Panic with/without agoraphobia

What is panic disorder?

When we are exposed to a physical threat, our bodies automatically gear up to fight or run away – this is called the fight-or-flight 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-or-flight response is triggered out of the blue when there’s no real danger; this is what’s 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 a lot after each panic attack that you might have another one. It starts when the fight-or-flight 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 leads you to be 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. Or they can only go into those situations with someone they trust. 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 what is called agoraphobia. Agoraphobia can be quite disabling and make it hard to do things that many people take for granted; for some people, agoraphobia can get so bad they have trouble even leaving their house without support.

You are not alone

People tend to suffer from both panic disorder and agoraphobia, but you can also experience either one without the other. Approximately one in thirty-five Australians will suffer from panic disorder at any one time, and a similar number will experience agoraphobia at any one time. The rates of current panic disorder are slightly lower amongst current serving members than matched community averages (1.4% compared to 2.5%), while the rates of agoraphobia are slightly higher (2.5% compared to 1.9%)[1] Many people with panic disorder and/or agoraphobia suffer from other mental health conditions as well; over their lifetime, someone with one of these disorders is 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.[2]

What treatments can help?

One of the most effective treatments for panic disorder and agoraphobia is cognitive behavioural therapy (CBT). This approach 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-or-flight response.
  • to challenge your fears and worries related to the physical symptoms you experience during a panic attack (e.g., fears 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, as they can make referrals for specialists, and support your efforts with medications if necessary.

  • This website has information on a range of professional care that is available to current and former serving members.

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.

The High Res website offers a range of self-help resources that help serving and ex-serving ADF members and their families manage stress and build resilience.

Take Action: Relax Your Body and Slow Your Breathing when you’re feeling anxious

Panic causes a range of physical symptoms that are unpleasant and make it difficult to think clearly.

The Progressive Muscle Relaxation tool teaches you how to tense and relax different muscle groups in your body. The Controlled Breathing tool teaches you how to slow your breathing rate. These tools will help you manage the physical symptoms of anxiety, so you can feel calmer and release tension from your body.

These tools take some practice at first. When you’re starting out it’s best to practice one (or both) of these tools once a day, when you are feeling calm. Once you’ve learnt the skills you can use them to calm yourself down whenever you begin to feel anxious or fearful.

You can also access both of these tools on the High Res app to use on the go. 

Take Action: Identify Unhelpful Thoughts about panic

If you think about panic attacks in an unhelpful way, E.g., "I’m going to die" or "I’m going crazy", it actually makes panic attacks more likely to occur.

Use the Challenge Your Thoughts tool to help you identify unhelpful thoughts about yourself or your ability to cope with panic attacks. This tool helps you to practice spotting any unhelpful thoughts and replacing them with more helpful ones.

When you’re starting out it’s a good idea to practice helpful thinking when you are feeling reasonably calm. Once you’ve learned the skills you can apply them when you experience panic.

The Challenge Your Thoughts tool is also available on the High Res app to use on the go. 

Sue’s story...

"I remember my first panic attack like it was yesterday. I guess I’d always been an anxious type, but this was like nothing I’d ever experienced. I was at a football game about six years ago, big crowd, St Kilda getting hammered by the Pies. I think I was a bit edgy – I’ve never liked being hemmed in, stuck somewhere I couldn’t get out of easily. Then suddenly this thing just took me over. I got these pains in my chest and I couldn’t breathe."


Read Sue's full story here.

[1] McFarlane, A. C., Hodson, S. E., Van Hooff, M., & Davies, C. (2011). Mental health in the Australian Defence Force: 2010 ADF Mental Health and Wellbeing Study: Full report. Canberra: Department of Defence.

[2] Merikangas, K.R., Swanson, S.A. (2010). Comorbidity in anxiety disorders. Behavioural Neurobiology of Anxiety and Its Treatment, 37-59.