Why do panic attacks happen and how can you treat them?

Panic attacks, a frightening combination of physical and psychological symptoms, are extremely unpleasant and can happen to anyone.

“It is estimated that most people will experience at least one of these out-of-the-blue attacks at some point in their life,” says clinical psychologist Dr Andrea Reinecke.

However, Dr Lynne Green says that some people may be more susceptible to panic attacks than others. “There are lots of factors that might increase the risk of an individual having panic attacks, including certain medications, traumatic events and memories, substance misuse and pre-existing health conditions. However, the number one factor is significant stress.”

Read: Ask a counsellor: “Why won’t my husband get help for panic attacks?”

So how can you tell if your rising day-to-day stress is turning into something more concerning? Here, mental health experts answer some frequently asked questions about panic attacks.

What is a panic attack?
“During a panic attack, the body’s autonomous fight-or-flight response takes over,” Dr Green explains. “This is a stress reaction that likely evolved out of the survival needs of our early ancestors, and activates the nervous system to help prepare the body to fight or flee.”

The result is an overwhelming sense of anxiety, fear, or a feeling of dread that something terrible is going to happen, at the same time as one or more physical symptoms. Symptoms can include shortness of breath, a tight chest, tingling in the fingers or hands, feeling slightly sweaty or dizzy and an increase in your heart rate.

What are the common causes of panic attacks?

“Panic attacks tend to occur in cases of severe anxiety,” says Dr Green. “They can happen completely out of the blue and without an obvious cause, or they may be expected, for example in relation to a known trigger such as exposure to something that feels scary.”

A trigger could be something such as having to do a presentation at work, being stuck on crowded public transport, or driving in heavy traffic. Or simply being overwhelmed at the end of a very stressful period.

Dr Green adds: “In situations where there is obvious danger, [people] would be expected to be fearful of the danger. However, where there is no obvious danger, individuals tend to be more fearful of the symptoms themselves – sometimes even believing them to be life threatening, such as evidence of an imminent heart attack.”

Read: How to recognise and combat stress early 

What should you do when a panic attack hits?

As a racing heartbeat is common during a panic attack, focusing on your breathing can help. It can feel as though you’re not getting enough oxygen, triggering you to breathe in faster and deeper but breathing out is the key during a panic attack.

Remember the phrase ‘When in doubt, breathe out’. And as you’re breathing out, remind yourself that you’re okay and not in danger.

If you’ve experienced a panic attack before, you can do breathing techniques to prepare in case it happens again.

If you practise the art of breathing out and not holding your breath when you feel good or content, then it’s easier to apply when you’re feeling anxious or stressed. This is because your body already knows what to do and remembers how to do this.

When should you seek professional help for panic attacks?

“Whilst panic attacks themselves are not life threatening and usually pass within 30 minutes or so, they can lead to serious complications, for example, through unhelpful behaviours such as self-medicating with alcohol to avoid feelings of anxiety that precede the panic,” says Dr Green. “They must always be taken seriously.”

Dr Reinecke advises: “If they happen repeatedly over six months, and you are starting to be worried about when your next attack will strike, you [could be] on the path towards an anxiety disorder that might need treatment.”

There is a difference between one-off attacks and a more serious problem. In true panic disorders, these feelings of panic and dread can come on without any trigger or warning and severely effect your ability to function day to day.

So for example, if your panic is triggered by an event such as a break-up, moving house or another life change, then this is normal. But if it stops you going out, doing things you enjoy, or you are getting them for no reason, then see a doctor.

Read: How to stop worrying about worrying

What is the treatment for panic attacks?

People who experience panic attacks are often worried, and sometimes even convinced, that their physical symptoms are caused by a medical condition.

“The first step would be to have one proper physical check-up, for peace of mind – thyroid, heart, hormones (eg menopause, the pill) etc can all contribute to feeling like this,” says Dr Reinecke.

Once any underlying physical issues have been checked, talking therapy can be very helpful. “Exposure therapy is a form of cognitive-behaviour therapy [CBT], where the patient learns to react differently to fear triggers. In our research, we have for instance developed a highly effective single-session treatment that leads to improvements in most of our panic disorder patients, and to life-changing improvements in a large number of patients,” says Dr Reinecke.

Where suitable, medication is another option. Your doctor may look into starting you on medication such as anti-anxiety or beta blocker drugs to control the heartbeat. These can be useful for some people in extreme situations where they can’t function otherwise.

Addressing certain lifestyle factors can also be beneficial, says Dr Foster: “In particular, this means exercising regularly, eating healthily (high sugar and high caffeine foods can make panic worse), having good sleep hygiene, and being sociable – just by meeting up and talking to friends, and allowing you to vent, can be extremely beneficial for your mental health.”

– With PA

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