Cognitive behavioral therapy (CBT) is a short-term method of treating panic disorder. CBT for panic disorder teaches people to change their negative thoughts and behaviors that trigger panic attacks so they can reduce symptoms and cope in healthier ways.1 Typical CBT therapy sessions last approximately 50 minutes and occur weekly for three to six months.
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How Does CBT for Panic Disorder Work?
Cognitive behavioral therapy is a common and effective treatment for panic disorder.2 The goal of CBT is to help the individual develop skills to recognize the connection between their thoughts, feelings, and behaviors; then apply those skills to manage how their thoughts and feelings interact and influence their behaviors.
CBT teaches coping mechanisms for anxiety and panic attacks, including cognitive restructuring and refocusing, problem solving, and relaxation techniques.3 Through CBT, individuals learn breathing and relaxation skills to help them during a panic attack. CBT can also help people evaluate the triggers of their attacks to learn ways to reframe these events so they are less likely to trigger a panic attack.
One of the most important components of CBT for panic disorder is to practice the skills acquired in therapy outside your therapy appointments. The skills must be applicable in the “real world” and the individual must be able to employ the skills learned when necessary outside of therapy.
8 CBT Techniques for Panic Disorder
Therapists use many different techniques and CBT exercises, including cognitive restructuring and breath control. We’ve included free CBT for panic disorder worksheets to help you get started with cognitive restructuring and setting S.M.A.R.T goals.
Eight of the most common techniques utilized in CBT specifically for treating panic disorder are:
1. Cognitive Restructuring
Cognitive restructuring helps people learn the difference between rational and irrational thoughts, called cognitive distortions. Once someone is able to accurately identify these distortions they can begin working toward restructuring their thoughts in healthier, productive ways.
During a panic attack, it’s hard to organize thoughts in a way that makes sense to others. For example, someone who has a fear of crowds is out with a group but loses the group and finds themselves alone in a large crowd. Cognitive restructuring can help the person remember that their life isn’t in danger and come up with ways to cope and prevent separations from happening in the future.
Cognitive Restructuring for Panic Disorder Worksheet
Recognize unhealthy thought patterns that are causing you increased anxiety and panic attacks by practicing cognitive restructuring.
8. S.M.A.R.T. Goals
S.M.A.R.T. goals can be especially helpful to someone with panic disorder because they provide structure and clarity, which can reduce feelings of overwhelm and improve confidence.
Here’s how each component of S.M.A.R.T goals contributes to better management of panic disorder:
- Specific: Specific goals help eliminate ambiguity. When you clearly define what you aim to achieve, it minimizes uncertainty, which can be a trigger for panic attacks.
- Measurable: Measurable goals allow for progress tracking. This can provide a sense of accomplishment and encourage continued effort, which builds confidence and reduces anxiety.
- Achievable: Setting achievable goals ensures that you don’t set yourself up for failure, which can exacerbate anxiety and panic. Realistic goals help build trust in your ability to succeed.
- Relevant: Goals that are relevant to the individual’s personal situation and needs help maintain motivation. For someone with panic disorder, goals should focus on what directly helps them manage or reduce symptoms.
- Time-bound: Having a deadline creates a sense of urgency but also provides a clear endpoint to assess progress. This helps in breaking down larger, overwhelming tasks into manageable chunks.
When you use S.M.A.R.T goals to break tasks into smaller, manageable goals you can prevent feeling overwhelmed. You’ll have a sense of control over your progress if your goals are specific and measurable, while accomplishing an achievable goal helps boost confidence and challenge negative thought patterns.
SMART Goals Worksheet for Panic Disorder
SMART Goals is a structured goal-setting method that helps individuals with panic disorder find clarity, which can reduce feelings of overwhelm.
3. Exposure Tasks
Exposure tasks in CBT involve exposing someone to the trigger that causes panic attacks. With prolonged exposure, the anxiety related to the trigger begins to decrease and eventually the individual can become desensitized to the stimulus.
For panic disorders, this can be helpful if someone has recurring emotional flashbacks to a particular traumatic event. Exposure therapy can be done through visualizations with a therapist—visualizing and confronting the trigger will make that individual less impacted by it over time.
4. Breath Control Procedures
Breath control procedures are important skills to master for those suffering from any type of anxiety, especially panic disorder. People often lose control of their breathing during a panic attack, causing the breath and heart rate to accelerate. Through breathwork, the individual can learn to control their breathing and reduce their heart rate. Learning breath control is critical in battling a panic attack.
Breathing exercises for anxiety are a great way to stay grounded during a panic attack. They help you focus on what is happening right now and not focus on “what-ifs.” A person’s physical state changes during a panic attack, and a breathing exercise can help regulate what is happening in their body, which can help them calm down.
5. Muscle Relaxation
Muscle relaxation is another way for a person experiencing a panic attack to regain control of their body. Muscle relaxation works by focusing on individual sections of the body and relaxing the muscles in that section, moving gradually through the body until all parts of the body are relaxed.
Similar to breathing exercises, muscle relaxation can be a good way to redirect the brain to focus on other things happening in the body, such as muscle tension disappearing. Finding ways to use your body to self-regulate is effective for relieving the symptoms during panic attacks. Muscle relaxation can help disarm and refocus the brain from the subject of the panic attack.
6. Grounding
Grounding is a relaxation and mindfulness technique that gets someone to focus on their five senses as a way to ground themselves in the present.
Here’s an example of a grounding exercise that might be helpful if you feel a panic attack coming on:
- Find five things you can see
- Find four things you can touch
- Find three things you can hear
- Find two things you can smell
- Find one thing you can taste
7. Mindfulness Training
Mindfulness training in CBT involves focusing your attention onto the present moment. This can be done through deep breathing exercises, muscle relaxation, or grounding techniques. Whichever method someone uses, the point of the exercise is to keep thoughts centered in the here and now.
Mindfulness-based CBT is a great intervention specifically for panic disorder. In a study lasting 8 weeks, it was found that individuals with panic disorder showed significant improvement on their intolerance of uncertainty as well as improvements in self reports on their overall symptoms of both depression and panic disorder. Mindfulness-based CBT can have a great impact on improving quality of life for those suffering from chronic panic attacks.4
8. Journaling
Journaling is usually given as homework by the CBT therapist. The act of journaling can provide a way of tracking thoughts and behaviors over time and discovering patterns in cognitive distortions. Try using anxiety journal prompts if you need help getting started, or one of the many journal apps. Journaling is a valuable tool for helping someone gain insight into their irrational thoughts and for beginning the process of cognitive restructuring.
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Examples of CBT for Panic Disorder
Cognitive behavioral therapists use many techniques when working with someone who has panic disorder. Treatment for panic disorder may focus heavily on one specific aspect of CBT, or a combination of different techniques may be applied. Some people find different techniques more helpful for them than others, and therapy can be modified to fit the unique needs of each individual.
Here are some examples of CBT for panic disorder:
Exposure Therapy for Agoraphobia-Induced Panic Attack
Exposure therapy for anxiety is a form of CBT commonly used for individuals with various types of anxiety. Individuals become exposed to whatever the stimulus is that triggers their anxiety during an exposure therapy session.
Sara is a 25-year-old woman who has agoraphobia, an anxiety disorder that causes extreme discomfort in public settings in which you feel you cannot escape. When placed in these uncomfortable situations, Sara often experiences intense panic attacks.
Sara’s therapist uses exposure therapy to treat this condition, gradually introducing her to the anxiety-inducing environments. At the start of the session, when introduced to the stressor, Sara’s anxiety increases exponentially. But by staying in the situation and allowing herself to feel the anxiety and adjust to it, she begins to become desensitized to the stressor.
Over time, Sara’s anxiety decreases to a much lower, more manageable degree. With repeated exposure therapy sessions, being in public settings becomes less and less anxiety-provoking for her.
Relaxation Techniques for Panic Attacks
There are many different relaxation techniques used in CBT for reducing the frequency and severity of panic attacks. Breathing techniques, muscle relaxation, and grounding exercises are among the most common.
Darcy is a fifty-five-year-old mother of three who attends therapy for panic disorder. During her CBT sessions, the therapist teaches Darcy several relaxation techniques she can use when she feels on the verge of a panic attack. Darcy practices the exercises with the therapist until she feels comfortable using the technique on her own.
Darcy’s therapist also assigns homework for her to complete between sessions. The more she can practice the relaxation techniques on her own in times that are less stressful and panic-inducing, the better she becomes at using the techniques during a panic attack.
Is CBT Effective for Panic Disorder?
CBT is an effective method for treating panic disorder and a variety of other anxiety-related disorders. In fact, many studies suggest that CBT is as effective, if not more so, than other therapy methods. Cognitive behavioral therapy is one of the few psychotherapy methods that has ample research and scientific evidence to support the claim that CBT is effective in producing change.2
- In a meta-analysis of 21 studies, it was found that CBT was the most effective intervention type for treating panic disorder, including over breathing retraining.6
- In a study looking at brain activity, it was found that CBT was effective in reversing the effects of a panic episode in those with panic disorder as evidenced by the increase of brain activity in the middle frontal and parietal lobes.7
- In a study lasting 10 weeks, it was found that online CBT was effective for those with social anxiety, depression and panic disorder.8
CBT Vs. Medication for Panic Disorder
Generally, CBT can improve symptoms of panic disorder on its own. In some cases, though, adding panic disorder medication to a therapy plan may be necessary for people who aren’t fully recovering with psychotherapy alone. CBT with medications improves overall severity of panic, mania, and anxiety.
Antidepressants like SSRIs and SNRIs are deemed first-line options for panic disorder since these are effective and usually well tolerated. The type of medication someone may be prescribed depends on many factors such as their medical history, severity of symptoms, tolerance to side effects, having a coexisting condition, etc. It’s best to speak with a health care practitioner or psychiatrist who can assess if the person is a good candidate for medication as well as which type, dosage, and length of treatment.10, 11
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The CBT Treatment Process & Timeline
CBT treatment is dependent on the individual and the severity of their symptoms, and this can impact the duration of treatment. The standard treatment model of CBT is about 12 weekly or bi-weekly sessions on average, with each session lasting one hour.
It can take time to experience results from CBT, depending on other mental health issues the individual is dealing with or other traumatic histories which may be at play. It’s important to go in with an open mind and with hope that, with the guidance of a therapist, you can work through these issues.
Example CBT Treatment Plan for Panic Disorder
A CBT treatment plan is created through a collaborative effort between the individual and their therapist. The goal is to create awareness about the current problem (panic disorder and associated difficulties) and how CBT can help. Together the individual and therapist formulate a strategy based on the person’s specific concerns, severity of symptoms, if there is presence of a comorbid condition, level of insight, lifestyle, cultural identity, etc. The treatment plan and the length of therapy will vary from person to person.
Below is a general overview of a CBT treatment plan for panic disorder:2, 9
Goals
- Reduce the frequency, intensity, and duration of panic attacks
- Reduce the fear associated with inability to manage panic attacks
- Minimize/eliminate evading places and activities believed to provoke panic attacks
Objectives
- Identify automatic, unreasonable fear-based thoughts
- Challenge and replace faulty beliefs with healthy alternatives
- Build self-confidence to manage and overcome panic attacks
- Confront situations/places/things that are avoided out of fear of having a panic attack until these no longer create such a response
- Develop an after-care plan to maintain progress upon completion of therapy
Interventions
- Therapist modeling to train individual on identifying distorted thoughts and replacing these with healthy self-talk
- Teaching relaxation techniques that will increase self-confidence to cope with panic attacks and decrease avoidant behavior
- Assigning homework to help identify personal distorted thoughts and replace them with reality-based alternatives, engage in gradual exposure to potential panic-inducing situations, etc.
- Discussing and establishing strategies so the individual can support themselves after treatment
How to Find a CBT Therapist
You can ask your primary care physician for a referral or call the number on the back of your insurance card to find a CBT therapist. You can also use a local therapist directory to search for therapists who provide in-person and online therapy options. Most insurance plans cover the cost of CBT therapy, but if you don’t have insurance coverage you can expect to pay about $100 per session.
You’ll also need a psychiatrist to diagnose, prescribe, and manage your medication if you require it. Online psychiatry is a convenient option to consider and many also accept insurance.
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At-Home CBT Exercises for Panic Disorder
While cognitive behavioral therapy should only be practiced by a qualified and experienced professional, there are certain CBT-related relaxation and coping exercises that you can try at home that can help relieve symptoms of panic disorder:
Deep Breathing Exercise
A simple deep breathing exercise that can be performed at home is 4-4-6. To do this exercise:
- Breath in through your nose for 4 seconds.
- Hold the breath in your lungs for 4 seconds.
- Breath out through your mouth for 6 seconds.
- Repeat.
Practice this for about 5-10 minutes at a time. This technique can be used to calm your breathing and slow your heart rate when you are feeling anxious.
Progressive Muscle Relaxation Exercise
An easy muscle relaxation exercise to try at home is the progressive muscle relaxation exercise:
- Feet: Curl your toes tightly into your feet, hold for 5 seconds, then release.
- Calves: Point your feet, hold for 5 seconds, then release.
- Thighs: Squeeze your thighs tightly together, hold for 5 seconds, then release.
- Torso: Tighten the muscles of your abdomen, hold for 5 seconds, then release.
- Back: Squeeze your shoulder blades together, hold for 5 seconds, then release.
- Shoulders: Lift your shoulders up toward your ears and squeeze them together, hold for 5 seconds, then release.
- Arms: Make fists and bend your arms, bringing your forearm toward your biceps and squeezing the muscles in the arms, hold for 5 seconds, then release.
- Hands: Make tight fists by curling your fingers into your palms, hold for 5 seconds, then release.
- Face: Scrunch your facial features and pull them toward the center of your face, hold for 5 seconds, then release.
- Full body: Tighten and squeeze all the muscles in your body together at the same time, hold for 5 seconds, then release.
Practice this muscle relaxation exercise daily to release anxiety-induced tension from your body.
Grounding Exercise
Grounding techniques for panic attacks can help keep focus on the here and now by seeking out sensory stimuli in your current environment. An imagery-guided grounding exercise can also be used as a way to calm anxiety.
To begin, think of a place you find comforting. Somewhere in your house, a favorite spot, a beach, or a memory from your childhood. Now spend 5-10 minutes visualizing this place that you have conjured in your mind.
Use your senses to help you:
- What do you see? Look around and take in your surroundings in this space. What can you see in the distance? What do you see close to you? Try to notice small details you might normally miss.
- What do you hear? Listen closely to the noises around you. Are the noises you hear soft or loud? Do they sound close by or far away?
- What do you taste? Are you eating or drinking something? If so, what does it taste like? Is it sweet or savory?
- What can you feel? Is it warm or cool? Is there a breeze? Is the sun shining on you warming your skin? Or are you bundled up in a soft blanket? Concentrate on how everything feels.
- What can you smell? What does the air smell like here? Is the scent strong or faint? Focus on the scents you smell and appreciate them.
Use this exercise to relax your mind when you are feeling anxious or stressed. Spend as long as you need visualizing your comfortable space. Allow yourself to feel calm and safe.
What Other Therapies Can Help Treat Panic Disorder?
CBT is usually the most common approach to treat a variety of anxiety conditions including panic disorder. But there are other therapeutic options that can help treat panic disorder either as a stand-alone method or an add-on strategy to the main treatment.
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Other therapy techniques that can help with panic disorder include:
- Bibliotherapy: Entails the use of books or other reading materials for self-improvement. Within a clinical context, books about anxiety or is often prescribed by counselors as a supplementary intervention to improve treatment outcomes.
- Mindfulness-based stress reduction: MBSR is an evidence-based approach that combines mindfulness meditation practices with contemporary psychological strategies to enhance overall wellbeing and ease chronic anxiety symptoms.12
- Acceptance and commitment therapy: ACT for anxiety is a new generation of CBT that utilizes mindfulness and acceptance techniques aimed at encouraging people to make positive life changes despite the hardships they may be experiencing.13
- Biofeedback: This is a psychophysiological intervention that enables people to recognize physical signs associated with stress and anxiety. In turn, biofeedback helps a person self-regulate bodily reactions, feel more relaxed, and diminish anxiety episodes.14
In My Experience
“Left untreated, panic disorder can be overwhelming and negatively impact your life. If you are living with panic disorder you should know you are not alone and treatment helps manage the symptoms. Finding a mental health provider who specializes in CBT for panic disorder can make a big difference in your symptom severity, frequency, and duration.”
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
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American Psychological Association. What is Cognitive Behavioral Therapy (2017). Retrieved from: https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
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Randall C. Wyatt, PhD and Erika L. Seid, MA. Cognitive Behavioral Therapy with Donald Meichenbaum, PHD. Retrieved from: https://s3.amazonaws.com/academia.edu.documents/52472591/InstrctrManualCBM.pdf
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Kim, M. K., Lee, K. S., Kim, B., Choi, T. K., & Lee, S. H. (2016). Impact of mindfulness-based cognitive therapy on intolerance of uncertainty in patients with panic disorder. Psychiatry investigation, 13(2), 196.
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Gregory, Barry. (2010). CBT Skills Workbook (Practical Exercises and Worksheets to Promote Change). Premier Publishing & Media.
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Efron, G., & Wootton, B. M. (2021). Remote cognitive behavioral therapy for panic disorder: A meta-analysis. Journal of Anxiety Disorders, 79, 102385.
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Neufang, S., Geiger, M. J., Homola, G. A., Mahr, M., Schiele, M. A., Gehrmann, A., … & Domschke, K. (2019). Cognitive-behavioral therapy effects on alerting network activity and effective connectivity in panic disorder. European archives of psychiatry and clinical neuroscience, 269(5), 587-598.
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Niles, A. N., Axelsson, E., Andersson, E., Hedman-Lagerlöf, E., Carlbring, P., Andersson, G., … & Ljótsson, B. (2021). Internet-based cognitive behavior therapy for depression, social anxiety disorder, and panic disorder: Effectiveness and predictors of response in a teaching clinic. Behaviour Research and Therapy, 136, 103767
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Frazer, D. W., Hinrichsen, G. A., & Jongsma, A. E., Jr. (2015). The older adult psychotherapy treatment planner, with DSM-5 updates (Second ed.). Wile
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Cackovic, C., Nazir, S., & Marwaha, R. (2022, June 21). Panic Disorder. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430973/
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DeGeorge, K. C., Grover, M., & Streeter, G. S. (2022). Generalized anxiety disorder and panic disorder in adults. American Family Physician, 106(2), 157-164.
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Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-Based Interventions for Anxiety and Depression. Psychiatric Clinics of North America, 40(4), 739–749. https://doi.org/10.1016/j.psc.2017.08.008
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Annunziata, A. J., Green, J. D., & Marx, B. P. (2016). Acceptance and Commitment Therapy for Depression and Anxiety. Encyclopedia of Mental Health, 1–10. https://doi.org/10.1016/b978-0-12-397045-9.00263-9
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Blum, J., Rockstroh, C., & Göritz, A. S. (2019). Heart Rate Variability Biofeedback Based on Slow-Paced Breathing With Immersive Virtual Reality Nature Scenery. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.02172
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Primary Changes: Updated for readability and clarity. Reviewed and added relevant resources. Added CBT for Panic Disorder infographic.
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Primary Changes: Updated for readability and clarity. Reviewed and added relevant resources. Added “What Is CBT?”, “Learning About Panic Attacks & Panic Disorder”, “Developing a CBT Treatment Plan for Panic Disorder”, “Is CBT or Medication Better for Treating Panic Disorder?”, and “What Other Therapies Can Help Treat Panic Disorder?”. New material written by Lydia Antonatos, LMHC, and reviewed by Kristen Fuller, MD.
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Primary Changes: Updated for Readability; Added examples to “Common CBT Techniques & Tools for Panic Disorder.” Added new research to “Is CBT Effective for Panic Disorder?” Added the sections, “Are There Any Risks?” “The CBT Treatment Process & Timeline,” and “How Much Does CBT Cost?” New content reviewed by Dena Westphalen, PharmD.
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Reviewer: Meera Patel, DO
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Frequently Asked Questions
How Much Does CBT Cost?
CBT is generally covered by mental health insurance. While coverage can significantly lower the cost of therapy, there is still usually a copay for mental health services. These can range from $10 to $100 depending on the network. Choosing an “in-network” provider might help with the out-of-pocket costs with copays and keep the cost down.
Out-of-network providers (those who do not accept insurance) may charge anywhere from $80 to $200 per session, some of whom may have a sliding scale option. It’s important to talk with your insurance provider about the amount of sessions they would cover, and be in contact with your therapist about the expected length of treatment.
Are There Any Risks to CBT?
There are no known risks of CBT at this time. However, it may not work for everyone or may not be as effective for everyone who receives CBT only as a treatment option (some people might do better with another treatment option or with the addition of medication).
How long does it take for CBT to work?
CBT for panic disorder is a short term treatment with an average of 12 to 16 sessions, but some people experience results in as few as eight sessions.
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Cognitive Behavioral Therapy for Panic Disorder Infographics
