A CBT-Based Guide to Cognitive Restructuring During Panic Attacks

How to Reinterpret Your Body’s Reactions and Regain Safety

When a panic attack strikes, it can feel terrifying. Your heart races, chest tightens, breathing quickens, and you may think:

“I’m going to die.” “I’m losing control.” “Something’s seriously wrong with me.”

But here’s the truth: panic attacks are not fatal. They are your body’s way of overreacting to perceived danger — a false alarm from your nervous system.

Step 1: Notice Your Automatic Thoughts

When symptoms appear, pause for a moment and ask yourself:

“What am I thinking right now?”

Recognize those automatic catastrophic thoughts: they feel true but are not facts. Awareness is the first step toward change.

Step 2: Understand What’s Really Happening

A panic attack triggers the body’s fight-or-flight response. Your brain misreads signals and releases adrenaline. That’s why your heart pounds and breathing speeds up — your body is preparing to “escape,” not to die.

Remind yourself:

“This is my body’s false alarm. I’m safe, and this reaction will pass.”

Step 3: Reframe the Thought — Cognitive Restructuring in Action

Automatic Thought	Realistic, Calming Reframe
“I’m having a heart attack.”	“My heart is racing because of adrenaline. This is temporary and not dangerous.”
“I can’t breathe.”	“I’m over-breathing. I can slow it down, and my body will settle.”
“I’m going crazy.”	“I still know what’s happening. This is anxiety, not madness.”

Tip: Write down these reframes and keep them on your phone or in your wallet for easy access. Read them when panic arises.

Step 4: Practice Calm Thinking + Physical Regulation

1. Breathing exercise (4-2-6 method): Inhale for 4 seconds → Hold for 2 → Exhale slowly for 6 seconds. Focus on the exhale — it signals safety to your nervous system.

2. Self-talk:

“This is just a panic attack. I am safe. It will pass.”

3. Grounding exercise: Name 5 things you can see, 4 you can touch, 3 you can hear. It brings you back to the present moment, away from imagined danger.

Step 5: Reflect and Learn

After each episode, take a few minutes to reflect:

• What was I thinking just before and during the panic?

• Was that thought accurate?

• What helped me calm down?

Each reflection helps your brain build a new response pattern — one based on understanding rather than fear.

A Final Word

Cognitive restructuring doesn’t mean suppressing fear. It means understanding it and gently teaching your brain that you are safe.

Next time a panic attack begins, say to yourself:

“This is my body’s alarm, not a real threat. I can breathe through it.”

If you’re in Toronto or Markham, Ontario and would like professional help learning CBT strategies for panic and anxiety, I offer psychotherapy sessions focused on Cognitive-Behavioural Therapy (CBT) to help you regain calm, confidence, and control.

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