Panic attack treatment and panic disorder therapy, online in NZ

What is a panic attack?

A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes, with symptoms such as a racing heart, breathlessness, chest tightness, dizziness, shaking and a sense of unreality or dread. Panic disorder is when repeated attacks lead to persistent fear of the next one and changes to how you live. Both respond well to CBT.

What happens in your body during a panic attack

A panic attack is the fight-or-flight response firing at full strength when there is nothing to fight or flee. Adrenaline floods the system within seconds. Every symptom has a physical explanation, and knowing them matters, because the fear in a panic attack comes from not knowing what the sensations mean.

• Racing or pounding heart. Your heart speeds up to pump blood to the muscles. It is doing its job, not failing.
• Breathlessness and chest tightness. Breathing gets faster and shallower, the chest muscles tense, and it can feel as if you cannot get a full breath. Over-breathing also lowers carbon dioxide in the blood, which causes the next group of symptoms.
• Dizziness, tingling, pins and needles, a numb face or hands. In a panic attack these are usually effects of over-breathing, not a stroke or a heart problem. Sudden numbness or weakness on one side of the face or body, a drooping face or slurred speech is different: call 111.
• Nausea, a churning stomach, needing the toilet. Digestion shuts down when the body thinks it needs to run.
• Shaking, sweating, hot flushes or chills. Muscles primed for action, and a body trying to cool itself.
• Feeling unreal, detached or "not here". A common and particularly frightening symptom, caused by changes in blood flow and attention. It passes.

Symptoms peak within minutes and then subside as the adrenaline is used up. The shaky, drained feeling afterwards can last longer. Attacks can happen out of the blue, in a specific place, or even wake you from sleep.

The fear of fear: how panic turns into panic disorder

One panic attack is unpleasant. Panic disorder develops when the attack itself becomes the thing you fear. David Clark's cognitive model of panic, which has shaped treatment since the 1980s, describes the loop: a bodily sensation is noticed, it is interpreted as a sign of catastrophe ("I'm having a heart attack", "I'm going to pass out", "I'm losing my mind"), that interpretation triggers anxiety, anxiety produces more sensations, and the sensations confirm the catastrophe.

After a few attacks, people start scanning their body for early signs. A slightly fast heartbeat after climbing the stairs becomes a warning. Then the avoidance begins. You stop going to the supermarket on Saturday because the queue at the checkout is where it happened last time. You take the long way rather than the Harbour Bridge or the Terrace Tunnel. You skip the gym because a raised heart rate feels dangerous. You stop drinking coffee, then stop going to cafés at all.

Alongside avoidance come safety behaviours: always carrying water, sitting near the exit, keeping your phone in your hand, never travelling alone, having a sedative in your bag "just in case". They feel like the only reason you cope. In fact they prevent you from discovering that you would have coped anyway. When the fear and avoidance spread to several kinds of situations, such as queues, crowds, public transport, bridges or being away from home alone, it is called agoraphobia.

First, rule out physical causes with your GP

If you have had chest pain, palpitations, breathlessness or fainting and have not yet seen a doctor, do that first. Thyroid problems, heart rhythm issues, asthma, low blood sugar, some medications and high caffeine intake can all produce sensations that look like panic, and your GP can check for them with a straightforward examination and, if needed, tests.

Once physical causes have been ruled out, the most useful thing you can do is believe the result. Repeated trips to the emergency department or repeated requests for heart tests are understandable, but they keep the fear alive, in the same way checking keeps health anxiety going. Your psychologist will help you agree a sensible line: new or different symptoms get checked; the familiar pattern gets treated as panic.

Your GP may also raise medication. Antidepressants are one option clinical guidelines describe for panic disorder, and the NICE guideline advises against benzodiazepines for panic because they are linked to poorer outcomes in the long term. Those are decisions for you and your GP or psychiatrist, not for your psychologist.

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CBT for panic, step by step

CBT is the psychological treatment recommended by NICE for panic disorder, delivered as weekly sessions over a few months. A network meta-analysis of 72 randomised trials pulled CBT for panic apart into its components and found that interoceptive exposure (deliberately bringing on feared bodily sensations) was linked to better outcomes, while adding muscle relaxation was linked to poorer ones. That shapes how we work.

1. Understanding the attack. You learn exactly what each symptom is and why it happens, and map your own cycle: the first sensation you notice, the thought that follows, what you do next. Many people describe this first stage alone as taking some of the terror out of the next attack.
2. Catching the catastrophic prediction. "I'll faint" or "my heart can't take this" are predictions, not facts. You and your psychologist look at the evidence from your own history: how many attacks, how many of the predicted outcomes.
3. Interoceptive exposure. In session and then at home you deliberately create the sensations you fear: spinning in a chair to bring on dizziness, breathing through a straw to feel short of breath, running on the spot to get your heart going, staring at a point to trigger unreality. Done repeatedly and on purpose, the sensations lose their meaning. The body learns they are uncomfortable but safe.
4. Dropping safety behaviours. Leaving the water bottle at home. Sitting in the middle of the row. Going to the supermarket alone. Each one is an experiment designed to find out what actually happens without the prop.
5. Going back to avoided places. Planned, graded and reviewed each week, until the supermarket is just a supermarket again.
6. Planning for the future. Panic can resurface under stress. Knowing what to do when it does is the difference between a bad afternoon and a relapse.

Why breathing exercises alone are often not enough

Slow breathing is useful and your psychologist may well teach it. But if controlled breathing becomes the only thing standing between you and catastrophe, it has become another safety behaviour, and the underlying belief ("without this I would lose control") stays untouched. The same goes for relaxation apps, grounding objects and distraction.

The research on treatment components supports this. Breathing retraining made treatment more acceptable to people, but added little to how well it worked, and muscle relaxation was associated with poorer results. The techniques that change panic are the ones that let you experience the sensations and find out they are survivable. Calming tools have a place; they are not the treatment.

Doing panic treatment online

CBT for panic disorder has been delivered in many formats, and a 2023 network meta-analysis of 74 trials found face-to-face individual therapy, group therapy and therapist-guided self-help all worked to a similar degree. Live video sessions sit comfortably inside that evidence, and research on video-delivered psychotherapy more generally shows outcomes comparable to in-person treatment.

For panic specifically, online delivery has some practical advantages. Interoceptive exercises can be done at home with your psychologist watching and coaching, in the room where attacks actually happen rather than a clinic that feels artificially safe. Exposure to real places (the mall, the motorway, the Interislander) is planned together and done between sessions, then reviewed. And for someone whose panic is tied to travelling or waiting rooms, not having to travel to a waiting room removes a barrier to starting at all.

When panic comes with other things

Panic rarely arrives alone. It often sits alongside generalised worry, health anxiety, social anxiety (panic in meetings or at parties) or depression, particularly after months of avoidance have shrunk your life. Some people develop panic after a traumatic event, in which case treatment may need to address the trauma as well; see our trauma therapy page.

Alcohol deserves a mention. A few drinks reliably calm a panic-prone nervous system for an evening and reliably make it more reactive the next day, and many people only connect the two in therapy. Your psychologist will ask about alcohol, caffeine, sleep and stimulant use, not to lecture but because they are often part of the picture.

What to expect at Mindwell

All Mindwell sessions are 50-minute video appointments through Carepatron, which runs in your browser. You book online at any time, choose a psychologist or take the first available, and can usually have a first session within 7 days. You do not need a referral. Your confirmation email contains the video link and calendar invite, and a short intake form follows separately.

In the first session your psychologist will take a detailed history of your attacks: when the first one happened, what the worst one was like, what you now avoid, what you carry with you, and what medical checks you have had. Together you will agree a plan. Panic treatment is usually weekly to begin with so that momentum builds.

Sessions are $199 + GST ($228.85 including GST), paid when you book, with a receipt for insurance. Sandy Laurenson, Jake Meads and Katherine Lee all work with panic as part of their anxiety practice. Mindwell works with adults 18 and over in New Zealand, is not an ACC provider, and is not a crisis service: if you think you may be having a medical emergency, call 111.

Related support: Anxiety therapy · Health anxiety · Social anxiety · Specific phobias