This cognitive approach to explaining panic
is credited to David M. Clark, M.D., a British psychiatrist who published his theory in 1985.
Certain drugs such as excessive caffeine; or
certain behaviors such as voluntary hyperventilation; can trigger panic attacks. Though these drugs or experiences produce
the same physical sensations in all people, usually only individuals with a history of panic attacks will experience
a panic attack in response. Research has suggested the reason for this difference lies in the interpretation of the
sensations. These drugs and physical sensations do not actually create panic, but the way in which the individual interprets
the experience makes the difference between a response of panic or non-panic.
People who panic in response to certain stimuli do so as
the result of a catastrophic misinterpretation of certain bodily sensations. The physical sensations usually misinterpreted
are those involved in normal anxiety responses: dizziness, breathlessness or heart palpitations. These sensations are interpreted
to be much more dangerous than they really are. One example is the healthy person who interprets heart palpitations as evidence
of the start of a heart attack. Or a person interpreting a feeling of breathlessness as evidence they are suffocating and
will therefore die. Or a person interpreting a shaky feeling as the start of the loss of control of themself and the onset
of going crazy.
Both external and internal stimuli
can provoke physical sensations. External tend to be places or situations where the person has previously experienced anxiety:
a supermarket, a freeway, a bridge, or a certain social situation. Internal stimuli are bodily sensations, thoughts and/or
images. If these stimuli are perceived as a threat, some mild anxiety is created. This mild anxiety creates, or intensifies,
a wide range of physical sensations. If these sensations are then interpreted in a catastrophic manner, the fear increases.
This then increases the body sensations and so on, creating a vicious cycle of sensations causing fear which cause sensations
which cause fear. This has also been referred to as the fear of fear cycle.
This model applies to all panic attacks
whether they are attacks that were preceded by anxiety, or the type of attacks that come "out of the blue". In the first type,
the anxiety that precedes the panic is called anticipatory anxiety, and that anxiety helped to actually create the
panic attack. That is, the anxiety over a panic caused mental and physical sensations that caused catastrophic thinking, therefore
leading to a panic attack. Again illustrating the fear of fear cycle: the fear of having a panic attack causes a panic
attack.
Another situation involves anxiety that is not the
result of a fear of panic, but rather anxiety over stressful events. During that period of anxiety, the person notices bodily
reactions, and catastrophically interprets those sensations, and then panics. A third situation involves panics that are triggered
not by anxiety or the fear of a panic, but rather by the misinterpretation of sensations that result from other emotions
such as anger or excitement, or the misinterpretation of sensations caused by physical activity. Such harmless acts
such as suddenly standing from a sitting position can cause dizziness; exercise can cause breathlessness or palpitations;
or drinking caffeine can cause palpitations. When these sensations are noticed, they can be interpreted in a catastrophic
manner, thereby triggering a panic attack. Often these attacks occur without the person consciously recognizing the triggering
physical sensation and catastrophic misinterpretation, therefore these panics can appear to come "out of the blue". In
summary, the following are the elements involved in the:
Vicious Cycle of Panic
* Trigger Stimulus (internal or external) leads to:
* Perceived Threat leads to:
* Apprehension leads to:
* Body Sensations leads to:
* Interpretation of Sensations as Catastrophic which leads
back to:
* Trigger Stimulus
