Panic Attacks: What's Happening and How to Cope

A panic attack feels like death. Your heart pounds, you can't breathe, the world goes strange. Many people end up in A&E convinced they're having a heart attack.

They're not. But that doesn't make it less terrifying.

What Is a Panic Attack?

A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes. It's your body's alarm system misfiring — seeing danger where there is none.

Research shows panic attacks activate the same physiological response as genuine life-threatening situations.

Symptoms

To be classified as a panic attack, you'll experience four or more of:

• Racing or pounding heart
• Sweating
• Trembling or shaking
• Shortness of breath
• Feeling of choking
• Chest pain or discomfort
• Nausea or stomach distress
• Dizziness or lightheadedness
• Chills or hot flushes
• Numbness or tingling
• Feelings of unreality or detachment
• Fear of losing control or "going crazy"
• Fear of dying

Why They Happen

Panic attacks are your fight-or-flight response firing inappropriately. Triggers can include:

• Stress accumulation
• Specific phobias
• Caffeine or substances
• Physical sensations misinterpreted as dangerous
• Sometimes, no clear trigger at all

What to Do During a Panic Attack

1. Remind Yourself What's Happening

"This is a panic attack. I'm not dying. It will pass."

2. Slow Your Breathing

Hyperventilation drives many symptoms. Try the physiological sigh: two short inhales through the nose, one long exhale through the mouth.

3. Ground Yourself

5-4-3-2-1: Name five things you see, four you can touch, three you hear, two you smell, one you taste.

4. Cold Water

Cold water on your face or holding ice triggers the dive reflex, slowing your heart rate.

5. Don't Fight It

Paradoxically, fighting the panic often intensifies it. Try to observe the sensations with curiosity rather than terror.

The Panic Cycle

Panic attacks often become self-perpetuating:

1. Physical sensation (heart skips a beat)
2. Catastrophic interpretation ("Something's wrong!")
3. Anxiety increases
4. More physical symptoms
5. More catastrophic interpretation
6. Full panic attack

Breaking this cycle — usually through CBT — is highly effective.

Panic Disorder

When panic attacks become recurrent and you develop fear of having more attacks, that's panic disorder. It affects about 2-3% of the population.

The good news: treatment is highly effective. CBT for panic disorder has some of the strongest evidence in all of psychology.

Preventing Panic Attacks

• Address underlying anxiety
• Regular stress management
• Limit caffeine and alcohol
• Regular exercise
• Adequate sleep
• Interoceptive exposure (deliberately inducing sensations to reduce fear of them)

When to Seek Help

If panic attacks are frequent, severely distressing, or causing you to avoid activities, professional help is warranted. You don't have to live in fear of the next attack.