Panic disorder can make a person’s world smaller very quickly.
You may stop driving on highways. You may avoid stores, airplanes, crowded places, exercise, being alone, sleeping away from home, or anything else you associate with the possibility of another panic attack.
At first, the fear may be about the attack itself.
Then it becomes:
What if I have another one?
What if it happens while I am driving?
What if I cannot get out?
What if something is wrong with my body?
That is why learning how to heal from panic disorder requires much more than learning how to calm yourself during an attack.
At Kinder in the Keys, we approach panic disorder from several directions at once. The thoughts matter. The emotions matter. The body matters. The behaviors that develop around panic matter.
I often describe anxiety treatment as a triangle. Every point has to be addressed:
Learn what anxiety is and what it is not
Change the thinking patterns that continue feeding anxiety
Process the unresolved emotional pain underneath the activation
You cannot ignore one side of the triangle and expect the entire system to change.
Anxiety is elusive. If you address only one piece, it often finds another place to show up.
Most importantly, panic disorder does not have to be permanent. Recovery is possible, but it takes time for both the mind and the body to learn a different way of responding.
What Is Panic Disorder?
A panic attack is a sudden surge of intense fear or physical distress.
Symptoms may include:
Racing or pounding heart
Shortness of breath
Chest discomfort
Trembling
Dizziness
Nausea
Chills
Tingling or numbness
Feeling detached or unreal
A sense that something terrible is about to happen
Having one panic attack does not automatically mean someone has panic disorder.
Panic disorder involves repeated panic attacks along with persistent fear of future attacks or behavioral changes designed to prevent them.
That last piece is important.
The person may begin changing her life around panic.
She starts avoiding places.
She stops doing things.
She depends on another person to feel safe.
She plans escape routes.
She avoids physical sensations that remind her of panic.
That is when panic begins controlling more than a moment. It begins controlling a life.
For a broader explanation of how panic disorder differs from other conditions, our guide to common anxiety disorders explains the major differences.
Panic Disorder Is Not the Same as Generalized Anxiety Disorder
Panic disorder and generalized anxiety disorder can overlap, but they are not the same condition.
Generalized anxiety disorder is primarily based in persistent worry across many areas of life.
Panic disorder is centered more around episodes of panic, fear of the physical sensations of panic, fear of future attacks, and the avoidance that develops around them.
A woman with generalized anxiety disorder can certainly have a panic attack.
But repeated panic attacks are not what define GAD.
For this article, we are talking specifically about panic disorder.
The First Thing I Address Is “What If” Thinking
One of the first things I teach people with panic disorder is that nothing meaningful can change while they continue practicing “what if” thinking.
What if I have a panic attack?
What if I faint?
What if I lose control?
What if I get into a car accident?
What if this feeling means something terrible?
What if I cannot stop it?
The problem is not only that these thoughts are hypothetical.
The problem is that anxiety almost always chooses the negative hypothetical.
So I challenge it.
What if you don’t have a panic attack?
What if the lion is not chasing you?
What if you do not get into a car accident?
Why is the frightening possibility getting all of the attention?
An anxious mind can take one possible negative outcome and treat it as though it is the most likely, most important, and most urgent outcome.
It is still only one possibility.
Learn to Stop the Thought
You cannot stop every thought from entering your mind.
You can stop following it.
When a “what if” thought begins, I teach clients to interrupt it.
Sometimes the response needs to be very direct:
Stop.
I am not doing this.
Then redirect attention to what is actually happening right now.
Not what could happen.
Not what might happen.
Not what anxiety is inventing.
What is happening now?
I sometimes tell clients:
Your thoughts are like incorrigible children, and you let them have all of the power.
Thoughts can be loud.
They can be demanding.
They can repeat themselves.
They can insist that they deserve your attention.
That does not mean they are correct.
A thought is not evidence.
A thought is not a prediction.
A thought does not deserve authority simply because it appeared.
Use a Dump Journal
Another tool I use is what I call a dump journal.
This is not a diary that needs to be beautifully written.
It is exactly what the name implies.
Dump everything in your head onto the page.
Write down:
The worries
The guilt
The anger
The unfinished conversations
The fears
The repetitive thoughts
The frustrations
The things you do not want to forget
The things you wish you could stop thinking about
Once it is on paper, you do not have to keep rehearsing it mentally.
The goal is not to analyze every sentence.
The goal is to help the mind release some of what it has been carrying.
Panic Often Gives You a Physical Warning
Many people with panic disorder have a physical sensation before they recognize that panic is building.
It may be:
Tightness in the chest
A strange feeling in the stomach
Muscle tension
Tingling
Dizziness
Pain
Pressure
Restlessness
A change in breathing
A feeling that something is simply “off”
Then the mind interprets the sensation.
That interpretation matters.
During the height of my own panic disorder, I might feel a pain in my thigh.
The old pattern would go something like this:
My thigh hurts.
Then:
What if something is terribly wrong?
Then:
What if I have cancer?
Then my body would continue escalating.
Eventually, I learned to respond differently.
Instead of immediately turning the sensation into catastrophe, I started asking:
What am I not dealing with?
What am I upset about?
What feels unresolved?
On one occasion, I realized I felt badly about something I had said to a friend.
The solution was not to continue analyzing the pain.
The solution was to go talk to my friend and resolve what was bothering me.
That does not mean every physical symptom is emotional. New, severe, or unexplained symptoms should be medically evaluated.
But once medical concerns have been appropriately addressed, a person with panic disorder has to learn not to turn every body sensation into evidence of disaster.
Do a Body Inventory Every Morning
I teach clients to begin paying attention to the body before panic is fully underway.
One method is a morning body inventory.
Before getting out of bed, slowly notice your body.
Pay attention to:
Jaw
Neck
Shoulders
Chest
Breathing
Stomach
Arms
Hands
Legs
Feet
Ask:
What feels calm?
What does not feel calm?
Do not immediately judge the sensation.
Notice it.
If something feels activated, ask whether there is something emotionally unfinished that needs attention.
Over time, this becomes an early-warning system.
Learn to Catch the Body Before Panic Peaks
Early in panic disorder, people often say:
“It came out of nowhere.”
As recovery progresses, they may start saying:
“I can feel my body beginning to rev up.”
That change is important.
The earlier you notice activation, the more opportunity you have to respond before panic reaches full force.
Eventually, the progression may look like this:
I suddenly had a panic attack.
Then:
I noticed my body starting to rev up.
Then:
I noticed it early and stayed in calm.
That is part of healing.
You are teaching the body a new pattern before the old one completely takes over.
Deal With the Emotional Pain
Thought work is not enough by itself.
Another point of the triangle is process therapy.
When I say “deal with the emotion,” I do not mean simply naming a feeling.
I mean working through unresolved pain.
That may include:
Childhood trauma
Abuse
Grief
Shame
Guilt
Anger
Abandonment
Relationship wounds
Loss
Old experiences that still carry emotional charge
The event already happened.
Therapeutic processing means working with the memory and the emotional response in the present so the past does not continue driving the same activation.
This work should be thoughtful, individualized, and appropriately paced.
But simply avoiding every painful memory is not the same thing as healing it.
Why One Therapy Modality Is Not Enough for Everyone
I do not believe anxiety should be treated with one rigid therapeutic modality for every person.
Different methods can help process different parts of the problem.
One woman may need more cognitive work.
Another may need deeper trauma processing.
Another may need behavioral change.
Another may need relationship work.
Another may need body-based awareness.
Most need a combination.
That is why individualized treatment matters.
The person should not have to fit into the therapy.
The therapy should address the person.
Learn What Panic Is and What It Is Not
Education is another part of treatment.
Panic feels dangerous.
That does not mean the panic response itself is always dangerous.
The body is activating an alarm system.
Heart rate increases.
Breathing changes.
Muscles tighten.
Attention narrows.
The body prepares for danger.
The problem is that the alarm can activate even when there is no actual threat.
Understanding that matters.
If the person interprets every body sensation as proof that something catastrophic is happening, the fear intensifies the symptoms.
Then the symptoms create more fear.
The cycle feeds itself.
The goal becomes:
Can I feel this sensation without automatically deciding it means danger?
Breathing During a Panic Attack
During panic, breathing often becomes shallow, fast, and concentrated high in the chest.
That can make dizziness, tingling, chest tightness, and the feeling of not getting enough air worse.
Once someone is in a full attack, simply saying:
“Take a deep breath.”
may not be enough.
One position I have used clinically is very simple.
Lie on your stomach.
Fold your arms in front of you.
Rest your head on your forearms.
Many people find that this position makes slower, deeper breathing easier.
You can use the position while doing something calming, such as watching a funny movie.
The point is not to force the body.
The point is to create conditions that help the body settle.
Build a Calm Toolbox
I encourage people with panic disorder to build a literal or figurative calm toolbox.
Do this before you need it.
Your toolbox may include:
A deck of cards
A funny book
A funny movie
Crayons and a coloring book
Gardening tools
Calm music
A puzzle
A comforting object
A familiar calming activity
A written reminder of what panic is and is not
The item itself is not the important part.
The goal is to give yourself several ways to help the nervous system move toward calm.
Be Careful About Adding More Stimulation During an Attack
Some people believe they should “burn through” panic by doing intense exercise.
I strongly disagree with using high-intensity exercise as a way to force an active panic attack to end.
Regular exercise can absolutely be good for mental and physical health.
That is different from being highly activated and then deliberately increasing heart rate, breathing rate, and physical arousal even more.
When clients have disagreed with me about this, I have sometimes told them to try it and report back.
They consistently told me it made the panic feel worse.
The same principle applies to other stimulation.
If your nervous system is already highly activated, that may not be the time for aggressive music, intense action, frightening television, or horror movies.
During the height of my own panic disorder, I went to see The Silence of the Lambs.
It was a terrible choice.
It contributed to one of the worst panic attacks I remember having.
If you are choosing a movie during panic, choose something funny, familiar, and predictable.
And if possible, avoid commercials that may suddenly introduce upsetting or activating material.
What About Medication?
Some people with panic disorder have a prescribed rescue medication.
If your medical provider has prescribed one, it can be one tool in the larger toolbox and should be taken only as directed by that clinician.
I prefer that clients develop many tools rather than believing medication is the only thing standing between them and panic.
For some people, a prescribed medication may remain the last tool in the box when the other strategies have not been enough.
Medication decisions should always remain individualized and medically supervised.
I Do Not Usually Do Deep Processing During a Full Attack in a One-Hour Session
There is also an important difference between helping someone settle during panic and conducting deeper therapeutic processing while the person is fully activated.
In a standard one-hour session, I generally do not intentionally push someone through an active panic attack.
There usually is not enough time.
If you activate the panic, you need enough time to do the therapeutic work, process what emerges, and allow the nervous system to come back down.
A one-hour appointment often does not provide that.
In a longer intensive or workshop setting, where there is substantial time and support, I may work differently.
The amount of time and containment available matters.
Panic Disorder Shrinks the World
Avoidance is one of the most important patterns in panic disorder.
You have an attack while driving.
So you stop driving on highways.
Then you avoid bridges.
Then you avoid driving alone.
Then you only go somewhere if another person drives.
Every decision feels reasonable because avoiding the situation lowers anxiety.
But your world keeps getting smaller.
Eventually, life begins revolving around preventing panic.
Recovery requires reversing that process.
Do One Thing Every Day That Scares You
One principle I teach is:
Do one thing every day that scares you.
I do not mean reckless behavior.
I am not talking about driving a motorcycle 150 miles per hour down the freeway.
I mean one safe thing that anxiety has convinced you not to do.
That might mean:
Drive one exit farther
Walk into the store
Sit somewhere other than beside the exit
Go somewhere alone
Make the call
Stay at the gathering longer
Travel a little farther from home
Do an activity you have been avoiding because of panic
To someone without panic disorder, those steps may sound insignificant.
To someone whose life has become smaller and smaller, they can feel enormous.
That is why they matter.
Discomfort Is Not the Same Thing as Danger
Healing anxiety is not always comfortable.
Sometimes the healthier choice feels less familiar.
Sometimes the body tells you to run simply because something is different.
The goal is not to make yourself comfortable every second.
The goal is to learn:
I can feel uncomfortable and still be safe.
That is an important distinction.
As the person repeatedly experiences discomfort without catastrophe, the old association begins to weaken.
The world gets bigger.
Certain Thoughts Can Become Panic Triggers
Sometimes specific subjects become associated with panic.
During my own panic disorder, thinking about the size of the universe and how small I was could trigger an attack.
At that stage, continuing to dwell on that subject was not useful.
I gave myself permission to step away from it temporarily.
Later, when my nervous system was calmer and more stable, I could think about it without immediately triggering panic.
The goal is not permanent avoidance.
The goal is to eventually regain the freedom to think, feel, and live without panic determining what you are allowed to engage with.
Why Panic Can Happen During Sleep
One of the most confusing experiences is waking from sleep in a panic attack.
People often say:
“But I wasn’t even thinking about anything.”
That is exactly the point.
Once the body has spent enough time living in activation, it can become very good at returning there.
The body does not always need a conscious catastrophic thought to begin the process.
That is why panic can even occur during sleep.
We will cover nocturnal panic in more depth in a separate article, because it deserves its own discussion. If anxiety is already interfering with your sleep, our guide to how to sleep with anxiety explains additional strategies for reducing nighttime activation.
But the important message is:
A body that learned activation can also learn calm.
The Body Needs Time to Learn Calm
Panic disorder is not necessarily permanent.
Recovery can happen.
But the mind and body need time.
If the nervous system has lived in activation for months or years, it has practiced that response repeatedly.
A small sensation may send it there.
A memory may send it there.
A thought may send it there.
A conflict may send it there.
A shift during sleep may send it there.
That does not mean the body is permanently damaged.
It means it has become practiced at activation.
Healing means practicing something different.
The mind learns:
A thought is not a prediction
“What if” does not deserve control
A body sensation is not automatically danger
Anxiety can rise without determining behavior
The body learns:
Calm is safe
Activation can come down
Uncomfortable sensations can pass
It does not have to remain prepared for danger
That learning takes repetition.
What Recovery From Panic Disorder Looks Like
Recovery is usually gradual.
One day you notice:
You felt your body beginning to rev up, but the attack never came.
You had a frightening thought and let it pass.
You drove somewhere you used to avoid.
You felt a physical sensation without catastrophizing it.
You slept through the night.
You went somewhere without planning an escape.
You stayed through the discomfort.
You stopped checking your body constantly.
You stopped asking everyone for reassurance.
You realized several days had passed without thinking about panic.
That is recovery.
Panic stops being the center of your life.
When a Higher Level of Care May Help
Many people can make significant progress in outpatient treatment.
But a higher level of support may be worth considering when:
Panic attacks are frequent
Avoidance has significantly restricted life
Fear of future attacks controls daily decisions
Symptoms remain severe despite outpatient care
Panic occurs alongside trauma, depression, or other significant mental health symptoms
The person cannot consistently practice new skills in her normal environment
The nervous system remains highly activated much of the time
For women who need more structure and support, our women’s anxiety treatment center provides residential treatment in a small, individualized setting.
How Kinder in the Keys Treats Panic Disorder
At Kinder in the Keys, we do not believe one technique treats every part of panic disorder.
Treatment may include:
Thought work
Process therapy
Trauma treatment when appropriate
Education about anxiety
Body awareness
Reduction of avoidance
Behavioral change
Nervous-system regulation
Individual psychotherapy
Sleep and lifestyle support
The goal is to address the entire anxiety triangle.
If we treat only the thoughts and ignore the emotional pain, something is missing.
If we process trauma but leave “what if” thinking untouched, something is missing.
If we teach coping skills but never help the person understand her body, something is missing.
Panic disorder has to be approached from multiple angles.
Panic Disorder Does Not Have to Control Your Life
If panic disorder has been running your life for a long time, it can feel permanent.
It is not necessarily permanent.
Your body learned activation.
Your thoughts learned certain patterns.
Your behaviors learned avoidance.
All of those patterns can change.
It takes time.
It takes repetition.
It takes doing uncomfortable things.
It takes learning not to give frightening thoughts all of the power.
And it takes teaching the body, over and over again, what calm feels like.
Eventually, the question can change from:
“What if I have another panic attack?”
to:
“What if I don’t?”
And even more importantly:
“If my body starts to rev up, I know what it is. I know what to do. It does not get to decide how I live.”
If panic disorder has made your world smaller despite outpatient treatment, learn more about residential anxiety treatment for women at Kinder in the Keys.
Frequently Asked Questions
Can you heal from panic disorder?
Yes. Many people recover from panic disorder and go on to live full lives without ongoing panic attacks controlling them. Recovery is more than simply learning to manage symptoms. Over time, the mind can stop feeding catastrophic “what if” thinking, the body can become less reactive, avoidance can decrease, and the nervous system can relearn calm.
For some people, that means panic attacks become much less frequent. For others, they may stop altogether. Recovery takes time and practice, and every person’s course is different, but panic disorder does not have to be a permanent condition.
Why does panic disorder make me afraid of my own body?
Physical sensations such as a racing heart, dizziness, tingling, or changes in breathing can become associated with previous panic attacks. The person may then interpret ordinary sensations as signs that another attack is beginning, which increases fear and further activates the body.
Why does “what if” thinking make panic worse?
“What if” thinking repeatedly directs attention toward imagined negative outcomes. The anxious mind tends to rehearse the dangerous possibility while ignoring equally possible neutral outcomes. Interrupting this pattern is an important part of changing the panic cycle.
Can you prevent a panic attack before it fully starts?
Sometimes. As people become more skilled at noticing early body cues, they may recognize activation before it reaches full panic and use calming strategies sooner. This is a learned skill and does not mean every attack can always be prevented.
Why can panic attacks happen while sleeping?
The nervous system can remain sensitized even when someone is asleep. A person does not need to be consciously worrying for the body to shift into an activated state. Nocturnal panic deserves separate discussion and will be covered in another article.
Should I exercise during an active panic attack?
Regular exercise can be beneficial for overall health and anxiety management. However, high-intensity exercise during an active panic attack can increase heart rate, breathing rate, and other sensations that some people already fear during panic. Individual strategies should be discussed with a qualified clinician.
When should I get professional help for panic disorder?
Seek professional help when panic attacks recur, fear of future attacks is changing your behavior, avoidance is restricting your life, symptoms are worsening, or attempts to manage panic on your own have not been enough.
Medically Reviewed By
Dr. Laura Tanzini, DrPH, LMFT
Doctor of Public Health | Specialty in Lifestyle Medicine
Licensed Marriage and Family Therapist (Florida & California)
Founder & CEO, Kinder in the Keys
This article has been clinically reviewed for accuracy and consistency with current behavioral health principles. Content is intended to provide general educational information and should not replace individualized evaluation, diagnosis, or treatment by a qualified healthcare professional.
Doctoral Research: Dr. Tanzini’s doctoral research at Loma Linda University examined childhood and adult traumatic events, cumulative trauma exposure, gender, forgiveness, life satisfaction, and long-term well-being.
Medical Disclaimer: This article is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. New, severe, or unexplained physical symptoms—particularly chest pain, fainting, severe difficulty breathing, or symptoms that may indicate a medical emergency—should be medically evaluated. If you have concerns about panic attacks, anxiety, medication, or your mental health, consult a qualified healthcare professional.