Panic Disorder Treatment in California (ERP Therapy)

Panic disorder involves both the experience of panic attacks and the ongoing impact they have afterward. You may notice sudden spikes of intense anxiety, followed by persistent worry about having another attack. Many people become highly aware of their body, monitoring sensations like heart rate, breathing, or dizziness and interpreting them as signs of danger. This can lead to a constant sense of anticipation, even when panic is not actively happening.

In daily life, panic disorder often shows up as a mix of fear, anticipation, and avoidance.

You might find yourself avoiding situations where escape feels difficult, staying close to “safe” places, or needing certain conditions to feel okay leaving the house. Activities like driving, being in crowds, or even relaxing can become associated with fear. Even during calm moments, your attention may stay focused on preventing the next panic attack.

According to the DSM-5, panic disorder involves recurrent, unexpected panic attacks along with ongoing concern about their meaning or impact.

A panic attack is defined as a sudden surge of intense fear or discomfort that peaks within minutes and includes symptoms such as a racing heart, sweating, trembling, shortness of breath, chest pain, dizziness, chills or heat sensations, numbness, feelings of unreality, or fear of losing control or dying.

In addition, at least one of the attacks is followed by one month or more of persistent concern about having additional attacks or their consequences, or significant changes in behavior aimed at avoiding them.

The symptoms cannot be better explained by a medical condition, substance use, or another mental health condition.

Anxiety is a normal response to stress or perceived threat. Panic disorder is different because the fear becomes intense, recurring, and focused on internal sensations rather than external danger.

Instead of reacting to a situation, the fear is often about what is happening inside your body and what it might mean.

There is no single cause, but panic disorder is often linked to how the brain interprets physical sensations. Normal bodily changes—like an increased heart rate or shortness of breath—can be misinterpreted as dangerous. This creates a feedback loop where anxiety increases the sensations, and the sensations increase anxiety.

Panic disorder is maintained by a reinforcing cycle:

Physical Sensation → Fear → Increased Anxiety → Stronger Sensations → More Fear

Attempts to avoid, escape, or control these sensations may bring short-term relief, but they teach the brain that the sensations are dangerous, which keeps the cycle going.

People with panic disorder often develop ways to feel safer or prevent panic from happening.

This can include avoiding certain places, staying close to exits, carrying items for reassurance, controlling breathing, or mentally monitoring the body for signs of danger. While these strategies feel helpful, they tend to reinforce the fear over time.

Exposure-based therapy, including Exposure and Response Prevention, is one of the most effective treatments for panic disorder. Rather than trying to eliminate anxiety, ERP helps you face the sensations you fear without trying to escape or control them. The goal is to change how your brain interprets these sensations.

ERP for panic disorder often involves intentionally bringing on physical sensations in a controlled way and allowing them to be present without reacting. This might include exercises that increase heart rate, create dizziness, or change breathing patterns, while practicing staying present and not trying to “fix” the experience. Over time, your brain learns that these sensations are uncomfortable but not dangerous.

Yes. Exposure-based approaches are among the most well-supported treatments for panic disorder. As people practice ERP, they often experience less fear of bodily sensations, fewer panic attacks, and greater confidence in their ability to handle anxiety when it arises.

Specialized treatments like Exposure and Response Prevention typically cost more than general talk therapy due to the advanced training, structure, and clinical expertise involved. Fees reflect the intensity of treatment, session length, and the therapist’s specialization. Many clients find that evidence-based, targeted treatment leads to faster and more durable improvement, reducing long-term therapy costs overall. 

For specific rates and insurance information, please visit the Fees & Insurance page.