Panic attacks are an extremely frightening experience; I know this from personal experience, and the sooner you start treatment, the sooner you recover.
Before I start talking about treatments, you must have a thorough understanding of panic attacks themselves. If you haven’t already done so, I recommend reading my guide, which covers everything you need to know about panic attacks.
Treatment can involve talking therapy and medication, but the NICE guidance (1) notes that the benefits of psychological therapy last the longest. As a psychologist who has worked with panic disorder for many years, I understand the benefit of therapy as it helps you (the person with panic) learn to cope on your own and recover using skills you have developed, as opposed to taking a pill to help with the symptoms.
Psychological therapy, along with self-help, is usually the first form of treatment to be offered for panic disorder. If you have already been to see your GP, they more than likely have suggested referring you for Cognitive Behavioural Therapy, CBT. When I worked in private practice, all my referrals from GPs were asking for CBT. This may be due to its efficacy or that it is the most well-known of the psychological therapies.
Panic Attacks Self-help
Dr Ryan’s online self-help course for Panic Attacks
Psychological therapy
Cognitive Behavioural Therapy (CBT).
This model is highly effective for treating panic disorder and can help you understand your triggers, i.e., what happens before you get a panic attack and give you practical ways to respond.
Read more detailed description of CBT here.
The model works on the premise that your thoughts and feelings are connected and that there shall exist thought processes that make you more fearful or more inclined to panic. Through a process known as reframing, you learn to change these scary thought patterns.
Read more on cognitions and CBT
For example, maybe you have had panic attacks in shopping centres and started to think that you can’t go into shopping centres as they make you panic. CBT will help you change this thought to a more realistic one, such as, even though I had a panic attack in a shopping centre, I have no evidence to suggest that it will happen again.
This might sound simplistic, but it is just one example of one thought process. But that one thought change may allow you back into the shopping centre to test and see if you panic again. Otherwise, your option was to avoid shopping centres altogether.
Another example of how CBT helps with panic is cognitive restructuring. For example, if you were in session with me now and told me that each time you panic, you think you will have a heart attack and die. This thought will frighten you more and serve to increase your anxiety.
Cognitive restructuring would suggest thinking, even though this is very frightening, this panic attack is harmless and will pass soon.
Again, if you are reading this and suffering several panic attacks a day, this might not offer much comfort. When I was having panic attacks, it did feel like I was dying, and telling myself it was harmless offered little respite at the start, but CBT is a process of changing all the things that are contributing to your panic and at the same time teaching you how to relax your body and mind. It’s the combination that helps.
Exposure therapy is part of CBT and stops your world from becoming smaller. When I had panic attacks, I stopped so many things I previously enjoyed out of fear of having another attack.
If you are doing this also, we call it avoidance, and avoidance, although it makes you feel better at the time as you are not forced to do something that scares you, it actually stops you from recovering. You won’t get better as you never allow yourself to see that you can manage in places that were previously a no-go for you. You can manage as you have been undertaking relaxation training and cognitive restructuring and are now starting behavioural experiments.
If you have never undertaken CBT, the thought of behavioural experiments is enough to put you off but let me explain how they work and benefit you.
Read more on behavioural experiments
It is not a case of making you do something that terrifies you, as that is unethical and will not work. Instead, these are controlled and undertaken in such a way as to give you the best possible chance of success, as having little wins encourages you to try the next step.
Mindfulness-Base Cognitive Therapy (MBCT) is CBT combined with mindfulness. I found this approach helpful for me and as a method when providing psychological therapy to clients.
The mindfulness aspect of this type of therapy gives you another perspective when experiencing panic. For example, rather than thinking I will have a heart attack or pass out, you observe and describe what is happening; I feel my heart beating faster and sweat on my skin.
This might feel simplistic, like the other techniques, but let’s look at the alternative. Continuing to think that you are having a heart attack increases the fear. It will only serve to increase the symptoms you currently experience. Observing and describing is not a miracle cure, but it will not increase the experience; it will plateau and eventually decrease.
Dialectical Behavioural Therapy (DBT). This model was originally developed to help people with personality disorders, and indeed this is where I undertook my professional training in the model, working as part of a DBT Team in the UK.
The skills training aspect of DBT is a valuable treatment for panic as, like mindfulness, it helps you to accept what is happening without making it worse.
Recap
Talking therapies have been shown to help with panic attacks, but everyone is different, and therapy may not be for you. If you have tried therapy and found it too difficult due to the attacks, it is worth speaking with your GP about medication options.
Medication
Medication can help with panic disorder and is often used simultaneously as therapy.
Beta-blockers are prescribed to help with the physical symptoms of panic attacks, such as an increased heart rate.
Your GP can prescribe selective serotonin reuptake inhibitors (SSRIs) to help with panic disorder. These do not help immediately like beta-blockers, as they are designed to help by increasing the amount of serotonin.
As your serotonin levels increase, your anxiety decreases.
Where to start
A stepped care model would suggest starting with the least intensive treatment before progressing to the next step.
For example, start with self-help. This does not have to be my course, any self-help. It could be a book from the library, but something that is the least intensive.
If self-help is not enough, start psychological therapy, and if this does not relieve your panic attacks, speak with your GP about medication options.
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