In addition to medication and therapy, one of the current standard treatments for panic disorder involves exposure therapy — recreating the feelings of a panic attack in a safe environment so a person can learn to tolerate them.
“The study showed that a structured program of brief, intense exercise was more effective than relaxation training in reducing panic symptoms, and the benefits lasted for at least six months after treatment ended,” says the study’s lead author, Ricardo William Muotri, a postdoctoral fellow at the Anxiety Disorders Program of the University of São Paulo Medical School in Brazil.
The research, published in Frontiers in Psychiatry, is “one of the first studies to test exercise itself as the main exposure treatment for panic disorder, not just an add-on,” Muotri adds.
What Is Interoceptive Exposure?
Panic disorder treatment can involve a particular type of exposure therapy called interoceptive exposure. “It works by intentionally and safely bringing on physical sensations that people usually fear during panic attacks, such as a fast heartbeat, shortness of breath, dizziness, or sweating,” Muotri says.
The intention is to teach patients that the physical sensations they experience during a panic attack aren’t dangerous — and “don’t mean death is imminent, as most fear during a panic attack,” says Deborah Vinall, PsyD, a licensed marriage and family therapist and chief psychological officer at the nonprofit Recovered. Dr. Vinall was not involved with the latest research.
“When someone having a panic attack remembers and reassures themself that ‘this is just a panic attack; it will subside, and I will be okay,’ the panic and its related physiological symptoms [subside] more quickly,” she says.
Interoceptive exposure is typically done in a therapist’s office. One method involves having a patient spin in a chair until they’re dizzy, explains Meredith Coles, PhD, a psychology professor and director of the Binghamton Anxiety Clinic at Binghamton University in New York. Dr. Coles was not involved with the research.
The new study suggests that short bursts of intense exercise may create the same kind of unpleasant or feared bodily sensations, Vinall says.
But the exercise therapy, Vinall adds, “ties the triggering bodily sensations to a natural stimulus — exercise — which connects these sensations to empowerment, not randomness or loss of control.”
“Because exercise feels more ‘real’ and meaningful” — compared with spinning in a chair for instance — “patients tend to engage better, tolerate it more easily, and stick with the treatment, which likely makes it more effective,” Muotri says.
How the Study Worked
In the study, 72 inactive adults with panic disorder who weren’t taking medications as treatment completed a 12-week program of brief intermittent intense exercise or relaxation training.
Each exercise session was supervised and followed a clear structure, Muotri says. Participants warmed up, walked at a moderate pace, and then did 30-second high-intensity sprints, followed by recovery walking. The number of intense bursts gradually increased over the 12 weeks.
“There was no traditional psychotherapy or verbal coaching during the sessions,” he says. “The therapeutic effect came mainly from repeatedly experiencing bodily sensations in a safe, controlled environment, not from talking about them.”
While both groups showed improvements, the exercise group had lower scores on the Panic Agoraphobia Scale than the relaxation group after 12 weeks. After 24 weeks, they also had fewer panic attacks and lower anxiety and depression.
The study has limits, though, Muotri says. It focused on sedentary adults, so the results may not apply in the same way to those who are already active. Exercise was also tested alone, not combined with medication or traditional talk therapy. He says future research should explore how the treatments work together. And longer-term studies are still needed.
What Is the Takeaway for People Who Have Panic Attacks?
The researchers suggested that incorporating structured, short high-intensity exercises into panic disorder treatment is a “low-cost and engaging option.”
Sometimes, therapists or doctors worry that intense exercise might trigger panic attacks, Muotri says, but study subjects didn’t experience panic attacks during their exercise sessions, even though they experienced strong physical sensations.
“This suggests that when these sensations happen in a safe and predictable setting, people respond very differently than they do during spontaneous panic attacks,” he says.
Talk to a Therapist Before Trying This Therapy
Exercise offers physical and mental benefits and can be a social activity that lowers depression, Coles says. For panic attacks, she says exercise could be incorporated as a patient-centered approach, and it may help some — but others may still need cognitive behavioral therapy to help address patterns of unhelpful negative thinking.
Exercise also increases blood flow to the brain and stimulates the release of the neurochemicals endorphins, serotonin, dopamine, and others, which can help regulate mood, improve focus, and lower stress, she explains.
But people who have panic attacks and want to try intense exercise should start by talking to their therapist for help “developing self-regulation tools and positive cognition reframes” to remember when they’re working out, she says. Then, ease into exercises while using those tools.
Starting a high-intensity workout on your own (without a therapist’s input) could trigger panic attacks for some, Vinall adds.
“The best results are likely when exercise is integrated into treatment with professional guidance,” Muotri says. “Exercise can be a practical, engaging, and scalable way to deliver interoceptive exposure, potentially expanding access to effective treatment.”