Panic Disorder Treatment on Long Island with Heart in Mind

Panic Attacks, Avoidance Behaviors, and Agoraphobia

One of the most disabling aspects of panic disorder isn’t the panic attacks themselves – it’s the avoidance that develops around them.

After experiencing panic attacks, many people start to:

• Avoid Places Where Attacks Have Occurred – If you had a panic attack at the grocery store, you might start avoiding grocery stores. If it happened while driving, you might stop driving or only drive short distances.
• Avoid Situations Where Escape Would Be Difficult – Crowded places, bridges, tunnels, elevators, airplanes, or anywhere you feel “trapped” become places to avoid.
• Avoid Physical Sensations That Mimic Panic – You might avoid exercise because it makes your heart race, or avoid caffeine because it makes you jittery. Anything that creates sensations similar to panic becomes something to fear.
• Rely on Safety Behaviors – You might only go places if someone is with you, always carry anxiety medication “just in case,” or map out escape routes before entering new situations.

This avoidance provides temporary relief – if you don’t go to the grocery store, you can’t have a panic attack there. But it also reinforces the belief that these situations are actually dangerous. Your world gets smaller and smaller as the list of avoided places grows longer.

Many people with panic disorder also develop agoraphobia, which is the fear of being in situations where escape might be difficult or help might not be available if a panic attack occurs. This can lead to avoiding leaving the house entirely, which significantly impacts quality of life, relationships, and ability to work or engage in normal activities.

What Causes Panic Disorder?

Panic disorder can develop for a variety of reasons, and it’s usually a combination of biological, psychological, and environmental factors:

• Genetics and Brain Chemistry – Panic disorder tends to run in families, and research shows that differences in brain chemistry and how the brain processes fear signals play a role.
• Stressful Life Events – Major life transitions, trauma, significant loss, or periods of chronic stress can trigger the onset of panic disorder.
• Anxiety Sensitivity – Some people are more sensitive to physical sensations and more likely to interpret normal bodily changes (like a racing heart) as dangerous. This heightened sensitivity can contribute to panic attacks.
• First Panic Attack Context – Sometimes, the first panic attack occurs during a particularly stressful time or in a specific situation (like driving or being in a crowded space), and the brain makes an association between that situation and danger.
• Learning and Conditioning – After experiencing panic attacks, your brain learns to fear the physical sensations of anxiety. This creates a feedback loop where fear of panic triggers the very symptoms you’re afraid of.

It is especially important to note, however, that many people experience panic attacks for no clear reason at all. One doesn’t need to have a severe trauma or life event for panic attacks to develop. They can occur at any time without a clear cause.

How We Treat Panic Disorder

At Heart in Mind Psychotherapy, we use evidence-based approaches that have been proven highly effective for panic disorder. Treatment is tailored to your specific symptoms, triggers, and goals.

Cognitive Behavioral Therapy (CBT) for Panic Disorder

CBT is the gold standard treatment for panic disorder. It works by helping you understand the relationship between your thoughts, physical sensations, and behaviors, and by teaching you how to break the panic cycle.

In CBT for panic disorder, you’ll work on:

• Reviewing the Panic Cycle – Learning how panic attacks work, what triggers them, and why they feel so intense. Understanding that panic attacks are not dangerous (even though they feel terrifying) is a crucial first step.
• Identifying Catastrophic Thoughts – Recognizing the thoughts that fuel panic: “I’m having a heart attack,” “I’m going to pass out,” “I’m losing control,” “Something terrible is happening.” These thoughts amplify the physical sensations and make panic worse.
• Challenging Catastrophic Interpretations – Testing whether your fears are actually true. Has a panic attack ever caused the catastrophic outcome you fear? What’s the actual evidence that you’re in danger?
• Interoceptive Exposure – Deliberately inducing the physical sensations associated with panic (like rapid heartbeat, dizziness, or breathlessness) in a safe, controlled environment. This helps your brain learn that these sensations are uncomfortable but not dangerous.
• Situational Exposure – Gradually facing the situations you’ve been avoiding, starting with less anxiety-provoking scenarios and working up to more challenging ones. This helps break the association between certain places or situations and danger.

CBT gives you tools to manage panic in real time and helps you stop avoiding the situations that have been controlling your life.

Interoceptive Exposure – Facing Physical Sensations

One of the most powerful components of panic disorder treatment is interoceptive exposure – the practice of intentionally creating the physical sensations you fear.

This might include:

• Hyperventilating – To create breathlessness and dizziness.
• Spinning in a Chair – To create dizziness and disorientation.
• Running in Place – To create a racing heart and shortness of breath.
• Breathing Through a Straw – To create the sensation of not getting enough air.

This might sound counterintuitive – why would you want to create the sensations you’re afraid of? But the goal is to help your brain learn that these sensations are not dangerous. When you experience them repeatedly in a safe environment and nothing catastrophic happens, your fear of the sensations decreases.

Over time, when these sensations arise naturally (like your heart racing after climbing stairs), they no longer trigger panic because your brain has learned they’re not a threat.

Exposure Therapy – Facing Avoided Situations

Exposure therapy involves gradually returning to the places and situations you’ve been avoiding. This is done systematically, starting with situations that trigger mild anxiety and working up to more challenging ones.

For example, if you’ve been avoiding:

• Driving – You might start by sitting in a parked car, then driving around your neighborhood, then driving on a highway for a short distance, gradually building up to longer drives.
• Crowded Places – You might start by going to a store during off-peak hours, then during busier times, then to a mall or crowded event.
• Being Alone – You might start by being alone in your home for short periods, then longer periods, then leaving the house alone for brief errands.

The goal isn’t to eliminate anxiety entirely – it’s to prove to yourself that you can handle these situations even when anxiety is present, and that the feared outcome (having a panic attack, losing control, being unable to escape) either doesn’t happen or isn’t as catastrophic as you believed.

Acceptance and Commitment Therapy (ACT)

ACT is also effective for panic disorder. Rather than trying to control or eliminate panic, ACT teaches you to accept anxiety as an uncomfortable but manageable experience, and to take action toward what matters to you even when panic is present.

In ACT, you’ll learn to:

• Defuse From Panic Thoughts – Creating distance between yourself and your thoughts so they don’t control your behavior. Just because you think “I’m going to have a panic attack” doesn’t mean you have to leave the situation.
• Accept Physical Sensations – Learning that discomfort is part of life and that you can experience uncomfortable sensations without fighting them or running from them.
• Clarify Your Values – Identifying what’s important to you and using those values to guide your actions rather than letting fear dictate your choices.

ACT is particularly helpful for people who have spent years trying to control or prevent panic and found that it only makes things worse.

Breathing Retraining and Relaxation Techniques

Many of the physical symptoms of panic attacks are caused by hyperventilation. We can address how we breathe (and how we think about breathing) to reduce the symptoms and potentially decrease the severity and frequency of the attacks.

While panic attacks can’t be “breathed away,” learning proper breathing techniques can help reduce the intensity of physical symptoms and prevent hyperventilation, which can worsen panic.

We teach:

• Diaphragmatic Breathing – Slow, deep breathing that activates the body’s relaxation response and reduces the physical intensity of panic.
• Grounding Techniques – Methods for staying present during panic rather than getting lost in catastrophic thoughts.
• Progressive Muscle Relaxation – Techniques for releasing physical tension that can accompany chronic anxiety about panic.

These tools don’t prevent panic attacks, but they can help you manage them more effectively when they occur.

What to Expect from Treatment

Panic disorder treatment is highly effective, but it requires commitment and practice. The timeline varies depending on the severity of your symptoms, how long you’ve been dealing with panic disorder, and how much avoidance has become part of your life.

Many people notice significant improvement within 12-16 weeks of consistent therapy, though some need longer depending on their circumstances.

Treatment involves:

• Regular Therapy Sessions – Typically weekly, at least initially, to build skills and maintain momentum.
• Between-Session Practice – The real work happens outside of therapy. You’ll practice exposure exercises, challenge catastrophic thoughts, and gradually face situations you’ve been avoiding.
• Tolerance for Discomfort – Exposure therapy is uncomfortable by design. You’ll experience anxiety during the process, but that’s how your brain learns that these situations and sensations are safe.
• Setbacks and Adjustments – Progress isn’t always linear. You might have a panic attack after weeks of feeling better, or you might struggle with a particular exposure. That’s normal and expected.

The goal of treatment is not to never have another panic attack. The goal is to reduce the frequency and intensity of attacks, eliminate the fear of panic, and stop avoiding situations because of the possibility of panic. Many people find that once they stop fearing panic attacks, the attacks themselves become much less frequent or stop entirely.

You Don’t Have to Live in Fear of Panic

Panic disorder can make you feel trapped, controlled by fear, and like you’ve lost your freedom. You might have organized your entire life around avoiding panic attacks, and even with all that avoidance, you still live in constant fear of when the next one will strike.

But it doesn’t have to be this way. Panic disorder is one of the most treatable anxiety disorders, and with the right support, you can learn to manage panic attacks, reduce their frequency, and stop letting the fear of panic control your life.

You don’t have to keep avoiding places, situations, or experiences because of the possibility of panic. You don’t have to keep living a smaller life than the one you want. You don’t have to keep feeling like your body is betraying you.

Treatment can help you understand panic, challenge the thoughts that fuel it, face the situations you’ve been avoiding, and reclaim the freedom that anxiety has taken away.

If you’re ready to start addressing your panic disorder, please reach out to Heart in Mind Psychotherapy today. Call (516) 430-8362 or fill out our contact form to schedule a consultation.