Panic disorder can be effectively treated with a variety of interventions, including psychological therapies and medication[9] with the strongest and most consistent evidence indicating that cognitive behavioral therapy has the most complete and longest duration of effect, followed by specific selective serotonin reuptake inhibitors.[37] Subsequent research by Barbara Milrod and her colleagues[38] suggests that psychoanalytic psychotherapy might be effective in relieving panic attacks, however, those results alone should be addressed with care. While the results obtained in joint treatments that include cognitive behavioral therapy and selective serotonin reuptake inhibitors are corroborated by many studies and meta-analysis, those obtained by Barbara Milrod are not. Scientific reliability of psychoanalytic psychotherapy for treating panic disorder has not yet been addressed. Specifically, the mechanisms by which psychoanalysis reduces panic are not understood; whereas cognitive-behavioral therapy has a clear conceptual basis that can be applied to panic. The term anxiolytic has become nearly synonymous with the benzodiazepines because these compounds have been, for almost 40 years, the drugs of choice for stress-related anxiety.
ACT is a type of CBT that encourages patients to again in positive behaviors even in the presence of negative thoughts and behaviors. The goal is to improve daily functioning despire having the disorder. It is particularly useful for treatment-resistant Generalized Anxiety Disorder and Depression. The length of treatment varies depending on the severity of symptoms.
Generalized anxiety disorder is a condition in which your worries overwhelm you to the point where your daily routine seems difficult to carry out, and you have been worrying this way for at least six months. You may feel on edge and have difficulty focusing on tasks. There may be a tendency to fear and expect the worst; some call this catastrophic thinking. You even may know that your worries are perhaps irrational, but you still go on feeling them. 
If you are greatly afraid, however, such as being terrified that there is a burglar in your home that is about to harm you, the body produces a high degree stress response. We generally experience high degree stress responses as being anxiety attacks: where the changes are so profound they get our full attention. The greater the degree of anxiety and stress response, the more changes the body experiences.
Simply put - agoraphobia means that you avoid a lot of ordinary activities and situations for fear of having panic attacks. To most people who get this diagnosis, the term sounds pretty scary, but that's all it means. It does not mean you are or will become house bound. That can happen to people, and is an extremely severe case of agoraphobia, but the great majority of people with agoraphobia do not experience it to that extent.

Some research suggests that people who have panic disorder might be very sensitive to sensory experiences (such as sunlight, smells and changes in the weather), but there's not enough evidence yet to say for sure. Also it's not clear whether having a high level of sensitivity to these sorts of things is something that might cause you to develop panic disorder, or whether it may be an effect of having it.
Panic attacks cause a variety of distressing symptoms that can be terrifying for the individual experiencing the attack. Some people mistake panic attacks for heart attacks and many believe that they are dying. Others feel a mixture of self-doubt or impending doom. Some can also find the episodes extremely embarrassing and refrain from telling their friends, family, or a mental health professional.
Panic attacks are characterized by feelings of fear, dread, and uncomfortable physical symptoms. These attacks are not classified as a mental health disorder on their own but typically occur as a part of a mental illness or medical condition. Panic attacks are classified into two types: expected and unexpected. Here's what you need to know about each one.
Anxiety cannot increase forever and you cannot experience peak levels of anxiety forever. Physiologically there is a point at which our anxiety cannot become any higher and our bodies will not maintain that peak level of anxiety indefinitely. At that point, there is nowhere for anxiety to go but down. It is uncomfortable to reach that peak but it is important to remember this anxiety will even out and then go down with time.
Many people use the terms anxiety attack and panic attack interchangeable, but in reality, they represent two different experiences. The DSM-5 uses the term panic attack to describe the hallmark features of panic disorder or panic attacks that occur as a result of another mental disorder. To be considered a panic attack, four or more of the symptoms outlined in the DSM-5 must be present.

Signs of mental health difficulty can be different in the workplace than in other settings. The Harvard Mental Health Letter outlines signs that you may notice in your co-workers, which could indicate a significant problem. For anxiety disorders, these can include restlessness, fatigue, difficulty concentrating, excess worrying, and a general impairment in quality of work.


Great questions. Unfortunately, there is usually no clear cut answer – and like many mental health disorders – it is likely caused by a combination of genetic, behavioral, and developmental factors. Anatomically speaking, Generalized Anxiety Disorder is most closely related to a disruption in the functional connectivity of the amygdala – the “emotional control center” of the brain – and how it processes feelings of fear and anxiety. Genetics also play a role in Generalized Anxiety Disorder. If you have a family member that also suffers from this disorder, your chances of suffering from it are increased, especially in the presence of a life stressor. Interestingly, long-term substance abuse also increases your chances of Generalized Anxiety Disorder, as the use of benzodiazepines can worsen your anxiety levels, as can excessive alcohol use. Tobacco use and caffeine are also both associated with increased levels of anxiety.

Heredity, other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role in the onset of panic disorder. Some research suggests panic attacks occur when a “suffocation alarm mechanism” in the brain is activated, falsely reporting that death is imminent. The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation.


David D. Burns recommends breathing exercises for those suffering from anxiety. One such breathing exercise is a 5-2-5 count. Using the stomach (or diaphragm)—and not the chest—inhale (feel the stomach come out, as opposed to the chest expanding) for 5 seconds. As the maximal point at inhalation is reached, hold the breath for 2 seconds. Then slowly exhale, over 5 seconds. Repeat this cycle twice and then breathe 'normally' for 5 cycles (1 cycle = 1 inhale + 1 exhale). The point is to focus on the breathing and relax the heart rate. Regular diaphragmatic breathing may be achieved by extending the outbreath by counting or humming.
A panic attack is a response of the sympathetic nervous system (SNS). The most common symptoms include trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, cold flashes, burning sensations (particularly in the facial or neck area), sweating, nausea, dizziness (or slight vertigo), light-headedness, hyperventilation, paresthesias (tingling sensations), sensations of choking or smothering, difficulty moving, and derealization. These physical symptoms are interpreted with alarm in people prone to panic attacks. This results in increased anxiety and forms a positive feedback loop.[10]
Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.
In this issue Holiday self-care tips Managing holiday stress Save the date - Mental Health Academy Holiday wishes from our team Welcome to another edition of the TeenMentalHealth.org Conversation – a place where we provide information on happenings in the area of youth mental health. Feel free to join the conversation by sharing questions, feedback, photos, [...]
Selective serotonin reuptake inhibitors, or SSRIs, work in the brain via a chemical messenger called serotonin. SSRIs commonly prescribed for panic disorder include Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa). SSRIs are also used to treat panic disorder when it occurs in combination with obsessive-compulsive disorder, social phobia, or depression. SSRI's tend to have fewer side effects than other antidepressants. Patients may initially experience nausea, drowsiness, diarrhea, or sexual side effects when they first take SSRIs, but over time, symptoms subside. An adjustment in dosage or a switch to another SSRI may also correct the problem. Clients should discuss all side effects or concerns with their doctor so that any needed changes in medication can be made.
Meditation may also be helpful in the treatment of panic disorders.[54] There was a meta-analysis of the comorbidity of panic disorders and agoraphobia. It used exposure therapy to treat the patients over a period. Hundreds of patients were used in these studies and they all met the DSM-IV criteria for both of these disorders.[55] A result was that thirty-two percent of patients had a panic episode after treatment. They concluded that the use of exposure therapy has lasting efficacy for a client who is living with a panic disorder and agoraphobia.[55]
Cognitive-behavioral therapy, or CBT, teaches patients to see the links between the their thoughts, beliefs, and actions. By changing distorted thought patterns that maintain the anxiety and by exposing the person to anxiety-provoking symptoms or situations in a gradual manner, CBT can help create mastery over the anxiety and panic symptoms. Therapy may help those with panic disorder to
"Anxiety" is a general term that describes a variety of experiences, including nervousness, fear, apprehension, and worry, that are common in several mental health disorders. While most of us have anxiety at some time, this is completely different from an anxiety attack or anxiety disorder. Normal feelings of nervousness, worry, and fear often have a known trigger (a major exam, money issues, or seeing a bug). But when you're having a full blown panic attack or anxiety attack, the symptoms — chest pain, flushing skin, racing heart, and difficulty breathing — can make you feel as though you're going to faint, lose your mind, or die. The reality is, you won’t. The key to surviving is to learn all you can about anxiety attacks and practice the skills you need to get through them.
Medications for panic disorder, such as antidepressants and benzodiazepines, can reduce the intensity of panic attacks and other anxiety-related symptoms. Psychotherapy can assist in helping you deal with difficult emotions and develop healthy coping techniques. Regardless of the options someone chooses, it's important to get help for panic and anxiety. The sooner a diagnosis has been made and treatment begins, the quicker a person can expect to cope with symptoms and manage life with panic disorder.
The symptoms of panic attacks typically occur rapidly and peak within minutes. Once a panic attack has subsided, the symptoms can taper off completely or the panic sufferer can remain in an anxious state, possibly repeating the panic attack cycle again. Limited-symptom panic attacks occur when all criteria are met, but the person experiences less than four of the listed symptoms.
Experiencing a chronic medical condition or severe or frequent illness can also increase risk for anxiety disorders, as well as dealing with significant illness of a family member or loved one. Given that several medical conditions have been linked to significant anxiety, in some cases a physician may perform medical tests to rule out an underlying medical condition. For instance, thyroid disease is often characterized by experiencing significant symptoms of anxiety. Menopause, heart disease, and diabetes have also been linked to anxiety symptoms. Additionally, drug abuse or withdrawal for many substances is characterized by acute anxiety, and chronic substance abuse can increase risk for developing an anxiety disorder. Anxiety can also be a side effect of certain medications. Experiencing significant sleep disturbances, such as difficulty falling asleep or staying asleep, may also be a risk factor for developing an anxiety disorder.
We all tend to avoid certain things or situations that make us uncomfortable or even fearful. But for someone with a phobia, certain places, events or objects create powerful reactions of strong, irrational fear. Most people with specific phobias have several things that can trigger those reactions; to avoid panic, they will work hard to avoid their triggers. Depending on the type and number of triggers, attempts to control fear can take over a person’s life.
The degree of accompanying stress response and its physiological, psychological, and emotional changes are directly proportional to the degree of anxiety. For example, if you are only slightly concerned, such as being slightly nervous about meeting someone new, the body produces a small degree stress response. The small degree stress response can be so slight that you don’t even notice it.
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