cause, but some of the factors that make it more likely that you will experience
panic attacks and panic disorder include:

• Being under a lot of stress. If you are under a lot of stress, or are already feeling quite
anxious, then it might not take much to make you feel panic.

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• Sensitivity to anxiety. Some people are more sensitive than others to the feelings in

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their bodies. They are more likely to notice them, and more likely to misinterpret them

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as being dangerous [5].
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• Strong biological reactions to stress. Some people’s bodies are more responsive to

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stressful events and produce more stress hormones such as epinephrine and cortisol.
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• Catastrophizing. Catastrophizing (thinking the worst) can be learned, sometimes

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through exposure to caregivers who were catastrophizers [6, 7]. Thinking in catastrophic
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ways can make it more likely that you will suffer from panic.
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• Other psychological problems. People suffering from a wide range of psychological

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problems, such as post-traumatic stress disorder (PTSD), obsessive compulsive disorder

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(OCD), or depression, often experience panic attacks as a result of the elevated anxiety
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associated with these conditions.

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There may be genes which predispose people to developing emotional problems in general,
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but no specific genes predispose people to developing panic.

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As we will see in the next section, no matter what causes panic, it is what keeps people
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having panic attacks that tends to be more important. Psychologists call these ‘mainte-
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nance factors’ are they are the focus of treatment.

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Understanding Panic

What keeps panic going?

Research studies have shown that Cognitive Behavior Therapy (CBT) is probably the
most effective treatment for panic disorder [8]. CBT therapists work a bit like firefighters:
while the fire is burning they’re not so interested in what caused it, but are more focused
on what is keeping it going, and what they can do to put it out. This is because if they can
work out what keeps a problem going, they can treat the problem by ‘removing the fuel’
and interrupting this maintaining cycle. A psychologist called David Clark identified the

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key parts that mean some people keep suffering from panic attacks [9]. Some of the things

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that psychologists now think are important in keeping panic going are:

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• Misinterpreting what your body sensations mean.
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• Being on the lookout for ‘dangerous’ body sensations.

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• Avoidance and safety-seeking behaviors.

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Understanding Panic

People who panic tend to misinterpret

harmless body sensations as being If someone told you there was an
signs of impending doom or escaped tiger in your neighbourhood
catastrophe. You might have thoughts then you would probably keep a
like: lookout when you left your house. It’s
• I’m going to die the same for body sensations that you
• I’m going to lose control
• I can’t breathe, I’ll pass out think are dangerous - you stay on the
lookout for them.

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• I’m having a heart attack

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Interpreting your body sensations as a The problem of being on the lookout is
sign of catastrophe activates your fight that you’re more likely to notice things.

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or flight system. This leads you to Even noticing and worrying about

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experience even more uncomfortable harmless body sensations can set off a
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and frightening body sensations in a ‘false alarm’ in your fight or flight
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worsening cycle. system and trigger anxiety.

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Misinterpreting what your Being on the lookout for
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body sensations mean ‘dangerous’ body sensations
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What keeps it going?

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Panic
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Avoidance and safety-seeking

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behaviors
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Safety-seeking behaviors are the things that you do to prevent

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the worst from happening. People with panic often do things like:
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• Carry medication (just in case)

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• Look for the exits (in case they need to make a quick getaway)
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• Distract themselves (to prevent panic from escalating)

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• Avoid exercise or coffee (to avoid increasing their heart rate)

Safety behaviors can make you feel reassured in the short term,
but they come with unintended consequences. They can prevent
you from learning that your panic symptoms are just the result of
a ‘false alarm’ from your fight or flight system.

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Understanding Panic

Misinterpreting what your body sensations mean

In the right circumstances nearly all of the body sensations we associate with panic can
feel entirely normal. For example:

• If you’re dancing at a party, feeling a bit sweaty and breathing more quickly wouldn’t feel
out of place.

• Standing up too quickly makes many people feel lightheaded or dizzy.

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• Feeling nauseous is common when people travel by boat.

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So if these are all normal feelings, why do they cause so much distress when people panic?

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An insight from cognitive behavioral therapy (CBT) is helpful here. CBT says that it’s not

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things (such as situations, events, or body sensations) that we get anxious about, but it is
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the meaning we make of them. For example:

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• If you had swollen tonsils and were feeling poorly, then you probably wouldn’t worry
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about having a tight feeling in your throat – it’s the kind of symptom that you might
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expect if you’re feeling unwell. But if you were giving a presentation in front of people
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and your throat started feeling tight then you might be more concerned.
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• Similarly, if you had just run to catch a bus then you probably wouldn’t be too worried
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about a pounding heartbeat when you sat down in your seat. But if you were in a super-
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market and your heart suddenly started beating quickly you might ask yourself why.
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David Clark’s model of panic, backed up by decades of research, shows that people who
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panic often misinterpret harmless body sensations as indicating an impending catastro-

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phe. Let’s look at some examples:

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Body sensation Panic interpretation

Throat feels tight I’m going to pass out
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Heart pounding in my chest I’m having a heart attack

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Feel ‘unreal’ and like I’m not really in the room I’m losing my mind
Body feels twitchy I’m going to lose control

CBT for panic pays a lot of attention to the meaning you make of your panic symptoms.
A cognitive behavioral therapist will help you to find out whether your frightening inter-
pretation is the right one.
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Understanding Panic

Avoidance and safety-seeking behaviors

It is natural to want to avoid danger or discomfort. Everyone does it, and when used in
the right amount avoidance is a helpful life skill. However, avoidance can be a problem
when we use it to try to manage our own thoughts and feelings. Avoiding things that you
associate with panic means that you never get to learn how safe those things really are, or
how well you would really be able to cope.

If you can’t avoid, safety-seeking behaviors (sometimes called safety behaviors) are things

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that you do to try to prevent your feared catastrophe from occurring. Everyone with panic
has unique safety behaviors, and yours will be linked to the kinds of things that you are

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concerned about [10, 11]. Here are some common safety behaviors:

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Worry / concern Safety behavior

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I’ll be trapped Sit at the edge of a group
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I’ll choke Carry a bottle of water

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I’ll have a heart attack Stop exercising

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I'll faint
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I'm going to lose control Control my behavior, look for escape routes
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I'm losing touch with reality Listen to music on headphones

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I'm going to be sick Sit down, squat down, move slowly

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Although safety behaviors often help you to feel safer in the short-term, they actually end
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up prolonging your panic. Safety behaviors prevent you from learning how likely your
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worries are to really occur.

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Understanding Panic

Being on the lookout for ‘dangerous’ body sensations

If you have had a panic attack once then it is common to fear having another one. You
might remain on the lookout afterward in case those sensations occur again. Many people
who suffer from panic become really good at noticing even the slightest warning sign of
another panic attack.

Psychologists think that vigilance for body sensations (being on the lookout for them) is
problematic because the more we pay attention to something the more that we are likely

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to notice it. Once they have noticed them, people who panic have a habit of misinterpret-
ing what their body sensations mean. This then sets off an unhelpful chain reaction – even

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though a body sensation is not dangerous it gets interpreted as such, and starts a spiral of

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Understanding Panic

Treatments for panic disorder

Psychological treatments for panic
Reasearch has indicated that psychological therapy, or a combination of psychological
therapy plus antidepressant medication, is the treatment of choice for panic disorder
[12]
. One of the most effective psychological treatments for panic is cognitive behavioral
therapy (CBT) [8]. If CBT is delivered face-to-face then the optimal range is between 7
and 14 hours of therapy, typically in the form of weekly sessions of 1-2 hours. Guided and

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non-guided self-help are also appropriate treatments for panic disorder [13].

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CBT is a popular form of talking therapy. CBT therapists understand that what we think

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and do affects the way we feel. Unlike some other therapies, it is often quite structured.
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After talking things through so that they can understand your problem, you can expect

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your therapist to set goals with you so that you both know what you are working towards.
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At the start of most sessions you will set an agenda together so that you have agreed what
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that session will concentrate on. Treatment for panic might include some of the following
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‘ingredients’ which research trials have shown to be helpful:

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Understanding Panic

Exploring your
symptoms and
monitoring your
progress
Education about the
nature of anxiety
Relapse prevention
and the fight or
flight system

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Practicing skills Panic Exploring thoughts

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Do you remember Ted from earlier? Here’s how he found therapy:

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I went to my doctor because I didn’t know what was happening to me. My doctor referred
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me to a psychologist. One of the things that I found most helpful was having an under-
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standing of why my body was reacting in such an extreme way – learning about the fight
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or flight response helped to take some of the sting out of my certainty that I was going to
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pass out.
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The other part of treatment that I found helpful was facing my fears head-on. It sounds
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a bit odd, but my therapist and I did experiments in session where we would deliberately
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bring on the symptoms of a panic attack by breathing through a drinking straw. It proved
that it could make me feel lightheaded, but that I was in no danger of passing out. We de-
liberately approached other situations that made me feel uncomfortable too, like being in
crowds or enclosed spaces. By the end of therapy, things had completely turned around. I
feel more in control of my life now and I don’t avoid things any more.

18
Understanding Panic

Alicia also found therapy helpful:

I started seeing a therapist and found it helpful to get treatment for panic attacks. At first
I didn’t believe that it was a psychological problem and worried that I would have a heart
attack if I started going out again or if I did too much. Talking to my therapist helped me to
open up. One of the helpful things that she made me do was researching the fight or flight
response and I learned that my pounding heart was an anxiety symptom. We did some
‘experiments’ in session that I found quite hard where she encouraged me to get my heart
racing by doing star jumps, and I had to ‘stay with’ my pounding heart instead of sitting

:
or
and resting. This helped me to realize that I wasn’t dying, and after that I started to do more
of the things that I had been avoiding. Eventually I was able to go back to work. I still notice

s
my heart beating fast sometimes, but I don’t worry about it any more.

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Medical approaches

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The UK National Institute of Health and Care Excellence (NICE) guidelines for panic
oa

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disorder [13] recommend that the only medicines that should be used in the longer-term
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management of panic disorder are selective serotonin reuptake inhibitors (SSRIs) and
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tricyclic antidepressants (TCAs). Benzodiazepines are associated with a poorer long-term

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outcome and should not be prescribed for the treatment of panic disorder.
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Understanding Panic

References

[1] Rees, R., Stokes, G., Stansfield, C., Oliver, E., Kneale, D., & Thomas, J. (2016). Prevalence of mental
health disorders in adult minority ethnic populations in England: a systematic review. Department of
Health.

[2] Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comor-
bidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of
General Psychiatry, 62(6), 617-627.

:
or
[3] Clark, D.M. and Salkovskis P. (2009). Cognitive Therapy for Panic Disorder: Manual for IAPT high
intensity therapists. Retrieved from: https://web.archive.org/web/20190704101855/https://www.

f
kss-ppn.nhs.uk/resources/publications/12-cognitive-therapy-for-panic-disorder-iapt-manual/file

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n

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[4] Fleet, R. P., Dupuis, G., Marchand, A., Burelle, D., Arsenault, A., & Beitman, B. D. (1996). Panic

ie
disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation,
pl

cl
and physician recognition. The American Journal of Medicine, 101(4), 371-380.

ds

ur
id
[5] Schmidt, N. B., Zvolensky, M. J., & Maner, J. K. (2006). Anxiety sensitivity: Prospective prediction
oa

yo
of panic attacks and Axis I pathology. Journal of Psychiatric Research, 40(8), 691-699.
p a
nl
ith
[6] Ehlers, A. (1993). Somatic symptoms and panic attacks: a retrospective study of learning experienc-
w

es. Behaviour Research and Therapy, 31, 269-278.

a

w
do

[7] Cox, B. J. (1996). The nature and assessment of catastrophic thoughts in panic disorder. Behaviour
to

Research and Therapy, 34(4), 363–374.

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rin
fre
de

[8] Pompoli, A., Furukawa, T. A., Imai, H., Tajika, A., Efthimiou, O., & Salanti, G. (2016). Psycholog-
ha

ical therapies for panic disorder with or without agoraphobia in adults: a network meta‐analysis.
-
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Cochrane Database of Systematic Reviews, (4).

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[9] Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
er

[10] Salkovskis, P. M., Clark, D. M., & Gelder, M. G. (1996). Cognition-behaviour links in the per-
U

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sistence of panic. Behaviour Research and Therapy, 34(5-6), 453-458.

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[11] Funayama, T., Furukawa, T. A., Nakano, Y., Noda, Y., Ogawa, S., Watanabe, N., ... & Noguchi, Y.
(2013). In‐situation safety behaviors among patients with panic disorder: Descriptive and correla-
ic

tional study. Psychiatry and Clinical Neurosciences, 67(5), 332-339.

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[12] Furukawa, T. A., Watanabe, N., & Churchill, R. (2007). Combined psychotherapy plus antidepres-
sants for panic disorder with or without agoraphobia. Cochrane Database of Systematic Reviews, (1).

[13] National Institute for Health and Care Excellence (2011). Generalised anxiety disorder and panic disorder
in adults: management. Retrieved from: https://www.nice.org.uk/guidance/cg113/resources/gen-
eralised-anxiety-disorder-and-panic-disorder-in-adults-management-pdf-35109387756997Re-
source details

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Understanding Panic

Resource details
Title: Understanding Panic
Language: English (US)
Translated title: Understanding Panic
Type: Guide
Document orientation: Portrait
URL: https://www.psychologytools.com/resource/understanding-panic/

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Terms & conditions

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This resource may be used by licensed members of Psychology Tools and their clients. Resources must be used in
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accordance with our terms and conditions which can be found at:
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Disclaimer
Your use of this resource is not intended to be, and should not be relied on, as a substitute for professional medical
ic

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