The first panic attack

Specialist CBT therapy for anxiety, OCD, depression and more in West London

A first panic like episode can be frightening because it is unfamiliar. A person may notice a racing heart, a change in breathing, chest discomfort, dizziness, shaking, tingling, nausea or a sense of unreality, alongside an urgent fear that something serious is happening. Those experiences are real and distressing. They should not be dismissed, and no article can determine their cause. If symptoms are new, severe, persistent, unusual for you, or include chest pain, fainting, marked breathlessness or any concern about immediate safety, seek urgent medical help. A clinician who knows your circumstances can consider physical causes. If you think you are having a medical emergency, call 999 or attend A&E. It is important not to assume that physical symptoms are anxiety simply because panic is one possible explanation. When urgent causes have been considered, some people find that a frightening episode is followed by a period of watchfulness. They scan for bodily changes, replay the moment, avoid the place where it happened or seek repeated reassurance. These responses can make sense in the short term. They may also become part of a cycle worth understanding, particularly if fear of another episode begins to affect travel, sleep, work or relationships. An assessment led conversation starts with the details rather than a label. What was happening beforehand? Was there illness, pain, medication change, alcohol or substance use, bereavement, prolonged stress, disrupted sleep or another relevant factor? What has happened since? The aim is to build an accurate picture and decide whether CBT, medical review or another kind of support is the appropriate next step. If CBT is suitable, the work is collaborative. We may map how bodily sensations, interpretations, attention and responses interact. We may discuss the role of avoidance and safety behaviours. Any behavioural experiment or exposure based work is planned together in therapy, with consent, pacing and safety in mind. It is not a request to expose yourself to frightening sensations or situations alone, and it does not promise a fixed outcome. People often want to know how to make an episode stop immediately. A gentler question can be what helps them remain safe and orientated while they obtain the appropriate support. Some find it useful to sit somewhere secure, contact a trusted person, follow medical advice already given or notice a few concrete details in the room. These are not substitutes for urgent care or a treatment plan. They are simply possible ways of making space for the next considered step. For more context, see the clinic’s information on <a href="/therapy/panic attacks/">CBT for panic</a> and the <a href="/guides/panic attacks comprehensive guide/">panic attacks clinical guide</a>. The Lyceum Clinic offers assessment led CBT online and in West London. A first conversation can help clarify whether this support is suitable after relevant medical questions have been considered.