What to Do During a Panic Attack: A Cognitive Behavioral Therapy Perspective for Patients

Abstract

Panic attacks are acute surges of fear accompanied by intense physical sensations and catastrophic interpretations of those sensations. Common symptoms include palpitations, shortness of breath, dizziness, chest tightness, trembling, and fears of losing control or dying. Although these episodes are deeply distressing, they are not inherently dangerous in medically healthy individuals. Cognitive Behavioral Therapy (CBT) conceptualizes panic attacks as self-perpetuating cycles involving bodily sensations, threat-focused thoughts, escalating physiological arousal, and avoidance behaviors. This article explains the CBT model of panic and outlines evidence-based strategies individuals can use during an attack to reduce fear, regain control, and weaken the panic cycle over time.

Introduction

Many individuals who experience panic attacks report feeling ambushed by their symptoms. A benign physiological change—such as a moment of lightheadedness or a racing heart—may be rapidly interpreted as evidence of imminent catastrophe. These interpretations trigger fear, which activates the sympathetic nervous system, increasing respiratory rate, heart rate, and muscle tension. The resulting sensations appear to confirm the original catastrophic belief, creating a feedback loop that escalates into full panic.

CBT has a robust empirical foundation for the treatment of panic disorder and other anxiety-related conditions. Rather than focusing solely on symptom elimination, CBT helps patients understand the mechanisms driving panic and develop new ways of responding to physical sensations and anxious thoughts when they arise.

A Cognitive–Behavioral Model of Panic

From a CBT standpoint, panic attacks typically unfold through the following sequence:

Trigger → Bodily Sensation → Catastrophic Thought → Fear → Heightened Arousal → Intensified Sensations → Escape or Safety Behaviors

For example, slight breathlessness may be interpreted as “I can’t breathe,” leading to fear and hypervigilance. Fear accelerates respiration and cardiac output, producing additional sensations that appear to confirm the threat interpretation. Attempts to flee, seek reassurance, or suppress symptoms may offer temporary relief but inadvertently reinforce the belief that the sensations were dangerous.

Understanding this chain is crucial because each link is modifiable through psychological intervention.

What to Do During a Panic Attack

CBT does not emphasize fighting panic or urgently forcing it to stop. Instead, the goal is to alter the cognitive and behavioral responses that maintain the episode.

1. Accurately Label the Experience

Patients are encouraged to remind themselves:

“This is a panic response. My nervous system is activated, but I am not in danger.”

This statement counters catastrophic misinterpretations and frames the sensations as temporary physiological events rather than medical emergencies.

2. Regulate Breathing

Hyperventilation can intensify dizziness, chest discomfort, and tingling sensations. Slow, diaphragmatic breathing is often recommended:

• Inhale through the nose for four seconds

• Pause briefly

• Exhale slowly for six seconds

• Repeat for several cycles

A prolonged exhalation activates parasympathetic processes that help reduce autonomic arousal.

3. Allow Sensations to Rise and Fall

Resisting or monitoring bodily sensations closely can heighten fear. CBT encourages an acceptance-based stance:

“These sensations are uncomfortable, but they are safe and will pass.”

Allowing symptoms to fluctuate without escape behaviors weakens the panic response over repeated exposures.

4. Ground Attention in the Present

Shifting attention away from internal scanning can interrupt escalation. Grounding strategies include:

• Naming five visible objects

• Pressing feet firmly into the floor

• Describing nearby sounds or textures

Such exercises reorient attention to external stimuli and reduce threat monitoring.

5. Question Catastrophic Thoughts

When possible, individuals are taught to evaluate fearful predictions:

• “What evidence suggests I am in real danger?”

• “Have these sensations resolved safely before?”

• “Is there another explanation for what I am feeling?”

Repeated cognitive reappraisal gradually reduces the credibility of panic-related beliefs.

6. Remain in the Situation When Safe

If medically appropriate, CBT encourages remaining in the feared situation rather than fleeing. Staying allows the nervous system to learn that panic peaks and subsides naturally without catastrophe—a learning process associated with durable symptom reduction.

After the Panic Attack: Consolidating Learning

CBT also addresses post-episode reactions, which often include rumination, reassurance-seeking, or behavioral restriction. Therapeutic work may involve:

• Reviewing the episode to identify triggers and thoughts

• Noting how symptoms resolved without harm

• Reducing reliance on safety behaviors

• Practicing controlled exposure to feared sensations

These steps transform panic attacks from unpredictable threats into understandable physiological processes.

When Professional Treatment Is Warranted

Recurrent panic attacks, persistent fear of recurrence, or avoidance of exercise, driving, school, or work may indicate the need for clinical care. CBT has demonstrated strong outcomes in helping individuals:

• Reduce panic frequency and severity

• Reinterpret bodily sensations

• Increase tolerance for physiological arousal

• Resume avoided activities

• Restore confidence in coping ability

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Beacon Counseling, LLC provides CBT-based treatment for all forms of anxiety, including panic attacks, generalized anxiety, social anxiety, and trauma-related distress.

For consultation or scheduling, families and individuals may contact the practice at 860-800-4758.

Conclusion

Panic attacks are frightening but fundamentally reversible nervous-system events. From a CBT perspective, meaningful recovery occurs not by eliminating bodily sensations altogether, but by changing how those sensations are interpreted and responded to in the moment. Through psychoeducation, breathing retraining, cognitive restructuring, and exposure-based strategies, individuals can learn to interrupt the panic cycle and regain a sense of safety and autonomy.

If panic or anxiety is interfering with daily life, consultation with a CBT-trained clinician may represent an important step toward lasting relief.