5 Lies Psychologists Tell About Panic Attacks

The truth may not set you free. But it can keep you from going down a dead end.

Posted Jun 24, 2020

1. Panic won't kill you. Does it count if panic kills you slowly? Working Paper 15 from the Harvard Center on the Developing Child reads, "Activation of the stress response increases glucose levels in the blood in order to generate more energy to fuel the “fight or flight” response, which prepares our muscles and brain to deal with a sudden threat. . . . prolonged glucose elevation can trigger a cascade of events culminating in insulin resistance, metabolic syndrome, obesity, and eventually a diagnosis of type 2 diabetes."

There is another way panic can cause a serious problem. The symptoms of panic are similar to some serious physical conditions. Don't just assume you are having panic. Get your symptoms checked out by a physician.

2. Irrational thoughts cause panic. No. The problem is not whether a thought is rational. The problem is whether a thought is believed. As stress hormone levels rise, we lose the ability to recognize imagination is imagination and mistake it for perception.

As we lose intuitive awareness whether we are perceiving, remembering, or imagining, whatever we have in mind — regardless of which mental process is producing it — is experienced as perception. So what is feared is experienced as happening.

For example, something triggers the release of stress hormones. I notice my heart pounding. I think it could be a heart attack. That thought — who is to say it is irrational? — releases additional stress hormones. Now, in what could be a life-threatening situation, I stop looking inward. I stop sensing what kind of processing is going on. Though the thought that this could be a heart attack is conjecture, there seems to be some evidence. The evidence, pounding heart, is real. So the thought that this might be a heart attack feels real.

Fear is now masquerading as fact. I "know" I am having a heart attack. This puts me in the "fight or flight" mode. But neither fight nor flight helps. I can't fight off a heart attack. I can't run away from a heart attack. I'm trapped. I'm doomed. I panic.

3. Deep breathing helps. Not really. A study found that breathing retraining (BR) may make things worse. The researchers summarized "patients receiving BR exhibited trends toward poorer end state functioning on both self and clinician rated measures . . . . We have suggested that therapists refrain from the use of respiratory-control techniques as a means for coping with or managing anxiety."

An authority on panic says breathing exercises are maladaptive. In his book Anxiety and its Disorders: The Nature and Treatment of Anxiety and Panic, David Barlow, Director of the Center for Anxiety and Related Disorders at Brown University, writes, "[A]ny behavior that . . . enables avoidance of or distraction from the panic sensation is maladaptive . . . because it is an attempt to keep the patient 'safe' from a false threat (i.e., panic symptoms, high anxiety) . . . . use of breathing retraining . . . is discouraged and is maladaptive."

4. CBT is the "Gold Standard Treatment" for panic. Insurance companies might agree with that. CBT costs them less gold. But most patients don't agree. Only one patient in six becomes panic free with CBT. 

This graph from a study published in the Journal of the American Medical Association shows the proportion of patients whose panic attacks were ended by CBT treatment. After 12 months, only 16% of those treated were panic free. Patients receiving only CBT are in dark gray.

Journal of the American Medical Association
A Randomized Effectiveness Trial of Cognitive-Behavioral Therapy and Medication for Primary Care Panic Disorder
Source: Journal of the American Medical Association

5. Medication works. Not for most people. In the graph above, patients receiving CBT and medication are shown in light gray. The addition of meds increased the percentage of patients who were panic-free at 12 months by 14%.

Is there any good news? Full disclosure: as an airline captain and licensed therapist, I developed a method of dealing with in-flight panic, so I am not a neutral observer. But 81% of my fear of flying course clients who experienced panic prior to taking the course became panic free in the air and 83% became panic-free on the ground. (If that sounds intriguing enough to read a few pages of my book on this method, click here. A neutral observer, Foreword Indies, awarded my book silver in the best self-help book of the year contest.)