Panic Formulation
The aim of a formulation is to help the client and therapist to come to a shared understanding of what a client is experiencing. The Panic Formulation worksheet, based on David Clark's influential cognitive model of panic, enables therapists to explore the cognitive, affective, somatic, and behavioral components responsible for the onset and maintenance of a client’s panic attacks.
Download or send
Choose your language
Professional version
Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
Client version
Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.
Editable version (PPT)
An editable Microsoft PowerPoint version of the resource.
Translation Template
Are you a qualified therapist who would like to help with our translation project?
Tags
Languages this resource is available in
Problems this resource might be used to address
Techniques associated with this resource
Mechanisms associated with this resource
Introduction & Theoretical Background
Panic attacks are characterized by a surge of anxiety with a rapid onset. Symptoms of a panic attack include:
- An abrupt surge of intense fear or discomfort that reaches its peak within a few minutes
- Palpitations, pounding heart, or an accelerated heart rate
- Sweating
- Trembling or shaking
- Difficulty breathing, or shortness of breath
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, or lightheaded
- Derealization and depersonalization
- Fear of losing control, going crazy, or passing out
- Fear of dying
- Hot flushes or cold chills
- Parathesia (numbness or tingling sensations)
- Dry mouth
The diagnosis of panic disorder is characterized by repeated panic attacks, some of which have an unexpected onset. People who struggle with panic disorder worry about the occurrence and consequences of future panic attacks, and make attempts to avoid situations or triggers they associate with panic. Panic attacks also occur in
Therapist Guidance
“One of the first steps in cognitive therapy for panic is to come to an understanding of how your panic works. Could we look at one of your recent panic attacks and see if we can work out what might have been happening for you?”
The aim of a formulation is to help the client and therapist to come to a shared understanding of what a client is experiencing. It is most helpful to encourage clients to identify a specific example of a recent time that they experienced panic. If clients struggle to do so, it may be helpful to encourage to them to use a panic self-monitoring record.
1. Situation or trigger. Help the client to become aware of internal or external triggers that precipitated their panic attack. Internal triggers can include thoughts, emotions, or body sensations. External triggers might include things that the client saw, heard, or experienced.
References And Further Reading
- Barlow, D. H., & Craske, M. G. (2006). Mastery of your anxiety and panic. Oxford University Press.
- Bernstein, D. A., & Borkovec, T. D. (1973). Progressive relaxation training: A manual for the helping professions. Research press.
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
- Clark, D. M., Salkovskis, P. M. (2009). Panic disorder: Manual for improving access to psychological therapy (IAPT) high intensity CBT therapists.
- Ehlers, A. (1993). Interoception and panic disorder. Advances in Behaviour Research and Therapy, 15(1), 3-21.
- Limmer, J., Kornhuber, J., & Martin, A. (2015). Panic and comorbid depression and their associations with stress reactivity, interoceptive awareness and interoceptive accuracy of various bioparameters. Journal of Affective Disorders, 185, 170-179.
- Pompoli, A., Furukawa, T. A., Efthimiou, O., Imai, H., Tajika, A., & Salanti, G. (2018). Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychological Medicine,