Panic attacks and panic disorder

A panic attack is a sudden surge of fear with physical symptoms, a racing heart, breathlessness, dizziness, chest tightness, that peaks within minutes even though it can feel endless. When attacks recur and start driving avoidance or worry about the next one, this is panic disorder. A clinical psychologist can help you understand what’s happening and break the cycle.

What panic attacks are and how they show up

A panic attack involves a rapid surge of physical symptoms: a pounding heart, shortness of breath, sweating, trembling, chest pain, dizziness or a feeling of unreality. These sensations are the body’s alarm system firing at full strength, the same fight-or-flight response that would be useful in genuine danger, but triggered when there is none. Because the physical symptoms are so intense, many people first assume something is medically wrong, and it’s common to visit A&E or a GP before a panic attack is recognised for what it is.

Panic disorder develops when attacks become recurrent and are followed by persistent worry about having another one, sometimes called anticipatory anxiety. This worry can itself trigger further attacks, creating a self-reinforcing cycle. Many people also start avoiding places or situations where previous attacks happened, public transport, crowded shops, enclosed spaces, which can gradually develop into agoraphobia if left unaddressed.

The bodily sensations of panic are often misread as a sign of physical illness, and this misreading is what tends to keep the cycle going. A racing heart gets interpreted as a heart attack, dizziness as fainting or losing control, breathlessness as suffocation. None of these outcomes actually happen during a panic attack, but the fear that they might is what makes each attack feel so alarming, and what drives the urge to avoid anywhere an attack might strike again.

Panic attacks can also occur alongside other anxiety difficulties, or as part of health anxiety, where the physical sensations themselves become a source of worry about underlying illness. Because the symptoms overlap so closely with those of a genuine medical emergency, it’s understandable that many people find their first few attacks deeply frightening and disorientating, even once they know, intellectually, that panic itself is not dangerous.

When to seek help

If panic attacks are recurring, if you find yourself constantly braced for the next one, or if avoidance is starting to limit where you go or what you do, it’s worth speaking to a psychologist. It is sensible to see a GP first to rule out any physical cause for symptoms such as chest pain or breathlessness, but once that has been checked, psychological therapy is the recommended next step. There is no need to wait until attacks have become severe or frequent before reaching out, addressing the pattern earlier tends to make treatment more straightforward.

How a clinical psychologist assesses and treats panic

Assessment looks at when attacks started, what tends to trigger them, how you interpret the physical sensations, and what you have started avoiding as a result. NICE recommends cognitive behavioural therapy (CBT) as the first-line psychological treatment for panic disorder, and it has one of the strongest evidence bases of any anxiety treatment.

CBT for panic typically works on two fronts. The first is cognitive: identifying and testing the catastrophic interpretations that often accompany physical sensations, for example believing a racing heart means a heart attack is imminent. The second is behavioural: gradually reducing avoidance and, where appropriate, using interoceptive exposure, deliberately and safely bringing on physical sensations similar to panic, such as through brief exercise, so you learn they are uncomfortable but not dangerous. Over time this breaks the link between the physical sensation and the fear response it used to trigger automatically.

What online sessions look like

Sessions run over secure video call, usually fifty minutes. Because panic disorder often involves avoidance of specific places, working from home can make certain exposure tasks more practical to plan and review, since your psychologist can talk you through an exercise before you try it in the actual setting where panic tends to strike. Between sessions you’ll typically practise agreed tasks and track how your body responded, which becomes useful evidence to work with in the next session.

You do not need any special equipment for online sessions, a private room, a laptop or phone and a reasonably stable connection is enough. Some people worry that a screen will make it harder to build a working relationship with their psychologist, but most find this settles within the first couple of sessions, and the practical benefits of not having to travel while managing an anxiety-related condition often outweigh the adjustment.

What panic-focused CBT involves week to week

Early sessions focus on understanding your personal pattern of panic: the physical sensations you notice first, the thoughts that follow, and what you do in response. Your psychologist will help you learn about the physiology of panic in detail, since accurate understanding of what is actually happening in your body is often one of the more powerful parts of treatment on its own. From there, sessions move into structured practice, testing out feared interpretations and gradually reducing avoidance, building towards situations that currently feel off-limits.

Panic and life in Islington and north London

Islington’s N1 postcodes take in Upper Street, Angel, Highbury, Canonbury and Barnsbury, with the Victoria and Northern lines running through the area. A crowded Victoria or Northern line platform is a common setting for panic attacks to strike, and the fear of having one on a commute can become as limiting as the attacks themselves. Online sessions mean you can work through this without adding travel to a clinic on top of an already demanding routine.

Getting started

Sessions are online, so there is nothing to wait for before starting. Our get started page is the quickest way in, and we will match you with a psychologist suited to your needs. You may also find our page on anxiety useful if worry is a wider pattern for you beyond the attacks themselves.