Panic Disorder Treatment
Take Back Your Life
Do you experience sudden rushes of fear that make you feel like you are dying, or about to lose control or lose your mind? You might be experiencing panic.
Panic attacks can be debilitating and exhausting. They sometimes come out of nowhere and make you feel like you’re always on edge, especially in places where the attacks have happened before.
It becomes too much to be in those places again, so they are avoided. Over time, the world just keeps getting smaller and smaller. Places that feel ‘safe’ are fewer and fewer. You are tired of feeling like you are going to die all the time. Soon, life isn’t ruled by your own values, wants, and needs; It’s ruled by fear.
Panic Disorder is incredibly treatable.
It doesn’t have to be this way. In fact, success rates for panic disorder treatment are high when using exposure therapy and cognitive-behavioral therapy (CBT) for panic.
In one study, 68% of participants with panic disorder were panic-free after 12 sessions of exposure therapy. It is not easy work, and it is also the best path to freedom. You won’t be alone; Your therapist is there to guide you, support you, and cheer you on.
Symptoms of Panic Disorder
Panic disorder is not a weakness, but a real mental illness. About 4.7% of adults have panic disorder at some point in their lives. Panic disorder is often described as “fear of fear.” It is characterized by:
Frequent panic attacks
Some of which come “out of the blue” (without a clear cause)
Persistent fear of having another panic attack
Avoidance of situations or places in an attempt to avoid further panic attacks
The avoidance may get to a point where individuals are unable to complete errands like going to the grocery store or attending a lecture. They start to shape their lives around avoiding another panic attack. Some people even develop agoraphobia, in which they are afraid to leave their home.
What Is a Panic Attack?
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), in order to be diagnosed as a panic attack, intense fear must arise suddenly and unexpectedly and reach its most intense within minutes (often less than a minute). This abrupt surge of fear can come in the midst of an otherwise calm or anxious state. Additionally, at least four of the following symptoms must be present at the same time:
Heart palpitations, pounding heart, or rapid heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or feeling unable to catch one’s breath
Feelings of choking
Chest pain, tightness, or discomfort
Nausea or stomach ache
Feeling dizzy, unsteady, light-headed, or faint
Feeling hot or cold
Numbness or tingling sensations
Derealization (feeling the world around you is not real, or like you are in a dream) or depersonalization (feeling detached from oneself, or that you are not real)
Fear of losing control or “going crazy”
Fear of dying
There is no specific requirement for how long panic attacks last, but there is a limit to how long a person’s body can keep up that much intense activation of the sympathetic nervous system.
What is the Panic Cycle in Panic Disorder?
The panic cycle describes how physical symptoms, thoughts, and behaviors interact to create panic attacks. Although clients don’t always realize it at first, panic attacks start with some kind of physical symptom. The symptom or symptoms that trigger panic attacks are different for different people, but they are related to symptoms of anxiety. For many, but not all, increased heart rate is the symptom. When a person experiences a quicker heart rate in their daily life, for whatever reason (maybe they went up a couple of flights of stairs), the person interprets that symptom as dangerous.
Often, it is the fear that they are having a heart attack. Because they are now concerned they are having a heart attack, their anxiety increases, which results in a further increase in heart rate. This further feeds into the fear that they are having a heart attack, which leads to further anxiety and further increased heart rate, and the cycle continues until they are experiencing full panic.
These thoughts are usually not consciously thought, word for word. It’s more of a broad concern. It also happens very quickly, within seconds, so most people don’t realize this cycle is even occurring. Usually, it just feels like they were fine, and then suddenly, they are having a full-blown panic attack. However, people can learn to identify what is happening by tracking their panic attacks and intentionally examining what happened.
To interrupt the panic cycle, it is helpful to notice the catastrophic interpretations you are having and re-evaluate. This can involve thinking “this is harmless” when experiencing momentary increased heart rate and then behaving in accordance with that thought. In other words, continue with whatever you were doing, without trying to seek safety, escape the situation, or get help. By doing this, you are communicating to yourself and to your body that there is no danger here, and it does not have to sound the alarm. This is a major part of CBT for panic disorder.
Two Dogs
Think of it this way: Imagine there are two dogs in front of you. One dog has a muzzle, and the other does not. Which dog are you going to be more afraid of? Probably the dog with the muzzle, because we don’t tend to put muzzles on dogs that don't bite. By putting additional safety measures in place or by trying to escape the situation you are in, you are communicating to yourself that the trigger is something to be afraid of. By acting as if you are NOT afraid of the physical symptom, you are teaching your body that everything is chill.
If you always engage in safety behaviors (like putting a muzzle on a dog), you will never learn that the trigger was safe, because you can always attribute your safety to the safety behaviors. Only by removing the safety behaviors can you learn something new (that the dog, or a little increase in heart rate) was safe all along.
Learn More About Panic Disorder
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Typically, a clinical interview is sufficient to diagnose panic disorder. With any diagnosis, it’s important to make sure there is not a different mental disorder or a medical cause for the problems. But if those things are ruled out and the client meets criteria (see the previous section), a diagnosis can usually be made. When I complete a clinical interview, I try not to just go over a checklist but also to explore what the experiences are like for them personally, to get a good sense of their individual symptoms.
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Yes, some people experience panic attacks but do not have panic disorder. Usually, those people experience panic attacks that are related to another mental disorder or medical condition. The difference is that people with panic disorder are intensely preoccupied with the fear of having another panic attack and avoid many situations in which they think a panic attack might happen. They also have to have at least some panic attacks that come “out of the blue,” when they aren’t already anxious or wouldn’t expect them.
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When panic attacks occur in the context of panic disorder, the trigger is usually a physical symptom. Part of therapy involves working to identify what the initial symptom usually is. Most people don’t know this prior to treatment because it feels like the panic attack simply goes from 0 to 100 and there isn’t a clear trigger. Assignments assist with building insight into the initial trigger for that specific person. For example, some people have panic attacks when their heart rate increases due to exercise.
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This is a common question people have, and the simple answer is no, panic disorder is not considered a disorder of psychosis. However, many people with panic disorder are afraid they will “go crazy” or have a psychotic break during a panic attack. Additionally, there are certain dissociative symptoms that some people experience during panic attacks, including derealization and depersonalization. However, dissociation is not a form of psychosis, either.
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The median age of onset for panic disorder across several countries is 32 years old. A meta-analysis (a study examining data from many different studies) revealed an average age of onset of 30.3 years. This doesn’t mean that everyone who has panic disorder develops it in their 30s. There is still a range, so people can develop it when older or younger. It is rare in childhood to early adolescence.
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Panic disorder is usually accompanied by at least one other mental illness. It’s commonly associated with other anxiety disorders (especially agoraphobia and illness anxiety disorder) and also with major depressive disorder and substance use disorders.
How Can Leap Counseling Help?
Panic disorder is, literally, terrifying. Living in fear of the next attack, avoiding more and more places and activities, and watching your life get smaller and smaller, is such a painful process. It limits your social life and makes it difficult to go out and do basic tasks. There are often many trips to the emergency room, and medical bills are racking up. Fees and expenses for getting groceries or other items delivered are expensive as well. It’s exhausting, but it doesn’t have to be this way!
Therapy for panic disorder can and does help. With me at Leap Counseling, you can expect evidence-based treatment tailored to you and your symptoms. That means that I prioritize using first-line, gold-standard treatments with decades of science backing them. I stays up to date on the latest science, but do not implement experimental treatments prematurely - not when treatments that we know work are available.
My Approach to Panic Disorder Treatment
The most effective treatment for panic disorder is cognitive-behavioral therapy (CBT). When using the right approach, panic disorder is one of the most treatable anxiety disorders. CBT for panic disorder has been shown to be effective in randomized controlled trials (RCTs; the most rigorous test of treatment efficacy), with recovery rates of 73-87%. These results have been replicated in many studies. Additionally, research has shown positive long-term effectiveness, meaning that the results persist and there are relatively low rates of relapse.
Research has also helped identify which CBT strategies are most effective for panic disorder. These include:
Interoceptive exposure: intentionally bringing about physical symptoms that are experienced during a panic attack. This may include running in place to increase heart rate or breathing through a straw to elicit a feeling of shortness of breath or chest tightness. These exposures show the body and mind that these sensations are not inherently dangerous.
Cognitive restructuring: identifying distorted or unhelpful thoughts and logically examining them before coming up with a more balanced, alternative thought.
Psychoeducation: providing education on the disorder, how it is maintained, and how and why CBT works
These strategies may sound harsh or scary. They are scary, and they are challenging. And, at the same time, they are couched in compassion, understanding, and support. You won’t be going through it alone. And the truth is, people are often much more courageous and strong than they give themselves credit for!
Treatment that focuses on trying to feel calmer is going to be second-rate. Because those strategies are just another form of avoidance of our feelings, which just feeds the anxiety over time. For example, strategies like muscle relaxation can actually impair progress when included in other CBT strategies for panic disorder. What is really needed to get better is to learn to approach those feelings that you are using all of your energy to avoid. Step by step. And in that way, it is possible to take your life back from panic.
Is Panic Disorder Treatment Right For You?
Choosing a therapist can be an intimidating process. It’s difficult to know if they can really help you or what treatments to look for. You may want to know more about the service I provide at Leap Counseling and Consultation. Here are some commonly asked questions about therapy for panic disorder:
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Cognitive-behavioral therapy (CBT) is the most effective form of treatment for panic disorder. There are specific CBT-based treatment programs for panic disorder that are backed by decades of research. These programs involve components such as exposure to unpleasant or avoided sensations, examining and challenging unhelpful thinking patterns, and overall learning how to tolerate feelings of anxiety. These strategies are then tailored to the client and their individual symptoms and needs.
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The goal of therapy is not to prevent panic attacks. “What?? Dr. Wood,” you say, “that’s the whole reason I want therapy. The panic attacks are the problem I want to address!” They are, and they aren’t. CBT has been shown to significantly decrease the frequency of panic attacks, often leading to being panic-free. However, this treatment is paradoxical in nature because anxiety disorders are paradoxical. The more people try to avoid their anxiety, to avoid or prevent panic attacks, the more anxious they become. So, treatment involves disrupting this pattern. It involves learning to approach anxiety instead of avoiding it. It does increase anxiety in the short-term. Of course it does; you are facing your fears! It’s going to be scary. But then, over time, it stops being as scary anymore. It’s not complicated, but it’s not easy. I recognize that, and I am there to help my clients through every step.
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Yes, it absolutely can! If it couldn’t, I wouldn’t do it. Research shows that telehealth is just as effective as in-person therapy, especially when therapy is CBT-based. In fact, there are some benefits to telehealth treatment. Since most clients are at home during session, we get to do the work in their typical environment, which can be very beneficial when doing exposure work. It’s just different than when we do the same exposures in a more manufactured setting.
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It usually takes about 2-3 months after starting weekly CBT sessions to see significant improvements, but it may take 6 months or more to achieve full recovery. The answer to this question depends on many factors. When there are additional mental disorders or if there are medical concerns, treatment may be more complex, require more elements, or may simply move a little slower. The length of treatment can depend on whether other conditions might need to be addressed first or at the same time. It can also vary depending on the client’s willingness to jump right into exposures or whether they need some help building that motivation first.
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People with panic disorder absolutely can recover and lead “normal” lives. Panic disorder wants to hold you back, but you don’t have to listen! Easier said than done, I know. But with support, change is possible. Panic disorder truly is so treatable. Starting treatment can feel like a huge leap of faith, but the risk is worth it. For those willing to take that risk and do the work, recovery is possible.
Ready to Begin Online Therapy for Panic Disorder in Wauwatosa, WI, and All PSYPACT States?
You don’t have to live in constant fear of the next panic attack. If panic disorder has taken hold of your life, therapy can help you get behind the wheel once again. Through evidence-based treatment, you can learn to face panic with greater confidence, break free from patterns of avoidance, and regain trust in your ability to handle difficult thoughts, feelings, and physical sensations.
Leap Counseling and Consultation is a Wisconsin-based solo therapy practice led by Dr. Johanna Wood, who specializes in panic disorder, OCD, and other anxiety disorders. Dr. Wood can treat clients in all PSYPACT states. Through personalized treatment, Dr. Wood helps clients break the cycle of panic disorder and move forward with confidence. Starting therapy is straightforward:
Contact me for a free 15-minute consultation
Meet with Dr. Wood, a panic disorder therapist in Wauwatosa, WI, for an intake session.
Start overcoming your fears and taking those steps toward the life you want to live.
Other Online Counseling Services Leap Counseling Provides in Wisconsin and Beyond
Living with panic disorder can feel isolating, but panic disorder therapy offers a path toward clarity, confidence, and lasting relief. With the right support, many people learn how to respond to feelings of anxiety in ways that allow them to live more freely and fully.
Panic disorder treatment isn’t the only therapy service offered at my Wisconsin-based online therapy practice. I understand you may have other concerns you would like to address. As a licensed online psychologist in Wisconsin and all PSYPACT states, I also provide therapy for OCD and other anxiety disorders such as agoraphobia, generalized anxiety disorder (GAD), social anxiety disorder, and phobias.
No matter where you’re starting, meaningful change is possible with compassionate, evidence-based care. Read my mental health blog to learn more about how therapy can help, and when you’re ready, reach out to schedule an appointment and take the next step toward feeling better.
Call to schedule a free 15-minute consultation