CBT for Panic Attacks and Panic Disorder

When the fear of panic starts becoming bigger than the panic itself

A panic attack can be frightening.

Your heart suddenly races.

Your breathing changes.

Your chest feels tight.

You feel dizzy, shaky, hot or nauseous.

You may feel detached from yourself or your surroundings.

Your thoughts can become difficult to control.

And sometimes there is an overwhelming feeling that something terrible is happening.

What if I'm having a heart attack?

What if I pass out?

What if I lose control?

What if I can't breathe?

What if I go crazy?

What if this happens again?

Then the panic eventually passes.

But that doesn't necessarily mean the fear is over.

You may start watching your body for signs that another attack is coming.

You may avoid places where you've panicked before.

You may stop exercising because your heart beating faster feels frightening.

You may sit near exits.

Carry water.

Take someone with you.

Avoid driving.

Avoid crowded places.

Avoid being alone.

Or even become frightened by the word “panic”, the thought of having another attack, or the slightest sensation that reminds you of one.

At ActionCBT, we understand that the problem isn't simply the panic attack.

Sometimes the real problem becomes everything you start doing to make sure it never happens again.

And that is where CBT can help.

Panic can make ordinary sensations feel dangerous

Your body changes constantly.

Your heart beats faster when you walk upstairs.

Your breathing changes when you exercise.

You can feel dizzy when you stand quickly.

You might feel hot when you're embarrassed.

Your stomach can turn when you're nervous.

These sensations are normal parts of being human.

But after a frightening panic attack, ordinary bodily sensations can take on a completely different meaning.

A racing heart becomes:

“Something is wrong.”

A dizzy feeling becomes:

“I'm going to faint.”

A change in breathing becomes:

“I can't breathe.”

The sensation creates fear.

The fear creates more physical sensations.

And those sensations appear to confirm the original fear.

Sensation → interpretation → fear → more sensation → more fear.

This is one of the cycles CBT can help you understand.

The fear of having another panic attack

After a panic attack, it is understandable to want to prevent another one.

You remember how frightening it was.

So you start looking for warning signs.

You monitor your heartbeat.

Notice your breathing.

Check how you feel.

Ask yourself:

“Am I okay?”

You may leave places early.

Avoid situations where help might not be available.

Or stop doing things altogether.

For a while, this can make life feel safer.

But your brain may learn:

“We were only safe because we avoided it.”

That can make the next situation feel even more threatening.

Eventually, you may not just be afraid of panic.

You may become afraid of anything that could possibly lead to panic.

When you start avoiding the thought of panic itself

Panic-related avoidance isn't always obvious.

You might avoid talking about panic.

Avoid reading about it.

Avoid saying the word.

Try not to think about your previous attacks.

Distract yourself whenever the memory comes up.

Push away the thought:

“What if I panic?”

You may even become frightened when the thought appears.

This can create a strange situation where the mind is constantly checking whether it is thinking about panic — while simultaneously trying not to think about it.

The harder you try to make the thought disappear, the more important it can seem.

CBT can help you change your relationship with these thoughts.

Not by pretending they aren't frightening.

And not by arguing with every thought.

But by learning that a thought about panic is not the same thing as a panic attack — and neither is a command that you have to escape.

Safety behaviours can quietly take over

You may still be doing everything you used to do.

Going to work.

Seeing friends.

Going shopping.

Driving.

Travelling.

But perhaps you are doing all of it with a safety net.

You sit near the door.

Carry medication “just in case”.

Keep your phone in your hand.

Make sure someone knows where you are.

Take water everywhere.

Check where the nearest bathroom is.

Avoid caffeine.

Monitor your heart rate.

Make sure you can leave quickly.

Ask someone to come with you.

These behaviours can feel sensible.

And sometimes they are.

But if you begin to believe:

“I can only cope because I have this with me,”

the safety behaviour can become part of the problem.

CBT can help you identify these patterns and experiment with what happens when you gradually rely on them less.

The goal isn't to take away everything that makes you feel comfortable.

It is to discover what you are capable of without needing anxiety to provide a guarantee first.

When panic starts shrinking your world

Sometimes the fear of panic becomes so strong that you begin avoiding places where escape might feel difficult.

Shopping centres.

Cinemas.

Public transport.

Driving on motorways.

Bridges.

Queues.

Airplanes.

Crowded events.

Being far from home.

Being alone.

This can be part of agoraphobia.

Agoraphobia isn't simply “being afraid of open spaces”.

It can involve fear of situations where you believe escaping might be difficult or help might not be available if panic or other frightening symptoms occur.

The result can be a life increasingly organised around staying close to somewhere that feels safe.

Home can become the safest place.

But the safer home becomes, the harder leaving can feel.

Your world gets smaller while the list of places that feel dangerous gets bigger.

CBT can help you gradually reverse that process.

Panic isn't dangerous — but it can feel terrifying

One of the most important parts of CBT for panic is understanding what happens during an attack.

The physical sensations of panic can be intense.

Your heart may pound.

You may feel short of breath.

You may feel dizzy.

Your chest may feel strange.

You may feel unreal or detached.

The experience can be genuinely terrifying.

Understanding the body's alarm response can help make sense of why these sensations occur.

But understanding alone isn't always enough.

You can know intellectually that panic is not dangerous and still feel terrified when your heart starts racing.

This is where ActionCBT becomes different.

We don't want you simply to understand panic.

We want you to build new experiences of panic.

We don't just talk about panic. We practise responding differently.

This is central to the ActionCBT approach.

You might understand that your racing heart is a normal response to adrenaline.

But what happens when your heart actually starts racing?

Do you immediately check it?

Stop what you're doing?

Escape?

Seek reassurance?

Monitor your breathing?

Tell yourself you must calm down?

Or desperately try to make the sensation disappear?

CBT can involve carefully designed behavioural experiments that allow you to discover what happens when you respond differently.

You may practise approaching sensations you have learned to fear.

You may experiment with reducing safety behaviours.

You may remain in situations you would normally escape.

You may allow anxious thoughts to be present without immediately responding to them.

And you learn from what actually happens.

Not because you need to prove you're brave.

Because experience can teach you something that reassurance and explanation cannot.

Interoceptive exposure: learning that sensations can be tolerated

For panic disorder, CBT may include interoceptive exposure.

This means deliberately and safely experiencing physical sensations that resemble aspects of panic.

For example, depending on the person and clinical formulation, therapy may involve activities that bring on sensations such as increased heart rate, breathlessness or dizziness.

The purpose is not to make you panic for the sake of it.

It is to create an opportunity to learn:

“I can experience this sensation.”

“I don't have to immediately escape.”

“The sensation can change without catastrophe.”

“I can allow my body to do what bodies sometimes do.”

This kind of learning can be much more powerful than simply being told:

“There is nothing to worry about.”

You don't have to eliminate panic before you live

One of the traps of panic disorder is making the absence of panic the condition for living.

I'll drive when I know I won't panic.

I'll travel when I feel confident.

I'll exercise when my heart doesn't scare me anymore.

I'll go out alone when I know I'll be okay.

But absolute certainty rarely arrives.

And waiting for it can keep life on hold.

The ActionCBT approach turns the question around.

Instead of:

“How do I make sure I never panic?”

we can ask:

“How do I want to live, even if panic sometimes happens?”

That is a much more freeing question.

What if panic happens?

This can be one of the most important questions in therapy.

Not:

“How can I guarantee that panic never happens?”

But:

“If panic happens, what could I do?”

You might discover that you can stay.

You can breathe naturally rather than desperately trying to control your breathing.

You can allow the sensations to rise and fall.

You can stop checking your body.

You can continue the conversation.

You can remain in the shop.

You can keep driving.

You can finish what you were doing.

You can let the wave pass.

And each experience can provide new information.

I can cope.

That is very different from:

“I am only safe when I prevent panic.”

The ActionCBT approach

ActionCBT combines evidence-informed CBT with practical behavioural work and coaching.

We don't believe panic therapy should simply be a series of conversations about why you feel anxious.

And we don't believe the answer is to hand you a list of breathing exercises and tell you to calm down.

Sometimes calming your body is useful.

But if your entire strategy becomes “I must get rid of these sensations immediately”, that can unintentionally reinforce the idea that the sensations are dangerous.

Instead, we build a formulation of your panic cycle.

What sensations do you fear?

What do you think they mean?

What do you do when they appear?

What are you avoiding?

What safety behaviours have developed?

Where has panic started limiting your life?

And what would you like to be able to do again?

From there, therapy becomes practical.

That might involve:

Interoceptive exposure.

Behavioural experiments.

Reducing safety behaviours.

Approaching avoided situations.

Working with catastrophic interpretations.

Changing reassurance-seeking.

Learning to tolerate uncertainty.

And practising responding differently when panic-related thoughts or sensations appear.

The intervention follows the formulation.

And then we take it into real life.

Because the goal isn't simply to know more about panic.

It is to become less controlled by it.

From avoiding panic to living beyond it

Panic can become the thing around which everything else is organised.

Where you go.

How far you travel.

Who you are with.

What you eat or drink.

Whether you exercise.

Where you sit.

Whether you leave home.

What you think about.

Even which words you allow yourself to say.

ActionCBT is about changing that.

Not by demanding that you become fearless.

Not by pretending panic is pleasant.

And not by promising that you will never experience anxiety again.

But by helping you discover that panic does not have to determine what you do.

Understand the panic cycle.

Stop treating every sensation as a warning.

Reduce the safety behaviours that keep fear going.

Approach what anxiety has taken away.

Get your choices back.

ActionCBT.

CBT for Panic Attacks and Panic Disorder in Adelaide Hills and Australia-wide

ActionCBT provides evidence-informed CBT for panic attacks, panic disorder and agoraphobia via telehealth throughout Australia, including for people searching for CBT for panic attacks in the Adelaide Hills.

If panic attacks are affecting where you go, what you do, who you see or how safe you feel leaving home, CBT can help you understand the cycle and begin changing it.

You don't need to wait until you feel confident.

You don't need to guarantee that panic will never happen again.

And you don't need to make your world smaller to feel safe.

We start where you are.

Then we take the work into real life — through carefully considered experiments, practice and action.