A sudden racing heart, dizziness, breathlessness, trembling or a sense that something terrible is about to happen can feel completely real. People sometimes call these experiences a false alarm because they may resemble danger even when no immediate external threat is apparent. That phrase can be useful, but it should not be used to dismiss symptoms or make a diagnosis from a blog. Physical symptoms can have many causes. New, severe, changing or worrying chest symptoms, breathlessness, fainting, weakness, neurological changes or symptoms that feel medically urgent need appropriate medical assessment. They should not automatically be attributed to panic, stress or anxiety. A person may need medical advice alongside psychological support. Panic like experiences can involve fear of the sensations themselves, uncertainty about what they mean, avoidance of places or activities, checking, reassurance seeking or a difficult memory. Assessment can explore the pattern, physical health, medication, substance use, sleep, safety and the person’s own goals. It can also clarify whether CBT or a different service may be appropriate. CBT may be considered after assessment. It does not ask a person to ignore medical advice, force breathing techniques, stop prescribed medication or carry out exposure exercises alone. If behavioural or interoceptive work is clinically appropriate, it is planned collaboratively with a qualified clinician, consent and careful attention to medical and personal context. The aim is not to promise that sensations will disappear or that someone will never feel frightened again. It may be to understand the cycle of attention, meaning, avoidance and fear, and to make more room for daily life. Progress varies, and a difficult episode does not mean that someone has failed. If symptoms come with crisis, thoughts of self harm or an inability to keep safe, urgent appropriate help is needed. For related information, see CBT support for panic at lyceumclinic.co.uk/therapy/panic attacks/, the panic attacks clinical guide at lyceumclinic.co.uk/guides/panic attacks subtypes explained/ and understanding the panic cycle at lyceumclinic.co.uk/guides/how to break panic attack cycle/. The Lyceum Clinic offers assessment led CBT online and in West London.