Panic Attacks, Panic Disorder, and the Fear of Fear: How Therapy Can Help

A racing heart. Tightness in your chest. Dizziness. Shaking. Shortness of breath. A strange feeling that you aren't quite connected to yourself or the world around you.

And then the thought:

What if something is seriously wrong with me?

For people who experience panic attacks, these sensations can be terrifying. Even after the panic attack ends, another problem can begin: worrying about when the next one will happen.

Over time, life can start revolving around preventing panic.

You might avoid driving, flying, exercising, crowded stores, unfamiliar places, being far from home, or situations where you worry it would be difficult to escape. You might constantly monitor your heart rate, breathing, dizziness, or other physical sensations. You may carry medications, water, snacks, or other "just in case" items everywhere you go.

Eventually, you may become afraid not only of particular situations, but of panic itself.

That's where treatment can help.

What Is a Panic Attack?

A panic attack is a sudden surge of intense fear or discomfort accompanied by physical and cognitive symptoms. These may include:

• Racing or pounding heart

• Shortness of breath or feeling unable to get a satisfying breath

• Chest discomfort

• Dizziness or lightheadedness

• Shaking or trembling

• Sweating

• Nausea or stomach discomfort

• Chills or feeling overheated

• Tingling or numbness

• Feeling detached from yourself or your surroundings

• Fear of losing control

• Fear of fainting

• Fear of "going crazy"

• Fear of dying

Because panic produces very real physical sensations, people experiencing their first panic attacks may understandably wonder whether they're having a medical emergency.

Medical concerns should always be appropriately evaluated. But when panic becomes recurrent and someone begins persistently worrying about or changing their behavior because of future attacks, Panic Disorder may be part of the picture.

The Panic Cycle

One of the most important things I help clients understand is that panic often becomes self-reinforcing.

Imagine noticing that your heart is beating a little faster than usual.

You think, Why is my heart doing that?

You start monitoring it.

Then comes another thought: What if I'm about to have a panic attack?

Your anxiety increases. Your heart beats faster. You notice the increased heart rate and interpret it as evidence that something really is wrong.

Now you're even more frightened.

You might sit down, check your pulse, control your breathing, call someone for reassurance, leave the situation, or take medication as quickly as possible.

The immediate relief from escaping or performing a safety behavior can unintentionally teach your brain:

"That sensation really was dangerous. I escaped just in time."

The next time you notice the sensation, your alarm system may respond even faster.

This is why treating panic isn't simply about learning how to "calm down."

We want to change your relationship with the sensations and uncertainty that have become frightening.

How I Treat Panic Disorder

My approach is grounded primarily in Cognitive Behavioral Therapy (CBT), exposure-based treatment, and Acceptance and Commitment Therapy (ACT).

Treatment is collaborative and individualized. We aren't trying to force you into frightening situations before you're ready, and the goal isn't to convince you that you'll never experience panic again.

Instead, we're helping your brain learn something different:

I can experience uncomfortable sensations without automatically treating them like an emergency.

Understanding What Your Body Is Doing

We begin by making sense of your individual panic cycle.

What sensations tend to trigger you?

What do you fear those sensations mean?

What do you do when panic begins?

What situations have you started avoiding?

We also identify less obvious safety behaviors, such as constantly monitoring your body, sitting near exits, checking your heart rate, only going places with a "safe person," researching symptoms, or repeatedly reassuring yourself that everything is okay.

These strategies aren't signs that you're doing something wrong. They make sense when your brain believes it's protecting you.

The problem is that they can prevent your brain from discovering what happens when you don't immediately respond to anxiety as though you're in danger.

Learning Not to Fear the Sensations of Panic

Exposure therapy can be particularly useful for panic disorder.

One type of exposure used in panic treatment is called interoceptive exposure.

Rather than only practicing feared situations, interoceptive exposures intentionally and safely bring on some of the physical sensations a person has learned to fear.

Depending on the person and appropriate medical considerations, treatment might involve exercises designed to temporarily create sensations such as a faster heartbeat, dizziness, breathlessness, warmth, or other familiar panic sensations.

Why would we intentionally practice something you desperately want to stop feeling?

Because avoiding a sensation teaches your brain that it needs to be avoided.

Approaching it gives your brain an opportunity to learn something new.

Instead of:

"My heart is racing. I have to make this stop."

we're working toward:

"My heart is racing. I don't like this sensation, but I can allow it to be here without immediately escaping from it."

That distinction can be incredibly important.

Getting Your Life Back From Avoidance

Treatment may also include gradually approaching situations you've begun avoiding because you're afraid of having a panic attack.

For one person, that might mean driving farther from home.

For another, it might mean exercising without repeatedly checking their heart rate.

Someone else might practice standing in a checkout line, sitting farther from an exit, going somewhere without their usual "just in case" items, flying, riding an elevator, or spending time somewhere they can't immediately leave.

The specific exposures aren't the point.

The goal is to help you stop organizing your life around preventing panic at all costs.

Where ACT Fits In

Acceptance and Commitment Therapy adds another important question:

What would you be doing if you weren't spending so much energy trying not to feel anxious?

Maybe you'd travel.

Exercise.

Drive somewhere alone.

Go to a concert.

Take your kids somewhere without planning an escape route.

Say yes to something spontaneous.

Or simply go through an ordinary day without constantly checking whether panic is about to happen.

ACT helps us practice making room for uncomfortable internal experiences while continuing to move toward the things that matter to you.

The goal isn't to love anxiety.

It's to build a life in which anxiety doesn't get to make all of your decisions.

"But What If I Have a Panic Attack?"

You might.

That answer can sound strange coming from a therapist who treats panic disorder, but promising that therapy will ensure you never panic again would reinforce the idea that panic must be prevented.

Instead, treatment helps change the question.

Rather than:

"How can I make sure I never have another panic attack?"

we begin working toward:

"If panic shows up, can I trust myself to experience it without immediately treating it as an emergency?"

Paradoxically, when people become less afraid of panic itself, the cycle that keeps panic going can begin to lose its power.

You Don't Have to Wait Until Your World Gets Smaller

Many people seek treatment only after panic has significantly restricted their lives.

Maybe you've stopped driving on highways.

Maybe you won't travel alone.

Maybe you avoid exercise because a racing heart feels frightening.

Maybe you carefully choose restaurants, stores, or seats based on how quickly you could leave.

Or maybe you're still doing everything you're "supposed" to do, but you're doing it while constantly monitoring your body and bracing for the next attack.

You don't have to wait until avoidance takes over your life to seek help.

I provide telehealth therapy for adults in Florida and Minnesota, with specialized treatment for anxiety and related conditions. Together, we can identify the cycle keeping panic going and gradually practice responding to anxiety in a different way.

The goal isn't a life in which your body never sounds a false alarm.

It's a life in which you don't have to live in fear of the alarm.