How to Cope with Unexpected Panic Attacks: Tools from CBT, DBT, and Psychodynamic Therapy

Anyone who has experienced a panic attack knows what a nuisance they are. Panic attacks are disorienting, terrifying, and seemingly uncontrollable. They often strike without warning and can leave you feeling as though you’re losing control, going crazy, or even dying.  Whether you’re a seasoned therapy-goer or someone just beginning to explore mental health resources, understanding how to cope with unexpected panic attacks is an essential step toward reclaiming a sense of safety in your mind and body.

In this blog, we’ll explore how to cope with panic attacks using a blend of therapeutic approaches: Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Psychodynamic Therapy. Each offers unique insights and tools, and together they can form a powerful strategy to navigate these overwhelming episodes.

Understanding Panic Attacks

Before jumping into coping strategies, let’s define what a panic attack is. A panic attack is a sudden, intense surge of fear or discomfort that reaches a peak usually within minutes. Common symptoms include:

• Heart palpitations or accelerated heart rate
• Sweating, trembling, or shaking
• Shortness of breath or a feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Dizziness, lightheadedness, or feeling faint
• Chills or hot flashes
• Numbness or tingling sensations
• Feelings of unreality (derealization) or being detached from oneself (depersonalization)
• Fear of losing control, going crazy, or dying

These symptoms are real, distressing, and often misunderstood. The key is to approach them with both compassion and strategy.

Part 1: CBT Tools – Reframing and Rewiring Your Thoughts

Cognitive Behavioral Therapy focuses on the relationship between thoughts, emotions, and behaviors. The core idea is that catastrophic and other negative thinking patterns often fuel panic attacks. While the physical symptoms are real, the mind tends to escalate them with thoughts like:

• “I’m going to faint.”
• “This is dangerous.”
• “What is wrong with me?”
• “I’m having a heart attack.”

These thoughts, in turn, intensify and fire up the anxiety response.

CBT Strategy #1: Thought Labeling and Reframing

The moment you sense a panic attack coming on, try to pause and label your thought:

“This is anxiety. I’ve felt this before. It’s uncomfortable, but not dangerous. I’ll get through this.”

Use grounding statements like:

• “This will pass.”
• “I’m not in danger.”
• “This is my body reacting to stress, not a life-threatening event.”

By acknowledging the panic as anxiety, not reality, you begin to reduce its intensity.

CBT Strategy #2: The 5-4-3-2-1 Grounding Technique

This classic CBT grounding method helps interrupt the panic spiral by anchoring your mind to the present moment:

• 5 things you can see
• 4 things you can touch
• 3 things you can hear
• 2 things you can smell
• 1 thing you can taste

This engages your senses and slows down racing thoughts, reducing the physiological response to panic.

 

Part 2: DBT Tools – Acceptance, Emotion Regulation, and Crisis Management

Dialectical Behavior Therapy, developed by Marsha Linehan, is a powerful approach for managing intense emotions. When a panic attack hits, DBT encourages a balance between acceptance and skillful behavior to manage the symptoms. 

DBT Strategy #1: TIPP Skills for Immediate Relief

TIPP is a set of emotional distress coping strategies from DBT that address the body’s physiological distress:

• T (Temperature): Splash very cold water on your face or hold an ice cube to your wrist. This activates the “dive reflex,” helping slow the heart rate and reset your nervous system. For a more intense version of this, try a full body cold plunge if you have access to one.
• I (Intense Exercise): Do 10–20 jumping jacks or run for a mile. Intense movement burns off the adrenaline surge associated with panic.
• P (Paced Breathing): Inhale for 4 counts, exhale for 6. Slower exhalations activate the parasympathetic nervous system, which relaxes your mind and body.
• P (Progressive Muscle Relaxation): Systematically tense and relax your muscle groups. This reduces somatic tension and reintroduces a sense of control. If you have the time and access to a gym, a strength training session will have similar benefits.

DBT Strategy #2: Radical Acceptance

Often, panic attacks come with a second layer of suffering: resistance. Thoughts like “I can’t believe this is happening,” or “I need to stop this now,” can escalate the experience.

Radical acceptance doesn’t mean giving up; it means acknowledging the moment for what it is without judgment.

Try saying to yourself:

“This is just a panic attack. I don’t like it, but I can tolerate it. This will go away soon.”

Letting go of the fight can paradoxically make the panic pass more quickly.

Part 3: Psychodynamic Insights – Uncovering the Roots

While CBT and DBT focus on present-moment coping and symptom reduction, Psychodynamic Therapy explores the underlying causes and emotional meanings behind panic. Panic attacks are often caused by “unconscious intrapsychic conflicts,” or in layman’s terms, conflicting feelings about past events that are being triggered in the present.

Panic attacks are often not just about the symptoms, but about something deeper trying to surface: a repressed emotion, unresolved conflict, or unacknowledged fear.

Psychodynamic Insight #1: Listening to the Panic

Instead of only managing the symptoms, ask:

• “What might this panic be trying to tell me?”
• “Is there something I’m avoiding emotionally?”
• “What feelings or memories arise when I sit with this panic?”

Sometimes, panic is the mind’s protest against emotional overload, unmet needs, or internal conflict. It might be triggered by a relationship dynamic, an old trauma, or a disavowed part of yourself seeking attention.

This doesn’t mean the attack is your fault — it means there’s an opportunity for self-understanding and growth.

Psychodynamic Insight #2: Patterns and Triggers

Begin tracking when your panic attacks occur. Look beyond the immediate stressors and ask:

• Is there a recurring situation or relationship that evokes anxiety?
• What were the circumstances of my first panic attack?
• Are there unconscious fears related to control, abandonment, or vulnerability?
• Is the panic louder during times when you’re asked to assert yourself, take a risk, or be vulnerable?

Working with a therapist in a psychodynamic framework can help you uncover the root causes of panic and gradually integrate what was once intolerable into something more manageable.

Putting It All Together: A Multi-Lens Approach

Coping with unexpected panic attacks doesn’t require choosing one therapeutic path. In fact, integrating CBT, DBT, and psychodynamic approaches can offer the most comprehensive healing:

• Use CBT to manage the thoughts and behaviors that fuel panic.
• Use DBT to regulate your emotional and physiological responses in the moment.
• Use psychodynamic therapy to understand the deeper emotional roots and recurring patterns.

Here’s a brief example of an integrated response to a panic attack:

You’re in a grocery store when suddenly your heart races, and you feel like you can’t breathe.

• You label the experience: “This is a panic attack. I’ve been here before.” (CBT)
• You splash cold water on your face in the restroom. (DBT – TIPP)
• You repeat: “This will pass. I am safe.” (CBT/DBT)
• Later, in therapy, you explore why being in crowds feels overwhelming and connects to past experiences of vulnerability. (Psychodynamic)

When to Seek Support

While self-help strategies can be powerful, you don’t have to go through this alone. If you’re experiencing frequent panic attacks or if they’re interfering with your daily life, therapy can help. A trained clinician can work with you to:

• Develop personalized coping strategies
• Identify and address root causes
• Build emotional resilience and self-understanding

The Bottom Line

Unexpected panic attacks are very inconvenient and can shake the ground beneath you, but they don’t have to keep ruining your day. With the right tools, support, and compassionate curiosity, you can learn not only to cope but also to resolve them. Each episode is not just a crisis to survive, but a message to listen to and a body to soothe. In time, you can gently rewire your mind and reduce or eliminate your panic attacks altogether.

If you’re struggling with panic or anxiety, you’re not alone. Reach out today — help is available, and healing is possible.