sensations which are misinterpreted are usually those which are involved in normal anxiety (for
example, heart palpitations, breathlessness, dizziness, etc.). The person believes these sensations to
be much more threatening than they really are. Examples would be a healthy man thinking heart
palpitations are the beginnings of a heart attack, a woman thinking that a shaky feeling means she is
about to faint or fall down, or a man driving a car thinking that the intense feelings he is having mean
he is about to lose control of himself and the car. Since the sensations that are misinterpreted are
usually those caused by anxiety, becoming afraid of them only makes them more intense (fear and
anxiety are different levels of the same body mechanism, the fight-or-flight response). When the
person experiences these sensations becoming more intense, he or she becomes more afraid ("my
heart attack is getting worse") which makes the sensations even more intense, increasing the fear in a
quickly escalating spiral that results in the greatest amount of fear you can have, namely, a panic
attack.
A panic attack occurs when:
(1) a person has a particular bodily sensation such as a racing heartbeat, chest pain, a choking
sensation, dizziness, etc.;
(2) thinks that the sensation means that he or she will suffer in some way (die, faint, lose control, be
humiliated);
(3) becomes afraid of the sensation and thereby causes it to intensify, which
(4) leads to more thinking of horrible consequences in a vicious circle that rapidly results in panic.
After the first panic attack people often develop a new fear. They become afraid of having another
panic attack. Since a panic attack is simply an intense fear response, becoming afraid of panic
means a person has become afraid of fear. When this develops, any sensation similar to past panic
attacks (such as a rapid heart beat or becoming light headed) is misinterpreted as the potential onset
of another panic attack. Since panic is simply intense anxiety, normal anxiety is usually
misinterpreted as the potential onset of another panic attack, particularly if it occurs in an "unsafe”
place such as while driving or in places where quick exit is difficult or embarrassing. This reinforces
the belief that panic attacks are spontaneous and outside of one's control.
Many people have read or been told that panic attacks are the result of a malfunction in body
chemistry. It is important to be absolutely clear about this issue. Panic is not the direct result of
some uncontrollable change in body chemistry. It is the result of a particular chain of thinking.
Overcoming panic attacks is difficult if you hold on to the incorrect belief that panic is the result of
something going on in your body that is out of your control. This belief is often inadvertently
encouraged by well meaning health professionals who have reviewed a particular series of research
articles that have been widely publicized in the popular press. This research found that certain
chemicals and bodily sensations lead to panic attacks in people who have a history of having such
attacks but rarely in people who have never before panicked. The chemicals that these researchers
found would lead to panic were sodium lactate (a chemical naturally produced by the body) and
caffeine. The bodily sensations that they found would lead to panic were those feelings produced
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