Understanding panic disorder

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What is panic disorder?

It's having repeated, unexpected panic attacks. And also living with constant worry about them coming back, or changing your life to avoid them. An isolated panic attack is not a disorder. It usually begins in late adolescence or early adulthood. It is more common in women. You have treatment, and with the right support, you can get your quality of life back.

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What it feels like to have a seizure

A sudden surge of fear or discomfort, sometimes for no apparent reason. The heart beats hard or very fast. There is sweating, chills and trembling. It's hard to breathe, weakness or dizziness. Hands tingle or fall asleep. You may have chest or stomach pain. You feel like you're losing control or something terrible is going to happen. It can happen at any time, even in your sleep. It lasts from a few minutes to an hour, and sometimes longer. It's very scary, but the attack itself isn't life-threatening and the symptoms subside.

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The panic cycle

It starts with a sensation of the body: a heartbeat, dizziness, shortness of breath. The mind interprets it as danger: He's going to give me something. That thought triggers more alarm and the sensation grows. The bigger it gets, the more convinced you are of the danger. Eventually the fear of the fear comes: you watch the body all day. Treatment breaks this cycle by teaching you to react differently to sensations.

Sources: 1, 2 (see Sources tab)

Panic and agoraphobia

Some people start to avoid places where they had an attack. Agoraphobia is the intense fear of places from which it would be difficult to escape or where there would be no help. For example, public transportation, queues, indoor or outdoor spaces, or being away from home. Life is getting smaller. It is also treatable.

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How it is diagnosed

Talk to a healthcare professional: family doctor, psychiatrist or psychologist. The usual thing is to go over your history first and do a physical. This rules out the possibility that the symptoms come from a physical problem. Diagnosis requires repeated and unexpected attacks, and concern or behavior changes for fear of further attacks. This guide is informative, not diagnostic.

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Which treatments work

Treatment is usually psychotherapy, medication, or both. Cognitive behavioral therapy is the best-studied psychotherapy for panic. It works with exposure: getting close to what you avoid. It includes exposure to one's own bodily sensations, to stop being afraid of them. Some antidepressants help, they take weeks to take effect. Beta-blockers can relieve physical symptoms such as a rapid pulse or tremor. Benzodiazepines are quick to calm, but they can be addictive. The guidelines generally do not recommend them for treating long-term anxiety. The medication is always prescribed and followed by a doctor. Getting enough sleep, exercise, and supporting yourself helps, but it is no substitute for treatment.

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Common myths

I'm going to die of a panic attack. The panic attack itself is not life threatening. I'm going crazy. No. It's an alarm from the body, not a loss of reason. If it happens to me on the street, it won't end. It always goes down. I have to avoid everything that causes it. Avoiding makes the problem bigger. "There's no solution." It is one of the anxiety problems that responds best to treatment.

Sources: 1 (see Sources tab)

Tips for each difficulty

Choose the area that weighs the most on you today. Mark the pattern you're going to practice and it'll be kept in My plan.

Breaking the cycle

The attack feeds off how you interpret what you feel. Changing the reading cuts the fuel.

Name what's happening. It's my alarm, it's not dangerous.Write down your predictions. Write down what you feared would happen and what really happened. Repeat after each attack.Stop monitoring your body. Taking your pulse or checking your breathing keeps the alarm on.Change the question. Instead of "What if I get something?" ask yourself "What happened the other times?"Accept the sensation. Don't try to make it go away now. Leave her alone and go on with what you were doing.

Sources: 1, 2. Guidelines are common techniques in cognitive behavioral therapy.

During an attack

There's not much to do. Do little and wait. The attack rises, reaches a maximum and falls.

Stay put. If it's safe, don't run off. Lean back or sit where you are.Breathe slowly. Breathe in for 4 seconds and out for 6. Use the circle in Tools.Loosen up. Lower your shoulders, open your hands, feel your feet on the ground.Look outwards. Describe five things you see. It takes the focus off the body.Wait for it to drop. Remember that it has always gone down. This time too.

Guidelines are common techniques in cognitive behavioral therapy.

Losing the fear of sensations

If you provoke the sensations on purpose, the brain learns they're not dangerous. It's best done with a psychologist's guidance. If you have a heart or breathing problem, or if you are pregnant, talk to your doctor first.

Raise your heart rate. Go up the stairs or walk fast for a minute. Notice the heart without doing anything to calm it.Bring on a mild dizziness. Turn slowly over yourself for a few seconds, close to a seat.Watch it go down. Just hold on to the feeling until I loosen up on my own.Repeat. Do it for several days, each repetition less scary.No tricks. Don't do it with someone - just in case - or with the pill in your hand.

Sources: 1. Guidelines are common techniques of cognitive behavioral therapy.

Getting places back

Every place you avoid gives reason to fear. They recover one by one and from less to more.

Make your list. Write down the places you avoid and score fear on a scale of 0 to 10.It starts with a 3 or a 4. Something that costs money, but you can do today.Stay until it eases. Don't leave when you're most anxious. Wait for me to come down.Repeat over several days. Move up to the next step when this one feels easy.More and more on your own. Accompanied first if necessary. Then with the person farthest away, then without.

Sources: 1, 2. Guidelines are common techniques in cognitive behavioral therapy.

Safety behaviours

They're the "just in case": sitting by the door, carrying water, not leaving without your cell phone or tablet. They bring relief in the moment, but stop you from finding out they weren't needed.

Spot yours. Write down everything you do or wear to feel safe.Drop one each week. Start with the easiest.See what happens. Write down what you feared and what happened when you didn't use it.Talk about the medication with your doctor. Don't change or leave medication on your own.

Guidelines are common techniques in cognitive behavioral therapy.

Helpful habits

Some habits raise your baseline alarm. Changing them doesn't cure the panic, but it helps.

Less caffeine. In people with panic disorder, doses of about five coffees caused attacks in half of the studies.Get enough sleep. Keep a regular schedule.Exercise. Besides lowering anxiety, it gets you used to noticing your heartbeat without being frightened.Avoid using alcohol to calm down. It eases the anxiety for a while, and the next day it's worse.Talk about it. Talk to someone you trust about what's happening to you.

Sources: 1, 3. Guidelines are common techniques in cognitive behavioral therapy.

If you're with someone

Seeing someone in the middle of an attack is impressive. Your calm is the best help.

Speak slowly and say little. Short phrases: I'm here, I'm going through.Breathe with the person. Take it slow and let me follow you.Don't argue or play it down. Avoid "it's nothing" or "take it easy".Don't rush them away. Staying and waiting teaches more than running.Encourage them to ask for help. Offer to walk her to the office.

Guidelines are common techniques in cognitive behavioral therapy.

Sources

The information comes from these guides and studies. The numbers of each subject refer to this list.

The U.S. National Institute of Mental Health (NIMH). Panic disorder: What you need to know. Open
Carpenter et al. (2018). Cognitive behavioural therapy for anxiety: meta-analysis of placebo-controlled trials. Open
Klevebrant and Frick (2022). Effects of caffeine on anxiety and panic attacks: meta-analysis. Open
World Health Organization (2025). Anxiety disorders: fact sheet. Open

This app provides information and general tips. It doesn't diagnose or replace your doctor or psychologist. If you are in crisis or thinking about harming yourself, call 112 or 024.

Would you rather talk it over with a professional? Order your first appointment at the Vivaldi Clinic., in person in Valencia or online.

This guide is produced by Clínica Vivaldi, a psychological health centre in Valencia.: María Teresa Fernández Vicente, Health psychologist and neuropsychologist (CV17304). November 9, 2026. This is the first time I've seen you. The scientific sources are in the Fonts tab. If you need professional help: An anxiety psychologist at the Vivaldi Clinic.