Panic attacks: what keeps the cycle going and how to break it

If you've experienced a panic attack, you'll know how frightening it can feel. Your heart might race. Your breathing changes. You feel dizzy, shaky, hot or disconnected from what's around you. You may feel an overwhelming need to escape. And then comes the thought: "What if something is seriously wrong?"

For some people, the fear is that they're having a heart attack or might faint. For others, it's a fear of losing control, being trapped, embarrassing themselves or not being able to escape. Afterwards, you might be told, "It was just anxiety", but when you've experienced it yourself, there's nothing "just" about it.

One of the most confusing things about panic is that even when part of you understands you're probably safe, your body can still react as though you're in danger. Understanding why this happens is often an important first step towards breaking the cycle.

Panic is your alarm system doing its job at the wrong time

Our bodies have an incredibly effective threat system. If you were genuinely in danger, your brain wouldn't want you calmly analysing the situation. It would prepare you to respond quickly.

Adrenaline is released. Your heart beats faster. Your breathing changes. Blood flow and muscle tension alter. Your attention becomes focused on potential danger. This is the familiar fight-or-flight response.

The problem with panic isn't that this system is broken. It's that the alarm is being triggered when there isn't an immediate physical danger. Then something particularly important can happen: we become frightened of the alarm itself.

A sensation appears – perhaps your heart skips a beat, you feel slightly dizzy, or your breathing feels different. You notice it. You interpret it as dangerous. Your anxiety increases. That creates more physical sensations. You notice those too, and suddenly you're caught in a feedback loop: you notice a sensation and interpret it as frightening. Your anxiety rises, the sensations become stronger, and this can quickly build into panic.

The body isn't necessarily creating the original danger. It's responding to the danger it believes is there.

The hidden part of panic: what happens between attacks

People understandably focus on the panic attack itself, but often it's what happens between panic attacks that keeps the problem going. After experiencing a frightening attack, your brain learns something: "That was dangerous. Make sure it doesn't happen again."

You may become more alert to your body. Is my heart beating normally? Why do I feel dizzy? Am I breathing properly? What if it happens while I'm driving? What if I panic in a meeting? What if I can't get out? This is sometimes called hypervigilance. You're no longer simply experiencing sensations. You're actively watching for them.

And when we repeatedly search for evidence of danger, we're much more likely to notice normal changes in our bodies that previously wouldn't have received any attention. A heartbeat that once went unnoticed suddenly feels significant. A moment of light-headedness becomes frightening. Feeling hot becomes evidence that panic might be starting. The fear of another panic attack can gradually become as difficult as the attacks themselves.

The things that make us feel safer can sometimes keep panic going

This is one of the most frustrating parts of anxiety. Naturally, we try to protect ourselves.

You might:

• sit near an exit
• avoid motorways
• only travel with someone you trust
• carry water everywhere
• check your heart rate
• Google symptoms
• ask someone for reassurance
• leave somewhere as soon as anxiety rises
• distract yourself whenever you notice a sensation.
• stop exercising because a racing heart reminds you of panic

These are often called safety behaviours, and they're completely understandable. The problem is that your brain may draw the wrong conclusion.

Imagine you attend an event but spend the whole time next to the exit because you're frightened you'll panic. Nothing terrible happens. You might think: "I was OK because I stayed near the exit." Rather than: "I was OK because the anxiety wasn't actually dangerous." Your safety behaviour gets the credit.

The same thing can happen with reassurance, checking, distraction or having another person with you. They can bring short-term relief while accidentally preventing your brain from learning something much more powerful: "I can experience anxiety and still be safe."

Avoidance makes sense, but it can shrink your world

If somewhere has triggered panic before, avoiding it feels logical, and avoidance works brilliantly in the short term. You don't enter the situation. Your anxiety drops. Your brain thinks: "Excellent. We escaped the danger." Unfortunately, that reinforces the belief that there really was something to escape from.

Over time, one avoided situation can become several. Motorways become difficult, then travelling further from home. Crowded places become uncomfortable, then restaurants or public transport.

For some people, their world gradually becomes smaller, not because they're incapable of doing these things, but because their brain has become increasingly protective. This is why recovery from panic often involves gradually doing more, rather than finding increasingly sophisticated ways of avoiding anxiety.

"But what if I panic?" This is often the question underneath everything. And understandably, people want therapy to provide a guarantee: "How do I make sure I never panic again?" But trying desperately not to panic can itself become part of the problem.

You might start monitoring yourself:

• "Am I anxious?"
• "Is it starting?"
• "Do I feel normal?"

The goal becomes controlling every sensation, and that keeps your attention firmly focused on threat. A different question can eventually become more helpful: "What if I did feel anxious and discovered I could handle it?" That's a very different relationship with panic.

So how do we begin to break the cycle?

Recovery isn't usually about convincing yourself that you'll never experience anxiety again. Anxiety is part of being human. Instead, therapy can help you gradually change what anxiety means to you and how you respond when it appears.

That might involve:

• understanding your individual panic cycle and triggers
• learning to interpret physical sensations differently
• reducing constant body monitoring and checking
• recognising reassurance and other safety behaviours
• gradually approaching situations you've been avoiding
• becoming more comfortable experiencing normal bodily sensations
• exploring underlying beliefs around danger, control, embarrassment or vulnerability
• learning that anxiety can rise and fall without needing to escape from it

This process is often gradual. You don't need to throw yourself immediately into your most frightening situation. Instead, you can begin building evidence that you are capable of experiencing anxiety without something catastrophic happening.

Every time you stay rather than immediately escape, tolerate uncertainty rather than check, or allow a sensation without trying desperately to remove it, you're giving your brain new information: "Maybe this isn't as dangerous as I thought." Over time, those experiences matter.

Recovery doesn't necessarily mean never feeling panic

There's an interesting paradox in panic recovery. The harder we fight to guarantee that panic will never happen, the more frightening the possibility of panic can become. 

Recovery can look different. It can become: "I don't want to panic, but I'm no longer frightened of what will happen if I do." And when the fear of panic begins to reduce, panic often loses much of its power.

You start doing things because you want to do them rather than deciding based on whether they might make you anxious. Your confidence grows. Your world gets bigger again. And perhaps most importantly, you begin trusting yourself and your body again.

You don't have to work this out alone

If panic attacks, health anxiety or fear are beginning to affect the way you live your life, counselling can help you understand what's happening and gradually change the patterns keeping the cycle going.

Counselling can offer a warm, practical and collaborative space to explore both what may be driving your anxiety and what is keeping it going now, while working at a pace that feels manageable for you.

You don't need to arrive knowing exactly why you feel this way or what you need from therapy. That's something you can work out with your counsellor.