Relapse prevention plan: panic
A plan for keeping up your progress with panic after therapy: what you learnt about the sensations you feared, your early warning signs, how to keep practising, and what to do after a setback. Based on Clark's (1986) cognitive model of panic and the relapse prevention approach of Larimer, Palmer and Marlatt (1999): it adds panic warning signs and self-practice.
Written by Tarun Vermani, Trainee Clinical Psychologist Updated
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Relapse prevention plan: panic
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What I've learned in therapy
Write down your own understanding of panic, in your own words. This is the part you will most want to remember if panic comes back.
Situations to watch out for
Some times make panic feelings, or old fears about them, more likely: stress, poor sleep, illness, big changes, or a time when your body feels different for an ordinary reason, such as a cold, a hot day or a lot of coffee. Planning for them helps.
My early warning signs
These are the signals that panic might be getting a foothold again. Catching them early makes them much easier to turn round.
If you haven't had these feelings checked by a doctor, or they change or feel different from usual, see your GP. If you think something is medically wrong right now, such as chest pain that could be a heart attack, call 999.
My coping toolkit
List the ideas and skills that helped you most. Choose ones that help you face panic feelings and learn from them, rather than ones that help you escape them. For each, rate how well it works for you: 0 is not at all, 10 is very well.
| # | Strategy or technique | When to use it | Works for me (0 to 10) | Actions |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 |
Keeping it going
What helped you in therapy will keep helping if you keep doing it. That usually means bringing on the sensations you used to fear, on purpose, so you keep finding out what they really mean; going to places and doing things you used to avoid; and leaving safety behaviours behind, so you keep learning that the feared thing does not happen.
Only try exercises you have agreed with your therapist. Check with your GP first if you have a heart or breathing condition or epilepsy, or are pregnant. Stop if you feel unwell in a way that is different from your usual panic feelings.
Choose which safety behaviours to drop with your therapist. Keep precautions that protect your real health or safety. Do not stop or change any prescribed medication on your own; talk to your prescriber first.
| # | What I will practise | Safety behaviour to drop | How often | Actions |
|---|---|---|---|---|
| 1 | ||||
| 2 |
My action plan for setbacks
A setback is not a relapse. If panic attacks come back or you notice yourself avoiding again, it usually means the old fears have had a chance to grow. The answer is the same as in therapy: remind yourself what the sensations really are, drop the safety behaviours, and go back to your practice.
My support network
People who can help you keep going. Ask them to encourage your practice, not to reassure you or do things for you.
| # | Name | Relationship | How they can help | Contact details | Actions |
|---|---|---|---|---|---|
| 1 |
My commitment
Finish with a short promise to yourself about how you will keep going.
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When to use ‘Relapse prevention plan: panic’
‘Relapse prevention plan: panic’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for panic.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 20 minutes. It moves through six short steps:
- What I've learned in therapy: Write down your own understanding of panic, in your own words. This is the part you will most want to remember if panic comes back.
- Situations to watch out for: Some times make panic feelings, or old fears about them, more likely: stress, poor sleep, illness, big changes, or a time when your body…
- My early warning signs: These are the signals that panic might be getting a foothold again. Catching them early makes them much easier to turn round. If you…
- My coping toolkit: List the ideas and skills that helped you most. Choose ones that help you face panic feelings and learn from them, rather than ones that…
- Keeping it going: What helped you in therapy will keep helping if you keep doing it. That usually means bringing on the sensations you used to fear, on…
- My action plan for setbacks: A setback is not a relapse. If panic attacks come back or you notice yourself avoiding again, it usually means the old fears have had a…
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, ‘Relapse prevention plan: panic’ works by putting clear, personalised coping steps in place for difficult moments. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Clark, D.M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470. doi:10.1016/0005-7967(86)90011-2
- Clark, D.M., Salkovskis, P.M., Hackmann, A., Wells, A., Ludgate, J., & Gelder, M. (1999). Brief cognitive therapy for panic disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 67(4), 583-589. doi:10.1037/0022-006X.67.4.583
- Larimer, M.E., Palmer, R.S., & Marlatt, G.A. (1999). Relapse prevention: An overview of Marlatt's cognitive-behavioral model. Alcohol Research & Health, 23(2), 151-160.
- Aslam, S.Y., Jenkin, A., Zortea, T., Wykes, C., Sadler, S., & Salkovskis, P.M. (2025). Evaluating the effectiveness of a focused CBT training for panic disorder: A randomized parallel trial. Psychological Medicine, 55, e356. doi:10.1017/S0033291725102353
- National Institute for Health and Care Excellence (2011). Generalised anxiety disorder and panic disorder in adults: management (CG113, updated 2020). London: NICE.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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An explainer on panic as a false alarm: how the body's fight-or-flight response, and the way we read its signals, can spiral into a panic attack. Based on Clark (1986): simplified to sensations, catastrophic misinterpretation and the spiral, with safety behaviours and avoidance added from later work (Salkovskis, 1991; Clark, 1999).
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