A cognitive approach to panic
Clark, D. M. (1986).
Behaviour Research and Therapy, 24, 461-470.

Abstract

Within this cognitive model, panic attacks are said to result from the catastrophic misinterpretation of certain bodily sensations. The sensations which are misinterpreted are mainly those involved in normal anxiety responses but also include other sensations. The catastrophic misinterpretation involves perceiving these sensations as much more dangerous than they really are.

The phenomenology of panic attacks

A panic attack consists of an intense feeling of apprehension or impending doom which is of sudden onset and which is associated with a wide range of distressing physical sensations. Panic attacks occur in both phobic and non-phobic anxiety disorders.

A cognitive model of panic attacks

It is proposed that panic attacks result from the catastrophic misinterpretation of certain bodily sensations. The sensations which are misinterpreted are mainly those which are involved in normal anxiety responses. The misinterpretation is perceiving these sensations as much more dangerous as they really are.

A wide range of stimuli can provoke a panic attack. These stimuli can be external and internal. If these stimuli are perceived as a threat, a state of mild apprehension results. This state is accompanied by a wide range of body sensations. If these anxiety-produced sensations are interpreted in a catastrophic fashion, a further increase in apprehension occurs, which produces a further increase in body sensations.

In the case of an ‘out of the blue’ panic attack, the trigger often seems to be the perception of a bodily sensation which itself is caused by a different emotional state or for example caffeine.

Other sensations than bodily sensations can also play a role in panic, particularly as triggering stimuli. Like the interpretation of mental processes.