Panic attacks and panic disorder
What is panic disorder?
Panic Disorder is an anxiety condition characterised by repeated, unexpected panic attacks—sudden surges of intense fear or discomfort that reach their peak within minutes. A panic attack is not “just feeling anxious”; it is a powerful physical and emotional response that often arrives abruptly, without a clear trigger.
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Common symptoms during a panic attack include:
• rapid heartbeat or chest tightness
• shortness of breath or a feeling of choking
• dizziness, trembling, or sweating
• numbness or tingling
• heat or cold sensations
• feelings of unreality or detachment
• fear of losing control, fainting, or dying
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Although these sensations can feel frightening, they are not dangerous. They are the body’s alarm system firing too strongly and too quickly.
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The Core Feature: Fear of the Panic Itself
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Panic Disorder develops not because panic attacks happen, but because the person begins to fear the possibility of having another attack. This fear leads to:
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• constant monitoring of bodily sensations
• catastrophic interpretations of normal physical shifts
• avoidance of places or situations where escape feels difficult
Over time, people start to avoid activities such as exercising, travelling, driving, being in crowds, or even being alone, because these situations might trigger physical sensations similar to a panic attack.
Why Panic Disorder Persists
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Research shows that Panic Disorder is maintained by a cycle of:
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Heightened sensitivity to bodily sensations
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Misinterpretation of these sensations as dangerous
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Avoidance of activities that produce similar sensations
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Increased fear and monitoring, which amplifies symptoms
This creates a feedback loop where the fear of panic becomes more distressing than the attack itself.
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What is agoraphobia?
Agoraphobia is the fear and intense anxiety of being in places or situations where escape might be difficult or where help may not be available if a panic attack occurs. People with agoraphobia often fear leaving the house alone, staying alone at home, using public transport, standing in queues, entering tunnels, crossing bridges, or going to cinemas, theatres, or crowded places. Many feel safer when accompanied by someone they trust and may only face these situations with support. Agoraphobia can last for many years and does not always include panic attacks. The person’s daily functioning is affected depending on the severity of the condition. Work, social life, and even basic tasks such as shopping can become very difficult. Many individuals also avoid activities that increase their heart rate,such as exercise or sexual activity,because they fear these sensations might trigger a panic attack.
The Link Between Agoraphobia and Panic Disorder
Agoraphobia and Panic Disorder are two separate anxiety disorders, but they are closely connected and often appear together. Many people develop agoraphobia after experiencing panic attacks. The fear of having another attack, especially in a place where escape feels difficult or help may not be available, leads the person to avoid situations such as public transport, crowds, travelling, or being far from home. Over time, the individual becomes highly sensitive to bodily sensations (like a fast heartbeat or dizziness) and may interpret them as signs that a panic attack is about to happen. This increases fear and strengthens avoidance, creating a cycle that maintains both conditions. Although agoraphobia can occur without panic attacks, for many people the central fear is the possibility of having one and not being able to cope. Because of this, the two disorders often overlap, but they remain distinct and can be diagnosed independently. Both conditions respond well to evidence-based psychological therapies that help reduce avoidance, challenge catastrophic interpretations, and rebuild confidence in managing anxiety.
How common are they?
It is estimated that 2%–4% of the general population will experience Panic Disorder at some point in their lives. Among those individuals, one-third to one-half will also develop agoraphobia.
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Research also shows that around 50% of people with Panic Disorder, whether or not agoraphobia is present, are likely to experience depression at some stage. This highlights how emotionally demanding these conditions can be and why timely, evidence-based treatment is important.
Treatment of Panic Attacks and Panic Disorder
The CBT Model of Panic Disorder
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Cognitive Behaviour Therapy, or CBT, is the primary evidence-based approach for treating Panic Disorder. According to this model, panic attacks begin with ordinary bodily sensations such as a faster heartbeat, light dizziness or a feeling of shortness of breath. The person interprets these sensations as signs of danger. Thoughts such as “I might faint,” “I am losing control,” or “I am having a heart attack” increase anxiety, which then intensifies the physical sensations. The cycle builds rapidly and results in a panic attack.
Over time, the individual starts avoiding situations, activities or sensations that seem capable of triggering another attack. Avoidance brings short-term relief but strengthens the belief that the sensations are unsafe and keeps the panic cycle active.
How We Treat Panic Disorder:
Psychoeducation
Treatment begins with understanding how the body’s anxiety system works. When people learn the physiology of panic, the fear of the symptoms often decreases and the experience becomes easier to manage.
Working with catastrophic interpretations
Together we observe the thoughts that appear during anxiety and panic. You learn to evaluate these interpretations more accurately and to respond to bodily sensations with clarity rather than fear.
Interoceptive exposure
This method gently and safely recreates harmless bodily sensations associated with panic. By practising with these sensations in a controlled environment, you learn that they are uncomfortable but not dangerous. With repetition, the fear response decreases and confidence grows.
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Reducing avoidance
We gradually reintroduce activities and situations that you have been avoiding. This may include physical activity, travelling or entering places where you have previously felt unsafe. The pace is collaborative and tailored to your needs. The aim is to rebuild trust in your ability to cope.
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Strengthening long-term skills
Throughout therapy, you learn strategies to recognise when the panic cycle is beginning, how to interrupt it and how to respond to anxiety with flexibility. These skills help maintain progress and prevent relapse.
The Aim of Treatment
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The goal is not to eliminate anxiety completely, since anxiety is a natural part of life. Instead, treatment helps you change the way you relate to bodily sensations and anxious thoughts so that they no longer escalate into panic or limit your daily life. Research consistently shows that this approach leads to significant and lasting improvement for most individuals.
Taking the First Step
Recognizing that your panic attacks may be part of a treatable condition is an important first step. If panic episodes or the fear of having another one are affecting your relationships, daily activities or overall quality of life, reaching out for professional support can bring meaningful relief. Panic can feel overwhelming, but you do not have to face it on your own.
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Therapy offers a safe and confidential space where you can understand what triggers your panic attacks, learn how the panic cycle works and develop effective skills to interrupt it. With the right guidance, it is possible to reduce the frequency and intensity of panic attacks, rebuild confidence and regain a sense of safety in your everyday life.