What you should know about panic, trauma, and therapy.

A panic attack can feel like it comes out of nowhere. Sudden, intense, physically alarming. And for a lot of people, the first one is exactly that — unexpected and terrifying. But panic disorder, the condition that develops when panic attacks become recurring and begin to shape your behavior, doesn’t happen because of the first panic attack. It happens because of what the brain learns from it.

The false alarm

Your body’s threat-detection system — the same one that drives you to jump when something startles you — doesn’t distinguish between real threats and perceived ones. When you have a panic attack, your brain registers the physical sensations (racing heart, dizziness, shortness of breath) as signs of danger. The alarm is real. The threat is not.

This is where the trouble begins. Your nervous system learns to associate those physical sensations with danger. Over time, even mild versions of those sensations — a faster heartbeat from caffeine, a slight dizziness from standing up quickly — can trigger a new wave of alarm. The panic attack becomes its own trigger.

Why avoidance feels like the right solution — and isn’t

The most natural response to something frightening is to avoid it. And for a while, avoidance works. If you stop driving on the highway because that’s where you had a panic attack, you stop having panic attacks on the highway. Problem solved, it seems.

But avoidance doesn’t change what the brain believes about the situation. It confirms it. By avoiding the highway, you’re sending your nervous system the message: you were right to be afraid — that place really is dangerous. The fear doesn’t diminish. It gets locked in. And then it spreads.

Common avoidance patterns

Avoidance in panic disorder is rarely dramatic at first. It tends to accumulate in small decisions over time:

• Taking surface streets instead of the freeway
• Skipping the gym because elevated heart rate feels dangerous
• Staying close to exits in restaurants, theaters, or waiting rooms
• Carrying water, medication, or a phone as safety objects
• Needing to know where the nearest exit or hospital is
• Avoiding travel, especially anything that limits the ability to leave quickly

None of these behaviors is dramatic. Together, they represent the slow accumulation of a condition that, left untreated, can significantly limit how you live.

What actually helps

Effective treatment for panic disorder works by targeting the core mechanisms keeping it in place — the catastrophic interpretation of body sensations and the avoidance that reinforces fear. This is what Cognitive Behavioral Therapy (CBT) for panic does. It doesn’t just teach coping strategies. It teaches your nervous system, through structured experience, that the situations and sensations you’ve been avoiding are not dangerous.

The change that comes from real panic treatment isn’t just symptom reduction. It’s that the panic stops making sense to the brain — and gradually loses its power.

EMDR stands for Eye Movement Desensitization and Reprocessing. The name is a mouthful, and the acronym doesn’t clarify much. What it describes is a structured, evidence-based therapy for trauma that uses bilateral stimulation — typically eye movements, but sometimes tapping or auditory tones — to help the brain reprocess distressing memories.

Why traumatic memories feel different

When you experience something overwhelming — an accident, an assault, a sudden loss, a threatening event — the brain sometimes can’t fully process what happened. The memory gets stored differently than ordinary memories. It retains the emotional and physical charge it had at the moment it happened. When something triggers that memory, you don’t just remember it — you feel it again, in your body, with much of the original intensity.

This is what distinguishes traumatic memory from ordinary memory: it doesn’t fade the way most memories do. It stays raw.

What EMDR does

EMDR works by engaging the brain’s natural memory processing system while you hold the traumatic memory in mind. The bilateral stimulation — usually the therapist moving their fingers back and forth in front of your eyes while you follow them — appears to activate the same processing that happens during REM sleep, when the brain consolidates and integrates experiences.

What an EMDR session looks like

EMDR is structured. It doesn’t involve free-associating about your past or lengthy verbal analysis of what happened. A typical processing session involves:

• Identifying a target memory and the emotions, body sensations, and negative beliefs associated with it
• Sets of bilateral stimulation (eye movements, tapping, or tones), each followed by a brief check-in
• Processing what came up during the set — which might be other memories, emotions, images, or insights
• Continuing until the distress level of the memory is significantly reduced and a more adaptive belief about the event is established

Who is EMDR for?

EMDR was originally developed for PTSD and has the strongest evidence base for trauma from specific events — accidents, violence, sexual assault, workplace incidents, sudden loss. It has also been used effectively for panic disorder, phobias, and other conditions where specific distressing memories or experiences are driving current symptoms.

It is not the right tool for every clinical situation, and it requires careful preparation — both client and therapist need to assess readiness before processing work begins. But for adults with specific traumatic experiences that haven’t resolved with time, EMDR is often a more direct path to relief than years of talk therapy.

Most people come into a first therapy session with some combination of relief at having made the call and anxiety about what’s going to happen. Both are understandable. Here’s what the first session actually involves — at least in this practice.

It’s an intake, not a crisis debrief

The first session is a structured conversation designed to get a clear picture of what’s going on, what’s brought you in now, and what you’re hoping to change. It is not a session where you are expected to emotionally disclose everything at once. You are not going to be pushed to tell the full story of something difficult before we’ve established any working relationship.

What the intake covers:

• Your history with the presenting issue — when it started, how it’s developed, what you’ve noticed about what makes it better or worse
• What you’ve already tried — past therapy, medication, self-help approaches, and what did or didn’t help
• Relevant background — not a comprehensive life history, but enough context to understand your situation
• What matters to you about getting better — what would actually change in your life if treatment worked

You should leave with something

By the end of the first session, you should have a clearer picture of what we’d be working on and how. I’ll share my clinical read on what’s going on and what treatment approach makes sense. If that doesn’t fit with how you see things, or if you have questions about direction, that’s the time to raise them.

A good first session doesn’t leave you feeling like you opened up for nothing. There should be a sense of direction — not certainty about everything, but a reasonable picture of what the work looks like.

You don’t have to have the right words

A lot of people delay making the first appointment because they’re not sure how to explain what’s going on. They worry they won’t describe it correctly, or that what they’re dealing with won’t “count.” This is almost never the barrier people fear it will be. Part of the therapist’s job in the first session is to help you articulate what’s going on — you don’t need to arrive with a prepared summary.

About the free consultation

Before the first full session, I offer a free 15-minute phone consultation. This is a low-stakes way to ask basic questions, get a sense of whether this feels like a fit, and decide whether you want to schedule. You don’t need to make any decisions during the consultation — it’s just a conversation.