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A serious condition that affects one out of every 75 people, panic disorder is an anxiety disorder where panic attacks occur repeatedly and without warning. Interfering with work and personal life, these attacks can happen many times each day or each week. Understanding different elements of this disorder will help massage therapists appropriately support their clients suffering from panic attacks.

Panic results from an adrenaline surge, otherwise referred to as the human body’s “fight or flight” response. Scientists know that certain parts of the brain and nervous system cause the emotional and physical surge of fear. A panic attack is very scary, but having a solitary attack doesn’t mean that you are developing panic disorder.

Many people with panic disorder also have agoraphobia. As defined by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, agoraphobia is defined as:

Anxiety about being in places or situations from which escape may be difficult or embarrassing or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms.

A panic attack is far more intense than the typical feeling of being ‘stressed out’. In fact, a panic attack is downright frightening. Symptoms of a panic attack include:

  • racing heartbeat
  • difficulty breathing, feeling as though you ‘can’t get enough air’
  • terror that is almost paralyzing
  • dizziness, lightheadedness or nausea
  • trembling, sweating, shaking
  • choking, chest pains
  • hot flashes, or sudden chills
  • tingling in fingers or toes (‘pins and needles’)
  • fear that you’re going to go crazy or are about to die

In addition to the above symptoms, a panic attack is marked by the following conditions:

  • It occurs suddenly, without warning and without any way to stop it.
  • The level of fear is disproportional to the actual situation and is fact, often unrelated.
  • It passes within a few minutes as the body cannot sustain the ‘fight or flight’ response for an extended period. However, repeated attacks can recur for hours.

Feelings of panic start suddenly and intensify quickly, usually within 10 minutes. The symptoms of panic disorder are the same as a panic attack except that the attacks come repeatedly, and the person is quite fearful between attacks that another attack will follow, changing behavior to avoid another. In total, panic attacks usually last from 20 to 30 minutes.

Because common symptoms of a panic attack include chest pain and shortness of breath, it may be mistaken for a heart attack. Only a qualified healthcare provider or a mental health professional can diagnose a panic disorder.


Several medicines can help treat panic disorder. If pharmaceutical therapy is chosen, a health care provider will carefully select the most appropriate prescription. Some popular medicines for panic are:

  • Anti-anxiety medicines such as lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and buspirone (BuSpar)
  • Selective serotonin reuptake inhibitor (SSRI) antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro)
  • Tricyclic antidepressants such as imipramine (Tofranil) and desipramine (Norpramin)
  • Other antidepressant medicines such as venlafaxine (Effexor) and mirtazapine (Remeron)

Each of these medications influence the body in a unique way, causing their own set of side effects. A massage therapist who is aware of a drug’s systemic effects, is then able to choose massage strokes to counter those effects. For example, typical side effects relevant in a massage setting of fluoxetine are orthostatic hypotension, sleepiness, anxiety and insomnia. Choosing tapotement if your client is prone to orthostatic hypotension and sleepiness or a slow and rhythmic rocking stroke to ease anxiety and insomnia would be logical massage stroke choices to best benefit such a client.


Seeing a psychiatrist or psychotherapist is often helpful for addressing panic disorder. Cognitive behavioral therapy (CBT) is a form of psychotherapy shown to be especially effective in treating panic. CBT helps identify and change thought patterns that lead to panic attacks. If you have a client with diagnosed or suspected panic disorder who hasn’t yet investigated this therapy, your suggestion to consider CBT may lead to a life-changing discovery.


In general, massage therapy may help lower stress levels and muscular tension. These benefits may help reduce the general anxiety that accompanies panic disorder. Any technique under a therapist’s belt that helps a client relax, whether it’s a massage stroke administered during a session or a relaxation method taught to the client for practicing at home, will benefit a sufferer of panic disorder. Below are six additional suggestions to consider when addressing this condition:

  1. To draw energy down and away from the head, end a session with the lower body or feet.
  2. Many panic sufferers experience tightness in their chest muscles from protecting against painful or shallow breathing. Within appropriate boundaries, seek for methods to open that area.
  3. Two appropriate acupressure points to relieve and prevent panic attacks are Pericardium 6 (P6) and Liver 3 (L3). P6 is on the ventral side of the forearm, between the two tendons of palmaris longus and flexor carpi radialis, approximately three finger widths proximal to the wrist crease. L3 is on the dorsum of the foot, in the depression distal to the junction of the first and second metatarsals.
  4. Cranial-Sacral therapy can add a profound dimension of healing to someone experiencing panic attacks.
  5. A slower rhythm is favored by many with anxiety disorders, since it relaxes the sympathetic nervous system.
  6. Incorporating an essential oil with soothing characteristics into your bodywork can provide an added healing dimension to your session.

A massage therapist has the knowledge and skills to help their clients with agoraphobia and panic disorder. Whether it’s administering massage strokes to counter medication’s side effects, suggesting cognitive behavioral therapy or incorporating one of the preceding six suggestions into a session, bodyworkers can significantly alter the course of this anxiety disorder.

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