Dr. Debra Kissen is a clinical psychologist and clinical director of the Light On Anxiety Treatment Center in Chicago, IL, who specialises in Cognitive Behavioral Therapy (CBT) for anxiety and related disorders.

What is the relationship between anxiety and panic?

The relationship between anxiety and panic is bi-directional. The more one tries to avoid feeling panic sensations, the more anxiety one feels which only leads to more panic. One can feel stuck in a vicious cycle of anxiety and panic.

Do panic attacks really occur “out of the blue"?

A panic attack may feel out of the blue. Sometimes the brain stumbles upon a threat trigger or false alarm outside of one’s awareness. In other words the brain thinks you are about to be eaten by a lion but your front rational brain realizes there is no lion.

Should people with panic avoid exercise, caffeine, and other stimulation?

No people experiencing panic disorder should NOT avoid caffeine or exercise or anything else. You need to teach your brain you are strong and can handle an array of sensations.

My panic attacks make me feel like I'm about to lose control, what can help with these symptoms?

Feeling like you are about to lose control is very different from actually being out of control. Picture a person that you imagine is out of control. Is this because of a feeling they are having, or a behavior they are engaging in? This is just more panic spam mail.

Will I spend the rest of my life feeling this anxious and awful? Is this my new normal?

There is much caused reason to be hopeful. Panic disorder is one of the most treatable mental health conditions. Find a mental health provider who offers CBT for panic and you will soon obtain relief through hard work and support.

What treatment and/or medication is effective for panic disorder and panic attacks?

CBT for panic disorder is treatment of choice. Key element of CBT for panic: interoceptive exposure (learning to play with vs. run from anxiety sensations). Panic disorder is highly treatable so do not lose hope! As for medication, be careful of benzo use as it reinforces to your brain that you were truly in danger and keeps panic cycle in play. There is more empirical support for panic attacks.

If there is one tip that you would provide to help get past panic disorder, what would it be?

Panic is a “FALSE alarm” that involves uncomfortable but harmless bodily sensations that can be induced by numerous activities, many of which we enjoy (e.g., espresso!) Avoidance increases anxiety about panic & remaining in a situation leads to victory. Put another way, panic symptoms are a sign that our bodies are doing what they should if we are actually in danger, in the case of the fear response. Hence “false alarm” of panic. The difference? With fear, we are paying attention to the threat, not our bodies.

Why do I feel like I’m going to pass out when I have a panic attack?

A panic attack is the body in fight/flight mode minus a real threat. When the body is in survival mode it takes in extra oxygen in order to fuel up. Given there is no “REAL DANGER” this extra oxygen does not get used and can lead to feeling light headed. When having a panic attack a common fear is that one will pass out but actually the opposite is true. A panic attack is associated with increase in blood pressure, passing out is associated with drop in blood pressure. One exception is blood harm phobia.