Your heart starts pounding on a packed subway car, the floor seems to tilt, and your first thought is that something is medically wrong. Soon you are planning your days around never feeling that again. You let the crowded train pass. You sit near the door in meetings. You keep water, an exit, and an excuse to leave close at hand. If you keep asking yourself, “How can I get help with my anxiety?”, know this first from Refresh Psychotherapy: panic is a recognized, treatable condition, and many people find the path forward more concrete than they expected.
The seven steps below cover what is commonly used, how a single panic attack differs from panic disorder, what medication can and cannot do, and what your first weeks look like with Refresh Psychotherapy in New York, NY.
1. How Can I Get Help With My Anxiety? Start With an Evidence-Based Treatment
A widely recommended first-line treatment for panic disorder is cognitive behavioral therapy (CBT) that includes interoceptive exposure, where you practice the body sensations you fear in a safe, planned way. Medication, most often an SSRI or SNRI from a prescriber, is another option, and some people use both.
This matches how the National Institute of Mental Health describes care for anxiety disorders: psychotherapy, medication, or both. CBT may help you notice the thoughts that turn a fast heartbeat into a crisis. It also offers new ways to respond, which may reduce how much the fear has to feed on.
Choosing therapy, medication, or both is a decision you make with clinicians who know your history. Many people start with therapy because the skills can stay with you after sessions end. Others also talk with a prescriber, which often happens when symptoms make it hard to work, sleep, or leave home, or when depression is part of the picture. Neither path means you are failing.
Waiting carries its own risk. The World Health Organization reports that effective treatments for anxiety disorders exist, yet only about 1 in 4 people who need care receive any treatment. If cost is part of your hesitation, Refresh Psychotherapy accepts Aetna, Cigna, and UnitedHealthcare and also offers cash pay, so it is worth checking your benefits before you decide care is out of reach.
2. What Is the Difference Between a Panic Attack and Panic Disorder?
A panic attack is a sudden wave of intense fear with strong body symptoms that peaks within minutes. Panic disorder means unexpected attacks keep happening, and for at least a month you either worry about the next one or change your life to avoid it.
During an attack, you might feel a pounding heart, sweating, trembling, shortness of breath, chest tightness, dizziness, or a sense of doom. Many people have one or two attacks in their lives, often during a stressful stretch, and never develop the disorder. One attack on a bad day does not mean you have panic disorder.
The disorder is defined less by the attack itself and more by what comes after it. You might check your pulse all day. You might avoid the express train or skip the gym because exercise makes your heart race. You might plan every meeting around the nearest exit. That ongoing fear of fear is what clinicians look for.
Avoidance can also grow over time. When it spreads to many places, it can become agoraphobia, which the NIMH describes as intense fear of situations such as public transportation, crowds, enclosed spaces, or being outside the home alone. For someone living in New York, that can shrink life down to a few safe blocks.
Before treatment, see a doctor to rule out medical causes, such as a heart rhythm or thyroid problem. A clean checkup does not mean your symptoms are imaginary. It may mean your body’s alarm system is working too hard, and that is something therapy can address.
3. What Can I Do in the Moment When My Heart Races or I Feel Dizzy?
In the moment, some people find it useful to slow their exhale, name the sensation as uncomfortable but not dangerous, and stay where they are until the wave passes. These skills are used because panic is driven by fear of the sensations themselves.
Panic usually follows a loop. You notice your heartbeat, and your mind reads it as danger. Your body releases adrenaline, which makes the sensations stronger and seems to confirm the danger. Each time you escape, you feel relief, and your brain may learn that leaving saved you. The next attack can then come faster.
To interrupt the loop, you can breathe in gently through your nose and breathe out slowly, making the exhale longer than the inhale. Then label what is happening in plain words: “This is a racing heart. It feels awful, and it can pass.” If you can, stay on the platform or in the meeting instead of leaving. Small safety habits, like gripping the railing or checking your pulse, can work the same way as escape, so some clinicians suggest trying to let them go. Staying may help your body learn that the sensation peaks and fades.
These are general skills, and a clinician tailors them to your symptoms and history. If you have never had a medical checkup for these symptoms, or the chest pain feels different from your usual panic, get medical care first.
Teletherapy can make this practice more real. With video sessions at Refresh Psychotherapy, you can work on these skills from home, in the place where your symptoms actually happen, not only in an office.
4. How Does CBT Approach Panic Disorder, Step by Step?
CBT approaches panic disorder by teaching you how panic works, testing the frightening thoughts behind it, and having you practice the feared sensations so your body may stop treating them as alarms. The general evidence-based sequence usually looks like this:
- Learn how panic works. You map your own panic loop so the sensations may feel less mysterious and less threatening.
- Question the catastrophic thought. This is cognitive restructuring. You and your clinician examine thoughts like “I’m having a heart attack” or “I’ll faint on the train” and weigh them against what has actually happened in past attacks.
- Practice between sessions. Homework is meant to turn insight into habit. You might track attacks, practice breathing, or try a planned exposure before your next session.
- Bring on the sensations on purpose. This is interoceptive exposure. Examples include spinning in a chair to bring on dizziness, running in place to raise your heart rate, or breathing through a thin straw to feel short of breath. You repeat each one, and for some people the fear decreases with repetition.
- Return to the places you avoid. Step by step, you work toward the subway, the elevator, or the crowded store.
- Plan for setbacks. You build a plan for what to do if symptoms flare during a stressful season.
Refresh does not give every client the same exposure ladder or a fixed number of sessions. Your clinician uses case conceptualization, which means understanding what keeps your symptoms going, and then chooses interventions such as CBT, ERP, behavioral activation, or ACT. The order and pace are tailored to your goals and what you are willing to try.
5. What if CBT Alone Has Not Helped? Other Approaches to Consider
If CBT alone has not been a good fit, the next step may be a different approach, such as ACT, exposure and response prevention (ERP), or EMDR. It may also be a closer look at whether panic is the whole picture.
You may be thinking that you already tried therapy and it did not work, so why would this time be any different. That worry makes sense. Sometimes the method was a poor fit. Sometimes the work never reached the sensations you fear most. And sometimes the diagnosis itself needed another look.
Acceptance and commitment therapy (ACT) takes a different angle. Instead of fighting a racing heart or arguing with every scary thought, you learn to make room for them while you keep doing what matters to you. That might mean riding the train to a job you care about with the fear along for the ride. For some people worn out from trying to control every sensation, this approach may feel like a relief.
Behavioral activation may be considered when avoidance has also pulled your mood down.
Your clinician chooses among these through case conceptualization, not guesswork, and no approach comes with a guarantee. Refresh also does not hire new graduates, because the practice values experienced clinicians who can tell these patterns apart.
6. What Medications Are Used for Panic Disorder, and How Do They Compare?
SSRIs and SNRIs are the usual first-line medications for panic disorder. Benzodiazepines act fast, but prescribers generally keep them short-term because of tolerance and dependence risk. Beta-blockers may ease physical symptoms such as a racing heart.
The main options a prescriber may discuss with you:
- SSRIs (selective serotonin reuptake inhibitors), a first-line daily option
- SNRIs (serotonin-norepinephrine reuptake inhibitors), another first-line daily option
- Benzodiazepines, sometimes used short-term while other treatment takes effect
- Beta-blockers, sometimes used for physical symptoms in specific situations
The NIMH notes that people can build up a tolerance to benzodiazepines and become dependent on them. Here is how the three classes compare:
| Medication class | Typical onset | Risks to discuss | Intended use |
|---|---|---|---|
| SSRIs and SNRIs | Usually several weeks | Side effects such as nausea or sleep changes; should not be stopped suddenly; boxed warning for young people | First-line, ongoing treatment |
| Benzodiazepines | Quickly | Drowsiness, tolerance, dependence, withdrawal if stopped suddenly; dangerous with alcohol or opioids | Short-term use |
| Beta-blockers | Quickly, for body symptoms | Fatigue, low blood pressure; not right for everyone | Physical symptoms like a racing heart or shaking; does not address the fear itself |
Medication is prescribed and managed by a psychiatrist or primary care clinician, not by your therapist. If you already see a prescriber, let your therapist know, and ask whether it would help for them to coordinate so both understand your plan. Never start, stop, or change a medication without your prescriber.
7. What Does Getting Started at Refresh Psychotherapy in New York, NY Look Like?
Once you know what treatment involves, the next question is often practical: how can I get help with my anxiety without feeling like just another file? At Refresh Psychotherapy, you choose your own therapist, and you spend your first 3 to 4 sessions in an assessment period with that same person.
Refresh does not assign clients to therapists. You read each clinician’s biography, specializations, therapeutic approach, and availability on the Refresh Psychotherapy website, then choose who feels right for you. The culturally diverse team considers your cultural identity throughout assessment and treatment, not as a side topic.
You might worry about opening up and being misunderstood or judged. That fear is common, and it is part of why the same clinician does your intake and your ongoing care, so you do not have to repeat painful history to a second person. If the fit feels off later, Refresh talks about it openly and helps you transfer to another clinician within the practice.
Every session is 60 minutes. Your first session is an intake, not therapy. It covers your symptoms, your psychiatric and medical history, past treatment, medications, stressors, safety, strengths, and goals. You and your therapist build the treatment plan together around session two. By session three or four, your Refresh Psychotherapy therapist confirms or refines the diagnosis using clinical interview and DSM-5 criteria. This step helps separate panic from look-alike conditions such as generalized anxiety or OCD.
How long does treatment take? Progress is individual, so Refresh does not promise a set number of sessions or a particular result. Your timeline depends on your symptoms, your goals, and how much practice fits into your life. If you also take an SSRI or SNRI, those medications usually need several weeks before any change might be noticed. What Refresh offers is a clear plan early on and a check on the diagnosis within the first month, so the work is aimed at the right target. Many high-achieving New Yorkers come in hoping for something simple: to ride the train again without bargaining with their own body.
Refresh offers outpatient individual therapy for adults in New York City, including Manhattan and Brooklyn, along with teletherapy for adults across New York State. If your schedule only allows time before work, at lunch, or in the evening, Refresh can often point you to a clinician with comparable expertise whose hours fit. Federal mental health parity rules generally require health plans not to limit mental health benefits more strictly than medical benefits, so ask your plan about your outpatient therapy benefits. If you need inpatient care, partial hospitalization (PHP), intensive outpatient treatment (IOP), or specialized eating disorder treatment, Refresh refers you to providers equipped for that level of care.
When should I seek help for panic attacks?
- Attacks keep coming, especially without warning
- You worry about the next attack most days
- You avoid the subway, crowds, elevators, driving, or exercise
- You plan your day around exits or a “safe” person
- You use alcohol or extra medication to get through situations
- Panic is affecting your work, sleep, or relationships
- You have had repeated emergency visits where the tests came back normal
If any of these sound familiar, your next step can be small and concrete. Read the clinician biographies at Refresh Psychotherapy, choose the therapist whose approach and availability fit you, and book your 60-minute intake, or call 646-685-4422 with questions about getting started and using your insurance. Before that first session, write down your last three panic attacks: where you were, what you felt first, and what you did next. That short record gives your therapist a head start on mapping your panic loop, and it may show you whether your attacks follow a pattern.
This article is for general education and is not medical advice. Individual experiences with treatment vary, and panic symptoms can overlap with heart, thyroid, and other medical conditions, so see a doctor to rule out medical causes. If you are in crisis or thinking about harming yourself, call or text 988 to reach the Suicide & Crisis Lifeline, or call 911. For free, confidential treatment referrals, contact the SAMHSA National Helpline.
Your Anxiety Deserves Real Support
Reading about anxiety treatment is a good first step, but it can still feel like a lot to take on when your mind is already racing. You do not have to have everything figured out before reaching out, and you do not have to wait until panic feels unmanageable. If you are in New York, NY and ready to talk with someone about individual psychotherapy, call the office at Refresh Psychotherapy and take that next step at your own pace.
