Jason sits in a meeting, half-listening as a coworker presents. Out of nowhere, his chest tightens. His heart races, pounding so loudly he’s sure others can hear it. A wave of heat rushes through his body, and his hands begin to tremble under the table. His breathing becomes shallow. The room suddenly feels smaller, the air thicker. “Something’s wrong, everyone is looking at me! What if this is a heart attack!”
He grips the edge of his chair, scanning for an exit as his mind races: Should I leave? What if everyone notices? The harder he tries to calm down, the faster his heart beats. Within minutes, the sensations crest and begin to fade, leaving him drained, embarrassed, and confused. He can’t explain what just happened, only that it felt terrifying and completely beyond his control.
What Jason experienced is a panic attack; a sudden surge of intense fear and physical sensations that peak within minutes, often convincing people they’re in danger even when they’re safe.
What Is a Panic Attack?
To understand panic attacks, it helps to know what’s happening both in the body and the brain when fear takes over.
A panic attack is a sudden, intense surge of fear or discomfort that peaks within minutes. It is often described as feeling as though something terrible is about to happen, even when there is no actual danger. During a panic attack, the body’s fight-or-flight system floods the system with adrenaline, creating powerful physical sensations that can feel catastrophic.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), a panic attack involves an abrupt surge of intense fear or intense discomfort accompanied by four or more of the following symptoms:
- Heart palpitations or accelerated heart rate
- Sweating
- Trembling or shaking
- Shortness of breath or a sensation of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Dizziness, lightheadedness, or feeling faint
- Chills or heat sensations
- Numbness or tingling (paresthesia)
- Feelings of unreality (derealization) or detachment from oneself (depersonalization)
- Fear of losing control or “going crazy”
- Fear of dying
Panic attacks typically reach their peak within 10 minutes and often subside within 20 to 30 minutes, though a lingering sense of exhaustion or unease can persist for much longer.
People experiencing a panic attack often mistake it for a medical emergency, such as a heart attack, which leads many to seek urgent medical care before realizing the cause is anxiety-related. The experience can be deeply unsettling, even traumatizing, and can cause individuals to begin anticipating or fearing another attack (Before seeking psychological help or therapy, one should get cleared by a doctor that it’s anxiety and nothing more serious or underlying).
Panic attacks are far more common than many realize. Research from the National Institute of Mental Health (2023) estimates that about 11% of adults in the United States experience at least one panic attack each year. These isolated attacks often occur during times of high stress, illness, or transition and may never repeat. When these attacks begin occurring repeatedly, without clear triggers, and the person develops ongoing fear or behavioral changes in response, the diagnosis may shift to panic disorder.
What Causes Panic
The causes of panic attacks are multifactorial, involving a combination of biological, psychological, and environmental influences. Although they can seem to arise “out of nowhere,” research shows that panic attacks reflect a misfiring of the body’s natural alarm system, the same system designed to protect us from real danger.
Some individuals have a genetic predisposition to heightened anxiety sensitivity. Neurochemical imbalances involving serotonin, norepinephrine, and GABA may also contribute to overactivation of the brain’s fear circuitry.
After an initial panic attack, the body and brain can become conditioned to associate normal bodily sensations (like a racing heart or shortness of breath) with danger. Over time, even minor sensations can trigger the same alarm response, leading to avoidance and hypervigilance.
Major stressors such as illness, loss, trauma, or life changes can act as catalysts for the first panic episode. People under prolonged stress may experience depleted physical and emotional reserves, making them more susceptible to sudden surges of anxiety.
Individuals with high anxiety sensitivity, the tendency to interpret normal sensations as dangerous, are at elevated risk. Catastrophic thinking (“I’m dying,” “What if I faint in public”) intensifies physiological arousal, creating a feedback loop that strengthens the panic response.
The Neuroscience of Panic
A panic attack happens when the brain’s alarm system overresponds. The amygdala, a small, almond-shaped part of the brain that detects danger, sends an urgent message to the body to prepare for fight, flight, or freeze. The body quickly releases stress hormones, such as adrenaline and cortisol, which speed up the heart rate, tighten muscles, and increase the breathing rate.
This reaction is helpful when real danger is present, such as when you need to escape from something threatening, but during a panic attack, the brain misinterprets normal body sensations (like a racing heart or feeling warm) as signs of danger. Because there’s no real threat, the body’s alarm keeps sounding even though it doesn’t need to.
At the same time, the part of the brain that helps you think clearly and stay calm, the prefrontal cortex, has trouble quieting the alarm. Brain imaging studies show that during a panic attack, the amygdala lights up with activity while the prefrontal cortex becomes dim and less active. This explains why it can feel impossible to “think” your way out of panic in the moment; the brain’s alarm system has temporarily taken over. This balance between the amygdala and prefrontal cortex is what treatment aims to restore.
How to Manage a Panic Attack in the Moment
Once we understand how panic takes hold in the brain, we can begin to learn how to ride out the wave when it happens.
Accept it, don’t fight it. When a panic attack strikes, the goal is not to stop it but to ride it out with awareness and compassion. The body’s alarm system has been mistakenly triggered and will return to normal once the surge of adrenaline subsides.
Acknowledge it. Remind yourself, “This is a panic attack. It’s not dangerous, and it will pass.”
Remember to breathe. Don’t worry if you aren’t able to use your favorite breathing tool. Just inhale gently and exhale. Even if your heart races,
breathing steadily tells your body there’s no emergency. The goal isn’t to slow your heart, but to remind your body that you’re safe.
Ground yourself. Notice three things you see, three things you hear, and three things you feel – “I feel the sun on my face, my shoes on my feet, and my jacket on my arms.”
Let sensations rise and fall. Panic attacks always peak and subside. The less you fight them, the faster they fade.
Use gentle self-talk such as, “I’m feeling afraid, but I’m not in danger.” Saying catastrophic statements like, “I’m going to die!”, “I hate this!”, “I’m so embarrassed,” “I can’t take this anymore!” releases more stress hormones and can prolong the attack.
The panic feelings “trick” you with their powerful fight, flight, or freeze symptoms. The urge to flee or escape is understandable, but not appropriate because you are not in danger. Panic attacks can’t really do all the things you fear they will do.
Instead, say, “This is my body over-reacting/over-responding. There is no evidence that panic attacks can hurt me. I will accept these sensations even though they are uncomfortable. Eventually, they will go away. They always do.”
Afterward, rest, hydrate, and note what helped. Over time, each successful encounter builds confidence that panic, though powerful, is manageable.
How to Retrain the Brain’s Alarm System
Practicing the tools above consistently helps retrain the brain’s response to panic. Each time you allow sensations to come and go without fleeing or fighting them, your brain learns that panic is uncomfortable but not dangerous. Over time, this reduces the amygdala’s fear sensitivity and strengthens the prefrontal cortex’s ability to stay calm. What once triggered intense alarm begins to feel tolerable, and the cycle of fear and avoidance weakens.
Evidence-Based Treatments
CBT is the most effective treatment for panic disorder. It helps identify and challenge catastrophic thoughts such as “I’m dying” or “I’m losing control.” Exposure and Response Prevention (ERP) offers a specific tool called Interoceptive exposure. This is intentionally inducing mild panic sensations in a controlled setting, and clients learn that these sensations are safe and temporary. Therapists use exposure hierarchies, starting with mild triggers and working upward, to help clients face sensations and situations they’ve been avoiding.
Mindfulness and Acceptance-Based Approaches
Mindfulness teaches us to be aware of and accept bodily sensations without judgment. Practices such as observing the breath, noting thoughts, and grounding in the present moment reduce fear reactivity and help individuals ride out sensations calmly. These are often integrated into CBT or Acceptance and Commitment Therapy (ACT).
Self-Compassion
Self-compassion is an inner resource that can be developed through practice. It involves giving yourself the same kindness and care you would give a friend. When experiencing panic, speaking to yourself in a gentle, kind tone activates the calming, soothing system in your brain and deactivates the amygdala.
Medication
For those who wish to try medication, Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) can significantly reduce the frequency and intensity of panic attacks. For short-term stabilization, a psychiatrist may prescribe benzodiazepines, though these are not recommended long-term due to dependency risks.
Lifestyle and Self-Care
Regular exercise, a balanced sleep schedule, and reducing caffeine and alcohol consumption help regulate the nervous system. Gentle, consistent movements, such as walking, yoga, or stretching, lower physiological
arousal. Maintaining a daily routine and practicing relaxation techniques, such as deep breathing or journaling, also promotes resilience.
Breaking Avoidance Patterns
Avoidance maintains panic by reinforcing the belief that sensations or settings are dangerous. Gradual exposure, starting small and building upward, helps reclaim confidence and freedom. Each success proves that panic can be tolerated without resorting to escape.
Final Word
Healing from panic is not about forcing yourself to feel brave; it’s about learning to meet fear with patience and kindness. Each small step builds your capacity to remain present in the face of discomfort. Over time, your nervous system settles more easily. With understanding, practice, and support, your brain can gradually relearn a sense of comfort and calm.
References
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470.
Craske, M. G., & Barlow, D. H. (2022). Panic Disorder and Agoraphobia. Oxford University Press.
National Institute of Mental Health. (2023). Panic Disorder: Facts & Statistics.