Panic Attack Exposures

Children and teens with panic disorder are typically sensitive to physical sensations such as increased heart rate, stomachache or chest pain. Although we know that these sensations are harmless and are in fact the body’s natural reaction to perceived threat or danger, over time, youth with panic disorder become afraid of these sensations. They may misinterpret these sensations as indicating there is something very wrong with them, such as a heart attack or an underlying illness*. As a result, these youth start to avoid locations or activities in which they believe they are at risk of experiencing their feared sensations, or purposely doing things they think will protect them, like never leaving home without a phone, or using slow breathing to prevent a panic attack. Consequently, life can become quite restrictive. In order to overcome panic, your child or teen must repeatedly generate their feared sensations in a safe setting to learn that their fears do not come true (for example, they don’t pass out, and they are capable of coping with the sensations). In doing so, your child or teen will eventually discover that their physical sensations no longer make them anxious. For many, this plan sounds counterintuitive since the recommendation is to have your youth experience the very symptoms they fear more not less. However, this intervention is well supported by many scientific studies and is safe for children and adults of all ages.

*Note: it is important that you are sure your youth is healthy before you embark on anxiety sensitivity exposure exercises. There are a select few medical conditions that mimic the symptoms of a panic attack, and thus having a brief medical assessment may be indicated.


Engaging in Panic Attack Exposures in 3 Steps


Step 1

Using the following list of exercises, try each exercise with your child to determine those that activate your child’s feared sensations. All exercises should create some physical sensations such as increased heart rate, rapid breathing and dizziness, among others (see examples in parentheses after each exercise). With some exercises your youth will experience no fear, while others will produce significant fear. Your child can rate each exercise using a 0-10 scale, with 0 meaning no fear of the sensations at all, and 10 being the highest level of fear of the sensations. Some youth really benefit from having their parent or caregiver demonstrate these exercises first.

Exposure exercises:

  • Running on the spot for 30 - 60 seconds (racing heart, breathlessness, chest discomfort).
  • Running up and down stairs for 30 - 60 seconds (racing heart, breathlessness, chest discomfort).
  • Rapid breathing. Agree ahead of time on a length of time that your child can repeatedly perform it with minimal anxiety. Then, try increasing it by 15 seconds, up to a maximum of 2 minutes for teens and 1 minute for children (dizziness, breathlessness, racing heart, numbness and tingling).
  • Breathe in and out through a small straw for 30 - 60 seconds while pinching nostrils (choking sensations, breathlessness, racing heart).
  • Shaking head from side to side, or moving head around by rotating our head in a circular motion for 30 seconds (dizziness).
  • Spinning around in place or spinning in a chair for 30 seconds (dizziness, nausea).
  • Hold breath for 15 - 30 seconds (breathlessness, dizziness).
  • Stare at your hand for 2 - 3 minutes (feelings of unreality – things looking and seeming weird).
  • Stare at a light on the ceiling for 1 minute and then try and read something (blurred vision).
  • Wear a tight turtleneck or scarf around your neck for a few minutes (tightness in the throat).  


Step 2

Once you and your child have created a list of exercises that create anxiety, you will begin with the exercise that is the least scary, and build up to the more scary exercises. Each exercise can be broken up into smaller steps if necessary (e.g. start with running on the spot for 30 seconds, then 45 seconds, and finally 1 minute). Have your child continue the exercise until s/he starts to feel the feared sensations. Encourage him/her to stay with the sensations rather than to escape. You can talk to your child during this experience, making comments such as, “These sensations are harmless.” “This is your body’s natural reaction to reduced oxygen.” “Your body will return to normal in a few minutes.” “You can ride it out- you’re doing great coping!” If your youth is finding it difficult to ride it out, you can have him/her use calm breathing {embed link} to help tolerate these sensations. However, use calm breathing with caution. It is important your child learns to cope with and tolerate the sensations, rather than misunderstanding that breathing is meant to control or stop the sensations. You can remind your child there is no need to control or stop the sensations as they are harmless. While doing the exercises, have your child rate his/her anxiety level using the 0-10 scale. Have your child repeat the exercise until his/her anxiety drops by about half (for example, if your child’s rating is a 6, have your child repeat the exercise until h/she experiences a 3). Focus on 1 exercise at a time. Once your child experiences very little anxiety when completing that exercise on several different occasions, move onto the next one. It is optimal for practices to be planned in advance and done on a daily basis. The more your child practices, the faster his or her fear will decrease.


Step 3

It is important for your child to start entering situations that s/he has been avoiding due to fears of having panic attacks. Once your child is no longer afraid of the sensations, s/he is ready to practice triggering his/her sensations while in feared locations or activities (for example, going places alone, entering crowded stores, or riding the bus). Ask your child to make a list of locations or activities and order the list from the least to the most scary. Starting with the situation that causes the least anxiety, encourage your child to repeatedly enter the situation and remain there until his/her anxiety decreases. If there is no anxiety in the situation, encourage your youth to use one of the panic sensation exercises to generate some physical sensations. Once your child can enter that situation without experiencing much anxiety, move on to the next item on the list. For additional details on this process, please read about Facing My Fears.