Specialism
Therapy for panic disorder
CBT for panic attacks and the fear of the next one — one of the best-evidenced treatments in mental health. Online across the UK, in English or Spanish.
Does this sound familiar?
It arrives out of nowhere. Your heart pounds, your chest tightens, your hands tingle, the ground feels unreliable — and with it comes an absolute certainty that something catastrophic is happening. You are having a heart attack. You are going to faint, or be sick, or lose control in front of everyone.
It passes. The tests come back clear, the doctor is reassuring, and part of you is relieved while another part is sure they have missed something. Because you were there, and it did not feel like anxiety. It felt like an emergency.
Then the second problem starts: the fear of the fear. You avoid the motorway, the supermarket, the gym, the train. You carry water, or medication, or stay near the exit. Your life gets smaller around a thing that has not actually happened yet.
You may also have been told, more than once, that it is just anxiety. That is true and it is not much use, because knowing the name of it does nothing while it is happening. What helps is understanding the mechanism precisely enough to interrupt it, which is what the treatment is for.
How I treat panic
CBT for panic disorder is one of the most effective treatments in the whole of mental health, and it is what NICE recommends. It works because panic runs on a specific, identifiable mistake: a harmless bodily sensation gets read as a catastrophe, the alarm fires, the sensations intensify, and the catastrophic reading is confirmed.
We map your version of that loop precisely — which sensation, which prediction, which safety behaviour. Then we test the prediction rather than argue with it. That includes interoceptive exposure: deliberately, in a controlled way, bringing on the sensations you fear so you can find out what they actually do. It sounds counter-intuitive and it is remarkably effective.
We also unpick the safety behaviours — the sitting down, the checking your pulse, the escaping early — because each one leaves the belief intact. Then we get back the places you have been avoiding, in a graded way you control.
Breathing exercises get a mention here because they are so often taught as the whole treatment, and they are not. Used to calm yourself down they work briefly; used as a way of preventing catastrophe they become another safety behaviour and keep the belief alive. I will teach you the difference, and we will use them deliberately rather than defensively.
What to expect
We start with an assessment session or two, including a proper look at what happens in your body and what you conclude from it. Panic often responds quickly: many people see meaningful change within 6–12 weekly sessions of 50 minutes.
If you have not had unexplained physical symptoms checked by a GP, I will ask you to do that — not because I doubt you, but because good therapy does not skip the medical picture. Once that is clear, we can treat the sensations as safe with real confidence rather than as an article of faith.
Sessions run online across the UK and worldwide, or in person at Sanctuary Therapy Centre in Prestwich and Hebden Bridge. Where avoidance has narrowed where you can go, we plan the return in steps you carry out in your own week, and review each one together afterwards.
Common questions
Could a panic attack actually harm me? Panic is your body's alarm system firing at full strength in the absence of danger. It is deeply unpleasant and it is not dangerous — people do not faint from panic (blood pressure goes up, not down), and it always comes back down on its own.
Why does it happen when nothing is wrong? Often the trigger is a sensation rather than a situation — caffeine, heat, standing up quickly, a poor night's sleep. The sensation gets misread, and the alarm does the rest.
Do I have to do the exposure exercises? They are the part that does the heavy lifting, but nothing happens without your agreement, and we build up gradually from a level you can manage. You are always in control of the pace.
I have agoraphobia as well — can you help? Yes. Avoidance of places is treated as part of the same picture, and getting those places back is usually the goal people care about most.
I have been prescribed diazepam for panic. Does that matter? It is worth discussing. Taken as needed during panic, sedatives can act as a safety behaviour and slow the learning down. That is a conversation for you and your prescriber, not a decision I make — but I will be honest about how it interacts with the treatment.
Why do the attacks happen at night, or when I am relaxing? This surprises people and it is very common. Panic needs a sensation to misread, not a stressful situation — and when you finally sit down, or lie down, you notice your body for the first time all day. A skipped heartbeat, a wave of heat, a change in breathing as you drift off. Nocturnal panic in particular convinces people something physical must be wrong, precisely because there was no obvious trigger. The mechanism is the same, and so is the treatment.
Can sessions be in Spanish? Yes — I offer therapy in English and Spanish.
Ready to take the first step?
Send an enquiry and Gisela will be in touch within one working day.