Panic Attacks Aren’t the Whole Problem and 7 Hidden Behaviors Keep Panic Disorder Going
Eliana Bonaguro is a licensed mental health counselor (LMHC) who specializes in obsessive-compulsive disorder (OCD) and anxiety disorders. She blends evidence-based therapy with visual storytelling through her illustrated self-help guides to make complex mental health concepts more approachable, engaging, and easier to understand.
A panic attack can feel overwhelming. For many people with panic disorder, though, the attack is just one part of the struggle. The things people do between attacks, like checking, avoiding, planning, escaping, and trying to prevent another attack, can slowly start to take over daily life. Some of these habits are so subtle that they seem like reasonable precautions, not signs of anxiety. But over time, life can start to revolve around one goal: I need to make sure I don’t panic.
What is panic disorder, and how can it lead to agoraphobia?
A panic attack is a sudden surge of intense fear or discomfort that can include a racing heart, shortness of breath, dizziness, trembling, nausea, chest discomfort, tingling, or a feeling of losing control. Having a panic attack does not automatically mean someone has panic disorder.
With panic disorder, recurrent unexpected panic attacks are accompanied by persistent concern about additional attacks or significant changes in behavior because of them. The National Institute of Mental Health reports that approximately 2.7% of United States. adults experienced panic disorder in the past year in the survey data it cites.
This cycle often starts when someone interprets normal body sensations or those related to anxiety as something scary. A racing heart might feel like something is wrong with your heart. Dizziness might make you think you could faint. Feeling detached or unreal can seem like you’re losing control. Then comes another layer of fear: What if this happens again?
That fear can lead people to avoid certain situations. When someone starts avoiding places where it might be hard to leave or get help, agoraphobia can develop. This can include public transportation, crowds, lines, enclosed or open spaces, or being outside alone. It’s important to know that having agoraphobia doesn’t always mean someone can’t leave their home. The changes can be much less obvious.
1. Monitoring your body for signs of another panic attack
After a frightening panic attack, people often become extraordinarily good at detecting changes in their bodies. Is my heart beating faster? Why do I feel lightheaded? Am I breathing normally? Is this nausea getting worse?
Scanning your body for signs of panic might feel like a way to protect yourself. You might think that if you notice panic early, you can stop it. But paying constant attention to these sensations makes them seem more important.
Normal changes in your body that most people ignore can suddenly feel like signs that something bad is starting. Fear makes your body more alert, which creates more sensations, and then you have even more to notice and worry about. Someone can end up feeling afraid not just of panic attacks, but also of the physical sensations that come with them.
2. Always knowing where the exit or bathroom is
Some safety habits are easy to overlook because they seem practical. You may still go to a restaurant, but only if you can sit near the door. You may attend a concert, but immediately locate the exits. You may go shopping, but first determine where the bathroom is. You may stand in line, but only if you know you can leave quickly.
None of these actions are a problem on their own. What matters is why you feel you need to do them.
If you start to believe, I can only stay here because I know how to get out, your escape plan might stop you from learning something important: Maybe you could handle the anxiety even without a safety plan.
3. Avoiding sensations that feel like panic
Sometimes, instead of avoiding certain places, people start avoiding certain feelings in their bodies. Exercise increases heart rate and breathing. Heat can cause sweating and lightheadedness. Stairs can make the heart pound. Caffeine may produce jitteriness. Being hungry or tired can create sensations that feel unfamiliar.
If you’ve learned to see these sensations as warning signs of panic, even normal experiences can start to feel scary. This is why cognitive behavioral therapy (CBT) for panic disorder often includes interoceptive exposure. This involves planned exercises that bring up the sensations you fear, but in a safe setting. The goal isn’t just to make you uncomfortable. It’s to help you change how you think about these sensations.
The National Institute of Mental Health identifies CBT as a well-studied treatment for panic disorder. It describes interoceptive exposure as a CBT technique involving exposure to bodily sensations associated with panic. The Beck Institute’s CBT training for panic disorder similarly addresses hypervigilance, safety behaviors, avoidance, catastrophic interpretations, interoceptive exposure, and in vivo exposure.
4. Using distraction to feel safe
Listening to music on the subway is normal. Looking at your phone while waiting in line is normal. Talking to a friend during a flight is normal.
Distraction becomes important to notice when it shifts from I like doing this to I need to do this, or I won’t be able to cope.
Someone might scroll on their phone the whole train ride to avoid noticing their body. They might call a friend every time they drive somewhere new. They might need headphones in a crowded store because paying attention to their anxiety feels too scary. The distinction is subtle but important.
When you need distraction to enter or stay in a situation you fear, it acts as a safety behavior. You might finish the activity but think, I made it through because I kept myself busy. This way, you never really get to test whether your fear is true.
5. Traveling only when conditions feel “safe”
Avoidance related to panic does not always look like refusing to travel. It can look like traveling, but only if you follow increasingly specific rules.
Someone might take the subway, but never during rush hour. Drive, but avoid highways or bridges. Go into Manhattan, but only with another person. Attend a show, but insist on an aisle seat. Eat at restaurants, but avoid crowded ones. Take an Uber instead of public transportation because leaving feels easier.
The problem is what happens when the list grows. First, one route is off limits, then another. Crowded trains are no longer an option. Long drives turn into short ones. Unfamiliar neighborhoods are skipped. Soon, you’re not asking, where do I want to go? but instead, where am I least likely to panic? This is how the line between panic disorder and agoraphobic avoidance can start to matter more and more.
6. Escaping as soon as anxiety rises
Escape feels powerful because it works right away. Imagine standing in a crowded store and suddenly feeling dizzy. Your heart starts racing. You think, I need to get out. You leave. Within minutes, your anxiety decreases. Your brain learns a strong lesson: Leaving made me feel safe.
But there’s something else you didn’t get to find out: maybe the anxiety would have gone up and then down even if you stayed. Maybe the feelings were uncomfortable, but you could have handled them. Maybe you could have stayed.
This is why avoidance is so hard to break. It gives quick relief, but it can also keep you believing that the situation was truly dangerous or too much to handle.
Treatment based on exposure takes a different approach. It lets you face situations you fear and learn something new, instead of always escaping. The National Institute of Mental Health (NIMH) describes exposure therapy as a CBT method that helps people confront fears linked to panic disorder and get back to activities they’ve been avoiding.
7. Gradually building your life around preventing panic
This might be the most important hidden behavior because it isn’t just one thing. It’s really a collection of many small choices.
You stop exercising because a racing heart scares you. You avoid the subway at certain times. You won't go somewhere unless someone comes with you. You check the bathroom before sitting down. You choose the seat closest to the exit. You avoid unfamiliar places. You leave as soon as anxiety reaches a certain level. You carry specific objects because you believe you might need them if panic begins.
None of these changes seem dramatic on their own. But together, they can shape your life around avoiding anxiety. That’s why treatment needs to focus on more than just the panic attack itself.
How are panic disorder and agoraphobia treated?
Effective treatment isn’t just about making panic go away. CBT for panic disorder can address catastrophic interpretations of physical sensations, hypervigilance, avoidance, and safety behaviors. Interventions based on exposure can include interoceptive exposure to feared physical sensations as well as in vivo exposure to situations that have become associated with fear.
For people seeking panic disorder and agoraphobia therapy in NYC, specialized treatment may therefore need to address both sides of the cycle: fear of the internal sensations of panic and the external situations that have gradually become associated with danger, escape, or loss of control.
This distinction matters in a city like New York, where everyday life may routinely involve crowded trains, elevators, theaters, restaurants, traffic, bridges, long lines, and situations where immediately leaving is inconvenient or impossible.
Treatment is tailored to each person. The goal isn’t to push anyone into their scariest situation right away or to promise they’ll never feel panic again. Instead, therapy helps people look at what they expect will happen, change how they react to scary sensations, rely less on safety behaviors, and slowly return to situations they’ve been avoiding because of anxiety.
The Beck Institute for Cognitive Behavior Therapy includes cognitive conceptualization, behavioral experiments, in vivo exposure, imaginal exposure, and interoceptive exposure among the CBT skills used to train clinicians to work with anxiety disorders, including panic disorder.
The goal isn’t to get rid of anxiety completely
One common trap with panic disorder is waiting until you feel totally safe before doing something. I'll take the subway when I'm sure I won't panic. I'll exercise when my heart rate doesn't scare me. I'll travel when I know I won't feel trapped. But feeling completely certain rarely happens.
Recovery often means something else: becoming more willing to feel uncertain, notice physical sensations, and handle temporary anxiety without letting them control where you go or what you do.
Over time, the question shifts from “How can I make sure I don’t panic?” to “What would I do if I didn’t have to plan my life around avoiding panic?” That’s a bigger, more freeing question.
Are you ready to stop letting panic run your life?
Learn more about panic disorder and agoraphobia therapy in NYC or follow Eliana Bonaguro, LMHC, on Instagram for educational content about anxiety, obsessive-compulsive disorder (OCD), panic disorder, and related conditions.
This article is for educational purposes and is not a substitute for individualized mental health or medical care.
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Eliana Bonaguro, Licensed Mental Health Counselor
Eliana Bonaguro, is a licensed mental health counselor (LMHC) specializing in OCD, anxiety disorders, panic disorder, agoraphobia, and Exposure and Response Prevention (ERP) therapy. She is also the author and illustrator of several mental health guides that blend evidence-based psychology with visual storytelling to make complex mental health concepts more approachable and easier to understand. Her insights and contributions have been featured in Forbes, Healthline, Newsweek, and RTOR.
