How to Manage a Panic Attack

Up to a third of people experience a panic attack at some point in their life. They usually happen during the day but can happen at night too. Panic attacks may happen to you just once or repeatedly over time. About 2 in 100 people will develop panic disorder where panic attacks become more frequent. While they’re unlikely to cause any lasting physical harm, panic attacks can be very distressing. Before we learn how to manage a panic attack, let’s get really clear on what they are and what causes them…

What is a Panic Attack?

A panic attack is a sudden intense onset of anxiety symptoms where the person experiences an overwhelming sense of a catastrophe. At the worst point of a panic attack, the feelings and bodily sensations are so intense, it’s common to think you will die, have a heart attack or faint. The peak of a panic attack can last up to ten minutes, although people have reported this lasting longer.

Panic Attack Symptoms:

– Heart pounding/palpitations

– Sweating, trembling or shaking

– Shortness of breath

– Chest pain

– Nausea or abdominal discomfort

– Feeling dizzy and disorientated

– Feeling faint or lightheaded

– Having a dry mouth

– Fear of collapsing or fainting

– Fear of losing control or going crazy

– Thinking you could be dying or having a heart attack

– Numbness or tingling

– A choking feeling

– Chills or hot flushes

– Over-breathing

– De-realisation/depersonalization

Why Do We Have Panic Attacks?

There is no single, clear answer to this question, but based on my clinical practice these are the most common reasons people have panic attacks:

A scary situation – Getting stuck in lift, finding yourself lost or feeling trapped in a situation can lead to panic. Once your threat system has been triggered, your body releases the stress hormone cortisol and adrenaline, creating a perfect storm for a panic attack.

An overactive/sensitive threat system – The amygdala is the part of the brain that processes emotions. One of its roles is the expression of fear and the processing of fear-inducing stimuli. If you experience a sustained period of stress or anxiety, it’s like taking the amygdala to the gym on a regular basis and toning it up like a muscle. It gets better and better at spotting threats and reacting to them. Common experiences leading to a sensitive threat system are traumas, bereavement and life transitions such as redundancy or divorce, financial worries or experiencing long-term stress and anxiety.

Catastrophic thinking – Catastrophic thinking can be defined as ruminating about irrational, worst-case outcomes. Anxiety is a normal reaction to catastrophic thinking. It can get so severe panic attacks begin to occur.

Misinterpretation of panic symptoms – A common experience in anxiety is to misinterpret the symptoms you have. For example, thinking heart palpations are the start of a heart attack. We are built to give meaning to our physical symptoms, so if there is no obvious trigger, your mind will come up with something. Because you’re in an anxious state, it will be an anxious conclusion, which will naturally increase anxiety levels and can trigger panic.

Underlying health worries – Experiencing ill health can make you more in tune with your body. Feelings and sensations you may have previously ignored begin to trigger your threat system and concern you. When you become more in tune with your internal experience, you may notice more and more feelings and sensations. This can result in anxiety leading to panic attacks.

Previous panic attacks – Panic attacks are so frightening people often develop a fear of having another one. When this happens, your mind tunes into any symptoms of anxiety the body experiences and sends a warning to the brain that another attack might be on the way. This can lead to a constant feeling of anxiety and panic attacks can become more frequent. People report feeling as if they are constantly checking or monitoring themselves.

Increased vulnerability – Things like alcohol, lack of support, stress, high levels of caffeine, overworking, depression, pregnancy or general hormonal changes can all increase the likelihood of experiencing panic attacks.

How to Manage a Panic Attack

Panic attacks can be very frightening and intense, but they are not dangerous. An attack won’t cause you any physical harm. The more you resist the experience of panic, the worse the panic will become. Here are some tips to help you learn how to manage a panic attack:

Learn some facts about panic attacks. They are not harmful. You can’t die from a panic attack and you are not going mad. You can’t faint or collapse as your blood pressure is high and to faint you need low blood pressure.

Don’t alter your breathing. Our bodies naturally take care of our oxygen input and output. If we alter this for any reason and hyperventilate, we can trigger or extend a panic attack. It’s common to advise people to sit down and take some deep breaths, but it’s important to trust your body and let it breathe for you. It does a good job when you’re sleeping, so don’t overthink it.

Ground yourself in the moment. Using your senses is a great way to do this. Try listing five things you can see, hear, touch and/or smell.

Relax your body posture. This tells your brain you are safe.

Don’t avoid triggers. If you panic in the supermarket, keep returning, even if it’s just for a short time. You can always build yourself up to staying longer.

Don’t look for distractions. This can feed into the panic as you’re telling your body you don’t want to experience the panicked feelings. Obviously, you don’t, but you need to train your brain and body to understand the symptoms are just unpleasant not dangerous.

Allow the feelings and ride them out. Panic is like a wave that rises and then reduces. You need to learn how to tolerate the feelings and get used to them. Another technique is to lean into the feeling and really allow it. Can you make it worse? You’ll soon find that the more you allow the feelings, the less you have them. The more you don’t want to feel them, the more you will.

Record your symptoms. Note down what you experience when you’re having a panic attack. When you feel calmer, think about what was going on in your body. The aim here is to stop your brain from misinterpreting the symptoms of panic for something dangerous happening in your body. Try reappraising your symptoms. For example, your heart wasn’t beating faster because you were having a heart attack. It was to get your blood pumping around your body.


Panic attacks are terrifying, but they are treatable. Cognitive behavioural therapy has been found to be the most effective psychological therapy for panic attacks. If you are struggling with panic, see your GP to have a health check and discuss having CBT. The sooner you get support to manage panic attacks, the easier they are to treat. If they have been going on for more than 2 months, consider getting help

Useful Links

What is a Panic Attack and How Can CBT Help?

How to Choose a CBT Therapist

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Sarah Rees

Sarah is a fully accredited Cognitive Behavioural Therapist and mental health writer delivering Modern Mental Health for you and with you in Mind. Sarah is the author of ‘The CBT Journal’ which helps you write for your wellbeing incorporating CBT techniques. For more information and to keep in touch have a look at