CBT for Panic Attacks and Agoraphobia
Evidence-based virtual therapy for panic attacks, panic disorder, agoraphobia, and fear of leaving home.
When fear of panic starts taking over
Panic attacks can be frightening. Your heart is racing, you can't catch your breath, you're dizzy or lightheaded, and you may genuinely feel like something is terribly wrong.
And when you've experienced that before, it makes sense that you might start doing everything you can to prevent it from happening again.
You might stop taking the bus. Avoid crowded places. Sit near the exit at restaurants. Check your heart rate. Make sure someone is with you when you leave the house. Or slowly start avoiding more and more situations because of the possibility of having another panic attack.
I've worked with many clients whose world had become incredibly small because of panic and agoraphobia—sometimes to the point where leaving the house felt nearly impossible.
It doesn't have to stay that way.
What are Panic Disorder & Agoraphobia?
Panic disorder involves recurrent panic attacks, often accompanied by an ongoing fear of having another one. The panic attack itself may last only minutes, but the fear of experiencing another attack can persist long after the physical symptoms have passed.
You may find yourself constantly monitoring your body for signs of panic, wondering "What if it happens again?" or interpreting normal physical sensations as signs that another attack is about to happen.
Agoraphobia can develop when you begin avoiding situations because you're afraid of having a panic attack and feeling trapped, unable to escape, or unable to get help.
This might mean avoiding things like:
Driving or being stuck in traffic
Public transportation
Shopping centres or grocery stores
Restaurants, theatres, or other crowded places
Elevators
Bridges or highways
Standing in long lines
Being far from home
Leaving the house alone
Being somewhere without an easy way to leave
Sometimes the avoidance is obvious. Other times, you may still be doing these things—but only with significant anxiety, extensive planning, or certain "safety behaviours" that help you feel more secure (ex: sitting near exits, only going out with safe people).
Over time, avoidance can become a cycle. The more you avoid something, the more threatening it can feel the next time you encounter it.
What does a panic attack feel like?
Panic attacks can involve a range of intense physical and psychological sensations, including:
Racing or pounding heart
Feeling hot or sweaty
Dizziness or lightheadedness
Shortness of breath or difficulty catching your breath
Chest discomfort or tightness
Trembling or shaking
Nausea
Numbness or tingling
Feeling detached from yourself or your surroundings
A feeling that something terrible is about to happen
Fear of losing control, fainting, dying, or "going crazy"
One of the most difficult parts of panic can be the meaning we attach to these sensations.
A racing heart can become "I'm having a heart attack."
Dizziness can become "I'm going to faint."
Feeling detached can become "I'm losing my mind."
And once these sensations are interpreted as dangerous, the fear itself can trigger even more physical sensations—creating a cycle that can feel completely out of control.
When is it time to get help?
Everyone experiences anxiety, and many people experience panic attacks at some point in their lives. Having a panic attack doesn't necessarily mean you have panic disorder.
The bigger question is what happens afterward.
Are you constantly worried about having another panic attack?
Have you started avoiding places or activities that you used to enjoy?
Do you need to have someone with you when you leave the house?
Are you planning your day around where you could escape or get help?
Are you checking your body for signs of anxiety?
Has your world gradually become smaller?
For some people, panic and agoraphobia can become so limiting that everyday activities—like going to work, grocery shopping, seeing friends, driving, or leaving the house—feel overwhelming or impossible.
If anxiety is getting in the way of the life you want to live, you don't have to wait until it gets worse to reach out.
How can CBT help with Panic Disorder & Agoraphobia?
Cognitive Behavioural Therapy (CBT) is an evidence-based approach that can be very effective for panic disorder and agoraphobia.
Treatment isn't about convincing yourself that you shouldn't be anxious or trying to eliminate every uncomfortable sensation.
Instead, we'll work on understanding the cycle that keeps panic and avoidance going—and gradually helping your brain learn that anxiety and physical sensations, while uncomfortable, are something you can handle.
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Understanding what is happening in your body can be an important first step.
We'll talk about the fight-or-flight response and why panic can create such intense physical sensations. Panic can feel dangerous, but the sensations themselves are part of a normal physiological response designed to protect you.
Learning to recognize these sensations without immediately interpreting them as a sign that something is wrong can begin to change the panic cycle.
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We'll also look at the thoughts and predictions that make panic more frightening.
What if I faint?
What if I can't breathe?
What if I lose control?
What if people notice?
What if I can't get out?
CBT can help you examine these predictions and develop a more flexible and realistic understanding of what panic means—and, importantly, what you're capable of handling.
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Exposure is often an important part of treatment for panic and agoraphobia.
This might involve gradually approaching situations you've been avoiding, as well as intentionally experiencing some of the physical sensations associated with panic.
The goal isn't to force yourself through overwhelming situations or to make anxiety disappear.
Instead, exposure gives you the opportunity to learn:
"I can feel anxious and still be okay."
"I don't need to escape every time I feel uncomfortable."
"The thing I was afraid would happen didn't happen."
"Even when I feel panic, I can handle it."
Over time, these experiences can help rebuild your confidence and give you more freedom to make choices based on what you want to do—not what anxiety tells you is safe.
A note on my approach:
Psychoeducation, cognitive strategies, and exposure can all be helpful in treating panic and agoraphobia. But what we focus on, and when, will depend on you.
I've worked with clients who weren't ready to begin exposure when we first started working together—and that's okay. We can start where you are.
I take your individual needs, goals, experiences, and readiness into account when developing a treatment plan. Sometimes that means spending more time understanding panic and building confidence before beginning exposure. Other times, we're ready to start approaching feared situations sooner.
I'll meet you where you're at and we'll work together to find an approach that feels manageable and meaningful for you. My aim is to never lose sight of the person sitting in front of me—the person who is showing up, often while doing something that already feels incredibly difficult.
You can get your life back
If you've been avoiding things because you're afraid of having a panic attack, it can be easy to feel like you've lost a part of your life.
Maybe you remember when you could spontaneously go somewhere without thinking twice. Maybe you want to travel again, drive on the highway, go to a concert, take the SkyTrain, meet a friend for coffee, or simply walk out your front door without having to think through every possible scenario.
I've worked with clients who felt very far from that version of themselves when we first started working together.
The goal of therapy isn't to promise that you'll never feel anxious again.
It's to help you become less afraid of anxiety—to trust yourself more, gradually expand your world, and get back to doing the things that matter to you.
You don't have to wait until you feel completely confident to start.
Let's take the first step
If panic attacks or agoraphobia are keeping you from living your life the way you'd like, therapy can help.