Your heart’s pounding, you’re sweating and you can’t catch your breath, and there’s this overwhelming sense that something terrible is about to happen—or maybe that you’re dying. And you have no idea why.
This is very likely a panic attack.
If you’ve never had one, panic attacks can sound like “just really bad anxiety.” Anyone who’s experienced one knows they’re in a league of their own. It’s not just feeling worried—it’s your body’s alarm system going haywire when you’re sitting in a meeting or grocery shopping or doing something completely mundane.
What Happens During a Panic Attack
Panic attacks are your fight-or-flight response having a malfunction. Your brain detects some kind of threat (real or imagined, major or minor), and your nervous system responds like you’re being chased by a tiger. Except there’s no tiger—just you, trying to figure out why your body has declared war on a Tuesday afternoon.
The physical symptoms hit fast and hard:
- Racing heart or chest pain
- Shortness of breath or feeling like you’re choking
- Sweating, trembling, or hot/cold flashes
- Nausea or stomach upset
- Dizziness or feeling detached from reality
- Intense fear of dying, losing control, or “going crazy”
The whole thing usually peaks within 10 minutes, though those can feel like the longest 10 minutes of your life. Your brain, helpful as always, starts cataloging every sensation: “Why is my heart beating so fast? Am I having a heart attack? Why can’t I breathe normally? Something is definitely wrong.”
And then anxiety about the anxiety kicks in.
The Fear of Fear Itself
Once you’ve had a panic attack, your brain files it under “Things to Avoid at All Costs.” But since panic attacks often seem to come out of nowhere, your brain starts scanning for any sensation that might signal another one coming.
Heart beating a little faster after climbing stairs? Uh oh, is this the start of another attack?
Feeling slightly lightheaded when you stand up? Here we go again.
Chest feels tight after a big meal? This is it, this is definitely it.
This hypervigilance to bodily sensations can trigger another panic attacks. You become anxious about becoming anxious, creating a feedback loop that keeps the whole system on high alert. It’s like having a smoke detector that goes off every time you make toast, and then you become terrified of making toast, which makes you nervous in the kitchen, which makes the smoke detector more sensitive.
Why Panic Attacks Feel So Convincing
The reason panic attacks are so terrifying isn’t just the physical discomfort—it’s that they feel so real and urgent. When your heart is racing and you can’t breathe properly, every instinct tells you something is seriously wrong.
This makes sense from an evolutionary perspective. If you were actually in danger, you’d want your body to take those sensations very seriously. The problem is that our modern brains can’t always distinguish between “actual tiger” and “stressful presentation” or “crowded subway” or “random moment for no apparent reason.”
Your body is doing exactly what it’s designed to do—it’s just doing it at the wrong time.
Common Triggers
Panic attacks can be triggered by obvious things like stressful situations, but they’re often more sneaky:
Physical sensations: Caffeine, exercise, hot rooms, or even excitement can create bodily sensations similar to anxiety, which your brain might misinterpret as danger.
Breathing changes: Anything that alters your breathing—laughing hard, yawning, even focusing too intently on your breath—can sometimes set off the alarm.
Stress buildup: Sometimes panic attacks happen when you’re actually relaxing, like weekends or vacations. Your body finally lets its guard down and releases all that accumulated tension at once.
Certain places: If you’ve had a panic attack somewhere before, your brain might decide that place is “dangerous” and react accordingly.
Nothing at all: Sometimes panic attacks just happen. Your nervous system misfires for reasons that aren’t clear, which is frustrating but completely normal.
What to Do During a Panic Attack
When you’re in the middle of a panic attack, your brain isn’t interested in logic. But there are some strategies that can help ride it out:
Breathe slower, not deeper: Focus on slowing down your exhale rather than taking big gulps of air. Try breathing in for 4 counts, holding for 4, exhaling for 6.
Name what’s happening: “I’m having a panic attack. This is uncomfortable but not dangerous. It will pass.” Sometimes just labeling it helps.
Ground yourself physically: Feel your feet on the ground, hold something cold, or use the 5-4-3-2-1 technique (name 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, 1 you can taste).
Don’t fight it: This sounds counterintuitive, but trying to force a panic attack to stop often makes it worse. Panic attacks have a natural timeline—they will end.
Stay put if possible: Running away can reinforce the idea that you were actually in danger. If you can safely stay where you are, it helps your brain learn that the situation isn’t threatening.
Things to Avoid
These may seem like a good idea, but they really belong on the not-to-do list:
Don’t breathe into a paper bag: This old advice can actually make things worse by reducing oxygen levels.
Don’t avoid everything: While it’s natural to want to avoid places or situations where you’ve had panic attacks, complete avoidance can make anxiety worse over time.
Don’t assume it’s all in your head: Panic attacks involve real physical symptoms. They’re not a sign of weakness or lack of willpower.
Don’t diagnose yourself with serious medical conditions: Yes, chest pain and shortness of breath can be concerning, but if you’ve been medically cleared and this pattern fits panic attacks, try not to spiral into WebMD.
That said, don’t necessarily skip medical evaluation: Of course, if you’re experiencing chest pain, shortness of breath, heart palpitations, or dizziness for the first time, see a doctor. ERs are very much used to panic sufferers–they can help you through, if that’s what’s going on. Once you’ve been medically evaluated and cleared, and if the pattern fits panic attacks, then you can focus on anxiety management strategies.
Building Long-Term Resilience
Some approaches to decreasing the likelihood of panic attacks over time:
Regular stress management: Panic attacks often happen when your overall stress level is high. Regular exercise, sufficient sleep, and stress reduction can make your nervous system less reactive.
Challenge catastrophic thinking: When you notice physical sensations, practice responding with “This is uncomfortable, but it’s not dangerous” rather than “Something terrible is happening.”
Get comfortable with discomfort: Learning to tolerate uncomfortable physical sensations without panicking about them can be a huge help. Practice noticing your heartbeat after exercise without immediately thinking “heart attack.”
Learn your early warning signs: Many people notice subtle changes before a full panic attack—slight dizziness, tension, or restlessness. Catching these early can help you respond before it escalates.
When to Get Help
Panic attacks are treatable. If they’re happening frequently, limiting your life, or causing you to avoid important activities, it’s worth talking to a professional. Therapy (especially CBT) and sometimes medication can be very effective.
You should definitely seek help if you’re:
- Having panic attacks regularly
- Avoiding places or activities because of fear of panic attacks
- Constantly worried about having another attack
- Experiencing depression alongside the anxiety
- Using alcohol or drugs to cope
Remember
Panic attacks are your nervous system’s false alarm—intense, uncomfortable, but not actually dangerous. They feel terrible in the moment, but they always end. The real challenge often isn’t the panic attack itself, but the anxiety about having another one.
Understanding what’s happening during a panic attack can help make them less frightening. They’re not a sign that you’re broken or weak—they’re a sign that you have a very sensitive alarm system that sometimes goes off at the wrong time.
With the right tools and sometimes professional help, most people can learn to manage panic attacks effectively. The goal isn’t necessarily to never have one again (though that’s certainly possible), but to reduce their frequency and intensity, and to respond to them without adding extra layers of fear and avoidance.
Your anxiety might occasionally have anxiety, but that doesn’t mean it gets to run the show.
If you’re struggling with panic attacks or anxiety, therapy can provide personalized strategies and support. Contact me at will@willbaum.com or (323) 610-0112 to discuss how we can work together on managing anxiety effectively.