The symptoms couldn’t be more intense.
Your heart is pounding and your breathing is too fast. You feel like you might be having a heart attack. You’re shaking and sweating. You feel lightheaded and sick to your stomach. Your hands and feet are numb. Your emotions, however, are anything but numb: You feel like you’re losing control, maybe even dying, and you have an overwhelming urge to escape. At the same time, you feel disconnected from your surroundings—even from your own body. These are some common panic attack symptoms.
If you’ve had one or more panic attacks, you’re far from alone. Every year, one out of nine adults experiences a panic attack. And up to half of all Americans may experience at least one panic attack during their lifetimes.
What is a panic attack?
A panic attack is a sudden episode of intense fear or discomfort. There are many possible triggers.
Attack-like symptoms. If you have panic disorder, experiencing one or more of the symptoms of a panic attack (even a relatively benign symptom, like feeling warm) can cause you to worry that you’re about to have an another attack. The worry-caused spike of adrenaline amplifies symptoms, triggering a full-blown attack.
Specific fears. Some people are triggered by the fear of specific settings and experiences, like flying in an airplane, riding in an elevator, being in a crowded space, public speaking, or sitting in a doctor’s office.
Stress. Intense stress—with your finances, work, or spouse, for example—can trigger an attack.
Stimulants. For some people, a stimulant is the cause, such as caffeine (in coffee or energy drinks, for example), nicotine, stimulant medications for attention-deficit hyperactivity disorder (ADHD), or illegal drugs like methamphetamines or cocaine.
Health problems. Several health problems can trigger an attack, like hyperthyroidism, perimenopause, chronic pain, or low blood sugar.
From panic attack to panic disorder
A panic attack typically peaks within 10 minutes and subsides within 20 to 30 minutes, although the sensations of the attack can linger. You might have one panic attack, or many.
If you’re having recurrent panic attacks, and you’ve been worried for at least a month about having more attacks, and you start to avoid situations that might trigger an attack, you may have what mental health professionals call panic disorder. About 6 percent of Americans will experience panic disorder during their lifetime.
If it’s not treated, panic disorder can be debilitating—you can develop agoraphobia (fear of being trapped, helpless, or embarrassed when you have a panic attack outside your home), social withdrawal, and depression.
How to stop a panic attack
Stopping a panic attack requires grounding yourself in present-time reality, calming the nervous system, and breaking the cycle of fear. There are several techniques to do so:
Breathing exercises
Breathing exercises are a particularly good way to counter hyperventilation, a common symptom of panic attacks in which fast, shallow breathing interferes with oxygen delivery. You can use breathing exercises to counter any of the symptoms of a panic attack.
Sing along. If you’re new to breathwork, an easy (and fun) way to deepen your breathing is to sing your favorite song—put in on and sing along. Singing a song you like activates the calming parasympathetic nervous system, stimulates the release of mood-improving endorphins, and stimulates the vagus nerve, slowing heart rate.
Box breathing is a widely-used breath exercise , in which you inhale for a count of four, hold for four, and exhale for four. For a panic attack, inhale, hold, and exhale for a count of six to eight, which activates the parasympathetic nervous system. Repeat the cycle as many times as necessary to calm yourself.
Diaphragmatic breathing. With this strategy, you breathe from the belly rather than the chest, which activates the parasympathetic nervous system. To do diaphragmatic breathing:
- Lie down on your back with your knees bent. A pillow under your knees helps. Or sit in a chair with your back straight and feet flat on the floor.
- Put one hand on your chest and the other on your abdomen, just below the rib cage.
- Inhale slowly through your nose. Breathe in slowly and deeply. Focus on expanding your abdomen, pushing the lower hand outward. The hand on your chest should stay as still as possible.
- Exhale slowly through your mouth. Purse your lips slightly, like you are blowing through a straw. Breathe out slowly and completely, allowing the belly to fall. Again, your chest should move very little.
- Repeat. Try this exercise for five to 10 minutes, one or two times daily to train your body. Gradually use this technique in moments of stress or panic.
Grounding exercises
Using the 5-4-3-2-1 technique, name five things you see, four things you feel, three things you hear, two things you smell, and one thing you taste. Another grounding exercise is to touch or describe objects near you in detail. When a panic attack is starting, do a grounding exercise until you feel present in the here-and-now.
Positive self-talk
Negative self-talk, like, “I’m having heart attack,” or “I’m losing my mind,” can trigger or worsen a panic attack. Positive self-talk, like “This will pass. I am safe. It’s just a panic attack” can ease or stop a panic attack. Repeat these affirmations or calming phrases until you don’t feel panicky.
Cold stimulation
Cold activates the mammalian drive reflex, which slows heart rate. Splash cold water on your face or hold an ice cube.
Movement
Light exercise like walking can use up anxiety-causing stress hormones and release tension, short-circuiting a panic attack.
Preventing a panic attack
There are two therapies that scientific research shows can help prevent a panic attack.
Cognitive behavioral therapy (CBT)
CBT has the most scientific support for treating panic attacks and panic disorder. It focuses on identifying, challenging, and changing the distorted thought patterns and behaviors that fuel anxiety and panic.
In therapy, which typically lasts about three months, clients may be asked to track their panic attacks and associated thoughts and emotions. Next, the therapist teaches the client to recognize specific thoughts that can spiral the individual into a panic attack. Then, CBT helps the client reframe those thoughts into more realistic, calming alternatives, like, “This feels terrifying, but no one has ever died from a panic attack. It will pass.” Or, “Panic makes me feel out of control, but I’m not losing my mind. This is temporary and treatable.”
CBT also uses so-called exposure techniques to reduce the fear of physical sensations experienced during a panic attack. For instance, the therapist may ask the client to spin in a chair to feel dizzy, so the client can realize dizziness is not dangerous. The therapist may also have the client put themselves in panic-triggering situations, like riding an elevator. Finally, the therapist and client reinforce the skills that have been learned, and plan for setbacks.
Many times, people who have panic attacks feel the attacks “come out of nowhere,” but that’s not the case. Learning triggers helps you feel more in control, and helps you avoid or prepare for situations where you know your anxiety will increase. A particularly effective CBT technique is to keep a log of your panic attacks. In one column, note where you were during the time you became triggered, and any negative thoughts you experienced. In another column, write the reframing thought that would be more helpful and positive.
Eye movement desensitization and reprocessing (EMDR)
This trauma-focused therapy was originally designed to treat PTSD, but it is increasingly used for panic and anxiety disorders, especially when traumatic memories or emotionally charged experiences contribute to the panic.
First, a person identifies a disturbing memory, image, or belief related to their panic. Then, the therapist guides them through bilateral stimulation, a method that stimulates both sides of the body and brain while the client focuses on the disturbing factor. Bilateral stimulation can involve eye movements (following the therapist’s finger moving side-to-side across their field of vision), tapping (alternately on the left and right sides of the body, like the knees or hands), or alternating sounds (tones or clicks delivered through headphones to the left and right ear). Bilateral input is theorized to help the brain “reprocess” traumatic or anxiety-laden experiences, reducing their emotional charge.
In a 2024 study on EMDR and panic disorder, scores on a test for panic dropped from 40 to 1.2 after 12 weeks of EMDR. “EMDR may represent an effective intervention technique for panic disorder…to protect against relapses and to overcome a fear of future attacks,” concluded the researchers.
Panic Attack vs Anxiety Attack
These two terms are often used interchangeably, but there are key differences between them.
Onset
A panic attack starts suddenly, often without warning. An anxiety attack develops gradually, in response to stress.
Duration
A panic attack peaks within minutes, while an anxiety attack can last for hours—or days.
Intensity
A panic attack feels overwhelming. The intensity of an anxiety attack is mild to moderate.
Trigger
You may not be able to identify the cause of a panic attack. Anxiety attacks are usually linked to a specific stressor, like financial worries.
Diagnosis
If you have recurrent panic attacks, you may have panic disorder. An anxiety attack not a formal term, but it can be related to generalized anxiety disorder (GAD), a formally diagnosed mental health problem.
