Panic attacks

Panic attacks are like waves. Sometimes we have to ride them out. Photo by Jeremy Bishop on Unsplash

What is a panic attack?  It is a sudden onset of fearful symptoms, including:

  • raised pulse
  • feeling as though you are going to faint
  • trembling
  • temperature changes
  • a strong feeling of fearfulness
  • churning stomach


Triggers can vary, but common triggers include:

  • nutritional and health triggers (e.g. caffeine, lack of sleep, sugar and easy carbohydrates)
  • environmental triggers (e.g. being near a feared object; being near conflict or threat; being in a crowd; being in an open space)
  • personal triggers (e.g. a reminder of a traumatic event; the mind setting off on a path of rumination about sensitive issues)


  • regular exercise, and nutrition that provides steady energy balance, are key
  • avoid highly pressurised situations
  • gradually expose yourself to moderately pressurised situations, in the company of trusted friends
  • find easy, well-focused activities which absorb the attention (e.g. games, cleaning, a walk or run)


  • ride it out like a wave – to a certain extent, treat it like a storm at sea, something that will pass, but cannot be cancelled out
  • breathe – breathe slowly in and out, focusing on your breath, perhaps counting the breaths
  • seek trusted company – it may help to stay with a calm friend for a while


  • Panic disorder is relatively common.  Essentially, a panic attack is a person’s insides triggering an acute fear response.
  • In our brains, roughly speaking, we have an emotional system (the limbic system), which is quite primitive.  We also have frontal lobes which act as an emotional control centre.
  • Cognitive Behavioural Therapy (CBT) is a form of therapy which appeals to the frontal lobes (our thinking skills) to better control the limbic system (our emotions).
  • Drugs have variable results, which are quite person-specific.  Whilst several antidepressants also have an anti-anxiety bias, many drugs used to calm hyper-anxiety also knock out alertness and responsiveness.


Therapy and counselling provides a safe space to explore and handle feelings of anxiety and panic.  Many clients find their limbic system naturally calms down when in trusted company, so being in a session can provide a calming personal intervention in its own right.

A good counsellor can also discuss nutritional, environmental and personal triggers specific to the client, and explore and trial different approaches through the weeks.

Deeper psychotherapy can work with a client to explore what may be triggering panic attacks.  Common examples include events in the present or past which a client may not have fully processed, leading to loss of a sense of control.  Therapist and client can reprocess such events together, developing newer narratives and habits that better fit the individual client.

Such work can be complex if there is an unconscious (repressed) element, whereby emotions are trying to surface, but the mind is trying to avoid them.  In these cases, therapy can be sensitively handled over a longer period, to ensure the client’s safety in ‘going there’.

Further reading

NHS website – about panic disorder

Psychiatry investigation – current research and management approaches

WebMD – repressed emotions