Panic attacks occur when our fight-flight-freeze response is triggered without an obvious external threat. Learning how to relax and control your breathing can help you manage panic attacks.

What is panic disorder?

When we are exposed to a physical threat, our bodies automatically gear up to fight or run away, known as the 'fight-flight-freeze response'. We become more alert, our heart starts racing, our muscles tense up, we sweat more and breathe more quickly.

These changes are designed to protect us from danger, but sometimes our fight-flight-freeze response is triggered out of the blue when there’s no real danger. This is known as a panic attack. Some people only get panic attacks occasionally, and they can be brought on by stress.

Panic disorder is when you have panic attacks quite often, say a couple of times a month or more, and you worry after each panic attack that you might have another one. It starts when the fight-flight-freeze response is too sensitive, like an overly sensitive car alarm that goes off at the wrong time.

Because you can see there is no outside danger, you start to assume that your physical symptoms are dangerous. You might start thinking things like, "I’m going crazy", "I’m having a heart attack" or "I’m going to die". This type of thinking makes you even more afraid and anxious.

What is agoraphobia?

Sometimes people get so worried about experiencing intense anxiety or having a panic attack that they start avoiding certain places or situations.

If you’ve found yourself avoiding crowds or public transport, or staying at home because it might be difficult to escape or get help if you experience a panic attack or related symptoms, you might have 'agoraphobia'.

Agoraphobia can be quite disabling as it makes it hard to do things that many people take for granted (even simple chores, like grocery shopping); for some people, agoraphobia can get so bad they have trouble leaving their house without support.

You are not alone

People tend to suffer from panic disorder and agoraphobia at the same time, but you can also experience either one without the other.

Around 3 per cent of Australians will suffer from panic disorder at some stage; a similar number will experience agoraphobia.

The rates of current panic disorder are slightly lower among current serving members than matched community averages (1.4 per cent compared to 2.5 per cent), while the rates of agoraphobia are slightly higher (2.5 per cent compared to 1.9 per cent). Estimates suggest that in a given year, about 11.9% of ex-serving ADF members experience agoraphobia, while 5.4% experience panic disorder.

People with panic disorder and/or agoraphobia are about four times more likely than the average person to have depression, and almost three times as likely to have a problem with drugs or alcohol.

What treatments can help?

One of the most effective treatments for panic disorder and agoraphobia is cognitive behavioural therapy (CBT). CBT recognises that the way we think and act affects the way we feel. With the help of a therapist, you will learn:

• more about your panic reactions and the fight-flight-freeze response.
• to challenge your fears and worries related to the physical symptoms you experience during a panic attack (for example, fear of having a heart attack or going crazy).
• to face the situations that you’re afraid of or avoid in a gradual and manageable way. This will allow you to return to the places or activities that you have been avoiding due to fears of having another panic attack.
• a range of relaxation and anxiety management strategies like breathing retraining, to help you get control when you feel a panic attack coming on.

It is generally best to start with psychological treatment; however, some people need a little extra help to get their anxiety under control, so your doctor might prescribe antidepressant medication to help you manage.

Where do I get help?

A GP is always a good place to start when trying to overcome panic disorder and/or agoraphobia. Your GP can make referrals to specialists, and support your efforts with medications if necessary.

Self-help resources

There are a number of resources you could use on your own or preferably together with your therapist to help you address some of the symptoms of panic disorder and/or agoraphobia.

Our Self-help tools and the High Res app offer a range of self-help resources that help serving and ex-serving ADF members and their families manage stress and build resilience.

Further reading

• Useful materials are available from beyondblue, the Clinical Research Unit for Anxiety and Depression and SANE.
• Mental Health Online is an internet based treatment clinic affiliated with Australia’s Swinburne University.