What Is a Panic Attack? Symptoms and What to Do in the Moment

Your heart suddenly races, your breathing tightens, your hands tingle and your mind shouts "Something is happening to me!" Many people who have a panic attack think, the first time, that they're having a heart attack or losing their mind. In this article we explain in plain language what a panic attack is, why it feels so powerful in the body and what you can do in the moment.

What is a panic attack?

A panic attack is a wave of intense fear or discomfort that starts suddenly and usually peaks within a few minutes. The body's "fight or flight" alarm system switches on at full power even though there is no real danger.

A panic attack can happen once or a few times, and that alone doesn't mean you have an illness. When attacks keep coming back and the worry "Will it happen again?" clearly affects your life, it may be assessed as panic disorder. Only a mental health professional can make that distinction.

What are the symptoms of a panic attack?

Panic attack symptoms are bodily sensations and the intense fearful thoughts that come with them. Not all of them appear in every attack; usually several occur together.

These symptoms are very real and very frightening; but the panic attack itself is not dangerous and passes on its own.

What causes panic attacks?

There is no single cause; stress, fatigue, caffeine, lack of sleep and a tendency to interpret bodily sensations as danger can all play a role. A cycle often described in CBT goes like this:

1. You notice a sensation in your body (for example, your heart beating a little faster).
2. You interpret it as a catastrophe: "Something is wrong with my heart."
3. This thought increases fear, and fear increases your heart rate and breathing.
4. The stronger symptoms seem to "confirm" the catastrophic thought, and the cycle speeds up.

The key to calming a panic attack is to break one link in this cycle: interpreting the sensation differently or slowing the body down.

What should you do during a panic attack?

During a panic attack the goal isn't to force it to stop but to slow your body down while letting the wave rise and fall. These steps can help:

1. Name it: Tell yourself in a calm voice: "This is a panic attack. It's frightening, but it isn't dangerous. It will pass."
2. Lengthen your exhale: Breathe in through your nose for 4 seconds and out slowly through your mouth for 6 seconds. A long exhale activates the body's calming system. For a more structured method, see our article on the 4-7-8 breathing technique.
3. Feel your feet on the ground: Notice the soles of your feet touching the floor; count a few objects around you. The 5-4-3-2-1 grounding technique works very well for this.
4. Try not to escape: If possible, stay where you are. Escaping brings relief in the moment but teaches your brain that "that place was dangerous".
5. Observe the sensations: Describe them without judgment: "My heart is beating fast, my hands are tingling." Looking at sensations with curiosity can reduce fear.
6. Watch the time: A panic attack usually peaks within a few minutes and then decreases. Looking at a clock reminds you that it's a wave.

What should you do after a panic attack?

Once the attack has passed, be kind to yourself; drink some water, rest and write down what happened. Writing answers to "When did it start, what did I think, how long did it last, did my worst fear come true?" gives your brain strong evidence for next time: "I was scared last time too, but it passed."

After an attack it's tempting to give up that place, that type of transport or that situation entirely; but over time this avoidance can make fear bigger. To return to the places you avoid in small steps, you can use gradual exposure.

How can you tell a panic attack from a heart attack?

It isn't always possible to tell a panic attack from a heart problem on your own. If you're experiencing chest pain for the first time, if the symptoms are different from your usual attacks, if the pain spreads to your arm, jaw or back, or if you're at risk of heart disease, call your local emergency number or go to the nearest emergency department right away. Having a doctor rule out heart and other medical causes also makes it easier to say "this is panic" during later attacks.

When should you seek professional help?

If attacks keep coming back, if the worry "Will it happen again?" fills your day, or if you've started avoiding certain places, transport or activities for fear of an attack, it's a good idea to see a psychiatrist or clinical psychologist. CBT is a commonly used, research-backed approach for panic disorder. If avoidance has spread to many different settings, have a look at our article on agoraphobia too.

In short

• A panic attack is a sudden, intense wave of fear that peaks within a few minutes; it is frightening but not dangerous.
• In the moment, naming the attack, lengthening your exhale, feeling your feet on the ground and letting the wave pass without escaping all help.
• If you're experiencing chest pain for the first time, get a medical assessment first; if attacks keep coming back, get support from a professional.