Conditions treated
Panic attacks are frightening — but they are not dangerous. Understanding what drives them is the key to overcoming them, and the evidence for effective treatment is exceptionally strong.
Understanding panic
A panic attack is an abrupt surge of intense fear accompanied by a sense of impending physical or mental catastrophe. Common features include heart palpitations, shortness of breath, dizziness, chest tightness, numbness or tingling, sweating, and a sense of unreality or detachment.
Panic attacks are generated by the body’s threat response — adrenaline release, increased heart rate, altered breathing — a system designed to prepare for physical action in the face of genuine danger. The experience is real and physical. What is misinterpreted is what is causing it.
Panic disorder is diagnosed when panic attacks are recurrent and when there is persistent concern about further attacks, their implications, or significant behavioural change as a result. Agoraphobia — avoidance of situations from which escape might be difficult — commonly develops alongside panic disorder.
Talk to Dr Mitchell about panic disorderWhat drives panic
The cognitive model of panic (Clark, 1986) — which underpins the most effective treatment — proposes that panic attacks are maintained by a specific misappraisal process. A physical sensation is catastrophically misinterpreted, producing anxiety, which intensifies the sensation, which is further misinterpreted — a rapidly escalating loop.
Safety behaviours are things people do to prevent or manage a feared outcome during a panic attack — sitting down, gripping something for support, escaping the situation, or seeking reassurance from others. They reduce symptoms quickly, which feels like relief. But this reinforces the belief that something dangerous was narrowly avoided, maintaining the cycle. Breaking that pattern is central to treatment.
Evidence-based treatment
CBT for panic disorder has one of the strongest evidence bases in all of mental health. Response rates are consistently high, treatment is typically brief, and the gains people make are well-maintained over time — more so than with medication alone.
NICE recommends CBT as a primary treatment for panic disorder. The research base is extensive and the outcomes are clear.
Treatment draws on several interlocking techniques, each addressing a different part of what maintains panic:
Understanding exactly what happens during a panic attack — and why it is not physically dangerous — is genuinely therapeutic. Many people report that the first session alone produces significant relief, simply from having an accurate explanation of their experience.
Working to identify and test the catastrophic misappraisals that drive panic. This is not about positive thinking — it is about developing a more accurate understanding of what physical sensations actually mean, and what the evidence really supports.
Deliberately inducing the physical sensations associated with panic — through exercise or breathing exercises — in a safe, controlled context. This demonstrates that the sensations themselves are harmless, and that anxiety reduces naturally without escape or safety behaviours.
For those who have developed avoidance of situations associated with panic, gradually re-engaging with these situations — without safety behaviours — to break the avoidance cycle and rebuild confidence.
Identifying and systematically reducing the behaviours that provide short-term relief but maintain the belief that panic is dangerous. Common examples include escaping situations, seeking reassurance, holding onto objects for support, or constantly monitoring physical sensations. This step is essential — maintaining safety behaviours prevents full recovery, even when other work has been done.
Sessions are available in person in Aberdeen or remotely. If you use BUPA, Aviva, Healix, WPA or another major insurer, please check your policy and get in touch to arrange an appointment.
Take the first step
Most people make a full recovery with the right approach. An initial consultation will clarify what is maintaining your panic and what treatment would involve — with no pressure to commit to anything further.
Request a consultation