Name: Panic attacks — what are the causes and therapies?
Uploaded: 2025-12-29T09:19:56.512Z
Duration: 6 min 24 s
Description: Panic attacks are more than anxiety. How do they start? What are the typical symptoms? And how does behavioral therapy like CBT work?

Panic attacks are more than anxiety. How do they start? What are the typical symptoms? And how does behavioral therapy like CBT work?

The article follows Selina Luhmann, who has struggled with panic disorder for over 15 years, describing her experiences with sudden and intense panic attacks that have significantly impacted her daily life. Medical professionals explain that panic disorder is characterized by repeated, unexpected panic attacks with strong physical symptoms, often triggered by misinterpretation of bodily signals and sometimes influenced by genetics.

Treatment through cognitive behavioural therapy (CBT) is highlighted, with exposure exercises and coping techniques helping patients confront and manage their symptoms. Selina's progress through CBT has enabled her to handle anxiety-provoking situations better, though she has yet to return to the cinema, which remains a personal goal.

Panic attacks — what are the causes and therapies?

Finally being able to go to the cinema again. Selina Luhmann hasn't managed that in years. She's been too afraid of having a bad panic attack. It starts with nausea, then dizziness, heart racing. I get really flushed and feel like I'm walking on clouds. There was one time at the cinema I could feel the panic coming on and it was really unpleasant. I had to leave during the film and figure out where the door was, where the exit was. I haven't been back to the movies since then. Selina is now 33. The symptoms first appeared 15 years ago, out of the blue, in a supermarket. I was in a long line at the checkout and I suddenly felt unwell. My heart started racing, like it was going to jump out of my chest. I felt sick, hot, sweaty. I thought I was having a heart attack. I just thought I need to get out of here, so I pushed my car to the side and ran out. She still managed to drive home, where the symptoms subsided. For a few years things quietened down, but then the attacks came back and Selina got worse and worse. Some weird neck issues started, all that tension in my body. She began to worry and went to a doctor. But blood tests and an ECG showed everything looked fine. Physically, she was healthy. The root of her symptoms is psychological. She has a panic disorder. A specialist in psychosomatic medicine and psychotherapy, Bernd Loewe knows the illness well. A panic disorder is defined by repeatedly occurring panic attacks. These are sudden, unexpected surges of intense anxiety, typically accompanied by strong physical symptoms. A racing heart, pressure in the chest, dizziness, tingling in the fingers, shortness of breath, the feeling of choking, fear of dying. Sometimes even the sensation of being detached from yourself. And when those attacks keep happening and are combined with fear of having another one or fear of the consequences, that's what we call a panic disorder. A panic attack begins in the brain, specifically in the amygdala, where fear is processed. The autonomic nervous system goes into alarm mode. Stress hormones like adrenaline and noradrenaline are released and surge through the body. That causes the heart to beat faster, the muscles tense up and sweating starts. The brain then misreads these physical reactions as a new threat and ramps up the alarm mode even more. The stress response intensifies, a vicious cycle. Many people are afraid they're dying. We know that people with panic disorder tend to perceive bodily signals more intensely and more threateningly. That's probably partly genetic. In 2023, Selina sought help at this clinic with a course of cognitive behavioural therapy, or CBT. To find out how the treatment works, we talked to psychotherapist Inse Neumann. The idea is that patients actively confront the situations or symptoms that trigger their anxiety. In exposure exercises, together, we deliberately try to provoke those symptoms. The goal is always for them to sit with the symptoms without doing anything to counteract them. And we know that by experiencing the symptoms, and we know that by experiencing the anxiety in this way, it gradually decreases over time. Many people hyperventilate during a panic attack. That's something we can reproduce quite well, for example by breathing deeply and quickly or by breathing through a straw. We use all kinds of techniques to get as close as possible to those physical sensations that trigger the panic. Selina also practices walking through shopping centres with her therapist, without her handbag, where she usually keeps her phone, water and just-in-case medication. I had to walk around a shopping centre for 45 minutes without any of my things, and when it hit me that I didn't have them, that was pretty challenging. The aim is to show her that the symptoms come, but they also go, and that she can handle them. In general, patients like Selina are encouraged to let their symptoms happen, but for occasional panic attacks that can hit anyone, there are coping techniques. Breathing out slowly and for a long time can help, or trying to reorient yourself, noticing what you can see around you, what you can hear, whether you can feel or smell or taste something. That works too. During a panic attack, the attention is focused intensely on the frightening physical sensations, so the aim is to shift attention to what's happening externally. Through CBT, Selina has gradually improved. She can now be around people or in busy shopping centres with much less anxiety. She's learned to mentally prepare for situations that used to overwhelm her. You're supposed to tell yourself, when you go somewhere that used to scare you, that you're ready, and that if a panic attack comes, that's OK. You don't avoid things anymore just because it might happen, and if it does happen, you let it. Fighting it usually makes it worse. Selina Luhmann still hasn't been back to the cinema, but it's high up on her to-do list for the next few months. Any film. I just want to go to the movies.

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