What is a Panic Attack? | Understanding Panic Attacks & Panic Disorder
You're at work and you suddenly start to feel your chest tightening up.
You start to feel clammy and cold. Your throat is dry and feels like it's closing up.
Your heart is beating really fast and you swear everyone around you can tell something is wrong.
Or maybe you're at home and you start to feel nauseous and dizzy.
It's hard to think straight.
You feel a bit disconnected from yourself- like you're there but not really there. It feels like you can't breathe. You feel this overwhelmingly intense feeling inside.
You are in the midst of a Panic Attack.
What is a Panic Attack?
A panic attack is a very intense, sudden onset of anxiety. Panic attacks are actually quite common. About 25- 30% of adults will experience at least one panic attack at some point in their life.
It includes physical symptoms including:
increased heart rate
sweating
shaking/trembling
feeling a shortness of breath, difficulty breathing
tightness in chest or chest pain
nausea
dizziness
chills/clamminess
hot flashes
a feeling of choking/throat closing up
numbness or tingling
It also includes emotional/mental symptoms of:
a feeling of detachment from yourself or that things don't feel real
fear of losing control or going "crazy"
fear of dying
A Panic attack will come on very suddenly and will usually peak within 10 to 20 minutes. Its lingering effects, however, can be felt hours later.
In many instances, the person will actually think they are dying and/or experiencing a heart attack. A real panic attack is not physically harmful.*
A common reaction after a panic attack is to be fearful of having another panic attack. This can then lead to avoiding certain situations or people. This avoidance can decrease your anxiety short-term, however long term it doesn’t address the anxiety and it actually increases.
*it's always best to get checked out physically by a medical professional if you have health concerns.
What is happening in a Panic Attack?
Panic Attacks are basically our fight or flight response hijacked. This response is necessary for your survival and it kicks in when your brain perceives some sort of potential threat to you.
When your fight-or-flight response gets activated, your body gets a surge of stress hormones, including adrenaline and cortisol. These hormones are important to get your body moving (to fight or run aka flight) in order to get to safety.
During a panic attack, you are not actually under a real threat, but your brain received the message that you were and sets off this response. Studies have shown that a person experiencing a panic attack can have their adrenaline levels spike by 2.5 times.
The physical symptoms you experience are very real and very difficult.
Why do I have Panic Attacks?
The exact reason (also called a trigger) for a panic attack is not always known. Many times a person doesn’t recognize or understand the trigger of the attack until later (sometimes it may not be until they explore this in therapy).
To understand what may be triggering panic attacks, it can be helpful to have a better understanding of the brain mechanisms that are in play.
Your fight or flight gets initiated by the area of your brain called the Amygdala. This is part of an inner part of your brain that is often called the "Emotional Brain" or the "Reptilian Brain" as it's responsible for our survival responses in our body.
Your Amygdala holds these "emotional memories"- these are basically the emotional sensations of big feeling events. This can include emotions of fear, love, disgust, sadness, etc. Many of these emotional memories are held onto as a warning for a future threat. These emotional memories are different than our "narrative" memories. Our narrative memories tell a story of what happened and they are held in a different area of the brain. These memories are more likely to be forgotten or to get fuzzy on the details over time.
For example, let’s say you were bitten by a dog as a young child. That experience included an emotional response of fear. Your amygdala holds onto that emotional memory as a warning for future situations. Your amygdala will also then create associations around that experience. For example- it may associate all dogs (or even all furry animals of that size) as a threat to your well-being.
Let's say you were pretty young when this happened- only 2 years old. As an adult, you don't have any narrative memory of it and it's not even something you think about. Well, your Amygdala never forgets. It still holds onto that emotional memory as a warning.
It's now 20 years later and you are going for a jog when all of a sudden, out of the corner of your eye you see a flash of a furry medium-sized animal running towards you and then you hear barking. Your amygdala receives this information and then instantly sets off your fight or flight response and you then find yourself experiencing a panic attack.
Many times the triggers may not be so "obvious." Triggers can also include a faint scent, a thought, the time of day, the weather, the time of year, a person's attributes, etc.
Any past experiences of trauma, painful experiences, loss, not getting our emotional needs met, etc., can all get associated with triggers. We may then experience panic attacks from a trigger that we are unaware of that is associated with a past emotional memory that we have no narrative memory of.
How do I stop a Panic Attack?
Unfortunately, you can't really stop a panic attack. It's like the saying- you can't unscramble an egg- once a panic attack has been set in motion (the surge of stress hormones has already begun), you can't stop it. You can, however, develop some skills to help you cope through and after the panic attack.
While it may seem that your panic attack came on very suddenly and without warning, often times when we look back we can see some signs. Research has shown that many times a person will start experiencing physical changes about an hour before the panic attack. These include an increased heart rate and breathing quickly.
You may also find your own unique warning signs (for example I had a client that will start to feel nauseous prior to a panic attack). Taking note of these can be helpful in order to then help yourself cope through the attack better.
If you struggle with anxiety, you are probably hyper-aware of what their body feels like and these increases in anxiety physical symptoms can often send them into an anxiety-thinking spiral. This can then of course contribute to the onset of the Panic Attack. Identifying and implementing strategies at the onset of panic attack symptoms can be very helpful to get you through it.
Coping with a Panic Attack
One of the first steps to take when feeling more anxious or one of your warning signs of a panic attack is to work on calming your body (therapy speak- this is to regulate your nervous system).
Panic is your body's response to stress- it's that fight or flight response. It is important to remind yourself that it is not dangerous and it is biologically impossible for this state to go on forever. When we are very stressed, this may be difficult to remember, as we tend to go into more negative/catastrophic thinking. Your brain is designed this way as its role is to keep you safe. The problem comes when you are not actually in danger, but your body is reacting as if you are, and therefore the thinking part of your brain also believes you are.
Some steps to take if you are on the verge or in a Panic Attack:
Remind yourself this is temporary and will pass.
Remind yourself that you are not in danger
Breathe into a paper bag (yes, this actually works! The excess carbon dioxide can help your brain…
Pace around the room (this can help burn off excess adrenaline that is building up)
Try a Grounding Exercise where you focus on your senses
Splash cold water on your face
Go outside and be in nature (if possible, put your bare feet on grass, dirt, sand, etc.)
Try to slow your breathing down or do a breathing exercise
After a Panic Attack
After that initial surge of a panic attack, you may feel a sort of “anxiety hangover.” This is when you will still experience the lingering physical effects of the panic attack and can also feel exhausted.
During a panic attack, you get a surge of Adrenaline and Cortisol. It does take time for these levels to decrease. Even though the actual panic attack may be over, you will still feel the effects of these stress hormones. Reminding yourself of this is important, as our brain can easily tell a different “story” to us about these feelings. Many times this “story” is anxiety-provoking and critical of ourselves (such as “I can never do anything right,” “I’m going to feel this way forever,” “I can never recover from this.”). If we get stuck into a more anxious “story” then this will tell our brain that the “danger” isn’t over yet, and then can keep us in this more anxious state.
It is therefore very important after a Panic Attack to continually remind yourself that 1) you are safe and 2) even though you may still be feeling the anxious effects, it will come back down again.
It can also be helpful to engage in activities that are soothing for yourself. This can include:
taking a bath or shower
drinking warm herbal tea (stay away from caffeine as this can then mimic the same physical effects as a panic attack)
connect with a trusted friend or family member
watch a familiar and comforting TV show
listen to calming music
take a nap
cuddle with a pet
What is Panic Disorder?
Panic Disorder is when you have recurrent, unexpected panic attacks (at least 2) and must experience at one month of worrying about having panic attacks and have behavior changes (such as avoiding certain situations) in fear of having a panic attack.
The frequency and severity of Panic Attacks can vary greatly, however in Panic Disorder, their response to Panic Attacks is similar. In Panic Disorder this is a great "fear of the fear"- meaning the fear of having another panic attack becomes very high. This will also include a lot of catastrophic/worst-case scenario thinking. So this idea that if a panic attack happens again, the worst thing they can think of is going to happen. For example- "if it happens at work, everyone will notice and they will think I'm crazy and then my boss is going to fire me."
This fear and catastrophic thinking then lead to behavioral changes to try to "avoid" having this worst-case scenario happen. They also become very hyper-aware, on super "alert" for any kind of potential anxiety feeling. This is called "Anxiety Sensitivity." This can then create more anxiety as any potential physical symptom of anxiety can set off a higher anxiety response.
As you can see, this becomes a feedback loop that keeps you in a high level of anxiety and fear over having another panic attack.
More on Panic Attacks
Panic attacks can be associated with other mental health disorders including:
Anxiety Disorders including Social Anxiety & Generalized Anxiety Disorder
Major Depressive Disorder
Bipolar Disorder
Substance Abuse
Eating Disorders
Seeking Out Help for Panic Attacks
If you have had a panic attack, are struggling with panic attacks, and/or are fearful about having another panic attack, it can be extremely beneficial to seek out professional help from a therapist. Many times when we struggle, we try to just “power through” and think that it will just get better. Unfortunately, for anxiety, many of the ways we attempt to cope with it, actually end up increasing our anxiety in the long run. Also, the longer we wait, the more symptoms there tends to be and the longer it can take to start to feel better. With that said- it’s never too late to seek out help.
You don’t have to continue living life this way, there is help available.
If you are in California and are interested in my therapy services to help you with your Panic Attack or Anxiety, please reach out! You can schedule a free consultation or an appointment at this link.
Disclaimer: This is not a replacement for a therapeutic relationship or mental health services. This is for educational purposes only and should be in used only in conjunction in working with a licensed mental health professional. If you are in California and looking for a professional therapist feel free to use the contact me to request an appointment or search Psychology Today for local therapists in your area.
