Lata K. McGinn, PhD

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What To Do If You Experience a Panic Attack

July 23, 2021

A panic attack is a sudden, intense episode of fear or dread accompanied by physical symptoms such as pounding heart, sweating, trembling or shaking, lightheadedness, feeling faint, shortness of breath, choking sensations, nausea, abdominal distress, chest pain, cold and hot chills, numbness and tingling, feelings of being detached or things seeming unreal. Individuals with panic disorder fear that they are going to die, go crazy, or lose control. They then begin to fear getting future attacks and will often change their behaviors to ward off panic attacks; a disorder called agoraphobia.

Tip 1: The first thing to remember is that a panic attack is an emotional alarm that is meant to protect us not harm us. Panic attacks, although unpleasant to experience, are not dangerous. Biologically, a panic attack is a fight-flight response or your body’s mechanism designed to protect you from danger. It is called the fight-flight response because it helps you fight or flee the danger to protect us.

If you are in danger, the fight-flight response would create fear and release adrenalin and create an automatic response in us to take immediate action (attack or run). In panic attacks, the fight-flight response kicks in even though you are not in any danger.

Tip 2: Panic attacks usually begin right after a stressful life event so focus on dealing with the stress you are under rather than trying to stop the panic attack.

Tip 3: Fearing that panic will harm you ironically only makes you have more panic attacks – your brain thinks you are in danger when you become afraid of panic attacks so the only thing it knows to do to protect you is to give you more panic attacks. Tell yourself you are not in danger and that it is just a harmless panic attack and that it will go away on its own without you doing anything to stop it.

Tip 4: Trying to stop a panic attack in the middle of an episode is not helpful because you are inadvertently telling your brain that you are in danger even though you are not. Letting the panic attack ride over you until it washes away and not changing your behavior to avoid it or escape it is the best thing you can do. Over time, your brain will learn that you are not in danger and the panic attacks will reduce over time.

Tip 5: Deep, slow breathing exercises (slow, diaphragmatic breathing) that help regulate oxygen and carbon dioxide can be calming and may be helpful to do regularly as a way of calming your over-anxious state in general. However, it is wise not to use it to stop a panic that you are afraid to have at the moment as it likely won’t work anyway and it will also inadvertently convince your brain that you are in danger.

Tip 6: It is best to first go to a medical doctor when you have your first attack to make sure it isn’t anything like a thyroid condition etc. Once the doctor rules out any physical basis for panic attacks, it is best to not keep going back and taking unnecessary medical tests over and over again.

Cognitive-behavioral therapy (CBT) has been shown to be effective in treating panic disorder and agoraphobia. First, individuals are educated about panic attacks and the physical symptoms of anxiety and fear that are experienced. Second, they are trained on how to examine and change their unhelpful thoughts and beliefs that lead to panic attacks in real-time.

In addition, individuals are trained to reduce physical tension and are then exposed to physical sensations of panic and to feared and avoided situations and sensations until the person realizes they are not dangerous. Repeated exposure helps to reduce the fear induced by these situations and teaches the person that the sensations experienced are not dangerous. When the fear of physical sensations is reduced, future panic attacks are reduced.

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