Panic like experiences can include racing heart, breathlessness, chest sensations, dizziness, shaking, sweating, nausea or a sense of unreality. A guide cannot diagnose panic disorder, determine a local cause or decide whether commuting, work pressure, crowded places or another situation is relevant for an individual. Local figures can provide broad context, but they cannot predict an individual experience or need for support. Assessment before assumptions An assessment can explore the pattern of episodes, physical health, sleep, substances, medication, current pressures, avoidance, reassurance seeking, daily functioning and personal goals. It should not assume that a person has panic disorder because they avoid travel or feel anxious at work. Medical and treatment scope boundaries Chest pain, breathlessness, fainting, new neurological symptoms, severe physical change or a first episode with concerning symptoms should not be automatically attributed to panic. Seek appropriate medical advice, particularly when symptoms are new, severe, changing or worrying. A therapy guide cannot exclude a physical cause, advise on medication or replace urgent assessment. Where clinically appropriate, CBT based support may explore interpretations of bodily sensations, avoidance, reassurance, routines and practical difficulties. Behavioural experiments, interoceptive work or exposure based work should be planned collaboratively with an appropriately trained clinician, not used as self directed online instructions. Urgent safety boundaries If you cannot keep yourself safe, have thoughts of harming yourself, experience psychosis, severe agitation, confusion or a sudden marked change in mental state, seek urgent help. In immediate danger, call 999 or attend A&E. Frequently asked questions Can commuting cause panic disorder? A guide cannot decide this. An assessment can explore whether travel is relevant to an individual’s pattern. Can I use exposure exercises from the internet? Exposure based work should be planned with an appropriately trained clinician. For related information, see https://lyceumclinic.co.uk/therapy/panic attacks/, https://lyceumclinic.co.uk/guides/panic attacks subtypes explained/, https://lyceumclinic.co.uk/guides/panic attacks relationships west london/ and https://lyceumclinic.co.uk/therapy/anxiety/. An enquiry can clarify whether CBT based support, medical review, specialist care or another source of help may be the relevant next step.