Cognitive Model of Panic Disorder: 3 Main Theories

Page content

Cognitive Models of Panic Disorder

Psychologists have a long record of interest in issues relating to fear and anxiety. A logical extension of this was the development of cognitive models of panic disorder. Two of the earliest theories were actually developed independently but at roughly the same time. Clark (1986) and Barlow (1988) developed models that have a good degree of conceptual overlap, but which deserve their own explanation.

Clarke’s Cognitive Model of Panic

It was David Clarke who coined the phrase “catastrophic misinterpretations” in order to describe the bodily sensations experienced by people who panic. Palpitations, for example, are prone to being misinterpreted as a heart attack, or dizziness as a sign of imminent collapse or loss of control. Clarke suggests the misinterpretation of bodily sensations is the cause of panic events and that changes in bodily sensations usually preceded an episode of panic. Once catastrophic misinterpretation is triggered, he argues, the likelihood of panic increases.

Various lines of evidence seem to support Clarke’s views. We now know that patients with panic disorder have a higher frequency of cognitions that lend themselves to catastrophic misinterpretations. Some of the clearest evidence comes from cases where panic events stop once the patient’s cognitions have been altered.

Criticisms of Clarke’s Approach

Some people are known to experience an episode of panic during sleep. Critics argue that Clarke’s model requires some active awareness of bodily sensation that cannot occur during sleep. A counter argument may be that we continue to filter information at the cognitive level during sleep which allows personally significant information to be processed and this may trigger a panic event at any point. Others question why it is that after continually being disproved, some people never seem to learn they are not experiencing a heart attack. It is just possible that the level of avoidance used by many sufferers means they never truly learn this lesson.

Learned Alarm Reaction (False Alarm Theory)

Barlow’s approach is often described as an integrated model because it attempts to link biological with cognitive functions. Barlow suggests that certain people are “hard-wired” from birth to react to certain stressful events. What makes these people different is their tendency towards overreaction. The ability to discriminate between true and false alarms is blurred and in some people the false alarm becomes a conditioned response to the bodily sensations associated with anxiety.

Barlow’s model shares many similarities with Clarke’s as to the manner in which bodily sensations are interpreted. Various studies show support for his theory that negative life events often precede the first panic attack. However, stress is not a unique precursor to panic as it is well known to precede other psychological conditions.

Anxiety Sensitivity Theory

Anxiety sensitivity refers to the fear of anxiety sensations and the belief that such sensations have harmful physical and/or psychological consequences. This form of cognitive vulnerability is considered to be a specific sensitivity to respond fearfully to one’s own sensations. It is considered to put people at greater risk of developing anxiety disorders, especially panic disorder with agoraphobia.

One characteristic of panic disorder is high levels of anxiety sensitivity, characterized by high levels of vigilance to one’s own bodily sensations that signal a threat. Depression and bipolar disorder are associated with anxiety sensitivity.


Barlow, D.H. (1988) Anxiety and its disorders: The nature and treatment of anxiety and panic. New York: Guilford Press.

Clarke, D.M (1986) A Cognitive Approach to Panic. Behaviour Research and Therapy. 24: 4, pp 461-470.

Reiss, S., Peterson, R.A., Gursky, D.M. & McNally, R.J (1986) Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy. 24: 1, pp 1-8.