Panic attacks - what to do when fear paralyzes you?

Panic attacks - what to do when fear paralyzes you?

Your heart is pounding. You cannot catch your breath. Your hands are trembling, you feel hot, then cold. A thought appears in your mind: I am dying. Or: I am losing my mind. It lasts a few minutes, but it feels like an eternity. And then it passes - leaving behind exhaustion, disorientation, and the fear that it will happen again.

This is what a panic attack looks like. If you have experienced it, you know there is hardly a more terrifying experience. If you have never experienced it - it is hard to imagine. A panic attack is not an exaggeration, not hysteria, and not an invention. It is a real, physiological response of the body that can be understood, managed, and - with appropriate help - significantly reduced in frequency. This article explains what actually happens in the body during a panic attack, how to cope with it when it occurs, and when to seek professional help.

What happens in the body during a panic attack?

A panic attack is a sudden activation of the sympathetic nervous system - the same system that activates when you are face to face with a real threat. The brain - specifically the amygdala - sends an alarm signal: danger. The body switches into fight-or-flight mode.

Within seconds, the adrenal glands release adrenaline and noradrenaline. The heart speeds up to pump blood to the muscles. Breathing becomes rapid and shallow - hyperventilation lowers the level of carbon dioxide in the blood, causing tingling in the hands, dizziness, and a sense of unreality. Muscles tense up, the digestive system slows down, pupils dilate.

The problem is that during a panic attack, there is no real threat. The body is responding to a false alarm. And because the symptoms are so intense, the person interprets them as proof that something terrible is happening - and this fuels another wave of panic. A vicious cycle forms: physical symptoms intensify anxiety, anxiety intensifies physical symptoms.

Understanding this mechanism is the first step to regaining control. A panic attack, although terrifying, is not dangerous to your health. The body cannot maintain the fight-or-flight response indefinitely - after several minutes, stress hormones begin to break down and symptoms gradually subside. This is a guarantee built into our biology.

Symptoms of a panic attack

According to the DSM-5 diagnostic criteria, a panic attack is a sudden surge of intense fear that peaks within minutes and includes at least four of the following symptoms:

• Heart palpitations or rapid heartbeat
• Sweating
• Trembling or shaking
• Shortness of breath or a feeling of choking
• Chest pain or discomfort
• Nausea or abdominal discomfort
• Dizziness, unsteadiness, feeling faint
• Chills or hot flashes
• Numbness or tingling
• A sense of detachment from reality (derealization) or from oneself (depersonalization)
• Fear of losing control or going crazy
• Fear of death

An attack usually lasts from 5 to 20 minutes, although in exceptional cases symptoms may persist longer. Peak intensity typically occurs within the first 10 minutes. After the attack, deep exhaustion often appears - both physical and mental - which can last for several hours. Some describe the state after a panic attack as a feeling of having been through something truly draining, which is true - the body expended an enormous amount of energy in a very short time.

Panic attack vs. heart attack - how to tell them apart?

This is one of the most common questions we hear from patients. Symptoms can overlap, which is why during the first episode of severe chest pain it is always worth consulting a doctor to rule out cardiac causes. It is better to go to the emergency room one time too many than one time too few.

However, there are differences that help distinguish them. Pain during a panic attack is usually localized, stabbing, and intensifies with deep breathing. Heart attack pain is diffuse, crushing, and radiates to the left arm, jaw, or back. A panic attack peaks within minutes and subsides - heart attack symptoms gradually intensify and do not pass. Panic attacks are often accompanied by tingling in the hands, shortness of breath from hyperventilation, and a sense of derealization - these are typical symptoms of lowered carbon dioxide levels, not heart disease.

If cardiac tests have revealed no abnormalities and symptoms recur - it is worth considering that you may be dealing with panic attacks. Many patients visit emergency rooms several or even a dozen times before anyone suggests a visit to a psychologist. Unfortunately, this is a common situation in the Polish healthcare system.

Panic disorder - when attacks keep recurring

A single panic attack can happen to anyone - it is estimated that up to 30 percent of people will experience one at least once in their lifetime, often during periods of high stress. We speak of panic disorder when attacks recur and the person begins living in fear of the next attack - which itself becomes a source of suffering.

Panic disorder often leads to so-called anticipatory anxiety: constant worry that an attack could happen at any moment. This in turn leads to avoidance of situations where an attack could be particularly troublesome or frightening - a crowded bus, a cinema, an airplane, a store queue, driving a car, social gatherings. In extreme cases, agoraphobia develops - the person stops leaving home because only there do they feel safe.

Panic disorder most commonly begins between the ages of 20 and 35 and is twice as common in women as in men. Without treatment, it tends to worsen - subsequent attacks become increasingly frequent, the list of avoided situations grows, and the patient's life shrinks.

What triggers panic attacks?

Panic attack triggers are individual, but most commonly include: intense stress (cumulative or sudden), lack of sleep, excess caffeine or alcohol, periods of major life changes (moving, changing jobs, divorce), illness or health concerns, and - paradoxically - the fear of an attack itself. In many people, attacks seem to come out of nowhere, without a clear trigger, which makes them even more frightening.

On a deeper level, panic attacks are often related to suppressed emotions, an excessive need for control, perfectionism, and difficulty expressing one's needs. A person who ignores signals of stress and overload for a long time may experience a panic attack as a kind of eruption - the body saying what the mind does not want to hear.

What to do during a panic attack?

When you feel an attack approaching or already underway, the most important thing is to remind yourself of one thing: this is panic, this is not a threat to my life, this will pass. This knowledge will not eliminate the symptoms immediately, but it interrupts the vicious cycle of catastrophic interpretation. The more often you repeat this truth to yourself, the faster your brain begins to accept it.

Specific techniques that help during an attack:

Diaphragmatic breathing. Hyperventilation is the engine of a panic attack - it drives tingling, dizziness, and shortness of breath. Consciously slowing your breathing can stop it. Inhale through the nose for four seconds, hold for two seconds, exhale through the mouth for six seconds. Repeat for several minutes. The key is that the exhale should be longer than the inhale - this activates the parasympathetic nervous system, which is the natural brake on the stress response. You can exhale through pursed lips, as if blowing through a straw - this automatically slows breathing.

The 5-4-3-2-1 technique. This is a grounding exercise that helps shift attention from frightening thoughts and bodily sensations to the concrete, safe surroundings. Name five things you can see, four you can hear, three you can touch, two you can smell, and one you can taste. This forces the brain to switch from alarm mode to observation mode.

Muscle tension and release. Tightly clench your fists, hold for five seconds, then release. Repeat with your arms, legs, feet. The contrast between tension and relaxation sends the brain a signal that there is no real threat - because if there were, you would not be able to consciously relax.

Cold. Cold water on the wrists or face can interrupt escalating panic. This is a simple intervention based on the so-called dive reflex - when the face comes into contact with cold, heart rate automatically slows. If you do not have access to water, press a cold object against your neck or cheeks.

Movement. If possible, stand up and walk. Physical movement helps discharge the adrenaline that the body produced in response to the false alarm. Even a few minutes of walking can speed up the subsiding of symptoms.

How is panic disorder treated?

Panic disorder is one of the most treatable mental health conditions. Research indicates that cognitive behavioral therapy (CBT) produces improvement in 70-90 percent of patients. This is not a promise but a result of years of clinical research.

In CBT, the patient learns to understand the mechanism of a panic attack - why the body reacts this way, what drives the vicious cycle, what thoughts turn normal bodily sensations into a terrifying experience. Then they learn to identify catastrophic interpretations of physical symptoms ("my heart is racing - it must be a heart attack" changes to "my heart is racing - it is adrenaline, it is a normal reaction, it will pass in a few minutes").

A key element is so-called interoceptive exposure - deliberately inducing physical symptoms resembling panic in the safe environment of the therapy office. The patient may, for example, breathe rapidly for a minute, spin in a chair, or run in place. The goal is to show the brain that these sensations - rapid heartbeat, dizziness, shortness of breath - are not dangerous. With each repetition, the anxiety response weakens.

The second phase is situational exposure - a gradual return to situations the patient has been avoiding. If someone stopped riding buses, trams, or the metro, the therapist will help plan gradual exposure: first entering a bus for one stop, then riding two stops, then a longer route - until the brain learns that these situations are not a threat.

Pharmacotherapy may be needed for frequent and intense attacks. SSRI medications, taken regularly, reduce the frequency of attacks - but their effects take two to four weeks to develop. Benzodiazepines can be used on an as-needed basis as quick relief, although due to the risk of dependence, psychiatrists use them cautiously and short-term. The best results come from combining pharmacotherapy with psychotherapy.

How can loved ones help?

If someone near you is having a panic attack, the most important thing is to remain calm. Your calm is contagious - just like panic. Do not say "calm down" or "nothing is wrong" - these words, although well-intentioned, may be perceived as dismissive. Instead, say calmly: "I am here. This is a panic attack. It will pass in a few minutes. You are safe." Offer to breathe together - inhale, exhale, slowly, in a rhythm that you set with your own calm breathing.

Do not force anything - do not make them drink water, do not push them outside for fresh air, do not hold their hand if they do not want it. Be present, calm, and patient. After the attack, do not judge or analyze - ask what they need. Sometimes it is simply silence and closeness.

It is also worth knowing what not to do: do not say "it is all in your head," do not suggest that the person should pull themselves together, do not talk about your own similar experiences during the attack. After the attack, in a calm moment, you can suggest a visit to a specialist - but gently and without pressure.

What to avoid if you have panic attacks

Several factors can intensify the tendency toward panic attacks. Excess caffeine (coffee, energy drinks, strong tea) stimulates the sympathetic nervous system and can lower the threshold for triggering panic. Alcohol - although seemingly calming - intensifies anxiety after a few hours (the so-called rebound effect). Sleep deprivation increases emotional reactivity and lowers the ability to regulate anxiety. Avoiding situations that once triggered panic provides temporary relief but reinforces the disorder - the brain learns that these situations really are dangerous.

Support at the Sztuka Harmonii Psychological Center

At the Sztuka Harmonii Psychological Center in Gdansk, we work with people experiencing panic attacks and panic disorder. Marta Turkoniak, MA, provides psychological consultations and psychotherapy for people with anxiety disorders, using a cognitive behavioral approach with elements of mindfulness. Milena Komorowska, MA, works within CBT and ACT, helping patients change their relationship with anxious thoughts and bodily sensations - so that fear stops dictating the terms of their lives. Aleksandra Lesner, MA, creates a safe therapeutic space in which the patient can examine their emotions and deeper anxiety mechanisms without judgment.

We accept patients at four locations in Gdansk and Gdynia. We also offer online psychological consultations - particularly useful for people who, due to anxiety, have difficulty traveling to the office. The first step is a consultation - it lasts 50 minutes and requires no preparation. Call 732 059 980 or book an appointment through our website. Panic attacks do not have to rule your life - effective help is available, and the prognosis for treating panic disorder is among the best in all of psychiatry.