Cognitive Therapy of Anxiety Disorders

Panic Disorder 277

people with agoraphobia reporting a past or current panic disorder (Antony & Swinson,
2000a; APA, 2000). In the latest epidemiological study panic disorder had a 12-month
prevalence of 2.7%, whereas agoraphobia without panic disorder was much less com-
mon at 0.8% (Kessler et al., 2005).
DSM-IV-TR defines panic attacks as “a discrete period of intense fear or discom-
fort in which four (or more) of the following symptoms developed abruptly and reached
a peak within 10 minutes” (APA, 2000, p. 432). The typical panic attack lasts between
5 and 20 minutes, although a heightened state of anxiety can linger long after the panic
episode subsides (Rachman, 2004). According to DSM-IV-TR, the defining symptoms
of panic are:

••Elevated heart rate or palpitations

••Sweating

••Trembling or shaking

••Smothering sensation or shortness of breath

••Feeling of choking

••Chest tightness, pain, or discomfort

••Abdominal distress or nausea

••Dizziness, lightheadedness, faintness, or feeling unsteady

••Feelings of unreality (derealization) or detachment from oneself (depersonaliza-

tion)

••Numbness or tingling sensations

••Chills or hot flushes

••Fear of losing control or going crazy

••Fear of dying

Table 8.1 lists a number of prominent features that characterize panic attacks.

Situational Triggers

Even though DSM-IV specifies that two unexpected panic attacks must occur to meet
diagnostic criteria for panic disorder, the majority of panic episodes are anticipated
because they are provoked by exposure to an identifiable stressor (Rachman, 2004).
Theaters, supermarkets, restaurants, department stores, buses, trains, airplanes, sub-

table 8.1. Critical features of panic attacks

••Situational triggers

••Abrupt onset of physiological arousal

••Heightened self-focus, hypervigilance of bodily sensations

••Perceived physical, mental, or behavioral catastrophe

••Apprehension, fear of future panic attacks

••Extensive safety seeking (escape, avoidance, etc.)

••Perceived lack of controllability

••Qualitatively distinct from anxiety