If you’ve ever experienced a heart-racing, heavy breathing, out-of-control episode that is overwhelming to the point of feeling like you have to flee, you have most likely experienced anxiety.
Anxiety is a heightened mental state in which an individual dreads uncertain and ill-defined events in the future.
People who experience elevated anxiety might have panic attacks, which are intense and can often occur out of the blue. They comprise an all-encompassing fear and terror that can feel near impossible to overcome (Grillon et al., 2017).
The presence of anxiety can be distressing and often debilitating, but understanding the origins of the anxiety can help combat external reactions, such as panic attacks.
This article will detail the symptoms and causes of panic attacks and provide treatment options and coping strategies to help facilitate your wellbeing.
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Panic Attacks vs Anxiety Attacks
Panic and anxiety are often used interchangeably to describe chronic feelings of fear, dread, and unease. However, anxiety and panic attacks are very different feelings.
Therefore, it is important to understand the classifications of both panic and anxiety.
An anxiety attack is actually not classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Anxiety is a chronic condition characterized by excessive worry over an upcoming event or situation (Joy, 2017).
Let me give you an example. Someone who is fearful of social situations might experience reoccurring anxious thoughts about social gatherings or interactions.
Due to its chronic nature, the term ‘anxiety attack’ is shorthand for describing experiencing symptoms of anxiety.
Panic attacks, on the other hand, come on suddenly and are an immediate response to a fearful situation. The body’s fight-or-flight response is the primary cause behind the onset of a panic attack.
More specifically, the body is responding to a perceived threat and attempts to escape (flight) to avoid the frightening situation or stimuli (Resources to Recover, 2020).
So, even though that same individual might experience chronic anxiety when entering social situations, a more immediately distressing event, like a social event where they do not know anyone, may cause a panic attack.
Panic attacks are classified by their immediacy and sudden onset, which can cause the individual experiencing them to question what caused them in the first place.
What Are Panic Attacks According to Psychology?
Panic itself is characterized by a feeling of overwhelming fear and terror.
Panic attacks are also considered the hallmark symptom of panic disorder (Grillon et al., 2017).
Indeed, panic disorder is described as an anxiety disorder characterized by panic attacks that are recurrent and unexpected. In panic disorder, at least one panic attack is followed by one month or more of the individual anticipating the attacks and, as a result, avoiding potential situations that may trigger an attack (Ankrom, 2020).
Therefore, for a diagnosis of panic disorder, panic attacks cannot occur because of another medical condition and must not be better accounted for by another disorder (i.e., if the panic attacks are triggered by social situations, social anxiety disorder or social phobia may be more applicable).
The DSM-V further classifies panic attacks by their manifestation. Prior to the update in the DSM-V, the DSM-IV had previously classified panic attacks under three categories: situationally bound/cued, situationally predisposed, or unexpected/uncued (Ankrom, 2020).
The current DSM-V has two categories to classify panic attacks (American Psychiatric Association, 2013):
- Expected panic attacks are those associated with a specific fear, like that of flying.
- Unexpected panic attacks have no apparent trigger or cue and may appear to occur out of the blue.
It is important to understand the origins of panic attacks. Knowing what brings on the attacks can help equip you with the tools to overcome them.
The Causes of Panic Attacks
So, what causes a panic attack?
The causes of panic attacks are varied. Risk factors can be both biological and situational. Genetic risk factors (e.g., familial history of mental illness or other conditions) can lead to more intense panic attacks and eventually cause more severe conditions such as panic disorder.
Temperament can also play a role in developing panic attacks. For instance, if you take on too many responsibilities or tend to ‘burn the candle at both ends,’ you may be more likely to experience a panic attack.
In terms of developing panic attacks in an isolated situation, experiencing a stressful life event such as a death or a significant change in your daily activity (e.g., moving, a new job) can trigger panic attacks.
Risk factors for developing panic attacks can also be environmental (e.g., abuse) or physiological, meaning they can be brought on by exaggerated thinking about physical symptoms that are unfamiliar (e.g., a newly diagnosed heart condition or a novel sensation).
Even though the causes of panic attacks can be varied, there are several common triggers and thought patterns, described as building blocks, that can contribute to the development of panic attacks and anxiety-related conditions (Perkins, n.d.).
Unpleasant life events
Everyone experiences unpleasant life events at some point in their lives, from a death in the family to losing a friend or a job. However, it is all about the reaction that an individual has to the unpleasant life event that leads to anxiety.
Even though these events are experienced by everyone, it comes down to brain chemistry and how you have been conditioned to react to these events that makes a difference.
Unhelpful thinking patterns
Thinking patterns can have an enormous influence on how an individual reacts to unpleasant life events.
Often, when we think about an unpleasant life event, we engage in automatic negative thoughts, as the unpleasant event can be upsetting. However, when negative thinking becomes a pattern, it can lead to panic attacks, as you are constantly thinking of the worst-case scenario.
Constant negative thoughts can also lead to catastrophic thinking, which assumes the worst-case scenario, no matter the situation.
Unpleasant emotions can go hand-in-hand with negative thinking patterns. At times, you may notice how you are feeling before noticing what you are thinking, and vice versa.
Often, feeling depressed, anxious, or angry can come to the forefront. However, it’s not the appearance of these negative or unpleasant emotions that cause problems, but their duration and frequency.
Similar to unhelpful thinking patterns, if your immediate emotional response is negative, then these feelings will persist, even when more positive events start to take place.
Over time, the combination of unpleasant thoughts, emotions, and unhelpful thinking patterns can lead to a physical manifestation of anxiety-related symptoms.
Panic attacks and other symptoms (e.g., trouble sleeping, dizziness, and nausea) can be a result of failing to fix the other negative thinking patterns and emotions.
Avoidance is a crucial mechanism that individuals often use to suppress their fears. For instance, if you experience anxiety when engaging in social situations, you may find it easier in the short term to avoid attending social engagements.
In more extreme cases, individuals may take avoidance more literally and choose to engage in harmful behaviors (e.g., alcohol and drug addiction, working excessively, or emotional eating) to help suppress their fears.
The above building blocks are used to understand the potential signs that may contribute to the development of a panic-related disorder.
Even though the signs may not be the same for everyone, these five are common contributors to developing panic or anxiety-related symptomatology.
What Do They Feel Like? 15 Symptoms & Signs
In order to identify if you are experiencing panic attacks, it is important to understand the symptoms and signs that may manifest.
Typically, panic attacks are brief and can last anywhere between 10 and 15 minutes. They come on fairly quickly and reach their highest peak within about 10 minutes.
At their onset, a panic attack can be characterized by:
- Fast or shallow breathing
- Quickening heartbeat
- Sharpening senses
As the attack progresses, further symptoms emerge as the ‘flight’ response continues and the body is put on high alert.
Other symptoms that are often associated with a panic attack include (Resources to Recover, 2020):
- Flank and/or chest pain
- Blurred vision
- Chills or hot flashes
- Racing heart rate
- Shaking and/or trembling
- Shortness of breath
- Muscle aches
- Numbness in lips and fingers/toes
Although panic attacks themselves typically last about 10–15 minutes, these symptoms can persist for longer, most commonly for up to a few hours.
That is why it is important to understand treatment and intervention options to help shorten the duration of the attacks or prevent them altogether.
Can Medication Help?
Antidepressants have been shown to reduce symptoms of panic attacks and can provide assistance in reducing the physical symptoms that come with an attack.
Both selective serotonin re-uptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) have been found to be equally effective at reducing panic severity and the number of attacks (Ham, Waters, & Oliver, 2005).
While neither medication has been proven to be more effective than the other at treating panic attacks, it is important to understand the chemicals in the brain that are targeted by both medication groups.
The aim of SSRIs is to increase the brain’s production of serotonin and norepinephrine, which are believed to improve mood.
By contrast, TCAs work by inhibiting transmitters that carry serotonin and norepinephrine into neurons (Christiansen, 2020).
The choice of medication should be based on the individual’s medical history and individual temperament. A consultation with your primary healthcare provider is always recommended before taking medication, as different medications will be more or less effective for different people.
Recovering From Panic Attacks: 2 Treatment Options
Several treatment options are available to facilitate recovery from panic attacks and panic disorder.
The process of determining which treatment is best is different for everyone, and ongoing consultation with your primary healthcare provider is essential in ensuring that your plan is effective for your specific situation.
A combination of therapy and medication is considered the best long-term solution for most mental health disorders, including chronic panic attacks.
Below are a few therapeutic treatment options to support individuals experiencing severe anxiety leading to chronic panic attacks.
Cognitive-Behavioral Therapy (CBT) has been proven to be more effective than general psychotherapy at treating panic attacks and panic disorder (Ham et al., 2005). Eight to 15 sessions of CBT have been found to be effective at treating panic-related symptoms (Ham et al., 2005). Specific aspects of CBT that are effective at treating panic attacks include exposure therapy and cognitive restructuring.
Exposure therapy focuses on gradually and repeatedly reentering feared situations. To do this, the practitioner builds you up by getting you to enter situations you are not afraid of, which slowly builds up your confidence and allows you to enter the feared situation.
Since panic attacks are characterized by a fear of specific physical sensation (e.g., dizziness), practitioners might also get you to engage in activities to simulate the feelings in a controlled environment such as spinning in a chair to simulate dizziness.
When a person experiences cognitive distortions to a high degree, they can experience symptoms of anxiety such as panic attacks.
Examples of cognitive distortions include: “I have the worst luck in the world,” “I’m no good at this. I should just give up,” or “They haven’t called back so that must mean they don’t care about me.”
Ruminating and continually endorsing these thoughts can cause elevated anxiety and lead to panic attacks and other anxiety-related symptomatology.
Mindfulness-Based Cognitive Therapy (MBCT)
Mindfulness refers to a mental state that is characterized by nonjudgmental awareness of the present moment experiences including one’s sensations, thoughts, bodily states, consciousness, and the environment (Hofmann & Gomez, 2017).
The overarching principle of mindfulness focuses on learning how to attend mindfully to body sensations using various mind–body meditative practices such as sitting meditation, body scans, gentle stretching, and yoga.
While the first few sessions of MBCT focus on utilizing guided meditation to bring attention to breathing and bodily sensations, progressive sessions focus on developing an independent practice and applying enhanced mindful awareness to stressful events (Hofmann & Gomez, 2017; Sipe & Eisendrath, 2012).
More specifically, MBCT seeks to help individuals that experience chronic depressive episodes.
However, it can also be applied to assist with combating panic attacks, as many of its core tenets and activities can help center you and have a calming effect when you are experiencing a panic attack.
With practice and consistent application, mindfulness strategies can eventually be implemented in the moment when you are having a panic attack or feel one coming on.
One of the most effective ways to track panic attacks is through journaling. Write down the events that led up to the attack, symptoms that arose, and the duration of the attack to help track symptoms and triggers.
PositivePsychology.com’s Helpful Resources
There are several resources to assist in incorporating meditation to help combat panic attacks.
On the topic of anxiety, you can read about anxiety therapy, how to cope with anxiety, and 6 relaxation techniques for managing anxiety and stress.
If you’re looking for more science-based ways to help others enhance their wellbeing, this signature collection contains 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.
A Take-Home Message
Anxiety can affect people differently, but when it interferes with everyday activity, it is considered problematic and indicative of a psychiatric or mental health disorder.
If you are having issues with panic attacks or anxiety that are interfering with your everyday functioning, it is important to remember that you are not alone.
Talk to your primary healthcare provider to find out your options and use the tips provided in this article to educate yourself about your condition and the symptoms you are experiencing.
Remember, knowledge is power, and even if it seems like things are hard right now, with the proper treatment plan in place, things will get better.
If your anxiety is becoming unmanageable and you are having suicidal inclinations, please reach out to your local crisis line. We have provided a list of international crisis lines here so you can seek help, no matter where you are.
Stay well, stay safe, and know that things will get better.
We hope you enjoyed reading this article. Don’t forget to download our three Stress & Burnout Prevention Exercises (PDF) for free.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
- Ankrom, S. (2020, July 7). DSM-5 criteria for diagnosing panic disorder. Verywell Mind. Retrieved March 19, 2021, from https://www.verywellmind.com/diagnosing-panic-disorder-2583930
- Christiansen, T. (Ed). (2020, December 10). Tricyclic antidepressants vs. SSRIs. The Recovery Village. Retrieved March 23, 2021, from
- Grillon, C., O’Connell, K., Lieberman, L., Alvarez, G., Geraci, M., Pine, D. S., & Ernst, M. (2017). Distinct responses to predictable and unpredictable threat in anxiety pathologies: Effects of panic attacks. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 2(7), 575–581.
- Ham, P., Waters, D. B., & Oliver, N. M. (2005). Treatment of panic disorder. American Family Physician, 71(4), 733–739.
- Hofmann, S. G., & Gomez, A. F. (2017). Mindfulness-based interventions for anxiety and depression. Psychiatric Clinics of North America, 40(4), 739–749.
- Joy, K. (2017, January 11). Anxiety attack vs. panic attack: 6 Things to know. Michigan Health. Retrieved March 21, 2021, from https://healthblog.uofmhealth.org/wellness-prevention/panic-attack-vs-anxiety-attack-6-things-to-know
- Perkins, M. (n.d.). 5 Building blocks leading to anxiety disorders. Mosaic Counselling and Coaching. Retrieved March 24, 2021, from https://www.mosaic-cc.co.uk/5-building-blocks-leading-anxiety-disorders/
- Resources to Recover (rtor.org). (2020, August 10). How panic attacks affects the body. www.rtor.org. Retrieved March 21, 2021, from https://www.rtor.org/2020/08/10/how-a-panic-attack-affects-the-body/
- Sipe, W. E., & Eisendrath, S. J. (2012). Mindfulness-based cognitive therapy: Theory and practice. The Canadian Journal of Psychiatry, 57(2), 63–69.