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Understanding Panic Attacks and Responding to Them Skip to content

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How to Prevent and Control a Panic Attack

It can be scary when your anxiety suddenly gets the best of you

Woman with medical provider

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En español | "Out of the blue, I was overcome by a suffocating sense of dread that started to gradually build. I started hyperventilating and my heart began pounding so hard that it felt like it would explode out of my chest. The world around me started spinning out of control. My hands were clutching the steering wheel so tightly, my fingers became numb. I thought, ‘Oh my God, I need to get out of here. This isn't safe!’ There was a sense of unreality and impending doom. It felt like the end of the world."

That's how Robert, a 63-year-old college professor in San Francisco (who asks that his last name not be included), describes the terror that suddenly hit when he was driving across the Oakland Bay Bridge one day. He had driven over the bridge countless times to and from work in Berkeley, but on this particular day — during rush hour on a foggy Thursday afternoon — he lost control. It was a panic attack.

The National Institute of Mental Health estimates that about 5 percent of adults in the U.S. will experience a panic disorder at least once in their lives. Sometimes they include panic attacks: full-on surges of anxiety that start abruptly, often without warning. And though they're short-lived — they usually reach their peak within 10 minutes, then fade within a half-hour — they can pack one heck of a punch. Among the symptoms: a racing heart, sweating, shaking, shortness of breath, chest pain, a sensation of choking, nausea, dizziness, numbness or chills, and hot or cold flashes.

In extreme cases, sufferers may report an out-of-body experience or an intense, inexplicable feeling of dread. Some go rushing to the ER, convinced they're having a heart attack, losing their mind, or even dying.

"The most eloquent description I've ever heard was from a patient,” says Philip Muskin, M.D., a professor of psychiatry at the Columbia University Irving Medical Center in New York City. “'Imagine that you're sitting all alone at home. It's dusk and the room is starting to get dark. Suddenly, you feel a hand slide around your throat. That's a panic attack.'”

What triggers an attack

One of the most frightening aspects of these episodes is their unpredictability: They can happen anywhere, at any time, even rousing you from a deep sleep. You can be overcome when you're perfectly calm or when you're stressed out — say, by the pressures of caring for a parent or a heavy workload at the office. Change, perhaps a big move, can also prime you for an overanxious fight-or-flight response.

A tendency toward panic attacks seems to run in families, and a person's temperament can make them more prone. Women are almost twice as likely to have panic attacks as men. (Menopause, and the hormonal imbalance that comes with it, can make some women especially vulnerable.)

Asthmatics are also at risk. “If someone has difficulty catching his or her breath, that can trigger a panic attack,” says Ken Yeager, director of the Stress, Trauma and Resilience (STAR) Program at The Ohio State University.

Fearing an attack

Some people may have just one or two panic attacks. Others have recurrent attacks and are in persistent fear of having more — a condition known as panic disorder. “I've seen patients get into a cycle where they start panicking about panicking,” says Richa Bhatia, M.D., a Middleboro, Mass.-based psychiatrist, and author of Demystifying Psychiatric Conditions & Treatments, and 65 Answers about Psychiatric Conditions. “It's like adding fuel to the fire.”

As your worry grows, you might start to avoid situations that may bring on a panic attack. “Your world becomes smaller,” says Reid Wilson, a psychologist and director of the Anxiety Disorders Treatment Center of Durham and Chapel Hill, N.C., and author of Don't Panic: Taking Control of Anxiety Attacks. “Eventually, it begins to intrude on your ability to enjoy life and be productive.”

After his terrifying ordeal on the Oakland Bay Bridge, Robert says he started taking detours to get to work, driving all the way down to San Jose and then circling back up to Berkeley — adding almost two hours to his commute each way — to avoid driving across San Francisco Bay.


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Treatment

The good news: Panic attacks are very treatable. Cognitive behavior therapy has been shown to be highly effective for those suffering from frequent attacks. There are also some tricks to help prevent a panic attack and get you through an out-of-the-blue episode.

Before an attack ...

Reassure yourself. “Panic attacks may feel awful,” says Muskin, “but can they physically harm you? Never."

Open up. If you know you're prone to panic attacks, clue in the people closest to you, so they'll be able to recognize the symptoms and help you through those episodes. There's another benefit that comes from exposing your anxieties. “Sometimes there's shame attached to panic attacks,” says Wilson. “But it's interesting: When someone starts sharing their stories, people come out of the woodwork and say, ‘Oh yeah, I've had that.'” It makes you feel so much better to know you're not alone.

Skip the stimulants. “Anything that's a stimulant and increases your adrenaline level can raise the likelihood of having an attack,” says Paul Hill, M.D., a Memphis, Tenn.-based psychiatrist. He points to both caffeine and over-the-counter drugs designed to boost energy. Certain medications also can trigger attacks, including allergy pills ("Some people are sensitive to the pseudoephedrine in decongestants,” says Muskin), as well as headache and migraine meds that may contain, yes, caffeine — such as aspirin and acetaminophen.

During an attack ...

Breathe slowly. When you feel a sudden rush of panic coming your way, concentrate on your breathing. “If you can regulate your breath, slowing it down to the most comfortable level possible, you may be able to avert an attack,” says Yeager. (Download a breathing app to your phone to help guide the rhythm of your breath.) Or, says Yeager, take a swig: “Typically, during an attack, you're panting and having trouble taking in oxygen. Taking a drink from a bottle of water helps regulate your breathing and restore normal respiration.”

Ground yourself. Offset that sudden fear by refocusing on the familiar. “When you have a panic attack, you start looking around and asking yourself, ‘Wait a second ...where am I?'” says Yeager. “Well, if you're at home, seek out three or four things that are comforting and make you feel safe.” It might be a painting, a cluster of family photos, even your backyard garden. Pretty soon, says Yeager, “You'll find yourself more psychologically grounded and less worried about the uncertainty.”

Another way to deflect your attention away from an attack: Find a piece of your environment that you can control. “Think of someone who has a loved one with a health diagnosis or who has a family challenge,” says Yeager. “How often do you see them cleaning the kitchen or organizing their drawers? That is a coping mechanism that is often underestimated.”

Acknowledge it. “Panic will yell, ‘Don't just sit there. Do something!'” says Wilson. But battling that anxiety won't lessen its impact. Instead, Wilson suggests a paradoxical strategy: “Rather than fighting those uncomfortable feelings, stay in the present moment and accept them for what they are — a normal bodily reaction to your fearful thoughts. ... Tell yourself, ‘Okay, this is uncomfortable, but I've got this.’ When you face down and challenge those catastrophic thoughts, you take away their intensity and power.”

Tighten up. Yep, it seems counterintuitive, but going from constant tension to exaggerated intermittent tension can help relax your body and calm your mind. Try this simple technique: Sitting in a chair, tighten and release the various muscle groups in your body. Start with your feet, tensing the muscles for 10 seconds, then work your way up your body.

After an attack ...

Check it out. It's a good idea to schedule an appointment with a doctor to discuss your symptoms. “People over the age of 50 may have undiagnosed medical problems,” says Bhatia. “They need to exercise caution to make sure they get other medical conditions ruled out.”

Conversely, it can be a relief to discover that what you feared was a heart attack was actually a panic attack. About 25 percent of the people who show up in an ER complaining of chest pain have panic disorder, not a physical problem.

"Get a proper diagnosis,” says Hill, “so the next time symptoms occur, you won't need to dial 911."

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