“I had this feeling like something terrible was about to happen. I didn’t know what, and I couldn’t stop it. It was so terrifying.”
“I didn’t even know how to explain how I was feeling other than it seemed like there was something wrong with my heart or my breathing or my brain.”
“I went to the emergency department because I thought there was something serious going on. When they said it was a panic attack I was mad, because no way a panic attack feels this bad.”
As these testimonials from Mayo Clinic patients can attest, experiencing a panic attack for the first time can be a bewildering and terrifying experience. A panic attack is a sudden surge of intense fear that peaks within minutes.
A panic attack is different from being diagnosed with panic disorder. Some people may have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends. But if you’ve had recurrent, unexpected panic attacks and spent long periods worrying about or trying to avoid another attack, you may have a condition called panic disorder. In the United States, it’s estimated that almost 5% of adults experience panic disorder at some time in their lives.
But rather than living in fear of your next attack, there are therapies and strategies you can use to manage panic disorder.
What does a panic attack feel like?
Panic attacks can feel incredibly scary, especially if you’re not sure what’s happening. Panic attacks can seem to appear “out of the blue,” for example, while sitting at your computer, or they can occur more expectedly in situations where you can point to a trigger, like a person who regularly experiences panic attacks before taking an exam. Signs and symptoms typically include:
- Sense of impending doom or danger.
- Fear of loss of control or death.
- Rapid, pounding heart rate.
- Sweating.
- Trembling or shaking.
- Shortness of breath or tightness in your throat.
- Chills.
- Hot flashes.
- Nausea.
- Abdominal cramping.
- Chest pain.
- Headache.
- Dizziness, lightheadedness or faintness.
- Numbness or tingling sensation.
- Feeling of unreality or detachment.
Typically, when having a panic attack, people experience a variety of emotions, physical sensations, thoughts and behaviors. All of these experiences tend to influence each other in a sort of cycle of panic. For example, physical sensations such as shortness of breath or chest pain may lead to fear and thoughts such as “I’m having a heart attack” or “I can’t breathe,” which may actually fuel the physical sensations. These experiences may lead a person to try to escape the situation or perhaps even seek emergency medical care, which may lead them to be even more fearful of physical sensations.
“It is hard to explain but things don’t seem real,” one Mayo Clinic patient says. “You don’t feel in control of your body and when you have that thought you freak out even more!”
A big part of treating panic attacks is helping to break this cycle — that is, helping patients realize that these symptoms are temporary and not dangerous. Treatment also involves helping people decrease their avoidance or escape behaviors, even in the presence of panic symptoms.
Strategies to manage a panic attack
According to Mayo Clinic psychologists Kristin Vickers, Ph.D., L.P., and Anne Roche, Ph.D. L.P., an important part of managing panic attacks is to learn what’s happening during an attack.
Panic attacks actually stem from your body’s “fight, flight or freeze” response when faced with a threat. In some instances — if, say, you’re being chased by a lion or being threatened in a dark alley — this nervous system response can be a helpful, adaptive trait.
“For example, your heart and breathing rate might increase to try to deliver oxygen throughout the body, you might start sweating as a cooling mechanism, or your muscles may become more tense to prepare for quick movement when in danger,” says Dr. Roche.
In panic disorder, you may experience this nervous system response seemingly “out of the blue” or when there’s not an identifiable threat requiring the fight-or-flight action. These body changes — which are normal and adaptive in a crisis — may feel incredibly frightening when you don’t understand where these reactions are coming from.
There are a few things you might consider doing to help yourself cope while a panic attack is occurring. To start, Dr. Vickers says you might even try reminding yourself, “This is a panic attack. It’s very uncomfortable, but it’s not dangerous.”
In fact, in cognitive behavioral therapy (CBT) for panic disorder, clinicians will work with their clients to gradually and purposefully elicit panic symptoms to practice experiencing them. This helps people “get used” to the symptoms and learn firsthand that they’re not dangerous.
“These symptoms never feel comfortable. It never feels good,” says Dr. Vickers. “But when people learn not to be afraid of these symptoms, it changes their experience with them.”
Some people are afraid that by treating these symptoms as not serious, they might someday write off an actually dangerous experience like a heart attack. But health care providers can help differentiate between panic and other serious medical conditions.
Dr. Vickers goes on to say that it’s helpful to think of the symptoms as waves: They build to a high point but eventually come back down. Panic symptoms are the same; they can’t physiologically be maintained forever, even though it might feel that way.
You first instinct may be to leave the situation that produces anxiety and panic to achieve short-term relief. This makes sense — your fight-or-flight response has kicked in! But running away actually contributes to more anxiety in the long term because it teaches your brain that panic attacks are unsafe and need to be avoided. In other words, it keeps the panic cycle spinning.
“As surprising as it might sound, one of the best things a person can do if they’re experiencing a panic attack is to stay in the situation they are in and allow the physical symptoms to peak and come down,” Dr. Vickers says.
There are strategies that can help you manage your nervous system during a panic attack. These strategies will not necessarily get rid of panic symptoms, but they can help refocus attention, ground you, and remind you that you are safe and don’t need to escape.
- Change your body temperature. Try putting your face in cold water or putting an icepack on your face. Even holding a piece of ice in your hand might be helpful. Some people may need to be careful about sudden temperature changes to the face, as this can cause the heart rate (and sometimes blood pressure) to drop.
- Move your body. You might think it’s helpful to sit or lay down during a panic attack. But if your body is ramped up by emotion, it can actually be helpful to expend some of that energy with movement.
- Use structured breathing exercises. Well-meaning people may suggest that someone experiencing a panic attack should “breathe deeply.” This may be counterproductive as the person may obsess about the act of breathing, which can make it feel even harder to catch your breath. The better approach is using a structured breathing activity, such as 4-7-8 breathing, where a person inhales through the nose for a count of 4, holds their breath for a count of 7, and exhales for a count of 8.
- Focus on your senses. You can try shifting your attention by grounding yourself in your five senses. Look around the room and notice five things you can see, four things you can touch, three things you can hear, and anything you can taste or smell around you.
Learning to manage panic attacks with cognitive behavioral therapy
The goal of CBT is to teach people about the panic cycle and how to practice strategies to help break the cycle.
Again, people often try to avoid any places, people, thoughts or activities that they think may trigger a panic attack. They might do things to distract themselves, like putting in headphones and listening to loud music in crowded stores.
“While it feels like it makes sense to try to avoid anything that might trigger a panic attack, and these strategies may even provide some sense of short-term relief, what we know is that avoidance fuels the fear fire,” says Dr. Vickers.
According to Dr. Vickers, the best supported evidence-based treatment approach for patients who are struggling with panic attacks at a clinical level is a component of cognitive behavioral therapy called exposure therapy.
In this type of therapy, a mental health professional guides patients to gradually, purposefully and systematically approach feared situations, places, activities and physical symptoms in contexts that are safe.
The exposure exercises are personalized to the individual but might include things like going to places or doing activities that tend to bring on anxiety or panic. Exposure exercises also often include purposefully bringing on panic-like physiological sensations, for example, by doing things like breathing through a straw or spinning around in a chair. This begins to “teach the brain” that panic symptoms are not, in fact, dangerous, and that you can experience these symptoms and the distress that comes with them and still be okay, even if they’re unpleasant and you don’t like them.
As you practice these exercises consistently and learn to approach feared situations, the idea of having a panic attack becomes less and less distressing — and panic attacks tend to become less frequent.
“I couldn’t believe the therapist wanted me to hyperventilate a little on purpose,” says one Mayo Clinic patient. “But we did a little at a time and I learned that I feel dizzy and floaty even after messing with my breathing a little. I learned not to be afraid of those feelings.”
You may learn to successfully manage your panic attacks only for them to show up at a later time. Some people are frustrated and ashamed to see their symptoms return, and delay going back to treatment, Dr. Vickers says. But this is common, and the sooner you return to treatment, the sooner you can get anxiety and panic back under control.
Medications can help reduce symptoms associated with panic attacks — as well as depression, if that’s an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks.
Selective serotonin reuptake inhibitors (SSRIs) are usually the first choice of medications to treat panic attacks. They’re generally safe with a low risk of serious side effects. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft).
How to help someone when they’re having a panic attack
If a loved one is experiencing a panic attack, try not to minimize or dismiss their symptoms. Remember that a panic attack can be a truly terrifying experience, and your loved one needs to know you’re taking that seriously.
“I get so frustrated with people telling me it’s no big deal and that there is nothing to worry about and just relax,” one Mayo Clinic patient said. “If they were having a panic attack, they would be doing anything but relaxing.”
Dr. Vickers suggests the following strategies to help someone calm down from a panic attack:
- Help them to shift their attention and ground themselves.
- Remind them that they are safe and help them connect with their surroundings.
- Suggest they move or do structured breathing.
- Ask the person to describe something to you in great detail, like a painting hanging in the room or another object close at hand.
- Show them a funny video online.
- Go through the alphabet and have them try to name a food, famous person or animal for each letter.
The goal is not to get the person feel happy and relaxed, Drs. Vickers and Roche say. The goal is to help the person tolerate a very uncomfortable experience until it gets better. Be sure to give the person with the panic attack choices and control over what they are willing to try based on what they think might help.
A person might feel exhausted or fatigued after experiencing a panic attack. It’s OK to take it slow and perhaps suggest doing something enjoyable together, like going outside for an easy walk.
While panic attacks can be scary, they’re not cause for serious alarm. Deliberate and conscious treatment will help and possibly prevent further progression. Talk to your health care team about any concerns or questions related to panic attacks.
Relevant reading
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