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Panic attacks: the alarm that goes off with no fire
Your heart races, the air seems not to go in and you feel certain something terrible is about to happen. Understanding what a panic attack is changes what you do during one, and that changes what happens next.
What is happening in your body
A panic attack is your body’s alarm system going off at full volume when there is no real danger in front of you. Your heart speeds up, your chest tightens, it feels as if you cannot get a full breath, your hands tingle, and you may feel dizzy, hot or cold, sick or shaky. Many people feel detached from their own body, or that the world has gone strange and distant, like watching a film.
All of this is the fight or flight response, the same one that would save your life if a car came straight at you. Adrenaline rises fast, usually peaks within about ten minutes, and then your body starts to settle on its own. Nobody stays at the height of panic for hours, because the body cannot keep that level going. You may be left tired and a little shaky, but the wave does pass.
The loop that turns a jolt into panic
What makes an attack grow is not the sensation itself but what your mind concludes about it. Your heart skips and the thought arrives: "I am having a heart attack". Dizziness becomes "I am going to faint". Feeling unreal becomes "I am going mad". Each of those thoughts is a fresh danger signal, so your body releases more adrenaline, the symptoms get worse, and that seems to prove the fear right.
Psychologists call this the catastrophic misinterpretation of bodily sensations. It explains why panic can strike out of nowhere, on the sofa or in the middle of the night: all it takes is noticing an odd heartbeat. It also explains why understanding the mechanism already helps. Once you know it is adrenaline, the feeling is still unpleasant, but it loses some of its power to frighten you.
What to do during an attack
The urge is to escape: leave the shop, get off the bus, call someone to come and get you. Escaping brings relief in the moment, but it teaches your brain that you only survived because you got out. If you can, stay where you are. Tell yourself something simple and true: "this is a panic attack, it is adrenaline, it will peak and then it will drop". Let the symptoms come without fighting them.
Keep your eyes open and notice what is around you: five things you can see, the weight of your feet on the floor, the temperature of the air. The aim is not to make the panic vanish but to go through it awake. Try not to keep checking your pulse or searching symptoms on your phone, because that pins your attention to the danger. When it passes, go back to what you were doing, even if only for five more minutes.
When fear of the fear shrinks your life
After a few attacks, many people start to dread the next one. They avoid places where it would be hard to get out or get help: the underground, a bank queue, the cinema, bridges, motorways, a crowded shopping centre. They also avoid anything that speeds up the heart, such as coffee, the gym, sex or a tense film. When the world keeps shrinking like this, and someone only leaves home with company or stops going out at all, it is called agoraphobia.
The best-studied treatment walks that road back, step by step. One part of it is called interoceptive exposure: bringing on the feared sensations on purpose, somewhere safe. Spinning in a chair until you feel dizzy, running up a flight of stairs, breathing through a thin straw for a minute. Repeated many times, this teaches your body that a fast heart and dizziness are uncomfortable, not dangerous. Then comes going back to the places you avoided, starting with the easiest.
When to see a doctor, and when to seek therapy
The first time you have chest pain or tightness, severe breathlessness or a faint, go to an emergency department. This matters most if the pain spreads to your arm or jaw, if you are over forty, have high blood pressure or diabetes, or smoke, or if the symptoms come on during physical effort. Getting checked is not an overreaction. If the tests are normal and the episodes keep returning in the same pattern, it makes sense to treat them as panic.
When attacks keep coming back and the fear of them starts to run your routine, it may be panic disorder, and panic disorder responds very well to treatment. Cognitive behavioural therapy for panic usually takes a limited number of sessions and trains exactly what this article describes, with a professional alongside you. In some cases medication helps too, always after a medical assessment. Nobody has to spend years afraid to leave the house.
Educational content. Not a substitute for professional care.