CBT for Panic Attacks & Agoraphobia (avoidance)

A panic attack is the body’s natural alarm system — thefight-flight response — going off at the wrong time. Your brain  thinks it is in danger and “sounds the alarm” when, in fact, you are completely safe.

Panic attacks feel terrible but are not dangerous. Feelings of panic — dread, pounding heart, tingling skin, shortness of breath — may be nothing more than normal fight-flight processes intended to keep you safe, not symptoms of a heart attack, stroke, or “going crazy.” Understanding this fact, that a panic attack is a false alarm, is the key to successful recovery.

Panic Disorder & Agoraphobia

Panic attacks are strong emotional events and can leave a powerful psychological impact.Worrying about having another attack, and/or avoiding places and circumstances where you believe an attack could occur, could be signs of Panic Disorder or  Panic Disorder with Agoraphobia.

Cognitive Behavior Therapy (CBT)

CBT is effective, clinically-proven treatment for panic attacks, panic disorder, and related avoidance. Studies show that CBT is as effective as medication with better long term results.  CBT strategies include:

Cognitive Restructuring

When the fight-flight response occurs, it’s natural to believe you are in true danger.  Fight -flight sensations can mimic symptoms of serious illness, such as heart attack, stroke,  or “going crazy,” and arise in situations that, while overwhelmingly safe, may hold a potential  for risk, such as riding elevators, flying, speaking in public. The belief (cognition) that you are in danger, even if you are in fact safe, can exert strong influence over your emotions: your fight-flight response will intensify, further reinforcing your catastrophic predictions, leading to greater fear and dysfunctional avoidance and escape.

CBT helps replace catastrophic cognitions with more reasonable, adaptive beliefs. When you start to feel panicky, It’s important to remind yourself that “this is a false alarm, I amnot in danger.” The goal is to develop a nurturing, coaching inner voice, to stay groundedand effectively accept and cope with panicky feelings as the fight-flight system runs its course (see “Exposure” below).


Mindfulness is the practice of accepting fight-flight sensations as they arise, in the moment, without judgment. Mindfulness helps you step back from, no longer be driven by panicky feelings, to create the emotional space to try out new, more effective responses that don’t involve avoidance and escape.  


The natural response to fear is avoidance and escape. Yet the more you attempt to avoid and escape, to suppress the fight-flight response, the stronger it becomes and the longer it lasts. This is because avoidance blocks your brain’s ability to learn that the feelings and sensations of the fight-flight response are not dangerous. Exposure is the process of allowing your emotions to play out so your brain can learn this. Once your brain learns that these feelings and sensations are not dangerous, it stops sounding the alarm, stops triggering panic.

Exposure is done gradually, starting with low to moderately stressful experiences and situations, and building “emotional muscle” with each successive step, until you can confidently take on the toughest challenges. Cognitive skills and mindfulness are practiced during exposure, to minimize discomfort and maximize success.