Panic attacks

Panic attacks can happen at any time, including during sleep. Some people have them a few times a year, others several times a week or even a day.

Many attacks come with no clear trigger. Others are linked to a phobia, like a fear of needles during a blood test. Fear of having another attack can be enough to set one off.

A single panic attack, or an occasional one, is not a mental disorder. Not everyone who has a panic attack goes on to have panic disorder.

Panic attacks are sudden, intense and short. Anxiety is usually milder, builds up more slowly, lasts longer and is often tied to a stress you can name.

When your brain senses danger, it releases adrenaline. Your heart speeds up, you breathe faster and your senses sharpen. In a real emergency, this helps. In a panic attack, it switches on when nothing is wrong.

When the alarm settles, another part of your nervous system acts like a brake and calms you back down.

In a panic, many people breathe fast and deep without noticing. This lowers carbon dioxide in the blood, which can cause light-headedness, tingling and a pounding heart. Those feelings are scary, so breathing speeds up even more.

Things linked with panic

• A very stressful or traumatic experience, such as a loss
• Difficult experiences in childhood
• Having a close relative with panic disorder
• Other mental health struggles, like anxiety or depression

Women are more likely than men to have panic disorder. It often begins in the late teens or early adulthood.

Some people only go out with a friend or partner, or ask others to do the shopping for them. These bring quick relief, but like avoidance, they can stop you finding out that the panic passes on its own.

CBT teaches new ways of thinking about and reacting to the feelings of panic. As people learn to respond differently to a racing heart or a light head, attacks can become less frequent.

Many people worry about when the next attack will come, or what the attacks might mean. That ongoing fear can lead to anxiety most of the time, not just during attacks.

Agoraphobia is an intense fear of places where escape or help might be hard if panic strikes, like buses, crowds or shops. Panic disorder that isn’t treated raises the risk of agoraphobia and other phobias.

Alcohol and substance misuse are commonly linked with panic disorder. Untreated panic raises the risk of alcohol or drug problems, and alcohol can make attacks worse.

Panic disorder often comes with depression, other kinds of anxiety, PTSD or OCD. When more than one struggle is present, a plan that covers the whole picture tends to help most.

Grounding and mindfulness can help you focus on the present instead of the fear.

Try this

1. Name 5 things you can see.
2. Name 4 things you can feel (your feet on the floor, your clothes).
3. Name 3 things you can hear.
4. Name 2 things you can smell.
5. Name 1 thing you can taste.

Purse your lips as if blowing out a candle, and breathe out slowly. Slow belly breaths that move your belly rather than your chest also help.

Phrases to try

• “I’ve got through this before.”
• “It’s a false alarm.”
• “My body is safe. This will pass.”
• “The feelings will peak, then fade.”

Reminding yourself that this is a panic attack, not a dangerous health emergency, can take some of the fear out of it.

Cognitive behavioral therapy (CBT) teaches new ways of thinking, behaving and reacting to the feelings of panic. It looks at how you react to attacks and what you think, and teaches you to stay calm during them.

You can also try a CBT-based self-help book for anxiety. A doctor can suggest one.

Exposure therapy, a common part of CBT, helps you face feared situations, beliefs and feelings so you can get back to things you have been avoiding. It is often paired with relaxation and breathing skills.

In “interoceptive exposure”, a therapist helps you bring on the body feelings linked to panic, like a fast heartbeat, in a safe and planned way. Over time, the feelings stop setting off the alarm.

Habits that can help

• Breathing exercises, yoga or pilates
• Enough sleep and a healthy diet
• Less caffeine, alcohol and sugary food and drink
• Not smoking
• Regular exercise to ease stress and tension

Support groups let you meet people who understand panic, in person or online. A doctor can suggest local groups. Talking openly with someone you trust helps too.

A provider may examine you to rule out a physical cause. Panic disorder can also come with heart, breathing, thyroid or gut conditions, so it helps to look at the whole picture.

Caffeine, alcohol and smoking can make attacks worse. Some herbal products and over-the-counter remedies can also increase anxiety, so check with your clinical provider before taking anything new.

Panic can affect driving. Talk with your clinical provider about whether driving is safe for you for now. In some countries, such as the UK, you must tell the driving agency about a condition that could affect your driving.

Try to avoid

• “Calm down” or “Just relax.” Panic can’t be switched off on command.
• “It’s all in your head.” The body feelings are real.
• “You’re overreacting.” It adds shame to fear.

It’s natural to want to protect someone from panic, by driving them everywhere or doing their errands. That brings quick relief but can keep the fear going over time. Real support mixes understanding with confidence that they can cope.

Instead

• Agree on a plan together during a calm moment.
• Join them for a hard step, then step back over time.
• Praise effort and courage, not only results.

Learn about panic, talk openly, and be patient: setbacks may happen. Keep your own routines and someone you can talk to.

Your provider may ask when the attacks began, how long they last, how often they come and how they affect your life. They can refer you to a mental health professional.

FindTreatment.gov is run by SAMHSA, a U.S. government agency. It lets you search for mental health services near you, confidentially and anonymously.

Find A Helpline (findahelpline.com) lists free, confidential helplines by country, by phone, text or chat. The International Association for Suicide Prevention partners with its creators to share it. If someone is in danger, call your local emergency number.