Panic attacks and anxiety disorder 

This page is presented as psychoeducation. We wish to stress that psychologists at the clinic use mostly CBT and other psychological techniques as evidence-based therapy for anxiety and panic attacks (see below). The nutritionist and GP may investigate and treat IBS-related symptoms as appropriate.

Panic attacks and anxiety disorder both have biological and psychological causes. There are many forms of anxiety. While some are related to stressful events, others seem to occur for no apparent reason. However, every effect has a cause. The causes of anxiety will vary from person to person. It is well-established that genetic variations, nutrient deficiencies, and dietary toxins all contribute to imbalances in brain chemicals (neurotransmitters). 

Recent studies have shown that dysregulation of the gut microbiota—particularly shifts in commensal bacteria—can influence the development and persistence of anxiety disorders. The gut–brain axis plays a crucial role in this relationship, as gut bacteria communicate with the central nervous system via immune, endocrine, and neural pathways. Disruptions in the microbiota can alter the levels of neurotransmitters and metabolites, some of which are implicated in modulating anxiety and mood states (Frontiers in Neuroscience, 2024; Frontiers in Endocrinology, 2022).

Research specifically highlights that certain gut bacteria produce trace amines and toxins that can impact neurotransmitter activity in the brain, potentially triggering anxiety and panic attacks (Frontiers in Cell and Developmental Biology, 2021). For example, short-chain fatty acids and other metabolites produced by intestinal bacteria have been shown to influence the brain-gut axis, and their dysregulation is associated with increased anxiety and depressive symptoms in individuals with IBS (Microbial Cell Factories, 2021; Frontiers in Public Health, 2022).

These findings suggest that targeting the gut microbiota—potentially through dietary interventions, probiotics, or even faecal microbiota transplantation—may offer promising strategies for treating the underlying causes of anxiety and achieving more effective long-term outcomes (Metabolites, 2024).

Definition of Anxiety Disorders

Anxiety disorders are the most common form of mental illness in Australia. The Diagnostic and Statistical Manual of mental Disorders (DSM-V) defines various types of anxiety disorders which can be grouped under several headings. Differential diagnosis and treatment of anxiety disorders requires relevant training, skills, and experience.

Please call the clinic or see a qualified psychologist for diagnosis and treatment.

A Panic Attack is a discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms can include shortness of breath, heart palpitations, chest pain/discomfort, choking, ‘smothering’ sensations, as well as fears of "going crazy" or losing control.

Agoraphobia is an anxiety or fear about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) in the instance of panic-like symptoms.

Panic Disorder Without Agoraphobia is characterised by recurrent unexpected panic attacks of persistent concern. Panic Disorder with Agoraphobia is characterised by both recurrent unexpected panic attacks and agoraphobia.

Agoraphobia Without History of Panic Disorder is characterised by the presence of Agoraphobia and panic-like symptoms without a history of unexpected panic attacks.

Specific Phobia is characterised by clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviours.

Social Phobia is characterised by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviours.

Obsessive-Compulsive Disorder is characterised by obsessions (which cause marked anxiety or distress) and/or by compulsions (which serve to neutralise the anxiety).

Post-traumatic Stress Disorder is characterised by the re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and avoidance of stimuli associated with the trauma.

Acute Stress Disorder is characterised by symptoms similar to those of post-traumatic stress disorder that occur immediately in the aftermath of an extremely traumatic event.

Generalised Anxiety Disorder is characterised by at least 6 months of persistent and excessive anxiety and worry.

Anxiety Disorder Due to a General Medical Condition is characterised by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a general medical condition.

Substance-Induced Anxiety Disorder is characterised by prominent symptoms of anxiety that are judged to be a direct physiological consequence of drug abuse, medication, or toxin exposure.

Anxiety Disorder Not Otherwise Specified is included for coding disorders with prominent anxiety or phobic avoidance that do not meet criteria for any of the specific Anxiety Disorders defined in this section (or anxiety symptoms about which there is inadequate or contradictory information).

Anxiety Disorders in Children & Adolescents

The DSM-V defines separation anxiety disorder as specific to children. This disorder is defined as anxiety regarding the separation from home/family that is excessive or inappropriate for the child’s age. In some children, separation anxiety takes the form of school avoidance. Children and adolescents can be diagnosed with panic disorder, phobias, generalised anxiety disorder, and post-traumatic stress disorder.

What Triggers Panic Anxiety Attacks?

In simple terms, anxiety is when the brain misinterprets physiological sensations as signalling threat which triggers a significant release of adrenaline. This adrenaline further exaggerates these sensations which reinforces the idea that something is very wrong. Anxiety is a normal, usually adaptive, emotional reaction to danger or to stressful situations perceived as threatening to a person's survival, anxiety disorder and panic attacks occur when that normal reaction is exaggerated, out of context. Although it is generally believed that stressful events trigger anxiety or panic attacks, many seem to occur for no apparent reason. Many people have a biological/genetic predisposition that makes them more susceptible to anxiety and panic.

The Pharmaceutical model suggests that abnormalities in the balance of some brain chemicals (neurotransmitters) are responsible for anxiety. This theory is supported by evidence that antidepressant and anti-anxiety medications are often useful in the treatment of anxiety for patients. However, these ‘chemical imbalances’ are themselves the cause of something more foundational. These causes are not usually investigated or treated in psychiatric practice with anti-depressant medications.

Gut-brain axis in anxiety and panic attacks

Whilst anyone can experience anxiety and panic attacks, these symptoms often run in families, due to shared genetic weaknesses, as well as poor diet and nutrient uptake which leads to abnormal overgrowth of certain gut bacteria. Stressful life events can also trigger anxiety and panic attacks. In some cases, metabolic dysfunction predisposes people to neurotransmitter imbalances. Such imbalances are a lack of essential nutrients or intestinal dysbiosis (unusual levels of gut bacteria). Recent evidence suggests that abnormal levels of commensal (usually occurring) gut bacteria can cause the release of high levels of trace amines and/or toxins into the blood stream. These amines and toxins then trigger neurotransmitter sites in the brain to malfunction, causing feelings of excessive tiredness, depression, anxiety and/or panic attacks.

Scientists at the Psychiatric department of Mt Sinai Hospital in New York examined hundreds of studies in the scientific literature and found that up to 90% of people with Irritable Bowel Syndrome (IBS) have a psychiatric mood disorder, with depression and anxiety being the most common. IBS, as a possible trigger for mood disorders, should thus be investigated and treated.

Catastrophising feelings

The symptoms that occur with panic attacks do not mean that there is a physical problem with the heart, chest, etc. Most of these symptoms occur due to an 'overdrive' of nervous impulses from the brain to various parts of the body during an episode of panic. The real problem are the mistaken fears of imminent danger and catastrophising them– not the feelings of panic themselves – since panic in itself is an important, evolutionary, emotional reaction designed to signal danger. For a person with anxiety disorders, this signal is unfounded, and  understanding this on a deeper level, will help master panic attacks. It would be wise to have a BNC clinician investigate your triggers.

What are the Sensations of Panic Attack?

A panic attack is nothing more than the misinterpretation of anxious bodily sensations as signalling that a person, situation, or event is dangerous or life threatening. Your belief that you are at risk, further exacerbates your anxiety, which then leads to more physical distress and catastrophic thoughts. Thus, there is a vicious cycle between bodily sensations, distorted thoughts, and anxiety, which can quickly result in more panic attacks.

The bodily sensations associated with anxiety are real enough, but it is their exaggerated interpretation (catastrophising) that leads to an escalation of fear, anxiety, and panic attacks.

Symptoms of Anxiety Attacks & Panic Attacks

Some symptoms of a panic attack include:

• Palpitations or a thumping heart.
• Sweating and trembling.
• Hot flushes or chills.
• Feeling short of breath, often accompanied by choking sensations.
• Chest pains.
• Feeling sick (nauseous).
• Feeling dizzy, or faint.
• Fears about dying or going crazy.
• Numbness or pins and needles.
• Feelings of unreality, detachment, dissociation, or depersonalisation.

During a panic attack many hyperventilate due to over-breathing in a shallow manner. If you over-breathe you 'blow out' too much carbon dioxide which changes the acidity in the blood. This can potentially cause other symptoms such as confusion, cramps, and worsen the severity/pain of heart palpitations, dizziness, and pins and needles. If this occurs, the experience may become more frightening for the sufferer, leading to further hyperventilation.
A panic attack usually lasts 5-10 minutes but can come in 'waves' over a period of up to 2 hours.

Psychological therapy for anxiety and panic attacks

Cognitive behavioural therapy (CBT) is the most widely recommended psychological therapy for anxiety disorders, including panic attacks and panic disorder. Peer-reviewed studies and clinical guidelines consistently identify CBT as the first-line treatment due to its robust evidence base and effectiveness (Pompoli et al., 2016; Locke et al., 2015). CBT helps individuals recognise and change patterns of thinking and behaviour that perpetuate their anxiety, often using exposure, cognitive restructuring, and skills training.

Other psychological therapies with some support in research include applied relaxation, psychodynamic therapy, and mindfulness-based therapies, though these have less extensive evidence than CBT. For panic disorder specifically, CBT with exposure techniques has shown the highest efficacy and is consistently recommended in clinical guidelines (Pompoli et al., 2016; Bandelow et al., 2017).

Research also suggests that psychological interventions like CBT produce longer-lasting effects and lower relapse rates compared to medication, particularly when therapy gains are maintained after treatment ends (Bandelow et al., 2017).

In summary, cognitive behavioural therapy is the most recommended and effective psychological treatment for anxiety disorders and panic attacks, with other modalities available based on patient needs and preferences (Pompoli et al., 2016; Locke et al., 2015; Bandelow et al., 2017).

Updated on:  10/02/2026 By: Dr. Jacques Duff – BA Psych; Grad Dip Psych; PhD; MAPS; MECNS; MAAAPB; MISNR; FANSA
Reviewed on: 20/02/2026 by: Bernard Ferriere - BA; Grad Dip App Psych; Dip Clinical Hypnosis; FCCP; MAPS; MASH; Clinical Psychologist