Reviewed by: Assel Omarova, MD, psychiatrist and addiction specialist · updated 6 Nov 2026
Key facts
- ICD-10 code
- F41.0
- Who leads care
- A psychiatrist and a CBT psychotherapist
- Format
- Video consultations, CBT sessions, an action plan for attacks
- Duration
- First appointment 50 minutes; a CBT course usually takes 10–16 sessions
- Confidentiality
- Medical confidentiality under the Kazakhstan Code “On Public Health”
- When it is urgent
- New chest pain, shortness of breath, or loss of consciousness — call 103 or 112
- Outcome
- Attacks become rarer or stop, and fear and avoidance fade
What you should know
A panic attack is frightening because it feels life-threatening: your heart pounds, you cannot get enough air, your head spins, and it seems you are about to have a heart attack or pass out. The mechanism is a sudden activation of the “fight or flight” system with no real danger present. The attack itself is not dangerous and passes within minutes, but people start to fear the next one, avoid places where it happened, and gradually narrow their lives. This is how panic disorder develops.
Many patients have their first attack on public transport, in a shopping mall, or in a meeting, and then spend years getting their heart checked. At Psychiatry Online, psychiatrists and psychotherapists work over video, which is especially valuable with panic: there is no need to cross the bridge to the other bank, sit in traffic, or wait in line — situations that can themselves trigger an attack. The appointment takes place wherever you feel safe.
Signs and Symptoms of a Panic Attack
- a sudden surge of intense fear that builds within a few minutes
- a pounding heart and a feeling that it is about to stop
- shortness of breath, a lump in the throat, a sense of choking or chest pressure
- dizziness, weakness, and a feeling that you might faint
- trembling, sweating, hot flashes or chills, numbness in the hands
- fear of dying, going crazy, or losing control
- avoiding public transport, stores, and places where an attack has happened
If at least two points apply and the state lasts longer than two weeks, it is worth seeing a specialist. Phone consultation is free. If life is at risk, call 112 or 103.
What Causes Panic Attacks
The key mechanism is the “vicious circle of panic” described in the cognitive model. A person notices a bodily sensation, such as a faster pulse, interprets it as dangerous (“it’s a heart attack”), this triggers fear, the fear intensifies the symptoms, and the circle closes. Predisposition is linked to heightened sensitivity to bodily sensations, heredity, and the way the brain’s threat-assessment systems work.
The first attack is often triggered by a period of chronic stress, lack of sleep, overwork, alcohol use, or large amounts of caffeine. The intense schedules of the civil service and corporate offices, with late meetings and reports, create fertile ground. In winter, when people spend long hours in stuffy rooms and move little, bodily sensations can become stronger. It is important to rule out physical causes: arrhythmias, hyperthyroidism, and hypoglycemia.
How Online Treatment for Panic Attacks Works
At the first video consultation, the doctor asks how an attack begins, how long it lasts, what sensations and thoughts accompany it, and which situations you have started to avoid. If you have had heart tests, it is useful to have the results ready. The specialist explains how panic works — and this alone reduces fear. At the end, you receive a treatment plan and a guide on what to do during an attack. You will need headphones and a place where you feel calm.
An ECG and lab tests cannot be done online. If symptoms appear for the first time or differ from your usual attacks — chest pain, shortness of breath on exertion, loss of consciousness — call 103 or 112 to rule out an emergency. If you have not been examined, the doctor will refer you for in-person tests. Whether medication can be prescribed and a prescription issued depends on Kazakhstan law.
How we help
Cognitive behavioral therapy
International guidelines name CBT as the first-line treatment for panic disorder. It helps break the circle of panic: you learn to interpret bodily sensations differently and test through experience that they are not dangerous. Research shows that after a course of CBT most patients have far fewer attacks or stop having them altogether.
Interoceptive exposure
This is part of CBT in which the patient, guided by a specialist, deliberately brings on safe bodily sensations similar to panic: rapid breathing or dizziness. The mechanism is habituation: the brain learns that these sensations do not lead to disaster. The exercises are done gradually and are easy to carry out online.
Situational exposure
A gradual return to places you have been avoiding: public transport, stores, elevators. Together with the specialist, you build a ladder of situations from easiest to hardest and work through them step by step. For example, you start with a short bus ride in the Almaty district of the city, then extend the route and the travel time.
Medication
For severe panic disorder, clinical guidelines recommend antidepressants from certain classes, often combined with CBT. Tranquilizers are used sparingly because of the risk of dependence. At Psychiatry Online, the class of medication and the length of treatment are decided by the psychiatrist, and medication is tapered off gradually.
Myths and facts
MythYou can die from a panic attack
FactA panic attack is unpleasant but not life-threatening for a healthy person. The symptoms are caused by a surge of adrenaline and pass within minutes. Still, symptoms that appear for the first time should be checked by a doctor to rule out physical causes.
MythYou should always carry a sedative with you
FactThe habit of relying on a pill “just in case” keeps fear and avoidance going. In CBT, such “safety” behaviors are gradually removed so that the brain learns you can cope without them.
MythIf the attacks have stopped, there’s no need for treatment
FactIf fear and avoidance are not addressed, attacks can return during stressful periods. A course of CBT helps consolidate progress, restore your usual activities, and noticeably lower the risk of relapse in the future.
How an online appointment works
- Message or callWrite on WhatsApp or call — our coordinator replies within minutes, day or night. You don't have to give your surname.
- Doctor and timeWe match you with a psychiatrist, addiction specialist or psychotherapist and agree on a time — often the same day.
- Video consultationA secure 50–60 minute video call: the doctor takes a detailed history and uses standardised scales if needed.
- Treatment planYou receive a clear summary, recommendations and a plan: what we do online and what needs an in-person visit or home call.
- Follow-upOnline follow-up sessions, messenger contact with your doctor, and treatment adjustments until you get a stable result.
Prices in Astana
| Online psychiatrist consultation (50–60 min) | 15 000 ₸ |
| Follow-up online consultation | 12 000 ₸ |
| One month of online psychiatric care | 60 000 ₸ |
The final cost is agreed before treatment starts. Prices are in tenge and do not constitute a public offer.
Where to get help
You can book in Astana online or at one of two branches: 72 Bogenbay batyra St., Astana, 37 Petrova St., office 23, Astana. Our coordinator replies on WhatsApp within minutes at any time, and a doctor usually connects by video the same day; home visits are available too — all city districts and nearby settlements.
Confidential and private
An online appointment in Astana is first of all about privacy: no clinic visit, no waiting room. A private room and headphones are enough. Data is stored in a secure system with restricted access and does not enter any state registry without legal grounds.
Questions and answers
What should I do during a panic attack?
Remind yourself that the attack is not dangerous and will pass in a few minutes. Slow your breathing, focus on the objects around you, and do not try to fight the sensations. If the symptoms are new or very intense, call 103 or 112.
Why do attacks happen at night?
Nighttime attacks occur in panic disorder: the brain can react to changes in breathing and heart rate during sleep. This is not a sign of a more serious illness, but you should tell your doctor about them so they can be factored into treatment and sleep-related breathing problems can be ruled out.
Do I need to have my heart checked?
If you have not been examined, it is worth having an ECG and basic blood tests to rule out physical causes. If your heart has already been checked and everything is normal, repeat tests are usually unnecessary and can keep anxiety going.
How long does treatment take?
A CBT course usually takes 10–16 sessions, and the first changes are noticeable within a few weeks. If medication is prescribed, it is taken for several months after improvement. The doctor will discuss the timeline after the diagnosis and an assessment of how severe the disorder is.
Can I get treatment if I’m afraid to leave the house?
Yes, this is one of the main advantages of the online format. You start treatment from home, and exposure to difficult situations happens gradually. There is no need to travel to a clinic — from the left bank, for example — at a moment when that feels impossible.
Is it anonymous?
Yes. Consultations are confidential, and information about them is protected by medical confidentiality under the Kazakhstan Code “On Public Health and the Healthcare System.” Information may be disclosed only in cases expressly provided for by law, and you do not have to name your employer.
Where can I be seen in Astana?
Online — from anywhere in the city or region. In person — at two branches: 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. Both are open 24/7; home visits cover all city districts and nearby settlements.
Sources and methodology
This page was prepared by the Psychiatry Online medical editorial team based on:
- International Classification of Diseases ICD-10 and ICD-11, World Health Organization
- Clinical diagnosis and treatment protocols of the Ministry of Health of the Republic of Kazakhstan
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
- NICE (UK) and APA (US) guidelines on the treatment of mental disorders
- WHO recommendations on telemedicine and digital health
This information is for reference only and does not replace a consultation with a specialist. Editorial policy
