Living with panic attacks can be overwhelming, affecting various aspects of life. At Edinburgh Therapy Service we provide compassionate and non-judgemental support and evidence-based interventions. Our dedicated team of therapists is here to guide you on a journey towards understanding, managing and ultimately overcoming the impact of panic disorder.
Panic disorder is a type of anxiety disorder marked by recurring panic attacks. These episodes constitute intense bouts of fear and discomfort, typically cresting within minutes. People undergoing panic attacks may manifest a spectrum of symptoms, including a rapid heartbeat, trembling, breathlessness, and a sense of impending doom. The fear of experiencing another panic attack can prompt notable alterations in behaviour, as people affected may avoid places or situations where an attack is anticipated.
While it’s natural for everyone to encounter moments of anxiety and panic in response to stress or danger, those with panic disorder struggle with these emotions regularly and sometimes unpredictably, often without an apparent trigger. Many people may undergo one or two panic attacks in their lifetimes, with the issue subsiding, especially when linked to a stressful situation’s conclusion. However, if you find yourself contending with recurrent panic attacks and enduring prolonged periods of constant fear of recurrence, you might be contending with panic disorder.
Although panic attacks, in themselves, are not life-threatening, their impact can be disconcerting, significantly influencing your overall quality of life.
While there are no different types of panic disorder per se, the distinction often lies between panic disorder without agoraphobia and panic disorder with agoraphobia. Panic disorder and agoraphobia can exist independently, but they often co-occur.
Agoraphobia involves a fear of situations or places where escape might be difficult or where help might not be readily available in the event of a panic attack. Those with agoraphobia may avoid places like crowded areas, public transportation, or open spaces, as these environments can trigger anxiety about having a panic attack. The fear of having a panic attack in public places or situations becomes a central theme of agoraphobia. As a result, those with panic disorder may develop agoraphobia as they start avoiding places where panic attacks have occurred or are perceived as likely to occur.
Panic disorder without agoraphobia: As described above, someone with panic disorder experiences recurrent and unexpected panic attacks. What distinguishes this type is the absence of agoraphobia, which is the fear or avoidance of situations or places where escape might be difficult or help might not be available in the event of a panic attack.
Panic disorder with agoraphobia: Here, people not only experience panic attacks but also develop a fear of situations where escape might be challenging or help might not be readily available. This fear can lead to avoidance of places like crowded areas, public transportation, or open spaces.
It’s advisable to seek help for panic disorder when the impact of recurrent panic attacks starts affecting your daily life and well-being and if you find that the fear of having another panic attack is leading to significant changes in your behaviour, such as avoiding certain places or situations.
We suggest seeking therapy if you experience frequent and intense panic attacks that interfere with your ability to function or enjoy life and if feelings of anxiety, stress, and panic persist regularly and without an apparent trigger.
The National Institute for Health and Care Excellence (NICE) guidelines in the UK recommend cognitive-behavioural therapy (CBT) as the first-line psychological treatment for panic disorder. Renowned for its evidence-based approach, CBT has demonstrated its effectiveness for panic disorder. However, there’s no one-size-fits-all solution for everyone, and alternative therapies and interventions can also be valuable in treating panic disorder.
While CBT is widely utilised, various therapeutic approaches can contribute to managing panic disorder. Approaches such as acceptance and commitment therapy (ACT), mindfulness-based cognitive therapy (MBCT), or compassion-focused therapy (CFT) offer additional avenues for those suffering from this issue.
Cognitive-behavioural therapy (CBT) is a structured and goal-oriented therapeutic approach that addresses the interconnected nature of thoughts, feelings, and behaviours. The process begins by identifying negative thought patterns associated with panic attacks, such as catastrophic interpretations of physical sensations. Through collaboration with a therapist, individuals then work on challenging and restructuring these thoughts, examining evidence supporting or contradicting them to develop more balanced perspectives.
A key component of CBT is behavioural experiments, where individuals gradually expose themselves to feared situations or sensations to test the accuracy of catastrophic thoughts. This gradual exposure helps individuals build resilience and reduce anxiety over time. Throughout the process, therapy aims to help people understand triggers for panic attacks and break the cycle of negative thought patterns, feelings, and behaviours.
CBT for panic disorder is typically a short-term, results-oriented therapy that equips the person with practical tools to overcome and manage panic attacks effectively.
Acceptance and commitment therapy (ACT) focuses on accepting the presence of distressing thoughts and feelings while committing to actions aligned with one’s values. Here’s how ACT works for panic disorder:
Mindfulness and acceptance: ACT incorporates mindfulness techniques to help individuals become more aware of their thoughts and emotions without judgement. This mindfulness allows clients to accept the existence of anxious thoughts and sensations without getting entangled in them.
Defusion from thoughts: ACT emphasises “defusion,” which involves distancing oneself from thoughts and feelings rather than becoming overwhelmed by them. This helps people view their anxious thoughts as passing events rather than fixed realities.
Values-based behavioural change: Through values clarification and commitment to action, clients in ACT make behavioural changes that are meaningful to them. This can include facing fears and engaging in activities that have been avoided due to anxiety.
Mindful exposure: Mindful exposure is a technique in ACT where individuals deliberately expose themselves to anxiety-provoking situations while staying present and committed to their values. This exposure helps build resilience to anxiety triggers.
Our primary therapeutic approach aligns with CBT, as recommended by the NICE guidelines. Recognizing that CBT may not be universally effective, we tailor our offerings to include alternative third-wave treatments such as acceptance and commitment therapy (ACT), mindfulness-based cognitive therapy (MBCT), or compassion-focused therapy (CFT) In acknowledging the diversity of individual needs, we may also employ a combination of tools derived from these approaches. We aim to personalise treatments to cater to the unique requirements of each client, ensuring a comprehensive and effective therapeutic experience.
Panic disorder is characterised by recurrent, unexpected panic attacks, which are sudden episodes of intense fear that reach a peak within minutes. Along with panic attacks, people with panic disorder may experience persistent worry about having another attack and may make significant changes in their behaviour to avoid situations that could trigger an attack. Here is a list of symptoms associated with panic disorder:
Physical symptoms
➤ Heart palpitations or accelerated heart rate.
➤ Sweating.
➤ Trembling or shaking.
➤ Sensations of shortness of breath or smothering.
➤ Chest pain or discomfort.
➤ Nausea or abdominal distress.
➤ Dizziness or lightheadedness.
➤ Chills or hot flashes.
Cognitive symptoms
➤ Fear of losing control or going crazy.
➤ Fear of dying.
➤ Feeling detached from oneself (depersonalization).
➤ Feeling detached from reality (derealization).
➤ Intrusive, distressing thoughts.
Behavioural symptoms
➤ Avoidance of situations or places associated with past panic attacks.
➤ Changes in routine or behaviour to prevent panic attacks.
➤ Seeking reassurance from others.
Anticipatory anxiety
➤ Persistent worry about having another panic attack.
➤ Fear of the consequences of a panic attack.
The exact cause of mental health disorders remains unclear, including panic disorder. However, certain recognized risk factors are associated with an increased likelihood of developing panic disorder. These factors include:
Genetics: Those with close relatives who have experienced panic disorder may be at a higher risk.
Brain chemistry: Imbalances in neurotransmitters, particularly serotonin and norepinephrine, which play a role in mood regulation and the stress response, are thought to contribute to panic disorder.
Biological factors: Changes in the way the brain functions, especially in areas related to the regulation of emotions and the fight-or-flight response, may be involved in the development of panic disorder.
Environmental factors: Stressful life events, such as a major life change, trauma, or chronic stress, can trigger or exacerbate panic attacks.
Personality factors: Certain personality traits, such as a tendency to be highly sensitive to stress or to interpret physical sensations as threatening.
Medical conditions: Some medical conditions, such as hyperthyroidism or mitral valve prolapse, can be associated with an increased risk of panic disorder. However, panic attacks can occur without any underlying medical condition.
Substance abuse: The use of certain substances, including stimulants and recreational drugs, can increase the risk of panic attacks. Withdrawal from certain substances may also trigger panic symptoms.
The Edinburgh Therapy Service offers both in-person panic disorder counselling in Edinburgh (United Kingdom), and convenient online therapy accessible worldwide You can find our exact location here. We specialise in therapy for anxiety disorders, offering a range of evidence-based approaches including ACT, CBT, CFT, MBCT, and customized combinations tailored to your specific needs.
Understanding the challenges posed by panic disorder, we empathize with the overwhelming nature of this experience. Yet, you’re not alone in this struggle. Our commitment is to stand beside you, working together. Take the step today to connect with us, initiating the path toward a more fulfilling life.
The Edinburgh Therapy Service is a psychotherapy and counseling practice based in Edinburgh, Scotland (United Kingdom). We offer therapy both in-person in Edinburgh and online, available in English and Spanish.
Contact us for more information or to book your first appointment: [email protected]