Panic Attack Prevention

Panic disorder involves a fear-of-fear cycle: bodily sensations get catastrophically misinterpreted, driving further arousal. This is why avoidance worsens it and why exposure-based CBT works. Medical mimics matter — thyroid disease, arrhythmia, anaemia and, rarely, phaeochromocytoma can present as panic and should be excluded once.

1) Rule out thyroid, cardiac and anaemia mimics once. 2) CBT with interoceptive exposure is first-line and outperforms every other option. 3) Cut caffeine — it is a reliable panic trigger in susceptible people — and reduce alcohol, as rebound anxiety drives next-day attacks. 4) Practise slow nasal breathing with extended exhale daily, not just during attacks. 5) Adjuncts with any data: inositol 12-18g/day (small trials suggesting comparable effect to fluvoxamine, GI side effects common), magnesium 200-400mg/day, L-theanine 200mg for acute arousal. 6) SSRIs are effective and appropriate where attacks are frequent.

• •Interoceptive exposure practice
• •Caffeine elimination
• •Alcohol reduction
• •Daily slow breathing practice
• •Regular aerobic exercise
• •Sleep regularity