What should you do if you have a panic attack abroad? Read about the causes of panic and health anxiety abroad, steps during an attack and support.
At a supermarket checkout, on the morning train or in bed in the middle of the night, your heart suddenly starts to race, your breathing tightens, your hands go numb. "Am I having a heart attack? Nobody knows me here, what will I say to the ambulance, will the doctor understand what I'm saying?" These thoughts make the fear even bigger. Having a panic attack abroad is an especially frightening experience for many people living away from home, because on top of the attack itself comes the fear of being alone and helpless in a foreign country. Panic attacks are often intertwined with health anxiety: you may begin to read every change in your body as a sign of a serious illness. In this article, I will try to explain why panic attacks can occur abroad, how they can be recognised, what you can do during an attack and how you can get support in the long term.
What Is a Panic Attack Abroad?
A panic attack is a surge of intense fear or distress that begins suddenly even though there is no obvious danger, and usually peaks within a few minutes. The body switches to the "fight or flight" response as if there were a real danger. This response is harmless in itself, but it can be extremely frightening for the person experiencing it. For the general symptoms of a panic attack, you can also look at the article on panic attack symptoms.
When a panic attack happens abroad, it takes on a particular colour. The person fears not only the symptoms in their body but also the unfamiliarity of the environment: not knowing the language fully, not knowing the health system, loved ones being far away. These additional fears can lead to the attack being experienced more intensely and to a stronger "what if it happens again" anxiety afterwards.
Imagine a young father living in Germany who, one evening after putting his children to bed, was sitting on the sofa when he suddenly felt tightness in his chest. His wife was at work and there was no one around he could call. He thought about calling the emergency number but could not put together in his head what he would say. The symptoms eased within twenty minutes; the check-ups done the next day came back normal. But after that night, whenever his wife was out, he began to feel uneasy and to check his pulse constantly. This example shows how a single attack, combined with the loneliness felt abroad, can turn into a lasting cycle of anxiety.
Its relationship with health anxiety
Health anxiety is a persistent worry that you have, or will get, a serious illness. People who have panic attacks often read the physical symptoms during an attack as signs of a serious illness. For someone living abroad, health anxiety can grow even more with questions such as "What happens if I fall ill here?" and "If the doctor doesn't understand me, will they make the wrong diagnosis?" I cover this topic in detail in the article on health anxiety.
Signs of Panic Attacks and Health Anxiety
Common symptoms during a panic attack
- Fast or irregular heartbeat, tightness in the chest
- Shortness of breath, feeling as if you are suffocating
- Dizziness, light-headedness, feeling as if you will faint
- Trembling, sweating, hot flushes or chills
- Numbness and tingling in the hands and feet
- Nausea, stomach pain
- A feeling of being detached from yourself or your surroundings
- Fear of losing control, going mad or dying
Signs of health anxiety
- Constantly checking physical symptoms, taking your pulse, searching for illnesses on the internet
- Going to the doctor often or, conversely, never going out of fear
- Not being able to relax even when test results come back normal
- Intense anxiety at news about illness, hospital dramas or the illnesses of people you know
Signs specific to life abroad
- Not leaving the house for fear of having an attack when alone or on public transport
- Avoiding situations in which you would have to speak the language of the country you live in
- Constantly consulting doctor friends in Turkey or family members about symptoms by phone
- Avoiding flights or long journeys, putting off visits to Turkey
Some of these symptoms can also appear in other health problems. For this reason, it is important to have a medical assessment for symptoms such as chest pain and shortness of breath that you experience for the first time. Once a physical cause has been ruled out, working on panic and anxiety is safer and more effective.
Why Do Panic Attacks Occur Abroad?
Biological predisposition, stress level and thinking patterns all play a part in panic attacks appearing. Life abroad can strengthen some of these factors.
Accumulated stress
Migration can keep a person's stress system on high alert for a long time. Processes such as learning a new language, finding a job, dealing with residence permits and helping children settle into a new school build up into a "load". A panic attack often appears after these intense periods of stress, sometimes even when things have calmed down a little.
The absence of a safety net
In Turkey, when something happens, you may have a relative you can call straight away, a neighbour who will take you to hospital. Abroad, this network may be weak. When the mind locks onto the thought "If something happens to me, no one can get to me in time", physical symptoms are read as more threatening.
Unfamiliarity with the health system
A different health system, appointment processes you are not used to waiting for, or a doctor-patient relationship different from the one in Turkey can increase the sense of uncertainty. The thought "They don't take me seriously here" can sometimes feed health anxiety. Each country's system works in its own way; understanding this difference can help reduce anxiety.
Language and the fear of losing control
During a panic attack, thinking and speaking become harder. A person may fear that they will not be able to ask for help or make themselves understood in a second language. This fear can lead to avoiding places where an attack is likely and, in time, to a narrowing of life.
Bad news from afar
A sudden illness or death of a relative in Turkey can trigger health anxiety. Thoughts such as "My father had a heart attack at this age too" can lead you to monitor your own body constantly.
The Impact of Panic Attacks on the Family and Daily Life
Panic attacks and health anxiety are not limited to the moments of attack. The "what if it happens again" worry can begin to steer daily decisions.
Avoidance and narrowing: Avoiding public transport, crowded places, being alone or long journeys can shrink a person's world. A social life that is already limited abroad can narrow further.
Spouse and children: A person who experiences panic may ask their spouse to be with them all the time. The spouse can then become both worried and worn out. Children can notice their parents' fear; they can also learn anxiety about their own bodies. A short, calm explanation to children ("Mum's body sometimes sounds the alarm for no reason, it's not dangerous, it passes") can reassure them.
Working life: Meetings, presentations or phone calls in a foreign language can become triggers. This can increase performance anxiety and create a vicious circle.
What You Can Do During and After a Panic Attack Abroad
During the attack
Name what is happening. Say quietly to yourself: "This is a panic attack. It is frightening but not dangerous. It will pass in a few minutes." If you have had a medical assessment before, remember that too.
Slow down your breathing. Breathe in through your nose for four seconds, hold for a second or two, and let it out slowly through your mouth over six seconds. Lengthening the out-breath supports the body's calming system. Avoid fast, deep breathing.
Bring your senses to the present. Name five things you can see around you, four sounds you can hear and three things you can touch. This method can draw your attention away from catastrophic thoughts.
Don't fight the symptoms. Trying to suppress symptoms often strengthens them. An attitude of "Come on then, you're here, I know you will pass" can reduce the way fear feeds itself.
Carry a "safety card". Keep a short note in the language of the country you live in on your phone or in your wallet: "I'm having a panic attack, I need a few minutes. Could you please give me a glass of water?" This note can reduce language anxiety. Add to the same place the emergency number of the country you live in and the phone number of someone you trust.
After the attack and in the long term
Have a medical check once, properly. If the symptoms have appeared for the first time, see your family doctor or general practitioner. If necessary, write down your symptoms in advance and prepare them with a translation app, or go to the appointment with someone you trust.
Reduce checking behaviours. Taking your pulse, constantly searching for symptoms online and asking everyone "Do you think this is normal?" bring relief in the short term but feed anxiety in the long term. First count these behaviours, then aim to reduce them gradually.
Return gradually to the places you avoid. List the situations you avoid from easiest to hardest. For example, first take the bus for one stop, then two, then at a busy time. Noticing at each step that anxiety rises and then falls by itself helps your brain to relearn.
Watch your sleep, caffeine and alcohol. Lack of sleep, strong coffee and energy drinks can make panic symptoms more likely. Alcohol can relax you for a short while and then increase anxiety.
Build a safety net. Identify at least one or two people in the city where you live whom you can call in an emergency. Even knowing this can reduce anxiety.
A panic attack is an alarm in your body that sounds at the wrong time; the key to recovery is not silencing the alarm but relearning that it is not danger.
When Should You Seek Professional Support?
A panic attack is frightening even when it happens only once. We recommend getting support from a mental health professional in these situations:
- If attacks recur or the worry that "it will happen again" occupies your days
- If you have started avoiding certain places, means of transport or being alone
- If your health anxiety does not ease even though medical tests are normal
- If you are limiting your work, social life or visits to Turkey because of anxiety
- If you use alcohol or other substances to cope with anxiety
- If anxiety is accompanied by depressive symptoms
In some cases medication support may be needed; this requires an assessment by a psychiatrist.
Important: If you are experiencing symptoms such as chest pain, shortness of breath or loss of consciousness for the first time, or if your symptoms are different from usual, do not overlook the possibility of a medical emergency and call the emergency number of the country you are in (112 in EU countries, 911 in the US and Canada, 999 or 112 in the UK, 000 in Australia). If you have thoughts of harming yourself, ask for emergency help in the same way. Online therapy is not an emergency intervention service; in situations of serious risk, local emergency services and psychiatric services are necessary.
How Are Panic Attacks Approached in Online Therapy in Your Native Language?
When working with panic attacks and health anxiety, you need to describe bodily sensations, fears and worst-case scenarios in detail. Describing expressions such as "göğsüm sıkışıyor" (my chest is tightening), "içim bayılıyor" (I feel faint inside) and "kalbim ağzıma geliyor" (my heart is in my mouth) in your native language can help the experience be understood more accurately. Your family doctor and mental health services in the country where you live are also important resources; online therapy in Turkish is an option that can be used alongside them.
Cognitive Behavioural Therapy (CBT) is a commonly used approach in panic disorder and health anxiety whose effectiveness is supported by research. The work generally includes the following components:
- Psychoeducation: How the panic cycle works, the body's alarm system and why the symptoms are not dangerous are explained.
- Working with catastrophic interpretations: Interpretations such as "I'm having a heart attack" are noticed and examined along with the evidence.
- Interoceptive exposure: In a safe setting, bodily sensations similar to panic symptoms are brought on in a controlled way, with the aim of learning not to fear these sensations.
- Reducing avoidance and safety behaviours: Avoided situations are approached gradually; checking and reassurance-seeking behaviours are given up step by step.
- Managing life stress: Stressors arising from migration and the support network are addressed together.
Online sessions can be planned with the time difference in mind; a quiet room, headphones and a secure connection are enough. For details, you can look at the pages on Turks living abroad and anxiety and panic.
Frequently Asked Questions
Can a panic attack kill you?
Although a panic attack is extremely frightening, it does not in itself pose a danger to life. However, because similar symptoms can also occur in other health problems, it is important to have a medical assessment the first time you experience it.
I'm afraid of not being able to explain my problem to a doctor in a foreign language. What can I do?
You can write your symptoms in Turkish in advance and prepare them with a translation app, go to the appointment with someone you trust, or ask whether interpreter support is available. Finding out in advance what the health institution in the country where you live offers in this respect can reduce your anxiety.
I'm afraid of flying to Turkey because I've had a panic attack. What should I do?
Practising breathing exercises before the flight, preparing activities to direct your attention during the flight and applying the principles of gradual exposure can help. If the avoidance has gone on for a long time, it is useful to deal with this in a planned way with a specialist.
Do panic attacks go away completely?
Many people find that with appropriate support their panic attacks decrease markedly and they are able to widen their lives again. The process varies from person to person; what matters is reducing avoidance and learning to build a new relationship with bodily sensations.
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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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