Understanding and Managing Panic Attacks

What Happens During a Panic Attack

Key Facts About Panic

• Panic attacks typically peak within 10 minutes and rarely last longer than 20 to 30 minutes
• They are not physically harmful, even though the symptoms feel frightening and intense
• Approximately 11 percent of adults experience at least one panic attack each year
• Panic disorder is diagnosed when attacks become recurrent and lead to persistent worry or behavioral avoidance
• Panic attacks can occur during sleep, known as nocturnal panic, and are not caused by nightmares
• Having one panic attack does not mean you will develop panic disorder

The Panic Cycle and How It Sustains Itself

Evidence-Based Treatments

1. Cognitive Behavioral Therapy (CBT): The gold-standard treatment for panic disorder. CBT teaches clients to identify and challenge catastrophic thoughts, tolerate physical sensations, and gradually re-engage with avoided situations. A network meta-analysis supports it as the first-line psychological treatment (Pompoli et al., 2016), and a follow-up study of its parts points to interoceptive exposure, deliberately bringing on the feared body sensations, as one of the most helpful (Pompoli et al., 2018).
2. Interoceptive Exposure: A core component of CBT in which clients deliberately induce panic-like sensations, such as breathing through a straw or spinning in a chair, to reduce fear of the sensations themselves.
3. Breathing Retraining: Slow, diaphragmatic breathing counteracts hyperventilation. A common protocol is inhaling for 4 counts, holding for 2, and exhaling for 6 to 8 counts to engage the parasympathetic nervous system.
4. Graduated Situational Exposure: Systematically and repeatedly facing avoided situations in a structured hierarchy helps the brain learn that these situations are safe.
5. Medication: SSRIs and SNRIs are first-line pharmacological options. Benzodiazepines may ease symptoms in the short term (Breilmann et al., 2019), but they carry dependence risks and are linked to poorer long-term outcomes, so UK clinical guidelines advise against prescribing them for panic disorder (National Institute for Health and Care Excellence, 2020).

What to Do During a Panic Attack

1. Remind yourself that this is a panic attack, not a medical emergency. The symptoms are uncomfortable but not dangerous.
2. Slow your breathing. Focus on long, slow exhales rather than trying to take deep breaths in.
3. Ground yourself by describing what you see, hear, and feel in the present moment.
4. Stay where you are if it is safe to do so. Leaving reinforces avoidance and makes future panic more likely.
5. Allow the wave to pass. Panic attacks have a natural time limit. Accepting the sensations rather than fighting them often shortens the episode.