Panic Attacks & Panic Disorder · Virtual · Six Provinces
Therapy for Panic Attacks
The first one usually gets mistaken for a heart attack. By the tenth, the attack itself is no longer the main problem — the fear of the next one is, and that fear quietly starts deciding where you go.
Free 15–20 minute consultation · No referral needed · Sessions noon–9pm Pacific, seven days
What is actually happening
A panic attack is your body's alarm system firing at full volume with nothing to fire at. The same adrenaline release that would be useful if a car were coming arrives while you are in a supermarket queue. Heart hammering, chest tight, air not going in properly, hands tingling, the room slightly unreal, and underneath all of it a certainty that you are dying or losing your mind.
It builds fast, tends to peak within about ten minutes, and then drains away leaving you shaky and exhausted. A great many people meet their first one in an emergency department, get told their heart is fine, and go home relieved and none the wiser about what happened.
None of that is imagined and none of it is weakness. The physiology is real — what is not real is the danger it is responding to.
The cycle that keeps it going
Panic runs on a loop that is unusually well described, and the loop is the reason therapy has something concrete to work with rather than just reassurance to offer.
It starts with a sensation — often a trivial one. You stand up quickly and your heart skips. You had a second coffee. It is hot on the train. The sensation gets noticed, and then interpreted: something is wrong with my heart. That interpretation is itself a threat signal, so the body does what it should do with a threat signal and releases adrenaline. Adrenaline produces a faster heart, tighter chest, shallower breathing — which is more evidence that something is badly wrong. The loop closes and tightens.
This is why the attack seems to come from nowhere. The trigger was internal and small, and you never consciously registered it.
Why avoidance makes it bigger
After a few attacks, you start avoiding wherever they happened — the motorway, the meeting room, the far end of the shop. The avoidance works, in the narrow sense that you do not panic there. But it also means you never get the information that would settle it, and the mind draws the only conclusion available: I avoided it, therefore I survived it. The list of places gets longer. For some people it shrinks to the front door, which is roughly how agoraphobia develops.
Safety behaviours do the same job more quietly
Sitting near the exit. Carrying water, or an unopened packet of pills you never take. Only going somewhere with a particular person. Checking your pulse. These feel like sensible management, and each one hands the same lesson to the same part of your brain: that you got through it because of the precaution. Which means the fear never gets tested.
Then the fear moves in advance of itself
Eventually the attacks matter less than the anticipation. You scan your own body for early signs, and scanning finds things — everybody's heart is occasionally irregular, everybody gets lightheaded — so the monitoring generates its own triggers. At that point people describe the problem as constant rather than episodic, and they are right.
What the work involves
Cognitive behavioural therapy for panic is structured, and it targets the loop rather than the symptom. Broadly it moves through four things, at whatever pace you set.
Mapping your own cycle
Not panic in general — yours. Which sensation starts it, what you conclude that sensation means, what you do next, and what that does to the sensation. People often find this part unexpectedly steadying, because a thing with a shape is less frightening than a thing that strikes at random.
Working on the interpretation
Not by arguing you out of it. Being told "you're fine, it's just anxiety" has never once stopped a panic attack. The work is closer to gathering your own evidence about what the sensation has actually meant, across the times it has happened, until the catastrophic reading loses its grip on its own.
Dropping the safety behaviours
Deliberately and gradually, one at a time, so that the situation can finally teach you something the precaution has been blocking. This is planned rather than sprung on you.
Approaching the sensations rather than escaping them
This is the part that surprises people. Some of the work involves bringing on the physical sensations on purpose — breathing quickly for a short period, spinning, running up stairs — in a controlled setting, so that a racing heart stops automatically meaning catastrophe. It is done in steps, with your agreement at each one, and never as an ambush.
Where panic sits on top of trauma — and it often does — the trauma is worked with directly rather than managed around, using EMDR or Internal Family Systems. Panic that started after a specific event usually needs that event addressed, not just the loop.
Get the medical side checked
Chest pain, breathlessness and palpitations have causes other than panic — thyroid problems, cardiac issues, some medications, and others besides. If a doctor has not looked at this, see one. Nothing on this page is a substitute for that, and a therapist cannot rule those things out.
Being medically cleared is not a dismissal, either. It is a useful piece of information, and it is often the thing that makes the psychological work possible.
Who you would be working with
Mohamad Shabib, MACP, CCC is a Canadian Certified Counsellor and a Registered Psychotherapist (Qualifying) with the College of Registered Psychotherapists of Ontario (CRPO). He is trained in CBT, with CBT for Trauma at Levels 1 and 2, alongside Advanced EMDR and Internal Family Systems. Sessions in English or Arabic. He sees clients across all six provinces the practice serves.
Alison Shaji, RCC is a Registered Clinical Counsellor in British Columbia, trained in CBT and DBT alongside EMDR and EFFT. Sessions in English, Hindi or Malayalam. Her registration is provincial, so she works with British Columbia clients.
Neither of them will diagnose you — that sits with physicians and psychologists — and you do not need a diagnosis to start.
Cost and appointment times
Individual sessions are $150 for fifty minutes. The first conversation is free — fifteen to twenty minutes, with no referral needed.
No provincial health plan in Canada covers counselling in private practice. Extended health plans often do, and which designation your plan names matters — some list a Canadian Certified Counsellor, some a Registered Psychotherapist, some a Registered Clinical Counsellor. You receive an insurance-ready receipt immediately after each session. Full detail on the fees page.
Sessions run seven days a week from noon to 9pm Pacific — which is up to 11pm on the Prairies and midnight in Ontario. A small number of reduced-fee spots are held; if cost is the obstacle, say so on the consultation call.
What you say in session is kept confidential, with the limits every Canadian therapist works under: a risk of serious harm to you or someone else, a child in need of protection, a court order or subpoena, and the reporting obligations a regulator can impose. Those are explained in full in the first session.
Common questions
Is a panic attack dangerous?
A panic attack is the body's alarm system firing when there is no threat — the same surge of adrenaline you would get from real danger, arriving without one. It is genuinely horrible and it is not medically dangerous in itself. That said, chest pain and breathlessness have other causes, so if you have not had this checked by a doctor, get it checked. Ruling things out medically is part of the work rather than a detour from it.
Why do panic attacks seem to come out of nowhere?
Usually they do not, but the trigger is a bodily sensation rather than an event — standing up too fast, caffeine, heat, a skipped breath, the tail end of a cold. The sensation gets read as a sign something is badly wrong, and that reading produces the adrenaline. Because the starting point is internal and often below conscious notice, the attack feels like it arrived from nowhere.
What does CBT for panic actually involve?
Mapping your own cycle first — which sensations start it, what you conclude they mean, what you do next. Then working on the interpretation, and gradually dropping the safety behaviours that feel protective but keep the fear intact. It often includes approaching the physical sensations on purpose, in a planned way, rather than only relaxing them away. It is structured and it is collaborative; nothing is done to you without discussion.
I panic at night and wake up in the middle of it. Is that the same thing?
Nocturnal panic is well described and more common than people expect, and it frightens people badly because there is no obvious trigger to point at. It is the same mechanism, starting from a sensation registered during sleep. It is worth raising specifically, because the sleep angle changes what is useful. Where sleep has become its own problem, that is covered on the sleep page.
Do I need a diagnosis or a referral first?
No referral is needed to book. Counsellors and psychotherapists do not diagnose — that sits with physicians and psychologists — and you do not need a diagnosis to start. If something in what you describe points toward a medical assessment or medication being worth discussing, you will be told so plainly.
What does it cost?
Individual sessions are $150 for fifty minutes, with a free fifteen to twenty minute consultation first. No provincial health plan in Canada covers counselling in private practice, but many extended health plans do — check which designation your plan names. You receive an insurance-ready receipt after every session.
If you need someone now
Therapy is not a crisis service. These are free and staffed around the clock:
- · 9-8-8 Suicide Crisis Helpline: call or text 9-8-8 (24/7)
- · Kids Help Phone: 1-800-668-6868, or text CONNECT to 686868
- · Hope for Wellness Help Line: 1-855-242-3310 (24/7)
If you are in immediate danger, please call 911.
Related pages
- Social anxiety — when the panic is specifically about being watched
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