Sometimes panic attacks are rooted in childhood trauma, according to Helen Resneck-Sannes, a California psychologist and author of "There Really is Something to Be Afraid Of: A Body-Oriented Psychotherapy for the Treatment of Panic Disorder"
"Usually there was a time, which they can usually think back to and remember, but sometimes don't, when they were humiliated," she said.
As a therapist, she teaches patients to feel the body's response to panic (shoulders up, inhaling without exhaling) and then uses breathing and other relaxation techniques to learn to control them.
"It's a step by step process that starts in the body, to calm it down and let it relax with positive images," Resneck-Sannes said. "I have them really stay in touch with what they are feeling in their body and what happens when they have a panic attack, so they have some control over their physiology."
Indeed, Simon told The New York Times in a 1987 interview that growing up she had a "terrible stutter."
"I was treated like a handicapped child,'' said Simon. ''I remember as a very young girl going on stage and playing Amy in 'Little Women,' but because of my stammer, I couldn't even say my opening line."
Her first major attack on stage was in the early 1960s in a performance with her sister, Lucy, as the Simon Sisters. After recording a solo record, she was persuaded to open for Cat Stevens in Los Angeles in 1971. But her anxiety increased and her performances dwindled.
After her million-selling single "Jesse" in 1981, Simon once again tried a tour of large concert halls, but during two shows in Pittsburgh, panic struck.
''I had two choices,'' Simon said. ''I could either leave the stage and say I was sick or tell the audience the truth. I decided to tell them I was having an anxiety attack, and they were incredibly supportive. They said, 'Go with it. We'll be with you.'"
"When the anxiety comes on, the adrenaline is so strong it topples me," she told the Times. "I never know when it's going to happen, except that the larger the audience, the more I feel I've got to lose. I really never wanted to be a performing artist. I just wanted to be a writer.''
But this week, singing alongside her son, Ben, for family, friends and a handful of critics at Joe's Pub in New York City, Simon seemed unflappable. She belted out old favorites like "Anticipation" and "Coming Around Again," as well as her new Brazilian-inspired material.
Simon confessed to using beta blockers before performing, which psychologists say slows down a pounding heart.
"Some people escape with drinking and doing drugs before they go on, I use Inderal," she said.
Still, Simon seems to have mastered her demons, mostly with a bit of self-talk and rituals like digging her nails into her scalp and "scruffing up" her still-flowing blond hair -- and the spanking.
"I don't think the science thing works as well as doing something," she added. "I liked to be spanked and that sounds really kinky, but it's not. I can do it with a rubber band. Yes, it works. It puts the pain I am feeling psychologically into my body. … It gets me out my head."