Panic attack

What is a panic attack?

A panic attack, so called, is an episode of acute anxiety. In it the nervous system goes into fight-flight mode, in which the nervous system displays extreme arousal. It is similar to an anxiety attack, with the difference that a panic attack comes on suddenly, rather than in gradual stages.

Signs and symptoms of panic attacks

Signs may include any of the following in combination:

  • Struggling to breathe
  • Feeling faint or light-headed
  • Racing/pounding heart
  • Shaking/trembling
  • Nausea
  • Dizziness
  • Sweating
  • Chest pains
  • ‘Jelly legs’

After the panic attack the person may experience dissociation from the body. Leading to experiences of derealisation.

How long do panic attacks last?

In most cases panic attacks last between 5 and 20 minutes, with symptoms of panic peaking after 5 minutes. Panic attacks lasting more than 10 minutes are usually the result of the individual having panicky thoughts about the panic attack itself, thus prolonging the issue.

What causes panic attacks?

Anxiety problems are partly genetic in origin, and the individual is 40% more likely to have anxiety if other close family members have the problem. Panic attacks typically occur in people with a prior history of anxiety, thus ‘priming’ the nervous system towards panic reactions.

Although panic attacks may seem to come out nowhere, they are actually triggered by external triggers, and by the catastrophic thoughts linked to them. Triggering events are anything associated with things the person dreads. For example, getting into a car might trigger panic about crashing the vehicle; an official brown envelope from the tax office might trigger panic about financial problems; children late home from school might trigger panic about their safety.

The most significant panic attack is not the first, but the second. The first one is brought on by anxiety over life events; the second one is brought on by fear of having another attack. The third follows on from the second, and so on.

Panic attacks are triggered by thoughts or reminders about previous attacks. For example:

If the previous attack was in the office, then going back to that space may trigger an attack by association.

If one panic attack occurred in the early afternoon then the person may have another at the same time (self-fulfilling prophecy).

If the person is feeling breathless, then that sensation may remind her of prior attacks, triggering a repetition of other panic symptoms.

Catastrophic thoughts include:

  • “Something terrible is going to happen.”
  • “I’d out of control.”
  • “I’m having a breakdown.”
  • “I’m suffocating.”
  • “I’m going mad.”
  • “I’m trapped.”
  • “I’m going to die.”

When the person resorts to emergency measures, such as taking a pill, leaving the building, or dialling 999 this compounds the problem. These reactions reinforce the idea that the person is under threat, sending a further signal to the brain to release more adrenalin through the blood.

Panic disorder

When individuals live in fear of panic attacks, their anxiety makes it more likely that another will happen. When panic attacks are repeated from one day to the next, the problem is called panic disorder.

Common treatments for panic attacks.

The most common medical intervention is through drugs. Benzodiazepines (tranquillisers) may be prescribed on a short-term basis to alleviate the symptoms, or SSRIs (anti-depressants) such as Sertraline for anxiety reduction.

However, these drugs do not cure the underlying problem, which lies in the patient’s thoughts and reactions. They merely reduce the symptoms.

How to manage panic attacks

The most effective way to deal with a panic attack (while you are having it) may sound counter-intuitive to many readers. Which is to accept that it is happening and do nothing. Simply resting in present moment awareness, and waiting for it to pass. Meanwhile, defusing from any troublesome thoughts you may have about the attack itself.

Reacting to the panic will only make it worse; because your resistance conveys catastrophic thoughts, such as the ones listed above.

In fact it is best not to call the problem ‘a panic attack’. This label fuels the idea that the person is under attack from some external force, when it is in fact your body in distress. In my own practice I encourage clients to re-baptise the problem with a neutral label, such as ‘adrenalin rush’, or ‘the wobbles’. Thus keeping in mind that the body is in distress due to unresolved problems and thoughts, that the reaction is not life-threatening, and will shortly pass. This process is known as normalisation.

In a mindful state of acceptance you treat panic as an unpleasant state of passing interest. Registering it as a sign that you need to pay more attention to your well-being. Recalling also that, left alone, it will be short-lived. Ground your attention in the now by counting three things you can see, three things you can hear, and three things you can sense.

You then create another focus. This could be a phone call to someone close to you, a simple task (such as making a warm drink) or, best of all, a vigorous activity such as a walk or some stretches.

You can use self-talk to work your way through this. For example:

I’m having the bojangles. It’s to do with all those problems I’m carrying. Time I did something about those. But right now this is another experience. So – I can see the laptop on the desk, the picture on the wall and the rug on the floor. I can hear the traffic outside, the phone ringing next door, the hum of the air-conditioner. I feel my feet on the floor, my back on the chair, and my hands on my lap. In this moment I can choose what to do – something that can help. Now…let’s try this.

After the panic attack

When the panic subsides it is important that you use the episode as a warning signal, and a cue for action. If you have been stressed, then look harder at stress reduction. If you are suffering from anxious thoughts, then learn to manage your worries. If you have recently felt overwhelmed at work then do something to reduce the load on you.

If you are unsure what to do then enrol the support of others. Otherwise, call a psychotherapist who can assist you towards a panic-free life.


Stress is an ignorant state. it believes that everything is an emergency. Nothing is that important.

Natalie Goldberg

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