Panic

What is panic?

Panic disorder is a form of anxiety in which panic attacks, sudden surges of intense fear with physical symptoms such as a racing heart, breathlessness and dizziness, recur and lead to ongoing worry about further attacks. It can develop alone or alongside agoraphobia, where certain places or situations start to feel unsafe.

A single panic attack is not the same as panic disorder. Many adults have one or two panic attacks during a stressful period and never have another. Panic disorder is diagnosed when attacks recur and are followed by weeks of anticipatory anxiety, changes in behaviour to avoid triggering situations, or both. The attacks themselves usually peak within ten minutes, but the fear of the next one can shape daily life long after the physical symptoms have settled.

Symptoms of panic

Panic attacks bring together physical and psychological symptoms that arrive quickly and can feel frightening in themselves.

Physical symptoms

A racing or pounding heart, chest tightness, shortness of breath, sweating, trembling, nausea, dizziness or lightheadedness, tingling in the hands or face, and a sense of choking or a lump in the throat are all common. Because these symptoms overlap with medical emergencies, many people experiencing their first panic attack understandably assume something is seriously wrong physically.

Psychological symptoms

Alongside the physical surge, people often describe a fear of losing control, a fear of dying, or a feeling of being detached from their surroundings or from themselves, sometimes called derealisation or depersonalisation. Between attacks, the psychological symptoms can persist as low-level dread about when the next one will happen, and a habit of scanning the body for early warning signs.

Types of panic

Panic presents in a few recognisable patterns. Panic disorder without agoraphobia involves recurrent attacks and worry about them, without significant avoidance of places or situations. Panic disorder with agoraphobia adds avoidance, where crowded spaces, public transport, queues or being far from home start to feel unsafe because leaving quickly would be difficult or embarrassing. Isolated panic attacks can also occur as part of other anxiety presentations, such as social anxiety or health anxiety, without meeting the full criteria for panic disorder. Nocturnal panic attacks, which wake someone from sleep with the same physical symptoms, are less common but distressing in a different way, since there is no clear trigger to make sense of.

How therapy can help

Therapy for panic works by breaking the cycle that keeps attacks going, the loop where physical sensations are interpreted as dangerous, that interpretation drives more anxiety, and the anxiety produces more physical sensations. Cognitive behavioural therapy (CBT) developed specifically for panic disorder is the treatment NICE recommends first, because the evidence base for it is stronger than for other psychological approaches with this particular presentation. CBT for panic helps someone understand what is actually happening in their body during an attack, test out the catastrophic predictions that fuel the fear, and gradually reduce the avoidance and safety behaviours that keep the problem in place. Applied relaxation, which trains rapid physical relaxation skills, has also shown benefit and can sit alongside CBT techniques for some people.

Our approach

We work with adults experiencing panic attacks and panic disorder entirely online, using secure video sessions. Clinical psychologists for Greenwich and south east London, we work online with adults from Greenwich itself, Blackheath, Charlton, Deptford, Lewisham, New Cross and Maze Hill, as well as further afield, since the therapy does not depend on visiting a particular building. Each piece of work starts with a thorough assessment of how panic shows up for that person specifically: the triggers, the physical pattern, the thoughts that follow, and what has already been tried. From there we build a shared formulation and a plan using CBT techniques with the strongest evidence for panic, rather than a generic template applied to everyone. We will update this site as the practice develops.

What does panic therapy involve?

Panic-focused CBT typically combines several elements. Psychoeducation comes first, explaining the biology of the fight-or-flight response so the physical symptoms make sense rather than feeling like evidence of danger. Breathing retraining addresses the overbreathing that often accompanies panic and intensifies dizziness and tingling. Cognitive work looks closely at the specific thoughts that appear during an attack, such as fears of fainting, losing control or having a heart attack, and tests them against what actually happens. Interoceptive exposure, deliberately and safely bringing on mild versions of the physical sensations in session, such as through brief exercise or controlled breathing, helps someone learn that the sensations themselves are uncomfortable rather than dangerous. Where agoraphobia has developed, gradual exposure to avoided situations is built in step by step, at a pace agreed together. Sessions are collaborative throughout: homework between sessions, reviewing what happened, and adjusting the plan as things change.

When to seek help

If chest pain, breathlessness or a racing heart appear for the first time, particularly alongside pain spreading to the arm or jaw, seek urgent medical assessment to rule out a physical cause before assuming it is panic. Once a doctor has confirmed there is no underlying physical condition, psychological therapy is the next sensible step if attacks continue or start to limit daily life. It is also worth seeking support sooner rather than later if avoidance is building, for example turning down plans, changing routes, or relying on someone else to accompany you places you used to go to alone. If you are in crisis or having thoughts of harming yourself, contact your GP, NHS 111, the Samaritans on 116 123, or attend A&E.