Panic attacks can start for a number of reasons.

STRESS
As mentioned, stressful events can cause anxiety to go up, which may lead to the alarm system being triggered. Are you aware of any stress in your life over the last few years? For example, work stress or being out of work, relationship problems, loss of a loved one, financial difficulties. Please make a note of any stresses that you are aware of.

If you feel you have had a lot of stress in your life recently, it might be useful to read, The Relaxation and Stress Reduction Workbook.

HEALTH WORRIES
Panic attacks often begin when a person becomes over-concerned about their health. This can happen for various reasons. Sometimes people with panic attacks have recently experienced the sudden death of someone they know or are close to. They then become very worried about their own health, and look for signs that they may be developing the same illness. They are often aware of medical 'mistakes' where serious illness has not been picked up, and so become worried that there is something seriously wrong. This leads to heightened anxiety. They then think the anxiety symptoms are evidence of a serious illness, which can result in panic. Think back to when your panic attacks began. Do you know anyone who died suddenly, for example from a brain hemorrhage or an asthma or heart attack?

OTHER HEALTH-RELATED REASONS
Sometimes panic attacks occur for the first time during a period of ill-health. For example some viruses can cause dizziness. Pregnancy or the menopause can cause changes in the way our body works that can lead to a first experience of panic. Consuming large amounts of caffeine, or low blood sugar can also lead to feelings of faintness. Can you think of any 'health-related' reasons for your panic attacks?

DIFFICULT EMOTIONS
Panic attacks often begin when there are feelings from the past or present that are being "swept under the carpet". Maybe you have relationship problems, or something from the past you need to deal with?

OUT OF THE BLUE
Sometimes we just don’t know why panic attacks begin. Some people even have their first panic attack when they are asleep! It may just be that certain people, in certain circumstances respond like the over-sensitive car alarm. Their alarm system is triggered when there is in fact no danger.

In some ways it is less important to know what causes panic attacks to begin and more important to know what keeps them going.

What keeps panic attacks going?

As you will remember panic affects your body, your thoughts and your behavior. All three work together to keep panic going.

Physical

Firstly, the physical symptoms can be part of the problem. For example, for people whose breathing is affected by anxiety, something called hyperventilation can occur. This just means someone is taking in too much air and not breathing it out. This is not dangerous but can lead to feelings of dizziness, and is often taken as further evidence that there is something seriously wrong.

Thoughts

Secondly, the physical symptoms and anxious thoughts form a vicious circle that keeps panic attacks coming back again and again. Also, focusing your mind on your body can lead to noticing small changes and seeing this as a threat. People who have panic attacks often worry that the physical symptoms mean something different from what they really do. Examples of some of the most common misinterpretations are:

People often find it hard to believe that our thoughts can produce such strong feelings as fear. But if we believe something 100% then we will feel exactly the same way as if it were true.

Another way thoughts can affect panic, is when someone starts to worry that they are going to panic in situations where they have panicked before. This, unfortunately, makes it more likely to happen again, and often leads to voidance.

Behavior

Thirdly, how a person behaves before, during and following a panic attack has a big part to play in whether panic attacks keep happening. The avoidance, escape, and safety behavior described earlier all add in to the vicious circle.

The vicious circle of panic

These physical symptoms, thoughts and behaviors form a vicious circle that keeps the panic attacks occurring over time.

“THREAT” > (Alarm bell)  > I'm sure my heart missed a beat  > Physical symptoms of anxiety, for example, heart thudding > Thinks “oh no, something is wrong” > Physical symptoms get worse > Thinks - "Now I really am having a heart attack” > (Safety behavior) Sits down. "If I hadn't sat down I really would have had a heart attack”…

SUMMARY.

1. Fear is our body's way of coping with threat - preparing us
to fight or run.

2. Panic attacks can begin for a number of reasons:
- stress.
- health worries.
- during a mild illness.
- because of difficult emotions.
- out of the blue.

3.  Panic attacks are kept going because of the vicious circle of
- physical symptoms.
- thoughts.
- behavior.

4.  By avoiding, escaping or preventing panic attacks, you may
- never find out that nothing terrible was going to happen.
- dread going back into the situation, because you fear another attack.
- lose confidence in your ability to cope alone.

Can panic attacks really harm me?

We have spent a lot of time looking at recognizing and understanding panic, because this should give you all the information you need to be able to accept that panic attacks are not harmful. If you can do this then you have come a long way to being able to end your panic attacks.

To what extent, sitting here now do you believe that your panic attacks mean that something awful is going to happen, (0-100%) for example, heart attack, stroke, fainting, choking, suffocating?

Next time you have a panic attack, can you rate at the time how much you believe something awful is going to happen?

SUMMARY: 

   Panic attacks are not harmful