Panic Attacks
It came out of nowhere, and now you are watching for the next one.
Panic is a body event before it is a thought, which is why reasoning with it rarely lands. We work with the physical alarm directly, then with the fear of the alarm itself.
Overview
The fear of the next one becomes the actual condition.
Maybe it happened in a grocery aisle, or in the car, or at two in the morning with no warning at all. Your heart went somewhere it has never been, your hands went numb, and some part of you was certain this was the real thing. Maybe you went to the emergency room and they ran the tests and everything came back clean, and you left with a piece of paper and no explanation you could use.
Here is what usually happens next. The attack itself becomes less of the problem than the waiting. You start scanning your own body for early signs. You stop taking the freeway, or you take it with the window cracked and a bottle of water in the cupholder. Your world quietly gets smaller in a way that looks, from outside, like preference. Panic work is about reversing that narrowing, and it is one of the more predictable pieces of therapy I do.
At a Glance
- Adults and couples, in person in San Diego
- Telehealth Monday through Friday across California
- EMDR certified, Gottman and EFIT Level 1 trained
- Free 15-minute consultation
Individual sessions are $210, or $325 for 90 minutes. Couples sessions are $225, or $345 for 90 minutes.
Full fees and policiesDoes This Sound Familiar?
The specifics, not a symptom list
Open any line to see how I would think about it with you.
You went to the ER and they found nothing.
That visit is common and it is not a wasted trip, because ruling things out matters. What it leaves behind is a body that produced a five-alarm response with no external cause, which is exactly what we can work with.
The Work
How panic work is sequenced
Breathing that is actually physiological
Not the version on a poster. Panic involves over-breathing, so the useful skill is a longer exhale than inhale, practiced until it is automatic and rehearsed in low-stakes moments so it is available in high-stakes ones.
Interoceptive exposure
We deliberately bring on the sensations you fear, in session, in a controlled way: breathing through a straw, spinning, running up stairs. Your brain learns that a racing heart is a racing heart and not a warning. This is uncomfortable and it is the piece that moves the needle fastest.
Then what the alarm is protecting
Panic often arrives at the end of a long stretch of ignoring something. Once the attacks are less frequent we look at what your system was under before the first one, which is where EMDR or attachment work sometimes comes in.
The Arc
A shape, not a protocol
Everyone moves differently. This is how this particular work usually unfolds here.
The precise order of sensations, the first thought, the length, what you did, and what you have avoided since. Panic is far more patterned than it feels, and seeing the pattern written down takes some of its authority away.
Questions
Answered plainly
Anything not covered here is worth asking on the free 15-minute consult.
Can panic attacks be treated online?
Yes, and in some ways telehealth helps, because we can work in the environment where the attacks happen. I can coach you through interoceptive exercises over video, and we can practice in your own car or kitchen rather than only in an office. I see clients across California by telehealth Monday through Friday.
Am I going to have to have a panic attack in your office?
We will deliberately bring on physical sensations, which is different from provoking a full attack, and nothing happens without you agreeing to it first. You set the pace and you can stop any exercise at any point.
How is this different from just calming down?
Calming techniques reduce an episode already in progress. They do not teach your brain that the sensations are safe, which is what stops the next one from being so frightening. That is why the exposure piece matters more than the relaxation piece.
I have had one attack. Is that enough reason to come in?
It is often the best time. The avoidance patterns that make panic entrenched build in the weeks after a first attack, so addressing it early usually means less to undo.
Do I need medication for this?
I am not a prescriber and I do not advise on medication. Some clients work with a physician or psychiatrist alongside therapy and some do not. If you want that conversation I will happily coordinate with whoever you are seeing.
Free 15-Minute Consult
Fifteen minutes to find out whether this is the right work.
Tell me what is actually going on. I will tell you honestly how I would approach it and what to expect.
In person in San Diego, and by telehealth across California.