Panic Attacks: Symptoms, Causes and How to Cope
I’ve never forgotten the paralysing fear of my panic attacks.
They began a few months after my wife died unexpectedly and my son had left home. My first happened while I was driving through a town I didn’t know, on my way to meet my son.
The fear seemed to come from nowhere. I had to pull over and sit for around twenty minutes before getting out of the car and walking for a while. Eventually, I felt able to call my son.
Then came the embarrassment of asking him to come to the car and guide me to where he was living. It was a one-way system, and, in that moment, I simply couldn’t work it out.
If you have experienced a panic attack, you may recognise that feeling: overwhelming fear accompanied by very real physical sensations, even though there may be no obvious danger around you.
What is a panic attack?
A panic attack is a sudden rush of intense fear or anxiety, usually accompanied by strong physical symptoms.
Your heart may race, your chest may feel tight, and you may feel shaky, dizzy, sick, hot, cold or strangely detached from what is happening around you. Many people feel as though something terrible is about to happen.
A panic attack happens when the body's natural fight, flight or freeze response becomes strongly activated. That response exists to protect us from danger, but sometimes it switches on when there is no immediate physical threat.
It can be helpful to think of it as a smoke alarm going off when there is no fire.
Understanding what is happening does not instantly remove the sensations, but it can reduce some of the fear surrounding them.
What are the symptoms of a panic attack?
Panic attacks vary from person to person. Common symptoms can include:
a racing or pounding heart
shortness of breath or chest tightness
dizziness or feeling faint
trembling or shakiness
sweating, hot flushes or chills
nausea or digestive discomfort
tingling or numbness
feeling detached, unreal or “not quite here”
fear of losing control
fear of collapsing or dying.
Because many of these symptoms are physical, it is understandable that people sometimes worry they are experiencing a medical emergency.
If symptoms are new, severe or different from anything you have experienced before, or you are uncertain about their cause, seek proper medical advice. If you believe you may be experiencing a medical emergency, seek urgent medical help.
Why do panic attacks happen?
There is not always one simple cause.
Panic attacks may happen during periods of stress, anxiety, grief, emotional pressure, poor sleep or difficult life events. Caffeine, alcohol and other factors can also make some people more susceptible.
Sometimes there is an obvious trigger. Driving, crowded places, shopping centres, social situations, health worries or conflict may be associated with an attack.
At other times panic seems to arrive completely out of the blue. That can be particularly unsettling because there appears to be nothing to explain the intensity of what you are feeling.
In my case, grief appears to have been an important factor. At the time I did not necessarily connect what my body was doing with everything that had happened emotionally.
Why can panic build so quickly?
Once the physical sensations begin, we can become frightened by the sensations themselves.
Your heart races and you think, “What is happening to me?”
You feel dizzy and think, “I’m going to collapse.”
You notice that thought and become even more frightened. The fear then increases the body's stress response, which can intensify the sensations. A cycle develops remarkably quickly.
Learning to recognise that cycle can make panic feel less mysterious and, over time, less frightening.
What should you do during a panic attack?
How do you cope with a panic attack? The aim is not to force the panic away. Fighting desperately against it can sometimes add another layer of fear.
Instead, try to help your mind and body recognise that you are safe in the present moment.
Remind yourself what is happening - Tell yourself: “This is panic. It feels frightening, but it will pass.” A calm inner voice can help interrupt thoughts that something catastrophic is happening.
Ground yourself in the present - Feel your feet against the floor or the support of the chair beneath you. Look around and notice ordinary things you can see. You might name objects, colours or sounds.
This gently moves your attention away from frightening internal sensations and towards the world around you.
Slow your breathing - You do not need to take enormous breaths. Instead, allow your breathing to become softer and slower. Try breathing comfortably into your abdomen rather than taking rapid breaths high in your chest.
A slightly longer, relaxed out-breath may also be helpful.
Give your thinking brain something to do - One technique I like is counting backwards from 100 in threes: 100, 97, 94, 91...
You could count leaves on a tree, paving stones or objects of a particular colour.
The point is not that arithmetic magically stops panic. It gives your attention a task outside the panic sensations and can help interrupt the spiral of frightened thoughts.
Stay where you are if it is safe and possible
Panic often creates a powerful urge to escape. Sometimes leaving is necessary — if you are driving, for example, pull over somewhere safe.
But automatically escaping every situation in which panic occurs, for example the supermarket, can strengthen the belief that the place itself was dangerous. Over time, this may contribute to avoidance and greater anxiety about returning to that place or situation..
If it is safe and manageable, staying where you are while the sensations gradually settle can help you discover that the panic will pass without having to escape.
What should you do after a panic attack?
You may feel exhausted, shaky or emotional afterwards. Your body has been through an intense stress response, so give yourself some time to recover.
Try not to criticise yourself.
Once you feel calmer, consider what may have contributed. Were you exhausted? Under unusual pressure? Skipping meals? Sleeping badly? Carrying a lot emotionally?
You do not have to analyse every detail. Simply noticing patterns can help you understand yourself better.
Can panic attacks be prevented?
There is no guarantee that you will never experience another panic attack. However, you can reduce some of the factors that make panic more likely and become less frightened of the sensations if they occur.
That’s what happened in my own case. Over the following year, my panic attacks gradually faded away, and I haven’t had one for 13 years now.
Regular sleep, eating consistently, staying hydrated, reducing excessive caffeine and alcohol, exercising, making time for rest and talking about difficult feelings can all support your general wellbeing.
Relaxation, mindfulness, breathing exercises, journaling or other calming practices may also help you manage stress. If you already use approaches such as self-hypnosis, tapping, meditation, yoga, visualisation or Reiki and find them relaxing, you may choose to include them as part of your self-care.
Perhaps most importantly, try to notice the fear of panic itself.
After one frightening attack, it is easy to start watching constantly for the next one: checking your heartbeat, noticing every dizzy sensation or avoiding places “just in case”.
Understandable though that is, fear and avoidance can keep the cycle going.
With appropriate support and practice, it is possible to become less frightened of these sensations and more confident in your ability to cope with them.
When should you seek help for panic attacks?
If panic attacks are happening regularly, affecting your confidence or causing you to avoid everyday activities, it is worth seeking additional support.
Speaking to your GP is a sensible starting point, particularly if the symptoms are new or you want to rule out a physical cause. Evidence-based treatments for panic disorder include cognitive behavioural therapy (CBT), and medication may be appropriate for some people.
You do not have to wait until things become unbearable before asking for help.
Final thoughts
Panic attacks can feel deeply frightening, but they do not have to define your life.
One of the most helpful things I learned was that the intensity of panic does not necessarily mean that I am in danger. Understanding what is happening, reducing the fear of the sensations themselves and learning ways to respond differently can make an enormous difference.
Sometimes panic can also be a sign that we have been carrying more stress, grief or emotional pressure than we realised.
If panic attacks are affecting your confidence or everyday life and you would like some additional support, you can read more about the services I offer or contact me to discuss how I may be able to help.
Health information note: This article provides general information and is not a substitute for medical advice, diagnosis or treatment. If you are concerned about symptoms, speak to a suitable healthcare professional.
For further information about panic attacks and panic disorder, see the NHS guidance on panic disorder.
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