In clinical work, we often encounter such a category of patients. When they are engaged in daily activities, they will suddenly feel palpitations, as if the heart is about to jump out of the mouth; chest tightness, chest pain, chest pressure; or difficulty in breathing, throat blockage, as if they can’t breathe and are about to suffocate. At the same time, there is a strong sense of fear, as if they are about to die, or about to lose their minds. This nervousness makes the patient unbearable, so he or she screams and calls for help. Many patients also experience hyperventilation, dizziness, non-real sensations, excessive sweating, facial flushing or pallor, unsteady gait, tremors, numbness in the arms and legs, gastrointestinal discomfort, and motor agitation. Because of this intense fear during the seizure, the patient is unbearable and often immediately requests emergency help. All background factors at the time of the seizure may be used as triggers by the patient and deliberately avoided. For example, if the last attack was at 3:00 p.m., the patient will be especially nervous at 3:00 p.m. If the attack was by train or airplane, the patient will deliberately avoid taking the train or airplane. If you can’t avoid it, you will be very nervous when you get on the train or airplane until the onset of symptoms. During the interictal period, most patients avoid some activities because they are afraid of not getting help when they have an attack, such as not wanting to go alone, not wanting to go to crowded places, not wanting to travel by car, or not wanting others to accompany them when they go out, and not being able to be alone at home. Visitors with some medical experience often suspect that there is something wrong with their heart or respiratory system, so they go to cardiology or respiratory medicine. However, repeated tests often fail to find any positive results. In some cases, the ECG, myocardial enzyme profile, and cardiac ultrasound are normal, but the patient is still not relieved of the suspicion of the disease until a coronary angiogram is negative, which may be slightly reassuring. In some cases, even though partial stenosis of the coronary arteries is found, it still does not correspond to the severity of clinical symptoms. In some cases, the symptoms of palpitations and chest tightness are still not effectively relieved after cardiac stenting, but they still cannot be convinced that they are due to anxiety and not some organic disease. In some patients, they travel frequently between major hospitals from local to provincial cities, and from provincial cities to Beijing, Shanghai, and Guangzhou, spending from tens to hundreds of thousands of dollars, with negative test results from several hospitals, but they are never helped to believe that they are not suffering from organic diseases. These symptoms are the typical clinical manifestations of patients with panic disorder. When encountering such patients, I often ask them rhetorically how they perceive the etiology and give them the example of earthquake formation. Why is there a connection between panic attacks and earthquakes? Let’s first look at the hazards of earthquakes and the causes of their formation. Far from earthquakes, the Wenchuan earthquake in May 2008 and the Great East Japan Earthquake in March this year were two major earthquakes that left a deep trauma to mankind and made us deeply appreciate the insignificance of human beings under the power of nature. At the same time, the attitude and behavior of the people of both countries after the earthquakes have also caused people to ponder deeply. Anyone with some knowledge of geography knows that most earthquakes are caused by the movement of the earth’s crust. When hard rocks are subjected to forces during crustal movement, they deform or even break, often resulting in earthquakes. Although there is still a debate on where the driving force of crustal movement comes from, and there are many speculations on the root cause of earthquakes, there is no doubt that “earthquakes are directly caused by the rupture of the rocks there”. Most of the earthquakes occur because of new fractures in the rocks under the ground, or because the existing fractures have moved again, and most of the strong earthquakes occur in the places where the existing fractures are located. So, what are the similarities between earthquakes and panic attacks? The first similarity is that they both occur at fractures. Earthquakes occur at fractures in the rock, while panic disorder occurs at the fracture between an overly high target and a realistic ability. The panic attacker often has a strong, sensitive, worrying and unwilling to let others share the burden. The episode is often preceded by a process of frequent exposure to stressful life events. The patient’s perfectionist tendencies collide frequently with stressful life events, tearing down the patient’s physical and psychological defenses and leading to a panic attack. The second similarity is that they both have a cumulative process. Earthquakes are caused by crustal movements, but while crustal movements are frequent, earthquakes do not happen every day; they have a process of accumulating energy to explode. The same is true for panic attacks. It is caused by a stressful life event, but as long as the intensity of the stressful life event has not exceeded the patient’s tolerance limit, panic attacks do not occur. The third similarity is that once an attack occurs, the consequences of both are more dire. When an earthquake occurs, the ground shakes. At this point, one really feels that “there is no place to live in the world, there is no place to live”. The feeling of near-death during a panic attack is no less than that of an earthquake. The fourth similarity is that after a single attack, there are often many more attacks. As long as the energy accumulated by the movement of the earth’s crust is not completely released by a single earthquake, there will certainly be many more aftershocks. The same is true for panic disorder; as long as the patient’s accumulated feelings of stress from multiple stimulating life events are not fully released through a single panic attack, several more panic attacks are sure to occur next. After all this analysis, how can it be treated? This is of greater concern to the patient. Still using the earthquake as an example, let’s talk about three suggestions: 1. Reduce the generation of fractures. Earthquakes often occur in fracture zones, and panic attacks often occur when the sense of stress is significantly greater than the patient’s realistic ability to cope. To actually prevent panic attacks, the best way is to not let the stress exceed the realistic capacity, which requires adjusting the personality basis of the patient’s perfectionist tendencies. However, this is where the key and paradox of treatment lies. Just as few people believe in earthquakes until they happen, if a panic attack does not occur, the patient will always think “I can do it, I can do it, I can always do it”. It is very difficult to get him to accept the adjustment. One of the most paradoxical things is that this strong, sensitive, worrying and reluctant to share his personality has won the patient a trophy in life, a belief that is in his blood and marrow. In his view, this is the best embodiment of his life values, he simply can not give up. 2. Release some energy appropriately. Just as the intensity of a major earthquake can be reduced by inducing a small earthquake before the big one, if we can take any measures to let out some of the pressure that has been building up for a long time, the frequency and intensity of panic attacks will be reduced. Exercise, singing, talking, are effective ways to vent the sense of stress, interested parties may wish to try. 3, accept the existence of aftershocks. When in the earthquake zone, if the appropriate safety measures are taken, even if there are aftershocks, we can still go through the day with ease. This can also be true for panic attacks. If it is clear from the examination that you have no organic disease, when a panic attack occurs, you can ignore the symptoms and do whatever you need to do. If you do this, you will be surprised to find that the symptoms will be significantly reduced or even disappear. I have many patients who have recovered and know this well. In addition, I think there is a lot to learn from the calmness with which the Japanese people dealt with the disaster after the earthquake in March this year. Of course, these are things that I often coach my patients to do on a psychological level. There are also now medications that can significantly reduce the number and severity of panic attacks. In my experience, psychotherapy, together with appropriate medication, can have a significant and long-lasting effect, and the period of drug reduction and withdrawal can be expected.