Therapy for Panic Attacks

What Happens in the Body

A panic attack is a sudden surge of the body's alarm system. The heart pounds, breathing speeds up or feels impossible, the chest tightens, hands tingle, the room may feel unreal, and there is often an overwhelming sense that something terrible is about to happen, like fainting, losing control or dying. The surge usually peaks within minutes and then passes, though it can leave you shaky and drained for hours.

The alarm itself is not broken. It is the same system that would help you run from real danger. In panic, it fires when there is no danger to run from, and the sensations it produces are frightening enough to feel like danger themselves.

A Medical Check Comes First

Panic can mimic other health problems, and other health problems can mimic panic. If you are having new physical symptoms, such as chest pain, shortness of breath, dizziness or a racing heart, please see a medical provider first to rule out physical causes. I am a counselor, and that check belongs with your doctor. If you ever think you are having a medical emergency, call 911.

Once medical causes have been looked at, therapy can help with the panic itself and with everything panic has started to change in your life.

The Fear of the Next One

Often, the hardest part of panic is not the attack. It is the fear of the next attack. You start watching your body for early signs. A skipped heartbeat or a warm face becomes a warning. That watching creates tension, and tension creates more sensations to notice, and the loop tightens.

Avoidance follows. You stop driving on the highway, skip the grocery store at busy times, leave concerts early, stay close to home. Each avoided place brings short-term relief and teaches your brain that the place really was dangerous. Over time the map of safe places can shrink a lot.

Body-Based Tools

Because panic lives so much in the body, somatic work is often part of how I help. We practice slowing the exhale, grounding through your feet and hands, and orienting to the room, when you are calm, so the skills are familiar when you need them.

We also work on your relationship with the sensations themselves. Learning to notice a racing heart with curiosity rather than alarm, and to let it rise and fall without fighting it, takes the fuel out of the fear. This is gentle, paced work, and you decide how far to go.

CBT Tools

From cognitive behavioral therapy comes understanding the thoughts that pour gasoline on the alarm, such as I am having a heart attack or I am going to lose control, and checking them against what actually happens during a surge. It also offers a way back into the places panic has taken, one agreed step at a time.

That might mean a short drive on a quiet road before a longer one, or a few minutes in a store before a full shop. You set the steps. I will not push you into a situation you have not chosen.

Panic in Children and Teens

Children often do not describe panic the way adults do. It may show up as stomachaches, headaches, feeling sick before school, sudden tears, or refusing to go somewhere, like a classroom, a friend's house or the car. Younger kids may not know why they feel bad; they only know they do not want to go.

Teens may describe it more clearly but hide it, especially at school. With children and teens I use play, drawings and simple body tools, and I involve parents so everyone understands what is happening and how to respond. My children and teens page has more.

Panic and Trauma

Sometimes panic is connected to earlier experiences, where a sound, a smell or a situation sets off the alarm because it resembles something that once was dangerous. If that is part of your picture, we can take it into account and go at a pace that feels safe. My trauma and PTSD page describes how I approach that work, and the main anxiety therapy page covers the wider picture.