Terrifying, and not dangerous
Panic attacks
A panic attack feels like a medical emergency. It is not one — and understanding exactly why is a substantial part of the treatment.
What is happening in your body
A panic attack is your fight-or-flight system firing at full strength with nothing to fight or flee from. Adrenaline floods your system. Your heart rate rises to move blood to your muscles. Your breathing quickens to take on more oxygen. Blood moves away from your extremities and your digestive system, which is why your hands tingle and you feel sick.
Every sensation is your body doing exactly what it is designed to do — brilliantly, at entirely the wrong moment.
This matters more than it sounds. Panic attacks are extremely unpleasant and they are not dangerous. You will not stop breathing, faint (blood pressure rises rather than falls), have a heart attack or go mad. Attacks are self-limiting: adrenaline is metabolised within minutes whether you do anything or not.
The loop that makes it a disorder
A single panic attack is unpleasant. What turns it into a condition is what happens next.
- You notice a bodily sensation — a skipped heartbeat, slight breathlessness.
- You interpret it as dangerous: something is wrong.
- That interpretation triggers adrenaline.
- Adrenaline intensifies the sensation.
- Which confirms the interpretation. Round it goes, faster.
Then the second layer arrives: fear of the next attack. You start avoiding places where one would be embarrassing or hard to escape — the motorway, the supermarket, the train, the meeting. Within months the avoidance is a bigger problem than the panic.
How we treat it
- Understand the mechanism properly. Not reassurance — actual explanation of what each sensation is and why. This alone reduces frequency for many people.
- Drop the safety behaviours. Sitting near the door, carrying water, holding your phone, having someone with you. These prevent you from ever learning that you would have been fine.
- Test the predictions deliberately. Bring on the sensations on purpose, in a controlled way, and find out that nothing happens. Uncomfortable, and among the most effective things in the whole of CBT.
- Rebuild what avoidance took. Systematically, at a pace you set.
- Stop fighting the sensation. The ACT contribution — trying to suppress panic reliably feeds it.
Panic responds unusually well to treatment. Of all the things on this website, this is the one where a relatively short piece of focused work most often produces a substantial change.
Get chest pain checked. If you have not had these symptoms assessed medically, see your GP first. Panic is a diagnosis of exclusion, and it would be wrong to treat cardiac symptoms as anxiety without a doctor having looked.
Related
Common questions
Can a panic attack actually harm me?
No. It is extremely unpleasant and it is not dangerous. Attacks are self-limiting and adrenaline clears within minutes. That said, get unexplained chest pain assessed by a doctor rather than assuming.
How long does treatment take?
Panic responds well and relatively quickly — often eight to twelve sessions, sometimes fewer where avoidance has not built up much.
What should I do during an attack?
Slow your out-breath, make it longer than the in-breath, and let the attack happen rather than fighting it. Fighting extends it. We practise this properly rather than in a paragraph.
I only get them at night.
Nocturnal panic attacks are well recognised and frightening, and they are treated the same way. Worth mentioning any alcohol use, since attacks often come during the rebound in the early hours.
Talk it through first
The first step is a short phone call. No commitment, no pressure — just a conversation about what is going on and whether I am the right person to help.
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