Therapy for panic attacks
Your heart is pounding so hard you're certain it will give out. You can't breathe, or you're breathing too fast, gasping for air that won't come. Your vision narrows. Your hands tingle and go numb. Waves of terror crash over you, and you're absolutely convinced you're dying right now. Then, as suddenly as it started, it passes. You're exhausted, shaken, and terrified it will happen again.
What panic attacks actually are
A panic attack is a sudden surge of intense fear that creates powerful physical symptoms even when there is no real danger. Your alarm system fires at full strength for no clear reason. The peak often lasts about ten minutes, and the lingering effects can stay with you for hours.
What happens during a panic attack
The physical sensations are overwhelming. Your heart races, your chest may feel tight, and you might struggle to catch your breath. Many people go to the emergency room the first time because the symptoms feel like a heart attack. You may feel dizzy, lightheaded, shaky, sweaty, or chilled. Nausea, stomach distress, and tingling in the hands, feet, or face are also common.
The mental experience is just as intense. You may feel disconnected from your surroundings or from yourself. Fear takes over, including fear of dying or losing control. Some people feel a powerful sense that something terrible is about to happen.
According toCAMH, panic disorder develops when these attacks happen repeatedly and you become worried about having more or start avoiding things out of fear. Not everyone with panic attacks develops panic disorder, but the fear of future attacks often becomes its own cycle.
Why panic attacks happen
Sometimes there is a clear trigger such as crowds, enclosed spaces, or driving. Other times the attack appears without warning while you are doing something ordinary. This unpredictability makes them even more frightening.
The real cause is the fight or flight system activating when it should not. Your brain misreads normal sensations as danger. This can be influenced by stress, poor sleep, caffeine, genetics, or learned fear responses. A first attack during a stressful time can make your brain hypersensitive to similar sensations, which creates more attacks. Worrying about panic can even trigger panic, creating a loop that feels hard to escape.
How common are panic attacks?
Research from the Public Health Agency of Canada shows panic attacks are incredibly common. Many people have one or two panic attacks in their lifetime and never have another. But for those who develop panic disorder, the condition can be debilitating without treatment. The good news? Treatment works remarkably well for panic attacks.
How panic attacks take over your life
The fear of fear
After a few panic attacks, you begin to fear the next one. You watch your body closely and react to any small sensation as a warning sign. A warm feeling or a slightly faster heartbeat can send you into alarm. This constant monitoring increases anxiety and leads you to avoid places or situations that feel risky. Over time, this avoidance makes your world smaller.
Agoraphobia and avoidance
Many people develop agoraphobia, which is the fear of being somewhere you cannot easily escape if a panic attack hits. You may avoid grocery stores, transit, highways, theatres, or crowded spaces. Some people stop leaving home. You choose seats near exits and turn down invitations or opportunities. These choices feel protective, but they actually keep the panic cycle going.
Relationships and independence
You may rely on others to go places with you, which strains relationships and creates guilt or frustration. Friends may stop inviting you out. Work becomes difficult if panic or avoidance interferes. Everyday tasks like shopping or school pickups feel overwhelming. Over time, your independence fades and you can feel trapped in your own life.
How therapy stops panic attacks
Why therapy works so well for panic
Panic attacks often improve quickly with therapy because they come from a specific misinterpretation of normal sensations. Once you learn what is actually happening in your body and understand that the feelings are intense but not dangerous, the fear starts to lose its power. Therapy teaches you to stop fighting the sensations, which helps them pass more quickly. With practice and guided exposure, you build confidence that you can handle panic without avoiding life. For many people, this leads to a major reduction in panic attacks.
Treatment approaches
Cognitive behavioural therapy (CBT) for panic
CBT is the gold standard treatment for panic disorder. According to research in multiple clinical trials, CBT produces significant improvement in most people with panic disorder. You learn to identify catastrophic thoughts ("I'm having a heart attack") and replace them with accurate ones ("This is panic, it's uncomfortable but not dangerous"). You practice breathing techniques and other coping skills. Most importantly, you do exposure exercises.
Interoceptive exposure
This is the most powerful technique for panic attacks. You deliberately trigger panic symptoms in therapy sessions: hyperventilating to feel breathless and dizzy, spinning to feel disoriented, running in place to increase heart rate, breathing through a straw to feel short of breath. Sounds terrifying, right? But here's what happens: you learn these sensations are uncomfortable but safe. Your brain stops interpreting them as dangerous. Over time, naturally occurring sensations no longer trigger panic because you're no longer afraid of them.
Situational exposure
You gradually face situations you've been avoiding because of panic. If you avoid grocery stores, you might start by driving to the parking lot, then walking to the entrance, then going inside for five minutes, eventually working up to a full shopping trip. The key is staying in the situation long enough for your anxiety to peak and then decrease naturally, teaching your brain that the situation is safe. Your therapist helps you create a hierarchy of feared situations and work through them systematically.
Panic-focused psychodynamic therapy
For some people, especially those who don't respond well to CBT, exploring the emotional meanings and unconscious conflicts underlying panic can be helpful. This approach looks at what panic might represent emotionally and addresses those underlying issues. It's less commonly used than CBT but can be effective, particularly when panic is related to unresolved trauma or attachment issues.
What to expect from therapy for panic attacks
Assessment and education
Your therapist starts by understanding your panic pattern. When the attacks began, how often they happen, what triggers them, what you avoid, and what you fear during an attack. This helps identify the cycle that keeps panic going.
Education comes next and often brings quick relief. You learn what panic attacks actually are, why the physical symptoms happen, and why they are not dangerous. Understanding the fight or flight response and seeing how adrenaline and breathing changes create the sensations helps reduce fear. Many people feel calmer just from learning how their body works.
Skills and exposure
You learn breathing techniques to manage hyperventilation and cognitive tools to challenge catastrophic thoughts. The main change happens through exposure. Your therapist guides you through exercises that recreate the sensations you fear, such as spinning or controlled hyperventilation, so you can learn they are safe.
Between sessions, you practise at home and gradually face avoided situations. This may include short trips to the store or brief drives on the highway. Exposures are planned with your therapist so they are difficult enough to create progress but still manageable.
Timeline for improvement
Many people notice fewer attacks within four to six weeks. By twelve weeks, most have either stopped having panic attacks or experience them far less often and with less intensity. More time may be needed when avoidance or agoraphobia is present, but panic disorder usually responds very well to treatment.
Even if you still have the occasional attack, your response to it changes. You understand what is happening and know you can handle it. Once the fear fades, attacks often stop entirely because the cycle is no longer being reinforced.
Find a therapist who specializes in panic attacks
Choosing the right therapist matters. Each province in Canada has its own regulations, which is why working with a recognized professional can make a real difference in your care. Stellocare takes the uncertainty out of the process by listing only verified therapists you can trust.
The right therapist for you
No therapists found with these specialties in Ontario.
Try selecting a different province.Resources and strategies for panic attacks
Canadian resources
Anxiety Canada – Self-Help Strategies for Panic Disorder
Anxiety Canada offers a free downloadable guide titled “Self-Help Strategies for Panic Disorder” that explains what panic attacks are, how they develop and includes CBT-based tools (e.g., calm breathing, exposure exercises).Visit Anxiety Canada guide
Canadian Mental Health Association – BounceBack®
CMHA’s BounceBack® is a free skill-building CBT-based program available across Canada for anxiety, worry and stress (including panic symptoms). It provides self-guided modules and telephone coaching in many provinces.Visit BounceBack® program
Ontario Shores Centre for Mental Health Sciences – Ontario Structured Psychotherapy (OSP)
The OSP program offers publicly-funded, evidence-based CBT and related therapy for adults in Ontario with anxiety-related conditions (including unexpected panic attacks and agoraphobic fears).Visit OSP program
MindBeacon – Digital CBT for Anxiety & Panic
MindBeacon offers guided digital CBT programs for Canadians dealing with anxiety and panic attacks. It includes therapist-guided modules, messaging support and is accessible online at flexible times.Visit MindBeacon
British Columbia Ministry of Mental Health and Addictions – Help Starts Here: Panic Attacks
This provincial resource provides accessible information about panic attacks, how they manifest, how to help someone during a panic attack and links to local supports for residents of British Columbia.Visit Help Starts Here (BC)
What to do during and after panic attacks
During a panic attack
- Remember it will pass: Panic attacks always end. Usually within 10 minutes, rarely longer than 30. You've survived every previous panic attack. You'll survive this one.
- Don't fight it: Trying to stop panic makes it worse. Instead, acknowledge "I'm having a panic attack. This is uncomfortable but not dangerous."
- Slow your breathing: Not to stop the panic, but to reduce hyperventilation. Breathe in for 4 counts, hold for 4, out for 6. Repeat.
- Stay where you are if possible: Running away or escaping teaches your brain the situation was dangerous, making future panic more likely.
- Focus outward: Name things you see around you. Feel your feet on the ground. Touch something and notice its texture. This grounds you in the present.
After a panic attack
- Be kind to yourself: Panic attacks are exhausting. Rest if you need to. Don't beat yourself up.
- Don't change your plans: If you were supposed to go somewhere after, still go if possible. Avoiding teaches fear.
- Analyze without catastrophizing: What triggered it? What were you thinking? This information helps you understand patterns, but don't spiral into "what if" thinking.
- Don't seek excessive reassurance: Calling multiple people to reassure you that you're okay maintains anxiety. One quick check is fine, but then move on.
Preventing panic attacks
- Reduce caffeine: Caffeine mimics panic symptoms and can trigger attacks. Try cutting back or eliminating it.
- Maintain sleep: Sleep deprivation makes you more vulnerable to panic. Prioritize consistent sleep.
- Exercise regularly: This seems counterintuitive because exercise increases heart rate, but regular exercise actually reduces panic frequency. Your body gets used to elevated heart rate in safe contexts.
- Stop avoiding: Every situation you avoid because of panic makes panic worse. Gradually face feared situations.
- Practice interoceptive exposure: Regularly trigger panic sensations on purpose (spin around, breathe through a straw, run in place) to reduce sensitivity to them.
What NOT to do
- Don't constantly monitor your body: This hypervigilance makes you more likely to notice and misinterpret normal sensations.
- Don't research panic attacks obsessively: A little education is helpful. Constant googling of symptoms feeds anxiety.
- Don't rely on safety behaviours: Always carrying medication "just in case," always having someone with you, always sitting near exits. These maintain panic.
- Don't use alcohol to cope: It might seem to help short-term but worsens anxiety overall and can lead to dependence.
Dare app (specifically designed for panic disorder), MindShift CBT from Anxiety Canada, Rootd (panic attack relief), and Calm or Headspace for breathing exercises and meditation.
Questions about panic attacks and treatment
How do I know it's a panic attack and not a heart attack?
If you haven't had cardiac evaluation and you're concerned, see a doctor. Chest pain should be checked out. That said, panic attack symptoms differ from heart attacks in important ways. Panic typically comes on suddenly at rest, peaks quickly, and resolves within 30 minutes. Heart attack pain is usually constant and worsening, often radiating to the arm or jaw. Panic causes tingling, numbness, and hyperventilation symptoms that heart attacks don't. After you've been medically cleared once, trust that future episodes with the same pattern are panic, not cardiac events.
Can panic attacks kill you or cause a heart attack?
No. This is the most important thing to understand. Panic attacks cannot kill you, cannot cause heart attacks, cannot cause strokes, cannot make you stop breathing, cannot make you faint (usually), and cannot make you go crazy or lose control. The sensations feel life threatening, but they're caused by adrenaline and hyperventilation, both of which are uncomfortable but not dangerous. Your heart is designed to handle much higher rates during exercise than what occurs during panic.
What if exposure therapy makes my panic worse?
Anxiety temporarily increases during exposure work. That's expected and necessary. However, properly done exposure is gradual and manageable. You work with your therapist to create a hierarchy from least to most feared, and you move at a pace that's challenging but not overwhelming. The anxiety during exposure should be tolerable (maybe 6 or 7 out of 10), not unbearable. If exposure consistently makes things worse, talk to your therapist about adjusting the approach.
Will I always have panic disorder?
Most people who complete treatment for panic disorder either stop having attacks entirely or have them so infrequently they're not a significant problem. Some people have occasional panic attacks during high stress but know how to manage them. Relapse can happen, especially during major life stressors, but the skills you learn in therapy stay with you. Many people consider themselves "recovered" from panic disorder even if they occasionally have mild symptoms, because they're no longer afraid or impaired by them.
Should I go to the ER during a panic attack?
If this is your first severe episode with chest pain and you're unsure what's happening, yes, seek medical care. Better safe than sorry. But once you've been medically evaluated and know you have panic disorder, going to the ER for future attacks is usually counterproductive. It reinforces that panic is dangerous and needs emergency intervention. Instead, use coping skills and remember that panic passes on its own. If you're unable to manage panic attacks outside of ER settings, you need immediate connection to mental health treatment.
Can children have panic attacks?
Yes, though they're less common in young children. Adolescents can definitely experience panic attacks. Children might describe symptoms differently or not understand what's happening. If your child has sudden episodes of intense fear with physical symptoms, consult a pediatrician and child psychologist. Treatment for children is similar to adult treatment but adapted for developmental level.
Related concerns
References
- Centre for Addiction and Mental Health (CAMH). (2024). Panic Disorder. Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/panic-disorder
- Public Health Agency of Canada. (2024). Mental Illness in Canada. Retrieved from https://www.canada.ca/en/public-health/services/chronic-diseases/mental-illness.html
- Anxiety Canada. (2024). Panic Disorder Resources. Retrieved from https://www.anxietycanada.com/
- Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 283(19), 2529-2536.
- Craske, M. G., & Barlow, D. H. (2022). Mastery of your anxiety and panic: Therapist guide. Oxford University Press.
- Otto, M. W., Pollack, M. H., & Maki, K. M. (2000). Empirically supported treatments for panic disorder: costs, benefits, and stepped care. Journal of Consulting and Clinical Psychology, 68(4), 556-563.
- Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337-346. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610618/
- Meuret, A. E., Wolitzky-Taylor, K. B., Twohig, M. P., & Craske, M. G. (2012). Coping skills and exposure therapy in panic disorder and agoraphobia: latest advances and future directions. Behavior Therapy, 43(2), 271-284.
- Roy-Byrne, P. P., Craske, M. G., & Stein, M. B. (2006). Panic disorder. The Lancet, 368(9540), 1023-1032.
- Sanchez-Meca, J., Rosa-Alcazar, A. I., Marin-Martinez, F., & Gomez-Conesa, A. (2010). Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis. Clinical Psychology Review, 30(1), 37-50.
- Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J., Santiago, H., Storey, J., Koselka, M., & Cook, J. (2000). Dismantling cognitive-behavioral treatment for panic disorder: Questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68(3), 417-424.
- Telch, M. J., Lucas, J. A., Schmidt, N. B., Hanna, H. H., LaNae Jaimez, T., & Lucas, R. A. (1993). Group cognitive-behavioral treatment of panic disorder. Behaviour Research and Therapy, 31(3), 279-287.
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Abby Molloy
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Victoria Jacobs
Registered Psychotherapist (ON)
Melodi Laframboise
Registered Psychotherapist (ON)
Penelope Waller Ulmer
Registered Psychologist (AB)
Daniella Sanchez
Registered Social Worker (ON)
Florence Wong
Registered Social Worker (BC)
Stefania Bonanno
Registered Social Worker (ON)
Haifa Behbahani
Registered Psychotherapist (Qualifying) (ON)
Katelyn Beveridge
Registered Psychotherapist (Qualifying) (ON)
Yuansheng Lu
Registered Psychotherapist (Qualifying) (ON)
Ravonna Littlewood
Registered Social Worker (ON)
Cindy Rose
Registered Psychotherapist (ON)
Renée LaJoie
Counselling Therapist (AB)
Peter Wong
Registered Psychotherapist (ON)
Kaycee Bevans
Registered Provisional Psychologist (AB)
Monica Pease
Registered Social Worker (ON)
Monika Goetz
Registered Social Worker (ON)
Chelsea Jackson
Registered Psychotherapist (ON)
Caitlin Pelkey
Registered Psychotherapist (Qualifying) (ON)
Asta Chan
Registered Social Worker (ON)
Abby Molloy
Registered Psychotherapist (Qualifying) (ON)
Victoria Jacobs
Registered Psychotherapist (ON)
Melodi Laframboise
Registered Psychotherapist (ON)