It just came out of nowhere and now you are here: anxiety, heart racing, chest tight, breathing wrong, a part of your brain convinced, absolutely convinced, that something terrible is happening.
What you are having is a panic attack. And while that doesn’t make it less frightening, it matters, because understanding what’s actually happening in your body is the first step to moving through it.
A panic attack is your body’s fight-or-flight response firing at full intensity in the absence of an actual threat (Barlow, 2002). Your amygdala (the brain’s threat detection system) has triggered an alarm. Adrenaline floods your system, your heart rate increases to pump blood to your muscles, your breathing accelerates to take in more oxygen, and your body is preparing to fight or run from a danger that isn’t there.
The physical sensations are real. The chest tightness, the racing heart, the dizziness, the tingling in your hands, these are all physiological responses to adrenaline. They are uncomfortable and they are frightening, but they are not dangerous (Clark, 1986).
The average panic attack peaks within 10 minutes and passes within 20 to 30. Your body cannot sustain that level of activation indefinitely, it does eventually pass.
It’s also important here to distinguish the difference between a panic attack and an anxiety attack: Panic attacks are sudden, intense surges of fear, often unexpected and peaking within 10 minutes. Anxiety attacks build gradually over time, often linked to specific stressors.
The reason panic attacks feel so catastrophic is partly the sensations themselves, and partly what you make of them.
Clark’s cognitive model of panic (1986) describes a very specific loop: a physical sensation is noticed, interpreted as dangerous, “my heart is racing, something is wrong”, which increases anxiety, which intensifies the physical sensation, which confirms the threat. Within seconds you are in a spiral that feels completely out of control.
The interpretation is the fuel. The sensation alone is unpleasant, but the sensation + the meaning (I am dying, I am going mad, I cannot cope) is what sends it to full panic.
This is also why panic attacks can feel random. Often they start with a physical sensation that gets misread, a coffee making your heart beat faster, feeling slightly hot in a crowded room, the body doing something ordinary that anxiety immediately flags as a threat.
These are evidence-based strategies for moving through a panic attack, not stopping it. The distinction matters as trying to stop a panic attack tends to intensify it. The goal is to move through it with as little added fuel as possible.
Name what is happening. “This is a panic attack and is not dangerous” This is accurate information delivered to a brain that is currently operating on false data. If possible, saying it out loud is more effective than thinking it (Lieberman et al., 2007).
Practice response prevention with support. Response prevention means resisting the urge to do what makes you feel safer in the short term such as checking your pulse, calling someone, googling symptoms or telling yourself that you are fine with the intention of making it go away. Every safety behaviour tells your nervous system that the threat was real. Approaches such as ERP build tolerance systematically at a pace that is challenging but not overwhelming.
Don’t fight the sensations. Resistance amplifies panic. Allowing the sensations to be there without adding the layer of fighting them removes fuel from the loop. This is the principle behind acceptance-based approaches and it is consistently evidenced (Hayes, Strosahl & Wilson, 1999).
Stay where you are if you can. Leaving the situation provides immediate relief but may provide long-term maintenance of panic. Every time you escape, your brain logs the location or situation as confirmed dangerous. If it is safe to stay, staying is the more useful choice.
Don’t overbreathe into a bag. The paper bag method is outdated and potentially counterproductive for some people. Focus on the extended exhale instead.
Don’t seek immediate reassurance. Texting someone to tell you you’re okay, googling your symptoms, calling someone to stay on the phone, these all provide short-term relief and reinforce the idea that you needed rescuing, which makes the next panic attack more likely, not less.
Don’t catastrophise the panic attack itself. Having a panic attack doesn’t mean you’re getting worse, it doesn’t mean therapy isn’t working, it doesn’t mean something is fundamentally wrong with you, it just means your nervous system fired. That’s all.
Give yourself time to settle. The adrenaline needs to clear your system and that takes longer than the panic attack itself. You may feel exhausted, shaky, or flat afterwards and that’s normal physiology.
When you’re ready, it’s worth reflecting on what was happening before it started without catastrophising around it or overanalysing it, because sometimes there is context around panic attacks and something the nervous system was already carrying before it tipped.
That context is where longer-term work would sit.
The strategies above will help you move through a panic attack but they might not stop them from happening.
Panic attacks reduce and eventually resolve when the underlying anxiety is worked with, when your mind learns through repeated experience, that the sensations are not dangerous, and when whatever is driving the chronic activation underneath is understood and addressed.
Integrative approaces including CBT with a focus on panic disorder, ERP/ interoceptive exposure which can be done within Hypnosis aswell (gradually learning to tolerate the physical sensations associated with panic without interpreting them as threats) have the strongest evidence base for long-term resolution.
If you are struggling with any of this and need support, I’d love to talk. You can get in touch with me or book a free 15-minute call here.
Anxiety Therapist working with fears, and the life built around them.
A 3-step free guide to understanding and interrupting repetitive patterns in your relationships, behaviour and emotional responses.
