When we feel anxious, we can feel uneasy and may experience physical symptoms such as chest pain and dizziness. For some people, this anxiety can become so intense that it triggers a panic attack, where you feel overwhelmed with fear and experience extreme physical symptoms.
After having an attack, you may start avoiding certain situations in case they trigger another attack. This can become a vicious cycle, as you start avoiding more and more things and become anxious about panic attacks. Here we’ll look at what triggers panic attacks when panic disorder might be diagnosed and what treatment can help.
What is a panic attack?
When you have a panic attack, your body feels a rush of fear and panic, leading to intense physical and mental symptoms. They can feel very frightening, especially if you haven’t experienced one before.
They are our body overreacting to stress and anxiety. Most attacks last between five and 20 minutes, however some have been reported to last up to an hour. Although it doesn’t feel like it at the time, panic attacks won’t cause you any physical harm.
It is important to note that panic attack symptoms can be similar to other medical conditions, such as heart attack, so if you are in any doubt about the cause of your symptoms - seek medical help.
It was a particularly stressful day with my kids and husband and I had a full blown panic attack that scared me so badly I had to go to A&E. My heart rate was so high, I thought I was having a heart attack. The doctor explained to me what was going on and told me to see my GP the next day, who diagnosed me.
Panic attack symptoms
Panic attack symptoms can come on very quickly and may appear out of nowhere. Common physical symptoms include:
- a fast or irregular heartbeat
- feeling very hot or cold
- feeling dizzy and lightheaded
- chest pain
- stomach pain
- sweating and shaking
- a tight throat or feeling as if you’re unable to breathe
- feeling as if you aren’t connected to your body or mind (this is called dissociation)
Mentally, you’ll likely feel very scared and worried that you’re going to pass out, have a heart attack or even that you're going to die.
What causes panic attacks?
Panic attacks are rooted in anxiety and, like many mental health conditions, anxiety can have many causes. Usually, conditions like this are linked to a combination of factors, including experiencing a traumatic or stressful life experience, having a close family member with the disorder and an imbalance of neurotransmitters (the chemical messengers in the brain).
You may notice that your panic attacks are triggered by certain places, situations or activities. There may be a pattern to your panic attacks (for example, before a stressful appointment or at night-time) or you may get them for no reason in particular.
If you are having panic attacks often, you may have panic disorder.
What is panic disorder?
A type of anxiety disorder, panic disorder is when you have regular panic attacks and often without any identifiable reason. It is common for those with panic disorder to also experience agoraphobia at the same time. Agoraphobia is when you feel anxious about being somewhere you think would be difficult to get out of, or where you think it would be hard to find help if you had a panic attack.
This can lead people to avoid everyday situations such as using public transport or even leaving the house. Sometimes agoraphobia develops after you have a panic attack, as you become worried about having another attack and avoid any situation which may lead to an attack.
In brief, an ancient part of our brain, which is a brain area even reptiles have, is the centre of fear and danger, amongst other things. This primal brain system is an absolute lifesaver. Its importance cannot be understated and neither can anxiety. Anxiety becomes problematic when it is disproportionate to the threat. The primal fight, flight, freeze system has become too sensitive and is being triggered when it is not needed.
Panic disorder in children
Panic attacks are more common in teenagers and adults than children, however, they can affect younger children and can be particularly tough to deal with. Depending on the severity, panic disorder can affect children’s development and learning.
How are panic attacks and panic disorder diagnosed?
If you are experiencing panic attacks, it’s advised to visit your doctor. To diagnose you, they will likely ask you to describe your symptoms, how often you have panic attacks and how long you’ve experienced them. They may also carry out some physical tests to rule out any other conditions that could be causing the symptoms.
If you have been experiencing regular or unexpected panic attacks followed by at least a month of ongoing concern about having more attacks, you may be diagnosed with panic disorder.
It can feel difficult speaking to someone you don’t know about how you’re feeling, but it’s important to be as honest as possible. This will ensure you get an accurate diagnosis and the right support.
If you are diagnosed with panic disorder and you drive, you will need to let the Driver and Vehicle Licensing Agency (DVLA) know. You can find out more from gov.uk about driving with a disability or health condition.
Counselling Directory member Dr Lee Valls discusses anxiety on Happiful's I am. I have podcast.
Treatment for panic disorder
The aim of treatment is to help ease anxiety symptoms and reduce the frequency of panic attacks. The most common approach is talking therapy and medication. Depending on your circumstances you may benefit from either one alone or a combination of the two.
In the first instance, you’ll likely be recommended to try cognitive behavioural therapy (CBT). You may be referred by your doctor, or you can refer yourself directly. You may also want to explore private therapists if this is accessible to you.
CBT can help you understand how you react and think when you have a panic attack and how you can change these. Your therapist can teach you breathing techniques and other behavioural changes that can help with anxiety.
Your doctor may also recommend antidepressant medication. It may take a little time to find the right type of medication and dose that suits you, so ensure you keep your doctor updated on how you’re feeling.
If CBT and medication aren’t helping, you may be referred to a specialist who can explore other therapy approaches.
Alongside your treatment, you may also benefit from talking to others who have anxiety. Support groups and charities can be incredibly supportive as people can share experiences and what works/doesn’t work for them.
As well as following your treatment plan, there are several lifestyle changes you can try to ease anxiety and prevent further attacks. Prioritising self-care is important, try to ensure you’re getting enough sleep and eating a well-balanced diet (what we eat can affect mood and anxiety levels). Avoid too much sugar caffeine and nicotine as these can all exacerbate anxiety symptoms.
Find ways to reduce stress and encourage more relaxation in your life. This could be through physical exercise, breathing exercises or even exploring complementary therapies like massage and aromatherapy.
Developing a mindfulness practice can help too, whether this is through meditation or activities like yoga. If you’re struggling to lower your stress levels, mindfulness-based stress reduction (MBSR) may be worth exploring.
How to stop a panic attack
If you can feel a panic attack coming on, try the following:
- Focus on your breathing, aim to breathe slowly, exhaling a little longer than you inhale.
- Try not to fight the attack and if possible, stay where you are.
- Tell yourself that this feeling will pass and remind yourself of previous attacks that you’ve lived through.
- Stamp your feet on the ground. This can help you come back to your body and control your breathing.
- Focus your attention on your senses. Try eating a mint, smelling an essential oil or touch something soft and think about how it feels/tastes/smells.
Breathe in comfort and ease and breath out tension and fear. Repeat three times.
- Dr David Kraft shares his tips for dealing with a panic attack.
When the panic attack passes, take it easy and ask yourself what your body and mind needs. You may want to sit somewhere quiet or drink some water. If you can, tell someone what’s happened and share with them ways they can help you if you have a panic attack in the future.
What should I be looking for in a counsellor or psychotherapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat panic disorder. However, the National Institute for Health and Care Excellence (NICE) have developed a set of guidelines that provide advice about the recommended treatments.
In the first instance, those suffering from panic disorder should be offered access to a support group and self-help information recommendations by their doctor. If this doesn't help, or the panic disorder is more severe, psychological treatments such as cognitive behavioural therapy and/or applied relaxation are recommended. Further treatment may require medication.
Read the full NICE guidelines:
There are several accredited courses, qualifications and workshops available that can improve a counsellors knowledge of a particular area, so for peace of mind, you may wish to check to see if they have had further training in treating panic disorder.