Having a panic attack can be one of the most terrifying things in the world. In this post we’ll learn how cognitive behavioral therapy (CBT) helps us respond to panic, and calm panic before it can escalate into a full-blown panic attack. Or, if we’re already in the middle of panic attack, how we can deescalate panic.
Panic attacks are so scary because we’re reacting to our anxiety as if it were a life-threatening situation. This engages our sympathetic nervous systems, setting off the fight or flight response. And this leads to a number of intense and distressing physiological symptoms associated with panic attacks such as:
- Chest pain or discomfort
- Elevated heart rate and/or racing or pounding heart
- Heart palpitations or our hearts skipping a beat
- Breathing faster or hyperventilating
- Feeling like we’re choking or suffocating
- Dizziness, light-headedness or feeling weak in the knees
- Nausea and other stomach symptoms
- Feeling detached, or like we’re floating away or watching ourselves from outside our bodies
- And many more …
And these physiological symptoms increase our anxiety, leading to catastrophic thoughts that are common during a panic attack, such as:
- I’m having a heart attack
- I can’t breathe
- I’m going to suffocate
- I’m having a stroke
- I’m about to pass out
- I’m losing control
- I’m going crazy
- I’m going to be sick
- I’m going to embarrass myself
- And so on …
In order to prevent or deescalate a panic attack, we need to come up with more accurate and less catastrophic thoughts about what’s going on in our bodies. And we need to reverse the effects of the sympathetic nervous system and the fight or flight response that’s driving our panic attack, by engaging our parasympathetic nervous systems.
In the video below, we’ll learn how to do all of this and more to manage a panic attack with techniques from CBT, which is the most effective way to treat panic attacks:
The Best Way to Stop Panic Attacks
This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.
In this video we’re going to learn how panic attacks get started, what happens during a panic attack, and how we can calm and de-escalate a panic attack once it does start to happen.
Panic attacks arise when we feel so anxious that our sympathetic nervous systems kick in and set off our fight-or-flight responses. And this brings on a wave of intense physiological reactions: we get a rush of adrenaline; our heart rates and breathing speed up; our pupils dilate and our muscles become tense; we start to produce more sweat; and so on. And these are all great ways for our bodies to react when we’re in a life-threatening situation. But during a panic attack our bodies misinterpret our anxiety as a life-threatening situation and react accordingly, setting off this fight-or-flight response as if our lives were in danger.
And if we were in a life-threatening situation our bodies would use this physiological response to help us fight off or flee from whatever the danger is. But when these physiological reactions arise in response to our anxiety, there’s nothing for us to do with them, there’s no outlet for them, because there is no life-threatening situation to fight off or escape. So we’re left with all of these intense physical symptoms and they don’t make any sense. We don’t understand why this is happening.
And so we start having catastrophic thoughts about what’s going on, and misinterpreting this physiological response as symptoms of some sort of health or medical crisis. And these thoughts cause more anxiety, that intensifies our physiological reactions, leading us to have more catastrophic thoughts, and so on, setting off a vicious cycle that can lead us into a full-blown panic attack. So let’s look at how this happens in more detail.
Sometimes our anxiety builds throughout the day and we might have moments of panic here and there that don’t escalate into a panic attack, but then at some point all of this anxiety becomes too much and it does set off a panic attack. Other times it can be an extremely anxious thought or distressing body sensation that sets off a panic attack. Or we may not even know what sets it off and it just seems to happen out of nowhere.
But regardless of the source when we have a panic attack something at some point signals to our sympathetic nervous systems that we’re in danger, which sets off the fight-or-flight response, initiating all of those physiological reactions we mentioned earlier, which again, are great to have if we’re in an actual life-threatening situation.
But if the threats are something like: we’re standing up in front of a group of people about to give a presentation; or we’re in an airplane or on a bus or in a mall or at the dentists and start feeling trapped or claustrophobic; or we’re sitting down about to write an exam; or we’re in a social situation where we’re really uncomfortable because we don’t know anyone; in these sorts of circumstances this intense physiological fight or flight response serves no purpose and can often set off a panic attack.
So at this point what’s driving our panic is a vicious cycle between what’s going on in our bodies—the physiological fight-or-flight response—and our thoughts about what’s going on in our bodies, and what all of these symptoms and sensations mean. So first let’s look at some of the most common physical and physiological symptoms associated with panic attacks.
A lot of these symptoms occur in our chests or hearts: like a feeling of tightness or tension in our chests; or an increased heart rate or a racing heart; or heart palpitations; or the feeling that our hearts are skipping a beat.
Symptoms related to our breathing are also common. We start breathing faster or even hyperventilating, and we can feel a tightness or lump or choking feeling in our throats, and it can start to seem like we can’t breathe or are suffocating.
Stomach symptoms are also common. We might feel nauseous or get cramps or have butterflies in our stomachs. Or get a sinking feeling in the pit of our stomachs. Or we might start to feel dizzy and like we’re going to pass out.
And we can start to feel warm or start to sweat or get sweaty palms. Or our hands may become cold or clammy or start to shake and our hands or feet might start to tingle or feel numb.
And then there are symptoms like feeling detached or like we’re in a dream or floating away or watching ourselves from outside our bodies.
There are any number of physical symptoms we can experience during a panic attack, and if yours didn’t get mentioned, the way we deal with all of them is similar enough that hopefully you’ll be able to find something that applies to your situation as well.
And then the other element involved in setting off a panic attack are the thoughts we have in response to these physiological symptoms and sensations in our bodies. So for example if we’re having a lot of symptoms in our hearts or chests we might think: I’m having a heart attack; I’m going to die.
For symptoms related to our breathing: i can’t breathe; I’m going to suffocate; I’m going to start choking.
For symptoms related to dizziness or feeling weak in the knees: I’m going to pass out; or I’m having a stroke.
And for symptoms related to our stomachs: I’m going to be sick; I’m going to throw up; or I’m going to have diarrhoea.
For symptoms like feeling detached or outside of our bodies we might think: I’m going crazy; or I’m losing control.
And then there are a number of common thoughts that can kick in regardless of the specific symptoms we’re experiencing: I’m so scared; i can’t stand this; this is never going to end; i don’t understand what’s happening to me. Or there’s something really wrong with me; something terrible is going to happen; I’m losing control; I’m going to need to run out of here; or I’m not going to be able to get out of here and I’m going to make a scene; I’m going to embarrass myself; what are people going to think of me?
And all of these types of thoughts increase our anxiety. And as a result our physiological and physical symptoms become more intense, leading to even more catastrophic thoughts, initiating a vicious cycle between our physiological and physical symptoms. And these catastrophic thoughts we have related to these symptoms that can lead us to start to panic.
So if we want to avoid this vicious cycle escalating into a full-blown panic attack, as soon as we start having these catastrophic thoughts about our physiological symptoms, we need to come up with alternative and more accurate explanations for what’s going on in our bodies that can help us reverse this cycle, making it less likely that we have a panic attack. So let’s look at some specific examples.
Probably the most common type of panic attack occurs when we experience something like a racing or pounding heart, maybe with some palpitations or some tightness in our chests, and we think we’re having a heart attack. And so we start panicking because we think we’re about to die. And it’s not uncommon for people to call an ambulance during a panic attack because they think they’re having a heart attack.
And if you ever do think you’re having a heart attack you should call for help. But if you’re watching this video it’s very unlikely that you’re going to have a heart attack anytime soon, because you’re probably under 55, an age at which heart attacks are very uncommon. But again if you do think you’re having a heart attack you should call your emergency services number. And if you’re worried about your heart’s health in general please consult your doctor.
And so this is a tricky thing for me to talk about because i don’t want to discourage anyone who thinks they’re having a heart attack from calling for help. But assuming we know there’s nothing wrong with our hearts and we’ve had panic attacks before, and we know what they feel like, and we know that this is just a panic attack, when we start getting these symptoms in our hearts and chests we need to remind ourselves that all of these symptoms are associated with anxiety and especially with the fight or flight response that gets activated when we start to panic. It doesn’t mean we’re having a heart attack. It doesn’t mean we’re going to die.
And by replacing a thought like, oh my god i think I’m about to die, with something like: I’m having extremely intense and uncomfortable feelings in my chest and heart because I’m panicking and my sympathetic nervous system has initiated the fight-or-flight response, we start to reverse the vicious cycle between our physical symptoms and our catastrophic thoughts about these symptoms that’s driving our panic.
And so we start to feel less panic. And as a result the intensity of our physiological symptoms begins to decrease. And because the physiological symptoms are no longer as strong, our thoughts about these symptoms continue to become less catastrophic and more calming, which further reduces our levels of panic.
And these physiological responses like a racing heart aren’t dangerous. They’re not going to cause a heart attack and they’re not going to damage our hearts. They’re just going to feel really uncomfortable, but then they’ll pass without causing any lasting harm.
And everything I’ve said about panicking or having a heart attack applies to panicking we’re having a stroke or any other sort of life-threatening medical crisis. All of our symptoms can be explained by anxiety and panic and the fight-or-flight response. And so if we’re in a heightened state of anxiety and start having these symptoms, it’s very probably just a panic attack. But if you think you’re actually in the middle of a life-threatening medical crisis then you should seek medical attention.
Now let’s look at symptoms related to our breathing. If we feel like we’re choking or can’t breathe or starting to suffocate, we need to reassure ourselves that this is nothing dangerous. It’s been set off by the fight-or-flight response, and it’s not physically possible for us to suffocate ourselves—when we need oxygen our bodies will reflexively breathe—so there’s no way we can suffocate during a panic attack.
But we can start to hyperventilate during a panic attack, which can lead to low levels of carbon dioxide in our blood, which can cause many of the symptoms we can have during a panic attack. So again if we start to hyperventilate we need to replace any catastrophic thoughts like, i can’t breathe, I’m going to suffocate, with reassuring thoughts that these are all normal symptoms of a panic attack and they’re nothing dangerous. And this can help calm our panic.
And then the second thing we can do about symptoms related to our breathing is to slow down our breathing, often we’re told if we’re feeling anxious we should take some deep breaths. But if we’re having a panic attack and we try taking deep breaths we often do this without slowing down our breathing as well. And then we start panting, taking lots of quick deep breaths, which can lead to hyperventilating. So we want to make sure that we’re taking slower rather than deeper breaths.
And there are all sorts of breathing techniques we can use to slow down our breathing so if you already have one that works for you there’s nothing special or magic about my technique. I just find it’s the easiest one for people to be able to do on the spot without any practice in the midst of a panic attack.
So i think the most effective way to slow down our breathing during a panic attack is to breathe into our nostrils for a count of two; pause for a count of two; and then breathe out of our mouths for a count of four through pursed or puckered lips, which slightly restricts the airflow naturally slowing down our exhale.
And then as our breathing slows down we can increase the length of the count breathing in for a count of three; holding our breath for a count of three; and then breathing out for a count of six, and so on. And i have a couple of videos that present this as a guided breathing exercise that you can try out if you are panicking and are finding it difficult to slow down your breathing.
So when we slow down our breathing like this not only does our breathing become easier and more comfortable, we engage our parasympathetic nervous systems. The autonomic nervous system is responsible for regulating our body’s unconscious actions. It includes the sympathetic nervous system, which is responsible for the fight-or-flight response; and the parasympathetic nervous system, which is the opposite of the sympathetic nervous system. And instead of a fight-or-flight response the parasympathetic nervous system is responsible for the rest and digest response, which helps our bodies recover and get things back to normal after a stressful situation.
And so slowing down our breathing helps not just with our breathing related symptoms, but since it engages our parasympathetic nervous systems, it reverses the effects of our sympathetic nervous systems and all of the physiological reactions brought on by the fight-or-flight response, so slowing down our breathing is a great way to help reduce panic.
This brings us to feelings of dizziness and fears that we’re going to pass out. A panic attack can’t cause us to pass out unless we have one of two phobias—a fear of blood or a fear of needles—in which case if we see some blood or get injected with a needle we might pass out. But otherwise we can’t pass out during a panic attack, because the fight-or-flight response elevates our blood pressure. And we pass out when there’s a sudden drop in our blood pressure. So having a panic attack is the opposite of being about to pass out. So the dizziness we feel is a result of anxiety and it’s not going to cause us to pass out or fall over.
Let’s look at symptoms related to our stomachs. Yes anxiety can cause us to get sick. We can throw up or have diarrhoea. But these aren’t life-threatening. They’re unpleasant and potentially embarrassing. But if we’re able to reassure ourselves that these feelings in our stomachs are the result of anxiety and the fight-or-flight response, which does affect digestion. And even if we’re not hyperventilating, slowing down our breathing still helps us engage our parasympathetic nervous systems, and the rest and digest response, which helps calm our anxiety, and our stomachs will start to feel better.
And we can’t go crazy or lose control during a panic attack. Symptoms that feel really weird or can be really scary like feeling detached or in a dreamlike state, or floating away, or watching ourselves from outside our bodies can make us feel like we’re going crazy, but we can’t go crazy (whatever that means) during a panic attack. Again these are just physiological symptoms brought on by our anxiety. And they’ll pass as the panic passes.
We can also try a grounding exercise called 54321 to help us reconnect with reality and we name: five things we can see; four things we can touch; three things we can hear; two things that we can smell; and one thing we can taste. And i have a video that helps guide you through this process if you want to try it out.
And for any other types of physiological or physical symptoms the strategy is the same. We replace our catastrophic thoughts about these symptoms with more accurate thoughts and explanations. And when we’re able to change our thinking then our anxiety and panic and the related physical symptoms we’re experiencing will begin to subside.
And then for the remaining thoughts we talked about earlier, we just need to come up with alternative and more accurate ways of assessing the situation that aren’t so catastrophic and therefore will reduce our anxiety.
For thoughts like, I’m so scared, i can’t stand this, this is never going to end, i don’t understand what’s happening, there must be something really wrong, with me something terrible is going to happen; instead we need to find a perspective more along the lines of, yes this is really scary and uncomfortable, but i know it’s a panic attack and it’s going to end, and the worst case scenario is that I’m going to feel really scared and uncomfortable for maybe 20 to 30 minutes. But then it’s going to pass and everything’s going to return to normal and I’m going to be fine. Or any similar perspective that helps calm our anxiety a little bit and makes it less likely that things continue to escalate.
For thoughts like, what if i can’t get out of here, what if i can’t escape, I’m going to end up making a scene; we need to remind ourselves that this is a panic attack. It feels really scary and uncomfortable but it’s not dangerous. These feelings are all because of anxiety, and slowing down our breathing can help us engage our parasympathetic nervous systems and the rest and digest response, which will help ease our feelings of panic. And doing a grounding exercise can also help, as well as replacing any of our catastrophic thoughts with more accurate and calmer ways of thinking about the situation we’re in. And even if we do have a panic attack, using these techniques can help reduce the severity and duration of the panic attack which is sometimes the best that we can do.
And for thoughts like, I’m losing control, I’m going to embarrass myself, what are people going to think of me; we need to tell ourselves we don’t lose control during a panic attack. It can feel like we’re losing control because of all the intense things going on in our bodies. But that doesn’t translate into acting out of control. And it’s unlikely that we embarrass ourselves during a panic attack, because most of the time nobody even notices. But even if people do notice, the fear “what will people think of me?” Is generally unfounded, because most people will have empathy and sympathy. So we may feel embarrassed, and that’s a natural reaction, but having a panic attack is not something the people around us will think we have any reason to feel embarrassed about.
But sometimes none of these things work and our panic escalates and we find ourselves in the middle of a full-blown panic attack. And so if this happens the best thing we can do is to just accept that we’re having a panic attack. Not because we don’t mind having a panic attack, but because at this stage there’s nothing we can do to prevent it from happening, because it’s already here.
And because trying to fight the panic attack is a battle we can’t win. And is only going to increase the fight-or-flight response, prolonging the panic attack and making it more intense. But the paradox is, if we’re able to just accept that we’re having a panic attack, and we just allow the panic attack to happen, it loses some of its power. Because since we’re accepting it rather than fighting it or trying to escape, there’s no need for the fight-or-flight response anymore—there’s nothing to fight and there’s nothing we’re trying to flee from—and so our physiological symptoms brought on by the fight-or-flight response begin to subside. And as a result our panic stops escalating and can begin to subside as well.
The Panic Attack Worksheet will help you plan how to respond to your physiological symptoms and catastrophic thoughts when you start to panic, in order to prevent or deescalate a panic attack. You can download the Panic Attack Worksheet in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.