Panic Attacks, Panic Disorder & Agoraphobia


Panic disorder is an anxiety disorder where individuals experience repeated panic attacks.  The normal physical sensations of anxiety are experienced as "dangerous" to the individual who then believes the symptoms mean they are are going to die (heart attack, will suffocate etc). 

Naturally, no-one wants these panic attacks, so we start to avoid situations where they might occur, and "fear the fear" - we are scared about experiencing the panic attack.  Avoidance can lead to Agoraphobia (from the latin for fear of open spaces), where we avoid certain places because of the fear of a panic attack and of not being able to escape, which eventually may keep us from going out at all.

See this page for information about anxiety and the normal body response.


Example of a vicious cycle of Panic




Cognitive Behaviour Therapy focuses on learning to challenge the unhelpful thoughts and beliefs, and gradually making changes in our behaviour so that we learn that the feared consequences do not happen, and that it is the anxiety that makes us feel the way we do.

In order to break the vicious cycle of repeated panic attacks and/or agoraphobia, we need to change the way we think, and change what we do.  Firstly, we can learn about how any anxiety affects our body.  This is the body's normal response to danger (or believing we're in danger):

The main problem with panic disorder is that when those adrenaline feelings really kick in, they feel like we are really suddenly seriously ill.  It can feel like we're choking, suffocating, having a heart attack.  It really feels like we could be dying, right now!  Terrifying.

In fact, these physical feelings of adrenaline are normal - it is simply the body's alarm system being activated in order to help us escape from a dangerous situation.  So it feels dangerous, even if it really isn't. 

We add meaning to the thoughts and feelings - we believe the thoughts, and we think the feelings mean we could be dying.

The feelings will pass.  If we could just notice the thoughts and feelings, and not react to them by believing them to be dangerous in themselves, if we could breathe deeply and focus on our breathing and allow the thoughts and feelings to come, and go, then the adrenaline will calm down within a few minutes. 


Self Help for Panic - video



The most effective technique for stopping a panic attack - even before it starts - is to:

  • Use STOPP skill
  • Focus on deep and slow belly Breathing,
  • Let other thoughts and feelings come and go as they will. 
  • Just notice the thoughts and feelings, then think about your breathing again.
  • Once the worst of the feelings have passed, then choose what to do now - where to focus.  Either carry on what you were doing, or do something else - with your full attention.



Thinking Differently - Challenging Thoughts

If we can change the way we think about a situation or about the normal anxiety feelings, then we will not feel so panicky.  We can learn to challenge those anxiety-provoking thoughts.  Thoughts are not statements of fact.  Don't believe everything you think!

Thoughts are just thoughts.  We look at life, and situations through distorted lenses.  Just because we think we're going to die, or have another panic attack, doesn't mean that is how it really is!  We are looking at the physical sensations of adrenaline or going out or to certain places or situations, through those very distorted lenses.

Learn to challenge the unhelpful and distorted thinking:


Thinking Differently:  Re-Focus

When we think about being in a situation or when we start to feel anxious, our focus of attention gets totally caught up in our own thoughts and feelings.   The physical feelings of anxiety just makes it worse, as we start to believe we could be dying.  It can be a horrible experience which leaves us feeling battered and exhausted - we just want to escape that situation to stop the feelings - and avoid repeating them!

It is very helpful to learn how to change our focus of attention and take more control over how we react to thoughts.  We can learn to just notice the thoughts and physical sensations of anxiety, acknowledge them, then let them pass.  Notice the Mind Bully and let it go - turn your focus of attention to something else.  First of all, you might learn to focus on your breathing.

Then you might learn and practise Mindfulness skills including Mindful Activity.  It's important to practise these skills frequently, every day, so that when you NEED them, you'll be able to use them effectively.




 Notice:            Where my attention is



Observe:        What I'm doing.  Think: "I am walking", "I am sitting", "I am breathing", then notice those sensations in your body 

 Wise Mind  What now?   How shall I continue?   Doing or Being?

NOW:  Mindfulness for Busy People leaflet




  • Choose an activity to do mindfully throughout the day, for one, two or five minutes. For example:  Drink a cup of tea.  Walk.  Wash the dishes. 

  • Whatever you are doing, be in that moment, right now.   See, hear, smell, touch, feel, breathe.

  • Simply notice whenever other thoughts and sensations come to mind, then re-focus on your chosen mindful activity.

  • Be patient and compassionate with yourself.

  • Describe - rather than judge good or bad, pleasant or unpleasant.

  • It is as it is.

Everything Flows.  Nothing is fixed.   Heraclitus


NOW:  Mindfulness for Busy People leaflet


The Visitor

Mindfulness of Emotions

Flexible Thinking

Mindful Breathing



Doing Differently

Our usual strategy for dealing with social anxiety, is to avoid social situations.  However, that just serves to keep the anxiety and panic going because we never find out that things will be ok.

Overcome Avoidance with graded exposure to gradually face your fears

Slowly, we can change what we do.  Use the Avoidance worksheet to identify what you don't do or where you don't go, then start by gradually exposing  yourself to the least feared situation in the list, using healthy coping strategies in those situations.

It's important that you see the situations through - stick with the anxiety - it will pass.


FACE Fear and Avoidance - VIDEO





Use STOPP skill to incorporate many strategies

STOP - just pause for a moment


Take a breath - one slow deep breath


Observe - there's the mind bully again.  My body and mind is reacting to the thoughts and anxiety feelings.


Pull back - this is just the anxiety talking.  Don't believe everything you think!  Let's stick with the facts - these thoughts are just opinions (Fact or Opinion).  These feelings are normal - it's just the body's alarm system doing its job, when it doesn't need to.  These feelings will pass.    


Practise / Proceed - What can I do right now?  


I can use these strategies:

Where can I put my focus of attention right now?  (Mindfulness & mindful activity).  What else can I do that would help me tolerate these thoughts and feelings without reacting to them?


Complete your own STOPP  Worksheet



Specific Panic Disorder Resources PDFs



Female voice, no music

3 mins 40 secs


Listen Online or  Add to Cart Download and use it when you most need it!


Male voice, no music

4 mins


Listen Online or Add to Cart Download to your mp3 player or phone and use it when you most need it!


(Panic & Health Anxiety version)

Female voice, with music.

26 mins
2.50  Add to Cart


(Panic & Health Anxiety)

Male voice, with music.

33 mins 50s
2.50  Add to Cart

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Panic Self Help Guide - this page as PDF

Self Help Books

Overcoming Panic and Agoraphobia

Introduction to Coping with Panic (Overcoming: Booklet series)

Panic Attacks: What They Are, Why They Happen and What You Can Do About Them