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Understanding and Managing Panic Attacks: A Comprehensive Guide

More and more people are seeking my help to overcome panic attacks, so I decided to dedicate this month's blog to this crucial topic. I hope this information can assist as many people as possible in managing and overcoming their panic attacks, improving their quality of life.


Panic attacks are sudden episodes of intense fear or discomfort that peak within minutes, accompanied by a variety of physical and psychological symptoms. They can occur unexpectedly or be triggered by specific situations. Understanding and managing panic attacks is crucial for improving one's quality of life.

Symptoms of Panic Attacks

Physical Symptoms:

  • Rapid heart rate or palpitations

  • Sweating

  • Trembling or shaking

  • Shortness of breath or a feeling of being smothered

  • Chest pain or discomfort

  • Nausea or abdominal distress

  • Dizziness, lightheadedness, or feeling faint

  • Chills or hot flushes

  • Numbness or tingling sensations

Psychological Symptoms:

  • Fear of losing control or "going crazy"

  • Fear of dying

  • Feelings of unreality (derealisation) or detachment from oneself (depersonalisation)

  • Intense fear or terror

Causes and Triggers

Several factors can contribute to panic attacks:

  • Genetics: Family history of panic attacks or panic disorder.

  • Brain Chemistry: Imbalances in neurotransmitters such as serotonin and norepinephrine.

  • Stress: Major life stressors, such as bereavement, divorce, or job loss.

  • Medical Conditions: Conditions like thyroid problems or heart issues.

  • Substance Use: Caffeine, alcohol, and certain drugs.

How Panic Attacks Affect Your Body

During a panic attack, the body's "fight-or-flight" response is activated without real danger, leading to various physical changes:

  • Increased Heart Rate and Blood Pressure: Preparing muscles for action.

  • Rapid Breathing: Leading to hyperventilation and dizziness.

  • Muscle Tension: Causing trembling or shaking.

  • Digestive Changes: Resulting in nausea or stomach discomfort.

  • Sweating: Often excessive and uncomfortable.

These responses, though natural in real danger, feel alarming during a panic attack, reinforcing fear and escalating the attack.

How Panic Attacks Affect Your Mind

Panic attacks can significantly impact your mental and emotional state:

  • Fear of Future Attacks: Leading to anticipatory anxiety.

  • Avoidance Behaviour: Avoiding situations or places where an attack might occur, potentially leading to agoraphobia.

  • Negative Thought Patterns: Catastrophising or overgeneralising fears.

  • Reduced Quality of Life: Interfering with daily activities, work, relationships, and overall well-being.

Managing and Overcoming Panic Attacks

Understanding and managing panic attacks involves recognising symptoms, understanding the physiology, breaking the cycle of panic, and seeking professional help.

Recognise and Acknowledge

  • Acknowledge the Attack: Recognise that what you are experiencing is a panic attack, not something more serious.

  • Accept the Feelings: Allow yourself to feel the emotions without judgement and remind yourself they are temporary.

Control Your Breathing

  • Deep Breathing: Inhale slowly through your nose for a count of four, hold for four seconds, then exhale slowly through your mouth for a count of six. Repeat until you feel calmer.

Ground Yourself

  • 5-4-3-2-1 Technique: Identify 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, and 1 you can taste. This helps refocus your mind on the present moment.

  • Engage Your Senses: Hold onto a textured object, chew gum, or smell something soothing like lavender.

Use Positive Affirmations

  • Reassure Yourself: Repeat calming phrases like “I am safe,” “This will pass,” or “I can handle this.”

  • Challenge Negative Thoughts: Counter irrational fears with rational statements, such as “This is uncomfortable, but it’s not life-threatening.”

Practise Muscle Relaxation

  • Progressive Muscle Relaxation: Tense and then relax different muscle groups in your body, starting from your toes and working up to your head to reduce overall tension.

Visualise a Calm Place

  • Imagery: Close your eyes and visualise a peaceful place like a beach or forest, imagining the details vividly, including sounds, smells, and sensations.

Engage in Physical Activity

  • Light Exercise: Take a walk, stretch, or do light exercises to reduce anxiety and release endorphins.

Use Distraction Techniques

  • Engage in an Activity: Focus on a task requiring concentration, like a puzzle, colouring, or reading.

  • Talk to Someone: Call a friend or family member and discuss something unrelated to the panic attack.

After the Attack

  • Reflect: Once the attack has passed, reflect on what triggered it and how you responded.

  • Journal: Write down your thoughts and feelings to identify patterns and triggers, aiding in preventing future attacks.

Long-term Strategies

  • Therapy: Consider seeing a professional who could help you managing anxiety and panic attacks.

  • Medication: Consult a healthcare provider about medications for managing panic disorder.

  • Lifestyle Changes: Incorporate regular exercise, a balanced diet, adequate sleep, and stress management techniques.

  • Mindfulness and Meditation: Practise mindfulness meditation regularly to enhance your ability to stay grounded and calm.

Tips for Ongoing Management

  • Avoid Caffeine and Alcohol: They can exacerbate anxiety and trigger panic attacks.

  • Stay Hydrated: Dehydration can contribute to anxiety.

  • Maintain a Routine: Consistent daily routines help reduce stress.

Emergency Plan

  • Know Your Plan: Have a written plan of steps to take during a panic attack and share it with close friends or family.

  • Emergency Contacts: Keep a list of emergency contacts who can help during an attack.

How Do We Address Panic Attacks Using Cognitive Behavioural Therapy?

Step 1: Education and Understanding

  • Learn About Panic Attacks: Understanding panic attacks can reduce fear and demystify the experience.

  • Recognise Symptoms: Identify the physical, emotional, and cognitive symptoms.

Step 2: Self-Monitoring

  • Keep a Panic Diary: Track panic attacks, noting date, time, duration, intensity, triggers, and symptoms.

  • Identify Patterns: Look for patterns and common triggers.

Step 3: Breathing Techniques

  • Diaphragmatic Breathing: Practise deep breathing exercises regularly. Inhale deeply through your nose, hold, and then exhale slowly through your mouth.

  • Controlled Breathing During Panic: Use controlled breathing when you feel a panic attack starting.

Step 4: Cognitive Restructuring

  • Identify Negative Thoughts: Write down negative thoughts and fears during a panic attack.

  • Challenge Irrational Beliefs: Examine evidence for and against these thoughts, asking questions like “What is the worst that can happen?” and “How likely is this to happen?”

  • Replace with Positive Thoughts: Replace irrational thoughts with balanced and realistic ones.

Step 5: Exposure Therapy

  • Create a Hierarchy of Fears: List situations triggering panic attacks, ranking them from least to most anxiety-provoking.

  • Gradual Exposure: Start with the least frightening situation and gradually expose yourself to it.

  • Stay in the Situation: Remain in the situation until anxiety reduces without avoiding or escaping it.

Step 6: Behavioural Experiments

  • Test Your Fears: Conduct experiments to test the validity of your fears. For instance, if you fear your heart racing means a heart attack, engage in safe physical activity and observe.

  • Record Outcomes: Note the results to challenge and disprove irrational beliefs.

Step 7: Mindfulness and Relaxation

  • Practise Mindfulness: Regularly engage in mindfulness exercises to stay present and reduce anxiety.

  • Progressive Muscle Relaxation: Tense and relax different muscle groups to reduce tension.

Step 8: Coping Statements

  • Develop Coping Statements: Create a list of calming statements for use during a panic attack, like “I’ve been through this before and I’m okay” or “This will pass.”

Step 9: Problem-Solving

  • Identify Problems: Determine specific problems or stressors contributing to anxiety.

  • Generate Solutions: Brainstorm potential solutions and strategies to address problems.

  • Implement and Evaluate: Try solutions and assess their effectiveness, making adjustments as needed.

Step 10: Lifestyle Changes and Maintenance

  • Healthy Lifestyle: Maintain a balanced diet, regular exercise, and adequate sleep.

  • Regular Practice: Continue practising CBT techniques regularly.

By consistently applying these strategies, you can significantly reduce the frequency and intensity of panic attacks and develop effective coping mechanisms to manage anxiety. Understanding and overcoming panic attacks is a journey, but with the right tools and support, it is entirely possible. 


Stay informed, stay prepared, and remember you are not alone in this journey. If you have any questions or need further assistance, please do not hesitate to reach out below.


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