PANIC ATTACKS
Panic, understood well enough to stop running from it.
Telehealth therapy for panic attacks, the fear of the next one, and the shrinking life that avoidance can build around them.
What a panic attack actually is
A panic attack is your body's alarm system going off at full volume without a real emergency in front of you. The heart pounds, breathing gets fast and shallow, your chest tightens, your hands tingle, the room might feel unreal. Many people are sure they are having a heart attack, losing their mind or about to pass out. It usually peaks within minutes and then fades, leaving you drained and shaken.
Those sensations are the same fight-or-flight response that would help you escape real danger. The problem is the timing. Panic is related to broader anxiety, but it has its own pattern, and it responds to a fairly specific kind of work.
A physical check comes first
If you are having new, different or worsening physical symptoms, such as chest pain, trouble breathing, fainting or an irregular heartbeat, see a physician before assuming it is panic. That is not a formality. Some medical conditions produce similar sensations, and ruling them out matters. It also helps the therapy, because it is much easier to work with panic once you know your heart is not the problem. If you ever think you are having a medical emergency, call 911.
The fear of the fear
After one or two attacks, many people start fearing the next one. You begin scanning your body for early signs. A slightly fast heartbeat after climbing stairs becomes a warning. That attention and worry itself raises your arousal, which produces more sensations, which feels like proof an attack is coming. The loop tightens. This is often called the fear-of-the-fear cycle, and it is often what keeps panic going long after the first attack.
How avoidance shrinks your world
It makes sense to stay away from places where panic happened: the grocery store, the highway, a crowded room, a meeting. Each time you avoid, you feel relief, and that relief teaches your brain the place really was dangerous. Over time, the list of avoided places grows. Some people end up planning their whole day around escape routes, carrying water or medication just in case, or only going out with a trusted person. Those safety habits feel protective, but they can keep the cycle running.
The CBT approaches used for panic
Cognitive Behavioral Therapy has well-established approaches for panic, and they are the core of this work. That can include:
- Understanding the cycle. Learning what your body is doing and why, so the sensations become less mysterious.
- Working with catastrophic thoughts. Noticing thoughts like "I'm dying" or "I'll lose control" and testing them against what actually happens.
- Gradual exposure to sensations. Deliberately and safely bringing on mild versions of feared sensations, so your brain learns they are uncomfortable but not dangerous.
- Returning to avoided places. A planned, step-by-step return, at a pace you agree to.
- Dropping safety behaviors. Gradually letting go of the habits that keep the fear alive.
This work is active. It involves practice between sessions, and it asks you to approach what you have been avoiding, with support and a plan.
Panic that follows trauma or service
Sometimes panic starts after something happened: an accident, an assault, a deployment, a critical incident on the job. The attacks may be set off by reminders, or they may seem to come from nowhere. When panic is tied to trauma, trauma-focused treatment may be part of the plan too. Zandria Hooks, LCSW, is EMDR trained and CPT certified in addition to using CBT, and she is prior active duty, now serving in the National Guard as a mental health provider, so panic that shows up during or after military service is familiar territory.
Panic questions
How do I know it is panic and not a heart problem?
You should not have to guess. New or changing physical symptoms like chest pain, shortness of breath or fainting deserve a medical evaluation first. Once a physician has checked you, therapy can focus on the panic cycle.
Will I have to have a panic attack in session?
No. Some CBT work involves gradually and deliberately approaching feared sensations, but it is planned together, step by step, and you stay in control of the pace.
Can panic be connected to trauma or military service?
It can. Panic sometimes starts after a traumatic event or during or after service. When that is the case, trauma-focused work may be part of the plan alongside panic-specific tools.
Should I be taking medication for panic?
That is a question for a physician or prescriber. Therapy here does not give medication advice, and it can run alongside whatever medical care you choose.
See rates and insurance and EAP, or request a free 15-minute consult on the contact page.
In crisis or thinking about harming yourself? This site is not for emergencies. Call or text 988, or dial 911. Veterans: press 1 after calling 988.
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