Panic Attacks: What They Are and What to Do in the Moment

Your heart starts pounding. Your chest feels tight. You can't catch your breath. Your hands tingle, the room feels unreal, and a terrifying thought takes over: Something is very wrong. I'm going to faint, lose control, or die.

Many people who have their first panic attack rush to the emergency room, convinced it's a heart attack. Then they're told their heart is fine, and they go home confused and embarrassed.

If this has happened to you, you're not alone, and you're not imagining it. Panic attacks are real, intense and very common. They're also very treatable.

What a panic attack is

A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes. It's your body's alarm system, the fight-or-flight response, firing at full strength even though there's no real danger.

Common symptoms include:

• Pounding or racing heart
• Shortness of breath or a feeling of choking
• Chest tightness or discomfort
• Sweating, trembling or shaking
• Dizziness or light-headedness
• Nausea or stomach upset
• Tingling or numbness
• Hot flushes or chills
• Feeling detached from yourself or your surroundings
• Fear of losing control, going crazy or dying

Why panic attacks happen

The fight-or-flight response is designed to save your life. When it switches on, adrenaline floods your body, your heart speeds up to pump blood to your muscles, and your breathing quickens. In a true emergency, this is helpful.

In a panic attack, the alarm goes off without a real threat. Common contributors include:

• Long-term stress or anxiety
• Major life changes or losses
• Lack of sleep
• Caffeine, nicotine or certain substances
• Family history of anxiety
• Past trauma

Often, the first attack seems to come out of nowhere. Afterwards, many people start fearing the next one, and that fear itself can trigger more attacks. This cycle is sometimes called panic disorder.

What to do during a panic attack

1. Name it

Say to yourself: "This is a panic attack. It feels awful, but it will pass. I am not in danger." Naming it reduces the fear of the unknown.

2. Slow your breathing

Breathe in gently through your nose for four counts, then out through your mouth for six counts. The longer out-breath signals safety to your nervous system. Avoid deep gulping breaths, which can make dizziness worse.

3. Ground yourself

Use the 5-4-3-2-1 method: name five things you can see, four you can feel, three you can hear, two you can smell and one you can taste. This brings your attention back to the present.

4. Use temperature

Hold something cool, splash cool water on your face, or place a cold pack on your wrists. A change in temperature can help reset your body.

5. Let it rise and fall

Fighting a panic attack often makes it stronger. Imagine it as a wave: it rises, peaks and falls. You don't have to stop it, only ride it.

6. Stay where you are, if safe

Leaving immediately can teach your brain that the situation was dangerous. If you're safe, try to stay until the panic eases.

After the attack

You might feel exhausted, shaky or tearful. That's normal. Drink water, rest, and be gentle with yourself. Later, it can help to note what was happening before the attack: where you were, what you were thinking, how you'd slept. Patterns often emerge.

How to help someone having a panic attack

• Stay calm and stay with them
• Speak slowly and simply: "You're having a panic attack. I'm here. It will pass."
• Breathe slowly with them
• Don't say "Calm down" or "It's all in your head"
• Ask what helps them

Breaking the fear of fear

Once someone has had a few panic attacks, the biggest problem often becomes the fear of the next one. People start watching their bodies closely for any sign of panic: a slightly faster heartbeat, a moment of dizziness. Normal sensations get interpreted as danger, which triggers the alarm.

People may also begin to avoid situations where attacks have happened, such as crowded places, public transport, driving or meetings. Over time, life can shrink around the fear.

A key part of recovering from panic is learning, gently and gradually, that these sensations are uncomfortable but not dangerous. In therapy, this is sometimes done through carefully guided exercises that bring on mild physical sensations, such as spinning in a chair or breathing through a straw, in a safe setting. Each time, the brain learns that the sensations pass without harm.

Gradually returning to avoided places, one small step at a time, also helps rebuild confidence.

Lifestyle factors that matter

• Reduce caffeine, especially if you notice it makes you jittery
• Sleep regularly, as tiredness makes the nervous system more reactive
• Move every day; exercise helps your body get used to a raised heart rate in a safe way
• Avoid using alcohol to calm anxiety, as it can worsen panic the next day

When to seek help

It's important to see a doctor at least once to rule out heart or other medical causes, especially for chest pain. Then consider counselling if:

• Panic attacks are happening repeatedly
• You're avoiding places, travel or activities for fear of an attack
• You're constantly worried about the next one
• Panic is affecting your work, studies or relationships

Approaches such as CBT are very effective for panic. In counselling, we work on understanding your body's alarm system, changing the frightening thoughts that fuel panic, and gradually reducing avoidance so your world can open up again.

Panic attacks feel like they control you. With the right tools, you can learn that you're safe even when your body says otherwise.