Managing Panic Attacks

Panic attacks are intense waves of fear characterized by overwhelming physical sensations and thoughts of imminent danger—despite often having no actual threat. They can feel like dying, having a heart attack, or losing control of your mind. If you've experienced one, you know how terrifying they are. The good news: panic attacks are not dangerous, and you can learn to manage them effectively.

Understanding Panic Attacks

A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause.

What Happens During a Panic Attack

Physical symptoms (4 or more indicate panic attack):

• Racing or pounding heart
• Sweating
• Trembling or shaking
• Shortness of breath or feeling smothered
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, lightheaded, or faint
• Chills or heat sensations
• Numbness or tingling
• Feeling detached from reality (derealization) or from yourself (depersonalization)

Mental symptoms:

• Fear of losing control or "going crazy"
• Fear of dying
• Overwhelming sense of dread
• Feeling trapped

Timeline:

• Peak intensity: Usually within 10 minutes
• Duration: Most last 20-30 minutes
• After-effects: Exhaustion, lingering worry

Why Panic Attacks Happen

The alarm system goes off when there's no fire.

The mechanism:

1. Your brain perceives a threat (real or imagined)
2. Activates fight-or-flight response
3. Releases adrenaline and stress hormones
4. Physical symptoms occur
5. You interpret symptoms as dangerous
6. Fear intensifies symptoms
7. Cycle continues

Common triggers:

• Stress or life changes
• Specific situations (crowds, enclosed spaces, driving)
• Physical sensations (rapid heartbeat from exercise)
• Caffeine, lack of sleep, low blood sugar
• Trauma reminders
• Sometimes no identifiable trigger

Key insight: The panic attack itself is your body's alarm system, not actual danger.

Panic Attack vs. Heart Attack

Panic attacks can feel like heart attacks but have key differences:

Panic attack:

• Sudden onset, peaks quickly
• Younger people (though can happen at any age)
• Triggered by stress or anxiety
• Sharp, stabbing chest pain
• Pain stays localized
• Symptoms resolve within 20-30 minutes

Heart attack:

• Pain builds gradually
• More common in older adults with risk factors
• Pain during or after physical exertion
• Pressure, squeezing chest pain
• Pain may radiate to arm, jaw, back
• Symptoms persist or worsen

If unsure, seek medical evaluation, especially the first time. Better safe than sorry.

Immediate Strategies During a Panic Attack

1. Recognize It's a Panic Attack

Why this helps: Knowing it's panic (not danger) reduces fear.

Remind yourself:

• "This is a panic attack. I'm not in danger."
• "This is uncomfortable but not harmful."
• "This will pass in minutes."
• "I've survived every panic attack before."

Affirmation: "I'm safe. My body is overreacting. This will pass."

2. Focus on Breathing

Why it works: Slow breathing deactivates fight-or-flight response.

Box Breathing:

1. Inhale slowly through nose for 4 counts
2. Hold for 4 counts
3. Exhale slowly through mouth for 4 counts
4. Hold for 4 counts
5. Repeat 4-5 rounds

4-7-8 Breathing:

1. Inhale for 4 counts
2. Hold for 7 counts
3. Exhale for 8 counts
4. Repeat

Key: Long exhales activate calming parasympathetic nervous system.

3. Ground Yourself with 5-4-3-2-1 Technique

Brings you to present moment and interrupts panic spiral.

Steps:

• 5 things you can see: Look around and name them
• 4 things you can touch: Feel textures (clothing, surface, object)
• 3 things you can hear: Notice sounds
• 2 things you can smell: Identify scents (or imagine favorite smells)
• 1 thing you can taste: Notice taste in mouth or chew gum

Why it works: Shifts attention from internal panic to external reality.

4. Progressive Muscle Relaxation

Quick version during panic:

1. Tense your fists tightly for 5 seconds
2. Release and notice the relaxation
3. Tense shoulders up to ears for 5 seconds
4. Release
5. Continue with legs, face, etc.

Why it works: Physical relaxation signals brain that danger has passed.

5. Move Your Body

Options:

• Walk, even if just pacing
• Stretch or gentle yoga
• Jump or shake out limbs
• Cold water on face or wrists

Why it works: Releases adrenaline, shifts focus, grounds you in body.

6. Use Cold Sensation

The dive reflex: Cold water on face activates calming response.

Methods:

• Splash cold water on face
• Hold ice cube in hand
• Press cold pack to forehead or neck
• Take cold drink slowly

7. Accept and Float Through It

Don't fight the panic—resistance increases fear.

Instead:

• Allow the sensations without resisting
• Observe them without judgment: "My heart is racing. That's what panic does."
• Imagine floating on waves of panic rather than fighting them
• Trust that the wave will crest and subside

Paradox: Acceptance often shortens panic attacks.

Long-Term Strategies to Reduce Panic Attacks

1. Understand Your Triggers

Keep a panic diary:

• When did it happen?
• Where were you?
• What were you doing beforehand?
• What were you thinking about?
• Any physical triggers? (caffeine, sleep deprivation, etc.)

Why it works: Pattern recognition helps you anticipate and prevent attacks.

2. Practice Daily Grounding

Even when not panicking:

• Daily meditation or mindfulness
• Regular breathing exercises
• Body awareness practices

Why it works: Builds skill and calms baseline anxiety that fuels panic.

3. Regular Exercise

Benefits:

• Releases pent-up adrenaline
• Improves stress resilience
• Reduces baseline anxiety
• Teaches body that increased heart rate isn't dangerous

Recommended: 30 minutes moderate exercise most days.

4. Limit Panic Triggers

Common triggers to manage:

• Caffeine: Reduces or eliminates if sensitive
• Alcohol: Can trigger panic during hangover/withdrawal
• Lack of sleep: Prioritize 7-9 hours
• Skipping meals: Maintain stable blood sugar
• Stressful media: Limit anxiety-provoking content

5. Cognitive Restructuring

Challenge catastrophic thoughts that fuel panic.

Example:

• Thought: "My racing heart means I'm having a heart attack"
• Reality check: "My heart races during panic. I've had this before and I'm fine. It's uncomfortable but not dangerous."

Process:

1. Notice the fearful thought
2. Question it: Is this true? What's the evidence?
3. Generate alternative, realistic thought
4. Repeat new thought

6. Exposure Practice

Gradual exposure to feared situations or sensations (with therapist support).

Interoceptive exposure: Safely experiencing physical sensations of panic:

• Spin in chair (dizziness)
• Breathe through straw (shortness of breath)
• Run in place (rapid heartbeat)

Why it works: Teaches brain these sensations aren't dangerous.

Situational exposure: Gradually approach avoided situations.

Important: Done systematically with support, not forcing yourself into overwhelming situations.

When to Seek Professional Help

Consider therapy if:

• Panic attacks are frequent (weekly or more)
• You avoid places/situations due to fear of panic
• Panic significantly impacts work, relationships, or daily life
• You have constant worry about next attack
• You've developed agoraphobia (fear of places where escape is difficult)

Panic Disorder

Diagnosis criteria (DSM-5):

• Recurrent unexpected panic attacks
• Persistent concern about having more attacks
• Worry about implications of attacks
• Significant change in behavior to avoid attacks

Treatment:

• Cognitive Behavioral Therapy (CBT): Most effective treatment
• Exposure therapy: Systematic desensitization
• Medication: SSRIs or benzodiazepines (short-term) if needed
• Combination: Often therapy + medication is most effective

Finding a Therapist

Look for:

• Licensed therapist specializing in anxiety disorders
• Training in CBT or exposure therapy
• Experience treating panic disorder

What to expect:

• Psychoeducation about panic
• Learning coping strategies
• Gradual exposure work
• Addressing underlying anxiety
• Typically 12-20 sessions for significant improvement

Common Questions

"Will I Die from a Panic Attack?"

No. Panic attacks are not medically dangerous. They feel terrifying, but they cannot harm you.

Truth: No one has died from a panic attack itself.

"What If I Faint?"

Unlikely. Panic attacks raise blood pressure; fainting requires drop in blood pressure.

Reality: Feeling faint is common; actually fainting during panic is rare.

"What If I Lose Control?"

You won't. Panic attacks don't cause loss of control, violent behavior, or "going crazy."

Truth: You remain aware and in control, even though it doesn't feel that way.

"What If This Never Stops?"

Panic attacks always end. Physiologically, your body cannot maintain peak panic indefinitely.

Timeline: Most resolve within 20-30 minutes, even without intervention.

"Should I Avoid Situations That Trigger Panic?"

Short-term: Avoiding might feel necessary for immediate relief.

Long-term: Avoidance reinforces fear and can develop into agoraphobia.

Better approach: Gradual, supported exposure to feared situations.

Practical Exercises

Exercise 1: Create a Panic Attack Toolkit

Assemble items that help:

• Card with grounding techniques written out
• Stress ball or ice pack
• Gum or mints
• Calming essential oil
• Photo or object that comforts you
• List of coping affirmations

Keep it: In your bag, car, or easily accessible.

Why it works: Having resources ready reduces panic about panic.

Exercise 2: Practice Breathing Daily

Duration: 5 minutes daily

Steps:

1. Set aside 5 minutes when calm
2. Practice box breathing or 4-7-8 breathing
3. Notice how your body feels
4. Build the skill now, so it's automatic during panic

Why it works: Skill-building when calm makes techniques accessible during panic.

Exercise 3: Panic Attack Exposure Script

With therapist or when ready:

1. Write detailed description of worst panic attack
2. Include physical sensations, thoughts, fears
3. Read it repeatedly (or record and listen)
4. Practice tolerating the anxiety the description creates
5. Notice anxiety rises then falls

Why it works: Desensitizes you to fear of panic itself.

Exercise 4: Thought Record

After each panic attack:

• Situation: Where were you, what was happening?
• Thought: What went through your mind?
• Feeling: What emotion and physical sensations?
• Alternative thought: What's a realistic perspective?
• Outcome: How do you feel after challenging the thought?

Why it works: Identifies and modifies thought patterns that fuel panic.

For Loved Ones: How to Help Someone Having a Panic Attack

Do:

• Stay calm and reassuring
• Ask "What can I do to help?"
• Encourage slow breathing
• Remind them it will pass
• Stay with them unless they prefer solitude
• Respect their needs (some want touch, others don't)

Don't:

• Minimize: "Just calm down" or "It's nothing"
• Show alarm or panic yourself
• Force them to do anything
• Take it personally if they're irritable
• Bring up stressful topics

After:

• Don't dwell on it excessively
• Encourage professional help if frequent
• Learn about panic to better understand

Summary

• Panic attacks are sudden, intense fear with physical symptoms—but not dangerous
• Peak quickly (within 10 minutes) and resolve within 20-30 minutes
• Immediate coping: Breathing exercises, 5-4-3-2-1 grounding, accepting rather than fighting
• Long-term prevention: Understand triggers, daily mindfulness, exercise, limit caffeine/alcohol
• Cognitive work: Challenge catastrophic thoughts about sensations
• Seek help if frequent, avoiding situations, or significantly impaired
• Most effective treatment: Cognitive Behavioral Therapy with exposure work

Further Reading

For more on related topics, explore:

• Understanding and Managing Anxiety - Address underlying anxiety that fuels panic
• Managing Overwhelm - Reduce stress that can trigger panic attacks
• Mindfulness for Beginners - Build daily grounding practice