Anxiety and panic attacks: the complete guide

If you’ve ever had a panic attack, you know how frightening it is. One minute you’re fine, and the next your heart is pounding, you can’t catch your breath and you’re sure something terrible is happening.

You’re far from alone. Around 1 in 20 adults in the US will have panic disorder at some point in their lives, and many more have the odd panic attack without ever developing it.

This guide covers what anxiety and panic attacks are, why they happen, how to get through one, and what helps them come less often. Each section links to a deeper post if you want to know more.

Anxiety and panic attacks: what’s the difference?

Anxiety is a feeling of worry, unease or dread. It usually builds gradually, often around something specific, like an exam, a health worry or money. It can hang around for hours or days, as a background hum of tension.

A panic attack is a sudden wave of intense fear that comes on fast, peaks within about 10 minutes, and then fades. It comes with strong body feelings, like a racing heart, shaking and feeling short of breath. It can be triggered by something, or seem to come out of nowhere, even in your sleep.

People often say “anxiety attack” to mean either one. Doctors only use the term “panic attack”, but what matters most is how it feels to you and what helps. We compare the two side by side in Panic attack vs anxiety attack.

What a panic attack feels like

Most people describe a panic attack as a rush of terror that seems to come from nowhere, along with:

• a pounding or racing heart
• feeling short of breath or like you’re choking
• chest tightness or pain
• shaking, sweating, chills or hot flushes
• dizziness or feeling faint
• tingling or numbness, often in the hands or around the mouth
• feeling unreal or detached from yourself
• a fear that you’re dying, losing control or “going crazy”

Afterwards, many people feel exhausted, shaky or tearful for hours. You can read more in What does a panic attack feel like? and see the full list in Panic attack symptoms.

Why panic attacks happen

A panic attack is your body’s fight-or-flight response, the alarm system that gets you ready to fight or run from danger, going off when there isn’t any real danger. Adrenaline floods your body, and every symptom you feel is part of getting you ready to move. We explain each one in What’s happening in your body during a panic attack.

There’s rarely a single cause. Panic attacks tend to come from a mix of:

• Genes and family history. Panic disorder often runs in families.
• Stress and big life changes, like a loss, a move, a new baby or a hard stretch at work.
• Being sensitive to body feelings. Some people are quicker to read a skipped heartbeat or a dizzy moment as a sign of danger.
• Things that act on your body, like a lot of caffeine, nicotine, cannabis, stimulants, or the morning after drinking.

Once you’ve had one panic attack, the fear of having another can become a trigger in itself. We look at all of this in What causes panic attacks?

Is it a panic attack, or something else?

Many panic symptoms overlap with other conditions, like heart or breathing problems. If you’ve never had a panic attack before, or your symptoms feel different from usual, get checked by a doctor.

Call 911 (or your local emergency number) straight away if you have chest pain that spreads to your arm, jaw, neck or back, severe trouble breathing, blue or grey lips, or you suddenly feel confused. Doctors would much rather check and find it was panic.

If breathlessness is your main symptom, How to tell if shortness of breath is from anxiety goes through the signs to look out for.

How to get through a panic attack

When panic hits, your brain is shouting that you’re in danger. These steps help your body catch up with the truth.

1. Name it. Tell yourself: “This is a panic attack. It feels awful, but it can’t hurt me, and it will pass.”
2. Slow your out-breath. Breathe in gently through your nose for 4, and out through your mouth for 6. A long out-breath works like a brake pedal for your body.
3. Come back to the room. Look for 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell and 1 you can taste.
4. Let it rise and fall. Fighting the feelings tends to feed them. Picture the panic as a wave and let it wash through you.
5. Stay if you can. Leaving the situation brings quick relief, but it teaches your brain the place was dangerous. Staying, even for a few minutes, teaches the opposite.

Our breathing exercises for panic attacks go through six ways to slow your breathing, and which to use when.

When panic attacks keep coming back

Having a panic attack doesn’t mean you have panic disorder. Panic disorder is when panic attacks keep happening out of the blue, and for a month or more you either worry a lot about having another one or change your life to avoid them, for example by staying away from stores, driving or exercise.

Some people start avoiding more and more places where they fear panic might strike, or where escape feels hard. This is called agoraphobia, and it’s very treatable too.

Treatments that work

Talking therapy. Cognitive behavioural therapy (CBT) is one of the main treatments for panic, and a large review of 72 studies found that it helps. CBT teaches you to see panic feelings for what they are, and often includes gently bringing on the feelings, for example by spinning on a chair, so your brain learns they’re safe. The UK’s NICE guideline recommends 7 to 14 hours of CBT in total, usually spread over up to four months.

Medicine. A doctor may suggest an antidepressant called an SSRI, which can lower how often panic attacks happen. These usually take a few weeks to start working. Other medicines are sometimes used for a short time. A doctor can talk you through what might suit you.

Self-help. Learning how panic works, practising slow breathing when you’re calm and slowly facing the places you’ve been avoiding all help. Many people do this with a book, an app or a course based on CBT, alongside or before therapy.

Everyday things that lower your baseline

Panic attacks are more likely when your body is already running hot. These habits help bring the background level down:

• Sleep. Being short on sleep makes your alarm system jumpier.
• Cut back on caffeine. Coffee, energy drinks and some teas can bring on panic-like feelings in people who are sensitive to them.
• Go easy on alcohol. It may calm you at first, but anxiety often rebounds the next day.
• Move your body. Regular exercise gets you used to a faster heartbeat and quicker breathing, so they feel less scary.
• Practise breathing when you’re calm, so it comes more easily when you need it.

If someone you love has panic attacks

Stay calm and stay with them. Speak slowly and simply: “You’re having a panic attack. It will pass. I’m right here.” Breathe slowly yourself so they can follow your rhythm, and let them set the pace. Afterwards, don’t make a big deal of it, but gently encourage them to talk to a doctor if it keeps happening. Our post on how to help someone having a panic attack has more on what to say and do.

How Breatheasy can help

Breatheasy brings these steps together in one place. Tap “I’m feeling anxious” and Luma walks you through it: rate how strong it feels from 1 to 10, breathe slowly as your phone pulses gently, ground yourself with 5-4-3-2-1, then see how far the anxiety came down. It works without internet, and it’s always free. Between attacks, ten-second check-ins and a journal help you spot your patterns, and bite-size lessons explain how panic works. Breatheasy is coming soon to iPhone and Android.

When to get help

Talk to a doctor if panic attacks keep happening, if you’re starting to avoid things because of them, or if they’re getting in the way of your life. You don’t need to wait until it’s unbearable.

If you’re in crisis or thinking about ending your life, call or text 988 in the US, or call 911 if you’re in danger.

Sources

• Panic disorder, NHS
• Panic Disorder: When Fear Overwhelms, National Institute of Mental Health
• Panic disorder statistics, National Institute of Mental Health
• Generalised anxiety disorder and panic disorder in adults, NICE guideline CG113
• Pompoli et al. (2018). Dismantling cognitive-behaviour therapy for panic disorder. Psychological Medicine.