Coping with Panic Attacks

By: Amy Marschall, PsyD

Seemingly out of nowhere, your heart starts racing. You are shaking, sweating, and struggling to breathe. You worry you may be dying. Then suddenly, it stops. If this experience is familiar to you, you are not alone. Approximately one in ten people have experienced at least one panic attack in the last year, and about five percent of people meet the criteria for a panic disorder at some point in their lives.

What Are Panic Attacks?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), a panic attack is “An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes,” consisting of four or more of the following symptoms:

  1. Racing heart
  2. Sweating
  3. Shaking
  4. Shortness of breath
  5. Choking sensation
  6. Chest pain
  7. Nausea
  8. Dizziness
  9. Chills or hot flashes
  10. Numbness or tingling sensations
  11. Feelings of unreality or detachment
  12. Fear of losing control
  13. Fear of dying

Panic attacks are accompanied by intense feelings of fear or anxiety. While they can have an identifiable trigger or onset, they can also occur seemingly out of nowhere. Some people experience nocturnal panic attacks, or waking up into a panic attack.

Panic attacks can accompany many different mental health diagnoses, including anxiety and trauma disorders. Some may experience a panic attack even if they do not have a diagnosed mental health issue, sometimes in response to a stressful life event. A panic attack is not a diagnosis, but recurring panic attacks can be noted in the context of a triggering mental health issue.

What Is Panic Disorder?

The DSM-5-TR defines Panic Disorder as “Recurrent unexpected panic attacks” (panic attacks that do not have an identifiable trigger or stressor) that interfere with functioning, including spending time worrying about future panic attacks and changing behavior to try and avoid these attacks. Surveys suggest that about two to three percent of people meet criteria for a Panic Disorder at some point in their lives.

How Are Panic Attacks Treated?

Even occasional panic attacks can be distressing. There is no minimum threshold to ask for help or receive support, so if your experience with panic symptoms upsets you or interferes with your life, it is okay to ask for help. If your panic attacks are secondary to another mental health issue, treatment for that condition might alleviate panic symptoms as well.

Research shows that both therapy interventions and medication can help treat panic symptoms. Cognitive Behavioral Therapy (CBT) is a type of therapy where a qualified mental health provider helps you identify how negative thought patterns and beliefs impact moods and behaviors. You can then learn to redirect unhelpful or unwanted thoughts to reduce these emotional responses and develop healthy coping skills. CBT can reduce panic symptoms both through in-person sessions and via telemental health, so if you struggle to find a local provider or your panic symptoms make it difficult to travel to your therapist’s office, you can still benefit from the treatment.

A physician or psychiatrist can also prescribe medication to treat panic disorder or other issues that cause panic attacks. There are three main classes of medication used to treat panic symptoms:

  • Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are commonly known as “antidepressants” and affect how your brain processes the neurotransmitter serotonin. They must be taken daily, and according to Mayo Clinic and the FDA, they are low risk for serious side effects.
  • Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs are similar to SSRIs in that they impact how your brain processes serotonin and also impact norepinephrine.
  • Benzodiazepines: Benzodiazepines are sedatives that are generally prescribed on an as-needed basis. For example, your prescriber may instruct you to take the medication when you feel a panic attack starting or when your anxiety rises. They are generally recommended on a short-term basis and have contraindications with other medications, and there is risk for side effects and dependence, so some prescribers are hesitant to recommend Benzodiazepines.

Am I Dying When I Have A Panic Attack?

Although a panic attack can cause you to feel like you are dying, a panic attack is not fatal. However, over time, recurrent panic attacks can lead to developing or worsening heart conditions, as well as higher blood pressure and increased risk of stroke.

At the same time, some people experience panic attacks triggered by anxiety related to a physical illness. Valid, rational fear for your physical health can cause panic attacks.

How Can I Cope With Panic Attacks?

Different coping skills are effective for different people, so you might have to try out various coping skills before finding the set that works for you. It is okay if your skill set is not the same as someone else’s. Some things that people find helpful in managing panic attacks include:

  • Remember That You Are Not Dying. Reminding yourself that your symptoms will pass can help prevent panic symptoms from escalating further.
  • Ground Yourself. Grounding refers to pulling your attention away from physical or emotional distress by focusing on external stimuli. You can practice grounding by describing something in your environment in great detail or try to name everything you can see that is a specific color or shape. Dr. Lisa Najavits wrote more strategies for grounding that you can try.
  • Use Imagery. During a time when you are calm and relaxed, come up with a place, time, or image that is very relaxing and safe. Practice imagining that place in great detail, and go back to that place in your mind when you feel yourself panicking.
  • Use A Guided Meditation. Apps like Calm and Mindshift offer free meditation tools that can help you bring yourself down from a panic attack. An external, guided meditation can be easier to use when you feel escalated, as all you have to do is listen.
  • Have A Sensory Item. Similar to grounding activities, sensory items like fidget spinners and squishies can provide a movement or tactile experience that brings your focus outside of your panic symptoms and help you de-escalate.

If you want to talk to a therapist about your symptoms and are not sure where to start, check out our tips for finding a provider.

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