Cognitive Model of Panic
Clark (1986) · Panic disorder
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
Clark's cognitive model of panic (1986) explains an attack as a maintaining cycle: ordinary bodily sensations are read as signs of immediate catastrophe, and the fear that follows makes those sensations stronger still.
Cognitive Model of Panic
Clark (1986)
Trigger
A trigger that draws attention to the body — an internal sensation (noticing your heartbeat, feeling breathless) or an external situation (a hot, crowded shop; exertion; stress).
Body Sensations
Bodily sensations of arousal — pounding or racing heart, breathlessness, chest tightness, dizziness, sweating, tingling, feelings of unreality. Anxiety amplifies these, so they grow stronger inside the loop.
Catastrophic Misinterpretation
Catastrophic misinterpretation: the sensations are read as a sign of immediate disaster — 'I'm having a heart attack', 'I'm going to faint', 'I can't breathe', 'I'm losing control or going mad'. This misinterpretation is the engine of the model.
Apprehension / Anxiety
Apprehension and rapidly mounting fear, with a sense of immediate danger. This further increases bodily arousal, feeding back into the sensations.
Safety Behaviours & Avoidance
Safety behaviours and avoidance — sitting or lying down, gripping or leaning on something, carrying medication or water, controlling breathing, and escaping or avoiding places where panic has struck. They reduce fear in the moment but prevent the person from disconfirming the catastrophic misinterpretation, so it survives.
The published model, shown for reference. Switch to “Blank” to see the empty template you complete with a client.
Understanding the model
A panic attack can feel as though it comes from nowhere and that something is seriously wrong with your body. This model shows how panic actually builds in a cycle — and why it can be so convincing in the moment.
It often starts when you notice a change in your body: your heart speeding up, feeling short of breath, dizzy or light-headed. These sensations are harmless in themselves, and there are many everyday reasons for them. But if they are read as a sign of immediate danger — a heart attack, fainting, suffocating, or losing control — that thought sparks fear.
Fear sets off the body's alarm response, which makes the very sensations stronger. Stronger sensations seem to confirm that something is badly wrong, so the fear climbs higher still. Within minutes this loop can spiral into a full panic attack.
To stay safe, people often sit down, leave, hold on to something, or carry medication, and may start avoiding places where panic has struck before. These responses bring relief in the moment, but they stop you from discovering that the sensations were not dangerous after all — so the cycle stays ready to repeat.
Questions therapists ask about this model.
Frequently asked questions
What keeps a panic attack going?
Attention lands on a bodily change — a racing heart, breathlessness, dizziness, a feeling of unreality. Read as evidence of something happening right now, such as a heart attack, fainting or losing control, that reading produces fear; fear raises arousal, and arousal makes the sensation stronger, so the loop tightens within minutes. Sitting down, holding on, controlling the breath or carrying medication bring relief and leave the feared meaning standing.
How is this different from the health anxiety model?
The feared outcome and its timescale differ. Panic turns on sensations of arousal and a catastrophe expected in the next few minutes. Warwick and Salkovskis (1990) describe a slower preoccupation with a serious illness that might already be present, sustained by body checking, searching and repeated reassurance rather than by escalating arousal. Clients often show both patterns, so the formulation follows the feared outcome the client actually describes.
Which presentations does the panic model suit?
It is written for panic disorder: recurrent attacks in which the client's fear centres on bodily sensations and on a catastrophe expected within minutes — collapse, suffocation, losing control — together with the avoidance of places where attacks have struck. Panic attacks that occur only within another problem, such as a fear of being judged or of one specific object, are usually better understood through that problem's own model. NICE CG113 covers panic disorder in adults.
Worksheets and reading for this model
Using this model in session — for therapists
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
References
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470.
- Clark, D. M., Salkovskis, P. M., Hackmann, A., Middleton, H., Anastasiades, P., & Gelder, M. (1994). A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry, 164(6), 759–769.
- Salkovskis, P. M., Clark, D. M., & Gelder, M. G. (1996). Cognition-behaviour links in the persistence of panic. Behaviour Research and Therapy, 34(5–6), 453–458.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
Cite this page (APA 7)
Vermani, T. (2026). Cognitive Model of Panic. Formulate. https://formulatetools.co.uk/tools/formulation/panic-cognitive-model
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- Samaritans: 116 123 — free, day or night, 365 days a year
- SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day
Build this formulation with your client
Create a free account to open the interactive formulation builder, complete this model collaboratively, and export it as a PDF or share it with your client.