Panic attack primer: What to do when fear strikes

Imagine that you’re walking down the street. All of a sudden you feel dizzy and nauseous. You start trembling. Then the chest pains come. You feel like you may be dying.

You check with your doctor. They give you the all clear physically. Then they tell you that it was likely a panic attack.

If you’ve ever had this experience, you’re far from alone. As many as 12 percent of people will have at least one panic attack every year.¹

Panic attacks can be scary, especially if you’ve never had one before. It’s natural to worry that it’s a medical emergency. In fact, panic attacks often prompt visits to the emergency room.²

Even if you have a history of panic attacks and know that you can ride them out, you still may find them unpleasant. To help cope, it’s useful to understand what causes them. And it’s key to have a few tools in your toolbox to take care of yourself in the moment.

What is a panic attack? And how will you know when you’re having one?

Panic attacks are defined by the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) as “an abrupt surge of intense fear or discomfort” that peaks within minutes and then wears off.³

While panic attacks and anxiety share some symptoms, there are a few key ways to tell them apart. Panic attacks tend to come on out of nowhere. Anxiety is often sparked by thoughts the person can pinpoint. The physical symptoms also tend to ramp up more slowly.

“With panic attacks, people may not know what the trigger is,” says Giselle Alexander, LCSW, a licensed therapist and AbleTo program advisor.

The biological causes of panic attacks are still being researched. Some theories focus on a malfunction in your brain’s alarm system. Regions of the brain that detect threats may be overactive. Or the brain may have an imbalance of chemicals that relay messages, known as neurotransmitters.⁴

We may not know exactly what causes panic attacks. But we do know what they look like. A panic attack includes at least four of the following symptoms:³

• Palpitations, pounding heart, or increased heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or feeling smothered
• Feelings of choking
• Chest pain or discomfort
• Nausea or upset stomach
• Feeling dizzy, unsteady, light-headed, or faint
• Chills or heat sensations
• Numbness or tingling
• Derealization (feelings of unreality) or depersonalization (being detached from yourself)
• Fear of losing control or “going crazy”
• Fear of dying

The physical signs can be difficult to separate from a medical emergency. That can make them particularly upsetting.

“Those symptoms can be very severe and disturbing for some people,” says Alexander. She adds that it’s important for first-time panic attack sufferers to consult with their healthcare provider to rule out medical issues.

Although panic attacks seem to come out of thin air at first, you may begin to notice that they occur at certain times. That’s common. People often experience panic attacks in response to specific triggers or in certain situations.

Your body’s state can also be a factor. “Some conditions may also make a person more vulnerable to panic attacks,” says Alexander.

Examples based on her training and experience include:

• Sleep disruption
• Substance use (caffeine, nicotine, other stimulants, alcohol)
• Medical issues, such as poor blood sugar regulation or thyroid problems
• Other mental health issues, like anxiety or depression
• Increased stressors

In time, you’ll likely become more aware of your risk for panic attacks. Recent research even suggests that your fitness trackers and social media posts can offer clues. One study found that these tools can point out signs like an elevated resting heart rate or poor mood states that often came up the day before people in the study had panic attacks.⁵

How to cope with panic

Yes, panic attacks can be alarming and uncomfortable. But the experience is also temporary.

Most panic attacks last only 5 to 10 minutes.¹ That may seem like forever when you’re in the middle of it. But there are steps you can take to surf the sensations until they subside.

“I encourage people who are prone to panic to have a toolkit,” says Alexander. “Find things that help you get through the moment.”

Alexander suggests including these tools to include in your kit:

• Sensory engagement: Intense sensory experiences bring you back to your body. Eat crunchy or sour foods. Expose your skin–especially your face–to ice cold temperatures. Rest under a weighted blanket. Sniff essential oils. Keep these items handy so that you can use them at any time.
• Grounding techniques: Certain movements can help bring you back into your body. One simple option is butterfly hugs, which involves crossing your arms over your chest and gently tapping one shoulder, then the other for a few minutes. There’s also havening, where you rub your hands up and down your upper arms. Another choice: tapping the karate chop point on the side of your hand.
• Breathwork: Deep breathing calms your fight-or-flight response. Alexander says that humming or singing can regulate your vagus nerve and disrupt the panic response.
• Meditation: Mindfulness practices will bring you back to the present. Try the AbleTo Manage an Anxiety Emergency meditation for starters.

Practice using these tools in a calm state. Then you’re more likely to remember to use them when a panic attack comes.

Take care of yourself after the panic has ebbed

Survived peak panic? Allow yourself some time to get back to normal after the sensations have passed, too. “Take a couple of seconds to be present,” says Alexander. “Regulate your breathing. Hydrate.”

Give yourself credit for handling a tough situation. And congratulate yourself when you use your tools effectively. “Getting through something like that is cause for celebration in my book,” says Alexander. “Recognize that you made it through.”

Mindset shifts can help you manage panic in the long-term, too. Like learning how to move through the experience without fighting it.

“There’s some radical acceptance involved,” says Alexander. “If you know you’re at risk for a panic attack, be OK with whatever happens during and after. Reassure yourself that you can get through it. Give yourself some grace.”

When to turn to a pro

Have you tried these techniques and feel like they’re not working? Noticing signs of panic disorder, like an increasing fear of having panic attacks? Or avoiding situations where they might come up?³ It may be time to connect with a therapist.

“They’ll work with you to identify your risk factors,” says Alexander. “They’ll also look at what happens before and during your panic attacks. And they’ll help you identify strategies to help you regulate and manage stress.”

A therapist may also offer cognitive behavioral therapy. This type of psychotherapy is known to address the unhelpful thoughts associated with panic disorder, especially when it includes mindfulness techniques.^4,6 Some people may also choose to work with a psychiatrist to explore medication options to manage panic.

Different strategies work for different people. Your care team will land on a solution that works for your unique situation.

“A good therapist knows that it’s a process,” says Alexander. “Your input is key in figuring out what works for you.”

Panic is scary. It can seem all-consuming. But it doesn’t have to rule your life. You can learn how to navigate through its ups and downs, whether on your own or with the guidance of a trusted therapist.

Sources

1. Wall D. Panic disorder: Fact sheet – ABCT – association for behavioral and cognitive therapies. ABCT. https://www.abct.org/fact-sheets/panic-disorder/. Published April 8, 2021. Accessed July 10, 2025.

2. Sung SC, Lim L, Lim SH, et al. Protocol for a multi-site randomized controlled trial of a stepped-care intervention for emergency department patients with panic-related anxiety. BMC Psychiatry. 2022;22(1):795. Published 2022 Dec 16. doi:10.1186/s12888-022-04387-z

3. Cackovic C, Nazir S, Marwaha R. Panic disorder. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK430973/. Published August 6, 2023. Accessed July 10, 2025.

4. Guan X, Cao P. Brain Mechanisms Underlying Panic Attack and Panic Disorder [published correction appears in Neurosci Bull. 2024 Jun;40(6):856. doi: 10.1007/s12264-024-01203-4.]. Neurosci Bull. 2024;40(6):795-814. doi:10.1007/s12264-023-01088-9

5. McGinnis EW, Loftness B, Lunna S, et al. Expecting the Unexpected: Predicting Panic Attacks From Mood, Twitter, and Apple Watch Data. IEEE Open J Eng Med Biol. 2024;5:14-20. Published 2024 Jan 15. doi:10.1109/OJEMB.2024.3354208

6. Gawankar NA, Pandey S. An Integrated Therapeutic Application Using Elements of Cognitive Behavioral Therapy and Mindfulness-based Cognitive Therapy in Treatment of Panic Disorder. Indian J Psychol Med. 2025;47(2):179-182. doi:10.1177/02537176241256304