Panic is a sudden burst of anxiety, a sharp surge of norepinephrine and epinephrine. This is the first fear produced by anxiety; it is the chemical signal that comes from your own brain to cause the physical sensations of anxiety. Panic frequently comes unbidden to dominate the thoughts and the behaviors of people with anxiety disorders. Spontaneous panic occurs when intense feelings and thoughts of panic come out of the blue, for no apparent reason. Situational panic occurs when panicky feelings and thoughts are closely tied to particular places or activities that repeatedly cause panic for an individual sufferer.

Agoraphobia/panic disorder usually starts with spontaneous panic and evolves to be mostly or even entirely situational panic, although the situations that trigger panic may be both many and varied. Being tired, stressed, or sick can make panic attacks more likely to occur. In specific phobia, the panic is limited to a particular situational panic, and the panic does not usually shift from one situation to another or involve multiple situations and/or activities, as it does for agoraphobia/panic disorder. Situational panic may arise when driving, flying, shopping, or riding in closed-in places such as elevators. For each person, the specific circumstances that trigger situational panic are usually consistent over the course of many years. People who are psychologically minded can sometimes recognize what particular disturbing thoughts brought on their spontaneous panicky episodes, but often there seems to be no way to understand what triggers them.

The most important fact to know about panic attacks, both spontaneous and situational, is that they will not harm your body. Panic attacks do not cause heart attacks, strokes, or other serious physical problems. In addition, panic attacks do not cause you to pass out, go crazy, or lose control of your body. A person having a panic attack can do, including driving a car or giving a speech. Panic attacks cause terrible feelings – the worst possible feelings – but they do not cause loss of consciousness or loss of control of your body. You might feel as if you will pass out, go crazy, or lose control, but that will not happen. Panic is a normal reaction to danger and, as such, is itself not dangerous. Panic attacks are distressing but not dangerous. They are the body`s normal alarm going of inappropriately. And then, because they are inappropriate, panic attacks trigger frightening self-doubt: "What is wrong with me?" This is not part of normal fear reactions.

There are a number of theories regarding the etiology of panic attacks. One is the cognitive theory proposed by Clark (1986). The cognitive theory of panic states that panic attacks result from catastrophic misinterpretation of certain bodily sensations that serve as signs of an imminent physical or mental disaster such as experiencing a heart attack or losing control of one`s faculties. Current cognitive-behavioral literature on anxiety stresses the importance of identifying symptoms of panic, specific interoceptive cues, and cognitive distortions.

The cognitive-behavioral perspective on panic has been combined therapeutically with behavioral strategies, particularly when symptoms of phobic avoidance develop (Barlow, 1998). The essential goal of cognitive-behavior therapy (CBT) is to reduce and eventually extinguish the association of heightened panic attacks and the somatic, cognitive, affective, and behavioral components that contribute to the escalating panic spiral.

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