What happens in the body during a panic attack?
Palpitations, breathlessness, dizziness, a sense of losing control. Knowing what a panic attack means in the body is the first step in breaking the cycle of fear.
Almost every client I see with panic attacks remembers the first one in detail: which ferry, which supermarket, which meeting they were in. Many went to A&E that day, had an ECG and were told “there is nothing wrong with you”, and instead of reassuring them that sentence confused them more. If nothing was wrong, what was that?
In this post I want to explain what happens in the body during a panic attack and why these reactions feel so frightening. Knowing does not stop an attack on its own, but it is an important part of shrinking the “what if it happens again” fear that follows.
When the alarm goes off at the wrong time
Our body has a very old alarm system that switches on in the face of danger. The sympathetic nervous system activates, the adrenal glands release adrenaline and within seconds the body moves into “fight or flight”. This system is designed to help us escape danger and is highly functional.
In a panic attack the alarm rings when there is no real danger. Sometimes there was one coffee too many, sometimes a sleepless night, sometimes no clear trigger at all. The body still prepares as if danger were present. An attack usually peaks within a few minutes and then slowly eases, but those few minutes feel very long to the person living them.
Every symptom is a preparation
- Palpitations and a racing heart: the heart beats faster and harder to send more blood and oxygen to the muscles.
- Fast, shallow breathing: the body tries to take in more oxygen. Fast breathing lowers carbon dioxide in the blood, which can cause tingling in the hands and feet, dizziness and a feeling of not getting enough air.
- Sweating, trembling, hot flushes: the body heats up and prepares to cool itself; tense muscles tremble.
- Chest tightness: tense chest muscles and fast breathing can create this feeling.
- A sense of unreality: some people describe the world or themselves feeling strange or far away. Frightening, but not dangerous.
None of these reactions harms a healthy body in itself. The problem starts with how the sensations are interpreted.
Sensation, interpretation and fear: the vicious cycle
A model often used in cognitive behavioural therapy describes the attack as a cycle. First a bodily sensation is noticed: the heart speeds up a little, or there is slight dizziness. Then it is interpreted catastrophically: “I am having a heart attack”, “I will faint”, “I am losing my mind”. The interpretation increases fear; fear strengthens the alarm; the alarm increases the sensations; and the stronger sensations seem to confirm the first interpretation.
The second problem, after the attack
For many people what is most exhausting is not the attack but the time between attacks. The fear of another one keeps them on constant alert: counting the pulse, checking the body, reading the smallest sensation as an alarm. Avoidance begins too, along with what we call safety behaviours such as always carrying water or sitting near the exit. They help in the short term but keep the fear going in the long term.
What can help during an attack?
- Slowing the breath: in through the nose for four, out through the mouth for six.
- Grounding: feeling your feet on the floor and the seat supporting you.
- Turning attention outwards: counting five objects you can see and three sounds you can hear.
- Telling yourself: “This is a panic attack. It is frightening but not dangerous. It will ease in a few minutes.”
Important: if there is chest pain, severe symptoms for the first time, fainting or symptoms different from usual, call 112. Panic attacks should be discussed after physical causes have been assessed by a doctor.
What we do in therapy
Cognitive behavioural therapy is one of the best supported approaches for panic attacks. We map your cycle together, meet the sensations in a safe and controlled way (for example, briefly breathing fast in a session to create dizziness on purpose) and step by step return to the places you avoid, always at your pace and with your agreement. Sometimes medication, decided by a psychiatrist, can also help; therapy and medication complement each other when needed.
The information in this post is general; for an assessment specific to you, I recommend speaking with a specialist.
