What to Do When Panic Attacks

“You will not be cured from panic attacks until you are no longer afraid to have one.”

Panic attacks are extremely prevalent, and are interestingly one of the main causes for ER visits (mistakenly thought of as experiencing a heart attack). The timing and cause of a panic attack can be seen in two distinct ways - the first way more obvious in it’s etiology, and the second way in a more unrecognized manifested way. Usually stemming from stressful situations in a person’s life, panic attacks are simply our body’s physical reaction to something we are enduring emotionally - intense stress, feeling overwhelmed, feeling trapped or out of control, or built up emotional tension. One does the best they can to endure a stressor, until they, well, can’t anymore. You’ve hit what I call, the “emotional wall”. Mid stressful event, your body goes into panic attack mode. On the other hand, the unrecognized manifestation of the occurrence of an attack is what I see more frequently in my office - We as humans do a fantastic job at “avoiding” or distracting ourselves from the difficult truths and emotions that we end up shelfing to get through our day. During idle time or when one finds themselves with no distraction, this can serve as a vulnerable time to experience an attack. Another way panic attacks arise is when we are triggered by something in our environment that we may or may not have realized until that very moment, was a trigger. (Think large crowds, seeing a certain person, hearing a certain story, feeling trapped, Costco, remembering a bad memory, etc). BTW, I have never heard a positive Costco story from a patient. If you want to face your anxiety triggers like a gangster, I highly recommend a membership…

What To Do

The quote above really is legit in terms of getting these bad boys under control. If you’re not afraid of them, they start to lose their power of you, hence subside in frequency, intensity, and duration. Here are some tips:

1) Recognize The Symptoms For Yourself

  • Overwhelming sense of being out of control

  • Increased heart rate

  • Chest pain

  • Heart Palpitations

  • Faster, shallow breathing, or hyperventilation 

  • Shaking

  • Tingling in the limbs

  • Dizziness

  • Sweating

  • Dry mouth

  • Decreased concentration

  • Unable to think clearly

  • Nausea

  • Tunnel vision

Most likely, you’re not dying, I promise. These are common indications of a panic attack and while in the heightened moment, it’s difficult NOT to think something awful is happing to you, is often times the fear of the symptoms of panic themselves that prolong and worsen the experience. “You start to get anxious about your anxiety”, is something I validate to my patients. Break this cycle of fear, break the cycle of panic attacks. One of the best things you can do in those moments is supportive self-talk acknowledging, “these physical things Im currently feeling, while uncomfortable, are my body telling me Im stressed. Im safe, this will pass, no feeling is ever final”. BTW, a person cannot endure a true panic attack for more than an hour. The average time is about 20 minutes.

2) Understanding and Reminding Yourself What’s Going on and Why

You are under a great deal of stress and your body is telling you this. A part of the brain (called the hypothalamus) is responsible for setting off a response in your body that is meant to protect you (the Fight or Flight or Freeze Response). For example, when you see a tiger running after you, your brain initiates the Fight or Flight Response so that you can do what you need to do to survive. In order to survive in a dangerous situation, your body has to be prepared for it - your heart will beat faster, your breathing will change, your blood flow shifts locations, you’re not thinking about anything else except how to survive, you can become nauseas, you sweat…. does this sound familiar?!  The stress in your life is that tiger causing your brain to have a panic attack.  Though scary, these symptoms are not dangerous. They are completely understandable, safe, and can be controlled.


Generally with a panic attack something will trigger the attack which you will probably be aware of. If nothing is obvious it will normally be obvious if you think about it.  For example if you are having several panic attacks a day, then in my experience, you are so sensitized your body may trigger one anytime.  Not looking after yourself and not eating regularly can also set off panic attacks for no reason.  Studies have shown that a high sugary diet and caffeine can trigger panic attacks.  Situations which are similar to what causes your panic attacks can trigger an attack. So if social interaction is a trigger and you were to meet a relative, even though you’re comfortable with this person, the brain can interpret this as social contact and anxiety can be triggered.    


3) Know Your Vulnerabilities to Having Panic Attacks

  • Your own, individual triggers (i.e. stressful situations, places, people, objects, etc)

  • If you carry the perception that anxiety is harmful

  • Are more attuned to somatic sensations in your body

  • Having a biological vulnerability to anxiety and/or depression

  • Sleep deprivation

  • Not allowing yourself to process recent stressful events

  • Caffeine and sugar

  • Having heightened fear situation anticipation, thus making the anxiety worse

4) Behavioral Interventions

a. Breathe - breathing is everything. Of particular interest, do slowww, deeeep exhales. Your heart rate slows down this way. Slow breathing literally short circuits the Fight/Flight/Freeze response by turning off the “time to fight or flee yo!!” system (the sympathetic nervous system) and instead turning on the “chill out” system (the parasympathetic nervous system). Just by breathing, you can prevent or calm down the panic attack. Don’t over-breath (the quick and shallow breathing you do when anxious) can cause or maintain panic and anxiety.

b. Distraction and the Grounding Technique - This is by far my favorite tool. Distraction is one of the key tools which can help reduce the strength of a panic attack.  However the distraction has to be of a strength to totally take the persons attention somewhere else.  The Grounding Technique can be a very helpful distraction. Simply use your five senses (be neutral to positive in content) to take your mind and body away from the attack:   

  • What are seeing in your environment right now? (Get as detailed as you can - colors, shapes, etc)

  • What sounds do you hear?

  • What does the temperature feel like, what does the seat feel like, how do your clothes feel?

  • What smells do you smell? Do you have a scented lotion on you? Take it out and smell it and describe to yourself what it smells like.

  • What taste do you have in your mouth? If you have access to a beverage, take a sip and describe to yourself what the flavors taste like.

c. Relaxation Techniques

Muscle tension can cause or maintain panic and anxiety. You cannot be relaxed and have a panic attack at the same time. It is physically impossible. So, relax your body:

5) Cognitive Interventions: Identify and then Challenge the Panic Attack Thoughts

Yes. I realize that in the beginning or in the midst of an attack, you’re not going to be able to think straight and do cognitive interventions - “hold on, lemme journal real quick about my thoughts and feelings as Im currently losing my shit…” So think of this section as some preventative work to help set you up to use it when you need it in the moment. The underlying basis for panic attacks can often be one’s (inaccurate) thoughts.  1) identify these inaccurate thoughts, and then 2) correct or remove these thoughts.

  • 1. You have to identify what thoughts are triggering panic and anxiety. Everyone is unique, but most panic attack sufferers will tend to fear the same issues - “This is dangerous”, “What is going on with my body”, “I am afraid to have a panic attack”, “I need to avoid stressful situations to get through this”, “I have to leave this situation to get through this”, “People are going to think I’m crazy”, “Im going to look stupid”. As you identify these thoughts, you may find that nearly all the thoughts are being exaggerated in your mind to be out of proportion or simply false.  If you analyze them you will find they are unnecessarily scary and in fact, inaccurate.  Once the thoughts have been identified and targeted you can really begin to fight back and start taking back the control. 

  • 2. Challenge your thinking. In order to do this, you need to make this as simple and effective as possible.  Take the thought you’ve just identified -“Im not going to be able to get through this attack if it happens”, and argue how it’s NOT true: “this is simply an indication that Im having a stressful moment, Ive gotten through this before, nothing bad happened in the previous times, this attack will stop just in a matter of time like it always has”.

You. Have. Control.

6. Keep Your Perspectives in Check

You may have thought during a panic attack that this was surely the time you were actually going to keel over and die. How many times have you actually died so far though? Probably not very many times I would assume. A panic attack does not kill you. So, you can deduce from the above evidence your thoughts are not accurate.  

The more you worry the more powerful your anxiety will be.  The less power you give your negative thoughts the more you can enjoy life again. If you believe you have panic disorder and you understand it cannot harm you, then every sensation can be systematically taken apart and challenged.  You can then start to desensitize yourself and gain your life back.  Slowly but surely, the panic attacks will be less severe and further apart.  The background anxiety (your “trait anxiety”) you walk around life with will begin to lessen, and situations which you once enjoyed will start to feel good again.

Panic attack sufferers have much more negative thoughts than normal people, and tend to loose a grip on the reality of certain situations.  The feared disaster is often not as bad as we first think.   Negativity Bias, I’ll write about this some other time.  Quite often we see things as a catastrophe when they are merely unpleasant.  For example, if we fainted at work it would not mean that the whole company was laughing at you.  Many people faint at work and although it’s an inconvenience, its not a life changing event.  If you think of embarrassing things that may have happened to you in the past they may have been distressing, but looking back were they really that bad?  Most people would feel sympathy and try to help you. About 1 in 4 people will suffer from some sort of mental illness with the most common being depression.  The chances are your boss will have experience with this and will be understanding. 

Speaking of disempowering the fear of fainting during a panic attack -  Sometimes people do faint. It’s a fact of life.  People typically faint when their blood pressure drops and it reduces the blood supply to their brain.  You often hear about soldiers fainting on parade when they have been stood up a long time.  This is because they are hot and their blood supply is being directed around their skin to try and cool them down. This means less blood supply for the rest of the body.  In these conditions the blood pressure may drop to the brain and the body takes over.  In ‘taking over’ it makes you faint so your lying down and your brain and heart are at the same level, so its less work for the heart to pump blood to your brain.  Its actually a safety mechanism and its there to help you.  It is not something to be feared.  In the case of panic when your heart beats faster and adrenaline is pumped around the body your blood pressure actually raises, this makes the likelihood of fainting extremely hard to do.  Panic and fear has the opposite effect on the body because its priming you to run, not to lie down.  

7) Practice Makes Perfect

Practice slow breathing, grounding, progressive muscle relaxation, mindfulness, and thought correction when you’re calm. The more you practice, the easier it will come to you when you actually need it because you’ve turned this into a habit. But be patient, this can often take time as thought processes and relaxation behaviors take time to feel natural.  And, eventually your subconscious mind will naturally be calm. 

You’ve got this.


Jessica Bergstrom