I understand the challenges of living with panic attacks and have helped many people with panic attacks over the past 20 years and encourage you take the time and equip yourself with the knowledge that shall help you overcome yours.
What are Panic Attacks?
What is a Panic Attack?
Panic attacks are distinct episodes of extreme fear that start abruptly and are characterised by a wave of physiological hyperarousal, catastrophic thinking (e.g., a belief that you are dying), and a powerful urge to escape. These attacks are so powerful and the symptoms you experience can leave you fearing another attack and avoiding situations where you think another could occur.
It’s important to know at the outset there are things you can do to learn how to stop panic attacks, and this article explains in detail how to do that. Learning how to manage panic attacks early on can stop you from developing panic disorder which is different from panic attacks in terms of severity, duration and mental health classification.
People often use the terms panic attacks and anxiety attacks interchangeably, but as you will learn in this article, there are differences between anxiety attacks and panic attacks.
It’s important to understand that a panic attack is a symptom, like a fever or a cough. Just as a fever can be a symptom of many different illnesses, a panic attack can be a symptom of various anxiety disorders, including panic disorder, social anxiety disorder, or specific phobias. Panic disorder, however, is the specific condition where panic attacks are the primary and recurring feature.
Think of it like this: experiencing a panic attack is like having a headache. Many things can cause a headache – stress, lack of sleep, or even the flu. Similarly, many things can trigger a panic attack. But having a recurring headache doesn’t necessarily mean you have a chronic migraine condition. In the same way, having panic attacks doesn’t automatically mean you have panic disorder.
It’s important to remember that panic attacks, while intensely uncomfortable and frightening, are not dangerous. You are not going to die or lose control, even though it might feel that way in the moment. Many people experiencing a panic attack worry they are having a heart attack or going crazy. It’s crucial to understand that these fears are a common part of panic, but they are not based in reality. Panic attacks are your body’s exaggerated response to stress, not a sign of a medical emergency.
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Understanding Panic Attacks
Components of panic attacks.
Panic attacks are complex experiences involving a combination of physical sensations, thoughts, and behaviours. Understanding these components is crucial for breaking the cycle of panic.
Situational Triggers
Panic attacks often occur in specific situations that become associated with the fear response. Imagine this scenario: You’re on a crowded train when you suddenly experience a panic attack. The next day, as you anticipate boarding the train again, anxiety starts to build. This apprehension culminates in another panic attack on the train. Your brain has now learned to connect the train with the unpleasant experience of panic, creating a conditioned fear response. This can happen with various situations, such as social events, enclosed spaces, or specific places like shops or classrooms. As a result, you might start avoiding these situations altogether. While this avoidance is understandable, it can actually strengthen the fear over time.
The Panic Cycle
- Catastrophic Thinking: Catastrophic thinking involves interpreting physical sensations and situations in the worst possible light. For example, a twinge in your chest might be perceived as a heart attack, or feeling dizzy could lead to fears of losing control. These catastrophic thoughts intensify anxiety and contribute to the feeling of overwhelming panic.
- Fear and Avoidance: After experiencing a panic attack, it’s natural to fear another one. This fear can lead to avoidance behaviors, such as:
- Carrying medication or a safety object: This provides a sense of security but can reinforce the belief that you can’t cope without it.
- Avoiding certain places or situations: This limits your life and prevents you from learning that these situations are safe.
- Constantly checking for escape routes: This maintains a state of anxiety and reinforces the feeling of being trapped.
- Relying on a friend or family member for reassurance: While support is helpful, excessive reassurance can prevent you from developing your own coping mechanisms.
These avoidance behaviours, while intended to provide safety, actually maintain the cycle of panic. By avoiding feared situations, you never get the chance to learn that they are safe, and your fear continues to grow.
Breaking the Cycle with Therapy:
Therapy, particularly Cognitive Behavioural Therapy (CBT) and Exposure Therapy, can be incredibly effective in treating panic attacks and I shall be discussing therapy options in more details towards the end of this article. Here’s how they address the core components:
- CBT: Helps identify and modify negative thought patterns (catastrophic thinking), reduce hypervigilance, and develop coping strategies for managing anxiety.
- Exposure Therapy: Gradually exposes you to feared situations in a safe and controlled environment, helping you break the association between those situations and panic.
Learn more about the role of fear and avoidance in panic disorder.
Learn about the Symptoms
Panic Attack Symptoms
Physical Symptoms
Before I discuss the physical symptoms of panic attacks in more detail, it is important you understand that many of more more distressing physical symptoms such as fast heart beat, chest pain, shortness of breath and dizziness can all be managed by learning to produce the relaxation response. In my article I show you various ways to stop the panic as it occurs by managing breathing and using grounding techniques.
As you read about panic attack symptoms, it’s important to know that the information comes from over 20 years of professional experience treating panic and anxiety disorders.
Professional Credentials & Affiliations
- Psychologist with 20+ Years of Experience: Specialising in OCD, anxiety disorders, and panic attacks.
- Doctorate in Psychology (PsychD): Obtained from The University of Surrey.
- Professional Memberships:
- Member of the British Psychological Society (BPS), Division of Neuropsychology.
- EuroPsy Registered Psychologist.
- Background: Formerly worked within the National Health Service (NHS) in the UK, now runs a private practice in Dublin, Ireland, offering in-person and online therapy.
Rapid Heartbeat
A rapid heartbeat is one of the most common symptoms during a panic attack and I shall explain why it happens and how to manage it.
When you are having a panic attack, it is because your body mistakenly perceives a threat and it is trying to protect you by getting you ready to fight or flight and one of the things it does is to release adrenaline (epinephrine) from the adrenal glands, which increases heart rate.
If this happened when you could see a real threat, you would accept the surge of adrenaline and not question the fast heart beat, but if this occurs in the middle of a meeting a work it can be very frightening indeed. This hold true for most symptoms, they are scary because they are happening in situations that you do not expect it, and that do not warrant such an explosion of chemical rushing through your body.
Try not to
- Focus to much on Your Heartbeat: Paying too much attention to your heartbeat or worrying about it can increase anxiety and make the rapid heartbeat worse.
- Racing Thoughts: Obsessively thinking about your rapid heartbeat can heighten the fear and create a feedback loop that further increases your anxiety.
Do this instead; start a breathing exercise.
Practicing deep breathing can be highly effective in calming a rapid heartbeat and reducing anxiety.
Step-by-Step Deep Breathing Exercise:
- Find a Quiet Space: (this is not always possible, so do this exercise wherever you happen to be during the attack.)
- Sit or lie down comfortably in a calm and quiet place.
- Close Your Eyes:
- If this is not comfortable for you, or you are not in a place where you can do this, it is perfectly okay to keep them open.
- Breathe in, nice and slowly:
- Count to four as you breathe in.
- Hold Your Breath:
- And hold for a count of four.
- Exhale Slowly:
- Exhale out through your mouth for a count of four, blowing gently.
- Take a pause and do it again:
- Pause for a count of four before beginning the next breath in.
- Repeat for Several Minutes:
- Keep doing this, your body will start to relax and your heartbeat will start to steady itself..
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Palpitations
Palpitations are a very uncomfortable symptom of panic attacks, but keep in mind they are a symptom, not a sign of some sort of impending doom. In my clinical practice I always ensure that every person attending for panic attacks, has met with a doctor to rule out medical conditions, so we can be sure they are not a sign of a medical emergency, but a symptoms of panic attacks.
You feel them because of big surge of adrenaline you get when your panic starts, this makes your heart beat stronger and unfortunately if you misinterpret them as something more serious than it is, this all only serve to increase your anxiety, and also your palpitations.
You can be calmly going about your business, and all of your sudden if feels like your heart is pounding out of your chest, it feels the way it would feel if you had been running for a bus, in that instance it wouldn’t frighten you as you would not why it’s beating so fast.
Try not to avoid situations in the future where you think you might get them as this will only make things worse in the long run, as you will have to reintroduce all the things you have been avoiding as part of CBT.
Actions That Will Help: Mindfulness
Practicing mindfulness can help you manage palpitations by reducing anxiety and bringing your focus to the present moment.
Step-by-Step Mindfulness Exercise:
- Find a Comfortable Position:
- Sit or lie down in a comfortable and quiet place where you can relax. If this is not possible, just do this exercise wherever you happen to be.
- Close Your Eyes:
- Only if convenient.
- Focus on Your Breath:
- Pay attention to your breathing. Try to notice, can you feel the air as it goes in your nose, its it warm or cold, what does it feel like? If you are in the middle of a panic attack it will probably feel like you are gulping air and that is okay, it will calm down.
- Gently Redirect Your Mind:
- If your mind starts to wander especially if it wanders into thoughts that will make you more anxious, gently bring your focus back to your breath without judgment, that means, don’t criticise yourself, just bring your mind back.
- Allow Thoughts to Pass:
- Acknowledge thoughts about palpitations, but let them pass without attaching further meaning or fear. Tell yourself, there’s a thought about panic, or there’s a thought about my heart and try not to engage with it further.
By practicing mindfulness, you can reduce the intensity of palpitations and break the cycle of fear that often accompanies them.
Chest Pain
Chest pain or discomfort is a common symptom during a panic attack, and it’s usually caused by muscle tension. Your chest muscles especially are overworked during panic. Think of how your chest would be expanding if you were running. During panic it is expanding like that and it creates pain, especially up round the top of the chest going into the neck, as these accessory muscles are used more when you panic or hyperventilate as opposed the breathing low down in your belly. These muscles are lifting and expanding your rib cage and this accounts for a lot of the pain you experience, and is why people like myself, psychologist, recommend belly breathing, or relaxation.
Try not to catastrophise, i.e. thinking that something more sinister is happening. If you are doing this and are not already in therapy, you can start working with these negative automatic thoughts by using the instructions in this article.
Try Progressive Muscle Relaxation
Progressive muscle relaxation is great exercise to help relieve this tension and is very easy to do.
Step-by-Step Progressive Muscle Relaxation:
- Find a Comfortable Position if possible
- Sit or lie down comfortably in a quiet place where you can relax; again this may not be possible if for example you are having a panic attack at your desk in work, if this is the case, carry on with the following steps while sitting at your desk.
- Start with Your Feet:
- Tense the muscles in your feet for a count of five, then release.
- Move to Your Calves:
- Tense your calf muscles for a count of five, then let the muscles go, all of this you can do and no-one will know.
- Continue Upward:
- Move to your thighs, abdomen, arms, and shoulders, tensing each muscle group for a count of five before relaxing.
- Notice the difference between tight and relaxed.:
- Pay close attention to the contrast between tension and relaxation as you progress through each muscle group. This helps you become more aware of the relaxation process and reduces overall tension.
By practicing progressive muscle relaxation, you can reduce the muscle tension that’s making your chest sore.
Shortness of Breath: Understanding and Managing the Symptoms
Up until I had panic attacks, breathing was not something I thought about, or felt. Experiencing shortness of breath during a panic attack is a lived experience; you are aware of every breath that you take, it it can feel like you are not getting enough air; some people call this air hunger, and trying to change it, to manage your breathing too much can make you more aware of what should be an automatic process that is outside of your conscious awareness, but first why does it happen?
When you breathe too fast during your panic, you hyperventilate, which results in a drop in carbon dioxide levels in your blood, and this is what makes you short of breath. When this happens as you go about your normal business, you could be in work about to step into a lift, and find your short of breath, it is very frightening indeed.
Try not to take big deep breaths as in this case it can make it worse, rather try the following breathing exercise.
Step-by-Step Breathing Exercise:
- Breathe In Slowly:
- Inhale slowly through your nose for a count of four.
- Hold Your Breath:
- Hold your breath for a count of seven.
- Exhale Slowly:
- Exhale slowly through your mouth for a count of eight.
- Repeat:
- Repeat this breathing pattern until you start to feel calmer. It can be done wherever you are, even in a lift or any other confined space.
By practicing this breathing exercise, you can calm your body’s stress response, reduce hyperventilation, and alleviate shortness of breath.
Hyperventilation
Hyperventilation can be one of the scariest symptoms of panic, but it’s important to understand that it is just a change in your breathing..
What Causes Hyperventilation During Anxiety?
- Explanation: Hyperventilation involves quick, shallow breathing, which can make you feel dizzy and light-headed.
- Why It Happens: The body’s response to stress increases oxygen intake, which can lead to symptoms that mimic serious conditions, like dizziness and disorientation.
- Example: In a crowded area, you might start breathing quickly, feeling light-headed and disoriented.
Actions That Might Not Help
- Ignoring Symptoms: Ignoring the symptoms might increase worry, making the hyperventilation worse. It’s best to take action to manage the breathing.
Actions That Will Help: Breathing into a Paper Bag
Breathing into a paper bag can help regulate your carbon dioxide levels and reduce hyperventilation symptoms.
Step-by-Step Instructions for Using a Paper Bag:
- Find a Paper Bag:
- Use a small, clean paper bag that you can comfortably hold over your mouth and nose.
- Hold the Bag Over Your Mouth and Nose:
- Ensure the bag fits securely around your mouth and nose to capture the air you exhale.
- Breathe Slowly:
- Breathe in and out of the bag slowly, focusing on regulating your breath.
- Continue for a Few Minutes:
- Continue breathing into the bag until you start to feel more relaxed and the dizziness subsides.
Important Note: Breathing into a paper bag may not be suitable for everyone. If you have asthma or physical conditions like COPD, consult with your doctor before using this technique during a panic attack.
By using this approach, you can help rebalance carbon dioxide levels in your body and alleviate the symptoms of hyperventilation.
Nausea or Upset Stomach
Nausea or upset stomach is a common symptom during high anxiety or panic attacks, often caused by the body’s stress response.
What Causes Nausea During Anxiety?
- Explanation: The stress response redirects blood flow away from the digestive system, causing feelings of nausea.
- Why It Happens: During high anxiety, the body prioritises survival functions over digestion, leading to digestive discomfort. You don’t need to digest your dinner when your life is in danger!
- Example: Preparing for a presentation, you may suddenly feel a wave of nausea, making you feel unwell.
Actions That Might Not Help
- Focusing on Symptoms: Paying too much attention to the feeling of nausea can make it worse, increasing anxiety and discomfort.
Actions That Will Help: Regulate Your Breathing
Regulating your breathing can help calm your body and alleviate nausea by returning your system to a more relaxed state.
Step-by-Step Instructions:
You might have noticed throughout this section on the symptoms of panic, that I recommend breathing exercises a lot and some I say to hold for four, and the one I shall give below will be slightly different. I am doing this to give you a choice of breathing exercises that can be used, if you find one that works better for you, then keep using that.
- Focus on Your Breathing:
- Breathe slowly and deeply, inhaling through your nose for a count of four, holding for a count of seven, and exhaling through your mouth for a count of eight.
- Calm Your Body:
- As you start to calm down, your body will transition from “fight or flight” mode to “rest and digest” mode, and your stomach will begin to feel better as blood flow returns to the digestive system.
Dizziness or Light-headedness
Dizziness or light-headedness is a common symptom during anxiety or panic attacks, often caused by changes in breathing and blood flow.
What Causes Dizziness During Anxiety?
- Explanation: Changes in breathing and blood flow can make you feel dizzy or or faint..
- Why It Happens: A lack of adequate blood flow to the brain can create these feelings, especially during a stress response.
- Example: When out with friends, you may suddenly feel light-headed and worry that you are about to faint.
Actions That Might Not Help
- Worrying About the Sensation: Worrying about dizziness can make it worse. Instead, acknowledge what is happening and take steps to make yourself feel better.
Actions That Will Help: Breathing and Relaxation
Sitting or lying down can help reduce dizziness by improving blood flow to the brain. Follow the steps below to help calm your body and reduce dizziness.
Step-by-Step Instructions:
- Sit or Lie Down:
- Find a comfortable place to sit or lie down as soon as you feel dizzy.
- Focus on Your Breathing:
- Breathe slowly and steadily. Inhale through your nose for a count of four, hold for a count of seven, and exhale through your mouth for a count of eight.
- Acknowledge the Sensation:
- Remind yourself that dizziness is a natural response to anxiety and not a sign of something dangerous. Your body is reacting to a stress response that isn’t needed at the moment.
- Continue Breathing Until Calm:
- Keep focusing on your breathing until the dizziness starts to subside and you feel calmer.
By sitting or lying down and focusing on your breathing, you can calm your body’s stress response, improve blood flow, and alleviate dizziness or light-headedness.
Tingling or Numbness (Paresthesia)
Tingling or numbness during a panic attack is often caused by hyperventilation, which we have spoken about above.
What Causes Tingling During Anxiety?
- Explanation: Hyperventilation can decrease carbon dioxide levels in the blood, leading to tingling .
- Why It Happens: A drop in carbon dioxide can lead to changes in blood pH and neural activity, and give you tingling or numbness.
- Example: Feeling tingling in your fingertips may lead to concern about your health, which can further escalate anxiety.
Actions That Might Not Help
- Overreacting to Sensations: Overreacting or focusing too much on the tingling can escalate panic and make the sensations worse.
Actions That Will Help: Grounding Techniques
Practicing grounding techniques can help bring your focus back to the present moment and reduce the tingling.
Step-by-Step: The 5-4-3-2-1 Grounding Technique:
- Identify 5 Things You Can See:
- Look around and name five things that you can see. This helps shift your focus away from internal sensations.
- Identify 4 Things You Can Touch:
- Notice four things you can physically touch and describe their textures.
- Identify 3 Things You Can Hear:
- Listen carefully and identify three different sounds in your environment.
- Identify 2 Things You Can Smell:
- Focus on two distinct smells around you, or think of two scents you enjoy.
- Identify 1 Thing You Can Taste:
- Notice one thing you can taste, or think about your favorite taste.
By engaging in the 5-4-3-2-1 technique, you can redirect your focus away from the tingling sensations and reduce the escalation of anxiety, helping to manage the physical symptoms more effectively.
Trembling or Shaking
What Causes Trembling During Panic Attacks?
- Explanation: Muscle tension from adrenaline can lead to trembling or shaking.
- Why It Happens: The body’s instinctual reaction to potential danger results in muscle readiness for action, which can cause shaking.
- Example: After a panic attack, you might find your hands shaking uncontrollably.
Actions That Might Not Help
- Hiding the Tremors: Attempting to hide or suppress the tremors can increase anxiety and make the shaking worse.
Actions That Will Help: Physical Movement
Using physical movement can help release the excess energy from the fight-or-flight response, reducing the trembling or shaking.
Step-by-Step Instructions:
- Walk or Stretch:
- If the situation allows, take a walk. Walking helps release the built-up energy in your muscles, allowing your body to relax.
- Shake Your Hands:
- If walking isn’t possible, gently shake your hands or stretch your muscles. This can help with tension.
By engaging in physical movement, you can help your body release the energy associated with the fight-or-flight response, which in turn can reduce trembling or shaking.
Sweating
Sweating is a common symptom during panic attacks, caused by the activation of the fight-or-flight response.
What Causes Sweating During Panic?
- Explanation: The activation of the fight-or-flight response increases sweat gland activity.
- Why It Happens: The body anticipates physical exertion, and sweating serves to cool the body in preparation.
- Example: During a panic attack, you might feel drenched in sweat, even though there is no physical exertion.
Actions That Might Not Help
- Focusing on Appearance: Focusing too much on how you look or how much you’re sweating can heighten self-consciousness and increase anxiety.
Actions That Will Help: Stay Hydrated
Staying hydrated can help regulate body temperature and ease anxiety. If sweating is one of your symptoms, water will help but be careful this does not turn into a safety behaviour, I shall be speaking about safety behaviours in a moment.
Step-by-Step Instructions:
- Keep a Bottle of Water Nearby:
- Always have a bottle of water within reach, especially during times when you may feel anxious.
- Sip Cold Water Slowly:
- Sip cold water slowly. The sensation of cool water can help regulate your body temperature and provide a calming effect.
- Focus on the Sensation of Coolness:
- Pay attention to the cool sensation as you drink. This can help divert your focus from sweating and reduce feelings of anxiety.
By staying hydrated and focusing on the cooling effect of water, you can help manage the physical discomfort associated with sweating during anxiety or panic attacks.
Chills or Hot Flashes
These sensations are part of the body’s “fight or flight” reaction, which involves the release of adrenaline and changes in blood circulation and the things that will help is any of the exercises already discussed that calm your nervous system such as breathing exercises, mindfulness and progressive muscle relaxation.
Dry Mouth
What Causes Dry Mouth?
- Explanation: Stress can inhibit saliva production, leading to a sensation of dry mouth.
- Why It Happens: The body reduces non-essential functions like digestion and saliva production during stress.
- Example: You might notice your mouth feels dry while speaking in public, which can add to your anxiety. This happened to me many years ago when I was interviewing for a psychology position in a large university in front of a panel of psychologists. I kept going and although this did help, as it would be letting my brain know that I am not in danger, a better way to have dealt with this would have been to acknowledge out loud to the room what was happening to me; that would have taken away the fear immediately.
Throat Tightness – Globus Sensation
Throat tightness can be caused by muscle tightness and it can also feel like something is stuck in your throat – Globus sensation.
What Causes Throat Tightness?
- Explanation: Muscle tension can create sensations of constriction in the throat.
- Why It Happens: The body’s stress response leads to muscle tension throughout the body, including the throat.
- Example: You might suddenly feel a tightness in your throat during a meeting, making it difficult to focus.
Actions That Might Not Help
- Focusing on Swallowing: Paying too much attention to swallowing can heighten the sensation of tightness and make the discomfort worse.
Actions That Will Help: Stay Calm and Hydrate
Taking small sips of water can help relax the muscles in your throat and ease the sensation of tightness.
Visual Disturbances (Blurriness or Tunnel Vision)
Visual disturbances such as blurriness or tunnel vision are symptoms caused by changes in blood flow and heightened anxiety.
What Causes Visual Disturbances During Anxiety?
- Explanation: Heightened anxiety and changes in blood flow can create temporary visual distortions, such as blurriness or tunnel vision.
- Why It Happens: The brain prioritises immediate danger, resulting in a narrowed field of vision or other visual disturbances.
- Example: During a panic attack, you might feel as though the room is closing in around you, which can be distressing.
Actions That Might Not Help
- Straining to See: Trying too hard to see clearly can increase anxiety, making the visual disturbances worse.
Actions That Will Help: Close Your Eyes and Breathe
Gently closing your eyes and focusing on your breathing can help reduce visual disturbances by calming your body and mind.
Step-by-Step Instructions:
- Find a Safe Place to Sit: again if possible, or just go ahead and do this wherever you can
- If you notice visual disturbances, find a safe place where you can sit down comfortably.
- Close Your Eyes:
- Gently close your eyes to reduce visual input and help calm your mind.
- Take Deep, Slow Breaths:
- Breathe in slowly through your nose for a count of four, hold for a count of seven, and exhale through your mouth for a count of eight.
- Allow Your Mind to Rest:
- Let your mind rest for a moment before reopening your eyes and reorienting yourself to your surroundings.
By closing your eyes and practicing deep breathing, you can calm your body’s stress response and alleviate the visual disturbances caused by anxiety.
Psychological Symptoms of Panic Attacks
Fear of Losing Control or Going Crazy
What Causes the Fear of Losing Control During Anxiety?
- Explanation: The overwhelming sensations experienced during a panic attack can lead individuals to fear losing control over their thoughts or actions.
- Why It Happens: Extreme stress creates a disconnect between rational thinking and emotional reactions, making it difficult to think clearly.
- Example: You might think, “I can’t handle this; I’m going to lose control.”
Actions That Might Not Help
- Ruminating on Fear: Dwelling on these fearful thoughts can spiral into further anxiety and make the situation worse.
Actions That Will Help: Challenge Negative Thoughts
Challenging negative thoughts can help you regain control and reduce anxiety.
Step-by-Step Instructions:
- Write Down Negative Thoughts:
- As soon as negative thoughts arise, write them down. This helps you identify and address them more effectively.
- Identify Cognitive Distortions:
- Look for any cognitive distortions, such as catastrophising or overgeneralisation. These distortions can make fears seem more real than they are.
- Evaluate the Evidence:
- Ask yourself what evidence supports or contradicts these negative thoughts. Are they based on facts, or are they exaggerated fears?
- Replace Negative Thoughts:
- Replace negative thoughts with more balanced, rational ones. For example, instead of thinking, “I’m going to lose control,” tell yourself, “I am experiencing anxiety, but I have managed it before, and I can do it again.”
By challenging negative thoughts and replacing them with rational ones, you can regain a sense of control and reduce the fear of losing control or going crazy during a panic attack.
Fear of Dying or Having a Heart Attack
Fear of dying or having a heart attack is a very common symptom of panic attacks.
What Causes the Fear of Dying During Panic?
- Explanation: Physical symptoms like rapid heartbeat and chest pain can mimic serious medical conditions, heightening fears of death.
- Why It Happens: The mind often jumps to catastrophic conclusions when faced with alarming sensations, leading to the belief that something life-threatening is occurring.
- Example: During a panic attack, you might believe you are experiencing a heart attack, which further escalates anxiety.
Actions That Might Not Help
- Seeking Emergency Help Unnecessarily: Repeatedly seeking emergency help can reinforce the belief that something is seriously wrong, making it harder to break the cycle of panic.
Actions That Will Help: Educate Yourself
Educating yourself about panic attacks and their symptoms can help you understand that these sensations are not dangerous.
Step-by-Step Instructions:
- Research Panic Attack Symptoms:
- Learn about the common symptoms of panic attacks and understand their benign nature. Knowing that these symptoms are not harmful can reduce fear.
- Read Articles or Books by Mental Health Professionals:
- Find reputable articles or books written by mental health professionals that explain anxiety and panic attacks. Understanding the science behind your symptoms can provide reassurance.
- Talk to supportive friends or family members about what you’ve learned. Sharing your knowledge can help normalise your experience and reduce feelings of isolation.
By educating yourself about panic attacks and sharing your knowledge with others, you can reduce the fear of dying or having a heart attack during a panic episode and feel more in control of your experience.
Derealisation (Feeling Detached from Reality)
What Causes Derealisation During Anxiety?
- Explanation: Your mind may dissociate in an attempt to cope with being bombarded with overwhelming feelings, which can make your surroundings feel unreal.
- Why It Happens: Derealisation is a defence mechanism that the mind uses to protect you from being overwhelmed by anxiety.
- Example: You might feel like you’re watching yourself from outside your body, as if you are not truly present.
Actions That Might Not Help
- Avoiding Reality: Avoiding reality or ignoring your surroundings can worsen anxiety and make derealisation more intense.
Actions That Will Help: Focus on the Present
Focusing on the present through grounding exercises can help reduce feelings of derealisation and bring you back to reality.
Step-by-Step: The 5-4-3-2-1 Grounding Method:
- Name Five Things You Can See:
- Look around and name five different things that you can see in your environment.
- Touch Four Objects and Describe Their Textures:
- Find four objects to touch and describe their textures (e.g., smooth, rough, soft).
- Listen for Three Sounds:
- Identify three different sounds in your surroundings. This could be distant chatter, birds chirping, or a ticking clock.
- Smell Two Scents:
- Notice two scents in your environment. If you can’t identify any smells, think of two scents you enjoy.
- Identify One Taste:
- Focus on one thing you can taste, or imagine your favourite flavour to help ground yourself.
By engaging in the 5-4-3-2-1 grounding exercise, you can bring your focus back to the present and reduce feelings of derealisation, helping you feel more connected to reality.
Depersonalisation (Feeling Detached from Yourself)
What Causes Depersonalisation During Anxiety?
- Explanation: This sensation occurs when the brain attempts to create distance from overwhelming fear as a way to protect itself.
- Why It Happens: The body may trigger dissociation as a coping mechanism for severe anxiety, leading to feelings of detachment from oneself.
- Example: You might feel as though you’re not fully present in your body, as if you are watching yourself from a distance.
Actions That Might Not Help
- Judging Yourself: Judging yourself harshly or thinking that you are losing control can worsen the sensation and increase anxiety.
Actions That Will Help: Practice Kind Self-Talk
Practicing kind self-talk can help reassure yourself during moments of depersonalisation and reduce anxiety.
Step-by-Step Instructions:
- Acknowledge What Is Happening:
- Remind yourself that what you are experiencing is a panic attack, and it will pass. It is your body’s way of coping with overwhelming emotions.
- Be Kind to Yourself:
- Tell yourself that it’s okay to feel this way and that you are doing the best you can. Use reassuring statements like, “I am safe. This feeling will pass.”
- Focus on Safety:
- Even though the sensation might feel scary, remind yourself that you are safe and that the feeling will eventually stop.
By practicing kind and supportive self-talk, you can reduce the fear associated with depersonalisation and help ground yourself during a panic episode.
Overwhelming Anxiety or Terror
The terror during a panic attack, is caused by the body’s stress response releasing hormones like cortisol.
What Causes Overwhelming Anxiety During Panic Attacks?
- Explanation: The body’s stress response releases hormones (like cortisol) that heighten panic, creating an intense feeling of anxiety.
- Why It Happens: The fight-or-flight response prepares the body for action, but can result in extreme anxiety even in safe situations. The feelings can be disproportionate to what is actually happening.
- Example: You could be in a supermarket reaching for a tin of beans, and your body reacts as if your life is in danger, causing an overwhelming sense of terror.
Actions That Might Not Help
- Trying to Force Yourself to Relax: Forcing yourself to relax can sometimes increase tension and worsen anxiety.
Actions That Will Help: Practice Mindfulness
Practicing mindfulness can help ground you in the present moment and reduce the intensity of anxiety.
Step-by-Step Instructions:
- Focus on Your Breath:
- Wherever you are, focus on your breathing. Take slow, deep breaths to calm your body.
- Notice Thoughts Without Judgement:
- As thoughts arise, simply notice them and let them pass without judgment. Don’t engage with them or try to push them away.
- Engage with Your Surroundings:
- Continuing with the supermarket example, focus on your surroundings. Notice the tin of beans as you lift it from the shelf. Feel its weight and texture in your hand. Describe the sensations to yourself to stay grounded in the present.
By practicing mindfulness, you can help manage overwhelming anxiety and bring your focus back to the present, reducing the feeling of terror and helping you regain control.
Irritability or Agitation
- Explanation: Prolonged anxiety can lead to irritability as the body stays in a heightened state of arousal, making it difficult to relax.
- Why It Happens: Continuous stress exhausts your emotional resources, leaving you with less capacity to cope with everyday situations. Simple things that wouldn’t normally bother you may now be frustrating.
- Example: You might find yourself snapping at friends or family during a particularly anxious phase.
Actions That Might Not Help
- Withdrawing from Others: Withdrawing can worsen feelings of loneliness and increase anxiety, making the irritability worse over time.
Actions That Will Help: Communicate Your Feelings
Tell someone you trust what you are going through.
Step-by-Step Instructions:
- Choose a Trusted Friend or Family Member:
- Identify someone you feel comfortable talking to—someone you trust and who is supportive.
- Explain What You’re Feeling:
- Let them know what you are experiencing. For example, “I’ve been feeling very anxious, and it’s making me more irritable than usual.”
- Ask for Understanding and Support:
- Let them know how they can help you.
By saying what you need and letting others know that you are aware you are more irritable than normal and doing your best, you take the pressure of yourself.
Feeling Overwhelmed or Out of Control: Understanding and Managing the Symptoms
- Explanation: The rapid onset of panic symptoms can create a sense of losing control over emotions and sensations.
- Why It Happens: The body’s fight-or-flight response can flood the system with intense sensations and thoughts, making them feel uncontrollable.
- Example: In a busy environment, you might feel overwhelmed by the noise, crowds, and general activity, which can amplify feelings of panic.
Actions That Might Not Help
- Trying to Overexert Control: Trying to overly control your environment or emotions can backfire, heightening anxiety and increasing feelings of helplessness.
Actions That Will Help: Establish a Routine
Establishing a routine can help create a sense of predictability and control, reducing feelings of overwhelm.
Step-by-Step Instructions:
- Create a Daily Schedule:
- Develop a daily routine that includes regular activities like work, exercise, meals, and relaxation. Consistent activities help to establish structure.
- Set Specific Times:
- Set specific times for each activity. For example, schedule meals at consistent times each day, and set aside specific blocks of time for work and relaxation.
- Stick to Your Routine:
- Stick to your routine as closely as possible. Having a predictable structure can provide comfort and help you regain a sense of control over your day.
By establishing a daily routine and sticking to it, you can create a sense of structure that helps manage the feelings.
Behavioural Symptoms
Avoidance
Avoidance is a common response to repeated panic attacks, and it is understandable that you want to avoid situations or places where you have a had a panic attack before, but in the long run, this does more harm than good.
What Causes Avoidance?
- Explanation: After experiencing several panic attacks, you may start avoiding situations or environments where those attacks occurred to prevent them from happening again.
- Why It Happens: The brain begins to associate certain environments with panic, leading to conditioned avoidance responses that can limit daily activities.
- Example: If someone has a panic attack in a grocery store, they may avoid that store or similar crowded places in the future.
Actions That Might Not Help
- Limiting Activities Through Avoidance: Avoidance can reinforce fear, making it even harder to face those environments later on. It can contribute to increased isolation and anxiety over time.
Actions That Will Help: Gradual Exposure
Gradual exposure to feared situations can help desensitise your response and reduce anxiety over time.
Step-by-Step Instructions:
- Identify the Situations You Are Avoiding:
- Make a list of the places or situations you have been avoiding due to fear of having a panic attack.
- Create a Hierarchy of Anxiety-Provoking Situations:
- Rank these situations from least anxiety-provoking to most anxiety-provoking. This hierarchy will help you determine where to start.
- Gradually Expose Yourself:
- Begin with the least anxiety-provoking situation. Face it for a short time while using coping strategies, such as breathing exercises.
- Progress Up the Hierarchy:
- Gradually work your way up the hierarchy, exposing yourself to more challenging situations as you become more comfortable.
- Use Coping Strategies:
- Throughout the exposure process, use techniques like deep breathing and mindfulness to manage anxiety and stay present.
By gradually exposing yourself to feared environments and using effective coping strategies, you can reduce avoidance behaviours and regain control over your life, allowing you to participate in previously feared activities with more confidence.
Seeking Reassurance
Seeking reassurance is a common behaviour during panic attacks, where you need the reassurance from others that you are okay, but the key to overcoming panic attacks is to be able to provide this reassurance yourself.
- Explanation: Individuals may look for reassurance to confirm they are safe and not in danger.
- Why It Happens: Seeking external validation can temporarily alleviate fears and provide a sense of security.
- Example: You might constantly ask a partner if your symptoms are “normal” as a way to feel reassured.
Actions That Might Not Help
- Needing Reassurance as a Crutch: Depending on reassurance to manage panic can create a dependency. While it may feel comforting in the moment, it can increase anxiety if the person you seek reassurance from is not available the next time you panic.
Actions That Will Help: Learn to Manage on Your Own
Learning to manage the attack on your own can help you build resilience and reduce dependency on others.
Step-by-Step Instructions:
- Use Self-Help Tips:
- Use the various tips provided on this page, such as breathing exercises, mindfulness, and grounding techniques, as they can help explain what is happening and provide relief.
- Remind Yourself of Past Success:
- Remind yourself that you have dealt with these symptoms before and survived. Self-reassurance can help reduce panic.
- Journal Your Experiences:
- Write down your experiences and how you coped with them. This can help you identify patterns in your anxiety and track the progress you are making over time.
By learning to manage panic attacks on your own and using effective self-help strategies, you can reduce the need for external reassurance and build confidence in your ability to handle anxiety independently.
Safety Behaviours
Safety behaviours are actions or items that you rely on during anxiety or panic attacks to feel safe. These can include carrying your phone in case you need to call someone, or walking near a wall in case you faint.
What Are Safety Behaviours and Why Do They Happen?
- Explanation: Safety behaviours are all the things that you have started to do in case you panic, which make you feel safe. Examples include carrying items like water or walking near walls.
- Why It Happens: These behaviours create a false sense of control and security, giving you temporary relief from anxiety.
- Example: Always needing to sit near a door or exit in case you need to get out quickly during a panic attack, or always carrying rescue remedy with you.
Actions That Might Not Help
- Reliance on Safety Behaviours: Relying on these items or actions can increase anxiety if they are not available, which can even trigger a panic attack.
Actions That Will Help: Cognitive Restructuring
Cognitive restructuring can help you challenge the beliefs that support safety behaviours and reduce your reliance on them.
Step-by-Step Instructions:
- Write Out All Your Safety Behaviours:
- Make a list of all the safety behaviours you use, such as carrying water or avoiding certain places.
- Challenge the Beliefs Behind These Behaviours:
- Ask yourself why you feel these behaviours are necessary. What do you believe will happen if you don’t have these items or perform these actions? Are these beliefs realistic?
- Gradually Reduce Reliance on Safety Behaviours:
- Start by facing situations without using your safety behaviours. Gradually expose yourself to situations while resisting the urge to use them. This will help you build confidence and reduce anxiety over time.
By gradually reducing your reliance on safety behaviours and challenging the beliefs that support them, you can regain a sense of control and reduce anxiety without needing external crutches.
FAQ
When you feel a rapid heartbeat, it’s important to remember that it is your body’s normal response to fear. Practice deep breathing techniques: inhale slowly through your nose for a count of four, hold for four, and exhale for four. This helps regulate your heart rate.
Chest pain during a panic attack is typically caused by muscle tension and anxiety, not by a heart problem. However, if you’re unsure or experiencing new symptoms, seek medical advice. For most people with panic disorder, understanding that chest pain is a common anxiety symptom can help reduce fear.
Dizziness or light-headedness often occurs due to rapid, shallow breathing (hyperventilation), which affects oxygen and carbon dioxide levels. Try to slow your breathing and focus on long, deep breaths to alleviate this sensation.
To stop hyperventilating, try controlled breathing techniques. Breathe in slowly through your nose for four counts, hold for seven counts, and exhale through your mouth for eight counts. Repeating this can help you regain control over your breathing.
Throat tightness is caused by muscle tension, which is part of the body’s stress response. Sipping water or focusing on deep, slow breathing can help relax your throat muscles.
No, the sensations of derealisation (feeling detached from reality) and depersonalisation (feeling detached from yourself) are not dangerous. They are the body’s way of coping with overwhelming anxiety. Practicing grounding techniques can help bring you back to the present moment.
It’s very unlikely that you will faint during a panic attack. Fainting happens when blood pressure drops, but during a panic attack, blood pressure usually rises. Sit down, focus on your breathing, and remind yourself that the sensation will pass.
When you feel overwhelmed, try to focus on your breath and use grounding techniques, such as the 5-4-3-2-1 method: name five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. This can help bring you back to the present and reduce the intensity of fear.
Nausea is a common symptom of anxiety because the body redirects blood away from the digestive system during the fight-or-flight response. Practice deep breathing and try to relax—once your anxiety decreases, the nausea should subside.
Safety behaviours are actions you take to feel safer during a panic attack, like carrying water or avoiding certain places. While they might help in the short term, they can increase dependency and anxiety in the long run. Gradually reducing these behaviours can help you gain more confidence in managing panic without relying on external aids.
Understanding the symptoms and components of a panic attack is crucial for recognizing how they interact and contribute to the overall experience. But panic attacks don’t exist in isolation. They often occur as part of a larger pattern, leading to a diagnosis of panic disorder. I want to talk now about what distinguishes panic disorder from simply experiencing occasional panic attacks; this information will be useful if you have just started having panic attacks.
Panic Disorder & Getting a Diagnosis
What is Panic Disorder?
Panic disorder is an anxiety disorder. Research suggests that around 2-3% of adults in the UK and Ireland experience panic disorder in any given year. Globally, it’s estimated that up to 3.8% of the population will experience panic disorder at some point in their lives.
Panic disorder typically begins in young adulthood, between the ages of 20 and 30. It’s also more common in women than men. While the exact reasons for this gender difference are not fully understood, it may be related to hormonal factors, differences in how men and women cope with stress, or societal expectation
Do I need to see a doctor?
If you have panic attacks, you have probably already met with your doctor or attended A&E if your attack was severe.
If you have not met with your doctor, I recommend making an appointment to rule out medical health conditions. Once ruled out, your GP will refer you to someone like me, a psychologist, or other mental health professionals to undertake an assessment.
How is panic disorder diagnosed?
To be diagnosed with panic disorder, the DSM-5 outlines specific criteria, including: (1) Recurrent unexpected panic attacks, (2) At least one attack followed by one month or more of persistent concern about having another attack, (3) Significant changes in behavior related to the attacks (such as avoidance).
Your psychologist will use a manual called the DSM5 to help with diagnosis. DSM5 stands for Diagnostic and Statistical Manual of Mental Disorders, fifth edition.
The psychologist will take a complete history and may perform other assessments to rule out other anxiety disorders.
Once you have a diagnosis, you will have the assurance that the startling physical symptoms you experience result from panic and not a medical emergency.
I had panic disorder myself, and it can take time to accept that nothing is wrong with you.
Your psychologist will then discuss treatment options with you.
Finding a Suitable Therapist
As a Doctor of Psychology with 20 years of experience specializing in anxiety disorders, I offer therapy services in the Dublin region and online throughout Ireland and the UK. You can learn more about my approach and contact me through my website.
However, I understand that you might be looking for a therapist outside of Dublin or someone with a specific approach or specialization. Here are some tips to help you find a suitable therapist:
- Ask for referrals: Talk to your GP, friends, family members, or other healthcare professionals for recommendations.
- Use online directories: Many online directories, such as the Irish Association for Counselling and Psychotherapy or the British Association for Counselling and Psychotherapy, allow you to search for therapists by location, specialization, and approach.
- Check therapist websites: Many therapists have websites where they describe their qualifications, experience, and approach to therapy.
- Consider your needs: Think about what you’re looking for in a therapist. Do you prefer a specific gender, age, or therapeutic approach? Do you need someone who specializes in a particular type of anxiety disorder?
- Schedule a consultation: Most therapists offer a free initial consultation. This is a chance for you to ask questions, get a sense of their style, and see if you feel comfortable with them.
- Ask about their experience with panic disorder: Make sure the therapist has experience treating panic disorder and uses evidence-based approaches like CBT or exposure therapy.
Additional points to consider:
- Insurance coverage: If you have health insurance, check if it covers therapy sessions and what the requirements are for finding an in-network provider.
- Cost: Therapy fees can vary. Discuss fees upfront and ask about sliding scale options if cost is a concern.
- Availability: Inquire about the therapist’s availability and whether they offer evening or weekend appointments.
- Online therapy: If you prefer online therapy, ensure the therapist is licensed and experienced in providing online sessions.
Types of Panic Attacks
The DSM-5 (1)notes two categories of panic attacks; unexpected and expected.
Unexpected panic attacks
appear to come out of nowhere in that there was no unique trigger, although a 24-hour monitoring study suggested that there were subtle cues that occur before a panic attack takes place. Towards the end of this article, I shall give tips on noticing and what to do with early warning signs of panic.
Expected panic attacks
are what we call situational panic attacks. They usually occur when you are expecting a trigger or are exposed to a trigger, such as shopping, driving or in other situation where you have experienced a panic attack before.
Specific places.
People can have panic attacks that occur in specific places, such as
- shops
- public transport
- work
- driving
- bed
The cycle of Panic
Panic disorder often involves a vicious cycle: a panic attack occurs, leading to intense fear of another attack. I’m my clinical experience and also personally when I had panic attacks, this fear, known as anticipatory anxiety, not only makes your life smaller as you actively try to avoid anything that you fear might lead to a panic attack, but it also makes you more likely to have a panic attacks as your thoughts creat more anxiety, I’ll shall explain this better later in the article when I discuss treatment options with you.
Impact on Daily Life
Living with panic disorder can be incredibly challenging. It can impact your work, relationships, and social life. You might find it difficult to concentrate, travel, or even leave the house. The constant fear and worry can take a toll on your emotional and physical well-being but it is incredibly important to seek treatment to avoid the long term effect of untreated panic attacks.
What does a Panic Attack Feel Like?
One minute you are going about your business, and the next, you might break into a sweat, your heart is pounding out of your chest, and it’s getting hard to breathe. It might feel like someone has placed a cushion over your mouth and nose, where it feels like you are getting smothered or suffocated, even though there is nothing on your face. Terrified and convinced that you are not breathing, there’s not enough air getting into your lungs. You check your pulse, which may be rapid, or you might not feel it.
Shaking, sweating and feeling complete and utter terror, you may think (maybe for the first time in your life) that you are dying. You may have had different symptoms, but if you have had a panic attack, you will relate to what I said.
Ending up in the hospital and getting a series of tests, to be told, “It’s okay; there’s nothing wrong with you. You just had a panic attack.” If you accept this information, or if it gives you some relief or explanation regarding what has just happened to you, you may never experience an attack again or as severe. More than likely, though, it is tough for your brain to understand that what you have just experienced is “just a panic attack.”
Panic Attacks and Fear
Fear is at the heart of panic attacks. Without fear, the panic would cease. Any sensation in your body can trigger unwanted thoughts. You might feel your heart beating and instantly worry about a heart attack. This fear of bodily sensations is a truly awful thing to experience as life pre panic, your body was calm and quiet, a container that you didn’t have to think about it, whereas now, every sensation is terrifying.
Things that you previously took for granted can now hold fear for you.
- Fear of going to bed: If you experience nocturnal panic attacks (panic attacks while sleeping), bedtime can become a source of anxiety. You might lie awake, hyper-aware of your heartbeat, and dread falling asleep only to be jolted awake by panic. This is where I experienced the worst of my panic and leads to a nervous exhaustion where you really understand the phrase tired and wired.
- Fear of going out: The fear of having a panic attack in public can make leaving the house feel overwhelming. Even the thought of going out can trigger anxiety, leading to avoidance and social isolation.
- Fear of being alone: For some, being alone with their thoughts can be unbearable. Without distractions, the fear of panic can intensify, making it difficult to relax or focus on everyday tasks.
Panic attacks take a toll on your body and mind. The surge of adrenaline can leave you feeling physically and emotionally drained, even “hyper.” It’s hard to “just relax” when your mind is racing, replaying the attack and worrying about the next one.
So far we have discussed panic attacks, what they feel like, the fear they invoke and in the next section I want to discuss possible causes as most clients who come to see me for therapy want to know what is behind their panic attacks, so I shall dedicate a sections and try to explain it.
What causes panic attacks?
According to cognitive theory, misinterpretations of bodily responses cause panic attacks.
This simply means that if you feel your heart racing, you might interpret this as threatening and become a trigger for panic. This can become a feedback loop.
For example, Colin noticed an increased heart rate and sweating when travelling on a train. He focused on these symptoms and panicked as he thought he would die; the change in heart rate and travelling on a train can become triggers for Colin, and he may avoid train travel in the future.
People who experience recurrent panic attacks selectively attend to sensations in their bodies, and any change may be frightening.
This hypervigilance to bodily sensations can increase the physical symptoms, which are then catastrophically interpreted by the individual as a threat, further increasing the symptoms and leading to avoidance and other behavioural changes that are not helpful with panic disorder in the long run.
This process of misinterpreting bodily sensations is central to the cognitive model of panic. For example, if your heart starts to race after climbing a flight of stairs, you might misinterpret this as a sign of a heart attack, triggering a panic attack. This misinterpretation is often fueled by ‘anxiety sensitivity,’ which is the fear of anxiety-related sensations. People with high anxiety sensitivity are more prone to panic attacks because they are more likely to misinterpret bodily sensations as dangerous.
Biological factors
Genetic predisposition
Panic disorder can run in families, suggesting a genetic predisposition.
Neurotransmitter imbalances
Imbalances in neurotransmitters, such as serotonin and norepinephrine, can also play a role.
Brain structures
Certain areas of the brain, like the amygdala (involved in fear responses) and the hippocampus (involved in memory), may function differently in people prone to panic.
Recent research has also explored the connection between the gut microbiome and panic attacks, suggesting that imbalances in gut bacteria may play a role in anxiety.
To help explain how your brain can influence panic attacks, I’ve created a quick video to show how you can remember to be anxious.
Environmental factors
Stressful life events
Stressful life events, such as trauma, major life changes, or significant losses, can increase the risk of panic attacks.
Learned behaviours
Learned behaviours, particularly in families where anxiety is prevalent, can also contribute. If you grew up observing a parent or caregiver experiencing panic attacks, you may be more likely to develop them yourself.
In addition to these cognitive factors, there are other possible causes for panic attacks and panic disorder:
It’s important to remember that panic attacks can also be triggered by:
Substance use
Certain substances, such as caffeine, nicotine, alcohol, and other drugs, can trigger panic attacks or worsen anxiety.
Medical conditions
Some medical conditions, such as hyperthyroidism or mitral valve prolapse, can mimic the symptoms of panic attacks. It’s essential to rule out any underlying medical causes with the help of a doctor.
Sleep disorders
such as sleep apnea, can also exacerbate panic symptoms and contribute to the development of panic disorder.
If you’re experiencing panic attacks, it’s really important to meet with someone like a myself, a psychologist or other mental health professional to get a proper diagnosis and rule out other conditions, before starting treatment.
If you want to read more research on possible causes of panic I recommend The National Institute of Mental Health as they regularly publish article on panic disorder.
Effective Treatments for Panic Disorder
Start with self-help.
How to Stop Panic Attacks
Recovery from panic disorder involves many different things that cover everything we have spoken about so far. For example
- Reduction in hypervigilance: Learning to reduce your focus on bodily sensations and avoid catastrophizing them. This can be through relaxation training.
- More balanced thinking: Replacing catastrophic interpretations of symptoms with more realistic and balanced thoughts and is taught as part of Cognitive Behavioural Therapy.
- Removal of avoidance and other safety-seeking behaviours: Gradually facing feared situations and reducing reliance on safety behaviours. This is also part of CBT, where you may well undertake behavioural experiments.
I recommend a stepped care model of therapy, which means starting with the least intensive approach and moving to more intensive treatments if needed:
- Step 1 – Self-help: This could involve reading self-help books, using online resources (like this article!), or engaging in self-guided programs.
- Step 2 – Individual therapy: If self-help isn’t sufficient, meeting with a therapist for individual therapy can provide more personalized guidance and support.
If you would like to learn more about managing your panic attacks I have written a comprehensive guide detailing various techniques to help you stop panic attacks.
Therapy
Several types of therapy are effective for treating panic disorder:
Cognitive Behavioural Therapy (CBT)
CBT helps you identify and change negative thought patterns and behaviours that contribute to panic attacks. It teaches you coping skills, such as cognitive restructuring (challenging negative thoughts) and relaxation techniques. Learn more about CBT for Panic Disorder.
Exposure Therapy
Exposure therapy involves gradually confronting feared situations or sensations in a safe and controlled environment. This helps reduce anxiety and avoidance over time. Learn more about exposure therapy can help with panic disorder.
Other Therapies
Other therapies, such as mindfulness-based therapies for panic disorder and Acceptance and Commitment Therapy (ACT), can also be helpful in managing panic disorder.
Learn more about evidence based treatments for panic disorder.
Medication
In some cases, medication may be recommended to help manage panic disorder symptoms. This could include:
- Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are a type of antidepressant that can also be effective for anxiety disorders.
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs are another type of antidepressant that can help with panic disorder.
- Benzodiazepines: Benzodiazepines are a type of anti-anxiety medication that can be used for short-term relief of panic symptoms. However, they are not typically recommended for long-term use due to the risk of dependence.
It’s crucial to work closely with a doctor or psychiatrist to determine if medication is right for you and to monitor any potential side effects. For more information on medication guidelines and considerations, consult the NHS UK for accessible medical advice, or explore the NIMH’s medication section for detailed fact sheets on SSRIs and benzodiazepines.
Holistic Approaches
In addition to therapy and medication, several holistic approaches can support your recovery from panic disorder:
- Lifestyle Changes:
- Sleep: Aim for 7-9 hours of quality sleep per night.
- Diet: Eat a balanced diet and limit your intake of caffeine, alcohol, and processed foods.
- Exercise: Engage in regular physical activity, as it can help reduce anxiety and improve mood.
- Stress Management: Practice stress management techniques, such as mindfulness, meditation, or yoga.
- Improving gut health through a balanced diet and probiotics may also help reduce panic symptoms. Learn more about the gut-microbiome connection here.
- Relaxation Techniques:
- Deep breathing exercises: Practice deep, slow breathing to calm your nervous system.
- Progressive muscle relaxation: is a guided relaxation technique to help with panic attacks.
- Mindfulness meditation: Focus on the present moment to reduce worry and rumination.
- If you haven’t already done so, please see my guide on how to implement relaxation exercises to help you manage panic.
- Support Groups: Connecting with others who understand what you’re going through can be incredibly helpful. Consider joining a support group for people with panic disorder.
The HSE YourMentalHealth website provides practical tips on stress reduction and healthy living in Ireland,
Early Warning Signs of Panic
Even though it can feel like panic attacks come out of the blue, there are usually early warning signs that, with practice, you can learn to recognize and manage. These might include:
- Feeling a tightness in your chest
- Noticing a change in your breathing
- Feeling your heart beat faster
- Feeling dizzy or lightheaded
When you notice these early warning signs, it’s important to:
- Remind yourself that you are experiencing the effects of anxiety and that it will pass.
- Engage in a mindfulness exercise: Focus on your breath, count each out-breath, and allow thoughts to come and go without judgment.
- Practice controlled breathing: Breathe in through your nose and out through your mouth, making sure your exhale is longer than your inhale.
Grounding Technique
If your mind is racing during a panic attack, grounding techniques can help bring you back to the present moment. This could involve:
- Focusing on your feet: Pay attention to the sensations of your feet on the ground.
- Engaging your senses: Notice what you see, hear, smell, taste, and touch around you.
- Mental exercises: Count backwards from 100, recite a poem or lyrics, or describe your surroundings in detail.
Coping Statements
Repeating positive coping statements can help challenge negative thoughts and reduce anxiety. These could include:
- “This will pass.”
- “I have felt this before, and it goes away.”
- “The sensations are because I am over-breathing, nothing else.”
- “If my thoughts are scary, I know they are not real. My thinking is irrational when I have a panic attack.”
- “So what? If I have a panic attack, it will pass.”
Accept Your Feelings
Don’t try to fight or run away from panic. Instead, try to accept it for what it is—your nervous system is overstimulated. Describe your feelings without adding judgment or catastrophic interpretations. For example, instead of thinking “I’m going to have a heart attack,” try saying “My heart is beating fast.”
By combining these various approaches and finding what works best for you, you can effectively manage panic disorder and carry on with your life.
Sources
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013.