Coping with panic attacks.

What a panic attack actually is

A panic attack is a sudden, intense surge of fear with very strong physical symptoms. Racing heart, breathlessness, chest tightness, dizziness, a feeling of unreality, a powerful sense that something terrible is about to happen.

It feels like a heart attack. It feels like you are dying. It feels like you are losing your mind. None of these are happening. A panic attack is your fight-or-flight system firing at full intensity in the absence of any actual threat, which is alarming precisely because there is no obvious cause.

The most important thing to know: panic attacks are not dangerous. The peak passes within around 10 minutes. The whole episode is usually over within half an hour. Your body cannot maintain that level of alarm indefinitely. It will end.

Why fighting them makes them worse

Most people respond to a panic attack by trying to stop it. This is completely understandable and almost always backfires.

The fight makes the physical sensations worse, which feeds the fear, which makes the sensations worse, which feeds the fear. This is the panic spiral.

The counterintuitive route, supported by panic-focused CBT research, is to stop fighting. Not to give in, but to stop adding fuel. When you can say "okay, this is a panic attack, it will pass, I am not in danger," the spiral loses its energy. This takes practice. It is also one of the things that genuinely works.

After the attack: what to do in the next hour

Once the worst has passed, the most useful thing is not to immediately analyse what happened. Your nervous system needs a wind-down.

• Drink water slowly. Your body has been through something physical.
• Find somewhere quiet. Lying down is fine.
• Don't try to "carry on" immediately. Give yourself an hour.
• Don't reach for caffeine. It mimics anxiety symptoms and can trigger another attack.
• If you can, message one person. You don't need a deep conversation. You just need to feel less alone.

The pattern over weeks

If you've had one panic attack, you may have another. This isn't a sign of weakness or that something is seriously wrong. It is how panic disorder often develops: the fear of having another attack becomes its own trigger.

The most evidence-supported approach to interrupting this pattern is panic-focused CBT, which includes a technique called interoceptive exposure. Carefully, with a therapist, you deliberately bring on some of the physical sensations (e.g. spinning to feel dizzy, breathing fast to feel breathless) and learn that the sensations are not dangerous. This breaks the fear-of-the-fear loop.

This is not something to do alone from a self-help page. But it is worth knowing that very effective treatment exists.

What to stop doing

Caffeine, particularly. It mimics the physical sensations of anxiety and can trigger attacks. Alcohol, particularly the rebound the next day. Avoiding places where you've previously panicked, which over time shrinks your world. Lack of sleep.

None of these cause panic on their own. All of them make it more likely.

When to get help

One panic attack is not a reason to panic about panicking. Several over a few weeks, particularly if you are starting to avoid places or situations, is a reason to seek support. CBT for panic has strong evidence and is often relatively brief. Your GP can refer you, or you can self-refer to NHS Talking Therapies, or you can come and talk to us.

If you'd like to talk to someone, our therapists are here. Get in touch when you're ready.