Your heart pounds. You can’t breathe. You feel like you’re going crazy or dying.

These are the terrifying symptoms of a panic attack that strike suddenly without any warning. They may even occur without a trigger when you’re relaxed.

During a panic attack, you may experience an abrupt wave of intense fear and terror characterized by its unexpectedness and debilitating, immobilizing intensity. You may also feel a detachment from reality and even impending doom. The discomfort reaches a peak within minutes, and during which time a variety of physical symptoms occur. The physical symptoms that you may experience include heart palpitation, trembling, sweating, shortness of breath, chest pain, chills, lightheadedness, and hot flashes.

Although panic attacks are not life-threatening, they can be frightening and leave a lasting imprint. If you are in a fast-paced environment with a lot of stimuli, this can feed your panic attack.

Some people may experience a recurrent panic attack. Repeat episodes of panic attacks are often triggered by a particular situation, such as public speaking or crossing a bridge – especially if that situation has triggered a panic attack before. The panic-inducing situation may be one in which you feel unable to escape or endangered, triggering the innate fight-or-flight response.

Left untreated, panic attacks can lead to chronic conditions such as panic disorder. You may eventually also withdraw from daily activities.

Signs and symptoms

Panic attack causes a range of sudden distressing symptoms that can happen suddenly without warning. Some people might think they are having a heart attack and are dying. Others feel a mixture of impending doom and self-doubt. The episodes may be extremely embarrassing. These episodes can happen at any moment, even while asleep.

The symptoms of a panic attack are mostly physical. Physical symptoms include:

  • Shortness of breath or hyperventilation
  • Heart palpitations or racing heart
  • Chest pain or discomfort
  • Trembling or shaking
  • Choking feeling
  • Sweating
  • Nausea
  • Abdominal cramping
  • Headache
  • Numbness or tingling sensations (paraesthesia)
  • Hot or cold flashes

Psychological symptoms include:

  • Fear of losing control, going crazy, or dying
  • The feeling of unreality or detachment
  • Sense of impending doom or danger
  • Derealization (feeling unreal) or depersonalization (being detached from oneself)
  • Experience frequent, unexpected panic attacks without any trigger
  • Feeling anxious and tense due to fear of future panic attacks (anticipatory anxiety)
  • Avoid certain situations or places that may trigger a panic attack (phobia avoidance)

The symptoms typically peak within 10 minutes and then recede. They usually last for 20 to 30 minutes and rarely last more than an hour. You may feel tired or worn out after a panic attack subsides.

Some people experience limited-symptom panic attacks, which are similar to full-blown panic attacks but consist of no fewer than four symptoms.

When you have recurrent panic attacks, and you frequently worry about having more episodes, you may have a condition known as panic disorder.

 

Causes of panic attacks

Although the exact causes for panic attacks are unknown, these factors may play a role:

  • Genetics
  • Major life transitions (e.g., getting married, college graduation, or having a baby)
  • Severe stress (e.g., divorce, unemployment, or death of a loved one)
  • An anxious or negative personality
  • Chronic medical conditions or mental health disorder
  • Traumatic event (e.g., sexual assault)
  • Specific phobias or obsessive-compulsive disorder
  • Drug or alcohol withdrawal

 

How to stop panic attacks

There are several techniques that you can practice to reduce the severity and duration of your panic attacks.

Learn and avoid triggers

Your panic attacks may have the same triggers, such as crowds, enclosed spaces, or interpersonal conflict. By learning to mitigate or prevent triggers, you may be able to reduce the frequency and intensity of attacks. Hence, simply knowing more about the panic attack can relieve your distress.

Have a plan in place

Have a plan ready so that you can follow through with the instructions when you feel a panic attack coming on. One idea might be to remove yourself from your current environment, sit down, and call a loved one that can help distract you from your symptoms and help you to calm down.

Acceptance and recognition

Acknowledge the situation and remember that the symptoms will soon pass and you’ll be alright.

Eliminate the fear that you may be dying or that impending doom is looming so that you can focus on relieving the symptoms instead.

Breathing exercise

Hyperventilation is among the most common symptoms of a panic attack that can make you feel out of control. Acknowledge that your shortness of breath is merely temporary.

Learn to breathe deeply in a controlled manner to combat the effects of hyperventilation. Breathe slowly from the abdomen, filling the lungs slowly and steadily.

Try this breathing exercise:

  • Breathe in as slowly and deeply through your nose
  • Breathe out slowly and deeply through your mouth
  • Count steadily from 1 to 4 during inhale and exhale
  • Close your eyes and concentrate on your breathing

Focus attention on each inhale and exhale. Repeat until your breathing becomes steady.

Close your eyes

To reduce the overwhelming triggers around you, close your eyes during a panic attack. This can block out excess stimuli and make it easier for you to focus on your breathing.

Essential oils

Lavender. Inhaling the scent of lavender oil may help relieve the symptoms of a panic attack. CAUTION: Avoid lavender oil if you are taking benzodiazepine; this combination can cause intense drowsiness.

Bergamot. The smell of bergamot oil can help stabilize anxious feelings and bring deep relaxation. It is also incredibly calming and refreshing.

Vetiver. Vetiver oil calms and stabilizes your nervousness. It can also help you fall asleep after a panic attack.

Practice muscle relaxation techniques

Progressive muscle relaxation stimulates your body’s relaxation response to counteract the stress response involved in panic attacks. If the mind detects that the body is relaxed, other physical symptoms, such as rapid breathing, may also dissipate.

Consciously relax one muscle at a time, beginning with your fingers and move your way up through your body. Clench your fist and hold it to the count of 10, and then release the clinch and let your hand relax completely. Do likewise with your feet and then gradually work your way up to each muscle groups in your body.

Muscle relaxation techniques would be most effective if you’ve practiced them beforehand.

Mindfulness

Panic attacks can make you feel detached from reality. Re-ground your thoughts with mindfulness techniques to redirect your focus away from sources of stress.

Actively observe your thoughts and sensations without judging or reacting to them. Focus on objective sensations you are familiar with, like feeling the texture of your jeans on your skin or digging your feet into the ground. You can also look at five separate objects, thinking about each for some time.

Picture a happy place

Close your eyes and visualize being in a happy place. Imagine being in a calm and relaxing paradise. Focus on every minute details of this happy place.

Repeat a mantra

A mantra is a phrase or sound that helps you focus and regroup. Internally repeating a mantra can help you escape from a panic attack. Whether it’s a simple mantra such as “This too shall pass,” or a mantra that speaks to you personally, repeat it internally until you feel the panic attack start to subside.

As you focus on gently repeating a mantra, your physical response can slow, allowing you to regulate your breathing and relax muscles.

Focus on an object

Pick a nearby object and consciously note every detail – from how it looks, how it feels, to who made it. This can help reduce the symptoms and severity of a panic attack.

Connect face-to-face with friends and family

Reach out to friends and family regularly. If you are a hermit, explore ways to meet new people, and build a supportive network.

Light aerobic exercise

Light rhythmic aerobic exercise can help to stop panic attacks. It helps stimulate the release of endorphin hormones that relax the body and regulate breathing. Best types of exercises include walking, running, swimming, or dancing.

The exception to this if you’re hyperventilating. Catch your breath first.

 

Treatment

Treatment can minimize the intensity and frequency of your panic attacks. The primary treatment options are psychotherapy and medication. Your specific treatment modality will depend on your preference, medical history, and the severity of your attacks.

Cognitive-behavioral therapy

Cognitive-behavioral therapy focuses on the thoughts and behaviors that are triggering or sustaining your panic attacks. The therapy also helps you look at your fears in a more realistic light.

As your treatment continues, therapy should help you figure out the situations or feelings that cause your attacks. Once you understand what’s happening, those triggers have less power to cause trouble.

Dialectical Behavioral Therapy

DBT is a form of cognitive therapy the emphasizes individual psychotherapy as well as group skills training to help people learn new skills and strategies – including mindfulness and distress tolerance – to manage panic attacks. The therapist will help you to learn new skills to improve the way you manage your emotions, your coping skills, and interpersonal relationships without defaulting to impulsive behavior.

Exposure therapy

Exposure therapy allows you to experience the physical symptoms of panic in a safe and controlled environment, allowing you to learn how to cope. The therapist will ask you to mimic activities that would typically trigger a panic attack. By repetitive exposure, those triggers will eventually lose their power. With each exposure, you acquire a greater sense of control over your panic.

Medication for panic attacks

Medication can be used to reduce the frequency of panic attacks temporarily. However, it neither treat nor resolves the problem. It is most effective when used in combination with other therapies, such as psychotherapy and lifestyle changes, that address the underlying causes of a panic attack.

You may have to try more than one medication before finding what works best for you.

Medications used may include:

  • Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, paroxetine, and fluoxetine are usually the first-line treatment for panic attacks due to their effectiveness and low risk of severe side effects.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs), including venlafaxine, are also helpful.
  • Benzodiazepines such as alprazolam and clonazepam may also be prescribed for panic attacks. However, they are highly addictive and have severe withdrawal symptoms.

 

How to help someone stop a panic attack

Seeing a loved one going through a panic attack can be a frightening experience. No matter how irrational you think, their response is, it’s important to remember that the danger seems real to them. Simply minimizing their fear or telling them to calm down won’t help. While you may not be able to stop your loved one’s panic attack, there are things you can do to help them through the experience. By assisting them in riding out the panic attack, you can help them feel less fearful of any future attacks.

Remain calm

Being calm, patient, understanding, and non-judgemental will help their panic subside quicker.

Focus on their breathing

Find a quiet place for your loved one to sit and then guide them to take slow, deep breaths for a few minutes. Stay by their side and assure them that this attack is only temporary and they will overcome it.

Do something physical

Together, raise and lower the arms or stamp the feet. You may also ask your loved one to do light aerobic exercise, such as walking, to burn off some of their stress.

Get your friend out of their head

Get your friend out of their head by asking them to name five items around them or talking soothingly about a common interest.

Urge them to seek help

Following a panic attack, reassure them and encourage them to seek advice for their condition.

 

Commonly-associated mental health disorders

Panic attacks may be linked to a few other psychological disorders.

Panic disorder

If you’ve had unexpected recurrent panic attacks, as well as a persistent fear of having another attack, you may have a panic disorder. It can take an emotional toll. The memory of the intense apprehension or terror you felt during the attacks can negatively impact your self-esteem and cause severe disruption to your everyday life.

Recurrent panic attacks are usually triggered by a particular situation, such as public speaking or driving – mainly if that situation has caused a panic attack before.

Agoraphobia

Agoraphobia is the fear of being in a location where escape or help would be impossible if a panic attack occurs. It usually develops within a year of your first episode of recurrent panic attacks.

If you have agoraphobia, you may avoid public places such as markets, or confined spaces such as an elevator due to fear that you won’t be able to escape if you get a panic attack.

Anxiety attacks

Many people use the terms anxiety attack and panic attack interchangeably, but in reality, they are not the same.

The symptoms of anxiety attacks tend to be less intense than those experienced during a panic attack. Furthermore, panic attacks tend to be accompanied by more severe physical symptoms.

It may be challenging to know whether what you’re experiencing is anxiety attack or a panic attack.