A panic attack can feel frightening and very physical — racing heart, breathlessness, dizziness, a sudden sense of losing control or not being real. They are not dangerous, but they can feel that way. This page has a short practical plan for during and after a panic attack, and clear routes for getting more help.
Practical panic attack plan
If panic is happening now or you want a short plan to practise, see the new Panic Attack Plan. It gives steps for the first few minutes, what to do afterwards, and when to seek urgent or professional help.
Key points about panic attacks
- Panic attacks can feel medically alarming. New, severe, unusual, or changing physical symptoms should be assessed medically, especially chest pain, fainting, breathing difficulty, or neurological symptoms.
- One panic attack does not automatically mean panic disorder. Repeated attacks, fear of another attack, avoidance, or disruption to daily life are reasons to seek professional help.
- The practical work is usually twofold: calm the body during the attack, then reduce fear of the sensations and rebuild avoided activities over time.
- If there is immediate danger, thoughts of self-harm, risk to someone else, or a medical emergency, use local emergency services or urgent crisis support rather than relying on a web page.
Helpful next steps: Find help and urgent support, Panic Attack Plan, anxiety treatment, anxiety therapy in Dublin and online, Dublin and online therapy.
Start here for panic attacks
Panic is frightening because the body can feel as if it is in real danger. These routes are meant to help readers choose a useful next step without turning the page into diagnosis or personal medical advice.
- If panic is happening now: use the Panic Attack Plan for a short step-by-step plan and aftercare.
- If symptoms are new or severe: start with Find Help and seek medical or urgent support when there is chest pain, fainting, severe breathlessness, injury risk, or immediate danger.
- If panic keeps returning: read about anxiety treatment and consider how therapy can work with fear of fear, avoidance, and the meaning attached to body sensations.
- If you are looking for therapy: see what happens in a first psychotherapy session and psychotherapy and counselling in Dublin and online.
Panic attacks seem to come out of the blue, and you suddenly experience fear and dread that can only be described as existential. Your heart may be beating faster and you feel like you cannot breathe anymore. Everything seems to close in on you. It feels as if this is the end or something very bad is going to happen to you. You may feel it is all over. You are experiencing a panic attack. Some people may fall to the floor (though they usually do so quite softly) or blackout from fear (though it is not a real blackout).
Panic attacks can begin at different stages of life, often from adolescence or early adulthood, but they can also occur later. Rates vary by study and country, and a panic attack can happen without meaning someone has panic disorder. What matters clinically is the pattern: repeated attacks, growing fear of another attack, avoidance, and the effect on everyday life.
Reoccurring Panic Attacks
Many people only have one or two panic attacks in their lifetime. However, if they occur more often, we call this a panic disorder. They are often grouped together with anxiety conditions. Even if it looks clearly like a panic attack, it is nevertheless important to make sure that there are no underlying physical conditions that can at least be partly responsible for the symptoms. Several treatments are available for panic attacks, and the earlier one begins the quicker they often subside. It is also important for the brain to unlearn to be afraid of being afraid, which helps prevent panic attacks in the future.
Symptoms
People with panic attacks often report a fear of dying or heart attack, flashing vision, faintness or nausea, numbness throughout the body, heavy breathing and hyperventilation, or loss of bodily control. Some people also suffer from tunnel vision, mostly due to blood flow leaving the head to more critical parts of the body in defense. These feelings may provoke a strong urge to escape or flee the place where the attack began (a consequence of the “fight-or-flight response”, in which the hormone causing this response is released in significant amounts). This response floods the body with hormones, particularly epinephrine (adrenaline), which aid it in defending against harm. [5]
According to DSM-5, a panic attack is characterized by four or more of the following symptoms (the presence of fewer than four symptoms may be considered a limited-symptom panic attack):
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- A feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Feelings of unreality (derealization) or being detached from oneself (depersonalization)
- Fear of losing control or going crazy
- Fear of dying
- Numbness or tingling sensations (paresthesias)
- Chills or hot flushes
Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something really bad is going to happen. [1][2] The maximum degree of symptoms occurs within minutes. There may be a fear of losing control or chest pain. [2] Panic attacks themselves are not dangerous. [3] They are distinguished from other forms of anxiety by their intensity and their sudden, episodic nature. [5] They are often experienced in conjunction with anxiety disorders and other psychological conditions, although panic attacks are not generally indicative of a mental disorder.
Fear of Fear
A common mechanism in panic attacks is the fear of being afraid. The more worried I am that I will have a panic attack, the more likely I am to have one. And the more I focus on my fear, the more afraid I will be. This is the vicious cycle of panic attacks. Most people notice a feeling before their panic attack begins, which they often describe as a feeling of imminent doom. The world around me seems to change, and I feel differently. Unfortunately, this often raises any existing tensions or anxiety even more. One goal in therapy is to gain the ability to not counter fear with fear.
Controlling the Emotions
While it is helpful to work with the emotions to better connect with oneself and others, to get one’s needs, values, and aspirations met, putting a lid on one’s emotions can lead to the phenomenon of a pressure cooker. At some point, the pressure on the inside gets just too high, and everything explodes. Trying to control one’s emotions by suppressing rather than working with them can raise anxiety levels, which in turn can also increase the chances of a panic attack. In your work with a therapist, one goal can be to gain a greater sense of emotional freedom and a better sense of control by identifying and adjusting any strategies of working with one’s emotions that are unhelpful.
Panic Attacks with other Mental Health Conditions
Panic attacks can occur as part of a number of mental health conditions, including panic disorder, social anxiety disorder, post-traumatic stress disorder, drug use, depression, and a number of medical problems. [2][4] They can either be triggered or occur unexpectedly. Often people are not aware of a specific trigger or the underlying issues, feelings and emotions that may contribute to a panic attack. Uncovering these deeper issues is an important part of therapy. An awareness of them usually makes the panic attacks subside.
Risk Factors
Risk factors do not mean panic attacks are inevitable. They can help identify what may be worth discussing with a GP, therapist, psychiatrist, or other clinician, especially when the symptoms are new, frequent, or changing.
- Family history of panic, anxiety, depression, or related conditions can increase vulnerability.
- Periods of high stress, loss, major life change, trauma, or relationship strain may make the nervous system more reactive.
- Existing anxiety, depression, trauma symptoms, OCD, substance use, sleep loss, or heavy caffeine use can make panic-like sensations more likely or more frightening.
- Smoking, alcohol, recreational drugs, medication effects, withdrawal, and some medical conditions can contribute to symptoms that resemble panic.
- Avoiding places or activities after a panic attack can protect someone in the short term, but over time it may teach the brain that those situations are dangerous.
Because panic-like symptoms can overlap with thyroid problems, heart or lung conditions, medication effects, substance use, or other physical issues, new or unusual symptoms should be medically checked. This is especially important when symptoms include chest pain, fainting, severe breathlessness, weakness on one side, confusion, or symptoms that feel different from previous attacks.
The Autonomous Nervous System
A panic attack is a response of the sympathetic nervous system (SNS). The most common symptoms include trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, cold flashes, burning sensations (particularly in the facial or neck area), sweating, nausea, dizziness (or slight vertigo), light-headedness, hyperventilation, paresthesias (tingling sensations), sensations of choking or smothering, difficulty moving, and derealization. These physical symptoms are interpreted with alarm in people prone to panic attacks. This results in increased anxiety and forms a positive feedback loop. [6]
Often, the onset of shortness of breath and chest pain are the predominant symptoms. Shallow and rapid breathing can change the pH level in one’s blood, which leads to even more symptoms of a panic attack. Breaking this vicious cycle is difficult once the panic attack has started.
Treatment of Panic Attacks
Psychotherapy should always be a part of treatment. It is considered a first-choice option. It is helpful to divide the therapies into three major approaches:
- tools – these therapies provide concrete tools, such as thinking differently about the fear or habituation through exposure to fearful stimuli (e.g. CBT)
- insight – these therapies focus on an understanding of why you have the fears in the first place, which often reduces them (e.g. psychodynamic psychotherapy)
- interaction – these therapies focus on the role of interpersonal interactions in the experience of fear, for example (interpersonal psychotherapy)
Cognitive Behavioral Therapy (CBT) may be the most widely tested therapeutic approach in the literature for anxiety and panic attacks, but that may also be due to the fact that is easier to operationalize and manualize. For current research on panic attacks, you may want to consult Google Scholar and the National Library of Medicine in the US.
Medication can be added to prevent the occurrence of panic attacks for a while. This lowers the anxiety of having another panic attack, which in itself lowers the likelihood of having a panic attack. First-line treatment is often an antidepressant from the group of serotonin reuptake inhibitors (SSRIs) for the longer term, sometimes in the short term in combination with a faster-acting benzodiazepine, like Alprazolam (Xanax(R)) or Lorazepam (Temesta(R)), as emergency stand-by medication. The disadvantage of the benzodiazepines is that their effect is not instantaneous, they work only for up to a couple of hours, they can lead to cognitive impairment, and, if they are taken regularly, they can be addictive. However, many patients find it psychologically helpful to carry a stand-by tablet with them. This already often lowers the fear of having a panic attack by breaking the vicious cycle of fearing the fear and the sense of having no control over the panic attacks.
Related panic and anxiety resources on this website
These links keep related panic, anxiety, mood, trauma, and service information close together so readers do not have to search through the site when they are already under stress.
- Find help and next steps
- Help with anxiety
- Panic Attack Plan
- Anxiety
- Anxiety treatment
- Anxiety self-help
- Generalized anxiety
- Social anxiety
- Obsessive-compulsive disorder (OCD)
- Depression
- Trauma
- First psychotherapy session
- Psychotherapy and counselling in Dublin and online
- Make an appointment
- Mental health community
Reliable panic attack and panic disorder resources
The links below point to established health services, clinical guidelines, public-health bodies, and professional organisations. They are included for further reading and support options, not as a substitute for individual assessment, diagnosis, medication advice, psychotherapy, or emergency care.
Ireland and UK
United States
Canada
Japan and Global
- Japan MHLW: panic disorder diagnostic criteria
- Japan NCNP Hospital: anxiety disorders
- WHO: anxiety disorders
For more articles about panic attacks on jonathanhaverkampf.com you may be interested in the following:
Becky G recalls battle with anxiety and panic attacks: ‘Full-blown tears, can’t breathe’
Communication-Focused Therapy (CFT) for Anxiety and Panic Attacks (2)
References
[1] “Anxiety Disorders”. NIMH. March 2016.
[2] American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 214–217, 938, ISBN 0890425558
[3] Geddes, John; Price, Jonathan; McKnight, Rebecca (2012). Psychiatry. OUP Oxford. p. 298. ISBN 9780199233960.
[4] Craske, MG; Stein, MB (24 June 2016). “Anxiety.”. Lancet (London, England). PMID 27349358.
[5] Bourne, E. (2005). The Anxiety and Phobia Workbook, 4th Edition: New Harbinger Press.
[6] Klerman, Gerald L.; Hirschfeld, Robert M. A.; Weissman, Myrna M. (1993). Panic Anxiety and Its Treatments: Report of the World Psychiatric Association Presidential Educational Program Task Force. American Psychiatric Association. p. 44. ISBN 978-0-88048-684-2.
About this resource
This page is public educational information about panic attacks and panic disorder. It cannot diagnose panic disorder, rule out medical causes of physical symptoms, provide medication advice, replace psychotherapy, or respond to an emergency.
Reviewed May 2026. This page is educational information and is not a substitute for individual medical, psychological, medication, or emergency advice.
© Dr Christian Jonathan Haverkampf. All rights reserved.
Psychotherapy & Counselling; Dublin, Ireland
This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition.
Trademarks belong to their respective owners. They have not been checked.
Related Research Summary
The CFT anxiety and panic paper summary gives a research-oriented route for readers who want more background after the public panic-attack information.
If you are supporting someone during panic, the companion guide how to help someone with anxiety explains calm phrases, what to avoid, and when medical or urgent help should come first.