Panic Attack



panic attack

This article explains what is a panic attack and consequences for counselling or psychotherapy with cognitive behavioural therapy.

The panic attack is a period of perceived and profound fear and in the absence of real danger and it is accompanied by at least four or thirteen thinking or bodily symptoms and those symptoms could be anything from heart palpitations, shaking, sweating, hands going white, dizziness or light-headedness, fear of losing control or impression of going crazy, numbing in hands or feet. The panic attack is essentially an anxiety disorder and it can accompany any type of anxiety disorder as well as depression or people who consume drugs or alcohol also known as substance misuse disorder.

There are also different types of panic attacks: unexpected attack is the one that is set off without any perceived danger, panic attack that is provoked by something we feel terrified of and clinically termed as ‘situationally bound’ (APA, 2000), and finally a panic attack that is called situationally predisposed and this type of attack usually occurs sometime or much later after the exposure of the perceived and dangerous cue or object.

It is not unusual that when people come for counselling or for therapy of the panic attacks that they report feelings and fear of dying, fear of getting a heart attack, or impression that they are going crazy and fear of not being able to escape from places or situations also known as agoraphobia. In order to understand what type of the panic attack the client has during the assessment, it is explored in what context the panic attack is triggered. The context in which the panic attack happens is useful to know for counselling and therapy of the panic attack.

As discussed above persons who have experienced the panic attacks may recognise that their panic attacks might be accompanied with feelings or fear of not being able to escape from certain places, which is a state of anxiety known as agoraphobia. This type of anxiety or agoraphobia includes the emergence of fear of enclosed places and inability or difficulty to escape and avoidance and then avoiding being in crowded places, enclosed places such as aeroplane and elevator. If the panic attack, as discussed above is not addressed through self-care or counselling or therapy, this could lead to a development of a panic disorder, that comprises recurrent unexpected panic attacks and this panic disorder could be accompanied by agoraphobia or the agoraphobia might be absent. The repeated panic attacks within a month with worries about future panic attacks, concerns about losing control and a development of negative changes in the affected person’s behaviour and without any physiological effects of drugs, medication or alcohol, or mental health issues would be diagnosed as panic disorder either with agoraphobia or without agoraphobia (APA, 2000).

Panic Attacks and Consequences for Psychotherapy

One of the important features of the panic attack, panic disorder with agoraphobia or without agoraphobia is the perceived sense of danger and the clients who self-refer for counselling or psychotherapy because of the agoraphobia or the panic attacks will often talk of thoughts, images, expectations related to danger and often these perceptions of danger are misconstructions. Consequently, in the counselling or therapy using cognitive behavioural therapy for anxiety or panic disorders, the therapist will focus on the client’s assessment of the danger and it will be explored whether this danger is real or not real and the work involves working with unrealistic appraisals of danger or overestimation of the danger, catastrophising or magnifying the perceived danger or bodily sensations and then modification of these unrealistic appraisals (Clark, Kirk, Salkovskis and Hawton, 1989). The counselling, therapy or cognitive behavioural therapy for the panic attack, the panic disorder or with or without agoraphobia further comprises work with worries and assumptions that maintain these overestimated perceptions of danger and understanding of it.

Not all information will be gathered in the session one and the assessment is, therefore, ongoing and the length of the therapy will vary from client to client. The counselling, therapy or psychotherapy with cognitive behavioural therapy for panic attack, panic disorder with or without agoraphobia not only includes the work with beliefs, thoughts and perceptions and their modification about it but it also involves work with lifestyle changes, understanding the role of stress, the physiology of stress and a stress management and the progress is being weekly discussed in the sessions until the client shows an improvement in decrease of the panic attacks or complete elimination of the panic attacks. Because some anxious patients or patients with panic attack might be also suffering from depression, the therapy might then also include cognitive behavioural therapy for depression or depression management. As for the avoidance, which is one of the criterion of agoraphobia, the work will include understanding if the agoraphobia is linked to danger perceived in closed places or places involving social situations which could be linked to social phobia and low confidence so work on low confidence might be required.


In this short article, I discussed what is the panic attack, the panic disorder and agoraphobia and brief consequences for the treatment or counselling with cognitive behavioural therapy. If you would like to schedule an appointment for counselling of the panic attack, social phobia, agoraphobia with cognitive behavioural therapy please do not hesitate to call text directly Leona Sears on 07 505 124 933 or directly email her on