What is Panic Disorder?
Up to 4 people in every 100 will experience moments of overwhelming fear and anxiety
that reach a peak in less than 10 minutes and appear to come on suddenly and
unexpectedly. During these attacks it is not unusual to experience symptoms such as
dizziness, a rapid heart beat, sweating, numbness, fear of a heart attack or of dying,
shaking, nausea as well as other physical and psychological sensations. Many people with
such symptoms are able to report feelings of anxiety dating back to childhood and
After a person experiences just one or two panic attacks they begin to anxiously
anticipate and fear when the next one will come. As the fear of another attack increases,
the individuals’ day to day life can be affected as they try to avoid situations where
panic attacks can or have occurred. In severe cases, some individuals end up developing
agoraphobia, which is a fear of going outside. Those who suffer from
agoraphobia may become housebound and unable to function day-to-day.
Panic attacks can manifest differently in children and adults simply because of
lifestyle differences. In children, panic and anxiety often materialize in the form of
school phobias, fear of performing (i.e. recitals, oral presentations), at home where
they are often afraid of the dark or of going upstairs and downstairs alone, as well as
in social situations such as meeting new people.
In adults, panic disorders can disrupt the marital relationship as the individual may
withdraw socially and from day to day activities as a way of avoiding having another
attack. It is also not uncommon for people to turn down business opportunities and to
suffer from poor productivity at work as a result of avoiding situations where panic
attacks may occur.
As well, many children and adults who are suffering from panic disorder are at greater
risk of having comorbid depression- whether as a primary or secondary disorder.
Depressive symptoms are important to look for and note because a diagnosis of comorbid
depression could alter treatment and therapy techniques.
A Self Test for Panic Disorder
If you think that you may have panic disorder, complete the following questionnaire.
Check off any of the symptoms if you have had them in the past month.[RAW]
If you have answered “yes” to at least 4 of the symptoms and/or “yes” to
either of the above questions, you may have panic disorder and you should see your
How Can Counselling Help?
Panic disorders and anxiety can be treated with the use of medication, specifically
antidepressants (e.g. SSRIs) as well as cognitive-behavioural therapy. In many cases,
counselling alone can be sufficient in treating anxiety. With cognitive behavioural
therapy, the patient learns to anticipate panic attacks by learning to identify
situations and physical cues and symptoms that frequently precede them. The patient is
also taught relaxation techniques, such as meditation and a variety of breathing skills
that can be used as coping strategies to get through the attack once it has started.
Family therapist, Susan Lieberman gives examples of various breathing skills and
relaxation techniques which patients can be taught in
The Calming Breath
- Take a deep breath, filling first your lower lungs then your upper lungs. Hold to a
count of 3 as your heart slows.
- Slowly exhale, saying “relax” (or a similar word) under your breath. Let go of your
- Let your muscles go limp and warm; loosen your face and jaw muscles.
- Remain in this “resting” position physically and mentally for a few seconds, or for
a couple of natural breaths.
USES: Incorporate this brief experience into your daily life. Use it
six to eight times a day to reduce the build up of normal tensions.
An example of a relaxation technique is Brief Muscle Relaxation.
Brief Muscle Relaxation
- Close your eyes and sit quietly, letting go if any distracting thoughts. (20
- Bend your arms, then cross them in front of your chest. Tighten your fists, arms,
shoulders, chest and back and lift your shoulders up to your ears, while you’re
breathing. (10 seconds) Now relax. (15-20 seconds)
- Crunch your face up, wrinkle your nose, squint your eyes, purse your lips and bite
down on your teeth. (10 seconds) Now relax. (15-20 seconds)
- Take a deep breath, pull in your stomach and tense your lower back. Hold your
breath while counting to “six”. Then exhale SLOWLY. Now relax. (15-20 seconds)
- Extend your legs and tense them, while pointing your toes toward your head. (10
seconds) Now relax. (15-20 seconds)
- Repeat steps 2-5
- Sit quietly, clearing your mind and focusing on your gentle breathing or on a
pleasant scene in your mind as you invite your body to feel relaxed, warm and heavy. (1
- Open your eyes, feeling refreshed and at ease.
USES: Anytime you want to release muscle tensions and quiet your
Often when a person is in the midst of a panic attack, the thoughts that are racing
through their mind are negative, self-critical and/or hopeless. Through
cognitive-behavioural therapy, the patient learns to recognize their negative thoughts
and then make a conscious decision to stop them. Such thoughts are often stopped with the
use of “self-talk” and supportive comments.
- It’s o.k. to take a chance here; this is a place to practice my
- I can be a little anxious and still perform my task.
- I don’t have to let these feelings stop me.
- I can handle these symptoms.
- I am free to come and go according to my comfort.
- I always have options, no matter what.
- This is not an emergency; I can think about what I need.
- I can be relaxed and in control at the same time.
- It’s o.k. to feel safe here.
- I deserve to feel comfortable here.
- I can slow down and think.
- I can trust my body.
USES: Whenever you are feeling anxious or panicky.
Lastly, a final example of a relaxation technique taught to patients in counselling is
- Find a quiet spot
- Sit in a comfortable position and focus on a single object. Then close your eyes.
Clear your mind of everything but that one object.
- Begin to breathe in slowly through your nose and mouth. When your lungs are full,
hold your breath for a count of 3. Slowly exhale.
- Repeat at least 5 times.
Panic disorder is frequently underdiagnosed in clinical practice. However, when
diagnosed correctly, panic disorders are extremely treatable. With the right use of
medications and/or therapy, panic attacks and anxiety can be reduced substantially and in
a large majority of patients, can be eliminated altogether in just a matter of weeks.