What's Actually Happening During a Panic Attack, and What Helps

3 days ago

4 min read

Your heart starts pounding out of nowhere. Your chest tightens, your hands tingle, and you cannot seem to get enough air. Within minutes, you are convinced something is terribly wrong, maybe a heart attack, maybe that you are losing your mind. Then, almost as suddenly, it passes.

If that sounds familiar, you are far from alone. Understanding what is actually happening in your body during a panic attack is one of the most powerful first steps toward feeling less afraid of the next one.

What a panic attack is

Clinicians define a panic attack as a sudden surge of intense fear or discomfort that peaks within minutes and comes with at least four physical or mental symptoms, according to a clinical review published by the National Library of Medicine. Most attacks peak within 10 to 20 minutes, though MedlinePlus notes that some symptoms can linger for an hour or more. Common symptoms include:

A pounding or racing heart
Sweating, chills, or hot flashes
Trembling or shaking
Shortness of breath or a smothering feeling
Chest pain or tightness
Dizziness or lightheadedness
Numbness or tingling in the hands, feet, or face
Nausea or an upset stomach
Feeling detached from yourself or your surroundings
Fear of losing control, "going crazy," or dying

Panic is also more common than many people realize. National Institute of Mental Health data estimate that 2.7% of U.S. adults had panic disorder in the past year and 4.7% will experience it at some point in their lives, with women affected more than twice as often as men.

What is happening in your body

A panic attack is your body's alarm system going off when there is no fire. The National Institute of Mental Health describes panic attacks as false alarms, moments when the body's normal survival instincts fire too often, too strongly, or both. Brain imaging research points to the amygdala, the brain's fear center, as a key area of dysfunction in people with panic disorder, according to the National Library of Medicine review.

When that alarm sounds, your body prepares to fight or flee. Your heart speeds up, your muscles tense, and your breathing quickens. Many people also begin to over-breathe without realizing it. Researchers at Southern Methodist University explain that hyperventilation pushes carbon dioxide in the bloodstream to abnormally low levels, which drives many of the sensations people fear most, such as dizziness and shortness of breath.

Then a cycle can kick in. You notice your heart pounding, assume it is a heart attack, and the fear intensifies the physical symptoms. NIMH notes that this vicious cycle is part of why attacks can seem to come out of the blue. The sensations are real and deeply uncomfortable, but the Anxiety and Depression Association of America notes that a panic attack poses no immediate danger.

Panic attack or panic disorder?

Having a panic attack does not automatically mean you have panic disorder. Panic attacks can also show up alongside other anxiety, mood, and substance use conditions. Panic disorder is diagnosed when attacks are recurrent and unexpected and are followed by at least a month of persistent worry about having another one, or by changes in behavior to avoid one, according to the NLM clinical review. Over time, people may start steering clear of places where attacks happened, like a crowded train, a grocery store, or the highway.

Because panic feels so physical, it is important to rule out other causes. Many people first seek care in the emergency room because an attack feels like a heart attack, MedlinePlus explains. If you are ever unsure about chest pain or other symptoms, the Anxiety and Depression Association of America advises seeking care without delay, since only medical tests can rule out a heart problem. Once your physical health checks out, you can focus on treating the panic itself.

What helps

In the moment

Name it. Remind yourself that this is a panic attack, that it will peak and pass, and that the sensations are your alarm system rather than an emergency. Once a doctor has cleared your heart health, the ADAA encourages responding to typical panic symptoms as panic, even when they feel frightening.
Breathe low and slow, not deep. It sounds backwards, but big gulps of air can make hyperventilation worse. In SMU research on a breathing therapy called CART, patients learned to breathe more slowly and, most importantly, more shallowly, which reduced both panic symptoms and hyperventilation.

Ride the wave. Leaving a situation brings quick relief, but it can teach your brain that the place itself was dangerous. Staying put safely can give your nervous system a chance to learn otherwise.

Over the long term

Cognitive behavioral therapy (CBT). NIMH identifies CBT as a research-supported treatment that teaches new ways of thinking, behaving, and reacting to the feelings that come before and during an attack. Attacks often become less frequent once you learn to respond differently to the physical sensations.
Exposure therapy. A core part of CBT, exposure helps you gradually face the situations and sensations you have been avoiding, often alongside relaxation skills.
Medication. SSRIs and SNRIs are commonly used and may take several weeks to work. Benzodiazepines act quickly but carry a risk of tolerance and dependence, so they are usually prescribed only for short periods.
Everyday habits. MedlinePlus recommends avoiding alcohol, cutting back on caffeine and other stimulants, eating at regular times, exercising, and getting enough sleep.

The outlook is encouraging. The NLM clinical review reports that current therapy and medication work for about 80% of patients.

When to reach out

Consider talking with a mental health professional if panic attacks keep coming back, if you find yourself worrying about the next one, or if you have started avoiding places and activities. NIMH advises seeking help once anxiety begins causing problems at work, at school, or with friends and family.

Panic can make your world feel smaller, but with the right tools, it does not have to stay that way. At Dr. Fallon's Practice, our licensed clinicians provide virtual therapy across New York State and specialize in all subtypes of anxiety, using evidence-based approaches like cognitive behavioral therapy to help you understand your panic, build practical coping skills, and reclaim the places and activities you have been avoiding.