Why Anxiety Turns Normal Sensations into Fear: The Cognitive Roots of Panic Attacks

Imagine the following situation: Michael was rushing to an important meeting. He arrived at the building and how annoying the elevator wasn’t working. “That means I have to climb six flights of stairs,” he thought to himself.

By the second floor, he felt his heartbeat speeding up. By the fifth floor, his pulse felt quite fast, at least to him, and that already frightened him.

“Oh no. Maybe something is wrong with me. Why is my heart beating so hard? What if it’s heart disease? What if I’m about to have a heart attack?”

Within moments, his heart rate increased even more. Then dizziness and an intense feeling of pressure joined the mix. In fact, he was having a panic attack. Needless to say, it was extremely unpleasant.

Situations like this had become an inseparable part of Michael’s life. He felt he could no longer bear it. Daily panic attacks and constant hyperarousal throughout most of the day.

Why does this happen?

Hundreds of studies have been conducted in this field. Many researchers have tried to understand what happens to a person during a panic attack, why they experience it, and what differentiates them from someone else who remains completely calm in the exact same situations.

In what follows, I want to present some of the findings that repeatedly appear in research and that we also see again and again in practice among people who struggle with anxiety. These studies largely support what is known as the cognitive model of anxiety. Sometimes, simply understanding what creates and maintains anxiety can ease the suffering, and at times it even helps a person respond more effectively. For therapists, this understanding is essential in building an appropriate treatment process.

Beyond that, it is also important for people close to those who suffer from anxiety disorders to understand the depth of the experience and the sense of helplessness involved. Unfortunately, when those around the anxious person do not understand what they are going through, criticism can intensify their suffering. It is crucial to recognize that they are caught in a very real and serious trap, and that without outside help, many people will not be able to overcome anxiety on their own.

Cognitive factors in anxiety

One critical and well documented point we often see in people experiencing anxiety is that their attention is biased toward detecting threats. You probably know people who believe “if something can go wrong, it surely will.” When attention is biased toward threat detection, thinking becomes focused on danger. The threat takes on disproportionate dimensions.

This is not because the person is unintelligent or lacks understanding, but is a perception that has taken root through life experiences. While there is often a genetic component, those genes may or may not be expressed depending on life experiences.

Consider once again Michael climbing the stairs. His attention is biased toward identifying threats. The moment his heart rate rises slightly above normal, he focuses on it because the possibility of a heart condition progressing into an attack feels extremely threatening. As a result, his attention is automatically drawn to that sensation.

This does not mean that attention is always focused on threats. Rather, in certain triggering situations, attention shifts there, and that is what starts the snowball that leads to a panic attack.

When safety signals disappear

For Michael, when the thought “maybe this is a heart problem” arises, something else happens as well. He becomes unable to notice things that indicate everything is actually fine. Research consistently identifies this process in people with anxiety.

This complicates matters significantly. If a person perceives a serious threat to their life and at the same time cannot notice any signs of safety, the situation becomes terrifying. At that point, the person is already inside the fear.

You can probably see that in such a state, the perceived level of threat is greatly exaggerated. When attention is focused only on danger and safety signals are filtered out, the proportions are no longer realistic.

As anxiety intensifies, people often become convinced that their physical sensations are dangerous or that they prove the situation truly is life threatening. Research shows this as well. It is important to understand that the person experiencing these sensations genuinely believes them. They struggle to consider alternative explanations or probabilities.

This is especially true at the beginning of a panic attack, when the brain becomes temporarily closed off to calm and rational thinking. This is a physiological process that occurs in every human being during extreme fear.

A brief dialogue with Michael

To illustrate this, following is a short exchange I had with Michael.

“Could it be that your rapid heartbeat was simply caused by climbing the stairs quickly?” I asked. “Maybe it doesn’t indicate a problem.”

“Uh… I don’t know,” Michael replied skeptically. “That doesn’t really help me.”

“I understand. Tell me, is it possible for someone to climb stairs like that and not have their heart rate increase?”

“No.”

“So maybe that’s what happened to you. It’s impossible for your heart rate not to rise. By the way,” I added with a smile, deliberately exaggerating, “how many times have you been hospitalized after a heartbeat like that?”

Sometimes exaggeration helps surface probability.

And the conversation continued, trying to explore alternative explanations and likelihoods from within his own way of thinking. This is not an easy task at all, but with careful work, it can help, alongside other therapeutic tools.

I share this dialogue to convey the depth of the experience and the way thinking becomes more focused on threat than on safety.

Understanding as a first step

There are additional cognitive and physiological processes that add fuel to the fire. Perhaps we will explore them in future articles.

For now, anyone who suffers from anxiety can begin to recognize the patterns of thinking that create and maintain it. Sometimes, understanding alone already brings a degree of relief. It is not uncommon for people to feel better simply because they realize they are not “going crazy.” That fear itself often accompanies anxiety and amplifies it.

Moreover, understanding what is happening can illuminate another key point: “I may be exaggerating my interpretation of what I’m experiencing. I truly cannot notice the signs that everything is okay, but that doesn’t mean those signs don’t exist. That’s what traps me.”

This insight, too, can sometimes reduce the intensity of anxiety.