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For adults
Panic attacks and agoraphobia
Panic disorder is one of the most treatable anxiety conditions there is. The mechanism is well understood, and once you can see it, most of the mystery goes out of it.
What a panic attack is
A panic attack is your body’s emergency system firing at full strength when there is no emergency. Adrenaline floods the system in seconds. Your heart accelerates, your breathing becomes fast and shallow, your chest tightens, your hands tingle, the room feels unreal, and a certainty arrives that you are about to die, collapse, lose control or go mad. It peaks within about ten minutes and it subsides whether or not you do anything.
Physiologically, nothing is going wrong. Everything happening in your body during a panic attack is what happens when a person is preparing to run from something dangerous. The system is working — it has simply been triggered by the wrong thing.
Panic disorder is what develops next. After a few attacks, you start monitoring for the sensations, and monitoring finds them, because the human body produces odd sensations constantly. A skipped beat after coffee, light-headedness on standing, breathing that feels effortful in a warm room. Each of these now reads as the beginning of an attack, which produces adrenaline, which produces the sensation properly. The fear of panic becomes the engine of panic.
What it actually looks like
- Sitting on the aisle, near the door, or at the end of the row — always.
- Checking your pulse several times a day, and finding it fast because you are checking.
- Carrying water, mints, a paper bag, propranolol or an unopened box of diazepam, and needing to know it is there rather than actually taking it.
- Driving a longer route to avoid the motorway, or the dual carriageway with no hard shoulder.
- Only going to the supermarket at quiet times, or only with your partner.
- Leaving the meeting, the restaurant or the queue and calling it a headache.
- Going to A&E convinced it was your heart, being discharged, and feeling relieved for a day.
- A map of the world that has quietly redrawn itself into safe places, borderline places, and places you no longer go.
Safety behaviours: the near-miss problem
The water bottle, the aisle seat, the partner beside you, the tablet in your pocket, the controlled breathing you start the moment you feel something — all of these get you through, and all of them prevent the learning. You go to the supermarket clutching your phone with your escape route planned, nothing terrible happens, and your brain records it as a near miss made survivable by the precautions.
Nothing changes until you go without them. That is not bravado — it is the entire mechanism of treatment, and it is done in graded steps that you choose.
How agoraphobia builds
Agoraphobia is rarely a fear of open spaces, whatever the word suggests. It is the fear of being somewhere you could not easily leave, or where help would be slow, if the sensations started. Motorways. Trains. Tunnels. Hairdressers’ chairs. Cinemas mid-film. Supermarket queues. Being alone in the house. Being far from home.
It builds by simple arithmetic. You avoid something, the relief is immediate, and avoidance is reinforced. The next situation that resembles it becomes harder. Over months or years the safe zone contracts, and people commonly describe reaching a point where they cannot identify the moment it became this small. I have worked with people who ran departments and could no longer get to the shop at the end of their road. It is not weakness, and it is not permanent.
What treatment involves
CBT for panic disorder is one of the most thoroughly tested psychological treatments there is, and NICE recommends CBT as a first-line psychological treatment for panic disorder and agoraphobia. It has three components and they work together.
We begin with the mechanism, in proper detail: what adrenaline does, why over-breathing causes tingling and unreality, why chest tightness follows tension, why you are not going to faint. This is not reassurance — it is a working model you can test, and testing it is what comes next.
Then interoceptive exposure, which is the part that surprises people. Rather than avoiding the sensations, we deliberately produce them: breathing rapidly through a straw, spinning in a chair, running up stairs, holding your breath. You generate the racing heart and the light-headedness on purpose, without escaping and without the safety behaviours, until your body stops treating them as an alarm. This is where the fear of the sensations is actually dismantled, and it borrows directly from the logic of exposure and response prevention.
Finally, situational exposure to reclaim the map. Together we build a list — the supermarket at 5pm, the train two stops, the motorway junction, an hour alone in the house — and you work up it, dropping the precautions as you go. This is the slower part and it is the part that gives you your life back.
When something else is in the mix
Panic frequently arrives alongside other things. Where the fear is that the symptoms signal an undiagnosed illness rather than that panic itself is intolerable, the picture overlaps heavily with health anxiety. Where attacks only happen in social situations, we are usually looking at social anxiety. Panic attacks also occur within specific phobias and around trauma anniversaries. The assessment establishes which, because the treatments differ in emphasis.
Working with me
I am a clinical psychologist and have been working in psychology since 2008. I trained at the University of Washington, a leading clinical research programme, completed my internship at Seattle Children’s Hospital and Harborview Medical Center, and a postdoctoral fellowship at the Evidence-Based Treatment Centers of Seattle, where I was Director of Training and Education and later Assistant Director of the Child Anxiety Center. I am board certified in Behavioral and Cognitive Psychology by the American Board of Professional Psychology, registered with the HCPC and chartered with the British Psychological Society.
I see adults online across the UK and in person near Ravenshead, Nottingham and Mansfield, weekdays from 9am to 9pm. Sessions are £120 with a 90-minute initial assessment at £180, and I am recognised by BUPA, AXA Health, Aviva, Vitality and WPA. The structure of a course of treatment is set out on how I work.
The first step is a free 30-minute call. Tell me what has been happening and I will tell you honestly what I think is going on and whether I can help.
Common questions
Can a panic attack actually harm me?
A panic attack is a full activation of the fight-or-flight response — adrenaline, a fast heart, rapid breathing, tingling, dizziness, a sense of unreality. It is deeply unpleasant and it is not dangerous in a healthy person. You will not stop breathing: breathlessness in panic comes from over-breathing, not under-breathing. You are very unlikely to faint, because fainting requires blood pressure to drop and in panic it rises. Get any new physical symptoms checked by your GP once. After that, the fear of the sensations is the thing to treat.
What is the difference between panic disorder and agoraphobia?
Panic disorder is recurrent unexpected panic attacks plus persistent worry about having another one. Agoraphobia is the avoidance that often follows: staying away from places where escape would be difficult or help unavailable — public transport, motorways, supermarkets, cinemas, queues, being far from home or alone. They frequently occur together, and the avoidance is usually what causes the greater loss of life. Some people with agoraphobia have never had a full panic attack; the fear is of being trapped or incapacitated.
How long does treatment take?
Panic disorder responds to CBT relatively quickly. A common course is roughly 8 to 16 sessions after the initial assessment, and many people notice a meaningful shift within the first few weeks once they understand the mechanism and start the exposure work. Where agoraphobic avoidance is long-standing and the map of safe places has narrowed considerably, it takes longer, because the territory has to be regained step by step. I will give you an estimate after the assessment.
Do I need to stop taking my medication before therapy?
No, and please do not change anything without speaking to the prescriber. I am a psychologist and do not prescribe; I work alongside GPs and psychiatrists. One thing worth discussing with your doctor is short-acting benzodiazepines taken as needed, and beta blockers used the same way — taken during or just before a feared situation they can function as a safety behaviour and blunt the learning that treatment depends on. That is a conversation to have with your prescriber, not a decision to make alone.
What if I panic during a session?
That is genuinely useful rather than a problem. Panic in session gives us something real to work with instead of a recollection, and it lets you find out what happens when you neither escape nor fight it. Later in treatment we deliberately bring the sensations on — through breathing exercises, spinning, or physical exertion — so you can practise the same thing on purpose. Nothing is done without your agreement, and you always know why we are doing it.
Can this be treated online if I cannot leave the house?
Yes, and for people whose agoraphobia has narrowed things severely, online is often the only realistic starting point. The work happens in your world anyway — the supermarket, the bus, the motorway junction — not in a consulting room. Working online means we can plan an exposure at your kitchen table and you can do it that afternoon. In-person sessions near Ravenshead, Nottingham and Mansfield are available later if they would be useful.
Related pages
Not sure whether this is the right fit?
Start with a free 30-minute call. We will talk through what is going on, I will tell you honestly whether I think I can help, and if I cannot I will try to point you to someone who can. There is no obligation and no charge.