Know the signs, learn your triggers, and find effective coping strategies for you.

By Lindsay Tigar
Updated August 21, 2020
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Suddenly, you can’t catch your breath. Your heart is beating out of your chest. Your palms are growing sweaty. Your thoughts are spiraling. Your chest is heavy and tight. This intense level of anxiety that often feels paralyzing is called a panic attack. 

Panic attacks are more common than you might think: 2 to 3 percent of adults will experience a panic disorder, and women are twice as likely as men to suffer from the symptoms, according to the Anxiety and Depression Association of America. While these episodes of intense anxiety don’t tend to last very long, they can be crippling and terrifying, making it challenging to perform primary motor function or responses. 

If you or someone you love is going through a high-stress period and experiencing panic attacks, it’s important to know the signs, find ways to cope, and learn how to move forward.

According to Yvonne Thomas, PhD, a licensed psychologist in Los Angeles, the good way to think of a panic attack as a volcano. Over time, emotions (both good and bad) build, and when we don’t process them effectively, they can reach a boiling point. When this happens, they erupt, creating a burst of psychological and physical symptoms. When they bubble over and we can’t control the outpour, it results in a panic attack. 

Nearly anyone can have a panic attack, particularly if they’re suffering through a significant, difficult life change, like a divorce, a miscarriage, the death of a family member or close friend, the loss of a job, or another traumatic event. 

Panic attacks can also happen when we’re happy, but anxious about a new chapter or beginning. “During periods of stress, people tend to experience an increase in overall levels of physical tension and a reduction in confidence in their ability to cope with life,” explains Regina Lazarovich, PhD, a licensed clinical psychologist at the Williamsburg Therapy Group. “In fact, most people tend to experience their first panic attack in their 20s, during an especially stressful life period, such as starting a new career or relationship.

Lazarovich says another major psychological contributor to panic attacks can be the act of believing that certain physical symptoms are physically, mentally, or socially harmful or dangerous. For example, if you watch a loved one experience a heart attack, Lazarovich says you may now have an increased likelihood of interpreting your own benign physical symptoms as harmful. 

Your chances of experiencing panic attacks can be higher if your parents suffer from them, since it’s likely that people inherit a genetic vulnerability to panic. Lazarovich says research estimates about 15 to 20 percent of first-degree relatives of someone with a panic disorder will develop a similar diagnosi themselves, compared to about 5 to 8 percent of the general U.S. population.

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The terms "panic attack" and "anxiety attack" are sometimes used interchangeably, but they're actually not quite the same. While both can feel intolerable, the biggest difference between panic and anxiety attacks has to do with time. Samantha Gaies, PhD, a clinical psychologist with New York Health Hypnosis & Integrative Therapy explains that panic attacks tend to be unprovoked, unpredictable, and it can be difficult to pinpoint a direct cause. Whereas an anxiety attack is typically a reaction to a tangible stressor. 

“Although some of the symptoms are similar—feelings of fear or worry, a racing heart, and shortness of breath—anxiety attacks are often experienced for a shorter, more finite period of time dependent on [whether] the stressor is relieved,” Gaies says.

Everyone experiences panic attacks differently, and our bodies display the symptoms in a variety of ways. However, there are some central themes that nearly all sufferers go through, which can help you figure out whether or not something is panic attack. 

It feels like you’re having a heart attack.

One of the reasons a panic attack is so scary is lack of control. In this way, it may be confused with a heart attack, according to Nicole Davis, PsyD, JD, a licensed psychologist at Therapeutic Oasis in Florida. This means chest pain and tightness, shortness of breath, numbing or tingling, and so on. It could also translate into dizziness, lightheadedness, hot or cold sweats and/or flashes, and in some cases, nausea or choking sensations.

It feels like you’re in danger.

You’re in the middle of an otherwise ordinary day, and suddenly, you feel like your life is in danger. There are no known threats around you, but still, you can’t shake the feeling that something terrible is happening or could happen at any moment. Gaies says this fight-or-flight response is what a panic attack can feel like. “In prehistoric times, when wild animals started chasing you, it was important for your heart to start beating quickly and your breath to kick into high gear; these reactions to stress would save your life,” she says. “Although today’s stressors don’t put us in physical danger, our bodies have not yet figured out how to react differently to emotional stressors versus physical threats.”

Or even like a near-death experience. 

Have you ever had a gut-wrenching, near-death experience? Maybe it was an almost car accident, barely staying on the ledge during a hike, or being stung by a bee or bitten by a snake. Whatever the case, you probably had to steady your heart rate and ‘come back’ to the present moment. This survival feeling is associated with panic attacks, according to Hanna Stensby, LMFT, a licensed marriage and family therapist at Couples Learn

“There seems to be no hard evidence for any of these feelings and the physical sensations come out of nowhere, but you cannot shake the feeling that something has gone horribly wrong,” she says. “Then surprisingly, you experience a somewhat quick dissipation of the symptoms, leaving you questioning your reality and your own mental stability due to the random, brief, but severely intense experience you just survived.”

It feels like you can’t control your thoughts. 

During a panic attack, it can feel as if you have zero control over your thoughts. This can lead to or include something known as catrophisizing, or jumping to the worst-case scenario outcome. Kama Hagar, certified holistic wellness coach, explains that our thoughts may frequently feel out-of-whack, but when they reach a petrifying level that slightly-off feeling turns into panic. “Panic causes the thoughts to frenzy and become irrational,” she explains. “The track that a panicked mind goes down is fear-laden with all imaginings of the most extreme possible outcomes and scenarios.”

It feels like an out-of-body experience.

If during a stressful situation, you separate from your body in ‘real-time’ and feel like an outsider looking in, a panic attack could be brewing. Also called derealization or depersonalization, Stensby says this happens due to our body’s natural defense against a threatening event. “The body attempts to create some space between the person and the painful event being experienced to reduce its intensity,” she says.  “This experience likely acts as a form of protective disassociation.”

Whether you or someone around you is going through a panic episode it’s essential to practice some soothing and calming rituals to take the intensity out of the moment. Try these to break through the symptoms and find peace with these methods.

Ground yourself in your senses. 

When we’re feeling panicky, it’s sometimes because we can’t grasp control of our bodies, minds, or emotions. What we can focus on is the present moment and what’s around us. Gaies calls this sensory grounding, and it’s an effective tool to use whenever we begin to experience symptoms. 

“Look at your surroundings and begin to name everything you see in minute detail: the shapes, textures, colors, and sizes of every object you see in front of you,” she recommends. “This helps to bring your attention away from thoughts and fears that can heighten the panic attack and puts you back into the present moment in which you can feel safe and secure once again.” Your brain can’t focus on two things at once, so try to fixate something else to replace the panicked thoughts. 

Breathe with intent.

Panic attacks can last anywhere from ten to thirty minutes, and during this time, you’ll want to escape, since many feel removing themselves from their location will make a difference. However, it usually has the opposite impact, causing your heart-rate to rise even higher, and intensify your worry. That’s where breathing techniques can come in incredibly handy, according to Lazarovich. Counting your inhales and exhales can be useful, and brings your attention to one activity, rather than spiraling thoughts.

For those who experience frequent panic attacks, it’s vital to learn how to manage these episodes and decrease them. First and foremost, professional treatment will offer unbeatable tools and resources. 

Seek professional treatment. 

One of the most widely-used treatments for panic attacks is Cognitive Behavior Therapy (CBT). This therapy method teaches different ways of thinking and reacting to panic symptoms and has been shown to help reduce or eliminate them, explains Paula Wilbourne, PhD, MS, the co-founder and chief science officer of mental wellness app Sibly. To find a trusted therapy provider near you (that’s also covered by your insurance plan), Wilbourne recommends searching on NIMH and via the database for Substance Abuse and Mental Health Services

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Be aware of your own signs. 

Once you understand what triggers your panic attacks, Davis says you can normalize the symptoms, rather than adding more anxiety. If you know seasons of heightened stress can be risky for you, schedule time to decompress. If you know being around certain family members is difficult, consider ways to distance yourself. If a big change, like a new job or getting married, can send you into overdrive, make sure you have outlets to discuss your feelings in a safe, calm place. 

Take care of yourself.

Seems simple, right? All too often, we put our own health on the bottom of our priority list, when it should be at the top. As Hagar explains, panic attacks are often formed from a place of ‘future-tripping’, where you fret over tomorrow, two months from now, and so on. By practicing meditation, you position yourself to focus on the here-and-now. Even five minutes a day makes a difference. Alcohol, sugar, caffeine processed foods, and dairy can all cause inflammation and stress, keeping adrenaline levels high. “When the body isn’t well-nourished, it becomes ill-prepared to battle mental, physical, or emotional journeys,” Hagar continues. “Make healthy fats, nutrient-rich veggies, whole grains and clean proteins your medicine.”

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Face your fears. 

Finally, and most importantly, Lazarovich says to face the feared situations and physical symptoms instead of avoiding or escaping. That is the best way to learn that panic attacks, while uncomfortable, are not dangerous and that it’s possible to survive and cope with feared symptoms and situations. Clinical psychologists refer to this as exposure therapy. “It is helpful to come up with a list of situations and physical sensations associated with panic and gradually and systematically face each feared item, working from the least to the most challenging,” she explains. “Ultimately, exposure to feared situations leads to more confidence and less anxiety about having a future panic attack.”

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