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A panic attack is an exaggeration of the body’s normal response to fear, stress or excitement. It is the rapid build-up of overwhelming sensations, such as a pounding heartbeat, feeling faint, sweating, nausea, chest pains, breathing discomfort, feelings of losing control, shaky limbs and legs turning to jelly. If you experience this, you may fear that you are going mad, blacking out, or having a heart attack. You may be convinced you are going to die in the course of the attack – making this a terrifying experience. The most important thing to remember is that, however dreadful you may feel during an attack, this is not going to happen. The bodily effects of panic attacks, such as breathlessness, are just part of the panic. If you would like further reassurance contact us
Panic attacks come on very quickly, symptoms usually peaking within 10 minutes. Most panic attacks last for between 5 and 20 minutes. Some people report attacks lasting for up to an hour, but they are likely to be experiencing one attack after another or a high level of anxiety after the initial attack. You may have one or two panic attacks and never experience another. Or you may have attacks once a month or several times each week. For some people they seem to come without warning and strike at random. This is one of the most distressing aspects of suffering from panic attacks – they may seem completely unpredictable, and therefore uncontrollable.
Panic attacks can also come in the night and wake you up. These night time attacks occur if your brain is on 'high alert' (due to anxiety) and can detect small changes in your body which it then interprets as a sign of danger. Night-time attacks may be particularly frightening, as you may feel confused and are helpless to do anything to spot them coming.
When faced with a situation seen as potentially threatening, the body automatically gears itself up for danger, by producing quantities of adrenalin for 'fight or flight'. This would have prepared our cave-dwelling ancestors to fight or run away from danger, but it’s much less appropriate to the stresses we encounter today.
Adrenalin has the following effects on your body:
These reactions occur in a matter of seconds, and can happen in moments of pleasurable excitement, as well as in fear-provoking and threatening situations.
When adrenalin floods your body, it can cause a number of different physical and emotional sensations that may affect you during a panic attack.
These may include:
A high level of adrenalin is not in itself a bad thing. It can give you the extra energy to deal with difficult demands and challenges. The damage is done when the levels of adrenalin don't fall, naturally, after a stressful event. Stress becomes prolonged and tension becomes a habit.
For many people, their first panic attack comes out of the blue and creates a state of arousal. You may find yourself becoming more nervous, impatient and irritable as you feel, understandably, apprehensive about having another attack.
If you experience panic attacks over a period of time, you may develop a fear of fear. Because you have become hyper-aware of the sensations associated with fear - sensitised to them - you tense up whenever anything at all reminds you of the original panic. This can include your own bodily sensations. So someone feeling hot, or with sweaty hands (perhaps because they are in a meeting in a warm room), may assume, automatically, that they are in for another panic attack. Anticipating this makes them tense up and produces the very panic response they feared.
You may start to associate particular places and situations with having an attack. In an attempt to avoid another one, you may steer clear of places where attacks have previously occurred. But this may put more and more restrictions on your day-to-day activities, and could lead to agoraphobia or social phobia.
Click here to find out more about Phobias
As you feel more out of control and restrict your activities, your enjoyment of life and your self-confidence is undermined. Many people who experience panic attacks become very depressed.
Click here to find out more about depression
There are a number of reasons why you might be having panic attacks. They range from stressful life experiences, which have caused you emotional distress, to problems with your diet or your breathing.
There are many physical and psychological factors, which may be interwoven. You may experience panic only in response to a particular situation, such as flying or visiting the dentist. Or you may feel perfectly fine during a stressful event, but may have an attack later. This is because adrenalin levels don’t drop straight away. Any major life changes and events can trigger panic attacks.
Incidents in childhood, and the way you were brought up and taught to think about yourself, can make you vulnerable to panic attacks later on. If you experienced great fear at being separated from a parent, you may have gone on to develop school phobia. As an adult, you may then have panic attacks when threatened with the loss of a support system or of someone who is important to you. Adult survivors of abuse in childhood also frequently suffer panic attacks.
If you are always anxious, you are more likely to have panic attacks. Being over-critical and disapproving of yourself, and striving to conform to the expectations of others, is common in people who panic. You may have difficulties in expressing your own needs and asserting yourself.
There are a number of physical causes that could be causing or contributing to your panic attacks:
Your panic attacks are likely to make you feel out of control and dependent; the victim of your bodily reactions and outside circumstances. The first step along the road to recovery is recognising that you have the power to control your symptoms. Contact us if you would like to learn ways of managing your panic
Start by really looking, in detail, at your panic attacks. When did they happen? Where were you? What were you thinking? See if you can identify particular thoughts that trigger a panic reaction.
A number of experts have emphasised the need to accept the panic attacks when they occur and that it may in fact be most helpful if you try and ride out the attacks to learn that no harm will come to you. This may sound strange, but fighting them only increases your level of fear and allows your panic to take on tremendous proportions. Accept that a panic attack is unpleasant and embarrassing, but that it isn't life-threatening or the end of the world. By going with the panic, you are reducing its power to terrify you.
Creative visualisation and affirmations are techniques that may be helpful. You can use them to re-train your imagination and to get yourself moving in a more positive direction.
Many people who suffer panic attacks have a vivid imagination, which they use to conjure up disaster, illness and death. You can train your imagination to focus on situations that give you a sense of wellbeing. You can imagine you are in a place that symbolises peace and relaxation for you, such as drifting on a lake. You can practise this anywhere but, until you have got used to doing this, try sitting in a chair with your limbs as floppy as possible, and think of calming images.
You can use visualisation to focus on situations that you fear. Imagine the situation and speak positively to yourself: 'I am doing well', 'This is easy'. These simple, positive, present-tense affirmations are messages that you can say silently or out loud.
These techniques do not provide a quick fix. If you have been used to thinking negatively, over a long period of time, you will need to practise every day. You may then gradually notice positive changes in the way you think of yourself and others.
You may be having panic attacks because there are aspects of your life that are undermining your confidence. It may be useful to look at your family life, your job, and so on, and identify changes you would like to make. If you feel trapped in a situation, and find it very difficult to express your true feelings (to say 'no' or to set proper limits in relationships, for example), you may find assertiveness training helpful.
If you habitually clench your jaw, and your shoulders are tensed up, this will generate further stress. Relaxation techniques focus on easing muscle tension and slowing down your breathing. It helps your mind to relax.
Hyperventilation (over-breathing) commonly leads to panic attacks. Many people get into the habit of breathing shallowly, from the upper chest, rather than more slowly from the abdomen. Put one hand on your upper chest and the other on your stomach. Notice which hand moves as you breathe. The hand on your chest should hardly move, if you are breathing correctly from the diaphragm, but the hand on your stomach should rise and fall. Practise this breathing, slowly and calmly, every day.
Unstable blood sugar levels can contribute to symptoms of panic. Eat regularly and avoid sugary foods and drinks, white flour and junk food. Instead, choose complex carbohydrates, such as potatoes, rice and pasta. Caffeine, alcohol and smoking all contribute to panic attacks and are best avoided.
If you are having a panic attack, try cupping your hands over your nose and mouth, or holding a paper bag (not plastic!) and breathing into it, for about 10 minutes. This should raise the level of carbon dioxide in the bloodstream and relieve symptoms.
Other first-aid tips include running on the spot during a panic attack. If you feel unreal, carry an object, such as the photograph of a loved one, to anchor you in reality, or finger a heavily textured object, such as a strip of sandpaper. You could also distract yourself, by trying to focus on what is going on around you.
The NICE (National Institute of Health and Clinical Excellence) guidelines on the treatment of anxiety state that benzodiazepine tranquillisers, such as diazepam (Valium), are associated with a less good outcome in the long-term and should not be used to treat panic disorder. If drug treatment is used, an SSRI antidepressant licensed for panic disorder, such as citalopram (Cipramil), should be used first, and if this is not effective, the tricyclic antidepressants imipramine or clomipramine (Anafranil) may be tried instead. Antidepressants, especially SSRIs, are difficult to come off for many people, so when you are ready to stop taking them, you should always withdraw slowly.
When starting antidepressants, the side effects may include anxious, jittery feelings. The longer you are on them, the more likely you are to experience withdrawal symptoms, which can include panic attacks.
Emotional conflicts and past difficulties may lead to anxiety, which is released through panic attacks. Without realising it, you may be experiencing these bodily sensations and physical reactions as a way of avoiding painful emotions. Psychotherapy can help you to understand your present reactions in the light of past difficulties, and to overcome them.
Our thoughts have a very powerful impact on our behaviour. You may be unaware of seemingly automatic thoughts and misinterpretations that provoke attacks. This is because thoughts happen so quickly and may take the form of images and sensations, rather than words.
The way we interpret things can cause extreme distress. But it is possible to bring about a state of wellbeing by changing habitual thought patterns. If we think that our racing heart is a sign of a possible heart attack we'll be very frightened, but if we think that it is due to excitement or too much coffee, we'll feel very differently about it.
CBT aims to identify and change the negative thought patterns and misinterpretations that are feeding your panic attacks. If you are interested in this kind of therapy contact us. It’s also possible to apply self-help techniques. (See our Stressbuster page)
Many people develop a pattern of avoiding situations that have previously provoked a panic attack. They may become withdrawn and phobic. A clinical psychologist can address the problem using behavioural therapy. The therapy concentrates on encouraging you to imagine anxiety-provoking situations, at the same time as practising relaxation. You will be encouraged to confront your fears, in fantasy, and then move on to facing your fears in reality. In learning to relax and face up to feared situations, you will unlearn your feelings of panic.
Complementary and alternative therapies can be helpful when people are experiencing stress-related symptoms, anxiety and depression. They can be a useful tool in promoting relaxation and inducing a state of wellbeing.
Complementary health practitioners stress the connections between mind and body, and aren’t concerned with merely treating symptoms. There is an enormous number of different therapies: acupuncture, aromatherapy, autogenic training and homeopathy, to name but a few.
British Association for Behavioural Cognitive Psychotherapies (BABCP)
0161 797 4484
Promotes CBT and provides a list of private accredited therapists
British Association for Counselling and Psychotherapy (BACP)
01455 883 300 (general enquiries)
0870 443 5220 (to find a therapist)
Anxiety UK
08444 775 774
For those suffering from anxiety disorders
No Panic
Helpline: 0808 808 0545
Helps people experiencing panic and anxiety disorders
Mental Health Matters Helpline
Confidential emotional support and guidance – Tel. 0800 107 0160
Mental Health Matters Helpline is a confidential service staffed by highly trained and experienced Telephone Helpline Workers, offering emotional support to anyone calling. We provide information on local and national services specific to Mental Health. You do not need a diagnosed illness to call, people contact us about many different issues's such as bereavement, relationship problems, loneliness/isolation and stress. Ongoing support is available, we are also here for carers in need of support.
Live it Well
The Live It Well website provides information on mental wellbeing, and provides more information about support groups and services in your area.
Signpost UK
The Signpost UK website provides information on mental health problems, information for carers and links to local services.
Kent County Council
If you have been trying to manage your symptoms by using alcohol or drugs please visit the Kent County Council website which provides a list of services that are availiable across Kent.