Panic Attacks: What They Are and How to Ride Them Out

Reading time: ~7 minutes

A panic attack is a sudden surge of intense fear that peaks within minutes. It can feel like a heart attack, like you're going crazy, like you're about to die — and almost everyone who has had one remembers exactly where they were the first time. Here is what is actually happening, and what to do.

What's actually happening

A panic attack is your fight-or-flight system firing at full power, with no actual danger to fight or flee from. Your amygdala has hit the alarm button, dumped a flood of adrenaline into your system, and your body is now sprinting in place.

Common symptoms during a panic attack include:

• Pounding or racing heart
• Shortness of breath, feeling unable to breathe
• Chest pain or tightness
• Trembling or shaking
• Sweating, hot or cold flushes
• Dizziness, lightheadedness
• Tingling in hands, feet, lips
• Nausea or stomach churning
• A sense of unreality (derealisation) or detachment from yourself (depersonalisation)
• A powerful fear of dying, fainting, or losing control

Three facts that change everything

1. Panic attacks are not dangerous. They feel catastrophic, but they cannot hurt you. Your heart can handle it. You will not stop breathing. You will not faint (panic raises blood pressure; fainting drops it).
2. They always end. The body cannot sustain peak adrenaline for long — usually 5 to 20 minutes. Your nervous system has a built-in off switch.
3. The fear of the panic attack is the panic attack. The first wave of symptoms is your body. The second wave — the fear that something is terribly wrong — is what keeps it going.

What to do during a panic attack

The instinct is to fight it, escape, or distract yourself frantically. All of those tend to make panic worse because they confirm the brain's belief that this is dangerous. The counterintuitive move — and the one that actually works — is to allow it.

Step 1: Name what's happening

Out loud or in your head: "This is a panic attack. It feels terrible. It is not dangerous. It will pass." Naming it short-circuits the second-wave fear.

Step 2: Slow your exhale

Don't try to take big breaths — that often makes hyperventilation worse. Instead, focus on long, slow exhales. Breathe in for 4, out for 6 or 8. (See our breathing techniques for more.)

Step 3: Ground into your senses

Use 5-4-3-2-1, or press your feet hard into the floor, or hold something cold. Anchor in the room.

Step 4: Don't run

If you can, stay where you are. Sit down if you need to. Running away tells your brain "that place was dangerous," and the panic will be more likely to come back next time you're there.

Step 5: Surf the wave

Imagine the panic as a wave. It rises, peaks, and falls — every single time. Your only job is to let it pass through you. The less you fight, the faster it ends.

Between attacks: how to make them less frequent

• Reduce caffeine. It mimics the physical symptoms of anxiety and is one of the most common hidden triggers.
• Sleep. Sleep deprivation lowers the threshold for panic. See sleep and anxiety.
• Move daily. Even a 20-minute walk discharges background stress.
• Practise breathing when calm. The technique only works in a panic if your body already knows it.
• Address the fear of fear. Most panic disorder is sustained by being afraid of having another attack. Therapy (especially CBT) is highly effective for this.

The way out of panic is through it. You can't outrun your own nervous system — but you can learn to let the wave pass.