Panic Attack: What To Do When It Happens

Panic attacks are a symptom of panic disorder and can occur quickly without warning, which may be scary for those who experience them. For many people, panic attacks can also be caused by an inciting event. Recognizing what incites panic attacks and employing panic-reducing strategies can often effectively control these symptoms. 

Sometimes, people experience difficulty identifying the inciting events that lead to their panic attacks. However, you can include a few mental health strategies in your routine that may help you identify the cause. One of the most productive ways to manage panic attacks and panic disorder may be stopping episodes before they happen, and there are a few tools and strategies geared toward doing so.

Mental and physical symptoms of panic attacks

Panic attacks present mental and physical symptoms outlined in the next section. They typically last between a few minutes to half an hour and present no real threat to your health or life.

How do I know if I'm having a panic attack? 

While panic attacks manifest in different ways from person to person, some common panic attack symptoms include the following: 

• Rapid heartbeat

• Sweating

• Whole body trembling or shaking

• Leg shaking

• Muscle tension

• Difficulty catching your breath

• Chest tightness or chest pain

• Nausea 

• Stomach aches 

• A sense of danger around the corner 

• Dizziness 

• Headaches

• Feeling "detached" from reality 

• Struggling to move your body or take action 

• Feeling the urge to run 

• Feeling the urge to defend yourself  

If you've experienced some of these symptoms, you may have had a panic attack. While these symptoms can be uncomfortable and unsettling, panic attacks are not life-threatening. However, if you’ve never had an unexpected panic attack and you’re having chest pain, doctors recommend going to the hospital to rule out the risk of a heart attack. 

If you have panic disorder, you may feel worried about having more panic attacks, which could cause further episodes. However, there are ways to manage anxiety and reduce the stress associated with panic disorder.  

What is panic disorder?

Panic disorder is a mental health condition that is classified as an anxiety disorder. It is characterized by recurring and unexpected panic attacks, which are episodes of intense fear, discomfort, and other anxiety symptoms. When people experience panic attacks, they may feel significant distress and fear that interferes with daily life.

There may not be any specific triggers for panic attacks – many people report panic attacks with no particular cause.

What causes panic attacks? 

A trigger is an event that causes an emotional reaction. The word "trigger" is associated with stimuli that remind individuals of traumatic events. When having a panic attack unrelated to trauma, you might refer to these events as "inciting events." A few common inciting events that might bring on panic attacks can include the following: 

• Scents

• Locations

• Specific individuals

• Tone of voice

• Abandonment 

• Fear of loss 

• A reminder of a traumatic event, like a conversation, challenging therapy session, etc. 

• Social situations

• Crowded rooms

• Phobias

• Being alone 

• Being pushed to do something you're not comfortable with 

• Being touched

Often, people can identify individuals or situations that cause stress. However, sometimes people report that they have panic attacks without cause. If you cannot identify the cause of your panic attack, it might be helpful to retrace your steps to think about what you were doing, whom you were talking to, and what you were thinking about leading up to the attack. Try to think of these causes after the panic attack, as the attack might cause you to struggle to think clearly.

Where there is tolerance, there is a chance that the individual will reach a point where they can no longer postpone the inevitable. When the stress or emotion catches up to them, they may have a panic attack.

How to cope with inciting events and triggers 

Inciting events may not always be able to be avoided. For example, you might know that seeing a particular person will upset you, so you do your best to try and avoid that person. However, they might pop up, or you may see a reminder of them online. As it can be challenging to plan for every scenario, you might constantly worry, which can increase anxiety. 

However, planning time more efficiently may circumvent specific causes of anxiety, such as heavy traffic, crowded rooms, or deadlines for school. If deadlines bring on feelings of panic, employ a proactive stance so that projects can be completed early. Many experts also suggest using tactics similar to those used in exposure and response prevention therapy (ERP) to cope with anxiety. 

The theory behind ERP is that avoiding your fears or performing compulsive behaviors can reinforce them by showing you that your fear controls you. However, by facing these fears, often alongside a compassionate therapist, you can start to see how these fears do not define you, offering a sense of confidence and resilience. 

How to know whether you are experiencing panic attacks related to trauma

Individuals who have been abused by someone from the family or romantic partner or who are survivors of violent crime or trauma may develop symptoms of post-traumatic stress disorder (PTSD). Events or individuals reminiscent of the traumatic event can bring on a panic attack. 

Removing yourself from triggering situations may help you avoid panic attacks. However, if you want to know how to treat panic attacks, it can also be helpful to confront the source of your stress, such as going to therapy to heal from a traumatic event you experienced.

What to do when a panic attack happens 

When stressors and triggers go unacknowledged and unmanaged, panic attacks may seem sudden. If possible, separate from the source of anxiety. Move to an open area, preferably where fresh air is available. If a change of location is impossible, consider closing your eyes and using visualization techniques to mentally take yourself to your happy place. You might imagine a beach, a forest, or a calming spot from your childhood. 

Try taking deep breaths and acknowledging that you are having a panic attack. It could help to recite a mantra such as "I'm safe, and this will pass." As you continue to breathe, allow your body to relax and practice deep breathing techniques, which may eventually end the panic attack.

If you struggle to control your behavior during a panic attack or feel the urge to run away, freeze, or stop talking, try to sit or lay down comfortably where you feel safe. If you have someone you trust in your life, you might let them know what helps you during a panic attack before it happens. For example, if someone talking to you while you're panicking makes it worse, you might ask them to support you without words by hugging you, offering you tea, or sitting with you until it passes. 

Managing daily stress to prevent panic attacks 

Managing daily stress through diet, exercise, and proper sleep can equip you to handle stressful events as they occur. Learning deep breathing techniques, working on challenging your anxiety by differentiating between emotional and rational thoughts, and engaging in meditation techniques can be helpful for people who have panic attacks.

Immediate coping mechanisms for panic attacks

Many people want to know how to stop a panic attack in its tracks immediately. If you are panicking, consider trying the following techniques for immediate relief. 

The TIPP skill from dialectical behavior therapy (DBT) 

Dialectical behavior therapy was developed by Marsha Linehan, Ph.D., to help individuals with profound emotional responses. One module of the DBT workbook is distress tolerance, which focuses on coping with extreme distress. The TIPP skill is one skill from this module, which is an acronym standing for the following: 

• T: Temperature 

• I: Intense Exercise 

• P: Paced Breathing 

• P:  Paired Muscle Relaxation 

To start, find a way to alter your temperature. Studies show that swimming in cold water stops panic attacks. If you can't swim, you can put your face in a sink of cold water, hold an ice cube, or take a cold shower. The temperature of a cold shower can reset your nervous system, potentially bringing you out of your panic. 

After changing your temperature, partake in a form of exercise. Swimming in cold water is one way you can combine both skills. However, you can also try running, taking a hike, running on a treadmill, or doing yoga. Exercising can increase endorphins in your brain, allowing you a mood boost. 

After you have finished the first two skills, sit or lay down in a comfortable location. Start pacing your breathing by counting on your in and out breaths. Depending on what works for you, you might count to five, eight, or ten. While breathing, you can practice paired muscle relaxation by thinking of relaxing each muscle as you breathe. Start with the muscles of your feet and move up to the top of your head, relaxing each part of your body. 

Sensory wellness skills

For many people, panic attacks occur due to sensory overload, which might be caused by loud noises, crowded rooms, or a disregard of your physical and sensory boundaries by others. When you're panicking, consider having a sensory wellness kit to use. This kit could include the following: 

• Fidget toys

• A stuffed animal 

• A weighted blanket

• A coloring book 

• Kind letters from someone you love

• A letter to yourself on how you've coped in the past

• Soothing music 

• An ice or heat pack to put on your body

• A puzzle 

• A book you love to read

• Sensory-friendly clothing (like comfortable pajamas) 

• A link to a progressive muscle relaxation guided meditation that you enjoy 

You might also add a space in your house where you can go when you panic, such as a comfortable section of your closet, a reading nook, a window ledge, or your bed. Set up this area to offer a quiet, comfortable, and personalized sensory environment to help you cope after a panic attack. 

If you often have panic attacks in public, consider bringing your sensory kit with you in a backpack or purse. 

Physical activities 

Physical activity can help release tension and take your mind off a panic attack happening in the present moment. Even going for a walk or following a relaxing guided yoga video from your living room can help you begin to ease out of a panicked state. 

Regular exercise can also reduce anxiety symptoms in the long-term, so you may want to consider introducing a workout routine like aerobic exercise into your daily life. 

Can medication help reduce symptoms of panic attacks?

Some healthcare professionals will recommend medications to manage and reduce tension, anxiety, and other symptoms. 

If your doctor prescribes medication, always discuss potential risks you should be aware of. For example, the benzodiazepine drug class comes with a boxed warning regarding the risk of physical dependence.*

Counseling options 

If you are struggling with panic attacks and don't find the above strategies beneficial, consider contacting a professional for support. A licensed therapist can gather a history of your symptoms and come up with an individualized plan for you to employ to address your anxiety and panic. If you are worried about meeting a therapist in person, you can also consider online therapy. 

Through an online therapy platform like BetterHelp, you can be matched with a therapist with experience treating anxiety and panic disorder. If you discover your therapist is not a match, you can switch therapists until you find a provider that meets your needs. In addition, online therapy can allow you to choose between phone, video, or chat sessions, which can be beneficial if you are worried about talking to someone face-to-face. 

An increasing number of studies have shown that internet-based cognitive behavioral therapy or CBT can significantly reduce the number of panic attacks someone has, as well as symptoms of anxiety and depression. Cognitive behavioral therapy is a framework that teaches people to replace unhelpful thoughts with helpful and productive ideas and beliefs using grounding techniques.