It comes out of nowhere. One moment you’re fine, the next your heart is pounding, you can’t breathe, and you’re convinced something is terribly wrong. Maybe you’ve been to the emergency room thinking you were having a heart attack, only to be told it was “just anxiety.”

Maybe you’ve started avoiding places where you’ve had panic attacks before. Maybe you spend your days dreading the next panic attack, scanning your body for any sign that one might be coming.

Panic attacks are terrifying. The physical symptoms are real and intense. And when they start happening repeatedly—when the fear of having more panic attacks begins controlling your life—you’re dealing with panic disorder.

At Therapy Group of DC, our therapists specialize in treating panic disorder using cognitive behavioral therapy and other evidence-based approaches. We help you understand what’s actually happening in your body, break the cycle of fear and avoidance, and reclaim your life from panic.

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Is Panic Disorder Therapy Right for You?

You might benefit from panic disorder treatment if you:

• Experience sudden episodes of intense fear with physical symptoms like a pounding heart, chest pain, or difficulty breathing
• Have had panic attacks that seemed to come out of nowhere
• Worry constantly about when the next panic attack will occur
• Avoid certain places, situations, or activities because you fear having a panic attack there
• Have gone to the ER or urgent care convinced you were having a heart attack, only to find nothing medically wrong
• Feel like you’re losing control or “going crazy” during episodes
• Experience tingling sensations, shaking sensations, or feelings of choking chest pain and smothering feelings during attacks
• Have started limiting your life to feel “safe”—not going certain places, always needing an escape route
• Wonder if the physical sensations you’re experiencing are actually dangerous
• Feel trapped by ongoing worry about panic symptoms

What to Know

• Panic disorder is highly treatable. Cognitive behavioral therapy is considered the gold standard treatment and has strong research support
• The physical symptoms are real—but not dangerous. Understanding what’s actually happening in your body is a key part of treatment
• Panic disorder affects 2-3% of Americans and often begins in the late teens or early adulthood
• Women are more likely than men to develop panic disorder, though anyone can experience it
• Treatment works. With the right approach, most people with panic disorder see significant improvement

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Understanding Panic Disorder

Panic disorder is one of several anxiety disorders characterized by recurrent and unexpected panic attacks along with persistent concern about having more attacks or significant changes in behavior to avoid them. According to the Diagnostic and Statistical Manual of Mental Disorders, panic disorder diagnosed requires both the attacks themselves and the ongoing worry or avoidance that follows.

A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes. During a panic attack, you might experience a pounding heart, sweating, trembling, shortness of breath, chest pain, nausea or abdominal distress, dizziness, chills or heat sensations, numbness or tingling sensations, feelings of unreality, fear of losing control, or fear of dying.

Not everyone who has a panic attack will develop panic disorder. Many people experience one or two panic attacks in their lifetime without developing the condition. Panic disorder develops when the attacks become recurrent and are followed by at least a month of persistent concern about additional attacks or their consequences, or significant behavioral changes designed to avoid attacks.

What Causes Panic Disorder?

The exact causes aren’t fully understood, but several factors contribute:

• Genetics and biology. Panic disorder sometimes runs in families. Differences in how the brain processes fear and regulates stress also play a role.
• Anxiety sensitivity. This refers to interpreting bodily sensations as dangerous—believing a racing heart means you’re having a heart attack. High anxiety sensitivity increases the likelihood of developing panic disorder.
• Stress and traumatic events. Major life stressors or traumatic events can trigger the first panic attack and make attacks more likely to continue.

How Panic Attacks Differ from Anxiety Attacks

While the terms are sometimes used interchangeably, there are differences. Panic attacks are sudden, intense, and typically peak within 10 minutes—sometimes even waking you from sleep. Anxiety attacks tend to build gradually in response to stress and are less intense overall. The Diagnostic and Statistical Manual defines panic attacks but doesn’t include “anxiety attacks” as a clinical term.

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Symptoms of Panic Disorder

Panic disorder symptoms fall into two categories: what happens during an attack, and what happens between attacks.

During Panic Attacks

When a panic attack occurs, you might experience:

• Physical symptoms — Pounding heart or rapid heartbeat, sweating, trembling or shaking sensations, shortness of breath or smothering feelings, chest pain or discomfort nausea, dizziness or lightheadedness, chills or hot flashes, numbness or tingling sensations
• Cognitive symptoms — Fear of losing control or “going crazy,” fear of dying, feeling detached from yourself or your surroundings, sense that things aren’t real

Panic attack symptoms typically peak within 10 minutes and resolve within 20-30 minutes, though you may feel drained or on edge for hours afterward.

Between Attacks

Equally important to treating panic disorder is understanding what happens between attacks:

• Anticipatory anxiety — Ongoing worry about when the next panic attack will occur. This persistent concern can become constant background noise, affecting your daily life even when you’re not actively panicking.
• Avoidance behaviors — Steering clear of places or situations where you’ve had panic attacks or fear having one. This might start small but can expand to significantly limit your life.
• Hypervigilance to bodily sensations — Constantly monitoring your body for early signs of panic. Ironically, this attention to physical sensations often increases anxiety and makes panic attacks more likely.
• Safety behaviors — Things you do to feel “safe,” like always sitting near exits, carrying medication “just in case,” or only going places with someone else.

Panic Disorder and Agoraphobia

Some people with panic disorder develop agoraphobia—fear and avoidance of situations where escape might be difficult or help unavailable if panic symptoms occur. This might include public transportation, open spaces, enclosed spaces, crowds, or being outside the home alone.

Agoraphobia can develop as the avoidance patterns of panic disorder expand. If this describes your experience, treatment addresses both conditions together.

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Panic Disorder and Other Mental Health Conditions

Panic disorder often occurs alongside other mental health conditions.

• Depression. Many people with panic disorder also experience depression. The limitations panic imposes, combined with constant anxiety, can contribute to low mood.
• Other anxiety disorders. Panic disorder commonly co-occurs with generalized anxiety disorder, social anxiety, or specific phobias.
• Post-traumatic stress disorder (PTSD). Traumatic events can trigger panic disorder, and the two conditions share some features.
• Obsessive compulsive disorder. Some people develop rituals or compulsions aimed at preventing attacks.
• Substance abuse. Some people turn to alcohol or substances to manage symptoms, which often makes panic worse over time.

If you’re experiencing symptoms of other mental health conditions alongside panic, your treatment plan will address the full picture.

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How We Treat Panic Disorder

Effective treatment for panic disorder typically involves psychotherapy, sometimes combined with medication. At Therapy Group of DC, we use evidence-based approaches tailored to your specific needs.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is the gold standard treatment for panic disorder. CBT helps you understand what panic attacks actually are—and what they aren’t. Learning that panic symptoms, while terrifying, are not dangerous helps reduce fear of the attacks themselves.

Treatment includes cognitive restructuring (challenging the catastrophic thoughts that fuel panic), interoceptive exposure (learning that physical sensations are uncomfortable but not dangerous), and gradually re-engaging with situations you’ve been avoiding. Research consistently shows CBT produces lasting results, with many people seeing significant improvement within 12-16 sessions.

Psychodynamic Therapy

For many people, panic disorder connects to deeper patterns—unprocessed emotions, conflicts about independence or safety, or early experiences that created a template for how your body responds to stress. Psychodynamic therapy explores these roots, helping you understand why panic has taken hold in your life.

This approach examines what panic might represent symbolically, how past relationships shape your current fears, and what emotional conflicts might be expressing themselves through your body. For some people, this deeper understanding creates shifts that symptom-focused approaches alone can’t reach.

Existential Approaches

Panic often involves confronting fundamental fears—death, loss of control, the fragility of existence. Existential therapy helps you face these realities directly rather than through the lens of panic. Many people find that addressing the deeper fears underneath panic leads to more profound and lasting change.

Acceptance and Commitment Therapy (ACT)

ACT helps you change your relationship to panic symptoms rather than trying to eliminate them. You’ll learn to accept anxious thoughts and feelings without struggling against them while committing to actions aligned with your values.

Medication

While our practice focuses on psychotherapy, medication can be part of treatment. SSRIs and SNRIs are commonly prescribed for panic disorder. Benzodiazepines can rapidly decrease panic but carry risks of dependence. If you’re considering medication, we can coordinate with psychiatric providers.

Research note: The combination of CBT with an SSRI often yields the greatest short-term benefits for people with panic disorder, though CBT alone produces lasting results for many.

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What to Expect in Panic Disorder Treatment

First Sessions: Assessment and Education

Your therapist will want to understand your full experience—when panic attacks started, what your first panic attack was like, how frequent attacks are now, and how panic is affecting your daily life. You’ll learn about the panic cycle: how panic attacks develop, why they feel dangerous when they’re not, and how avoidance maintains the problem.

Building Skills and Exposure

Before exposure work, you’ll develop skills for managing panic symptoms. This might include deep breathing techniques, grounding exercises, and cognitive skills for challenging catastrophic thinking.

The core of treatment involves gradually confronting what you fear—both the physical sensations of panic (interoceptive exposure) and situations you’ve been avoiding. Your therapist will help you catalog feared situations and work through them progressively.

Timeline

Treatment duration varies, but many people see substantial improvement within 12-16 sessions of CBT. The goal isn’t just to reduce panic attacks—it’s to help you stop fearing them so they no longer control your life.

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Our Panic Disorder Therapists

Our therapists include clinical psychologists and licensed professional counselors trained in cognitive behavioral therapy and other evidence-based approaches for treating panic disorder and anxiety disorders. They understand the specific challenges of panic and the courage it takes to face your fears.

Dr. Michael Burrows, Ph.D.

Dr. Burrows draws on psychodynamic and relational approaches to help clients understand the deeper roots of their panic. His focus on how past experiences and relationships shape current symptoms helps clients address panic at its source. View Dr. Burrows’s full profile →

Dr. Tyler Miles, Psy.D.

Dr. Miles specializes in anxiety using ACT, client-centered therapy, and cognitive behavioral therapy. Her focus on psychological flexibility helps clients engage with life fully even when panic symptoms are present. View Dr. Miles’s full profile →

Dr. Rose Medcalf, Psy.D.

Dr. Medcalf integrates client-centered, feminist, and psychodynamic approaches. Her warm style creates a safe space to explore the fears and vulnerabilities that fuel panic, while building resilience and new ways of handling stress. View Dr. Medcalf’s full profile →

Xihlovo Mabunda, MS, LPC

Xihlovo integrates EMDR and psychodynamic therapy. When past experiences or trauma contribute to panic disorder, her approach helps address those deeper roots while building skills for managing symptoms. View Xihlovo’s full profile →

Dr. Paul Rizzo, Psy.D.

Dr. Rizzo uses existential and humanistic approaches to help clients confront the deeper fears that often underlie panic—mortality, loss of control, uncertainty. His focus on meaning and authenticity helps clients find peace with the existential realities panic makes impossible to ignore. View Dr. Rizzo’s full profile →

Dr. Kevin Isserman, Psy.D.

Dr. Isserman uses client-centered and psychodynamic approaches to create a supportive space for exploring what’s driving your panic. His warm, validating style helps clients build self-trust and reduce the hypervigilance that maintains panic disorder. View Dr. Isserman’s full profile →

Dr. Rob Drinkwater, Ph.D.

Dr. Drinkwater uses existential, family systems, and psychodynamic therapy to help clients explore the emotional patterns underlying panic. His focus on living more intentionally helps clients see panic not just as a symptom to eliminate but as a signal worth understanding. View Dr. Drinkwater’s full profile →

Kevin Malley, MS, LPC, NCC

Kevin uses existential, relational, and person-centered approaches to help clients navigate panic and anxiety. His grounded, present-focused style helps clients develop a new relationship with the physical sensations and fears that drive panic disorder. View Kevin’s full profile →

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Begin Panic Attack Therapy in Washington DC

Panic disorder is treatable. With the right approach, you can understand what’s happening, break the cycle of fear and avoidance, and stop living at the mercy of panic attacks.

Schedule an Appointment →

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Frequently Asked Questions

What therapy is best for panic disorder?

Cognitive behavioral therapy (CBT) is considered the gold standard treatment for panic disorder and is recommended by the American Psychiatric Association. CBT teaches you to understand panic, challenge catastrophic thoughts, and gradually face feared situations and sensations. Research consistently shows that CBT produces lasting improvement for most people with panic disorder.

Will panic disorder ever go away?

For many people, panic disorder can be effectively treated, and panic attacks can become infrequent or stop entirely. With proper treatment for panic disorder, most people see significant improvement. Some people may experience occasional panic attacks during times of stress, but they no longer live in fear of them. The goal of treatment is not just to reduce panic attacks but to eliminate the fear and avoidance that make panic disorder so disabling.

How to support someone with panic disorder?

Stay calm and reassuring during panic attacks—don’t dismiss their experience, but remind them that panic attacks, while frightening, are not dangerous and will pass. Avoid enabling avoidance; gently encourage them to maintain normal activities. Learn about panic disorder so you understand what they’re experiencing. Encourage them to seek treatment with a mental health professional. Most importantly, be patient—recovery takes time.

What is the 3-3-3 rule for panic attacks?

The 3-3-3 rule is a grounding technique sometimes suggested for managing panic symptoms: name three things you can see, three sounds you can hear, and move three parts of your body. This technique helps interrupt the panic cycle by shifting attention away from frightening bodily sensations and catastrophic thoughts. While it can be helpful in the moment, it’s not a substitute for comprehensive panic disorder treatment.

What’s the difference between panic attacks and panic disorder?

A panic attack is a single episode of intense fear with physical symptoms. Many people have one or two panic attacks without developing panic disorder. Panic disorder is diagnosed when panic attacks are recurrent and unexpected, and when they’re followed by at least a month of persistent concern about having more panic attacks, worry about their consequences, or significant behavioral changes to avoid them. The distinction matters because treatment for panic disorder addresses not just the attacks themselves but the cycle of fear and avoidance that maintains the condition.

Can you have panic attacks without having panic disorder?

Yes. Panic attacks can occur in the context of other anxiety disorders, depression, PTSD, and other mental disorders. They can also happen as isolated events that don’t develop into a pattern. According to the American Psychiatric Association, panic disorder specifically requires recurrent unexpected panic attacks plus ongoing worry about attacks or significant behavioral changes. If you’re experiencing panic attacks, a mental health professional can help determine whether you have panic disorder or another condition causing anxiety attacks.