Before we go into panic disorder, it’s important that we go over what panic attacks are. These are usually brief episodes of very intense anxiety that are characterized by four or more of the following symptoms: palpitations or racing heart, sweating, trembling or shaking, shortness of breath, sensation of choking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady, lighthearted or faint, feelings of unreality (derealization) or being detached from oneself (depersonalization), fear of losing control or going crazy, fear of dying, numbness or tingling sensations, chills or hot flashes.

Panic attacks can be “cued” or “uncued.” A cued panic attack is one we experience when we encounter an object, situation, person, or thought that makes us particularly anxious. So, for example, someone with social anxiety disorder might experience a panic attack while going to a birthday party. Or someone who’s terrified of spiders might have one when they find an 8-legged creature in their shower.

Uncued panic attacks, on the other hand, happen “out of the blue” and are, by definition, impossible to predict. If you experience this type of unannounced panic attacks, you might begin to worry about when you will have the next one. In other words, you might get anxious about when you might feel physical anxiety or panicky again. And you might start engaging in all kinds of avoidant behaviors in order to prevent or avoid the panic attacks. When the worries and avoidant behaviors become too frequent and interfere with your day-to-day life, this becomes panic disorder.

If you have panic disorder you might try to avoid or modify situations that trigger your anxiety. A very common response is to avoid places where previous panic attacks occurred. Some people might avoid going to certain places, or consuming certain foods, or being alone. These techniques might offer relief in the short term, but over time, they make the anxiety worse and lead to more avoidance, which, in turn, increases the anxiety even further. You might begin to avoid more and more situations and end up living a very restricted life. Taken to an extreme, this can lead to agoraphobia, which basically consists of being confined to one’s home or specific places.

The good news is that panic disorder is a very treatable condition. Cognitive behavioral therapy (CBT) has been shown to be extremely effective. It consists of learning how to think differently about panic attacks and those situations that are the source of anxiety. For example, “How likely is it that this panic attack will never end?” “What is the worst that could happen?” “What would you tell a friend in this situation?” The key is to remember that, even though panic attacks are quite unpleasant (and can be terrifying), they tend to be relatively short lived and will soon be over.

In addition, CBT teaches you to embrace uncertainty – to be ok with the fact that panic attacks cannot be predicted. This is, of course, very difficult to do, but the more that you can get into this mindset, the less anxiety you will feel and the more in control you’ll be. In other words, these cognitive techniques can help turn the vicious cycle of anxiety and avoidance into a virtuous one of openness, courage, and strength.

Further, CBT for panic disorder consists of conducting exposure exercises, where you might put yourself in anxiety-provoking situations. One type of exposure is called "interoceptive exposure" and it entails allowing yourself to experience panic-type sensations in order to learn that they are not as dangerous or catastrophic as you might think. This can be achieved through breathing through a straw or doing jumping jacks, for example (please always do this under the supervision of a mental health professional). The second type of exposure is the situational type, and it entails going into situations that you tend to avoid to learn that they are not systematically causing the panic attacks. Combined with the cognitive strategies, these behavioral exercises can be very useful in helping you overcome panic disorder.

I have spent most of my academic and clinical career working with clients with panic disorder. I received my Ph.D. in Clinical Psychology from Yale University, where I e trained extensively on exposure therapy for panic disorder. I conducted further training at Weill Cornell Medical School / New York Presbyterian Hospital. I currently teach CBT to graduate students at Columbia University and Yeshiva University and to psychiatry residents at Mount Sinai Hospital. I have also written over 60 peer-reviewed articles on anxiety, OCD, rumination, and worry (for the full list of my academic publications, please go here). I currently write articles for Psychology Today, including “The 60-Second Approach to Managing Emotions” which has tips for managing panic attacks.

If you’re interested in learning more about CBT for panic disorder, please get in touch!