Much like other psychology terms (think “I’m a bit OCD” or “they’re such a narcissist”), the phrase panic attack is often used casually, without truly understanding what it means. So, let’s break it down.
A panic attack is defined as an “abrupt surge of intense fear or discomfort that reaches a peak within minutes”. It’s a feeling of panic that is often accompanied by intense physical symptoms. These symptoms can differ from person to person but may include sweating, shaking, butterflies/nausea, hyperventilation, chest pain, dizziness and many more. From this definition, it would be easy to assume that panic attacks are the result of an anxiety-provoking situation (e.g. public speaking, a job interview or meeting new people). However, the defining feature of panic attacks is that they do not need a specific trigger. It is not usually the situation that sets them off; it is the fear of the panic attack itself.
As mentioned, someone having a panic attack will experience intense physical symptoms (e.g. chest pain). In that moment, what the person fears the most is the consequences of the panic attack. Another defining feature of panic attacks is that, at their core, there is a misinterpretation of the physical symptoms. Meaning that the person mistakes their physical anxiety symptoms for the sign that something really bad is going to happen.
Imagine this: you’re sitting at your desk when suddenly your chest tightens, and your heart starts racing. Your first thought? “Am I having a heart attack?”. The fear of what’s happening in your body takes over. Panic attacks often work this way—not because something dangerous is happening around you, but because your brain misinterprets normal physical sensations as a serious threat.
This misinterpretation is what keeps the panic going. The more anxious you feel, the stronger the physical symptoms become—chest tightness, racing heart, shortness of breath. And the stronger those sensations, the more your anxiety spikes. It’s a vicious cycle: anxiety fuels the body, and the body fuels the anxiety, until the panic peaks. By seeing it as a cycle, it’s easier to understand why panic attacks can feel so overwhelming—and why they often seem to come out of nowhere.
As a therapist, I don’t tend to use the term anxiety attack because it’s very broad and doesn’t accurately describe what someone is experiencing. Anxiety is highly individual, and in therapy, we need more information than simply knowing that someone feels anxious. For the purpose of this article, when I do use the term, I’m referring to a state of intense and overwhelming anxiety.
It is common for people to label any acute episode of anxiety as a panic attack, when that may not actually be the case. In many situations, what they’re experiencing would be more accurately described as an anxiety attack. While both panic attacks and anxiety attacks are extremely uncomfortable and distressing to experience, the mechanisms behind them are quite different. Therefore, it is important to distinguish between the two so that the right treatment can be provided.
As mentioned, the key features of a panic attack are that they have a sudden onset. It isn’t linked to a specific trigger or situation; they usually peak within a few minutes, and they come with intense physical symptoms that are misinterpreted to mean imminent danger (e.g., serious illness or death). An anxiety attack, on the other hand, is often linked to a specific upcoming or ongoing situation. They may start gradually and build up over time. The person experiencing an anxiety attack is likely to have some physical symptoms, but the misinterpretation is not present. Anxiety attacks tend to involve more cognitive symptoms, such as excessive worry.
There is a large evidence base that supports CBT for the treatment of both anxiety and panic attacks. Recurring panic attacks are a symptom of what is known as panic disorder. The use of CBT for treating panic disorder is also well established.
CBT for panic disorder involves fully understanding how the person experiences panic attacks. This is an important first step, because everyone will have slightly different physical symptoms and misinterpretations. For example, someone might experience dizziness and fear they are going to pass out, while others may experience dizziness and fear it means an imminent aneurysm.
Once the therapist and client have a shared understanding of the physical symptoms and what those symptoms mean to the individual, the real therapeutic work can begin. In my practice, I tend to start with the cognitive side of CBT rather than the behavioural. This is because changing behaviour becomes much easier once we’ve identified and addressed any unhelpful beliefs or assumptions driving it. Cognitive work often involves identifying and gently challenging unhelpful thoughts, such as “If I feel dizzy, it means something bad is about to happen.” We may also explore past experiences that have led someone to form these beliefs in the first place.
However, much of the work in treating panic disorder is behavioural. Ideally, this begins once there has been a slight shift in the client’s unhelpful thinking. However, for some people, seeing real-world evidence through behavioural work is what allows those beliefs to change. Behavioural techniques in CBT vary, but they all share the same goal: to help the client gather real-life evidence that challenges unhelpful assumptions and supports a more balanced, realistic way of thinking. After all, seeing is believing.
An example of a behavioural technique used in panic disorder is symptom induction. This involves deliberately bringing on the physical sensations associated with a panic attack within the safety of a therapy session. While this may sound daunting, it is both carefully planned and highly effective.
For instance, if a client experiences dizziness during panic attacks and believes it signals something catastrophic, such as a brain aneurysm, the therapist may help induce dizziness by spinning in a chair, standing up quickly, or holding the head upside down for a short period. When the sensation arises in a controlled and safe environment, the therapist can support the client through the anxiety and help them test the belief that the dizziness is dangerous or life-threatening. Crucially, this process demonstrates to the client that these sensations can be triggered easily and are not signs of something fundamentally wrong within their body. Just as importantly, the sensations pass without harm. Symptom induction is a powerful experience—something the client can mentally return to during future panic attacks as evidence that the symptoms, while uncomfortable, are not dangerous.
Panic attacks are episodes of intense anxiety in which physical sensations are misinterpreted as signs of serious danger, such as fainting or dying. CBT is an effective, evidence-based treatment that addresses both the unhelpful thoughts that keep this cycle going and the behaviours that reinforce it, using techniques such as symptom induction.
If you or someone you know is struggling with panic attacks and would like support, Thrive Psychology Services offers consultation sessions to explore whether CBT might be a good fit for you. To get started, simply head to the contact page and fill out the form.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Locke, A. B., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American family physician, 91(9), 617-624.
Clark, D. M., & Ehlers, A. (1993). An overview of the cognitive theory and treatment of panic disorder. Applied and preventive psychology, 2(3), 131-139.
Clark, D. M., & Salkovskis, P. M. (n.d.). Panic disorder: Manual for Improving Access to Psychological Therapies (IAPT) high-intensity CBT therapists [Unpublished treatment manual]. University of Oxford & University of Bath.