Panic attack – what happens in the brain and body, how to stop it and when to see a psychiatrist?
If you have ever had a panic attack, this probably sounds familiar: sudden heart palpitations, shortness of breath, dizziness, sweating, shaking, and inside the thought: “this is a heart attack / stroke / I’m dying / I’m going crazy”. After a few–fifteen minutes the symptoms abate, and you are left with shame, fear of the next attack and the question whether it was “just nerves”.
Let’s start with the most important thing: what you are experiencing is real.
On the other hand – what we call a panic attack is well described in guidelines and research, and treatment of panic attacks is quite different from “a request for a calming pill”.
What is a panic attack – symptoms in plain language
How does a panic attack present in the body?
In guidelines on panic disorder a panic attack is defined as a sudden wave of intense fear or discomfort that reaches a peak within minutes and is associated with several of the symptoms below:
The most common physical symptoms include among others.:
accelerated heartbeat, palpitations, a feeling of a “strong pounding” in the chest,
shortness of breath, “not enough air”, pressure or pain in the chest,
dizziness, “detachment”, feeling faint,
sweating, chills or hot flashes,
trembling of hands or legs, muscle tension, “jaw clenching”,
nausea, “tightness” in the stomach, dry mouth.
What is happening in the mind?
In addition there are psychological symptoms:
intense fear for life (“I’m about to die”, “it’s a heart attack/stroke”),
fear of losing control (“I’m going to go mad”, “I’ll lose it in public”),
a sense of detachment from reality or from one’s own body (derealisation, depersonalisation).
The whole episode usually lasts from a few to several minutes, then gradually subsides – although anticipatory anxiety about another attack can remain for a long time.
Important: a panic attack itself is not a heart attack or stroke.
At the same time, especially with a first attack and presence of risk factors (age, cardiac diseases, etc.) clinicians correctly recommend ruling out somatic causes – which is why you may end up in the emergency department before seeing a psychiatrist.
What happens in the brain and body during a panic attack?
The alarm system in overdrive
A panic attack is a situation where the nervous system switches into “fight or flight” mode, even though objectively there is no danger that requires such a reaction.
In broad terms:
the brain (especially fear‑related structures like the amygdala) misinterprets signals from the body or environment as dangerous,
the sympathetic system is activated: heart rate and breathing accelerate, muscle tension increases, stress hormones are released,
hyperventilation (rapid, shallow breathing) can appear, which further worsens dizziness, tingling and the sensation of breathlessness.
It is a vicious circle: you feel symptoms → you interpret them as danger (“heart attack”) → anxiety increases → the body reacts even more strongly → anxiety rises further.
That’s why treatment of panic attacks emphasises reprogramming both thoughts and bodily reactions – and here psychotherapy, medications and breathing techniques come into play.
Panic attack – what to do “here and now”? How to stop it step by step
You can’t “stop” the episode like pausing a movie, but you can reduce its intensity and regain a sense of control. This doesn’t replace treatment, but it is a crucial coping element.
How to stop a panic attack step by step?
Based on clinical recommendations and educational materials you can apply these steps:
Step 1: Name what is happening
in your mind or out loud tell yourself:
“This is a panic attack. It is very unpleasant, but it does not threaten my life and it will pass.”this helps break the spiral of “this is a heart attack / I’m dying”.
Step 2: Address breathing (exit hyperventilation)
Research and clinical practice recommend calm, diaphragmatic breathing with extended exhalation:
sit or lean in a safe place,
breathe through your nose and direct the breath “lower” (into the belly, not just the chest),
you can use a simple pattern, e.g. 4‑2‑6:
inhale through the nose for 4 seconds,
hold for 2 seconds,
calmly exhale through the mouth for 6 seconds,
repeat for a few minutes, focusing on counting.
Such exercises help slow breathing, calm the heart and soothe the nervous system.
Step 3: Grounding (return to the “here and now”)
Therapeutic materials often recommend so‑called grounding techniques:
look around and name: 5 things you see, 4 things you can touch, 3 things you hear, 2 things you feel, 1 thing you can taste,
you can also press your feet firmly to the floor, feel the chair under you, the texture of something in your hand.
The aim is to shift attention from the head and symptoms back to the real environment.
Step 4: Reminder – this will pass
During a panic attack the brain likes to throw out sentences like “this will be forever”.
With patients we teach having a “ready rescue phrase”, e.g.:
“The worst will pass in a few–fifteen minutes, I’ve been through this before.”
“This is a wave – I don’t have to stop it, just ride through it.”
It’s not a magic phrase, but it helps avoid adding another layer of anxiety.
Treatment of panic attacks – when are techniques not enough?
If panic attacks occur sporadically in a very specific situation (e.g. a single attack after huge stress), sometimes psychoeducation, learning breathing techniques and working with a psychologist on the current crisis is sufficient.
However, if:
attacks repeat,
you start avoiding places/situations (“just so I don’t have an attack”),
you live in constant fear of the next attack,
then we are talking about panic disorder and guidelines are clear: organised treatment is needed.
Psychotherapy – the foundation of panic attack treatment
Clinical recommendations recognise cognitive‑behavioral therapy (CBT) as one of the most effective methods for treating panic attacks.
CBT for panic disorder includes among others.:
psychoeducation – understanding what a panic attack is (what happens in brain and body),
work with thoughts – catching and changing catastrophic interpretations of symptoms (“heart racing = I will die”) to more realistic ones,
exposure – gradual, controlled “exposure” to situations that evoke fear (e.g. driving, queues, public spaces),
learning breathing and relaxation techniques.
Research and guidelines (also international) indicate that CBT can offer lasting improvement and reduce relapse risk even after therapy ends.
Pharmacotherapy – when do medications enter the picture?
Current guidelines for panic disorder state that first‑line treatment is CBT and/or antidepressant medications (SSRIs, sometimes venlafaxine).
In brief:
SSRIs (e.g. sertraline, paroxetine, escitalopram) and SNRIs (e.g. venlafaxine) have documented efficacy in reducing the frequency and severity of panic attacks,
benzodiazepines may be used short‑term at the start of treatment in severe cases, but due to risk of dependence and relapse they are not recommended as long‑term monotherapy.
Reviews indicate that:
CBT and pharmacotherapy are comparably effective in the short term,
relapses after discontinuing medications occur more often than after finishing CBT,
combining SSRI + CBT can be particularly helpful in severe cases, though it requires an individual plan.
When do panic attacks require help from a psychiatrist?
This is not about “deserving” a psychiatrist, but about safety and treatment effectiveness.
Signals that you should see a psychiatrist
Guidelines and clinical practice suggest that psychiatric consultation is particularly indicated when:
panic attacks recur (e.g. several times a month or more),
you begin avoiding places/situations for fear of an attack (bus, shopping, work, university),
anticipatory anxiety appears – constant tension “what if it happens again?”,
symptoms are so severe that functioning is difficult (work, school, relationships),
in addition to panic attacks depressive symptoms appear (sadness, lack of energy, loss of pleasure, resignation thoughts).
In these situations a psychiatrist may:
confirm or rule out panic disorder diagnosis,
propose pharmacotherapy (if needed),
refer to appropriate psychotherapy or collaborate with your therapist,
issue sick leave (L4) if the mental state temporarily prevents work.
When to seek urgent help?
Regardless of how long you’ve had panic attacks, urgent help is required when:
very severe somatic symptoms occur during an attack in a person with cardiac risk factors – acute conditions (heart attack, embolism, stroke) must be excluded,
alongside anxiety there are suicidal thoughts with a plan, a sense you might act on them – this calls for urgent contact with a doctor / emergency department / emergency numbers.
A panic attack itself is not lethal, but decisions made during it (e.g. fleeing while driving) can be dangerous – so treating it seriously is important.
FAQ
What are the symptoms of a panic attack?
The most common symptoms are:
sudden palpitations, shortness of breath, chest pain/pressure,
dizziness, a sense of “detachment”,
sweating, trembling, muscle tension, nausea,
intense fear of death, loss of control, “going crazy”.
Symptoms build up quickly within minutes and usually resolve within several tens of minutes.
Panic attack – what to do during one?
name it (“this is a panic attack, it will pass”),
calm your breathing (e.g. diaphragmatic breathing 4‑2‑6),
use grounding techniques (focus on present stimuli),
if it’s the first time and you have cardiac risk, consult a doctor to rule out somatic causes.
How is treatment for panic attacks structured?
Guidelines recommend in panic attack treatment:
psychotherapy, especially cognitive‑behavioral therapy (CBT),
in many cases – antidepressant medications (SSRI/SNRI),
learning breathing and tension‑regulation techniques,
in severe anxiety – sometimes short‑term benzodiazepines under strict supervision.
Treatment plans are individually chosen by a doctor and/or psychotherapist.
If this text sounded like a description of your experiences, it doesn’t mean “something is wrong with you”.
It means your alarm system is overloaded – and it’s worth having someone help recalibrate it.
You may consider a psychiatric consultation (online or in‑person) to:
make sure we’re dealing with isolated panic attacks or panic disorder,
plan treatment together: therapy, possibly medication, work with breathing and the body.
This text is informational and educational. It does not replace an individual medical consultation or diagnosis. In case of severe somatic symptoms or suicidal thoughts contact a doctor urgently or call for help.
Sources
Urbann Clinic, “What a panic attack looks like – symptoms of panic disorder” – description of panic attack symptoms consistent with diagnostic criteria and clinical practice.
CBT.pl, “Panic attacks – symptoms, causes and treatment methods for panic disorder” – discussion of CBT, breathing techniques and relaxation in treating panic attacks.
Mp.pl / guidelines, “Panic disorder – clinical practice guidelines” – diagnostic and therapeutic recommendations, including SSRIs and CBT as first‑line treatments.
Pollack MH et al., “Combined antidepressants and CBT for panic disorder with agoraphobia” – description of guidelines where CBT and SSRI/SNRI are first‑line therapies; analysis of monotherapy and combined treatment effectiveness.
AAFP, “Eight Strategies for Optimizing Treatment of Panic Disorder” – practical guidance on pharmacotherapy (SSRI, benzodiazepines) and the role of CBT.
Educational articles on breathing techniques and exposure in panic – among others. descriptions of diaphragmatic breathing, the 4‑2‑6 pattern and the role of body‑work in reducing symptoms.
Clinical patient guides, “Panic attack: how to help yourself and another person?” – discussion of symptoms and treatment methods (CBT, pharmacotherapy).
