# Therapy for panic attacks: what treatment involves, how long it takes and how to choose > Your heart starts racing on the underground and you are sure you are going to die. When to see a psychologist for panic attacks, what effective therapy is like and how long it takes. *https://mypsicotest.com/en/blog/therapy-for-panic-attacks/ · Published: 2026-10-15 · 9 min read · MyPsicoTest team* You are on the underground and, without any warning, your heart starts racing. You cannot get enough air, your hands tingle and you are certain you are about to faint, or worse. You get off at the next stop. Ten minutes later it has passed, but since that day you have not felt calm anywhere you cannot leave quickly. Panic attacks are terrifying, but they respond very well to therapy. If you are thinking about **therapy for panic attacks**, this guide explains when it is worth seeing a psychologist, which treatment works, what therapy is like from the inside, how long it takes, whether it works online, where medication fits in and how to choose a professional. ## When to see a psychologist for panic attacks A one-off attack is more common than people think. In the [World Mental Health surveys](https://pubmed.ncbi.nlm.nih.gov/27775828/) coordinated by the WHO, with more than 142,000 adults in 25 countries, 13.2% had had at least one panic attack in their life. Only a minority of them, 12.8%, went on to develop **panic disorder**, which affects 1.7% of the population. What did make a difference was repetition: recurrent attacks were linked to more mental health problems later on, and one-off attacks were not. The NHS explains that panic disorder is diagnosed when attacks are regular and unexpected and are followed by at least a month of constant worry about having more. It is the cycle of living in fear of fear: you avoid places so it will not happen again, and that avoidance feeds the panic. It is worth asking for help if: - You have had several attacks in recent weeks. - You live on edge, waiting for the next one. - You avoid the underground, traffic jams, queues, crowded places or going out alone. - You never go anywhere without water, a pill "just in case" or someone to go with you. - You often check your pulse or have been to A&E several times about your heart. - You use alcohol or pills to calm down. If it is the first time or you have doubts, see a doctor first: the NHS points out that many of these symptoms can have other causes and that a doctor can examine you to rule them out. We explain what happens in your body during an attack, and when to go to A&E, in [Panic attack: what it is, why it feels like a heart attack and what to do](https://mypsicotest.com/en/blog/panic-attack/). If you want to get your bearings before an appointment, the [Anxiety Test](https://mypsicotest.com/en/anxiety-test/) asks about the last two weeks and includes statements such as "I have noticed palpitations, a racing heart, sweating or shortness of breath without any physical exertion" and "I have avoided situations, places or activities because of the anxiety they cause me". ## Which treatment works for panic attacks NICE, the UK clinical guideline body, recommends **cognitive behavioural therapy (CBT)** for panic disorder, delivered by trained and supervised professionals who follow evidence-based protocols. We explain the approach in general in [Cognitive behavioural therapy: what it is, how it works and what it treats](https://mypsicotest.com/en/blog/cognitive-behavioural-therapy/). Not all CBT is the same. A [meta-analysis by Pompoli and colleagues](https://pubmed.ncbi.nlm.nih.gov/29368665/) took the therapy apart to see which pieces work, with 72 studies and more than 4,000 participants. What was most closely linked to improvement was **interoceptive exposure**, controlled exposure to body sensations, and having the therapy delivered by a professional rather than through self-help materials. Muscle relaxation and virtual reality exposure, on the other hand, were linked to worse results, while breathing retraining and exposure to feared situations helped people stay in treatment but had little effect on how well it worked. ### What therapy for panic attacks is like from the inside Therapy builds on the cognitive model described by the psychologist David Clark in 1986: a normal body sensation, such as a palpitation or a slight dizziness, is interpreted as a catastrophe, a heart attack, fainting or going mad. That interpretation triggers fear, the fear increases the sensations, and the sensations seem to confirm that something is wrong. In practice, therapy usually follows these steps: 1. **Understanding the panic cycle.** Knowing what is happening in your body and why already brings the fear down a great deal. 2. **Questioning catastrophic interpretations** with your own evidence: how many times you have felt you were about to faint, and how many times you actually did. 3. **Facing the sensations.** The sensations you fear are brought on deliberately and in a controlled way: spinning in a chair to get dizzy, breathing through a straw, running up stairs to speed up your heart. Repeating this until they stop being frightening is what teaches your body that they are not dangerous. 4. **Dropping safety behaviours.** The pill in your pocket, always sitting near the exit or never going out alone bring short-term relief but stop you from finding out that nothing bad happens. 5. **Going back to the places you avoid**, step by step: one underground stop, then two, a short queue at the supermarket, a trip on your own. 6. **Preventing relapse.** At the end you put together a plan for more stressful times, when the fear may try to come back. ![Young woman standing in an underground carriage holding the pole, one of the places many people with panic attacks learn to reclaim in therapy](https://mypsicotest.com/assets/img/blog-ataques-de-panico-transporte-publico-1200.webp) It is not a comfortable treatment, because the whole point is to do what panic tells you to avoid. That is why it moves in small steps and at your pace. One more important detail: slow breathing helps, but on its own it does little for panic, and if it becomes the only thing you do to keep an attack away, it can end up working as one more safety behaviour. ### What about medication? NICE is clear about benzodiazepine tranquillisers: they are linked to worse long-term outcomes and should not be prescribed for panic disorder. Nor does it recommend sedating antihistamines or antipsychotics. If long-term medication is needed, the option is antidepressants, mainly SSRIs, which according to the NHS take two to four weeks to start working and up to eight weeks to work fully. They are prescribed by a doctor, not the psychologist, and should not be stopped suddenly. We explain the differences between the two routes in [Anxiety medication or therapy: what works better for anxiety](https://mypsicotest.com/en/blog/anxiety-medication-or-therapy/). ## How long therapy for panic attacks takes It is a short treatment. NICE recommends a total of 7 to 14 hours of CBT, in weekly sessions of one to two hours, completed within a maximum of four months. It also allows for briefer versions of around seven hours combined with self-help materials and, for some people, intensive CBT concentrated into a very short period. What lengthens the process most is avoidance. Having attacks without having given anything up is not the same as spending months without taking public transport or going out alone. Either way, the professional should explain the plan from the start and track with you how many attacks you have, how much they frighten you and what you have stopped doing. ## Does online therapy for panic attacks work? Yes. A [meta-analysis by Efron and Wootton](https://pubmed.ncbi.nlm.nih.gov/33774557/) pooled 21 studies with more than 1,600 people who did CBT for panic disorder remotely, online, by video call or with guided books. Improvement was large, therapy worked better than doing nothing and the results were similar to other active treatments such as face-to-face CBT. Another review, by Stech and colleagues, focused on internet-delivered CBT and found that improvements in panic and agoraphobia held three to six months later. So **online therapy** is not a second-best option. With panic, video calls also have advantages of their own. If agoraphobia keeps you at home, you can start without having to leave. Exposure to sensations works just as well in your living room, and the professional can stay with you on your phone while you take your first steps on the underground or in the supermarket. If you have never had therapy by video call, [Online psychologist: how to choose well and what to expect from video-call therapy](https://mypsicotest.com/en/blog/online-psychologist-how-to-choose/) may help. ## How to choose a psychologist for panic attacks These checks help you get it right: - **Registration as a health professional.** This comes first. - **They use CBT and exposure**, both to sensations and to the places you avoid. Ask directly how they treat panic. - **They do more than teach you to breathe or relax.** That helps, but it is not the treatment. - **They work on safety behaviours** and avoidance, not just on the moment of the attack. - **A plan with measurable goals** and a rough idea of how many sessions it will take. - **Coordination with your doctor**, if you take medication or want to come off it. ## A psychologist for panic attacks At MyPsicoTest we recommend [Xènia Capel Salcedo](https://psicologaigualada.es/en/therapist-psychologist-igualada/), a licensed clinical psychologist (COPC 14982) with a master's degree in Clinical Psychology and Psychotherapy. She sees clients in Igualada and Sant Sadurní d'Anoia and also through [online therapy](https://psicologaigualada.es/en/online-therapy-online-therapist/), and on her blog she has written an article about online therapy for panic attacks. In it she explains how she works, based on Clark's model: a first phase of assessment and explaining the panic cycle, then work on catastrophic interpretations, exposure to sensations, which she guides by video call and you then practise between sessions, and gradual exposure to avoided situations, during which she can stay with you live by video call. She finishes with relapse prevention. She uses breathing as a complementary tool rather than the main treatment, because used the wrong way it can become a safety behaviour. She works from an integrative, evidence-based approach: on her website she explains that she uses tools from cognitive behavioural therapy, EMDR, systemic therapy and person-centred therapy. Sessions are available in English, Spanish or Catalan, and the first contact is a free, no-commitment information consultation. She herself points out that in a serious crisis or psychiatric emergency, immediate in-person care is what is needed. ## Frequently asked questions ### What kind of psychologist treats panic attacks? A licensed psychologist trained in cognitive behavioural therapy and experienced in exposure, both to body sensations and to the situations you avoid. It is the psychological treatment that guidelines recommend. ### How many sessions does panic attack treatment take? NICE recommends 7 to 14 hours of cognitive behavioural therapy, in weekly sessions of one to two hours, over a maximum of four months. It can take longer if there is a lot of avoidance or agoraphobia. ### Can therapy help you overcome panic attacks? Cognitive behavioural therapy is the psychological treatment with the strongest support for panic disorder, and in a review of internet-delivered CBT the improvement held three to six months later. The goal is for the attacks to stop running your life and for you to know what to do if they come back. ### What is interoceptive exposure? It means deliberately bringing on, in a controlled way, the sensations that frighten you most, such as dizziness or a racing heart, to find out that they are not dangerous. It is one of the pieces most closely linked to improvement in panic. ### Does online therapy work for panic attacks? Yes. A meta-analysis of 21 studies found that remote therapy worked about as well as other active treatments such as face-to-face therapy, and it lets you start even if agoraphobia keeps you at home. ### Can I take tranquillisers for panic attacks? NICE advises against benzodiazepines for panic disorder because they are linked to worse long-term outcomes. If long-term medication is needed, the option is antidepressants, prescribed by a doctor. ### Does a single panic attack need treatment? Not necessarily. More than 13% of adults have at least one in their lifetime and only a minority develop panic disorder. It is worth getting help if the attacks keep coming back, if you live waiting for the next one or if you start avoiding places.