CBT for Panic Attacks

Track every panic attack in a structured log: when, where, peak anxiety, symptoms, the catastrophic thought, and your belief in it. This is the foundation — all other techniques build on the data you collect.

1. Log each attack as soon after as possible (use the tool above)
2. Note the trigger or situation (or "out of the blue")
3. Rate peak anxiety 0-100 and check physical symptoms
4. Write the catastrophic thought and rate belief in it 0-100
5. After 1-2 weeks, review for patterns: triggers, time of day, thought themes

The diary itself reduces panic: attacks become predictable data rather than mysterious threats. Most people find their attacks are less frequent and less intense just from tracking.

The core of CBT for panic: identify the catastrophic thought ("I'm having a heart attack") and replace it with the accurate explanation ("This is an adrenaline surge, harmless, peaking in 10 minutes"). The panic diary tool above auto-generates these reframes.

1. Heart attack → Panic raises heart rate and blood pressure. Heart attacks involve blocked blood flow. Panic cannot cause a heart attack. No one has died from a panic attack.
2. Fainting → Fainting requires LOW blood pressure. Panic causes HIGH blood pressure (fight-or-flight). You cannot faint from panic.
3. Losing control / going crazy → Feeling unreal (derealization) is a known adrenaline effect. It is distressing but harmless and passes. You remain in control of your actions.
4. Choking / suffocating → Chest tightness is muscle tension, not airway blockage. Your breathing is automatic and won't stop. Slow your exhale.

Rate your belief in the catastrophic thought before (0-100) and after the reframe. With practice, the belief drops, and so does the panic.

The most powerful single technique for panic disorder. Deliberately induce the body sensations you fear and sit with them without escaping. This teaches your brain the sensations are uncomfortable but not dangerous — breaking the fear of fear at the experiential level.

1. Spinning (for dizziness): spin in a chair for 30-60 seconds, then stop and sit with the dizziness for 2 minutes without trying to suppress it
2. Hyperventilation (for lightheadedness/tingling): breathe rapidly and deeply for 60 seconds, then breathe normally and observe the sensations pass
3. Breathing through a straw (for air hunger): breathe through a narrow straw for 30 seconds (nose pinch), then release and notice the sensation resolves
4. Standing up quickly (for lightheadedness): sit, then stand rapidly and hold still through the head rush
5. Repeat each exercise daily for 5-10 minutes. The fear drops within a few sessions.

Key rule: do NOT escape or "fix" the sensation. Stay with it until it passes on its own. That is what teaches your brain it is safe. This is the opposite of avoidance.

Slow, deep belly breathing (4-6 breaths per minute) counteracts hyperventilation and gives a sense of control. It is not the primary mechanism of CBT for panic (that's cognitive restructuring + interoceptive exposure), but it is a useful in-the-moment tool.

1. Place one hand on your chest, one on your belly
2. Breathe in through the nose for 4 counts — the belly hand should rise, the chest hand should stay still
3. Breathe out slowly through pursed lips for 6 counts
4. Repeat for 2-3 minutes. Target 5-6 breaths per minute.
5. Practice when calm so it's automatic when you need it

Caution: don't over-rely on breathing as a "safety behavior" (something you must do to prevent panic). Use it as a tool, not a crutch. The goal is to learn you can handle the sensations even without breathing exercises.

Panic-prone people carry high baseline muscle tension. Progressive muscle relaxation (PMR) teaches you to recognize and release tension, lowering your overall arousal so panic is less likely to trigger.

1. Sit or lie comfortably. Starting with your feet, tense the muscles for 5 seconds, then release for 10.
2. Move up: calves, thighs, stomach, hands, arms, shoulders, neck, jaw, forehead
3. Notice the contrast between tension and relaxation
4. Practice 15 minutes daily. With 2-3 weeks, you'll catch tension earlier.
5. Advanced: "applied relaxation" — learn to release tension in 30 seconds, then 10, then on a cue word, so you can deploy it at the first sign of panic

After you've reduced your fear of the body sensations (via interoceptive exposure), gradually re-enter the situations you've been avoiding (driving, crowds, stores, being alone). This is situation exposure — the same graded-exposure principle used for social anxiety and phobias.

1. List the situations you avoid due to panic fear, rated 0-100
2. Start with the easiest. Enter it and stay until anxiety drops by half.
3. Don't take "safety" objects (water, phone, medication) unless medically needed — they become safety behaviors that maintain fear
4. Move up the list as each item becomes manageable
5. Expect setbacks — they are normal and not a sign of failure