Do you feel your heart race when riding the subway? Do you become so tense and frightened when crossing a footbridge that you feel like your legs might collapse? When driving in heavy traffic, do you feel trapped, overwhelmed by extreme fear, with your arms and legs going numb as if blood isn't circulating? Do you feel like you might faint during work meetings? Amid such seemingly irrational and chaotic changes in life, do you feel like your whole world has come crashing down? Do you feel like you're no longer the person you used to be?

If your body and mind no longer respond to your will or common sense—even when there’s no real reason to feel anxious or afraid—and if you find yourself avoiding things you used to enjoy with a smile, while your daily activities shrink more and more, then there is a high possibility that you are suffering from Panic Disorder.

You might be too afraid to talk about your condition, worried that others will laugh at you or think you’re mentally unstable. You may even hide it from close family and friends because you don’t want to worry them, keeping the fact that you’re suffering from panic disorder locked away as a tightly held secret. In your heart, conflicting emotions may arise—anguish and confusion asking, “Why is this happening to me? I’ve lived a good and sincere life; what did I do to deserve this?” mingled with a flicker of hope: “Maybe someday I’ll be okay again.”

Gone are the days when you could wake up, breathe in the fresh morning air, go to work feeling fulfilled, chat over coffee with coworkers, and return home to relax watching a drama or variety show with your family—experiencing small joys in the everyday. That once-effortless daily routine—getting up, washing your face, getting ready, eating breakfast, and taking the subway to work—now feels like walking through a minefield, with each step a terrifying challenge.

This overwhelming, irrational fear is something you carry alone, quietly battling it day after day. It feels unbearably lonely and sorrowful. What gets you through is the baseless hope that “things will get better someday,” and perhaps the sight of your sweet children asleep at home.
I have seen many people struggle with panic disorder in this exact way. And to each one, I want to say: You are still healthy and strong—please don’t worry. Imagine I’m sitting beside you, gently encouraging you. Please continue reading with that in mind.

1. What Is Panic Disorder and Why Does It Occur?

Panic disorder is different from a typical “phobia.” In a phobia, fear is triggered by a specific object, situation, or environment. However, in panic disorder, it’s not the object or situation itself that causes fear—it's the person's extreme and uncontrollable reaction to it, which leads them to believe something terrible will happen. In other words, it’s not a fear caused by an external trigger, but rather a fear of the fear itself (Carbonell, 2004). For example, someone with a chicken phobia feels fear when seeing a live chicken. But someone with panic disorder might even feel fearful seeing a cooked chicken soup (“samgyetang”).

In some countries, the number of people seeking help for panic disorder has steadily increased over the past decade. Theories point to genetic, neurological, and psychological causes, but no single definitive explanation exists. Statistically, many people with panic disorder tend to have a genetic predisposition, grew up around seriously ill or alcoholic family members (which made the world seem unsafe), or have a personality that overextends itself trying to please others. It also often develops naturally in one’s 20s or 30s during the journey toward personal independence (Carbonell, 2004).

But if this analysis resonates with you, there's no need to be discouraged. You are not to blame for your genetic makeup or upbringing. Many healthy individuals can develop panic disorder due to various reasons. The most common triggers include severe depression, unresolved problems in a difficult marriage or life situation, the loss of a loved one, or chronic stress over uncertain issues (Carbonell, 2004).

Once someone has experienced panic in a particular place or situation, they often avoid those places. They may rely on rituals, bring someone along, carry emergency items (like a phone, medication, or therapist’s contact), try to distract themselves, or attempt to “fight through” the fear (Carbonell, 2004). However, these strategies often worsen the condition, making symptoms more chronic and difficult to treat.

2. Characteristics of Panic Disorder

Panic disorder is marked by distorted fear responses. When fear in specific places is not properly addressed, a pattern of “situation → fear response” begins to spread and activate in other areas—like poisonous mushrooms sprouting unexpectedly. Human bodies and cognitive systems are still not so different from those of our primitive ancestors. In that sense, our internal systems can be seen as outdated. They are wired to respond to threats through one of three survival strategies: fight, flight, or freeze (Carbonell, 2004).

However, when this “threat–interpretation–response” mechanism breaks down, people start reacting inappropriately to situations that aren't truly dangerous. This faulty response can be described as being "tricked" by unnecessary fear (Carbonell, 2004). For instance, encountering a tiger in the forest justifies an adrenaline rush—sweating, racing heart, and readiness to flee. But if you’re riding a subway you've used many times, and suddenly experience that same intense fight-or-flight response while crossing a bridge, that’s not a rational reaction.

In such cases, it's helpful to consciously remind yourself: “There’s no real danger. I’m just experiencing a feeling of fear.” This is the first step toward regaining control.

Being diagnosed with panic disorder often means that long-held patterns of thought and stress have accumulated to the point where your emotional system becomes overheated and hypersensitive. Think of your mind as a personality—it’s exhausted, overwhelmed, and unusually sensitive. As a result, it can no longer interpret situations accurately.

This doesn’t mean that a specific trigger caused the panic—it means your internal system is already so overheated that it reacts with panic to even minor stimuli, without reason. You might wonder how this disconnect between reality and your response is possible. Think of it like this: when you see a juicy orange in a magazine, you might immediately start salivating. That’s your body responding to a mental image. Similarly, a harmless situation can evoke panic simply because your mind vividly associates it with past fear.

So even if a situation isn’t dangerous, your body reacts as if it is. And once you start noticing your body’s reaction, you begin to believe, “This really is scary!”—falling into a kind of psychological trap.

Relying on avoidance, support people, or safety objects may provide temporary comfort, but eventually, the number of avoided situations grows, your social life shrinks, confidence erodes, and you sink deeper into the cycle of panic disorder.

3. The Mindset Needed to Overcome Panic Disorder

When individuals with panic disorder respond to their “exhausted and overheated mind (fire)” with fear and avoidance—“a negative, fearful attitude (gasoline)”—it’s like pouring fuel on flames. This ignites a vicious cycle. I understand how terrifying and painful panic symptoms can feel, but in order to overcome panic disorder—this "paper tiger" of fear—you must resist being overly afraid of it.

For example, many people with panic disorder avoid specific places or situations they fear. If they must face them, they often only go accompanied by someone they trust or while carrying “safety objects” like medication or a phone. This is called self-protective behavior. But the more you rely on these tactics, the less chance you give yourself to overcome the disorder on your own (Carbonell, 2004).

Say you avoid a certain convenience store because you once had a panic attack there. If you want to break free from that fear, you must face the anxiety deliberately and repeatedly, until you clearly see that the fear has no substance—that it cannot overpower your will and confidence. Avoiding discomfort may provide momentary relief, but in the long run, it limits your freedom.

That’s why Dr. Carbonell and many experts advise taking small, steady steps without despair or frustration over your body’s reactions or your anxious thoughts. Worrying about a situation doesn’t mean you’ve failed to overcome cognitive distortion—it simply reflects how hard it is to sit with the discomfort. Panic symptoms often trigger a chain reaction of negative thoughts like self-loathing, shame, or hopelessness.

So it’s essential to look at your experience objectively and realistically, regardless of your thoughts or bodily sensations. Wait out the discomfort rather than reacting to it impulsively. Panic symptoms typically include four elements: physical arousal, distorted thinking, emotional disturbance, and desperate behavior (Carbonell, 2004).
During a panic attack, people may struggle to breathe, feel muscle tension in their jaw, neck, or shoulders, try to hide their distress by leaning against a wall, or abruptly leave a room looking for an exit. After experiencing this repeatedly, many people begin to assess every new place by one question: “Is there an exit or escape route if I panic?” They may avoid places where escape isn’t easy, like airplanes, boats, or amusement park rides.

Over time, it’s not the situation that they fear—it’s the possibility of panicking without a way to escape. That’s why it’s crucial to train yourself to face panic with calm objectivity rather than fear.

An Example of How to Confront Panic (Carbonell, 2004):

1. Physical symptoms begin: “I feel dizzy and hot… My left arm feels numb and tingly.”
2. Automatic, irrational interpretation: “What if I’m having a heart attack? I might faint or even die.”
3. Emotional reaction escalates: Increased fear and panic.
4. Catastrophic thinking continues: “Oh no, it’s really happening… Is this the end? What’s wrong with me? Will this ever stop?”
5. Emotional spiral: Anger, shame, self-hatred.
6. Acceptance begins: “Why is this happening…? Okay, let me pull myself together. I hate these symptoms, but they’ve never actually harmed me. I’ve made it through before. Let’s practice getting through this again.”
7. Apply known technique: Begin deep, diaphragmatic breathing.
8. Observe the physical symptoms subside: “I’m not dizzy anymore. My arm feels normal.”
9. Notice the change: “Okay, I feel a lot better.”
10. Feel pride in the progress: “Panic doesn’t scare me like it used to.”

The more you practice facing your fears in this way, the less frequent and intense your panic episodes will become. The specific situations that trigger panic are, in a way, “invitations” to re-enter the panic experience (Carbonell, 2004). If you respond with avoidance and excessive self-protection, panic intensifies. But if you respond with calm, grounded realism, the fear becomes easier to manage.

With consistent, active practice, you can ultimately free yourself from the grip of panic disorder.

4. Specific Treatment Strategies

The foundational strategies for overcoming panic disorder include diaphragmatic (belly) breathing, keeping a panic diary, Cognitive Behavioral Therapy (CBT) to build realistic understanding, and gradual exposure therapy. While medication may provide short-term relief, long-term reliance can hinder your ability to defeat the "paper tiger" of panic using your own strength and rational thinking. Once symptoms are no longer severe, it's often better to reduce or discontinue medication—with professional guidance.

While I have explained CBT in detail in previous writings, let me now explain the other strategies based on Dr. Carbonell’s guidance (2004).

A. Diaphragmatic (Belly) Breathing Technique

When experiencing panic symptoms, breathing tends to become shallow, which intensifies anxiety. One of the simplest and most effective things you can do is deep belly breathing. Even just knowing this technique can help reduce the fear that panic might suddenly strike.

Here’s how to do it:
1. Place one hand on your belly near the waistband, and the other hand on the center of your chest.
2. Open your mouth and let out a sigh. As you exhale, relax your shoulders and upper body. The point of sighing is not to empty your lungs but to relax your upper body muscles.
3. Hold your breath for a few seconds.
4. Close your mouth. Slowly inhale through your nose while pushing your belly outward. Let your abdomen rise—even if it feels awkward, try to inhale fully and pause briefly.
5. Hold your breath for as long as feels comfortable. You might feel lightheaded or start yawning—this is normal.
6. Open your mouth and exhale slowly, drawing your belly inward.
7. Pause briefly.
8. Close your mouth and begin inhaling through your nose again.
9. Repeat this cycle for a few minutes until the panic symptoms subside and you feel calmer.

B. Writing a Panic Diary

People with panic disorder often hate even thinking about the places or situations that trigger their symptoms. This isn’t unique to you—most individuals with panic disorder feel this way. For these people, being asked to recall those moments vividly and describe their thoughts, feelings, and physical symptoms in a journal may sound overwhelming or even shocking.

However, keeping a panic diary is extremely helpful for escaping the trap of panic disorder. Writing just two or three times a week about the situations in which panic occurred—what you felt, thought, and how you responded—helps you observe yourself objectively, as if you were watching a character in a drama or movie.

Through this self-reflection, you begin to understand what specifically happened in those moments and how you reacted. This allows you to see your situation and symptoms from a new, realistic perspective (Carbonell, 2004). There’s no fixed format for a panic diary—you’re free to make it your own.

C. Cognitive Behavioral Therapy (CBT)

CBT is one of the most effective treatments for individuals struggling with fear and anxiety. People with panic disorder often experience cognitive distortions—they misinterpret or exaggerate reality due to an overheated emotional state. These distorted thoughts quickly chain together, leading to catastrophic conclusions.

For instance, a person who once saw rain through a bus window as romantic might now think:
“It’s raining → traffic will be bad → more people on the bus → bus gets humid and crowded → not enough oxygen → chest tightness and dizziness → I might have a heart attack → I feel numb and short of breath → I’m going to die.”

CBT helps you break this chain. Panic disorder doesn’t appear overnight—it develops over time through stress, suppressive situations, and experiences that conflict with your values and expectations. These build a cognitive system that becomes misaligned and eventually collapses under its own weight.

CBT involves deconstructing these distorted thoughts and rebuilding a healthy, value-based cognitive framework. Even when your body overreacts, you can retrain your mind to stay grounded in reality. Practicing this regularly helps your mind regain control over your body.

D. Progressive Exposure Therapy

Gradual exposure is one of the most critical and essential steps in overcoming panic disorder. When done successfully, it restores your sense of freedom and control.

Start by listing the places, actions, or situations you avoid due to fear of a panic attack. Break each down into manageable levels—from least to most anxiety-provoking. For example, if driving triggers panic, identify variables such as:
· Type of road (highway, alley, country road)
· Presence of obstacles (construction zones, traffic)
· Distance from home
· Time of day
· Whether you’ll cross bridges or tunnels
· If it’s a familiar route
· Whether you’re alone or with someone

You can do the same for elevators, airplanes, boats, malls, subways, and underground arcades. Rate your anticipated anxiety level for each scenario on a scale from 0 to 100, and organize them in order from least to most stressful.

Start with the least anxiety-inducing scenario. If it's too difficult to go alone at first, bring a companion or carry a comfort object. However, avoid working on multiple scenarios at once. Focus on one and build confidence before moving to the next.

If your panic symptoms lessen with a companion, that’s a successful first step. Gradually transition to facing the situation alone. If you're using medication, consult with a professional before adjusting or stopping it, especially if your symptoms have improved.

Should setbacks occur, don’t be discouraged. Return to earlier steps and keep practicing. Throughout exposure, repeat affirmations like:
· “I am mentally and physically healthy.”
· “These panic symptoms are nothing but a paper tiger—I will not go crazy or die because of them.”

With consistent practice, you can conquer each step and ultimately free yourself from panic disorder.

5. Real-Life Exposure Practice Example: Airplane Travel

For many people with panic disorder, flying is the ultimate challenge. While most other situations offer some form of escape, being mid-flight over the Pacific Ocean with no exit and no immediate access to medical help makes airplanes seem impossible—even as part of exposure therapy. As a result, many individuals miss out on long-desired international travel or make excuses to avoid work-related trips.

But this doesn’t have to continue. As I’ve said many times, experiencing panic symptoms on a plane will not make you go insane or die. Trust me—and consider this your invitation to try exposure therapy through flying.

If imagining a flight feels too overwhelming, start smaller. Choose a short domestic flight or a route that doesn’t cross open water. For example, imagine a loved one living in close area urgently awaiting your visit before surgery. Use that motivation to begin the journey.

When planning, consider factors like:
· Flight duration and distance
· Whether the route crosses the ocean
· Aircraft size (major airlines and larger planes are preferable for beginners)
· Daytime vs. nighttime flights
(Carbonell, 2004)

Here are Dr. Carbonell’s suggestions for preparing:
1. List the symptoms you imagine you’ll experience during the flight—physical, emotional, cognitive, and behavioral.
2. Graph your stress levels over time—before boarding, during takeoff, mid-flight, landing, and return.
3. Carry small note cards with encouraging messages like “Start belly breathing!” or “Is this just discomfort, or real danger? Think it through.”
4. Write in your panic diary on the plane. Use positive self-talk or mental scripts like, “Remember when you used to get excited watching planes take off?”
5. Ask a family member or friend to prepare a surprise gift—perhaps a humorous plush toy or a note with words of encouragement—to open right after boarding.
6. Double-check all essentials like your ticket and passport beforehand.

The night before, you may think, “Why am I doing this?” Remind yourself:
“Because I need to face my fear. This is how I’ll grow stronger, wiser, and more confident.”

On the day of your flight, board early—delays will only heighten your doubt. Once on board, avoid trying too hard to distract yourself. Rather than chatting excessively or diving into reading, sit calmly, breathe deeply, and stay grounded.

If you feel uneasy, ask a flight attendant for water. Most airlines train their staff to assist passengers with panic symptoms and have emergency procedures in place—including landing at the nearest airport if needed.

Know this, and you’ll feel more at ease. Sit with any emotion that arises. Keep your focus. The plane will take off, and as you rise into the clouds, you may realize—surprisingly—that no panic symptoms have appeared. You may even cry with relief, whispering: “I’ve done it. I’m finally healed.”

A Final Word of Encouragement

Compared to other mental health conditions, panic disorder is quite treatable—especially with commitment and practice. Imagine a gorilla in a cage. After months of hitting his head on the bars trying to reach a banana, due to the pain and frustration, the gorilla will stop trying—even after the bars are removed. It’s heartbreaking.

Could it be that you, too, are now trapped by an imaginary cage? Panic disorder is essentially fear without substance. By facing it bravely and deliberately, you can build the strength to overcome it.

Through this process, you can rebuild your cognitive system—stronger, freer, and more resilient than before. If your overheated mind is distorting reality, and you’ve been fueling your fear with protective behaviors, now is the time to step back. Cool the fire. Observe from a distance. Reclaim your mental sovereignty. Take back leadership over your life.

This can be the start of a virtuous cycle—a return to a more meaningful, fulfilling life.

To those who have suffered with panic disorder for six months or even ten years:
Let go of the past. Embrace your right to a full life, shared with others.
Start today.

And through all the difficult experiences you've endured, I believe that you can grow in maturity and develop a deeper sense of gratitude for life. In time, your journey of healing can become a foundation from which you are able to support others who are struggling with panic disorder. You may one day offer encouragement and hope to those facing panic disorder.

Wishing you health and happiness—always.

This article is a translated version of Dr. Kim's original work featured on this page (이 글의 한국어 버젼은 아래 페이지에서 보실 수 있습니다.):

https://brunch.co.kr/@byungilkim/39

Blog

Are You Feeling Hopeless Because of Panic Disorder? : Es...