A panic attack is a sudden, overwhelming feeling of acute and disabling anxiety that involves a frightening rush of intense physical and psychological symptoms.

Panic attacks come on very quickly, at any time, even during sleep. Most panic attacks last for between 5 and 20 minutes, but some people report attacks lasting for a matter of seconds to over an hour.

A person may have one or two panic attacks and never experience another. Or they may have attacks once a month or several times each week. For some people they seem to come without warning and strike at random.


Physiologically you may become aware of:
• a sensation that your heart is beating fast and irregularly (palpitations)
• hot and cold flashes/sweating
• trembling and tingling sensations
• shortness of breath
• a choking sensation
• chest pain
• feeling sick and/or dizziness

Psychologically, you may feel an overwhelming sense of fear and a sense of unreality, as if you’re detached from the world around you. You may feel that you’re going mad, about to black out, or that you’re having a heart attack. You may be convinced that you’re going to die in the course of the attack making this a terrifying experience.


While the various symptoms of a panic attack may cause someone to feel that their body is failing, falling apart, about to stop working altogether, the mind is in fact doing all it can to protect the body from perceived harm. When our senses perceive danger, the amygdala in the brain becomes alert and the
sympathetic nervous system is activated, getting the body ready for strenuous physical activity - “fight or flight”. It’s an evolutionary survival mechanism.

As the body tries to take in more oxygen to allow for immediate physical activity, the breathing quickens. The body also releases hormones, such as adrenaline, causing the heart to beat faster and the muscles to tense up. Sweating begins, to prevent overheating. The mouth may feel dry as the digestive system slows down to allow more blood to be sent to the muscles. The senses become heightened and the brain can seem to “white out”.

These physiological changes make the body ready and able to take action and so protect a person in a dangerous situation either by running away or by fighting. But, because most of the situations that we face do not actually require us to fight or run away, immediate strenuous activity rarely ensues. The excess adrenaline is, therefore, not immediately used and its effects only gradually subside, potentially leaving a person feeling agitated and anxious for a long time.


• Genetic predisposition.
• Sex: women are twice as likely as men to suffer panic attacks, menopausal or pregnant women
being more likely to experience panic attacks than anyone else.
• Physical response to certain medication/medical withdrawal.
• The amygdala can become hyper-sensitive and activate the “fight or flight” response seemingly
habitually, even in non-threatening situations.
• An over-active thyroid gland (Hyperthyroidism)
• Low blood sugar level (Hypoglycemia)

• Not dealing with stresses as they arise, allowing them to build up thus developing a sense of
being out of control.
• Stimulant use: amphetamines, cocaine, alcohol and caffeine.

Despite the above possible biological and behavioural causes of panic attacks, the predominant causes are cognitive.

During a panic attack we typically first become aware of intense physical sensations that generate those feelings of terror and panic, before we consciously understand why. But, those physical sensations do not occur all by themselves. They are driven by the senses perceiving a threat. That perception of a threat activates the amygdala that automatically switches on the sympathetic nervous system that produces the “fight or flight” physical symptoms.

So, what is of importance here is to begin to identify what it was that was perceived by to be a threat and why the mind perceived it to be a threat.

There are so many factors that play a part in determining what a person might perceive to be a threat, and they all centre on specific beliefs that are held by an individual about themselves, their abilities and about their safety in the world around them. (Refer to the Core Beliefs Audit).

For example: if a person has formed the belief that they are someone who has panic attacks, experiencing a panic attack generally becomes a self-fulfilling prophecy. If a person lacks self-trust when facing certain situations, panic can ensue. If someone has an approach to life that tells them that life happens to them rather than they being in control of it, panic often follows. And so on.

Plus, memories of past panic attacks can cause a fear of one re-occurring. This fear/negative anticipation can, by itself, generate a panic attack.


1. Educate yourself about what a panic attack is – when you understand what is generating it, you know that you can learn how to control it.

2. Learn how to control your breathing; breathing in through the nose for the count of 5 and breathing out through the nose for the count of 7 (the extended outward breath switches on the parasympathetic nervous system – the relaxation system). When you breathe your shoulders should remain still whilst the diaphragm rises and falls with each inhalation and exhalation. Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. Deep breathing, on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you develop a coping skill that you can use to calm yourself down when you begin to feel anxious. If you know how to control your breathing, you are also less likely to create the very sensations that you are afraid of.

3. Deal with stresses as they arise, and do not allow them to build up.

4. Begin to define yourself as someone who used to experience panic attacks rather than someone who has them.

5. Understand that panic attacks are not “the enemy” – far from it; they’re trying to help you. Address the fear of the fear of having a panic attack and remember that, even though it may well feel as though you’re going to die, you are not. It’s simply your mind attempting to help you survive a perceived danger by going into “fight or flight” mode.

6. Address any other unhelpful core beliefs you have around panic attacks, around yourself, your abilities and your general safety in the world, and transform them into something far more beneficial for you (refer to the Core Beliefs Audit).

7. On a daily basis, practise relaxation techniques to strengthen the body’s relaxation response - the opposite of the stress response involved in anxiety and panic.

8. Visualise remaining calm in situations that would, in the past, have generated a panic attack. When the mind imagines a specific situation, the body behaves/reacts as though it’s really happening. So, in a safe environment, through mentally rehearsing remaining calm in past trigger situations, the body gets used to responding calmly.

9. General health hygiene: exercise regularly, eat healthily, stop taking stimulants such as amphetamines, cocaine, alcohol and caffeine, and get plenty of good quality sleep.

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