Panic Disorder

Panic disorder is a type of anxiety disorder which is characterised by recurring panic attacks. A panic attack is a brief period of intense discomfort and anxiety, and can cause symptoms like breathlessness and palpitations. During a panic attack, the individual will typically have thoughts such as ‘I’m going mad’ or ‘I’m having a heart attack’ and as a result, can avoid situations which they believe cause the attacks, such as exercising or going to crowded place.

It is relatively common with a lifetime prevalence of about 3.5%.

But what actually causes the panic attacks? It has been argued by some researchers (e.g Clark, 1996) that people with panic disorder interpret normal internal physiological changes, such as heart beat slowing down or getting faster, as a sign that something is seriously wrong with them. These individuals are biased to interpret signals as negative, which increases anxiety and leads to panic – something clearly shown by the flow chart below:

An experiment by Rapee et al (1986) shows how a negative bias causes panic. Participants with panic disorder were asked to breathe in a substance of 50% oxygen and 50% carbon dioxide. Half of the participants were given a thorough explanation of the process and any side effects, while the other half were not given this information. They found that the group which were given the information panicked less and had fewer catastrophic thoughts than the group who were not given the information. This therefore provides evidence to suggest that it is the negative interpretation which causes anxiety and panic – if the side effects were attributed to the procedure then this does not occur.

But why is panic disorder so persistent? If the sufferer thinks they are going to have a heart attack every time they have a panic attack, but this doesn’t happen, why don’t they realise that it is extremely unlikely that the event will actually occur?
The answer to this is that the individual engages in ‘safety behaviours’ which prevent them from learning that the situation is not harmful. For example, if they think they are going to have a heart attack, they will sit down and be very still. When the heart attack doesn’t happen, they think that its because of the fact they sat down, not the fact that they were never going to have one anyway – to them it is a ‘near miss’.

Knowing that safety behaviours contribute to the disorder, one of the main steps in treatment is removing them. This allows people to realise that they are not in a harmful situation, and allows for the therapist to help them restructure their negative thoughts into ones that are more realistic.