Isabella is a 20-year-old college student, and she’s stuck in a bathroom.

Her heart is racing. 

She can’t stop hyperventilating.

She’s having a full-blown panic attack, and she’s waiting it out, alone, for it to pass.

This is what she, one of my clients, was dealing with, and what nearly 5% of the U.S. population living with panic disorder experiences regularly. Most traditional approaches tell people like Isabella to just calm down.

“Take deep breaths.”

“Slow your breathing.”

“Relax.”

But anyone who’s experienced a panic attack knows- that advice doesn’t work. Here’s why… and what to do instead.

The Real Cause of Panic Attacks

Here’s the truth: panic attacks don’t start in the mind; they start in the body.  Maybe your heart skips a beat. Maybe you feel lightheaded or notice your breathing shift. That’s the trigger.

What turns that trigger into a full-blown panic attack is step two: your judgment of the sensation. If your brain decides that racing heart = danger, your nervous system amps up even further. Now you’re not just feeling anxiety, you’re anxious about feeling anxiety. That’s when the spiral begins.

Then, we often try to force ourselves to calm down. But here’s the trap: trying to shut down the sensation only reinforces the belief that it’s dangerous. Finally, terrified of what just happened, your brain stays on high alert, constantly scanning your body for signs of danger. And the next time a little flutter of anxiety arises, the panic cycle reactivates.

This cycle is well-documented in the clinical literature and forms the basis of interoceptive exposure therapy, which targets exactly this loop. And yet, less than 20% of clinicians use it (Boettcher et al., 2016)—even though it’s  “the single least utilized evidence-based anxiety treatment” (Hipol & Deacon, 2013). 

The Panic Attack Cycle: 

1. Trigger: A heightened physical sensation
   
2. Cause: Your brain judges it as dangerous (e.g., “I thought I was having a heart attack” said Isabella), which creates anxiety about anxiety
   
3. Response: You try to suppress it — force yourself to calm down
   
4. Perpetuation: This reinforces the fear of that sensation, and your body stays hypervigilant, scanning for signs of danger

Each time you feel that sensation again, your body jumps straight to panic. 

Why Traditional Advice Falls Short

When you try to “just breathe” to force calm, you’re actually reinforcing the idea that your sensations are unsafe. Avoidance amplifies the loop. Studies show that repeated avoidance of feared body sensations maintains anxiety, while exposure helps rewire the brain’s response through extinction learning (Boettcher et al., 2016).

What works better? A method that teaches your body to interpret those sensations as safe, even familiar. That’s where the AIR Method™ comes in.

A – Adaptive Coping

To break the panic loop, we don’t suppress the sensations- we reframe them. Research supports this. In fact, panic is often driven not by heightened body awareness, but by distorted beliefs about what those sensations mean—like thinking “I’m going to pass out” when you feel lightheaded (Yoris et al., 2015). 

 Instead of seeing them as a threat, we teach the body to recognize them as safe. That starts by meeting anxiety with curiosity instead of fear. When the sensations come up, we don’t say “go away”—we say, “oh hey, I know this feeling. Let’s go.” That shift turns the entire cycle on its head. 

And how do we do that? Breathwork paired with cognitive tools that help you challenge and reframe these automatic thoughts.

I – Integrate Through Breathwork

We begin with interoceptive exposure, the evidence-based practice of safely recreating the very sensations that trigger panic- racing heart, breathlessness, tingling, lightheadedness- and teaching the body they’re not dangerous (Boettcher et al., 2016; Meuret et al., 2018).

In our work, we use both controlled hyperventilation and hypoventilation therapy, techniques that deliberately alter breathing to simulate panic symptoms in a safe, guided way. Studies have shown that even repeated exposure to dyspnea (breathlessness) through slow, shallow breathing can reduce panicogenic thoughts and increase tolerance (Meuret et al., 2018). Importantly, it’s not about avoiding discomfort- it’s about building confidence through it.

Studies have shown that even repeated exposure to dyspnea (breathlessness) through slow, shallow breathing can reduce panicogenic thoughts and increase tolerance (Meuret et al., 2018). Importantly, it’s not about avoiding discomfort—it’s about building confidence through it.

In our protocol, we begin with just 10 seconds- enough to create micro versions of the sensations and practice changing our response. Instead of fear, we reframe: “I’m getting an air high. Bring it on.”

“Towards the middle of our sessions, I was feeling the shortness of breath… I was starting to feel a little bit of the quickening heart rate, but through the coping skills that you gave me, I was able to fight it off — which was insane.” – Isabella

This form of breathwork targets all four somatic domains commonly activated in panic attacks  (Boettcher et al., 2016):

• Cardiovascular (racing heart)
  
• Audiovestibular (dizziness)
  
• Respiratory (shortness of breath)
  
• Dissociative (derealization)

Meta-analyses show that interoception-based interventions, especially when combining multiple modalities (like breath + body scan), produce medium to large reductions in anxiety (Khoury et al., 2018). The effects are even more significant in anxiety-related disorders.

But breathwork isn’t just a tool for reprocessing panic; it’s a tool for preventing it. Most people with anxiety have dysfunctional baseline breathing patterns: shallow, upper-chest breathing that keeps the body in a low-level fight-or-flight state all day long. That kind of breathing reinforces the idea that something is wrong, even when it isn’t.

It’s like you’re a boxer in the ring, bracing for a punch that might come at any moment. Your ribs and intercostal muscles stay tight and guarded. There’s no room to expand, no space to relax—so your breath stays stuck in your chest. Over time, your body forgets what it feels like to truly exhale.

With our Breathing IQ method, we teach you how to restore optimal diaphragmatic breathing. That means learning to soften the ribcage, expand through the sides and back, and let the body take up the space it’s been craving. You don’t have to armor up all the time. When your breath becomes more fluid and expansive, your body starts to believe it’s safe again.

We also address pacing, teaching your system to breathe low, slow, and through the nose. Over time, this reshapes your body’s baseline response to stress, helping you scan for safety, not threat. Optimizing your mechanics is like sending a safety signal to your brain- 21,000 times a day.

R – Reclaim With Ice Baths

Finally, we use cold exposure as the best low stakes practicing ground to give you a physical, embodied experience of reclaiming your power.

The ice bath is the perfect training ground because your mind treats it like a big monster, even though it’s just a bucket of water. But when you do step in and breathe yourself to safety, your entire body learns: “I can conquer this. I’m way stronger than I thought. I can handle any discomfort.”

The reason why ice baths are so effective at Ice Bath Boston & Breath is because we customize three variables for every person:

• Temperature of the water
  
• Exposure: How much of your body is immersed
  
• Time: How long you stay in

We adjusting these settings, we meet you right where you are- so it’s cool, not shocking for you. Then, when you get into that cold water and breathe yourself into calm, you prove to your nervous system that you are capable. That you can meet discomfort, move through it, and emerge stronger. As you acclimate over time, we adjust the variables slowly and at your own pace to build up your capacity. 

“After I get out of the ice bath, I feel amazing. A couple months ago, I felt so stuck — I thought, this is just how I’m going to feel forever. Now I know that’s not true.” – Isabella

Putting It All Together

Through the AIR Method, we hit every aspect of the panic cycle:

• Trigger: Ice baths teach your body to move toward the thing it once feared.
  
• Cause: We reframe catastrophic thoughts using story work and cognitive tools through adaptive coping.
  
• Response: Breathwork helps you create a new association with the sensations: not fear, but control.
  
• Baseline: We optimize your breathing mechanics, so your everyday breath reinforces safety—not stress.

Meta-analytic reviews show that breath and respiratory therapy are highly effective for anxiety, especially when practiced consistently over time (Leyro et al., 2021). This work is cumulative. The more you do it, the stronger your nervous system becomes.

Ready to Interrupt the Panic Cycle?

This isn’t about “just breathe.”

It’s about building a body that knows what to do when fear shows up—and a mind that doesn’t make it worse.

When you’re ready to reclaim your calm, we’re here to guide you through it.

References

Boettcher, H., Brake, C. A., & Barlow, D. H. (2016). Origins and outlook of interoceptive exposure. Journal of Behavior Therapy and Experimental Psychiatry, 53, 41–51. https://doi.org/10.1016/j.jbtep.2015.10.009

Farris, S. G., et al. (2025). Getting Comfortable With Physical Discomfort: A Scoping Review of Interoceptive Exposure in Physical and Mental Health Conditions. Cognitive Behaviour Therapy, 54(1), 43–64. https://doi.org/10.1080/16506073.2024.2298246

Feinstein, J. S., Adolphs, R., Damasio, A., & Tranel, D. (2016). Panic anxiety in humans with bilateral amygdala lesions: Pharmacological induction via cardiorespiratory interoceptive pathways. Nature Neuroscience, 19(6), 958–960. https://doi.org/10.1038/nn.4304

Khoury, B., Marchand, A., & Fortin, G. (2018). Interoception in psychiatric disorders: A review of randomized controlled trials with interoception-based interventions. Harvard Review of Psychiatry, 26(5), 250–263. https://doi.org/10.1097/HRP.0000000000000194

Leyro, T. M., Pappens, M., Schruers, K., & Smits, J. A. J. (2021). Respiratory therapy for the treatment of anxiety: Meta-analytic review and meta-regression analysis. Journal of Anxiety Disorders, 83, 102446. https://doi.org/10.1016/j.janxdis.2021.102446

Meuret, A. E., Ritz, T., Wilhelm, F. H., Roth, W. T., & Rosenfield, D. (2018). Hypoventilation therapy alleviates panic by repeated induction of dyspnea. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 539–545. https://doi.org/10.1016/j.bpsc.2018.01.010

Yoris, A., et al. (2015). The roles of interoceptive sensitivity and metacognitive interoception in panic. Behavioral and Brain Functions, 11(1), 14. https://doi.org/10.1186/s12993-015-0058-8