A Practical Guide For Getting Through Panic Attacks
Panic attacks are brief episodes of severe anxiety accompanied by physical symptoms like sweating, shakiness, chest pain, shortness of breath, or tingling sensations. These attacks can occur independently for no apparent cause, due to an inciting event, or as a symptom of a mental illness like panic disorder.
If you're experiencing panic attacks or want to know what to do if you ever have one, there are a few ways you can manage anxiety, control your nervous system, and regain control of your body. You're not alone, and it can be possible to find relief from these attacks, including while they occur.
Panic disorder: Physical symptoms of a panic attack
Panic attack symptoms are generally categorized under panic disorder, a type of anxiety disorder. While the physical and emotional symptoms can vary for each person, panic attacks tend to present similar sensations for many people.
Below are common symptoms of anxiety and panic attacks:
Rapid breathing
Dry mouth
Sweating
Agitation or irritability
Chills or hot flashes
Feeling dizzy, lightheaded, or tight in the head
Shaking or trembling
Heart palpitations (skipping a beat)
Increased heart rate or pounding in the chest
Tightness, pain, or discomfort in the chest
Feeling short of breath
A lump in the throat or a choking sensation
Nausea (or vomiting)
Numbness or tingling
Feeling frozen or unable to talk
Racing thoughts
Difficulty concentrating
Depersonalization or derealization (feelings of unreality and detachment)
Fear of losing control
Fear of dying
Fear of other people seeing your panic attack in public
Many people report that their panic attacks don't seem to have a cause or specific trigger. Others, however, can identify their anxiety symptoms or potential triggers ahead of time (e.g., negative thought patterns about fears of interacting with certain people).
Regardless of whether there is an identifiable cause, many people report that panic attacks feel like they’re on the verge of having a medical emergency like a heart attack. Others may attach a spiritual meaning to the experience.
What causes panic attacks?
The source of a panic attack can vary. In some cases, they may occur due to a traumatic event, chronic stress, or panic disorder. However, there might not be a source for every person.
A systematic review from 2019 indicated that individuals who experience strong responses to stress may be at a higher risk of having panic attacks.
When stress occurs in the body, it can activate the "fight or flight" response of the sympathetic nervous system. The body releases stress-related chemicals that can cause an increased heart rate, increased blood pressure, flushed skin, a blunted pain response, dilated pupils, and loss of bowel and bladder control. The parasympathetic nervous system returns the body to its original state. If it does not respond appropriately, the aroused "fight or flight" feeling lasts, potentially extending a panic attack.
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How to get through a panic attack alone
Through years of research, mental health professionals have learned how to treat panic attacks. Panic attacks are highly treatable and not life-threatening.
By understanding this fact, you may be able to reduce feelings of panic when you feel them arising.
However, in the short term, you can use a few strategies designed to reduce stress to begin to calm yourself. After identifying which coping strategies and treatments work for you, you can learn how to potentially prevent these episodes from occurring.
Recognize you are having a panic attack
To control a panic attack, it may be beneficial to acknowledge that you are having one. Notice the sensations you feel and recognize that they are signs of a panic attack. If you have had a panic attack before, you can remind yourself of previous times you had a panic attack and thought it might be something else.
If you're having trouble breathing or feeling unreal, tell yourself internally or externally that you're experiencing a panic attack and that it will pass. You might try some breathing exercises and breathe slowly to calm your sympathetic nervous system and help it recognize that you’re not in any real danger. This may be enough to begin to reduce tension and anxiety symptoms so your panic attack is more manageable.
Remember that a panic attack is not life-threatening on its own. Panic attacks often pass quickly, and your nervous system may return to baseline. Repeat these facts as affirmations to de-escalate the intensity of your panic.
Drink water
Once you recognize you're having a panic attack, have a few sips of water. Drinking water relieves dry mouth and can help support your body's return to homeostasis by stimulating your parasympathetic nervous system. Additionally, putting cool or chilly foods or drinks in your mouth may ground you in the present moment.
Take deep, slow breaths
Many guides that explain how to treat a panic attack include a section on deep breathing. While deep breathing can help some people immediately, it can increase anxiety for others. If you are well-practiced in deep breathing, using that skill may remedy panic attacks. However, it may not be the immediate solution for you if you do not have much experience with breathing exercises before experiencing your panic attack. Without guidance, you may hyperventilate.
Many tools can help you with deep breathing. If you're a visual learner, you could watch visual deep breathing guides. If you prefer to be guided by someone auditorily, many guided breathing exercises are available for free through music apps, video streaming sites, and other online locations.
Get moving
Moving your body may also help you reduce panic, as panic attacks sometimes cause people to "freeze" in place. Try some light exercise and throw your sneakers on for a few laps around your kitchen, doing jumping jacks, or dancing to your favorite music. Aerobic exercise can be beneficial to building resilience in the long term, but it has short-term benefits, too. Exercise can release pent-up physical energy, as it works alongside the adrenaline rush your body experiences during a panic attack.
Ground yourself
When experiencing a panic attack, you might experience dissociation (feeling unreal or detached from your body). Even if you are not experiencing depersonalization or derealization, grounding exercises may help you feel present and in control of your thoughts and bodily sensations. Below are a few potential grounding techniques:
Drinking cold water
Deep breathing exercises
Exercise
Walking outside barefoot
Smelling a strong scent like vanilla extract, or an essential oil
Receiving physical touch like a hug or back rub
Observing and stating out loud the names of five different items in your environment
Picking a color and naming every item of that color in the room
Holding an ice cube
Putting your face in cold water to "reset" your nervous system
Swimming or taking a shower in cold water
Listening to a guided progressive muscle relaxation technique video to relax your whole body
Practicing cognitive behavioral therapy techniques alone, with a therapist, or between therapy sessions
Return to your routine
After grounding yourself, try to return to whatever task you were doing before the panic attack occurred. If you can't focus on your routine, focus on another task. Refocusing your thoughts on an external activity may prevent you from ruminating on the discomfort you have experienced. However, if you are exhausted after the attack, you might also try taking a nap to replenish your energy.
Connect with others after the fact
It might also be helpful to talk to a trusted friend or loved one to let them know what happened if they were not present for the attack. Connecting with other people could help you feel present after a panic attack. They may also offer validation and support to help you return to regular activities.
Eat a snack
Try to have a snack during or after your panic attack. You can replenish your energy with a tasty and nutritious treat. In addition, experiencing the sensation of taste could be a form of mindfulness or grounding. If you struggle to gain the energy to cook, go for a walk, shop, clean, or order food (if you can afford to).
Can medications help with panic attacks?
Some healthcare professionals may prescribe medications to reduce anxiety symptoms. For example, you may be prescribed benzodiazepines for short-term management.
Always discuss the potential side effects of a medication your doctor prescribes. The benzodiazepine drug class carries a boxed warning because of the risk of addiction* and withdrawal when you stop using them.
*If you believe you or a loved one is experiencing or at risk of addiction or substance use disorder, reach out for help immediately. The SAMHSA National Helpline can be reached at 1-800-662-4357 and is available 24/7.
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Address panic attacks in a safe and non-judgmental environment
Counseling and professional support for long-term panic attack prevention
Seeking professional help may offer you the tools to cope with panic attacks and prevent future episodes. Through therapeutic methods, you may build coping skills and resilience. Your therapist can teach you how to decrease catastrophizing thoughts and help you determine whether you are holding onto thoughts based on specific fears or phobias. As you work through these symptoms, you may also learn to restructure your thought patterns and sit through the discomfort of anxiety until it passes.
In addition, if you're living with a mental health condition like panic disorder or post-traumatic stress disorder (PTSD), these conditions may contribute to panic attacks. You can work through a treatment plan for symptoms with your therapist. If you're living with panic disorder, online therapy through a platform like BetterHelp may make it easier to get help without leaving home. With online therapy, you meet with your therapist from the comfort of your home, or anywhere you have an internet connection.
Research shows that online treatment can be effective in treating panic disorder. One review reported that internet-based modalities were as effective at relieving symptoms as in-person therapy, and another review showed they could reduce symptoms by as much as 50%. When you sign up for an online platform, you can take a questionnaire about your symptoms and get matched with someone specializing in your condition or therapeutic goals.
Takeaway
How do I overcome panic attacks alone?
Panic attack symptoms can be frightening, especially if you are alone when they occur. If you’ve found yourself wondering how to get through a panic attack alone, it can be helpful to familiarize yourself with the following strategies:
- Name what’s happening: If you’ve experienced panic attacks before, you’re probably familiar with the symptoms you encounter during them, such as a racing heartbeat or dizziness. When you are having a panic attack, however, you may experience a sense of dread or doom about your symptoms. Remind yourself that you’re experiencing symptoms of a panic attack, and you will be okay.
- Remember that it will pass: When you’re having a panic attack, it may seem like it will last forever. However, most panic attacks last for 30 minutes or less, and you will get through it.
- Practice breathing exercises: Many people hyperventilate (breathe quickly) when they’re having a panic attack. Deep breaths can help you counteract this. Try the 4-7-8 breathing exercise by breathing in through your nose for four seconds, holding for seven seconds, and breathing out for eight seconds. Many people find a few repetitions of deep breathing can relieve anxiety.
- Give yourself a butterfly hug: Wrap your arms around yourself and tap each shoulder one at a time with the opposite hand. You can sync your tapping with a breathing exercise if you want. This technique is frequently used to address distressing or traumatic experiences during eye movement desensitization and reprocessing (EMDR) therapy.
- Get grounded: Mindfulness can help center the present moment, which can be helpful if you’re experiencing dissociation or detachment. Try petting your dog, running your hands over a soft blanket, or touching the floor with your toes. Focus on the physical sensations you feel when you do this. For example, if you’re touching the floor with your feet, consider how the temperature of the floor feels, whether it’s smooth or rough or if it is soft or hard. Focusing on the five senses (sight, smell, touch, hearing, taste) can help you slow down your thoughts and stay present.
What is the 333 rule for panic attacks?
The rule of three, or “333 rule,” is a grounding strategy that can be utilized for panic attacks. The approach involves looking at your surroundings and focusing on:
- Three things you see: Become visually aware of your surroundings. You can take notice of anything, such as a chair, a rug, or a doorknob.
- Three sounds you hear: Do you hear a bird cawing or a car driving by? Maybe you’re in a public space and you hear the sound of people talking or shuffling papers?
- Three things you can move or touch: You may move your limbs or touch physical objects within your reach, such as a blanket, something in your pocket, a pencil, or your shoelaces.
Mindfulness and grounding techniques such as the 333 rule help you focus on the five senses and quiet, racing internal thoughts.
What triggers panic attacks?
There are many things that can trigger panic attacks for different people. Common triggers include:
- Chronic or intense stress
- Sudden changes in the environment
- Financial stress
- Traumatic events
- Interpersonal conflict
- Poor sleep quality
- Excessive caffeine intake
- Illness
A panic attack is an intense fear response (also called a “flight-fight-freeze” response) that occurs when there isn’t actually a serious danger or threat present. Though most panic attacks are not physically dangerous, they can be very frightening and intense, which leads many people to avoid certain situations in an attempt to prevent panic attacks. For example, you may avoid restaurants, school, or the doctor's office if you’ve had panic attacks in those locations before. Phobic avoidance, while understandable, can make panic attacks worse over time, impact self-confidence, disrupt daily life, and contribute to the development of panic disorder. If you’re experiencing frequent or disruptive panic attacks, it’s a good idea to speak with a licensed mental health professional or medical practitioner.
How scary are panic attacks?
Panic attacks cause gripping fear and intense worry. Many people describe feeling out of control, like they’re having a heart attack or as if they’re going to die. These fears can drive even more stress and panic. Though panic attacks are not physically dangerous, they can be extremely distressing and cause frightening physical symptoms. Sometimes, symptoms are severe enough that people experiencing a panic attack go to the emergency department.
If you are experiencing symptoms of a panic attack for the first time or you’re worried about your health, it’s important to see a medical provider. A doctor will ask about your physical symptoms, psychological symptoms, and any other symptoms you’re experiencing. They may order blood work or an EKG to rule out other conditions. A medical professional may prescribe medications such as benzodiazepines to help manage panic attacks in the short term.
How long can panic attacks last?
The majority of panic attacks last for 5-20 minutes. However, there are some instances where panic attacks can last for an hour or where people experience several panic attacks back-to-back. Symptoms typically arise suddenly, peak within 10 minutes, and then slowly subside.
Many people find that deep breathing exercises, meditation, talk therapy, and medications can help reduce the frequency, severity, and duration of panic attacks.
How do I let go of anxiety?
When you’re experiencing racing thoughts, worry, or dread, try the following techniques:
- Get regular exercise: Routine exercise can improve symptoms of anxiety and depression. Try aerobic exercises like 30 minutes of brisk walking or jogging three to five days per week.
- Validate your feelings: When you experience anxiety, your body is communicating with you. Don’t try to ignore your symptoms. Instead, recognize that you’re experiencing a bout of anxiety but that these feelings will not last forever.
- Release tension: Stretching can connect you to your body and environment, relieve muscle tension, and complement deep breathing exercises.
- Know that the feeling won’t last forever: Though you might not be able to stop a panic attack on demand, you may find it comforting to remember that this is a biological response to a trigger that will subside (usually within 10 or 15 minutes).
- Learn about your biology: Once panic attacks start, the brain goes into overdrive. Your amygdala sends a signal to the hypothalamus, which promotes the release of anxiety hormones (cortisol and adrenaline) and increases your heart rate. This is called a flight-fight-freeze response, and it can be very difficult to think rationally once it’s been initiated. However, by learning more about panic attacks, you can walk yourself through your symptoms, which can be reassuring. For example, if you’re feeling light-headed, you could remind yourself: “I’m feeling light-headed because my blood is being redirected to my limbs. I’m breathing hard because my body is responding in an evolutionarily honed way to adrenaline. Everything my body is doing right now is designed to keep me safe and safeguard me.”
What is the 54321 rule for panic?
The 54321 method is a grounding technique similar to the 333 rule. To practice the 54321 technique, focus on:
- Five things you see: What do you notice around you? Furniture? Blankets? A computer? Cleaning products? Plants? Take note of five things, focusing on their shape, color, and other details.
- Four things you can move or touch: Notice how things like your jeans, nails, water bottle, or pencil feel when you touch them.
- Three things you hear: Do you hear your pet breathing? Your neighbor listening to music? An AC unit running? Leaves rustling in the wind? Try to hone in on quiet noises, instead of loud, potentially overstimulating ones.
- Two things you smell: Spray a perfume, diffuse an essential oil, open a fresh pack of gum, or find another scent you enjoy.
- One thing you taste: Have a bite of food, brush your teeth, have a sip of a drink, or chew some gum and notice how it tastes. Does it have a sweet, spicy, sour, bitter, salty, and/or umami taste? What is the texture like? Is it hot or cold?
What is the 5-5-5 rule for anxiety?
The 5-5-5 method is a simple breathing exercise. To practice it, breathe in for five seconds, hold your breath for five seconds, and breathe out for five seconds. Complete a few repetitions, which itself can be helpful, or use it to prepare yourself for the 54321 method or the 333 rule.
Do you cry during panic attacks?
Many people cry before, during, and/or after a panic attack. Some common symptoms of a panic attack include:
- Fearing death or an impending doom
- Intense worry
- Racing or pounding heart
- Heart palpitations
- Feeling out of breath
- Hyperventilation
- Numb or tingling sensations in hands
- LIght-headedness
- Chest pain
- Weakness or dizziness
- Sweating
- Gastrointestinal distress
- Chills
- Trembling
- Crying
- Feeling immobile
- Intense fatigue
- Dry mouth
You are not alone, and your panic attacks can get better. Therapy can help you address distressing symptoms and avoidance if fear controls your life.
Can lack of sleep cause panic attacks?
Anxiety and sleep impact each other bidirectionally, meaning anxiety can contribute to poor sleep quality, and poor sleep quality can contribute to anxiety. The following strategies can help improve your sleep quality:
- Get in the zone: Calm, relaxing, repetitive tasks can help slow down the mind and relieve background stress before you go to bed. This might include counting sheep, reading a book, practicing breathing exercises, or following through a gentle yoga routine.
- Reduce caffeine intake: Excessive caffeine intake can trigger panic attacks and disrupt sleep cycles. Consider reducing the amount of caffeine you consume and only consuming caffeinated products in the morning so they are no longer in your system by the time you go to bed.
- Have a bedtime routine: A consistent bedtime routine can help you fall asleep more easily. For example, you could brush your teeth, put on pajamas, stretch for five minutes, and then read in bed for 15 minutes each evening.
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