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Why Do We Panic?

A better understanding of the path from stress to anxiety to full-blown panic disorder offers soothing news for sufferers

Why do some people experience only isolated attacks, whereas others develop full-blown panic disorder? Bar­low has synthesized his research and that of others to develop an integrated theory of anxiety disorders, which states that certain predispositions are necessary to develop panic disorder:

  • A generalized biological vulnerability toward anxiety, leading us to overreact to the events of daily life.
  • A generalized psychological vulnerability to develop anxiety caused by early childhood learning (such as overprotection from our parents) that the world is a dangerous place and that stress is overwhelming and cannot be controlled.
  • A specific psychological vulnerability in which we learn in childhood that some situations or objects are dangerous even if they are not.

Panic disorder develops when a person with these vulnerabilities experiences prolonged stress and a panic attack. The first attack activates the psychological vulnerabilities, creating a hypersensitivity to external and internal cues associated with the attack. As a result, even medication containing a mild stimulant can provoke an ­attack.

Still, there is good news. Two findings in particular can provide reassurance for those with panic disorder. The first is that all panic attacks are triggered by known events, even though the sufferer may be unaware of them. This knowledge can reduce the anxiety associated with the sense of unpredictability. Second, it can be reassuring to learn that a panic attack is a misfiring of the fight-or-flight response in the absence of danger.

Basic research not only has helped us understand panic disorder but also has led to effective treatments. In particular, Barlow and his associates developed panic-control treatment, described in their 2006 book Mastery of Your Anxiety and Panic. It involves education about panic disorder and somewhat gradual exposure to the internal and external cues that trigger panic attacks, along with changing the catastrophic interpretations of bodily cues so that they no longer trigger the attacks. This treatment has in most instances surpassed drug therapies for the disorder over the long term.

(Further Reading)

  • Anxiety and Its Disorders. Second edition. David H. Barlow. Guilford Press, 2002.
  • A Review of the Evidence from Family, Twin and Adoption Studies for a Genetic Contribution to Adult Psychiatric Disorders. R. A. Shih, P. L. Belmonte and P. P. Zandi in International Review of Psychiatry, Vol. 16, No. 4, pages 260–283; 2004.
  • Mastery of Your Anxiety and Panic: Workbook (Treatments That Work). Fourth edition. David H. Barlow and Michelle G. Craske. Oxford University Press, 2006.
  • Panic Disorder and Agoraphobia. Michelle G. Craske and David H. Barlow in Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual. Fourth edition. Edited by D. H. Barlow. Guilford Press, 2008.
  • For a referral to a therapist in your area who uses panic-control treatment or similar treatments, contact the Center for Anxiety and Related Disorders at www.bu.edu/card or the Association for Behavioral and Cognitive Therapies at www.aabt.org
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