Build confidence in managing and reducing panic attacks
Panic disorder is characterized by unexpected panic attacks and the ongoing fear of having more attacks. It often results in avoidance of preferred or daily activities such as driving or going to a public place - which means it has a deep impact on functioning.
Many people experience panic disorder, whether they’ve had one panic or more, and fear that they will faint, have a heart attack, or lose control when they feel the physical sensations of a panic attack.
Panic disorder is best treated with exposure therapy, which helps you gradually learn that you can tolerate the physical sensations and uncertainty of a panic attack. The most effective treatment also focuses on internal resources, such as developing a sense of capability in handling what comes, and may also include talk therapy to address how panic disorder has impacted your sense of self and ways of being.
Recognizing panic disorder symptoms
You’ll recognize panic disorder if you’re familiar with any of these experiences:
Heightened sensitivity to physical sensations such as dizziness or shortness of breath
Anxious reaction to physical sensations, including thoughts such as, “I’m going to faint,” or “Am I having a heart attack?”
Persistent worry about having panic attacks in the future, fear of losing control, “going crazy,” or dying
Physical sensations with no medical explanation, such as heart palpitations, shortness of breath, dizziness, chest pain or discomfort, sweating, trembling/shaking, dizziness or lightheadedness, chills or hot flashes, etc.
Avoidance of activities, places, etc. that you associate with a panic attack or in which you fear you will have a panic attack - e.g. avoiding the grocery store for fear you will pass out in public, or avoiding driving for fear that you will be alone and have a panic attack
Panic attacks and general anxiety may have some overlap but also have distinct differences. Panic disorder typically includes anxiety that is acute and comes on quickly, peaking in minutes. The fear is typically based around having another panic attack, catastrophe caused by having a panic attack, or of the physical symptoms. General anxiety is less acute, lasts longer, and tends to focus on ongoing and lasting worries across a broad spectrum.
What to expect in panic disorder treatment
Our therapy includes a combination of treatment modalities for a holistic, whole-person approach. It’s important to note that therapy is gradual and you will never be rushed into something that you don’t feel ready for or don’t want to do. You will also never do your first exposure therapy alone - we’ll do it together! I will never ever ask you to do something that I wouldn’t do myself.
Here’s a look at what you can expect:
Psychoeducation: Understanding what’s happening in your body and brain when you experience a panic attack - and what reinforces the panic and keeps it popping up - can be incredibly helpful. Once you know what’s happening, you are better equipped to respond to yourself and to the panic. Psychoeducation will include explanations of how anxiety behaves, how it tricks us, and what can break the pattern.
Interoceptive Exposure: IE therapy is when we gradually evoke the physical sensations of a panic attack in a controlled environment to reduce the fear of the sensations. By repeatedly experiencing the symptoms and tolerating the anxiety that comes with them, you will be less sensitive to the sensations over time and be less influenced by anxious thoughts.
General Exposure: With typical exposure, we will gradually have you face feared places or activities, such as going out in public or driving, to reduce anxiety about having a panic attack during these activities/outings over time.
Narrative & Talk Therapy: We’ll focus on helping separate you and the anxiety, and reshape the stories that you tell about yourself and your panic attacks. By highlighting strengths, values, and intentions, you can develop a greater sense of resilience and de-center panic attacks in your sense of self. With this, panic attacks will have less influence over how you view yourself, and you will have more agency in managing your life.
In-Between Sessions - Exposure therapy typically includes in-between homework in the form of practicing the exposures conducted in session. This follow-through is important in order to continue developing your resilience and sense of capability, and reducing anxiety over time in various environments. At the end of each session, you’ll receive clear instructions for what to practice on your own.
The OCD therapy process
Panic attack therapy can be done either in-person or online - whatever is most convenient or comfortable for you. This also makes scheduling more flexible! Whether online or in-person, we will practice exposures together before you practice them on your own between sessions.
Virtual sessions may also include screen sharing to explain or demonstrate concepts during psychoeducation or while we plan exposure practice. If you have difficulty accessing a computer and you join by your phone, we can still conduct exposure therapy.
Our therapy structure may look like:
First sessions: exploring how panic disorder came to have power and influence over your life, thinking, and behavior; outlining the fears and symptoms that are associated with each other; creating a hierarchy of feared sensations to target
Ongoing sessions: introduce exposure to feared sensations; practice exposures together in session; begin practicing independently outside of session; tracking how fear and anxiety respond to exposures; making adjustments as necessary
Closing sessions: planning how to continue exposures as necessary outside of therapy; how to apply skills to other problems; developing confidence and a sense of capability and resilience by exploring how you’ve been able to confront and manage these fears and sensations
My role in your ERP therapy
You can learn how to manage panic attacks, and decrease your anxiety about panic attacks and catastrophe! With exposure therapy and talk therapy, I have helped clients conquer their fears of driving, going out in public places such as the grocery store, engage in daily activities, be alone in their home or in a public place, and more.
Clients with panic disorder often feel ashamed or embarrassed about the fears or the panic - therapy is a safe, warm, judgment-free space to heal and build your resilience.
Frequently asked questions about panic disorder therapy
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Therapy for panic attacks can take anywhere from 4 to 12 sessions or more, depending on the severity of your symptoms, other problems you may be facing, and your personal preference. Some clients prefer to stay in therapy after their panic is under control to work on other types of activities or to work on developing their sense of self after panic.
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Panic attacks are sudden, intense bursts of fear with physical symptoms, while anxiety tends to be more chronic and generalized. General anxiety does not always include the physical symptoms that a panic attack does, and if it does those symptoms are may be less acute.
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One thing you’ll learn in exposure therapy is that conquering anxiety is all about embracing uncertainty and feeling capable in the face of uncertainty. To that end, no one can ever guarantee that panic attacks will stop completely, that you’ll never panic again, or that you’ll never feel anxious about physical sensations again. However, research and experience have consistently shown that interoceptive exposure and therapy help reduce the symptoms of panic attacks, including physical sensations and anxious thoughts. You may or may not never panic attack, but you will likely panic less and your anxiety will be less intense. Many people do fully recover from panic disorder or experience major symptom reduction.
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Medication is not necessary to treat panic attacks. In some cases, it can be helpful to abate symptoms if symptoms are particularly severe or are intruding on your daily life to the point that your functioning is severely impacted (e.g. you are having a hard time going to work or taking care of your children).
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Time taken to see improvement can vary, based on how severe your symptoms are, other problems such as general anxiety, and more. Many clients see improvement within a few weeks with a combination of psychoeducation, exposure, and talk therapy.
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While having a panic attack can feel physically threatening, the symptoms are an adrenaline response and are typically not physically threatening.
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The differences between panic disorder and occasional panic attacks are frequency, predictability, and their impact on your functioning and daily life.
If panic attacks take you by surprise, they are impacting your ability to go about your daily life, or you are scared of having more, you should seek professional help.
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This is understandable! If this is the case, we can start extra slow, and build your confidence by working on small problems in your life first. We will also spend plenty of time building trust and rapport in therapy before we do anything scary.
I also never, ever ask a client to do something I wouldn’t do - which means I will engage in exposures with you. This can help therapy be less scary.
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Panic attacks are caused by a sudden surge of fear or stress that triggers the body’s “fight or flight” response, often without a clear threat. They can be linked to genetics, brain chemistry (especially imbalances in serotonin or norepinephrine), chronic stress, trauma, or anxiety disorders. Sometimes they’re triggered by specific situations, while other times they seem to come out of nowhere.
To get started, schedule a free consultation so that we can talk about what you’d like to work on and what you’re looking for.
I can share more background on my approach and therapy style, and we can chat about logistics and scheduling.