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Panic Attack & Agoraphobia Therapy in Central London (W1W) & Online

For people who fear losing control, their body, or being unable to escape

Panic attacks can feel overwhelming and frightening, often arriving suddenly, without warning. You may feel your heart racing, your breathing change, dizziness, chest tightness, or a sense that something catastrophic is about to happen.

For some people, panic leads to avoidance: certain places, travel, exercise, meetings, public spaces, or being alone. Over time, life can become organised around preventing panic rather than living freely.

I offer therapy for panic attacks and agoraphobia in Central London (W1 / W1W) and online, helping adults reduce panic by changing the fear-body-avoidance cycle that keeps it going.

How panic attacks and agoraphobia often present

People commonly describe:

  • Sudden surges of intense fear with strong physical sensations
  • Fear of fainting, losing control, or “going crazy”
  • Monitoring the body for early signs of panic
  • Avoiding places where escape feels difficult
  • Needing reassurance, exits, or safety behaviours
  • Feeling embarrassed, frustrated, or misunderstood

Panic attacks are frightening, but they are not dangerous. The problem is not the panic itself, but how the body and mind respond to it over time.

The panic-avoidance cycle

Panic attacks are maintained by a powerful feedback loop:

  • A physical sensation or internal shift occurs
  • The mind interprets danger (“This is panic, I won’t cope”)
  • Anxiety escalates rapidly
  • The body responds with intense sensations
  • You respond by:
    • escaping or avoiding
    • monitoring your body
    • seeking reassurance
    • controlling breathing or movement
  • Panic subsides
  • The brain learns: this situation is dangerous
  • Anticipatory fear grows, and avoidance expands

Agoraphobia develops when avoidance becomes the main way of preventing panic.

How ISTDP understands panic

From an ISTDP perspective, panic attacks often occur when strong emotions are activated but not yet tolerable.

Instead of emotions being experienced directly, the nervous system shifts into panic as a way of discharging emotional energy rapidly. Panic becomes the body’s emergency brake.

In therapy, we focus on:

  • identifying what emotional triggers precede panic
  • understanding how anxiety is experienced in your body
  • increasing emotional capacity so panic is no longer required
  • reducing fear of internal experience itself

The aim is not just to manage panic, but to remove the conditions that make panic necessary.

How therapy helps with panic and agoraphobia

Therapy is active and collaborative. We work to:

  • Understand your specific panic cycle
  • Reduce fear of bodily sensations
  • Gradually reduce avoidance and safety behaviours
  • Build confidence in your ability to tolerate internal experience
  • Reclaim activities and spaces that panic has restricted

For many people, change begins when panic is no longer treated as an emergency.

What sessions usually involve

Early sessions

  • Mapping panic triggers and bodily responses
  • Clarifying what panic is protecting against
  • Reducing fear of sensations in session

Ongoing work

  • Working directly with anxiety and panic responses
  • Increasing tolerance for emotional and physical activation
  • Gradually reversing avoidance patterns
  • Translating progress into real-world situations

Sessions are paced carefully and collaboratively.

Related ways I work

Depending on what maintains your panic, therapy may integrate:

  • CBT approaches, for exposure to sensations and situations
  • ISTDP, when panic is linked to emotional avoidance or overcontrol
  • PPS-informed work, when bodily sensations are the main trigger

You may also find these pages helpful:

Frequently asked questions

Are panic attacks dangerous?
No. Panic attacks are extremely uncomfortable but not harmful. Therapy helps reduce fear of the sensations themselves.

Will exposure be forced?
No. Exposure is collaborative and paced. The aim is confidence, not overwhelm.

Can panic be linked to stress or emotions?
Yes. Panic often increases during periods of pressure, emotional conflict, or suppressed feelings.

Do you offer therapy online?
Yes. Panic therapy works effectively both online and in person.

Next steps

If panic or avoidance is limiting your life, therapy can help you regain confidence and freedom.