Panic Attack Therapy and Treatment in NYC
How Therapy Helps Panic Attacks and Panic Disorder
Many people who experience panic attacks become increasingly concerned about having another one. This is understandable. Panic attacks are intense, frightening experiences, and many people worry that the symptoms indicate something dangerous is happening. They may fear they are having a heart attack, losing control, fainting, or “going crazy.”
It’s understandable that someone who has these kind of episodes would come to dread or fear them. Over time, a fear of future panic attacks can become a problem in its own right. Some people begin avoiding situations where they worry an attack might occur. Others become highly focused on their bodies, constantly checking or scanning for signs of anything amiss. Some carry “just in case” items, seek reassurance from loved ones, or develop other habits intended to prevent panic attacks from happening.
Therapy helps break the cycle of fear, avoidance, and panic. Rather than simply teaching people how to feel calmer in the short term, effective CBT treatment helps them develop a different relationship with panic symptoms. They learn why panic attacks happen, what maintains them over time, and how to respond to them in ways that reduce the attacks’ power and impact.
As treatment progresses, people often become less fearful of the sensations associated with panic attacks and more willing to engage in activities they had been avoiding. This increased confidence can lead to fewer panic attacks and a greater sense of freedom in everyday life.
Why Panic Disorder Persists
Many people assume that panic disorder is caused by having panic attacks. In reality, the problem is often not the attacks themselves, but what happens afterward.
Someone might experience an unexpected panic attack while driving, shopping, exercising, or just relaxing at home. The experience is frightening, and naturally they begin wondering when the next attack will happen. They may become more alert to bodily sensations such as a racing heart, dizziness, shortness of breath, or feelings of unreality.
Over time, some people begin changing their behavior in an effort to prevent future attacks. They may avoid certain places, situations, activities, or physical sensations that seem associated with panic. For example, a person who had a panic attack while driving might start avoiding highways. Someone who experienced panic symptoms during exercise may stop working out. Others may begin carrying medications, water bottles, or other “just in case” items everywhere they go.
RELATED: Avoidance: There’s No Escaping Its Importance in Anxiety
While these strategies often provide short-term relief, they can unintentionally strengthen the problem. Each time a person avoids a feared situation or relies on a safety behavior, they miss an opportunity to learn that panic symptoms, while uncomfortable, are not dangerous. The fear remains unchallenged, and the cycle continues.
Many people also become highly focused on their bodies, constantly monitoring themselves for signs of anxiety. Ironically, the more attention they pay to normal bodily sensations, the more noticeable and alarming those sensations can become. This increased vigilance can make panic attacks more likely, creating a self-perpetuating cycle of fear and avoidance.
Fortunately, panic disorder is highly treatable. Effective therapy helps people break this cycle by reducing fear of panic symptoms, eliminating avoidance patterns, and building confidence in their ability to tolerate anxiety when it arises.
How CBT Treats Panic Disorder
Thankfully, there are effective treatments for panic symptoms and the suffering they can cause. Cognitive-behavioral therapy (CBT) has been proven highly effective in the treatment of panic attacks and panic disorder. CBT for panic entails learning and practicing various skills that impart long-lasting benefit and symptom relief. These skills may involve any or all of the following:
- Changing your thought processes
- Helping you become less reactive to triggering bodily sensations
- Learning about exactly what happens in your body during an attack
- Changing habits that might be inadvertently worsening the attacks
You can learn more about this treatment on our CBT for panic disorder page.
What Are Panic Attacks?
A panic attack is a sudden surge of intense fear or discomfort that reaches a peak within a few minutes and then gradually subsides. During a panic attack, people often experience powerful physical sensations such as a racing heart, shortness of breath, dizziness, shaking, chest tightness, or feelings of unreality. Many people worry that they are having a medical emergency, losing control, or “going crazy.”
Panic attacks can occur in the context of several mental health conditions, including panic disorder, social anxiety disorder, generalized anxiety disorder, PTSD, and phobias. While panic attacks are frightening, the symptoms do not indicate a medical emergency. Understanding why they happen is often the first step toward overcoming them.
Symptoms of Panic Attacks
Some common symptoms that can occur during a panic attack, include the following:
- Increased heart rate or palpitations
- Sweating
- Trembling or shaking
- Feeling short of breath or smothering
- Feeling of choking
- Chest pain or tightness
- Nausea or abdominal discomfort
- Feeling dizzy or lightheaded
- Cold or hot flashes
- Numbness or tingling
- Feeling that things are not real (derealization) or feeling detached from oneself (depersonalization)
- Fear of losing control or “going crazy”
- Fear of dying
Why Panic Attacks Happen
Panic attacks occur when the body’s fight-or-flight response is activated despite the absence of actual danger. This system evolved to help us survive dangerous situations by preparing us to fight, flee, or protect ourselves.
When the fight-or-flight response turns on, a number of physical changes occur automatically. Your heart beats faster, your breathing changes, your muscles tense, and your body releases stress hormones such as adrenaline. These changes are helpful when facing a genuine threat, but they can feel alarming when no actual danger is present.
Many people interpret these sensations as signs that something is seriously wrong. They may worry they are having a heart attack, passing out, losing control, or “going crazy.” These interpretations often increase fear, which can intensify the panic experience.
Role of the Fight-or-Flight System
When we are faced with danger, our “fight-or-flight” system is activated. This system has evolved to help us survive when facing threats in the environment. This response leads to a number of physiological changes in the body. While these changes are helpful for escaping a threat, they can also produce the uncomfortable sensations described above. Take a look at the chart below:
| Physiological Change | Benefit for Escaping Threat | Associated Panic Symptoms |
|---|---|---|
| Faster breathing | Take in more oxygen to meet energy demands | Feeling dizzy or lightheaded; shortness of breath; chest pain or tightness |
| Increase heart rate | Increase blood flow to muscles for energy | Palpitations or pounding heart |
| Increase muscle tension | Provide body with extra speed and strength | Trembling or shaking |
| Dilate blood vessels to muscles Constrict other blood vessels | Maximize blood flow to muscles and core organs | Numbness and tingling Cold or hot flashes |
| Slow digestion | Conserve energy/direct blood flow toward muscles | Nausea or abdominal discomfort |
| Hyperfocus/tunnel vision | Hyperfocus/tunnel vision | Derealization or depersonalization Panicked thoughts |
As you can see from the above chart, the same physiological processes that are helpful for survival when faced with a threat are also responsible for panic attacks. Think of a panic attack as a helpful reaction occurring in response to the wrong triggers. These triggers can be stressful or shocking thoughts or emotions (as in the case of predictable panic attacks), or even small physiological changes outside conscious awareness. This is one reason why panic attacks sometimes seem to come “out of the blue.”
Understanding that panic symptoms are the result of a highly sensitive alarm system — not a dangerous medical event — is often an important first step in recovery.
Frequently Asked Questions
The first step is an assessment in which the therapist will try to determine why the panic attacks are happening. If you have panic disorder, the therapist will teach you about what is happening in your body during panic attacks and why. Then they’ll work with you to make you less reactive to your panic triggers, whether those are physiological, situational or mental. You will learn how to practice reducing avoidance when you encounter triggers. Lastly, as your difficulty from the panic attacks decreases, the therapist will create a plan with you to prevent the attacks from returning.
Yes, they can, but often they continue to recur until the causes of the attacks are addressed. If you’re vulnerable to panic attacks, it’s always helpful to address those vulnerabilities. Panic disorder can, and often does, get worse without treatment.
Typically cognitive-behavioral therapy for panic disorder lasts from 10-15 sessions. If you do the homework exercises as assigned by your therapist, your course of treatment will be briefer. If you aren’t able to do the homework exercises, you can expect your course of treatment to be less effective and longer than the standard 10-15 sessions.
Cognitive-behavioral therapy is an effective treatment for panic disorder. In fact, it is a first-line treatment for the condition. This means that mental health providers should provide (or recommend) this treatment first before recommending other treatments. Medications are also considered a first-line treatment for panic disorder.
A noted 2005 summary of research found that CBT was “significantly more effective” than medication in some studies on panic disorder, and that CBT was overall “at least as effective” as medications for this condition. Some studies show that the combination of CBT and medication is more effective than either one alone.