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PANIC STATIONS

Panic Stations

Module 1

Overview of Panic

Introduction

Understanding Panic and Fear 2

Panic and Anxiety 3

Anxiety Symptoms Worksheet

Module Summary

About This Module 9

PANIC

STATIONS

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Module 1: Overview of Panic

PANIC STATIONS

Introduction

Panic and anxiety can affect any kind of person at any stage of their life. In fact, it is estimated that about 1

in every 30 people experience significant panic at some time in their life. So remember, you are not alone.

The aim of this InfoPax module is to provide you with some general information about panic attacks and

panic disorder, and to describe the types of symptoms common to panic.

Understanding Panic and Fear

To understand panic, we need to understand fear. You can think of fear as an automatic alarm response

that switches on the moment there is danger. Think about what would happen to you if a dangerous animal

approached you. For most people it would be panic stations! You, and almost everyone, would go through

a whole series of bodily changes, like your heart pumping, breathing faster, sweating, all in order to respond

to the danger in front of you. This alarm response would probably lead us to either run for our lives or

become sufficiently ‘pumped up’ to physically defend ourselves. It is, in fact, an important survival

mechanism.

Sometimes, however, it is possible to have this intense fear response when there is no

danger – in a way, it is a false alarm that seems to happen when you least expect it.

This initial panic attack is the same brief, intense episode of fear or uneasiness that

you might have in response to realistic danger, but it happens in situations that most

people would not be afraid about. It is like someone ringing the fire alarm when there

is no fire! Let’s have a look at some of the symptoms of a panic attack:



Skipping, racing or pounding heart 

Dizziness, lightheadedness, feeling faint



Sweating



Tingling or numbness in parts of your body



Trembling or shaking



Hot flushes or chills

 Shortness of breath or difficulty breathing

 Choking sensations

 Feeling things around you are strange, unreal,

detached, unfamiliar, or feeling detached from

your body



Chest pain, pressure or discomfort



Thoughts of losing control or going crazy



Nausea, stomach problems or sudden diarrhoea 

Fear of dying

Many people experience some mild sensations when they feel anxious about something, but a panic attack

is much more intense than usual. It includes 4 or more of the above symptoms, and peaks within about 10

minutes. As you can see from the list, many of the symptoms are similar to what you might experience if

you were in a truly dangerous situation. A panic attack can be very frightening and you may feel a strong

desire to escape the situation or to seek emergency assistance.

Panic disorder is used to describe the condition where panic attacks seem to happen unexpectedly rather

than always in predictable situations. Importantly, someone with panic disorder has a persistent fear of

having another attack or worries about the consequences of the attack. Many people change their

behaviour to try to prevent panic attacks. Some people are affected so much that they try to avoid any

place where it might be difficult to get help or to escape from. When this avoidance is severe it is called

agoraphobia.

If your symptoms are very severe or if a doctor has not checked your symptoms, it is

important to have an assessment conducted by a qualified health professional. It is important

to ensure that these symptoms are the result of anxiety and not caused by something else.

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Panic and Anxiety

When we talk about a panic attack, it is very much a sudden and intense episode of physical and

emotional reactions. However, when we are anxious we often feel similar symptoms, such as tensing up to

prepare ourselves for what might happen next. You might think of anxiety as worry or nervous

apprehension about the future, a sense that you cannot control or predict future events.

Feeling anxious and afraid is very much a part of the experience of being human. Although you might not

think so, anxiety can actually be helpful. Feeling a little anxious about something means we will be more

alert and responsive to our environment, just as athletes often “pump themselves up” before an event. It is

only when there is a very high level of anxiety that it might begin to cause us some difficulties.

Fear is also part of being human. As mentioned, fear is a true alarm that signals imminent danger and allows

our bodies to respond to increase our chances of survival. However, there are other times when real

physical danger isn’t there. Think about a person walking through a poorly lit alley at night. They might feel

anxious because they are worried that something dangerous may happen. Now, there may or may not be

anything dangerous in the alleyway, but what is important is that they believe there is something dangerous.

It is this belief that causes the anxiety.

FIGHT/FLIGHT RESPONSE

When there is real danger, or when we believe there is danger, our bodies go through a series of changes

called the fight/flight response. It helps us to respond to real physical threat. When a person’s fight/flight

response is activated, three major types of responses occur. These include physiology (body responses),

behaviour (action responses), and cognitions (thinking responses).

Physiology

When we become anxious and afraid, be it in response to physical threat or in situations where there is no

real danger, our bodies experience several changes. Some of these symptoms have already been mentioned,

such as heart pounding, breathing more quickly, sweaty palms, and lightheadedness. These are common

reactions that occur when we become anxious.

Think about some of your own physical responses when you become anxious - what do you notice?

You might think you are alone in reacting this way, but really, we all experience these types of reactions

when we experience fear and anxiety. Basically, our bodies are designed to release certain chemicals when

we believe a threat exists, in case we need to either run away, or stand and be ready to fight. There are

important reasons why these reactions occur.

 An increase in heart rate and strength of heart beat enables blood and oxygen to be pumped

around the body faster so you might feel like your heart is ‘pounding’.

 An increase in the rate and depth of breathing in order to compensate for the anticipated

increase in carbon dioxide production and use of oxygen. You may start to sigh, to yawn, or notice

breathlessness, choking or smothering feelings, tightness and pain in the chest. This response also

reduces the blood supply to the head, and while not dangerous, you might feel dizziness, light-

headedness, blurred vision, confusion, feelings of unreality and hot flushes.

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 A redistribution of blood from areas that aren’t as vital to those that are, such as away from

skin, fingers and toes towards large vital organs. Your skin might look pale or you might feel cold, or

there might be a feeling of numbness and tingling in your fingers and toes.

 An increase in sweating causes the body to become more slippery, making it harder for a predator

to grab, and also cooling the body, preventing it from overheating.

 Widening of the pupils of the eyes lets in more light and enables you to better scan the

environment for danger. You may notice blurred vision, spots before the eyes, or just a sense that the

light is too bright.

 Decreased activity of the digestive system allows more energy to be diverted to fight/flight

systems. A decrease in salivation may leave you with a dry mouth and decreased activity in the digestive

system may lead to feelings of nausea or a heavy stomach.

 Muscle tension in preparation for fight/flight results in subjective feelings of tension, sometimes

resulting in aches and pains and trembling and shaking. The whole physical process is a comprehensive

one that often leaves the individual feeling quite exhausted.

As you can see, these physical alarm responses are important when facing danger, but they can also occur

when there is a false alarm, when there is no danger.

Hyperventilation and anxious breathing

You probably already know that we breathe in to obtain oxygen and we breathe out to expel carbon

dioxide. The body naturally maintains optimal levels of oxygen and carbon dioxide, and this balance is in

part maintained through how fast and how deeply we breathe. When we exercise, for example, we breathe

faster and more deeply in order to replace the oxygen being used and expel the extra carbon dioxide

produced by metabolic changes. Anxiety causes an increase in our breathing rate, as part of the physical

fight or flight response to a perceived threat. However, when our breathing rate increases without any

physical exertion, we breathe out too much carbon dioxide. If the body cannot quickly return carbon

dioxide levels to the optimal range, we experience further symptoms such as dizziness, light-headedness,

headache, weakness and tingling in the extremities and muscle stiffness.

Some people who have panic attacks may overbreathe, producing these sensations of anxiety. For people

with panic, these physiological sensations can be quite distressing as they may be perceived as being a sign

of an oncoming attack, or something dangerous such as a heart attack. We will discuss this in more detail

when looking at beliefs and cognitions about physiological sensations.

Behaviour

When we feel anxious or expect to feel anxious, we often act in some way to control our anxiety. One

way you may do this is by keeping away from situations where you might have panic attacks. This is called

avoidance, and might include:

• Situations where you’ve had panic attacks in the past

• Situations from which it is difficult to escape, or where it might be difficult to get help, such as public

transport, shopping centres, driving in peak hour traffic, places where medical help is not available

• Situations or activities which might result in similar sensations, such as physical activity, drinking coffee,

having sex, emotional activities such as watching horror movies or getting angry

What kinds of situations/activities do you avoid so as not to have a panic attack?

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A second action response may be to behave differently, or to use “safety behaviours”. For example, you

might make sure you are next to an escape route, carry medication with you, or ensure that you are next

to a wall to lean on. Or do you try to distract yourself from your anxiety by seeking reassurance, reading

something intently, or bring music to listen to? Although this may not seem harmful to begin with, if you

become dependent on them it can be even more distressing if one day it’s not possible to use them.

How do you behave differently as a result of your panic attacks?

These action responses may have been used so often that they have become a familiar way of life to you, a

habit that you don’t really think about. However, you can unlearn the “anxiety habit” and build new habits

for coping with your anxiety and panic.

Cognitions

There are a number of thinking responses or cognitive changes that are associated with anxiety and panic.

Firstly, as a normal part of the fight/flight response, we begin to shift our attention to our surroundings and

search for potential threat. This is a helpful response in physically dangerous situations, but it is not so

helpful in other situations. It becomes very difficult to concentrate and attend to your ongoing activities

because you are scanning your environment for danger. When there are no external signs of danger, you

may start to scan internally for evidence of threat, focusing on physical sensations such as a pounding heart

or sweating. This often results in people thinking that there is something wrong with them - they must be

going crazy or dying.

Secondly, some types of thoughts are often associated with panic disorder

1. Catastrophic thoughts about normal or anxious physical sensations (eg “My heart skipped a beat - I

must be having a heart attack!”)

2. Over-estimating the chance that they will have a panic attack (eg “I’ll definitely have a panic attack if I

catch the bus to work”)

3. Over-estimating the cost of having a panic attack: thinking that the consequences of having a panic

attack will be very serious or very negative.

When you become anxious, what kinds of thoughts do you have?

These three types of responses: physiology, behaviour, and cognitions, all combine to form the experience

of anxiety and panic. Some reactions may be more noticeable than others may, but they are all important

components and will be addressed throughout the modules.

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WHEN DO PANIC ATTACKS HAPPEN?

Fear or panic?

As we mentioned earlier, panic symptoms are very similar to fear symptoms. When we become afraid, we

have an automatic alarm response that allows us to prepare to fight or flee. So, if we are confronted by a

wild animal, or – more commonly these days – a dangerous situation on the roads, we tend to respond

with that automatic alarm system. Some people might say that they “panicked” in these situations. When

we are talking about panic disorder, however, we usually refer to “panic attacks” that don’t seem to be in

response to those dangerous situations.

Panic Disorder

We’ve briefly discussed that we use the term “panic disorder” when someone has panic attacks that seem

to happen unexpectedly, and when there is significant anxiety about having another panic attack. Panic

attacks can happen when the person perceives internal symptoms that might signal that something

dangerous or terrible will happen, perhaps as a heart attack or losing their mind. We will discuss this in

further detail in the next module.

Phobias

In addition to being prominent in panic disorder, panic attacks can also occur in other anxiety problems.

You’ve probably heard about various phobias mentioned in movies and on television, where people show

an intense fear of things like spiders, elevators, or public speaking. People who have social anxiety, for

example, may have a panic attack when they have to give a presentation to people because of their intense

anxiety about the situation. As with the description of panic attacks earlier in this module, this intense fear

occurs in the absence of actual physical danger. Instead, it occurs in the presence of a perceived threat.

Even some phobias that may seem to be in response to possible physical danger, such as with snakes, or

spiders, the “alarm” occurs even when the person is not directly confronted by the danger (eg the spider is

several metres away rather than in front of their face). So, people who are intensely afraid of particular

situations, objects, or animals may also have panic attacks in relation to situations that are feared intensely.

Nocturnal panic

Sometimes, people who have panic disorder have “nocturnal panic”, or panic attacks that occur during the

night when they are sleeping. These panic attacks similarly occur unexpectedly, rather than due to other

prompts such as nightmares or unexpected sounds. This may seem quite curious, because most people

would think that this is when they are most relaxed. In fact, studies have shown that nocturnal panic often

occurs when the person is falling into a deep sleep, when their bodies are beginning to relax and “let go”.

These changes in physiological sensations can be detected by the brain because our

brains continue to process information during sleep. For people with panic disorder,

these changes may be interpreted as a signal that something dangerous might

happen, such as a heart attack, resulting in a sense of panic that wakes them from

their sleep.

It can happen to anyone

While you may think that only people who have anxiety problems have panic attacks, it may actually be a

more common experience in the wider community. There are some suggestions that around 1 in 10

individuals has had a spontaneous, unexpected panic attack.

Now that we have talked a little about what panic attacks are and when they occur, we can begin to look

more closely at how they happen, how panic disorder develops, and what can be done about it. We will do

this in Module 2. On the next page is a worksheet where you can summarise your symptoms of panic.

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Anxiety Symptoms Worksheet

Anxiety symptoms can often be grouped into 3 categories. Some symptoms are of the

physical or body type, for example, shortness of breath, tightness in the chest,

lightheadedness, etc. Some symptoms are of the cognitive type which may include thought

responses such as, “I’m going to have a heart attack”, “I’m losing my mind”, etc. The third category of

symptoms is to do with your behaviours or actions, how you act and behave as a result of your anxiety, for

example: avoiding public transport, carrying something to read as a distraction, not drinking coffee, etc.

Throughout this module, you have been asked about some of your body responses, thought responses and

physical/body responses. You can summarise your responses on this sheet.

PHYSICAL/ BODY COGNITIVE/

THINKING

BEHAVIOURAL/

ACTIONS

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Module Summary

• Panic attacks are brief, sudden surges of intense anxiety, with symptoms that are very similar

to intense fear. The term panic disorder is used when panic attacks seem to happen

unexpectedly and where there is excessive anxiety about panic attacks.

• The fight/flight response is a normal human reaction that occurs in response to fear when a

person is in physical danger. Sometimes it is also activated when there is no real danger. This

includes three major types of reactions:

• Body responses such as increased heart rate, increased breathing, increasing blood towards

muscles and important organs, sweating, and muscle tension.

• Behaviours such as avoidance of feared situations or changing your behaviour in those

situations.

• Thinking responses such as searching for threatening information in anxious situations, which

reinforces the general belief that you will be negatively evaluated by other people.

• Although panic and fear can be very similar, the term “panic attack” refers to a surge of

intense fear. Panic attacks can occur under a number of conditions

• For people who have panic disorder, panic attacks happen unexpectedly and there is

considerable distress about having future panic attacks.

• People who have phobias may also have panic attacks in relation to the feared situation or

object.

• Some people with panic disorder may awake from their sleep with a panic attack after they

have been sleeping. Some people may process physiological changes related to deep sleep,

interpreting them as dangerous, and awake in a panic.

In the next module we

will look a bit more

closely at how panic

attacks and panic

disorder develop.

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PANIC STATIONS

About This Module

CONTRIBUTORS

Paula Nathan (MPsych*)

Director, Centre for Clinical Interventions

Adjunct Senior Lecturer, School of Psychiatry and Clinical

Neuroscience, The University of Western Australia

Dr Helen Correia (MApp Psych*; PhD)

Centre for Clinical Interventions

*MPych/MApp Psych: Masters of Psychology (Clinical Psychology)

Some of the material in this module was taken from

Nathan, P.R., Rees, C.S., Lim, L., & Smith, L.M. (2001). Mood Management – Anxiety: A Cognitive Behavioural

Treatment Programme for Individual Therapy. Perth: Rioby Publishing.

BACKGROUND

The concepts and strategies in this module have been developed from evidence based psychological

practice, primarily Cognitive-Behaviour Therapy (CBT). CBT for panic disorder is a type of psychotherapy

that is based on the theory that panic disorder is a result of problematic cognitions (thoughts) and

behaviours. There is strong scientific evidence to support that cognitions and behaviours can play an

important role in panic disorder, and that targeting cognitions and behaviours in therapy can help many

people to overcome panic disorder. Examples of this evidence have been reported in the following:

Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Panic

Disorder and Agoraphobia. (2003). Australian and New Zealand clinical practice guidelines for the

treatment of panic disorder and agoraphobia. Aust N Z J Psychiatry, 37(6), 641-56.

REFERENCES

These are some of the professional references used to create this module.

Barlow, D.H. (2002). Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic (2

Edition).

London: Guilford Press

Craske, M.G., & Barlow, D.H. (2001). Panic disorder and agoraphobia. In D.H. Barlow (Ed.), Clinical

Handbook Of Psychological Disorders, Third Edition. New York: Guilford Press.

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