Panic Attacks: How to Get Through Them, and Why They Happen

Oct 3

You are standing in line at the grocery store when it hits. Your heart begins to pound, your chest tightens, and you cannot seem to get a full breath. Your hands tingle. The fluorescent lights suddenly feel too bright, and the room seems to tilt. A single thought takes over: something is terribly wrong. You abandon your cart and rush outside, certain you are having a heart attack. Twenty minutes later, sitting in your car, the wave has passed, and you are left shaken, exhausted, and afraid it will happen again.

If you have had a panic attack, you know how terrifying it can be. You also are not alone, and panic is one of the most treatable experiences in mental health. This post explains what a panic attack is, why it builds the way it does, how to get through one, and what helps over the long term.

What a panic attack is

A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes (American Psychiatric Association, 2022). It can bring a pounding heart, sweating, trembling, shortness of breath, chest discomfort, nausea, dizziness, tingling, chills or hot flushes, a sense of unreality or detachment, and a powerful fear of losing control, going crazy, or dying. Some attacks have a clear trigger, while others seem to come out of nowhere.

Panic attacks are far more common than many people realize. In a large U.S. study, about 28% of adults reported having at least one panic attack in their lifetime, while about 4% met criteria for panic disorder (Kessler et al., 2006). Panic disorder involves recurring, unexpected attacks along with ongoing worry about future attacks or changes in behaviour to avoid them.

An important note: panic attacks themselves are not physically dangerous, but some medical conditions, including heart, thyroid, and lung problems, can cause similar symptoms. If you have never had your symptoms assessed, or if you have chest pain or symptoms that feel different from usual, seek medical care. Call 9-1-1 in an emergency.

Why panic builds: the panic cycle

One of the most influential explanations of panic comes from psychologist David Clark. His cognitive model proposes that panic attacks are driven by catastrophic misinterpretation of normal body sensations (Clark, 1986).

It works like this. Something, perhaps a stressful thought, a warm room, or a cup of coffee, causes a small change in the body, such as a slightly faster heartbeat. The mind reads that sensation as a sign of danger: "Something is wrong with my heart." That belief triggers anxiety, and anxiety switches on the body's fight-or-flight response, which produces more sensations: a faster heart, quicker breathing, dizziness. Those stronger sensations seem to confirm the danger, which intensifies the fear. Within seconds, the cycle can spiral into a full panic attack.

Understanding this cycle is powerful, because it shows where the cycle can be interrupted: in how we interpret sensations, in how we respond to them, and in what we do afterward.

How to get through a panic attack

The goal during an attack is not to make the feelings vanish instantly. Trying to force panic away often backfires, because the struggle itself signals danger. The goal is to ride the wave until it passes, which it will.

Name it. Tell yourself: "This is a panic attack. It feels awful, but it is not dangerous, and it will pass." Naming the experience can loosen the grip of catastrophic thoughts.

Slow your breathing. Breathe gently through your nose, with a slightly longer out-breath than in-breath, for example in for a count of four and out for a count of six. Some people find this helps the body settle. The aim is not to force calm, but to stop feeding the cycle.

Ground yourself. Bring your attention to the present by noticing five things you can see, four you can hear, three you can touch, two you can smell, and one you can taste.

Allow the sensations. Rather than fighting them, let them be there. Picture them as a wave that rises, peaks, and falls. Panic tends to lose some of its power when it is not being resisted.

Stay, if you can. Where it is safe, try staying where you are rather than escaping. This helps your brain learn that the situation is survivable.

It is much easier to use these steps if you practise them when you feel calm, so that they are familiar when panic arrives.

Why avoidance can keep panic going

After a frightening attack, it is natural to avoid the places or activities linked to it, such as driving, crowded stores, or exercise. Many people also develop safety behaviours, like always carrying water, sitting near exits, or never going out alone. These strategies bring short-term relief, but they can also teach the brain that the situation really was dangerous and that you only got through it because of the safety behaviour. Over time, life can quietly shrink.

Therapy for panic often involves gradually and safely facing these situations, step by step, at a manageable pace. It can also involve deliberately bringing on mild versions of the feared sensations, such as a faster heartbeat, in a controlled setting, so the brain learns they are uncomfortable but not dangerous.

What helps over the long term

The encouraging news is that panic is very treatable. Canadian clinical practice guidelines identify cognitive behavioural therapy as an effective first-line treatment for panic disorder. Certain antidepressant medications are also first-line options, while benzodiazepines are generally recommended only for short-term use because of concerns about dependence and side effects (Katzman et al., 2014). A therapist and physician can help you decide what fits your situation.

It may be time to reach out if attacks are happening often, if you worry constantly about the next one, if you are avoiding places or activities, if panic is affecting your work or relationships, or if you are using alcohol or other substances to cope.

Reflection questions worth exploring

These prompts are best explored with a professional rather than used to reach conclusions on your own.

What sensations do I notice first when panic begins?
What is the most frightening thought I have during an attack?
What would a calmer, more balanced version of that thought sound like?
Which places or activities have I started avoiding?
What would I do more of if panic were less of a concern?

Support at Vive Wellness Therapy

At Vive Wellness Therapy, we understand how frightening and disruptive panic attacks can be. We offer evidence-informed support to help you understand your panic, build skills for getting through attacks, and gradually reclaim the places and activities that panic has taken from you. If you would like support, we would be glad to hear from you whenever you feel ready.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470. https://doi.org/10.1016/0005-7967(86)90011-2

Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14(Suppl. 1), S1. https://doi.org/10.1186/1471-244X-14-S1-S1

Kessler, R. C., Chiu, W. T., Jin, R., Ruscio, A. M., Shear, K., & Walters, E. E. (2006). The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Archives of General Psychiatry, 63(4), 415–424. https://doi.org/10.1001/archpsyc.63.4.415

This article is provided by Vive Wellness Therapy for general informational and educational purposes only. It is intended to be used alongside professional therapy and medical care and is not a substitute for assessment, diagnosis, or treatment by a qualified health professional. If you experience chest pain or symptoms that are new, severe, or different from usual, seek medical care. Research and clinical guidance evolve over time, and information in this article may become outdated or contain inaccuracies. If you are in crisis or thinking about suicide, call or text 9-8-8 (Suicide Crisis Helpline, available 24/7 across Canada; in Quebec, calls connect to 1-866-APPELLE). If you or someone else is in immediate danger, call 9-1-1 or go to your nearest emergency department.