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💓 Panic

What happens in the body during panic, how to ride one out, and why it passes.

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What it is

A panic attack is a sudden rush of intense fear with strong body sensations — a pounding heart, fast breathing, dizziness, shaking, tingling, a tight chest or a sense that something terrible is about to happen. It usually peaks within about ten minutes and then fades.

Panic is the body’s alarm system going off when there is no danger to fight or run from. It feels frightening, but a panic attack itself is not dangerous: the sensations are the body’s normal stress response turned up very high, and they pass.

Why it happens

A build-up of stress, poor sleep or exhaustion leaves the alarm system on a hair trigger.
You notice a body sensation — a skipped beat, breathlessness — and read it as a sign of danger, which makes the body more alarmed.
You start to fear the panic itself, and that fear keeps the cycle going.
Caffeine, some drugs, or withdrawal from them can bring on or add to the sensations.

How it can show up

A racing or pounding heart, chest tightness, shortness of breath.
Dizziness, shaking, sweating, tingling in the hands or face, feeling hot or cold.
Feeling detached or unreal, or sure you are about to faint, lose control or die.
Afterwards: worrying about the next one, or avoiding places where one happened.

Everyone is different. These are common signs, not a checklist.

What helps right now

Tell yourself what is happening: “This is panic. It is my alarm system. It feels awful and it will pass.”
Let your breathing slow down gently — breathe out for longer than you breathe in. Don’t force deep gulps of air.
Stay where you are if you can, rather than escaping. Leaving teaches the body that the place was dangerous.
Ground yourself in your senses: name five things you can see, four you can hear, three you can touch.
Let the sensations rise and fall without fighting them. Fighting panic tends to feed it; letting it peak lets it pass.

Guided techniques to try

Slow breathing — (2–5 min · Moderate evidence)
5-4-3-2-1 grounding — (2–5 min · Practical evidence)
The double-inhale sigh — (1–5 min · Emerging evidence)

What helps over time

Learn how panic works — understanding the alarm system takes away much of its power.
Gradually return to the places and activities you have started avoiding, in small steps.
Practise calming skills when you are calm, so they are ready when you need them.
Cut back on things that add to the sensations, like a lot of caffeine.
If panic attacks keep happening, talk to a doctor. Panic responds well to treatment, especially cognitive behavioural therapy.

What tends to keep it going

Always escaping the situation. It brings quick relief and teaches the body to panic there again.
Checking your pulse or searching symptoms online over and over. Watching for danger keeps the alarm on.
Using alcohol to calm down. It can make anxiety and panic worse the next day.

When to get help

Any one of these is enough of a reason to talk to a doctor, a counsellor or someone you trust.

Panic attacks keep happening, or you are changing your life to avoid them.
You worry about the next attack most days.
It is the first time and you are not sure what it was — get it checked.

What the evidence says

Strong evidence: Many good-quality studies, usually including randomised trials and reviews that pool them, point the same way. Guidelines tend to recommend it.

Cognitive behavioural therapy for panic, including learning how the alarm system works and gradually facing feared sensations and places, has strong evidence and is recommended in major guidelines. Breathing and grounding skills help many people ride an attack out.

Where this comes from: UK National Institute for Health and Care Excellence (NICE); US National Institute of Mental Health (NIMH); Cognitive behavioural therapy (CBT) research; Slow-breathing and breathwork research.

Fields that study this: Clinical psychology, Psychiatry, Neuroscience.

Afterwards, ask yourself

What would you tell a friend who was in the middle of a panic attack?

Understand it better

What a panic attack is — A sudden rush of fear with a racing heart and a sense of danger. Frightening — and, once understood, less so. (7 min · Beginner)
Getting through a panic attack — What to do while it is happening, and why fighting it or fleeing tends to keep it coming back. (6 min · Beginner)
Understanding anxiety — Anxiety is your alarm system working hard. What it feels like, why it happens, and why it is so convincing. (7 min · Beginner)
Why avoidance keeps fear going — Avoiding what scares you brings relief now and keeps the fear alive. The idea behind gradual facing. (8 min · Intermediate)

Short on time?

“I think I’m having a panic attack” — A sudden rush of fear: pounding heart, fast breathing, a sense that something terrible is happening.

If you need more support

When self-help isn’t enough — Signs it is time to talk to someone, and who you can talk to.