Disorder

Case Study of Panic Disorder: Casting Free Of Fear

Written By

Dr. Amar Shinde

Last Updated on: 29 Jul 2025

Patient Information

Age: 27
Gender: Male
Background: Software engineer, lives in Mumbai alone

History or Cause

Aditya (name changed for privacy reasons) was a high-performing software engineer who was working remotely for a mid-sized tech firm. Aditya's life seemed stable, at least on the surface; earnings were positive, work ethic was good, and he had a chill, reflective style. But there was turmoil going on inside Aditya, and fear was appearing from nowhere. 

It all started subtly. One day during a client video call, he experienced a surge of dizziness, a pounding heart, and chest tightness. He thought he was having a heart attack, so he phoned 911. The ER testing determined there was nothing wrong. "It's probably stress," they told him. But it happened again. And again. Soon, Aditya was going to the ER every week, scared of death, and had a very clean bill of health.

Aditya stopped exercising out of fear of overactivating his heart. He stopped going to grocery stores, he stopped using elevators, and he stopped making phone calls; he stopped doing things where help might not be readily available. His world was getting smaller. By the fourth trip to the ER, Aditya had not left his apartment in four weeks except to check the mailbox.

After his second visit to the ER, a compassionate physician recommended a psychiatric evaluation. This evaluation made all the difference.

Diagnosis:

Aditya was referred to a licensed psychiatrist and clinical psychologist for a comprehensive psychiatric assessment. The full evaluation consisted of:

Assessment Tools:

• Panic Disorder Severity Scale (PDSS)
• Generalised Anxiety Disorder-7 (GAD-7)
• Beck Depression Inventory-II (BDI-II)
• Structured Clinical Interview for DSM-5 Disorders (SCID-5)

Findings:

• PDSS 16: severe panic disorder;
• GAD-7 9: mild generalised anxiety;
• BDI-II 11: mild depression;
• SCID-5 confirmed the presence of recurrent and unexpected panic attacks associated with persistent concern and avoidance behaviour.

Final Diagnosis:

• Panic Disorder with Agoraphobia (DSM-5)

Aditya met DSM-5 criteria for panic disorder: he experienced both unexpected panic attacks, he had a chronic fear of having subsequent unexpected panic attacks, and he had significant avoidance behaviour related to the panic attacks.

Treatment:

Approach:

Aditya's treatment plan was based on a stepped-care model and progressed from psychoeducation to cognitive behavioural therapy (CBT) to appropriate medications, and not only between exposure therapy and/or CBT. Our focus was to help him regain control over his life, decrease physiological reactivity to anxiety, and assist him with living fully in life outside of his apartment.

Program:

1. Psychoeducation and Awareness Building (Week 1-2):

• Aditya learnt about the underlying physiology of panic and how the fight-or-flight mechanism, although evolutionarily useful, can also be triggered inappropriately.
  
• This helped him decrease immediate health-related anxiety because he understood that panic attacks are not lethal.
  
• I used the metaphor of a “false fire alarm” to help him understand he was having a false alarm, loud and scary, but not a fire.

2. Cognitive Behavioural Therapy (CBT) (Ongoing, Weekly Sessions):

• Focused on breaking the "fear of fear" cycle.
  
• Identified and challenged catastrophic thinking: "If my heart races, I will die."
  
• Developed safety statements: "This will be fine. I survived this before."
  
• Panic Diary: Aditya completed a panic diary. He wrote the episodes down; he wrote down the triggers, his thoughts, and then the outcome.

3. Interoceptive Exposure Therapy (Weeks 3-6):

• This method was effective for Aditya in reducing reactivity to bodily sensations.
  
• As part of therapy, he practised activities purposefully designed to mimic panic symptoms in a safe environment. These symptoms included the following.
  
  • Spinning in a chair to create dizziness.
    
  • Jogging in place to elevate his heart rate.
    
  • Breathing through a straw to create breathlessness.
    
• Spinning in a chair to create dizziness.
  
• Jogging in place to elevate his heart rate.
  
• Breathing through a straw to create breathlessness.
  
• Eventually, normalisation of panic symptoms occurred, reducing Aditya's fear of them through this process.
  
• Spinning in a chair to create dizziness.
  
• Jogging in place to elevate his heart rate.
  
• Breathing through a straw to create breathlessness.
  

4. In Vivo Exposure (Week 7+):

• Gradual re-entry into spaces Aditya had avoided, for example:
  
  • Walking around the block.
    
  • Walking to the store for short visits.
    
  • Walking to socialise briefly.
    
• Walking around the block.
  
• Walking to the store for short visits.
  
• Walking to socialise briefly.
  
• Each outing was accompanied by processing sessions to reflect and celebrate the activity that took place.
• Walking around the block.
  
• Walking to the store for short visits.
  
• Walking to socialise briefly.
  

5. Group Therapy (Week 8+):

• Aditya joined a weekly support group with other patients with anxiety and panic disorders.
  
• Hearing other people's lived experience normalised Aditya's hardship while providing a sense of belonging to a group.

6. Medication (Optional):

• Aditya was prescribed sertraline (Zoloft) starting at 25 mg/day and titrated to 50mg.
  
• Aditya was also prescribed a short-acting benzodiazepine (clonazepam 0.5mg) for use during acute panic episodes, which he rarely utilised after Week 4.
  
• Aditya's medications were reviewed every two weeks by the therapist in Mumbai to check adherence, dosage, side effects, etc.

Therapy:

CBT Tools Used:

• Thought Records: recording anxious thinking and evaluating the evidence for/against these thoughts.
•  Behavioural Experiments: testing the predictions we make (e.g., "If I go outside, I will die") and being able to prove them false. 
•  Cognitive Restructuring: switching automatic panic thoughts on a dime and replacing them with proportional responses.
•  Socratic Questioning: Interrupting the 'what if' cycle.
• Habituation Hierarchy: A hierarchy of pre-real-life exposure activities from easiest to hardest.

Mindfulness and Breathing:

• Aditya was taught abdominal breathing for 2 days.
• Mindfulness app usage prompted him to be more in the here and now, rather than stuck on fearful “what ifs”.
• Added a nightly body-scan meditation which can help with sleep and relaxing the nervous system.

Plan for Relapse Prevention (Constructed in Month 3):

• Early warning signs that were identified (increased body scanning and avoidant behaviour)
• Coping strategies: working out, journaling, calling a support buddy, etc.
• Emergency kit: A calming playlist, a breathing script, and a range of grounding exercises.

Improvements/Recovery Timeline

Week 1-2:

• Sleep improved with breathwork exercises.
  
• Sertraline began stabilising mood
  
• First exposure challenge: standing on his apartment balcony for 10 minutes
  

Week 3-4:

• Completed all interoceptive exposure exercises without panic.
  
• Reduced emergency room-related health anxiety.
  
• Began taking short daily walks around the complex.

Week 5-6:

• Had first "panic attack" without escalating into a full-blown panic and used CBT tools successfully.
  
• Went grocery shopping alone (a huge milestone.)
  
• Smiled during a therapy session and said, "I didn't think I'd get here."

Week 7-8:

• Returned to part-time remote work.
  
• Joined a local support group.
  
• Began cooking again – he used to love cooking.

Month 3-4:

• Started seeing friends and going to public spaces, small restaurants, parks, etc.
  
• First panic-free week in almost a year.
  
• Described mental state as "75% back to being me".

Months 5-6:

• Tapered clonazepam completely.
  
• Reduced sertraline down to a maintenance dose.
  
• Took a weekend trip to visit his parents, a trip he had been avoiding for over a year.
  
• Described this phase as thriving, not just surviving!

Jagruti Rehab Treatment’s Success on Daniel’s Life:

The transformation of Daniel was freeing. Instead of leading a life where he feels fear and avoids, he started to consciously move towards an enabler and Hopeful way. Now he is working full-time, going to a co-working space for work, but with no A

He is exercising frequently and uses jogging, not to be afraid of his heartbeat, but to embrace it. He has been catching up with friends and has started dating once again.

Most importantly, he’s not living in fear anymore.

Family and Community:

Parents of Daniel, who were once terrified by these health scares themselves, now describe their son as "being present and peaceful." And his younger sister has taken up therapy for her anxiety after finding solace and open honesty in Daniel.

Aditya became a mentor in the group. He started leading new admits through their first exposures, letting them know that things will improve and that there is hope. He is even considering starting a blog to share his recovery journal.

The Final Thought

This panic disorder case study shows an intimate story of what someone with a panic disorder would encounter and have to overcome. But it also shows that with the right therapy—organised CBT, medication, and supportive guidance. Moreover, recovery is rewarding.

Panic disorder attacks not just the meek, but also those who are strong, cerebral, and excellent performers. But like all storms, it finally breaks. And when the mist clears, folks like Aditya emerge on the other side, wing-clipped but better, stronger, and more self-aware, more empathetic travellers.

Recovery is not linear; it’s a dance, two steps forward, one step back. To each beat, Aditya danced.

And now he is not just surviving the panic attacks; he is outpacing them.

Dr. Amar Shinde

Dr. Amar Shinde, founder of Jagruti Rehab, is a renowned psychiatrist in India with over two decades of experience in mental health, addiction recovery, and neuropsychiatry, dedicated to holistic, compassionate patient care.