Panic Disorder

Panic attacks can feel like a bolt of lightning: sudden, overwhelming, and terrifying. You might feel like you can’t breathe, like your heart is about to give out, or like you’re losing your grip on reality. And if you’ve experienced more than one, the fear of having another can become just as disruptive as the attacks themselves. That fear can start to shape your life: where you go, who you see, what you avoid.

If you’re stuck in that cycle, you’re not alone. Panic Disorder is more common than most people think, and it’s also highly treatable. At Cognitive Behavioral Therapy & Assessment Associates (CBTAA), we specialize in evidence-based treatment for panic and anxiety. Using Cognitive Behavioral Therapy (CBT), exposure techniques, and emotional regulation tools, we help you understand what’s happening in your body, interrupt the fear cycle, and rebuild trust in yourself.

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What is Panic Disorder?

Panic Disorder is a specific type of anxiety disorder that centers not just on the experience of panic attacks, but on the persistent dread of their return. Unlike Generalized Anxiety Disorder (GAD), where the worry tends to spread across many areas of life, Panic Disorder narrows in on one haunting question: “What if it happens again?” A panic attack often feels like a sudden wave crashing over you: your heart races, your chest tightens, your vision might blur, and you feel like you’re losing control. These episodes come on abruptly, often peaking within minutes, and the symptoms can be so intense they’re mistaken for a heart attack or medical emergency.

But the real disruption happens between the attacks. The fear of having another one, especially in public, at work, while driving, or far from help, can quietly take over daily life. You might start avoiding anything that could trigger another episode. Not because you want to, but because it feels safer. Maybe you stop taking the subway, decline social invitations, avoid exercise because it mimics panic symptoms, or even feel nervous being alone. These behaviors are subtle at first, but over time they can shrink your world.

Panic Disorder can also exist alongside other forms of anxiety, like GAD or health anxiety. You might find yourself feeling anxious all the time, with occasional surges into full panic, which only reinforces the belief that something is wrong or unsafe. This cycle of panic, fear of panic, and avoidance can feel relentless. Our goal is to help you manage panic, rebuild trust in your body, and reclaim a life that feels safe, grounded, and fully yours. Therapy doesn’t ask you to stop being afraid overnight. It gives you the tools to move forward, even when fear shows up.

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Understanding the Panic Cycle

Panic attacks can feel like they come out of nowhere, but they follow a very specific pattern, one that Cognitive Behavioral Therapy (CBT) is designed to interrupt. This pattern is known as the panic cycle, and it’s what turns one frightening experience into a chronic condition. When you understand the cycle, you can begin to break it.

How the Panic Cycle Works

A physical sensation shows up, often out of the blue

You might notice your heart skipping a beat, a sudden wave of dizziness, shortness of breath, or nausea. These sensations can come on while you’re walking to work, standing in line, or even sitting on the couch. They’re often harmless, caused by stress, fatigue, hunger, or caffeine, but they feel intense.

You interpret the sensation as dangerous.

Instead of thinking, “I’m tired” or “That was just a flutter,” your brain jumps to something catastrophic: “I’m going to pass out.” “I might die.” “What if I lose control and embarrass myself?” These thoughts set off alarm bells, triggering your body’s fight-or-flight system.

Anxiety intensifies the sensations.

The more fear you feel, the more your body reacts. Your heart beats faster. Your breathing becomes shallow. You feel hot, shaky, detached, or unsteady. Your brain, sensing danger, pours on more adrenaline, fueling the very sensations you were afraid of in the first place.

You try to escape, neutralize, or prevent the experience.

This might mean leaving the room, sitting down immediately, grabbing cold water, texting a friend, or avoiding whatever situation you were in when the sensation started. These coping strategies are called safety behaviors, and while they provide temporary relief, they also reinforce the belief that the situation was dangerous and that you needed to escape.

Your brain learns the wrong lesson.

When the panic subsides, it seems like the actions you took like leaving, avoiding, distracting were what kept you safe. The truth? Panic naturally peaks and then resolves on its own. But because your brain linked safety to the escape or ritual, it becomes more afraid of similar situations. This reinforces avoidance, shrinks your world, and keeps the cycle going.

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Symptoms of Panic Disorder

Panic disorder involves more than just the panic attacks themselves. It includes a mix of physical symptoms, psychological fears, and behavioral changes that can significantly disrupt daily life.

Physical Symptoms of a Panic Attack

• Racing or pounding heartbeat: your heart may feel like it’s beating out of your chest, skipping beats, or fluttering uncontrollably, and can often be mistaken for a heart condition.
  
  
• Shortness of breath or chest tightness: breathing can feel shallow, restricted, or like you can’t get enough air, sometimes leading to the sensation of choking or suffocating.
  
  
• Dizziness, nausea, or lightheadedness: you might feel faint, unsteady on your feet, or queasy, like the room is spinning or your body is about to collapse.
  
  
• Sweating, shaking, or trembling: these are common panic symptoms, even in the absence of heat or exertion. Some people shake visibly, others internally.
  
  
• Numbness or tingling in the hands or feet: known as paresthesia, this sensation is caused by hyperventilation and can make your limbs feel prickly or detached.
  
  
• Chills or hot flashes: a wave of heat or cold can pass through your body suddenly, adding to the sense that something is going wrong.
  
  
• A choking sensation or lump in the throat: your throat might tighten, making it hard to swallow or breathe comfortably.
  
  
• Feelings of unreality or detachment: often described as feeling “not real” or “outside your body,” these sensations can be terrifying and disorienting.
  
  
• Fear of dying, losing control, or going crazy: these fears are common during a panic attack and can escalate the intensity of the episode, even if there’s no actual danger.

Psychological and Behavioral Symptoms

Constant fear of having another panic attack: you may live in fear of the next attack, constantly anticipating when or where it might strike.

Avoiding places or situations where panic occurred: locations like stores, public transit, or even your workplace may be avoided, not because they’re unsafe, but because they’re associated with previous episodes.

Relying on “safety items”: many people carry water, gum, medication, or other comfort items they believe will help if an attack happens again.

Only feeling safe with a trusted person nearby: you may avoid going places alone, or feel unable to function unless a partner, friend, or family member is close by.

Hypervigilance to bodily sensations: small, everyday sensations, like a flutter in your chest or a moment of lightheadedness, can feel like warning signs, leading to intense scanning and over-monitoring.

Feeling like your world is shrinking: as avoidance increases, your daily routine may become more limited. Activities you used to enjoy or handle easily might now feel off-limits or risky.

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Key Evidence-Based Treatments for Panic Disorder

At CBTAA, we treat Panic Disorder with a combination of science-backed strategies and individualized care. The most effective treatment targets both the thoughts that fuel fear and the behaviors that keep the panic cycle going. Therapy is not about avoiding symptoms, it’s about changing your relationship with them and regaining a sense of control.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is the leading, research-backed treatment for Panic Disorder, and for good reason. It doesn’t just help you cope with panic attacks; it teaches you how to change the thoughts and behaviors that keep the panic cycle alive. CBT is active, practical, and deeply empowering. Instead of avoiding fear, you’ll learn how to face it, one step at a time, with the tools and support you need.

CBT starts with understanding how panic works. Your therapist will help you map out the cycle of panic in your life: what triggers it, how your body reacts, what you tell yourself in those moments, and how you tend to respond. These patterns often become automatic, and CBT helps you slow them down, examine them, and begin to respond differently.

Understand the mind-body connection

One of the first things you’ll learn is how your thoughts, physical sensations, emotions, and behaviors are all linked. When you fear a racing heart or shortness of breath, your thoughts can escalate that fear—leading to more physical symptoms, and reinforcing the belief that something is dangerously wrong. CBT breaks that loop by helping you recognize what’s happening in real time and choose new, more helpful responses.

Shift catastrophic thinking

Panic thrives on the worst-case-scenario thinking, “I’m going to pass out,” “I’ll have a heart attack,” or “Everyone will see me lose control.” In CBT, you’ll practice identifying those automatic thoughts and challenging them with evidence. What’s the actual likelihood you’ll faint in the middle of the grocery store? Have you ever passed out before during a panic attack? What happened instead? With guided practice, these beliefs begin to soften, making space for more accurate and less fear-driven interpretations.

Engage in structured exposure work

Avoidance feeds panic. That’s why CBT includes exposure therapy. The process is gradual, planned, and always paced to what feels manageable for you. Together with your therapist, you begin by practicing small steps that help retrain your brain to understand, “This isn’t dangerous. I can handle this.” Over time, this approach helps you rebuild a sense of safety in the places and situations you have been avoiding.

A key part of exposure therapy for panic is something called interoceptive exposure, which focuses on feared body sensations rather than external situations alone. Many people with panic disorder become highly sensitive to physical feelings like a racing heart, dizziness, or shortness of breath. In therapy, we intentionally and safely recreate these sensations in session—through brief exercises such as jogging in place, spinning in a chair, or breathing through a straw. By bringing on these sensations in a controlled setting, you learn that they are uncomfortable but not harmful, and that they pass on their own.

Combining interoceptive exposure with real-world practice helps reduce both the fear of bodily sensations and the fear of environments where panic has occurred. This dual approach breaks the cycle of avoidance and panic, and gives you the confidence to re-engage with daily life.

Reduce safety behaviors

CBT also targets the subtle behaviors like carrying water, sitting near exits, or only going out with a friend that may seem helpful, but actually keep fear alive. By gently letting go of these habits, you’ll discover that it’s you who kept yourself safe all along, not the water bottle, or the backup plan, or the escape route.

Build real distress tolerance

Perhaps most importantly, CBT helps you grow your capacity to tolerate discomfort. Not by avoiding it, but by practicing it. You’ll learn how to stay grounded in moments of rising panic, how to ride the wave instead of trying to fight it, and how to recover more quickly when anxiety does spike. This is what turns temporary symptom relief into lasting, internalized change.

CBT is not just about talking through your fears, it’s about doing something different with them. It’s collaborative, meaning you and your therapist work as a team to make decisions and measure progress together. And it’s structured, with clear goals and practical tools you’ll use both inside and outside of sessions. Over time, CBT helps you become more than just someone managing panic, you become someone who feels confident, capable, and in charge of your own life again.

Dialectal Behavior Therapy (DBT)

While CBT is typically the foundation of treatment for Panic Disorder, DBT-informed care can be especially helpful when panic is layered with emotional intensity, chronic distress, or relationship struggles. If you find yourself swinging between emotional extremes, feeling easily overwhelmed, or stuck in self-criticism, DBT can offer added tools to help you regulate your nervous system and stay grounded during moments of internal chaos.

DBT focuses on building four key skills: mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. In the context of Panic Disorder, that might mean learning how to calm yourself during a surge of anxiety, accept discomfort without judgment, or navigate conflict without fear spiraling into panic. These are practical, learnable skills that support not just panic recovery, but emotional stability in everyday life.

Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) is a powerful treatment for Panic Disorder, especially when trying to get rid of fear hasn’t worked. Instead of fighting panic, ACT helps you shift your relationship with it, so it no longer dictates what you can or can’t do.

At its core, ACT teaches you how to make space for discomfort without letting it steer your life. You’ll learn to notice anxious thoughts without getting pulled into them, to accept body sensations without spiraling, and to take meaningful action even when fear is present.

A key part of ACT is values-based living, which means identifying what matters most to you and using that as your guide. Whether it’s connection, creativity, or independence, your values become the compass that keeps you moving forward, even when anxiety shows up.

Rather than chasing calm or certainty, ACT helps you build psychological flexibility: the ability to stay grounded, take action, and live with purpose, even when panic comes along for the ride.

Medication Support

While therapy alone is highly effective for many people with panic disorder, some clients benefit from adding medication to their treatment, especially when panic attacks are severe, frequent, or tied to other mental health concerns like depression, PTSD, or chronic insomnia. However, fast-acting medications like benzodiazepines are not recommended for long-term use with panic disorder.

At CBTAA, we don’t prescribe in-house, but we work closely with trusted psychiatrists and primary care providers to ensure your care is well-coordinated. If medication feels appropriate, your therapist can help guide that conversation, connect you with a prescriber, and integrate any pharmacological treatment into your broader therapy plan. Whether or not you choose to pursue medication, you’ll have a team that’s aligned, communicative, and focused on your long-term well-being.

The good news is that the majority of people are able to overcome panic disorder without needing long-term medication. With the right therapy, including CBT and interoceptive exposure, we can help you build up a consistent practice of new skills. Lasting change is not only possible, it’s common.

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What to Expect in Panic Disorder Therapy

Treatment starts with a collaborative, therapeutic assessment. In your first few sessions, your therapist will take time to understand how panic shows up in your life i.e. what triggers it, what situations you avoid, and how it’s affecting your day-to-day functioning. You’ll talk about your goals for therapy and begin learning how the panic cycle works. Even early on, your therapist may introduce small interventions to help you feel more grounded and in control.

As therapy progresses, you’ll begin building a toolkit to shift how you respond to fear. This includes identifying and challenging distorted thoughts, practicing exposure strategies, developing emotion regulation skills, and gradually reducing safety behaviors. You’ll work closely with your therapist to understand your personal triggers and experiment with new ways of responding to panic, both in and out of session. Over time, these strategies help reduce the intensity and frequency of panic, and increase your confidence in handling discomfort.

Eventually, the focus turns to maintaining progress and fully reclaiming your life. You’ll prepare for potential setbacks by developing a relapse prevention plan and identifying the signs that anxiety may be creeping back in. This phase is also about building long-term resilience, continuing to practice your skills, revisiting values that guide your choices, and strengthening your sense of safety in your own body. The goal isn’t to eliminate anxiety completely, but to help you live with more freedom, self-trust, and a deep belief in your ability to face whatever comes next.

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When to Consider Seeking Help for Panic

You don’t need to hit a crisis point to start therapy. In fact, the earlier you seek support, the easier it can be to interrupt the cycle of fear and avoidance. That said, it’s never too late to make a change. Many people live with panic for years before realizing help is available—and effective.

You might benefit from therapy for Panic Disorder if:

• You’ve experienced one or more panic attacks and now live in fear of the next one. That constant anticipation can be just as distressing as the attack itself.
  
  
• You’ve started avoiding places, situations, or activities like driving, going to the gym, traveling, or even being alone because of fear.
  
  
• You feel hyperaware of your body, constantly scanning for signs that another attack is coming.
  
  
• You rely on safety behaviors or rituals (like carrying water, sitting near exits, or only going out with someone you trust) to feel “just okay.”
  
  
• Panic is interfering with your relationships, work, or sense of independence. Life starts to feel smaller, and more controlled by fear.
  
  
• You feel stuck, ashamed, or confused about what’s happening, and nothing you’ve tried has really helped.

If any of this sounds familiar, therapy can help. Panic Disorder is treatable with the right tools and support, you can learn to move through fear rather than around it, and begin living with more ease and confidence again.

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Get Started with CBTAA for Panic Disorder

If panic is making your world feel smaller, therapy can help you reclaim it. At CBTAA, we specialize in evidence-based treatments for Panic Disorder, including Cognitive Behavioral Therapy (CBT), Exposure Therapy, ACT, and DBT-informed care. Whether your symptoms are new or something you’ve lived with for years, we meet you where you are, with compassion, structure, and a treatment plan tailored to your needs.

Our clinicians are highly trained, collaborative, and focused on helping you build skills that last. From your first session, we’ll work together to understand your experience, interrupt the panic cycle, and help you move toward greater confidence and freedom.

We offer in-person therapy across New York City, New York, New Jersey, and Connecticut, as well as HIPAA-compliant virtual sessions for flexible access to care.

Book a free 15-minute consultation with one of our Clinical Coordinators to get matched with a therapist who’s right for you.