Disorder

Panic Disorder Case Study: Breaking Free from the Grip of Fear

Written By

Jagruti Rehab

Last Updated on: 10 Jun 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 very 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)
• Generalized 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.
• Eventually, normalisation of panic symptoms occurred, reducing Aditya's fear of them through this process.
  

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.
• Each outing was accompanied by processing sessions to reflect and celebrate the activity that took place.

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: challenging the 'what if' spiral.
•  Exposure Hierarchy: Creating exposure tasks ranging from the least distressful task to the most distressful.

Mindfulness and Breathing:

• Aditya practised diaphragmatic breathing 2 x day. 
• Mindfulness app use encouraged him to get into the present moment as opposed to fearful "what ifs". 
• Introduced body-scan meditation every night to help with sleep and aid in calming the nervous system.

Relapse Prevention Plan (developed in Month 3):

• Identified early warning signs (increased body scanning, avoidant behaviour) 
• Coping strategies: exercise, journaling, calling a support buddy, etc.
• Emergency toolkit: a calming playlist, a breathing script, and a variety 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:

Daniel’s change was genuinely liberating. From a life of fear and avoidance, he consciously started to move towards independence and a hopeful path. He is now working full-time and going to a co-working space for work without experiencing agoraphobia.

He is exercising frequently and uses jogging, not to be afraid of his heartbeat, but to embrace it. He has reconnected with friends and has begun dating again. Most importantly, he is no longer living in fear of fear.

Family and Community:

Daniel’s parents, who had once experienced panic themselves when faced with the health scares, describe their son now as “present and peaceful”. His younger sister, compelled by Daniel's candidness, has started therapy for her anxiety. 

Aditya had become a mentor in his support group, following the recovery journey of newly admitted members, helping them with their first exposures, and reminding them that there is not only hope but that it can get better. He is even contemplating the idea of a new blog to share his recovery journal.

The Final Thought:

This case study of a panic disorder provides a very personal account of how anxiety disorders can completely take over a person's sense of safety, reality, and joy. But it also demonstrates that with the right treatment, structured CBT, medication, and supportive guidance like Jagruti Rehab in Hyderabad. Moreover, recovery is rewarding.

Panic disorder can affect the vulnerable, but it can also affect the strong, analytical, and high achievers. However, just like all storms, it passes. And when the fog settles, people like Aditya come out the other side with a more resilient, more self-aware, and more empathetic approach to fellow travellers.

Recovery is not a straight line but a dance, two steps forward, one step back. In each beat, Aditya kept moving.

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

Author

Jagruti Rehabilitation Centre is a leading facility specializing in mental health, dementia, and addiction recovery. The team of psychiatrists, psychologists, and caregivers is committed to empowering individuals on their journey to recovery.