Summary—A cognitive model of panic is described. Within this model panic attacks are said to result from the catastrophic misinterpretation of certain bodily sensations. The sensations which are mis-interpreted are mainly those involved in normal anxiety responses (e.g. palpitations, breathlessness, dizziness etc.) but also include some other sensations. The catastrophic misinterpretation involves perceiving these sensations as much more dangerous than they really are (e.g. perceiving palpitations as evidence of an impending heart attack). A review of the literature indicates that the proposed model is consistent with the major features of panic. In particular, it is consistent with the nature of the cognitive disturbance in panic patients, the perceived sequence of events in an attack, the occurrence of ‘spontaneous’ attacks, the role of hyperventilation in attacks, the effects of sodium lactate and the literature on psychological and pharmacological treatments. Finally, a series of direct tests of the model are proposed.
Ever since Freud’s (1894) classic essay on anxiety neurosis, it has been accepted that panic attacks are a frequent accompaniment of certain types of anxiety disorder. However, it is only relatively recently that panic attacks have become a focus of research interest in their own right. This shift in emphasis is largely a result of the work of Donald Klein. In a series of studies which started in the 1960s, Klein and his colleagues (Klein, 1964; Zitrin, Klein and Woerner, 1980; Zitrin, Woerner and Klein, 1981; Zitrin, Klein, Woerner and Ross, 1983) appeared to demonstrate that anxiety disorders which are characterized by panic attacks respond to imipramine while anxiety disorders which are not characterized by panic attacks fail to respond to imipramine. This `pharmacological dissociation’ led Klein (1981) to propose that panic anxiety is qualitatively different from non-panic anxiety. A view which was subsequently endorsed by the writers of DSM-III (APA, 1980) when they created the two diagnostic categories of ‘panic disorder’ and `agoraphobia with panic’ and used the presence or absence of panic attacks as a major criteria for distinguishing between different types of anxiety disorder. Following the publication of DSM-III, there has been an enormous increase in research on panic attacks. Perhaps because drug studies were the major stimulus for the creation of the diagnostic category of panic disorder, most recent research has concentrated on biological approaches to the understanding of panic. However, there are a number of reasons for supposing that panic attacks might be best understood from a cognitive perspective. After a brief description of the phenomenology of panic attacks, the present article presents a cognitive approach to the understanding of panic. A literature review indicates that the proposed cognitive model is consistent with existing information on the nature of panic and the article concludes with a set of specific predictions which could be used to test the model.