Why Panic Attacks Feel So Scary and How Cognitive Behavioral Therapy Helps You Reclaim Control
Panic attacks can feel terrifying! Sudden, overwhelming, and out of your control. Your heart races, your chest tightens, your breath feels shallow, and your mind floods with scary thoughts like “I’m going to pass out”, “I’m dying”, or “I must be having a heart attack and need to get to the emergency room ASAP”. While panic attacks are not actually dangerous, the sensations feel so real and so intense that it’s hard to believe you’re safe in the moment.
If you’ve ever experienced one, you know that it’s not just physical. It’s emotional, mental, and often deeply confusing. You may find yourself constantly worried about when the next one will happen or start avoiding certain situations “just in case”. Over time, this fear of having another attack can start to shrink your world, a pattern that’s at the core of panic disorder among other anxiety disorders.
What’s Actually Happening During a Panic Attack
Panic attacks are the body’s “fight or flight” response firing at the wrong time. It’s like a faulty smoke alarm, where the wiring has been crossed and it now goes off when there is no threat of an actual fire. Sounds inefficient, right? Of course, I would want my smoke alarm to go off loudly if a fire started in my house in the middle of the night. But do I want it to go off when I am making waffles in the morning and my waffle iron is releasing some harmless steam? Absolutely not!
The fight-or-flight system that gets activated in a panic attack is the same system that would help you run from danger, except with panic attacks, there’s no real danger present. The brain misinterprets a normal sensation (like a flutter in your chest or shortness of breath) as a sign of threat, and your body instantly reacts.
Adrenaline surges, heart rate increases, breathing speeds up, and muscles tense. These changes are meant to help you survive, but when they happen unexpectedly, they can feel alarming, scary, and catastrophic. The more you focus on them, the more your body reacts as if you’re in a life threatening situation, creating a feedback loop that can make the panic feel unbearable.
Why It Feels Like You’re Dying
The physical symptoms of panic mimic what we associate with serious medical emergencies. A pounding heart can feel like a heart attack. Dizziness can feel like you’re about to faint. Shortness of breath can make you fear you’re suffocating. It’s no wonder why it’s common for people to often end up in the emergency room after their first attack.
What’s important to understand is that panic attacks are false alarms. The sensations are real, but they’re not signs of danger. They are just normal fluctuations in your body. Your body is safe. The panic system has simply learned to misfire.
How Fear of Panic Keeps the Cycle Going
After a first panic attack, many people start to fear the sensations themselves. You might think, “What if it happens again while I’m driving?” or “What if I pass out in public?” This fear leads to avoidance like skipping activities, staying close to home, always keeping “safety” items nearby, or only going certain places if a trusted support person comes with you. We call these safety behaviors.
While avoidance or the use of safety behaviors works in the short term (it temporarily makes your anxiety go down!), they actually strengthen the cycle of panic over time. Each time you avoid a situation, your brain learns,“this situation must really be dangerous, good thing I didn’t do it, avoiding it keeps me safe”. Over time, the more you avoid, panic becomes more likely, not less, and you feel like there is less and less you can do. This is when many people report that it feels like their world is shrinking.
How Therapy Helps You Reclaim Control
Cognitive Behavioral Therapy (CBT) is the gold standard treatment for panic disorder. CBT helps you understand what’s happening in your body and teaches you new ways to respond so panic no longer controls your life.
In therapy, we start by breaking down the panic cycle by first identifying what triggers panic, how you interpret different physical sensations, and the behaviors that maintain it. After that, you’ll learn tools to challenge catastrophic thoughts and gradually face the sensations and situations you’ve been avoiding.
One powerful CBT tool that we use to treat panic disorder is called interoceptive exposure. It involves intentionally bringing on physical sensations that you may experience during a panic attack in a safe and controlled environment at first, like the therapy room. For example, you might spin in a chair to feel dizzy or run in place to feel your heart race. By doing this repeatedly, your brain learns that these sensations are uncomfortable, but not dangerous. Over time, the sensations lose their power to trigger panic and you’ll start to recognize them as normal fluctuations in your body and not catastrophic symptoms.
What Recovery Looks Like
Making progress in therapy doesn’t mean you’ll never feel anxious again. Progress may mean that when anxiety shows up, it no longer dictates your choices. You may learn that you can feel anxious and still make it to that concert you’ve been wanting to go to. Or, something in your chest feels “not just right” and you can still go on that date with your spouse you’ve been waiting for all week. You’ll learn to recognize the early signs of panic, allow the physical sensations to come and go, and move forward with your day anyway. And just like that, rather than shrinking, you may feel like your life is finally expanding again.
At the Center for Anxiety & Behavior Therapy, our clinicians specialize in evidence-based treatment for panic disorder. We help our clients understand what’s happening in their bodies, face the fears that keep the panic cycle going, and build lasting confidence in their ability to cope.
If panic attacks have started to limit your life, CBT can help you take that control back and learn to trust your body again. If you’re ready to begin, reach out to our team at CABT. We’re here to help you take the first step toward lasting relief.