help-for-panic-attacks-and-panic-disorder

Understanding Panic Disorder: How It Develops, What Maintains It, and How Therapy Can Help

Panic disorder involves recurrent, unexpected panic attacks and an ongoing fear of having more. A panic attack is a sudden surge of intense fear or discomfort that peaks quickly and is accompanied by strong physical sensations. For many people, panic attacks feel frightening, overwhelming, and out of control.

Over time, panic disorder can lead people to restrict their lives in an effort to prevent future attacks. Understanding how panic disorder develops and what keeps it going is an important step toward recovery.

What Is Panic Disorder?

Panic disorder is characterized by repeated panic attacks followed by persistent worry about additional attacks or their consequences (such as losing control, having a heart attack, or fainting).

Common symptoms during a panic attack include:
• Rapid heart rate or chest tightness
• Shortness of breath or choking sensations
• Dizziness, lightheadedness, or feeling faint
• Sweating, shaking, or trembling
• Nausea or stomach discomfort
• Feelings of unreality or detachment
• Fear of dying, losing control, or “going crazy”

Panic attacks are not dangerous, but they feel dangerous. Panic disorder develops when these sensations become feared and avoided.

How Panic Disorder Develops

Panic disorder often begins with an initial panic attack that feels unexpected and alarming. This first experience may occur during a period of stress, illness, exhaustion, or emotional overload, or it may seem to come “out of the blue.”

Afterward, people may begin to:
• Closely monitor bodily sensations
• Interpret normal physical changes as signs of danger
• Worry about when the next attack will happen

This creates a cycle where fear of panic becomes a trigger for panic itself.

Past experiences can also shape vulnerability to panic disorder, including:
• Growing up in environments where physical symptoms were feared or catastrophised
• Previous medical trauma or health anxiety
• High sensitivity to bodily sensations
• Chronic stress or emotional suppression

How Panic Disorder Is Maintained

Panic disorder is maintained by a fear-of-fear cycle. The more a person tries to prevent panic, the more attention is placed on bodily sensations, increasing anxiety.

Key maintaining factors include:

• Catastrophic misinterpretation of physical sensations
• Hypervigilance to bodily changes
• Avoidance of situations associated with panic
• Safety behaviours (carrying water, sitting near exits, distraction)
• Reduced trust in the body’s ability to regulate itself

Over time, the nervous system learns that certain sensations are dangerous, even though they are part of the body’s normal stress response.

Therapeutic Approaches for Panic Disorder

Panic disorder is highly treatable. Therapy focuses on helping people change their relationship with bodily sensations, fear, and avoidance.

Cognitive Behavioural Therapy (CBT): Understanding and Interrupting the Panic Cycle

CBT helps clients understand how thoughts, physical sensations, emotions, and behaviours interact to maintain panic.

Key CBT components include:
• Identifying catastrophic thoughts about bodily sensations
• Learning how panic attacks actually work in the body
• Testing feared predictions through gradual exposure
• Reducing safety behaviours that maintain anxiety

CBT helps clients replace fear-based interpretations with more accurate and compassionate ones, restoring trust in the body.

Interoceptive Exposure: Learning That Sensations Are Safe

Interoceptive exposure is a core treatment for panic disorder. It involves intentionally bringing on feared bodily sensations in a safe, controlled way so the nervous system can learn that these sensations are uncomfortable but not dangerous.

Examples may include:
• Spinning to create dizziness
• Breathing through a straw to simulate shortness of breath
• Light exercise to increase heart rate

With repeated practice, the fear response decreases, and confidence increases. The goal is not to eliminate sensations, but to remove the fear associated with them.

Schema Therapy: Addressing Deeper Emotional Patterns

For some people, panic disorder connects to deeper schemas such as:
• Vulnerability to Harm or Illness
• Loss of Control
• Emotional Inhibition

Schema therapy helps clients understand how these patterns developed and how they influence reactions to bodily sensations and stress. Experiential techniques help update emotional memories and build a stronger sense of internal safety.

Acceptance and Commitment Therapy (ACT): Making Space for Panic While Living Fully

ACT helps people stop fighting panic and instead focus on living in alignment with their values.

ACT teaches:
• How to notice panic-related thoughts without engaging with them
• How to allow sensations to rise and fall without resistance
• How to move toward meaningful activities even when anxiety is present

As people stop avoiding panic, its intensity and impact often decrease.

Internal Family Systems (IFS): Working With Protective Parts

IFS understands panic as arising from protective parts of the system that are trying to prevent perceived danger.

These may include:
• A vigilant part scanning for bodily threats
• An alarm part that triggers panic
• An avoidant part that restricts activity

IFS therapy helps clients relate to these parts with curiosity and compassion, and to heal underlying vulnerable parts that may hold fear, helplessness, or past overwhelm.

As internal safety increases, protective parts often no longer need to activate panic responses as intensely.

Rebuilding Trust in the Body

Recovery from panic disorder involves learning that your body is not broken or dangerous. Panic is a powerful but harmless stress response, and it can be unlearned.

With the right therapeutic support, people can regain confidence, re-enter avoided situations, and move through the world with greater freedom and trust.

If panic attacks are interfering with your life, therapy can help you feel safe in your body again. Contact us today!

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