Working with Panic Attacks and Anxiety: An Integrative Counselling Approach

Panic attacks can feel overwhelming—your heart races, your breath feels tight, and your body seems out of control. For many people, it can feel like a wave of fear that comes from nowhere. Counselling offers a safe place to begin untangling these experiences, and with an integrative approach, a counsellor can bring together different ways of working so that support feels tailored to you.

Here’s an idea of how a counsellor might help, drawing on Person-Centred counselling, CBT (Cognitive Behavioural Therapy), Gestalt therapy, and Somatic approaches.

Creating Safety First: Person-Centred Foundations

At the start, the focus is on creating a safe, supportive relationship. Your counsellor will listen without judgement, offering empathy and understanding. If you’ve ever felt embarrassed or “weak” for having panic attacks, being accepted just as you are can be a huge relief.

In early sessions, this might look like you sharing your story at your own pace, while the counsellor listens deeply—helping you feel less alone in your experience.

Making Sense of Panic: CBT Techniques

Together, you and your counsellor may look at what happens before, during, and after a panic attack. For example, you might keep a simple “thought diary,” noting down situations where anxiety builds and the thoughts that come with it—such as “I can’t breathe, I’m going to faint.”

In the session, the counsellor might guide you to gently question these thoughts: “What usually happens when you feel like you’ll faint? Have you ever actually fainted during a panic attack?” This helps separate the fear from the facts.

You might also learn practical coping skills, like slow breathing or grounding techniques, to use when panic starts to rise.

Bringing Awareness to the Present: Gestalt Work

Gestalt therapy focuses on what’s happening in the here and now. Instead of only talking about panic, your counsellor may invite you to notice what’s happening in your body as you sit together: “Can you sense where the anxiety is strongest right now?”

You may discover tightness in your chest or tension in your hands. The counsellor might invite you to stay with that sensation for a few moments—not to make it go away, but to become curious about it. Sometimes, simply noticing what the body is holding brings new understanding.

Working with the Body for Anxiety: Somatic Approaches

Since panic attacks live in the body, somatic work focuses directly on helping your nervous system regulate. In a session, this might involve:

• Grounding through the senses: The counsellor might guide you to press your feet into the floor, noticing the solid support beneath you, or to look around the room and focus on the window or door - emphasising that you are not trapped.

• Breath awareness: You might practise slowing your breathing, or placing a hand on your chest or belly to feel the movement of breath.

• Releasing tension: If your body feels full of restless energy, the counsellor may suggest gently shaking out your arms or stretching—helping release some of the “fight or flight” energy.

• Resourcing: You might explore what helps your body feel safe—like wrapping yourself in a blanket or holding a grounding object—and practise noticing the physical sense of comfort it brings.

  
  

These small, practical exercises help you learn that even when panic rises, your body can also find ways back to safety.

Integration in Action

In practice, a session may weave these approaches together. For example, and remembering that every person and session is different:

• You may begin by sharing a recent panic episode and feeling heard (Person-Centred).

• Together, you may notice the thoughts that fuelled it (CBT).

• The counsellor may then guide you to tune into the sensations in your body as you recall the experience (Gestalt).

• Finally, you may practice a grounding exercise—pressing your feet into the floor and breathing into your belly (Somatic).

  
  

This combination gives you both insight and tools, while also deepening your connection to yourself.

Moving Towards Calm and Confidence

Panic attacks can feel all-consuming, but counselling offers a pathway to healing. By combining Person-Centred compassion, CBT strategies, Gestalt awareness, and Somatic grounding, integrative counselling helps you not just cope with panic but also reconnect with a sense of calm, resilience, and confidence in daily life.

Try This at Home: A Simple Grounding Exercise

If you’re feeling anxious right now, here’s a gentle exercise you can try:

1. Sit with your feet flat on the ground. Notice the contact between your feet and the floor.

2. Take a slow breath in through your nose for a count of four. Hold for two. Breathe out through your mouth for a count of six. Repeat this a few times.

3. Look around and name five things you can see, four things you can feel, three things you can hear, two things you can smell, and one thing you can taste.

4. Finally, place a hand on your chest or stomach and remind yourself: “This feeling will pass. I am safe right now.”

   
   

This simple practice can help bring your mind and body back into the present moment, reducing the intensity of panic and giving you back a sense of control.