Panic disorder therapy: what works, and how to find a therapist

If panic attacks keep coming back, or worry about the next one is shrinking your life, therapy can make a huge difference. Panic disorder is one of the most treatable anxiety problems, and many people stop having panic attacks altogether.

Here’s what therapy for panic disorder involves, how medicine fits in, and how to find the right therapist.

The main treatment: CBT for panic

Cognitive behavioural therapy (CBT) is the most researched treatment for panic disorder. A large review of 72 studies found it helps, and it’s recommended by guidelines in the US and the UK.

CBT for panic usually includes:

• Learning how panic works. Understanding the fight-or-flight response and the panic loop takes away much of the fear.
• Spotting and testing scary thoughts, like “my racing heart means a heart attack”, and finding more accurate ways of seeing things.
• Interoceptive exposure. This means gently bringing on panic-like body feelings on purpose, for example by spinning in a chair, running on the spot or breathing through a straw, so your brain learns they’re safe.
• Facing avoided situations, like driving, stores or crowds, one step at a time.
• Dropping safety behaviours, like always carrying water or sitting near the exit, which keep the fear going.

The UK’s NICE guideline recommends 7 to 14 hours of CBT in total, usually over up to four months. Many people notice a difference well before the end.

Other therapies

• Guided self-help: working through a CBT-based book, course or app with regular support from a therapist. It can be a good first step.
• Acceptance and commitment therapy (ACT): helps you make room for difficult feelings while doing what matters to you.
• Applied relaxation: learning to relax your muscles quickly when anxiety rises.

What about medicine?

SSRIs and SNRIs, types of antidepressant, can reduce how often panic attacks happen. They usually take a few weeks to start working, and a doctor will talk you through side effects.

Benzodiazepines, like alprazolam or clonazepam, work quickly, but the body can get used to them, and some people become dependent. The National Institute of Mental Health notes they’re usually prescribed only for short periods, and the UK’s NICE guideline says they shouldn’t be used to treat panic disorder.

Many people do well with therapy alone. Some use therapy and medicine together. A doctor can help you decide.

How to find a therapist

1. Start with your doctor. They can refer you, and rule out physical causes of your symptoms.
2. Check your insurance. Most insurers list mental health providers covered by your plan.
3. Search a directory. In the US, the government’s FindTreatment.gov lists mental health services near you. Professional directories let you filter by issue and therapy type.
4. Look for the right training. Search for therapists who treat panic disorder or anxiety with CBT.
5. Consider online therapy. Video sessions work well for panic, and can make it easier to fit therapy into your life.
6. Ask about cost. If money is tight, ask about sliding-scale fees, or look for a community mental health center or a university training clinic.

Questions to ask a therapist

• Do you treat panic disorder often?
• Do you use CBT for panic, including exposure?
• How many sessions do you usually expect?
• What will we do between sessions?

A good therapist will be happy to answer. It’s also important that you feel comfortable with them, so it’s fine to try someone else if it doesn’t feel right.

How Breatheasy can help

Breatheasy works alongside therapy, not instead of it. Tap “I’m feeling anxious” and Luma walks you through a panic attack: rate how strong it feels, breathe slowly as your phone pulses gently, ground yourself with 5-4-3-2-1, then see how far the anxiety came down. Bite-size lessons explain how panic works, and check-ins and a journal give you something to bring to your next session. The panic button works without internet and is always free. Breatheasy is coming soon to iPhone and Android.

When to get help

Talk to a doctor if panic attacks keep happening, if you’re worrying about the next one, or if you’re avoiding things because of them. You don’t need to wait until it’s severe.

If you’re in crisis or thinking about ending your life, call or text 988, or call 911 if you’re in danger.

Sources

• Pompoli et al. (2018). Dismantling cognitive-behaviour therapy for panic disorder. Psychological Medicine.
• Generalised anxiety disorder and panic disorder in adults, NICE guideline CG113
• Panic Disorder: When Fear Overwhelms, National Institute of Mental Health
• Panic disorder, NHS