What are the symptoms of a panic attack and what do you do during one? Learn why palpitations, breathlessness and fear of dying occur, and how therapy helps.
All at once your heart starts pounding as if it will burst out of your chest, your breathing tightens, your hands go numb, and a single thought crosses your mind: "I am dying right now." A few minutes later everything slowly settles, but what remains is a huge fear and the question, "What if it happens again?" Many people who go through this end up in the emergency department after the first attack, only to be told after the tests that there is no physical problem. Although the symptoms of a panic attack are very real and frightening, they are not dangerous, and once they are understood they can be managed. In this article we explain in detail what a panic attack is, its symptoms and causes, what you can do during an attack, and how it is approached in therapy.
What Is a Panic Attack?
A panic attack is a wave of intense fear or distress that starts suddenly, even though there is no real danger, and reaches its peak within a few minutes. Strong physical sensations and catastrophic thoughts accompany this wave. An attack usually peaks within ten minutes and then gradually fades; afterwards, however, the person may feel tired, uneasy and "on guard" for hours.
To understand a panic attack, it helps to think of the body's alarm system. When we sense danger, our brain triggers the "fight or flight" response: the heart beats faster, more blood is pumped to the muscles, breathing speeds up, digestion slows down and sweating increases. This response can save your life in a moment of real danger. In a panic attack, however, the alarm system effectively raises a false alarm when there is no danger. The body's reaction is real, but the danger is not.
An important distinction needs to be made here: having a panic attack does not mean you have panic disorder. Many people experience one or several panic attacks at some point in their lives, especially under intense stress. Panic disorder, on the other hand, is defined by attacks that recur unexpectedly, and by the person beginning to change their life out of fear of having another one. Only an assessment by a specialist can clarify this distinction.
What Are the Symptoms of a Panic Attack?
Panic attack symptoms can be grouped into three categories: physical, mental and emotional. Not all of these symptoms appear in a single attack; they can vary from person to person and from attack to attack.
Physical Symptoms
- Palpitations, or a fast or forceful heartbeat
- Chest pain or a feeling of tightness in the chest
- Shortness of breath, or feeling as if you are suffocating
- Sweating, trembling or shaking
- Dizziness, light-headedness, feeling as if you might faint
- Nausea or abdominal pain
- Numbness and tingling in the hands, feet or face
- Sudden chills or hot flushes
- A lump-in-the-throat sensation
Mental and Emotional Symptoms
- Fear of dying: "I'm having a heart attack", "I'm going to die right now"
- Fear of losing control or going mad
- A sense of unreality: your surroundings seem distant, blurry or dream-like
- Feeling detached from yourself: as if you are watching yourself from the outside
- An urge to escape and get to a safe place immediately
Symptoms After an Attack
The effects can continue after the attack has passed. Fatigue, weakness, tension, a wish to cry and worry about having another attack are common. Over time this worry can turn into a constant state of alertness called anticipatory anxiety. The person may begin to monitor their body constantly, counting their heartbeats or taking their pulse.
Night-Time Panic Attacks
Some people have their attacks at night, waking suddenly from sleep. Waking up with a racing heart, sweating and intense fear is especially bewildering, because the person asks, "I was asleep, I wasn't thinking about anything, how can I be panicking?" Night-time attacks are not dangerous either, and like daytime attacks they are linked to the body's alarm system becoming oversensitive. Over time, however, they can lead to problems such as fear of falling asleep, putting off bedtime and insomnia. For this reason, night-time attacks are also worth addressing separately in therapy.
Why Do Symptoms Differ From Person to Person?
During an attack, one person focuses mostly on their heart, while another fears the breathlessness or the dizziness. This difference may be related to a person's earlier experiences, the illnesses they have seen in their family and their beliefs about their body. For example, someone who has lost a close relative to a heart attack may react to palpitations with a stronger fear.
Panic attack symptoms can resemble those of heart and lung conditions, thyroid problems or certain other medical conditions. For this reason, if you are experiencing complaints such as chest pain or shortness of breath for the first time, you must have a medical assessment. Once medical causes have been ruled out, psychological support can be planned.
Why Do Panic Attack Symptoms Occur?
There is no single cause of a panic attack. It usually emerges when several factors come together.
Biological and Hereditary Predisposition
Anxiety disorders in the family can make a person's alarm system work more sensitively. Some people are born noticing bodily sensations more intensely and reacting to them more strongly.
Stressful Life Events
The first panic attack often comes after, or in the middle of, a period of intense stress. A change of job, a break-up, the loss of someone close, an exam period, childbirth, moving house or financial difficulties are examples of such periods. In Turkey in recent years, the uncertainty created by the cost of living, the fast pace of life in big cities and collective traumas such as the 6 February 2023 earthquakes have increased the stress load of many people.
Misinterpreting Bodily Sensations
According to the Cognitive Behavioural Therapy model, at the centre of a panic attack lies the interpretation of bodily sensations as catastrophic. Say you notice your heart speeding up after climbing the stairs. If you interpret it as "I climbed the stairs, that's normal", nothing happens. But if you think, "My heart feels strange, I might be having a heart attack", your anxiety rises; anxiety speeds the heart up even more, and that strengthens the catastrophic thought. In this way a vicious circle forms in a short time, and the attack begins.
Lifestyle Factors
Lack of sleep, heavy caffeine consumption, irregular eating, energy drinks and the use of certain substances can put the body in a more aroused state and make attacks easier to trigger.
How Does a Panic Attack Affect Daily Life?
The hardest part of a panic attack is often not the attack itself but the way the fear of an attack narrows life. The person begins to avoid places where they have had an attack or think they might. The metrobus, the metro, bridge traffic, shopping centres, crowded meetings, lifts and flights gradually join the list of "risky" places.
This avoidance brings relief in the short term, but in the long term it feeds the fear. The reason is that the person never experiences going to the place they fear and coming back without having an attack. Some people are afraid of staying home alone, others of going far from home. Safety behaviours can also develop, such as always carrying water, a phone or a particular item, or going out only with a relative.
Imagine someone living in Istanbul who crosses the bridge to work every day and has a panic attack in traffic one morning. The next day they choose a much longer route to avoid the bridge, and after a while they begin to struggle to go to work and to take time off often. A picture like this can deeply affect a person's working life, relationships and self-confidence. Within the family, reactions such as "There's nothing wrong with you, you're exaggerating" or, conversely, overprotectiveness can make the situation even harder.
A panic attack will not kill you, and it will not make you lose your mind or your control; but the more you run from it, the more it can narrow the boundaries of your life.
What to Do During a Panic Attack
Some things you can do during an attack may help the symptoms pass faster and the fear ease. The aim of these suggestions is not to "stop" the attack but to learn to stay with it.
- Name what is happening: Remind yourself, "This is a panic attack. It's frightening but not dangerous. It will pass in a few minutes."
- Slow your breathing: Breathe in through your nose for four seconds, hold briefly, and breathe out slowly through your mouth for six seconds. A longer out-breath supports the body's calming system. Avoid breathing very deeply and quickly.
- Ground your body: Feel your feet on the floor and focus on the texture of the chair you are sitting on.
- Use your senses: Count five things you can see around you, four things you can touch and three sounds you can hear. This method moves your attention from bodily sensations to the present moment.
- Try not to flee: If possible, stay where you are. Experiencing an attack passing by itself is one of the strongest antidotes to the next attack.
- Do not fight the sensations: Accept that your heart is beating fast. Forcing it with "it must stop right now" can increase anxiety.
What Can You Do in the Long Term?
- Cut down on caffeine and energy drinks.
- Take care to sleep and eat regularly.
- Do light exercise such as walking a few days a week; this is also a way of teaching your body that a faster heartbeat is not dangerous.
- Practise breathing and relaxation exercises regularly, not only during an attack but in calm times too.
- Make a list of the places you avoid and try approaching them again in small steps, starting with the easiest.
If you would like to know the difference between panic attacks and general anxiety, you can take a look at our article on anxiety symptoms.
When Should You Seek Professional Support?
Support from a mental health professional is recommended in the following situations:
- If attacks recur and come at unexpected times,
- If the fear of a new attack occupies your days,
- If, out of fear of attacks, you have started avoiding certain places, forms of transport or activities,
- If your work, school or social life is affected because of this,
- If, alongside the attacks, there are marked depressive symptoms, intense hopelessness or an increase in alcohol use.
These signs do not mean a diagnosis on their own; however, they may indicate that it is time for an assessment. If symptoms are very intense, an assessment by a psychiatrist can also be part of the process. If you are having thoughts of harming yourself, do not wait: call 112 (emergency services) or go to the nearest emergency department. Also remember that for symptoms such as chest pain and shortness of breath experienced for the first time, a medical assessment must come first.
How Is a Panic Attack Approached in Therapy?
One of the most researched approaches with demonstrated effectiveness for panic attacks and panic disorder is Cognitive Behavioural Therapy. The therapy process generally includes the following steps:
Psychoeducation
In the first stage, what a panic attack is, how the body's alarm system works and why the symptoms are not dangerous are discussed in detail. As panic attack symptoms are understood, the fear that accompanies them begins to ease.
Mapping the Panic Cycle
By examining recent attacks together, the therapist and client build a personal cycle that includes triggers, bodily sensations, catastrophic thoughts and safety behaviours.
Cognitive Work
Thoughts such as "If my heart has sped up, I'm having a heart attack" are examined in the light of evidence, and more realistic alternatives are developed.
Exposure to Sensations and Situations
An important part of therapy is deliberately bringing on the feared bodily sensations in a controlled way. Exercises such as speeding up the heartbeat by running on the spot, or experiencing the sense of breathlessness by breathing through a straw, allow you to learn directly that these sensations are not dangerous. Then the avoided situations are approached gradually. This process is planned with respect for the client's pace and with their consent.
Reducing Safety Behaviours and Preventing Relapse
Behaviours such as carrying a water bottle or constantly taking your pulse are gradually dropped. In the final stage, an action plan is prepared for difficult periods that may come in the future.
For more information on how anxiety and panic complaints are worked with, you can look at our anxiety and panic page.
Frequently Asked Questions
How can you tell a panic attack from a heart attack?
Because the symptoms can be similar, you should not try to tell them apart on your own. Medical assessment is essential, especially for chest pain and shortness of breath experienced for the first time. Once medical causes have been ruled out, psychological support can be planned for similar recurring attacks.
How long does a panic attack last?
An attack usually peaks within a few minutes and generally eases markedly within ten to twenty minutes. Afterwards, tiredness and tension may continue for a while.
Do panic attacks go away completely?
With appropriate support, many people experience a marked reduction in the frequency and severity of attacks, and find that fear no longer runs their life. The process varies from person to person, and it would not be right to give a definite timeframe.
What should the person next to me do while I am having a panic attack?
It helps if they stay calm, say short, reassuring sentences such as "I'm here, this will pass", and keep pace with your slowing breath. Forcing the person to go somewhere or saying "You're exaggerating" can increase the fear; knowing that support is available during this process is often reassuring too.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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