Panic Attacks: What They Are and How to Cope When One Hits

If you have ever had a panic attack, you probably remember it clearly. It can come out of nowhere: your heart starts pounding, your chest feels tight, you cannot seem to catch your breath, and a wave of dread tells you something is terribly wrong. Many people who have their first panic attack go to an emergency room convinced they are having a heart attack. If that has happened to you, you are not alone, and you are not "overreacting". This article explains what a panic attack is, why it feels the way it does and what you can do to cope.

What is a panic attack?

A panic attack is a sudden episode of overwhelming fear or anxiety, often with intense physical symptoms. The NHS describes panic as the most severe form of anxiety, and notes that an attack can come on very quickly and sometimes for no apparent reason. Attacks can happen during a stressful moment, but they can also strike when you feel relaxed, or even wake you from sleep.

According to the National Institute of Mental Health (NIMH) and the NHS, common symptoms include:

• A pounding or racing heart
• Shortness of breath, difficulty breathing or a choking sensation
• Chest pain
• Sweating, chills or hot flushes
• Trembling or shaky limbs
• Dizziness, weakness or feeling faint
• Nausea or a churning stomach
• Numbness or tingling in the hands or fingers
• Feeling disconnected from your body
• A sense of dread, losing control or fear of dying

The NHS says most panic attacks last between 5 and 20 minutes, although some have been reported to last up to an hour. NIMH similarly notes that an attack can last from a few minutes to an hour or sometimes longer.

Why does panic feel so physical?

Panic is your body's alarm system going off at the wrong time. When your brain senses danger, it prepares you to fight or run: your heart speeds up, your breathing gets faster and your muscles tense. That response is useful when there is a real threat. During a panic attack, the alarm fires even though there is nothing to fight or escape.

The trouble is that the physical symptoms themselves can feel alarming. A fast heartbeat is easy to read as a heart problem, and fast breathing can bring on dizziness and tingling, which can feel like more proof that something is badly wrong. NIMH gives exactly this example: someone might feel their heart pounding and assume they are having a heart attack. That fear can feed the panic and keep the cycle going.

It is worth knowing, though, that many of these symptoms can also be caused by other health problems. If you have chest pain or trouble breathing and you are not sure what is happening, especially for the first time, seek medical help right away. It is always fine to get checked.

Panic attacks vs. panic disorder

Having a panic attack does not mean you have a mental health condition. Many people have one or two in their lives, often during a period of heavy stress, and never have another.

Panic disorder is different. According to NIMH, people with panic disorder have sudden and repeated panic attacks, and they also spend a lot of time worrying about when the next one will happen. They may start to avoid places or situations where attacks have occurred before. The NHS describes how this can create a cycle of living "in fear of fear", which can lead to even more attacks. Panic disorder is one of several anxiety disorders. NIMH notes that it is more common in women than in men and often begins in the late teens or early adulthood.

What to do during a panic attack

When panic hits, it can be hard to think clearly, so it helps to have a simple plan ready in advance. The NHS suggests that, when you feel an attack coming on, you:

• Stay where you are, if possible. Running away from the situation can teach your brain that the place was dangerous.
• Breathe slowly and deeply. Try breathing in gently through your nose for a count of about four, then out slowly through your mouth for a little longer. Slowing your breath can ease dizziness and tingling.
• Remind yourself that the attack will pass. It may help to say to yourself, "This is panic. It feels awful, but it is not dangerous, and it will pass."
• Focus on something calm. Picture a peaceful place, or notice what you can see, hear and touch around you to bring your attention back to the present.

You do not need to make the feelings go away instantly. Often the most helpful thing is to let the wave rise and fall without fighting it. Practising techniques from our guide to mindfulness for beginners on calmer days can make them easier to use when you need them.

Reducing the chance of future attacks

Everyday habits can lower your overall level of anxiety and may make attacks less frequent. The NHS recommends:

• Learning breathing exercises and practising them regularly, not only during an attack.
• Regular physical activity to reduce stress and tension. Our article on exercise and mood has ideas for getting started.
• Relaxing activities such as yoga or pilates.
• Cutting back on caffeine, alcohol and sugary food and drinks, and stopping smoking, since they can all make attacks worse. See our guide to alcohol and mental health for more.
• Self-help based on cognitive behavioural therapy (CBT), such as a self-help book your doctor recommends.

Good sleep and ways of managing everyday stress also support a calmer nervous system. And if you have had an attack, try to treat yourself gently afterwards. Feeling drained or shaken is normal, and a little self-compassion goes a long way.

Treatment works

If panic attacks keep coming back, or worry about them is starting to shape your life, it is worth talking to a doctor or mental health professional. According to NIMH, treatment for panic disorder typically involves psychotherapy, medication or both, and with the right treatment and support people can manage their symptoms and improve their quality of life.

Cognitive behavioral therapy is commonly used and well studied. It teaches different ways of thinking about and responding to the feelings that come before and during an attack. One CBT technique, called interoceptive exposure, gently and safely brings on the bodily sensations of panic, such as a fast heartbeat, so you can learn they are not dangerous. Exposure therapy can also help you return to places and activities you have been avoiding. Medications, such as certain antidepressants, may be recommended too. Finding the right approach can take some time, so be patient with the process. Our overview of types of therapy and tips for your first psychiatrist appointment can help you prepare.

Getting help

Panic attacks can make you feel powerless, but they are one of the most treatable mental health problems. Reaching out to your primary care doctor is a good first step. If you are supporting someone who has panic attacks, our article on how to support a loved one may help.

If you ever have thoughts of harming yourself or ending your life, please reach out right away. In the US, call or text 988 to reach the Suicide & Crisis Lifeline, any time, day or night. In an emergency, call 911.

Medical disclaimer: This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always consult a qualified health professional about your situation. See our full disclaimer.