Hello and welcome! Glad you found us!
Managing something like panic disorder can be rough at times. I too suffer from PD, so I can comiserate.
Really, the best way to make progress is to change the way we THINK (the "what iffing") and the way we react to anxiety. We get stuck in that anxious cycle of worry that just keeps going round and round. It isn't easy, and it takes time, work and patience, but it's possible.
Having the RIGHT therapist, and the right kind of therapy (ie, CBT, which is great for anxiety sufferers) makes all the difference in the world. If you feel you're not seeing progress with your therapist, find a new one. Sometimes it takes some time and trying a few different therapists until you find that one who really makes a difference and starts making the light bulb go off!
Also, medication can be an important part of treatment. Again, it's the same kind of thing, a lot of trial and error until you find the right medication. Medication will only help to control your symptoms of panic while you work on the other stuff in therapy, it doesn't "cure" anxiety. It's a lot like treating any other chronic condition, like hypertension, diabetes.
I would recommend that you speak with your doctor about trying a new medication. One possibility would be to try a different antidepressant (like Zoloft, Lexapro, etc) along with a short acting anxiolytic, like Xanax or Ativan to be used "as needed" as a rescue med in the event of a panic attack. That combination of medications is commonly prescribed, because it tends to be pretty effective. Just something to mention to your doctor. Make sure your meds are being managed by a psychiatrist too, not just your PCP. That's important. And the same thing I said above in regards to your therapist applies for your doctor as well...if you aren't seeing progress, or you feel your doc isn't listening to your concerns, find a new one.
Lastly, there are LOTS of things YOU can do on your own to help address your anxiety. I can tell that you're very knowledgeable about your condition, which is great. The more we know and understand, the more fear it takes away for us. There are so many self help books out there that you could pick up. Here is a link to a list of resources I compiled:
Look through it and pick a book or two. The one that I recommend to everyone is "The Anxiety and Phobia Workbook" by Edmund Bourne. It's a must have, it's set up much like a textbook, so it's interactive and allows you to do a lot of hands on work with your anxiety. It's important to push yourself, set goals and try your best to accomplish them. The more you do that, the more power it takes away from the panic.
For instance, working on avoidant behavior. Most of us with PD have a hard time returning to places, or exposing ourselves to a situation where we've had a panic attack. We also tend to flee when we panic, back to a "safe" place (usually home). That's because it relieves the anxiety for us.
The MORE you can ride it out, and avoid fleeing, the better you will get. Same with avoiding people, places and things that we relate to anxiety. It's all about conditioning if you think about it. You have a panic attack at the grocery store.....even though the store itself is totally irrelevant and did not CAUSE the panic attack, you will fear it, right? Same way if you have a panic attack at 5pm at dinner time. You will begin to relate the time of day, even the FOOD you were eating to the panic, and begin avoiding the food, and like clockwork, becoming anxious every day at 5pm. It's conditioning, and every time we avoid a place or situation that we fear because of a previous attack, we're sending a message to our brains that there IS indeed something to fear, whereas if you push yourself to purposely PUT yourself in those places and situations (gradually of course), it sends the opposite message, that there is NOTHING to fear. It's called exposure therapy, and it's VERY effective for people with PD.
Those are things YOU can work on on your own, setting some small goals and working your way up. It won't always be easy, you will have days where you will meet your goals and then some, and days when you cannot even walk out the door, and that's okay! It's a process, you have to be kind to yourself and patient with yourself. Celebrate every accomplishment, there are no small successes in this struggle, they're all part of the progress, like stepping stones. So, celebrate the good days and try not to beat yourself up over the bad ones.
To give you some examples on goals you could set in reference to facing your fears and working on the avoidant behavior, let's go back to the grocery store example. You set a goal that Monday you will go to the store, sit in the parking lot in your car for 5 minutes, then return home.
Tuesday, you will return to the store and go in and walk around for a few minutes (obviously, the longer the better, but if your anxiety is high, even a minute or two will be something). Then, get back in your car and go home.
Wednesday, you set a goal to go in the store, and buy one or two items, going through the check out line, getting in your car, and going home.
You get the idea...gradually and slowly exposing yourself to anxiety producing situations or environments. If you do that for a while, it WILL change the way YOU react to that stimuli (the store). If you can find a therapist well versed with CBT and exposure therapy, they can help you with those kinds of exercises. The more you expose yourself to something that once caused you anxiety or panic, the less you will fear it.