In today's uncertain and anxious world, panic attacks have become an increasingly prominent topic. They are not simply "exaggerated fear" — they are a complex psychological and physical experience often associated with a sense of losing control, a racing heartbeat, shortness of breath, and even the feeling that "something terrible is about to happen".

Anxiety vs. Panic Attack: Gradual Tension vs. Catastrophic Fear

• Anxiety – a prolonged feeling of tension and unease associated with anticipation of future threats. Symptoms include worry, muscle tension, fatigue, and difficulty concentrating.
• Panic attack – a sudden episode of intense fear or terror, often without a clear cause. The symptoms are dramatic: palpitations, shortness of breath, dizziness, and a sense of losing control. It typically lasts from a few minutes to half an hour.

Key difference: anxiety is gradual and anticipatory, whereas a panic attack is sudden and intense, almost "catastrophic" in sensation (Clark, 1986).

Panic as an Inner Signal: The Body Speaks When the Mind Cannot

From a psychodynamic perspective, a panic attack can be understood as a signal of internal psychological processes and conflicts that have not been fully brought to consciousness.

Classical psychoanalysis views the panic attack not simply as fear, but as a signal from the unconscious parts of the psyche. Anxiety is a signal from the ego that repressed impulses are attempting to break through into consciousness (Freud, 1995).

The Collapse of Inner Security: Catastrophe in the Psyche

Panic attacks often arise when the sense of security provided by the "good internal object" disappears. Anxiety in this context is experienced as a sense of:

• Disintegration – a sense that the inner world is falling apart
• Annihilation – fear of internal or external "destruction"
• Loss of control – a sense that nothing can be managed
• Psychic death – a feeling of total inner catastrophe (Brener, 1975).

How to Support Someone During a Panic Attack: Presence Instead of Pressure

Stay calm: Maintaining a calm presence can help the person feel safer and more grounded.

Avoid intrusive questions: Questions like "Are you okay?" can feel like pressure. Focus on supportive words and actions.

Acknowledge their experience: Rather than minimising: "I understand this feels frightening, but you are safe."

Support their breathing: You can count together: "Breathe in… 1, 2, 3, 4… Breathe out… 1, 2, 3, 4."

How Can Psychotherapy Help?

Understanding the causes: The psychotherapist helps the patient connect panic attacks to specific inner conflicts or unconscious fears.

Creating a safe space: The therapist functions as a "good internal object," allowing the patient to express their anxiety without fear of rejection.

Long-term stability: The goal is not merely to suppress the symptom but to build a stable inner world.

Conclusion

Panic attacks can be terrifying, but they are understandable and treatable. Through psychotherapy, a person can learn what lies behind these sudden episodes of anxiety, restore their inner sense of security, and develop the skills to cope with moments of crisis.

References

1. Barlow, D. H. (2002). Anxiety and its disorders (2nd ed.). New York: Guilford Press.
2. Bion, W. R. (1962). Learning from experience. London: Heinemann.
3. Brener, C. (1975). Panic. New York: Jason Aronson.
4. Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470.
5. Klein, M. (2005). Love, Envy and Gratitude. Sofia: Lik.
6. National Institute of Mental Health. (2022). Panic disorder. https://www.nimh.nih.gov/health/topics/panic-disorder