Therapy for Panic Attacks in Madrid: What Works and What to Expect
Cognitive behavioral therapy (CBT) is the best-supported therapy for panic attacks. Spain’s own clinical guideline lists it as one of the treatments of choice for panic disorder. It usually runs for weeks, not years, and it works on the fear of the attack as much as on the attack itself. If you live in Madrid and want to do this in English, you have in-person and online options. This guide explains what happens in treatment, how long it takes, what to do while an attack is happening, and how to pick the right therapist.
TL;DR
CBT is a first-choice treatment for panic disorder in Spain’s official guideline. It combines education about panic, exposure to feared sensations, cognitive work, and breathing and relaxation skills.
Typical CBT takes about 8 to 16 weekly sessions in the Spanish guideline. An Australian professional source describes 5 to 10 hourly sessions over a maximum of four months.
During an attack, slow breathing, naming what is happening, and remembering that the peak passes are your core tools.
Medication can sit alongside therapy. A doctor decides that, and therapy comes first when it is available.
At Heske Therapy in Madrid we work in English, Spanish and Dutch, in the office or online, and you can start with a free discovery call.
Table of Contents
What a panic attack is, and why it keeps coming back
A panic attack is a sudden surge of fear with strong physical symptoms: a pounding heart, tightness in the chest, dizziness, trembling, a feeling that you cannot get enough air. It feels like danger, even when nothing around you is dangerous. Many people end up in an emergency room the first time because the experience is so physical.
One attack does not mean you have a disorder. The pattern that matters is the one that follows. You begin to fear the next attack. You start scanning your body for signs. You avoid the metro, the gym, a crowded bar, a long meeting, anything that once came before an attack. That fear of fear is what keeps panic going, and it is the main target of effective therapy.
As an expat, you may be carrying extra load. A new language, a bureaucracy you are still learning, distance from family, a job with no clear off switch. None of that causes panic on its own, but it can lower your margin. If you recognize yourself here, our article on culture shock triggers expats face in Spain may help you see the wider picture.
Which therapy works for panic attacks
The strongest evidence points to CBT. Spain’s national Clinical Practice Guideline for anxiety recommends it as one of the treatments of choice for panic disorder because it improves panic symptoms and quality of life, according to the guideline published through GuíaSalud. The US National Institute of Mental Health also describes exposure therapy as a common CBT method that confronts the fears and beliefs tied to panic symptoms, including through exposure to bodily sensations.
A fair note on the research: a review of psychological therapies for panic disorder found them better than waiting-list controls, while noting that study quality varied. That is why we look for a therapist who tracks your progress session by session instead of promising a fixed outcome.
The building blocks of CBT for panic
According to the Spanish guideline, therapy for panic disorder can include:
Psychoeducation: learning what panic is, what happens in your body, and why it is not dangerous in the way it feels.
Exposure: facing the sensations or situations you fear, step by step, until they lose their power.
Cognitive restructuring: testing the catastrophic thoughts (“I’m going to faint,” “I’m losing control”) against what actually happens.
Breathing and relaxation: practical skills for lowering arousal and managing hyperventilation.
Panic-management techniques: a plan you can use in the moment.
These pieces work together. Breathing alone can feel like a trick. Exposure alone can feel like torture. Together, with a therapist guiding the pace, they teach your nervous system that the sensations are survivable.
Where other approaches fit
At Heske Therapy we practice integrative psychotherapy: CBT, EMDR, counseling, clinical hypnotherapy and Rapid Transformational Therapy (RTT). Our approach is designed to fit the person, not the label. When panic is tied to a specific past event, a period of intense stress, or a long-standing emotional block, we may combine CBT skills with trauma-focused work or hypnotherapy. We present these as part of a personalized plan, and we agree on that plan with you in the first sessions.
What happens in therapy, and how long it takes
A typical course starts with an assessment: when the attacks began, what you notice in your body, what you avoid, and how it affects your work and relationships. From there, sessions follow a structure. You review the week, learn one new skill, practice it, and take a task home.
On length, the sources agree on a short, time-limited treatment:
Source | Typical CBT course for panic |
On average 8 to 16 weekly sessions of 1 to 2 hours | |
5 to 10 sessions of 1 hour, often weekly, over a maximum of 4 months, with homework and symptom monitoring |
The homework is not a formality. Symptom diaries and practice between sessions are where the change happens, because panic is learned in daily life and unlearned there too.
A realistic path, week by week
No two courses are identical, but many follow this arc:
Weeks 1 to 2: assessment, understanding the panic cycle, first breathing and grounding skills.
Weeks 3 to 6: working with thoughts that fuel the fear, and beginning gentle exposure to body sensations.
Weeks 6 to 12: exposure to the situations you avoid, building confidence in real settings.
Final weeks: a relapse-prevention plan, so you know what to do if a wobble returns.
How quickly you move depends on how long the attacks have lasted, how much you avoid, and how much you can practice. We keep the structure time-limited on purpose. You should always know where you are in the process.
What to do during a panic attack
The Spanish guideline lists the measures used when an attack is happening: calming the person, relaxation techniques, written advice, and breathing exercises to manage hyperventilation. Here is how that looks in practice.
Name it. Say to yourself: “This is a panic attack. It is uncomfortable, and it will pass.” Naming it takes some power from the alarm.
Slow your breathing. Breathe in through your nose for about four counts and out slowly through your mouth for six. A longer exhale tends to settle the body. Keep going for a few minutes.
Ground yourself in the room. Look for five things you can see, four you can touch, three you can hear, two you can smell, one you can taste. A five-senses grounding routine you can also use at home gives your attention somewhere to go besides your heartbeat.
Do not fight the wave. Trying to force the sensations away usually makes them louder. Let them rise and fall while you breathe.
Stay where you are if it is safe. Leaving a situation teaches your brain that escape was necessary. Staying a little longer, even a minute, teaches the opposite.
Tell someone. The guideline also advises that family members be informed about how to help when a new attack happens. A friend who knows what to say (“I’m here, this will pass, breathe with me”) makes a real difference.
These are tools for the moment, not a cure. They get stronger when they are part of a therapy plan, because then you are also working on why the attacks come.
Medication and therapy: how they relate
Many people ask whether they need pills. The Spanish guideline says that combining CBT with an antidepressant such as an SSRI or a tricyclic is recommended depending on patient preference, and that antidepressants alone are not the first line when appropriate CBT is available. It also notes that benzodiazepines such as alprazolam or lorazepam may be used for the immediate treatment of serious attacks.
Those are decisions for a physician or psychiatrist, not for a therapist and not for you to improvise. If you are already taking medication, keep taking it as prescribed and tell your doctor you are starting therapy. If you would like to discuss medication, your GP (médico de cabecera) or a psychiatrist is the right person. We work alongside them when that is the best route for you.
Where we stand: a point of view from our practice
We see many expats who wait. They have had panic attacks for months, sometimes years, and they are telling themselves it is just stress, just the move, just a bad stretch at work. Meanwhile their world shrinks. They stop taking the metro or flying home, or they dread meetings.
Our view is simple. Panic responds well to structured, time-limited work, and the sooner you start, the less avoidance you have to unlearn. That is why we offer a clear three-month engagement rather than open-ended sessions. It gives you a start, a middle and an end, and a plan you can see.
We also believe the therapy has to fit your life. You are busy, you may be far from home, and you may think and feel more fully in English. So we offer sessions in English, Spanish and Dutch, in our Madrid office or online. We combine evidence-based methods such as CBT with EMDR, clinical hypnotherapy and RTT, because panic is rarely just one thing. For some people the root is a past event. For others it is chronic overwork or a build-up of unprocessed emotion. A personalized plan lets us work on what is driving yours.
What we want you to leave with is not just fewer attacks. It is the sense of regaining control: you know what your body is doing, you know what to do next, and you are no longer organizing your life around a fear.
— Heske
How to choose a therapist for panic attacks
Ask these questions before you commit:
Do you use CBT or another evidence-based method for panic? The answer should be specific: exposure, cognitive work, homework. Vague answers about “working on anxiety” are not enough.
How long is the treatment and how is progress measured? Look for a defined plan with check-ins, not an open-ended arrangement.
Can I work in my own language? Describing fear in a second language is harder. A therapist who works in English, or your first language, lets you describe sensations precisely.
Is the therapist licensed, and what is their training? In Spain, check the professional’s registration and credentials. Our guide on how to choose a therapist in Spain walks through this.
Is online an option? The American Academy of Family Physicians notes that therapist-supported internet CBT may expand access, although evidence comparing it with other therapies is limited. If you travel or work odd hours, a flexible format helps you stay consistent.
Do you offer a first conversation? A short introductory call lets you judge whether you feel safe and understood.
If you are still working out your options, see our overviews of therapy in English in Spain and three verified ways to find English therapy in Madrid. If you will be abroad for part of the treatment, read about online therapy from abroad.
Panic, sleep, body tension and related patterns
Panic rarely arrives alone. Many of the people we see also notice:
Night-time symptoms: waking with a racing heart, or dreading bed. Our article on recurrent nightmare therapy covers one common sleep pattern.
Physical tension: a clenched jaw and tight shoulders. We explain the link in bruxism and anxiety.
Self-doubt: a sense of being a fraud at work, which keeps the nervous system on alert. See impostor syndrome as an expat in Spain.
Treating these together, rather than as separate problems, is often what makes the change last. This is where an integrative plan earns its place.
Practical matters: cost, insurance and time off work
Before starting, it helps to know the numbers. Our published packages are:
Create a Breakthrough in 3 Months: €600 per month, with a three-month minimum commitment.
The Classic RTT all-in Package: €750 one-off, with an online version at the same price.
21-day just RTT Package: €550 one-off, also available online.
Pack of 4 Counseling Sessions: €375 one-off, in the office.
If you have private health insurance, check what it covers before you buy sessions. Many policies cap the number of sessions or require a referral. We explain how in therapy insurance rules in Spain and reimbursement for psychotherapy.
If attacks are making it impossible to work, talk to your GP. In Spain, temporary disability (incapacidad temporal) can apply when a worker is receiving Social Security health care and is unable to work, as the Social Security manual on temporary disability describes. Your doctor decides whether it applies to you.
Start with a free discovery call
If panic is shaping your days, you do not have to sort it out alone or wait for it to get worse. We begin with a free discovery call: you tell us what is happening, we explain how we would approach it, and you decide whether we are the right fit. From there we build a personalized plan, in the office in Madrid or online, in English, Spanish or Dutch.
If the plan makes sense to you, you can start with the three-month Breakthrough program or see all plans and pricing. For a lighter start, a single counseling session in our Madrid office is an option. Apply for a discovery call, and we will take it from there.
When panic needs urgent help
Therapy is not an emergency service. If you think you are having a heart attack, if chest pain is new and severe, or if you are in danger, call 112, the emergency number in Spain. If you are having thoughts of suicide, or you are worried about someone else, Spain’s 024 line offers confidential phone and chat support for people at risk, their relatives, and bereaved people. If you have never had a medical check for these symptoms, see your doctor as well, so physical causes are ruled out and your therapy can focus on what is driving the fear.
FAQ
What type of therapy is effective for panic attacks and anxiety?
CBT has the strongest support. Spain’s clinical guideline names it as one of the treatments of choice for panic disorder. It combines education, exposure to feared sensations, cognitive work, and breathing and relaxation skills. Other methods, such as EMDR or hypnotherapy, can be added when your history calls for it.
How many sessions will I need?
The Spanish guideline reports an average of 8 to 16 weekly sessions of 1 to 2 hours for CBT. An Australian professional source describes 5 to 10 hourly sessions over a maximum of four months. Your own number depends on how long the attacks have lasted and how much you avoid. At our practice, a three-month engagement is the standard starting point.
Can I do therapy for panic attacks online?
Yes. There is limited evidence that therapist-supported internet CBT can widen access and be effective, though comparisons with other therapies are limited. We offer online sessions as well as office sessions in Madrid, so you can choose what you can keep up consistently.
Will I need medication?
Not necessarily. The Spanish guideline says antidepressants alone are not first-line when appropriate CBT is available, and that combining CBT with an SSRI or tricyclic can be recommended depending on your preference. A doctor or psychiatrist makes that decision with you. Do not stop or start medication without their advice.
What should I do during a panic attack?
Name what is happening, slow your breathing with a longer exhale, and ground yourself in what you can see, touch and hear. Stay in place if it is safe, and let the wave rise and fall. If you ever feel the situation is a true emergency, call 112.
Sources
Recommended
Comments