Your heart starts pounding on a Red Line platform, your hands go numb, and for a few minutes you’re sure you’re about to faint or die. Then it passes, and you’re left shaky and embarrassed, wondering what just happened. One attack like that is frightening, and it is also common. Not everyone who has a panic attack goes on to develop panic disorder.
What sends people looking for panic disorder treatment is usually what comes after: attacks that keep arriving without warning, steady worry about the next one, and places you quietly stop going. Panic disorder is treatable with therapy, medication, or both. This post covers how an attack differs from the disorder, when to see a doctor first, the main kinds of therapy for panic attacks, what sessions are like, and how long treatment tends to take.
Panic attack or panic disorder?
A panic attack is a sudden surge of intense fear that peaks within minutes. It comes with a burst of physical symptoms, often several at once:
- A pounding or racing heart
- Sweating, trembling, or shaking
- Shortness of breath or a feeling of choking
- Chest pain or tightness
- Nausea or abdominal distress
- Dizziness, or feeling faint or unsteady
- Chills or waves of heat
- Numbness or tingling
- Feeling unreal, or detached from yourself
- Fear of losing control, “going crazy,” or dying
Panic attacks can happen as part of other anxiety disorders, too. In social anxiety, for example, a presentation or a crowded party is often what sets them off. Panic disorder is different. Clinicians diagnose it when unexpected panic attacks keep coming back and are followed by at least a month of persistent worry about having more, or by changes in what you do to avoid them.
That second part matters for treatment. For many people with panic disorder, the fear of the next attack shapes daily life more than the attacks do. You sit near the exit, skip the gym because a racing heart feels dangerous, and turn down the work trip. Avoiding those things protects you from an attack there, at least for a while. The price is a smaller life.
If you came here for what to do in the middle of an attack, our guide to getting through a panic attack covers that. This post is about treating the pattern.
When to rule out a medical cause first
Panic feels physical because it is physical. That’s also why the first stop is often a doctor rather than a therapist. Panic attacks can also come from substances, medications, or a medical condition such as an overactive thyroid or an inner-ear balance problem. Chest pain gets checked by a doctor, every time it’s new.
If you have chest pain that has never been looked at, or an attack feels different from your usual ones, get seen right away. Call 911 for chest pain that feels crushing, spreads to your arm or jaw, or comes with fainting. That is what emergency care is for.
It is common to reach therapy after two or three trips to urgent care, embarrassed that every test came back normal. We think those visits were sensible. Getting your heart checked was the right call. The normal results help, too, because they let us treat the fear as fear instead of arguing with it.
A normal workup is not a dead end. It gives therapy something solid to stand on: your heart has been checked, so the work can focus on why your body keeps sounding the alarm.
Panic disorder treatment options
Treatment for panic disorder usually takes one of three shapes:
- Therapy on its own, which is where many people start
- Medication through a prescriber, such as a psychiatrist, a psychiatric nurse practitioner, or your primary care doctor
- Both together, with your therapist and prescriber each handling their part
A 2005 review of the evidence written for family doctors found that CBT can be used alone or alongside antidepressant medication, and both paths had good support. Which one fits you depends on how often the attacks come, what else is going on, what you’ve tried before, and what you prefer.
Psychotherapy for panic disorder: the main approaches
Several kinds of talk therapy help with panic. They start in different places, and a good therapist can draw on more than one. In our view, how well you and your therapist work together matters as much as the name of the method.
Psychodynamic therapy
Psychodynamic therapy looks at what the panic is attached to. Attacks often begin during a stretch of change or strain: a move, a loss, a new job, a relationship that feels hard to leave or hard to keep. A version built for panic, called panic-focused psychodynamic psychotherapy, works on the feelings under the attacks that are hard to say out loud, like anger, fear of being on your own, or feeling trapped.
It has trial evidence behind it. In a small 2007 study of 49 adults with panic disorder, 73% of those who had this therapy twice a week for 12 weeks had responded, compared with 39% of those taught relaxation skills. For a wider look at the approach, see the strengths and weaknesses of psychodynamic therapy.
Emotion-focused therapy
Emotion-focused therapy works with the feelings that sit underneath fear. Panic can show up just as something else starts to rise, like grief, anger, or shame. In this approach you learn to notice those feelings in your body and stay with them long enough to understand what they need, so they have less reason to come out as alarm.
Cognitive behavioral therapy (CBT)
Panic-focused cognitive behavioral therapy (CBT) has a large research base. A 2003 review of the approach describes it as a first-line treatment that typically runs 12 to 15 sessions, aimed at breaking the loop of dread, panic, and avoidance.
A core piece is interoceptive exposure, which means bringing on the sensations you fear on purpose, with your therapist. You might spin in a chair until you’re dizzy, breathe through a thin straw, or run in place until your heart pounds. Your body learns that a racing heart is uncomfortable and survivable. Gradually returning to the places you’ve avoided usually comes next.
Other approaches
Acceptance and commitment therapy (ACT) and mindfulness-based therapies teach you to let sensations rise and fall without fighting them. Head-to-head research on panic therapies is still limited. In a larger trial of 201 adults at two sites comparing CBT, panic-focused psychodynamic psychotherapy, and relaxation training over 12 weeks, all three substantially improved panic disorder, though results differed between the sites.
What therapy for panic attacks looks like
The first few sessions are mostly about getting the whole picture. That means what your attacks are like, when they started, what you’ve begun to avoid, which medical checks you’ve had, and what else was happening in your life around then.
Panic doesn't have to run your schedule
If panic attacks are shrinking your days, therapy can help you understand them and take back the places you've been avoiding. Our DC therapists work with panic and anxiety.
Our therapists don’t run one fixed program. They draw on the approaches above to fit the person, so many people get a mix: some work on the sensations, some on what the panic is tied to. Over a course of treatment, the work usually covers these steps:
Get the physical side checked
Learn what your body is doing
Look at what the panic is tied to
Turn toward what you've been avoiding
Plan for the next wave
You don’t have to take these in order, and a good therapist won’t rush the hard ones.
A lot of panic work happens in the small places people have quietly stopped going: the Metro, the gym, a long meeting with no easy exit. We pay as much attention to those as to the attacks, because a shrinking life is often what hurts most. It is also the part that grows back.
Many people notice the attacks easing before the avoidance does. That’s normal. The places you stopped going often come back last.
How long does panic disorder treatment take?
It depends on how long the panic has been around and what else is going on. The structured courses described above, CBT and panic-focused psychodynamic therapy alike, were built to run about three months.
Some people finish there. Others stay longer, because the panic turned out to be tied to something bigger, like a relationship, a loss, or a long habit of keeping feelings to themselves. Neither path means you did it wrong.
Setbacks are common, especially during a stressful stretch or after weeks of poor sleep. A single attack after a good run is a chance to use what you learned, not proof that treatment failed.
Medication for panic disorder
Medication is prescribed and managed by a psychiatrist, a psychiatric nurse practitioner, or a primary care doctor, not by a therapist. If you’re curious about it, that’s the person to ask. The NIMH guide linked above describes the main options in general terms:
- Antidepressants, mainly SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors), are commonly used and may take several weeks to start working.
- Benzodiazepines can ease symptoms quickly. Some people build tolerance or become dependent on them, so prescribers may limit them to brief periods.
Don’t start, stop, or change a medication on your own. Your prescriber can help you do it safely. If you take medication, therapy can still help, and it’s worth letting each of them know about the other.
Finding a panic disorder therapist in DC
It may be time to reach out if attacks keep coming back, if worry about the next one is shaping your days, or if your world has gotten smaller to stay safe. You don’t need to wait until it feels unbearable.
Our therapy for panic disorder starts where you are. Some people want to understand the attacks, some want their commute back, and plenty want both. If panic sits inside wider worry, our anxiety therapy covers that too, and if the fear centers on your heart or your body, health anxiety is often part of the picture.
Panic is treatable, and you can start where you are
If panic attacks, or the fear of the next one, are shaping your days, our Dupont Circle therapists can help you understand what's happening and take back what panic has narrowed.
Last updated: October 2026
This blog is for informational purposes only and does not constitute medical or mental health advice. Always consult with a qualified mental health professional for personalized guidance regarding your specific situation.
