Clark (1986) · Panic disorder
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.
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.
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
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