Understand the cause of your panic attacks in order to select the treatment that will work for you.
Dr Elaine Ryan
Page last reviewed and updated by Dr Elaine Ryan on
11th May 2020
This article is to help you
understand your panic attacks better, and
help to show you how to stop them by choosing the right treatment or self help
My name is Elaine and I am a psychologist. I also had Panic Disorder. In 2007, I banged on my neighbours door as I genuinely believed I was dying. In the next month I ended up in Accident and Emergency, 5 times. This was the start of my panic attacks.
This page is very long, so I shall start with the questions most people ask me, before delving into more deeper explanations.
A panic attack is the name given to a set of physical and emotional symptoms that you experience when your brain mistakenly identifies something as a ‘threat’ to you. Your panic attack occurs when you are given a stress response in a situation that you do not need it.
There are particular symptoms that you experience and most people believe that something is seriously wrong with them, perhaps that they are even dying. The symptoms can be similar to serious and even life threatening conditions, with the major exception, there is no danger to your health, you are feeling the effects of adrenaline.
Panic attacks can be caused by yet undiscovered medical conditions, drug misuse, but the cause for most people is a build up of anxiety, which goes unnoticed until you experience your first panic attack.
Yes, there are treatments available to help you recover from panic.
How do I know if I am having a panic attack?
If it’s your first panic attack, you will probably not recognise it as Panic, rather, you will think that you are dying, and probably get someone (or take yourself) to hospital.
It’s different for everyone, but one thing they all have in common is that it feels like something very serious is happening.
I have a more detailed list of symptoms relating to anxiety here., but the following list is more specific to panic attacks
- gulping for air; each in breath can feel like a gulp and your chest expands too much
- feeling like your breathing is not right; you are very aware of your breath and it is not regular
- feeling like you are dying or having a heart attack
- feeling like you are suffocating
All of these symptoms are due to your fight or flight response getting activated in a situation where it is not needed.
You might also find it useful to read my account of what my first panic attack was like. Read it, and then come back to this page.
The following video is one of my webinars which helps to explain panic attacks. It is one of several videos on this page.
One minute you are going about your business and the next, you might break into a sweat, your heart is pounding out of your chest, it’s getting hard to breathe.
This is a panic attack, but it can be different for different people.
You might feel like someone has placed a cushion over your mouth and nose, where it feels like you are getting smothered or suffocated, even though there is nothing over your face. This is something I personally experienced each time I had a panic, so I feel for you if you get this. It does go away; I have not experienced this for years.
You are terrified and convinced that you are not breathing, there’s not enough air getting into your lungs. ( I used to put my finger beneath my nostrils to get reassurance that there was still air going in and out!)
You check your pulse, and it may be rapid, or you might not be able to feel it at all.
You are shaking, sweating and feeling complete and utter terror as you might be having the thought (maybe for the first time in your life) that you are actually dying. You could also feel pins and needles, numbness and/or tingling anywhere in your body (this used to bother me a lot in my arms and legs.)
You may have had different symptoms, but if you have had a panic attack, you will be able to relate to what I have just said.
You could very well end up in hospital and get a series of tests, to be told
“It’s okay, there’s nothing wrong with you. You just had a panic attack.”
If you are very accepting of this information, or if it gives you some sort of relief or explanation regarding what has just happened to you, you may never experience an attack again, or as severe.
More than likely though, it is very hard for your brain to understand, that what you have just experienced, is “just a panic attack.”
When I had panic attacks, I felt like my life was spiralling out of control. I was physically and emotionally exhausted as my panic attacks would wake me from my sleep. In work, I couldn’t concentrate as all my attention was focused on helping me to breathe. I took time of work and flew home, I can still remember standing in the queue at the airport, trying to look normal and sneakily taking my pulse, which made it worse.
After one month out of work, feeling a good bit better, I flew back and once I arrived back into my apartment, bang, it all started again. That was 12 years ago and during those 12 years I have studied panic attacks; for myself, I am a psychologist, but the knowledge I acquired through training wasn’t helping me in the long term, so I took time out (years) to study it myself in depth. Now I can hopefully help you.
If you would like my help, all of my materials are now available in an online course. You can view the course here, or have a look inside the course in the video below.
Hopefully all of the above can help you identify if you might have had a panic attack, but ultimately, go to you doctor to rule out medical causes, as once they have been ruled out, then you will more than likely be told that you have had a panic attack.
How to Stop Panic Attacks
If you want to overcome panic attacks, it will be helpful for you to find out what caused you to panic in the first place. Understanding the cause will help you to select the right treatment.
Panic Attack Self Help and Treatment
The recommended treatment for panic attacks is Cognitive Behavioural Therapy; CBT. CBT is an excellent model for addressing the thought processes that occur with panic attacks, and also is extremely useful in helping you change behaviours that may keep your panic attacks going.
However, many people and this could be you, have panic attacks that just come out of the blue, and I would personally recommend having an understanding of your brain, in addition to CBT. I say this because there are different routes in your brain that can result in panic attacks and I shall explain this to you once I talk about the cause of your panic attacks.
What causes Panic Attacks?
Panic attacks can be caused by;
- your amygdala
- anticipatory anxiety
- underlying medical conditions
There are medical conditions that mimic the symptoms of panic, you can read about them here..
This simply means that you may be having panic attacks, but the underlying cause may not be anxiety.
Panic Attacks caused by your amygdala
Many people experience panic attacks that just occur out of the blue, or in similar situations, that do not necessarily involve anticipatory anxiety. If this is you, it is probably your amygdala. I shall explain what sort of treatment you need in a minute, but I better give you an example first.
Example of amygdala based panic
Lets say you keep having panic attacks in the car (or in a lift, or plane; the same places.) If a therapist tries to work with this using your thought processes alone, it may not work, as your amygdala is not logical.
Your amygdala acts first and thinks second. This simply means that if you are in danger (ie. your brain detects a ‘threat’) it will not wait to protect you while you rationalise whether or not you are in danger. It activates your fight or flight response first, just in case, to prepare you for danger, as it is better to be prepared than risk being harmed.
If this is you, and you want to stop having panic attacks, you need to retrain your amygdala to let it know the car (lift or plane, or whatever your trigger is) will not harm you.
Your amygdala learns from experience. If you keep having panic attacks, and do nothing about it, your amygdala will keep activating your stress response in situations you do not need it; you will keep having panic attacks.
Panic Attacks caused by anticipatory anxiety
Anticipatory anxiety simply means you are worried about something that may happen in the future, such as “what if I have panic attack;” you anticipate something bad happening, or see the worse case scenario. Being afraid makes up a large part of anticipatory anxiety.
Early warning signs
Even though it may seem like panic attacks come out of the blue, there are usually early warning signs that, with practice, you can learn how to stop a panic attack.
Start to monitor your attacks and note what your own early warning signs are.
Possible early warning signs include,
feeling a tightness in your chest
noticing a change in your breathing
feeling your heart beat faster
When you have developed a list of early warning signs, you are in a better position to stop your anxiety from developing.
What to do if you spot your own early warning signs of anxiety.
Remind yourself you are simply experiencing the effects of anxiety and that it will not harm you.
Start a mindfulness exercise such as the following one
Start by simply noticing your breath.
This may be difficult at first, but this is why it is called a mindfulness practice.
It does not have to be perfect each time you try it: you simply practice.
You can read more on Mindfulness by clicking here.
If your breathing feels labored or fast or uncomfortable, just notice it, and try not to engage your thought process, as anxiety related thoughts may increase your anxiety.
Start to count each out breath
breathe in, breathe out 1
breathe in, breathe out 2
breathe in, breathe out 3
breathe in, breathe out 4
breathe in, breathe out 5
Repeat this until the number 10 and start again with the number 1 through to 10.
Focusing on your breathing, with no judgement, and letting your thoughts come and go as they please will eventually calm your body and mind.
If you feel other symptoms of anxiety while doing this, just notice them and bring your attention back to your breathing.
If your heart is racing, just notice it racing, and bring your attention back to counting your out breaths.
At first this may feel difficult, but with practice you will lower your anxiety.
This is a good exercise to do on a daily basis, not just when you feel your own early warning signs of anxiety.
Developing a daily practice will help you to lower your overall anxiety levels and make it less likely that you will experience a panic attack.
Why breathing helps
When you notice your own early warning signs, regardless of what they are, they are due to the activation of the stress response (your sympathetic nervous system). You can read more on this by clicking here.
To calm down, whatever it is that you feel in your body, you need to activate your relaxation response (your parasympathetic nervous system.)
Different rates of breathing, result in different emotions and feelings in your body.
You breathe too much during a panic attack, resulting in hyperventilation.
What happens when you breathe too much?
Your heart rate speeds up.
You take in too much oxygen and your carbon dioxide levels lower.
This is known as hypocapnic alkalosis – or more simply put, your blood is too alkaline and makes you
suffocating or smothering feelings
And a host of other symptoms.
You can read more about the symptoms of anxiety by clicking here.
When feeling unreal, light headed and dizzy, you panic, which of course, makes you feel worse and your symptoms increase.
Breathing is something that your brain takes care of, it is normally outside of your control.
If you are having a panic attack, you are breathing more than you should be, and you need to take control.
Taking control of your own breathing will allow the anxiety to melt away.
Controlling your breathing will
Calm your heart rate
Restore the levels of carbon dioxide, and your uncomfortable symptoms will go away
How to take control
If it feels like you are gulping in air, or notice that your belly really expands when you breath in, you are taking in too much air.
The uncomfortable feeling of panic breathing will naturally make you want to breathe more deeply, but don’t.
Your over breathing is the problem.
Breathe in, through your nose, slowly, do not gulp.
Breathe out slowly, through your mouth, as if you were blowing up a balloon. Make sure your exhale is longer than your inhale.
Each time you breathe out, relax your shoulders, let them drop.
Wait for the next breath to come. If you are gulping in air, you probably started to breathe in, before you needed to.
Wait for the next breath to come.
What to do if you are controlling your breathing and your mind is racing?
It is normal to have scary thoughts during a panic attack. In addition to taking your control of your breathing, you need to ground yourself.
This will take your attention away from your thoughts.
Focus on something else. I would recommend focusing on something else in your body, as your body is always with you!
Focus on the soles of your feet.
Shift them about a bit.
How do they feel on the ground.
Walk around and pay attention to your heel coming into contact with the ground, followed by the rest of your foot.
By doing this, you are taking your attention away from scary thoughts that add to your anxiety, and focusing on something neutral – something real. Your feet on the floor.
All of this sound too simple for you?
It may sound simple but bear in mind.
You experience a panic attack, due to activation of your sympathetic nervous system; your stress response
This is controlled by your brain, you did not choose to activate it.
Controlling your breathing IS your choice. You are activating your parasympathetic nervous; your relaxation response, which will restore balance in your body.
Focus on your feet too simple for you?
If you continue to focus on thoughts that are fuelled by panic, you will most certainly spiral more into panic.
Focusing on your feet, is you choosing to focus on thoughts that are not adding to your panic.
Remind yourself that you are only feeling this because you are hyperventilating and that you will be okay, or by using coping statements.
This will pass
I have felt this before and it goes away
The sensations are because I am over breathing, nothing else.
If my thoughts are scary, I know that they are not real. My thinking is irrational when I have a panic attack.
Pay no attention to my thoughts – I choose to focus on something else.
So what? if I am having a panic attack. It will pass
You can add some coping statements of your own.
Accept your feelings
Don’t run away from panic, but do not fight it either – just accept it.
Accept it for what it is – your nervous system being over stimulated.
Accept your feelings of panic without your own spin on what is happening. By this I mean thoughts such as “I am going to die, I can’t handle this” etc.
Accepting your feelings, is just describing them, for example
My heart is beating fast – as opposed to – I am going to have a heart attack
My breathing is fast as opposed to – I am suffocating
My heart is beating fast
I feel pins and needles
I am sweating
This way, you are simply accepting what is happening, without adding fuel to the fire.
Take control of your panic attacks by
What not to do
Do not smoke
If you are a smoker, you might reach for a cigarette to help you relax. Smoking will stimulate your nervous system, causing your heart to beat faster, and may in fact, make you more anxious than you were.
Do not misinterpret your symptoms
If you have had panic attacks before, you will know that any of your anxious thoughts relating to what may “really be happening” do not come true.
If your mind is focusing on some other scary reason for your symptoms, this will create more anxiety.
Talk yourself through it, know that whatever symptoms you feel, that it as a direct result of your sympathetic nervous system.
Do not run away from whatever you are doing.
It is a natural reaction to leave wherever you are, when you have a panic attack. If you are in a shop, you will want to leave, to get outside for fresh air.
It is not the shop, or the air in the shop that is resulting in the difficulties you have breathing.
It is your sympathetic nervous system.
If you leave whatever you are doing, you are sending a signal to yourself, that you are not safe where you are.
If you can manage to talk yourself through it, and stay where you are, your body and brain will thank you for it.
With panic attacks, it is all too easy to avoid places that you believe may cause you to have an attack.
It is not the place that is causing your panic.
It is your body giving you a stress response in situations where you do not need it.
Do not fight it.
With practice you can learn to accept that what you are feeling is as a result of anxiety. This acceptance, lessens the fear. Having less fear means that the attack will pass quicker.
Learning not to do these things will take away some of the fear.
Without fear, there is no panic.
- 1. Taylor C. B. (2006). Panic disorder. BMJ (Clinical research ed.), 332(7547), 951–955. doi:10.1136/bmj.332.7547.951