From the author: I invite psychologists and psychotherapists to learn how to work professionally with clients suffering from panic attacks at the seminar “Psychotherapy of Panic Disorder”. You can learn more about the seminar and register for it by following the link: This article describes the theory cognitive psychotherapy for panic attacks. From it you will learn about the vicious circle of panic, the reinforcement of the habit of panic, as well as the thoughts and beliefs that lead to panic. From the point of view of cognitive psychotherapy, panic attacks are the result of logical errors in a person’s thoughts and beliefs. During the first panic attack, errors in thinking lead to a vicious circle of panic. First panic attack Typically, the first panic attack begins with the body's physiological reaction to stress, alcohol, heat, overwork, lack of sleep, etc. As a result of these factors, a strong heartbeat, a feeling of shortness of breath, weakness and other symptoms of panic attacks begin. At this moment, it is not possible to stop the symptoms. If the cause of palpitations, dizziness or weakness is not obvious to you, then thoughts involuntarily arise: “What’s wrong with me? What if this is something serious?” And immediately one of the answers comes to mind: “It’s a heart attack” “It’s a stroke” “It’s anaphylactic shock” “I’m going crazy” “I’m suffocating” “I’m fainting” “ This is a sign of a serious illness.” It is not surprising that these thoughts are frightening. With fear, adrenaline is produced, which provokes an increase in bodily symptoms and causes the appearance of new ones. New symptoms confirm the correctness of previous thoughts. Following this, a catastrophic prediction appears: “I will die.” Fear increasingly turns into panic, causing the release of a new portion of adrenaline. Symptoms are increasing. In turn, the thought arises: “I’m definitely dying.” The spiral of panic begins to spin. This creates a vicious circle of panic, which includes symptoms, thoughts, fear and the release of adrenaline. After the first attack, you remember the panic and symptoms well, but the thoughts that caused them do not remain in memory. Other attacks The next time, neither stress nor fatigue is needed to develop a panic attack. It's enough to listen to your body. Or remember past panic attacks. Catastrophic interpretation of body sensations or memories of panic – that is, thoughts will lead to fear, adrenaline and bodily symptoms. That is, to a vicious circle of panic. Thoughts during panic, as a rule, are not remembered. They are difficult to formulate. But they are the ones who turn a little fear into severe panic. Such thoughts are called automatic. Automatic thoughts Automatic thoughts are part of the internal dialogue. That part of it that is not associated with purposeful logical thinking. In contrast, automatic thinking is spontaneous, illogical and fragmentary. Automatic thoughts, as in the examples above, can appear in the form of phrases. And they can appear in the form of frightening images. For example, a mental picture will arise that you are driving an ambulance to the hospital with a wailing siren. Automatic thoughts are fast, fleeting and curtailed. Sometimes in my mind I hear: “Horror!” It takes a lot of effort to understand what this word means and what exactly scares you. Automatic thoughts are poorly understood, but they influence your emotions and behavior. They are perceived as truth and are not questioned. Most often, automatic thoughts do not give rise to panic. Panic only appears when automatic thoughts contain specific logical errors. Certain cognitive errors in thoughts cause fear. And the vicious circle of panic starts again. Read about typical errors in thinking in the article “Cognitive errors during panic attacks.” With each new attack, new, increasingly catastrophic automatic thoughts appear. If you do nothing about them, then the attacks will intensify. During psychotherapy, automatic thoughts are recognized, cognitive errors are detected, and these errors are worked on. But not only automatic thoughts.