Can ART Help with Panic Attacks?
Panic can be incredibly convincing.
Your heart races.
Your chest tightens.
You feel dizzy.
You cannot get a satisfying breath.
Your hands tingle.
Your stomach drops.
You may feel unreal.
And one thought arrives immediately:
Something is wrong.
Even when you have had panic before.
Even when a doctor has told you your heart is healthy.
Even when part of you knows:
“This may be anxiety.”
The body is making a very strong argument.
What is a panic attack?
A panic attack is a sudden surge of intense fear or discomfort accompanied by physical and cognitive symptoms.
Those can include:
racing or pounding heart,
sweating,
trembling,
shortness of breath,
choking sensations,
chest discomfort,
nausea,
dizziness,
chills or heat,
numbness or tingling,
feelings of unreality,
fear of losing control,
or fear of dying.
The attack may peak quickly.
That suddenness is part of what makes panic so frightening.
Panic attacks are not all the same
This matters enormously for treatment.
One person may panic because:
a trauma trigger activates a learned threat response.
Another may become terrified of:
normal bodily sensations.
Another may panic in:
crowded or enclosed places.
Another may experience attacks related to:
medical trauma.
Another may be dealing with:
panic disorder.
And another may have physical symptoms from a medical condition that should not be assumed to be anxiety.
“Panic attack” describes an experience.
It does not by itself explain why the experience is happening.
Why can panic feel like it comes from nowhere?
Sometimes the trigger is obvious.
You enter the hospital.
You see the person.
You hear the sound.
You drive past the location.
And panic begins.
Other times, the cue is subtle.
A body sensation.
A smell.
A change in breathing.
A facial expression.
A thought that barely reached conscious awareness.
Your nervous system may react before you consciously identify what set it off.
That can make panic feel completely random.
Sometimes the body sensation becomes the trigger
This is especially important in panic disorder.
Imagine your heart beats a little faster.
You notice it.
Then you think:
“Why is my heart racing?”
Fear increases.
Your heart beats faster.
You notice that increase.
Now you think:
“This is getting worse.”
The body response intensifies.
The fear of the sensation creates more of the sensation.
That loop can escalate very quickly.
Panic often involves catastrophic interpretation
The physical sensation itself may not be the whole problem.
The meaning attached to it matters.
A racing heart becomes:
“I am having a heart attack.”
Dizziness becomes:
“I am going to faint.”
Feeling unreal becomes:
“I am losing my mind.”
Shortness of breath becomes:
“I am going to suffocate.”
Once those interpretations take hold, the nervous system has even more reason to escalate.
So where does ART fit?
Accelerated Resolution Therapy may be useful when panic is connected to a clear:
memory,
trigger,
image,
or traumatic experience.
For example:
panic began after a medical emergency.
Panic occurs when driving after an accident.
Panic appears around a specific relationship cue.
Panic is triggered by a memory of feeling trapped.
Panic began after one frightening episode that now keeps replaying.
Those situations provide a focused target.
ART may help with the memory that taught the body to panic
Suppose someone had a severe panic attack on an airplane.
Afterward, the person becomes afraid of:
flying,
feeling trapped,
their heart racing,
or not being able to escape.
The original panic episode itself may become traumatic.
Now the person is not only afraid of flying.
They are afraid of having that experience again.
ART may help process the original episode and the imagery associated with it.
Panic can become traumatic in its own right
A first panic attack can be terrifying.
People often think:
“I am dying.”
“I am having a stroke.”
“I am losing control.”
“I need to get out.”
If the experience is sufficiently frightening, the memory of the panic attack can become a trigger for future attacks.
The person begins scanning for:
the slightest dizziness,
the slightest heart-rate change,
the slightest breathing irregularity.
The fear becomes:
What if panic happens again?
Fear of fear can maintain panic
This is sometimes called fear of fear.
The person is no longer only responding to an external threat.
They are afraid of their own internal sensations.
That creates a difficult problem because you cannot permanently avoid:
your heartbeat,
your breathing,
your stomach,
or your balance system.
The body becomes the feared environment.
Is ART enough for panic disorder?
Not necessarily.
This is where treatment precision matters.
If panic is primarily maintained by fear of bodily sensations, one of the best-established treatments is cognitive behavioral therapy that includes interoceptive exposure.
That means deliberately and safely creating some of the sensations a person fears.
For example:
spinning to produce dizziness,
briefly increasing heart rate,
or using other exercises designed to produce safe versions of panic sensations.
The purpose is new learning:
“This sensation is uncomfortable, but it is not dangerous.”
Why interoceptive exposure can be so effective
Someone with panic disorder may believe:
“If my heart races, something terrible is happening.”
Interoceptive exposure allows the person to experience a racing heart deliberately.
Nothing catastrophic happens.
The brain receives new information.
The feared sensation becomes less mysterious.
Less dangerous.
Less capable of triggering a full panic spiral.
That is very different from simply trying to relax whenever the sensation appears.
ART and interoceptive exposure may target different problems
Imagine panic has two major components.
Component one:
A frightening memory or trauma cue immediately activates panic.
Component two:
The person has become terrified of panic sensations themselves.
ART may be especially useful for the first.
Interoceptive exposure may be especially useful for the second.
Some clients may need both.
What if panic is connected to medical trauma?
This is one of the clearest situations in which ART may make sense.
Someone experienced:
a frightening diagnosis,
a medical emergency,
difficulty breathing,
severe pain,
an invasive procedure,
or a hospitalization.
Later, ordinary body sensations begin to feel dangerous.
A flutter in the chest becomes:
“It is happening again.”
ART may help process the original medical memory.
But the client may also need help learning that current benign sensations are not necessarily signs of the same emergency.
Medical evaluation still matters
Not every episode of:
chest pain,
palpitations,
shortness of breath,
dizziness,
or faintness
should be assumed to be panic.
Physical symptoms can have medical causes.
Therapy should not diagnose anxiety simply because the symptoms occur during stress.
Appropriate medical evaluation matters when symptoms are new, unexplained, or clinically concerning.
What if panic is tied to trauma triggers?
Then the treatment may look different.
A person may panic when:
someone raises their voice,
a car suddenly brakes,
they smell a hospital odor,
they hear a particular sound,
or they see someone who resembles a past aggressor.
Now the panic may be part of a trauma-response network.
ART may target the memory or image connected to that cue.
Why insight alone may not stop panic
A person may say:
“I know I am safe.”
“I know this feeling cannot actually hurt me.”
“I understand exactly why I panic.”
And still panic.
That does not mean the person lacks insight.
It may mean the fear response is operating through:
conditioned learning,
body sensations,
memory,
and threat prediction
rather than conscious reasoning alone.
ART works with more than thoughts
ART involves:
memory,
imagery,
emotion,
body sensations,
and visually guided eye movements.
That may be useful when panic does not respond to reassurance because the problem is not primarily verbal.
The person may not need another explanation.
They may need the emotional memory to change.
What if the panic is driven by a frightening image?
Some panic is highly visual.
The person imagines:
collapsing,
fainting,
being trapped,
dying,
having a medical emergency,
losing control publicly,
or being unable to escape.
That mental picture may become a trigger itself.
ART can work directly with feared imagery.
Future imagery can trigger present panic
The feared event does not need to be happening.
The nervous system can respond to an imagined catastrophe.
If you vividly picture:
being unable to breathe on an airplane,
passing out in a restaurant,
or collapsing while alone,
the body may react as though the threat is approaching.
That makes future-oriented imagery a meaningful treatment target.
Can ART help anticipatory anxiety?
Potentially.
Anticipatory anxiety often involves repeatedly imagining:
the next panic attack,
the next flight,
the next medical appointment,
the next crowded room.
If the person is rehearsing the catastrophe mentally over and over, imagery-focused work may reduce the emotional intensity of that scenario.
But behavioral avoidance may still need attention.
Why avoiding panic triggers can make the problem bigger
Panic can gradually shrink a person's world.
First:
“I will avoid that restaurant.”
Then:
“I will avoid crowded places.”
Then:
“I will not drive far from home.”
Then:
“I should probably stay near a hospital.”
Avoidance provides immediate relief.
But it may teach the brain:
“I survived because I avoided.”
That can make the fear stronger over time.
Agoraphobia can develop around panic
Agoraphobia involves fear of situations where escape may feel difficult or help may not be available if panic-like symptoms occur.
Someone may begin avoiding:
public transportation,
crowds,
stores,
theaters,
driving,
or being far from home.
If that pattern is present, treating one trauma memory may not be enough.
Behavioral exposure to avoided situations may also be needed.
Does ART replace panic-focused CBT?
No.
ART should not be presented as a universal substitute for panic-focused CBT.
CBT has a strong evidence base for panic disorder.
It often targets:
catastrophic interpretations,
fear of physical sensations,
avoidance,
and safety behaviors.
ART may be an excellent addition when there is also a specific traumatic or image-based target.
Different mechanisms call for different interventions.
Can ART help if panic started after one event?
This is where ART may be particularly appealing.
Suppose someone never had panic before.
Then:
a car accident happens.
A terrifying medical episode happens.
They become trapped somewhere.
They experience an unexpected panic attack.
Afterward, panic begins recurring.
There may be one highly charged event organizing the problem.
That gives ART something concrete to process.
What if there is no clear origin?
Then we do not need to invent one.
Not every panic disorder is secretly unresolved trauma.
The current maintaining factors may matter more than the origin.
If the primary problem is:
fear of body sensations,
catastrophic interpretation,
and avoidance,
panic-focused CBT may be the cleaner treatment.
A good formulation matters more than forcing the problem into one modality.
IFS can help with panic too
Panic often creates internal conflict.
One part says:
“Calm down.”
Another says:
“We are absolutely not safe.”
Another becomes angry:
“This is ridiculous.”
Another wants to flee.
Parts work can help reduce the internal fight.
Instead of attacking the panicked part, we can ask:
What is it afraid will happen?
What is it trying to prevent?
What does it need to know?
That can be useful before or alongside ART, EMDR, CBT, or exposure.
Why fighting panic often backfires
The moment someone notices panic beginning, they may think:
“No. Not again.”
“I have to stop this.”
“This cannot happen.”
That resistance can add another layer of alarm.
Now the original sensation is joined by:
fear of panic itself.
Trying desperately to suppress the experience can sometimes amplify it.
The goal is not to never feel adrenaline again
Adrenaline is not pathological.
Your nervous system is supposed to mobilize.
The problem is when normal or harmless cues repeatedly trigger emergency-level responses.
Treatment is not about creating a permanently calm body.
It is about improving discrimination:
What is actually dangerous?
What is uncomfortable but safe?
Can eye movements directly stop a panic attack?
ART is not best understood as an emergency technique for switching off panic in real time.
The eye movements are part of a structured therapeutic process.
They are not simply a calming trick.
If someone uses bilateral stimulation informally and finds it grounding, that is different from saying they are doing ART.
The modality is more than the eye movements.
Why “nervous system regulation” is not enough
Panic is often discussed as a nervous-system problem.
That is partly true.
But if treatment focuses only on calming, the person may learn:
“I am safe only when I can make this sensation disappear.”
That can reinforce fear of activation.
Sometimes the more important learning is:
“I can feel this sensation and still be okay.”
That is a very different kind of regulation.
What if I feel like I cannot breathe?
Panic can create a powerful sensation of breathlessness.
That sensation can become especially frightening if someone has previously experienced:
asthma,
a respiratory illness,
a medical emergency,
or another event involving difficulty breathing.
Therapy should distinguish:
fear of the sensation
from
actual respiratory problems.
Again, medical and psychological contributors can coexist.
What if dizziness triggers panic?
Dizziness is another common panic trigger.
Someone feels slightly lightheaded.
Then thinks:
“I am going to pass out.”
Fear increases.
The sensation increases.
If dizziness is medically explained and benign, interoceptive work may help reduce fear of the sensation.
If dizziness became frightening because of one traumatic incident, processing that memory may also be useful.
What about panic while driving?
Driving panic can involve:
fear of having an attack,
fear of being unable to escape,
fear after an accident,
or fear of losing control of the vehicle.
Those are different targets.
ART may help if there is a clear traumatic memory.
Behavioral driving exposure may still be needed if the person has stopped driving or avoids certain roads.
What about panic in crowds?
Again, the formulation matters.
Is the person afraid of:
being trapped?
fainting?
being watched?
being unable to get help?
a previous crowd-related trauma?
The treatment should target the feared outcome, not merely the location.
Can a therapy intensive help with panic?
Potentially, especially when there is a clear trauma-linked target.
A longer session can provide space for:
assessment,
parts work,
ART or EMDR,
imagery,
and planning for behavioral practice afterward.
But if someone has active panic disorder with extensive avoidance, one intensive may not replace the need for repeated real-world learning.
What would a focused panic target look like?
For example:
“The first panic attack in the grocery store.”
“The medical event that made every heart sensation terrifying.”
“The accident that started driving panic.”
“The image of fainting in public.”
“The fear that I will lose control and no one will help.”
Those are much more specific than:
“I have anxiety.”
Specific targets make treatment planning clearer.
Can panic improve quickly?
Sometimes.
A specific trigger or memory may shift quickly.
That does not mean every maintaining factor disappears immediately.
Someone may process the original event and still need practice:
driving,
flying,
entering stores,
or allowing body sensations.
Improvement can be fast and still require follow-through.
How ART differs from EMDR for panic-related targets
Both ART and EMDR can work with emotionally charged memories.
ART is generally more structured and directive.
EMDR is generally more associative.
If panic is linked to one highly visual event, ART may feel especially intuitive.
If the panic connects into a broader web of earlier experiences, EMDR may be useful.
Neither should be presented as universally superior.
When ART may be worth considering
ART may be particularly relevant when:
panic began after a specific frightening event,
there is one intrusive memory tied to the attacks,
a vivid feared image repeatedly triggers panic,
the body reacts strongly to a trauma cue,
the client understands the fear intellectually but the memory still feels active,
or panic is part of a broader trauma response.
When another treatment may be more direct
Panic-focused CBT or exposure may be more direct when:
the primary problem is fear of bodily sensations,
panic attacks occur unexpectedly without a meaningful trauma target,
catastrophic interpretation drives the attacks,
agoraphobic avoidance is central,
or the person needs repeated behavioral learning rather than primarily memory processing.
That is not a failure of ART.
It is good treatment matching.
Working with Laura Geftman, LCSW
I use Accelerated Resolution Therapy, EMDR, IFS, Cognitive Processing Therapy, Prolonged Exposure, CBT, psychodynamic, interpersonal, attachment, and schema therapies depending on the client and clinical question.
With panic, I am especially interested in understanding:
What happened right before the panic started?
What does the person think the sensations mean?
Is there a trauma memory?
Is there a feared future image?
What are they avoiding?
And are they afraid of the situation—or afraid of panic itself?
Those distinctions matter.
I offer focused therapy and therapy intensives for adults in Pennsylvania, New Jersey, New York, and Florida.
In-person therapy intensives are available in Ardmore, PA, on the Main Line near Philadelphia.
Virtual therapy may also be available when clinically appropriate.
Interested in working on panic that feels stuck?
If panic seems connected to a specific memory, trigger, frightening image, or trauma-related body response, ART or EMDR may be worth exploring.
If the fear is primarily about bodily sensations and having another panic attack, panic-focused CBT or exposure may be more direct.
The goal is not simply to stop the feeling.
It is to understand what is maintaining it and target the right mechanism.
Suggested Reading
If you are interested in panic, body-based anxiety, ART, EMDR, or trauma responses, these related articles may be helpful:
Can Trauma Therapy Help With a Memory I Can’t Stop Replaying?
How Does Imagery Rescripting Work in Accelerated Resolution Therapy?
How Do Eye Movements Work in Accelerated Resolution Therapy?
What Is Memory Reconsolidation—and Does It Explain Trauma Therapy?
FAQ
Can ART help with panic attacks?
Potentially, especially when panic is connected to a specific traumatic memory, trigger, catastrophic image, or body-based trauma response. ART-specific research on panic disorder itself is limited, so it should not be presented as an established first-line panic treatment.
What therapy has the strongest evidence for panic disorder?
Cognitive behavioral therapy is one of the best-established treatments for panic disorder, often including interoceptive exposure to feared physical sensations and behavioral exposure to avoided situations.
What is interoceptive exposure?
Interoceptive exposure involves deliberately creating safe versions of bodily sensations associated with panic, such as increased heart rate or dizziness, so the person can learn that the sensations are uncomfortable but not dangerous.
Can trauma cause panic attacks?
Yes. Trauma-related cues can trigger intense physiological arousal that may feel like panic. But panic attacks can also occur without trauma, so assessment matters.
Can ART help if my first panic attack itself felt traumatic?
Potentially. A frightening panic episode can become a highly charged memory that contributes to fear of future attacks. ART may provide a way to work with that memory.
Can ART help with panic while driving?
It may help when driving panic is linked to an accident, earlier panic episode, or another specific traumatic event. If driving avoidance has developed, gradual behavioral exposure may still be needed.
Can ART help with medical panic?
Potentially, particularly when panic is connected to a frightening medical event or medical trauma. New or unexplained physical symptoms should still receive appropriate medical evaluation rather than automatically being attributed to anxiety.
Does ART replace CBT for panic disorder?
Not necessarily. ART may target trauma memories or imagery, while CBT can directly target catastrophic interpretations, fear of bodily sensations, and avoidance. Some clients may benefit from both.
Can panic be treated in a therapy intensive?
Sometimes, especially when there is a clear trauma-related target. If panic disorder includes broad avoidance or fear of bodily sensations, ongoing exposure-based work may also be needed.
How do I know whether ART or panic-focused CBT makes more sense?
The key question is what is maintaining the panic. If the attacks revolve around a specific memory or trauma cue, ART may be relevant. If fear of physical sensations and catastrophic interpretation are central, panic-focused CBT may be more direct.