Panic Attacks: What Are They? How Are They Managed?

How Are They Managed?

A panic attack is a sudden feeling of intense fear that triggers severe physical reactions, such as rapid heart rate and shortness of breath, when there is no real danger or apparent cause.1,2  Panic disorder is an anxiety disorder in which a person experiences recurrent and often unexpected panic attacks that are often followed by periods of time in which the individual is so fearful of experiencing another attack that they will change their behavior to avoid situations that might trigger an attack (e.g., won’t leave their house).3 Staff at the Mayo Clinic report that most individuals will experience at least one panic attack in their lifetime, usually induced by circumstantial stress.3 It is estimated that 11 percent of the general United States population experience panic attacks, and 2 to 3 percent of those individuals go on to develop panic disorder.2


Though not life-threatening, panic attacks can negatively impact quality of life and overall mental well-being. In addition to an overwhelming feeling of fear, rapid heartbeat, and shortness of breath, symptoms of a panic attack may include:1,2

  • feelings of impending doom or danger
  • worry about loss of control or death
  • sweating
  • hot flashes
  • trembling
  • shaking
  • chills
  • abdominal cramping
  • numbness
  • tingling sensations
  • chest pains/pressure
  • headaches
  • throat tightness
  • dizziness
  • lightheadedness
  • nausea
  • uncertainty
  • feelings of detachment from reality.

Causes and Risk Factors

While the causes of panic attacks are not yet well understood, the Mayo Clinic suggests that family history of panic attacks (genetics), exposure to major stress, changes in brain function, and a sensitive temperament (i.e., being prone to stress and negative emotions) are factors commonly associated with panic attacks.1,2 Having a family history of panic attacks or panic disorder; personal history of sexual or physical abuse, trauma, or major life change(s); and even smoking and excessive intake of caffeine have been shown to increase the risk of experiencing panic attack.1,2

Nervous System Influence

It has been hypothesized that panic attacks are connected to the “fight-or-flight” response in mammals.4,5 The fight-or-flight response is a survival mechanism prompted by the sympathetic nervous system that enables mammals to react quickly to danger.6–8 Basically, when a threat is perceived, the autonomic nervous system, which controls unconscious bodily functions (e.g., breathing, heart rate, digestion, etc), triggers a number of physiological changes in the body to prepare it to flee from or fight the threat. The hormone epinephrine—aka adrenaline—is released, which causes a number of reactions in the body: the heart beats faster and breathing quickens, increasing blood flow and oxygen to the muscles and brain. The increased oxygen to the brain sharpens the senses and makes us more alert. Epinephrine also triggers the release of sugars and fats into the bloodstream, which supply the body with the energy needed for an intense burst of physical activity.4–8 When the fight-or-flight response is triggered, other functions of the body, like digestion, are turned off.6–9

As the threat and, subsequently, the release of adrenaline subsides, the parasympathetic nervous system kicks in, returning heart and breathing rates and blood pressure to normal and channeling blood back to the digestive system and other systems in the body.7,9 Overall, the parasympathetic nervous system counteracts the alarmed sympathetic nervous system effects, preserves energy, mends the body, and helps create a sense of calmness and safety.4–9

How to Stop a Panic Attack

If you feel a panic attack coming on, there are things you can do to stop the triggered sympathetic nervous system response and alleviate or prevent a panic attack within minutes: The purpose of these simple actions is to send calming signals to the brain and remind it that you are not in danger. 1,2,10–17

Acknowledge the panic attack—Acknowledging that you are experiencing a panic attack can give you a sense of control over your fears.10

Chew gum—Research has shown that chewing suppresses stress-induced activation of the autonomic nervous system.11

Splash cold water on your face—Research has shown that cold-water face immersion stimulates the parasympathetic system, which counteracts the stress-induced effects of the sympathetic nervous system.12

Practice deep breathing—Research suggests that breathing triggers the brain to activate GABA neurotransmitters, which calm behavioral responses to stress.13 Slowly inhale for five seconds, hold for two seconds, and exhale for five seconds. Repeat until calm. The number of seconds can be adjusted for your personal comfort.

Soften your eyes—The release of adrenaline during a panic attack might cause you to experience tunnel vision (a part of the fight-or-flight response that allows you to hyperfocus on the threat). To counteract this, try to “soften” your gaze. Gently massage the skin around your eyes while keeping them closed. After a minute or two, open your eyes and encourage the use of your peripheral vision, making note everything around you without looking directly at it.14

Practice grounding techniques—”Grounding” refers to the practice of distracting a person from distressful feelings by focusing on the five senses.

 —  Take note of your surroundings. Name five things you can see, five things you can hear, five things you can touch, five things you can taste, and five things you can smell. This can help calm and distract you from intrusive stressful thoughts.

—  Take off your socks and/or shoes and plant your feet on the ground. This especially helps if it is cold outside. Research has shown that physical contact with the earth can relax the mind and improve mood.15,16

—  Consciously relax one muscle at a time. Start with a muscle or muscle group in which you feel the most tension or pressure, such as your chest/diaphragm, and concentrate on relaxing that muscle, then work your way through surrounding muscles.17 

—  Massage tense muscles. Give yourself a forearm massage—Cross your arms, grabbing the opposite elbows, and slowly pull your hands toward your wrists. Repeat for a few minutes while practicing deep breathing.17

Engage in light physical activity—Take a walk, go for a swim, or go on a bike ride.17

Repeat a personal mantra—For example, repeat the words, “This too shall pass,” or “All is well. I am OK.”

Contact someone you trust and makes you feel safe—Call or text a friend or family member and just have a conversation about something…anything.

Seeking Treatment for Panic attacks is Important

Individuals who experience panic attacks should not hesitate to seek professional help. Without treatment, frequent panic attacks, along with the constant feeling of uncertainty and worry over when the next attack will occur, can prompt avoidance behaviors (e.g., reluctance to leave the house, drive, and/or socialize with people), increase one’s risk of developing other debilitating mental health issues (e.g., depression, suicidal ideation), and/or increase one’s risk of abusing drugs or alcohol—all of which can substantially interfere with school, work, personal relationships, physical health, and overall quality of life.18  Evidence-based, effective treatment methods for frequent panic attacks are available. A qualified healthcare professional can work with the individual to develop a comprehensive treatment plan based on that individual’s specific needs. This treatment plan would likely include psychotherapy (e.g., cognitive behavioral therapy) with a qualified mental health therapist, medication(s) (e.g., anti-anxiety, antidepressant), and/or other evidence-based therapies that have been shown to ease symptoms of anxiety (e.g., physical activity, good nutrition).18


1.    Mayo Clinic site. Panic attacks and panic disorder. 4 MAY 2018. Accessed 4 Apr 2021.

2.    Cleveland Clinic site. Panic disorder. Updated 12 Aug 2020. Accessed 4 Apr 2021.

3.    American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Press, Inc.;2013.

 4.   Goddard AW. The neurobiology of panic: a chronic stress disorder. Chronic Stress (Thousand Oaks). epub 10 Nov 2017;1.

5.    Kim JE, Dager SR, Lyoo IK. The role of the amygdala in the pathophysiology of panic disorder: evidence from neuroimaging studies. Biol Mood Anxiety Disord. 2012;2:20.

6.    Alshak MN, M Das J. Neuroanatomy, sympathetic nervous system. In: StatPearls [internet]. Treasure Island (Florida): StatPearls Publishing;2021. 

7.    McCorry LK. Physiology of the autonomic nervous system. Am J Pharm Educ. 2007;71(4):78.

8.    Harvard Health Publishing site. Harvard Medical School. Understanding the stress response. Updated 6 Jul 2020. Accessed 14 Apr 2020.

9.    British Broadcasting Corperation site. Nervous system – peripheral nervous system. Accessed 4 Apr 2021.

10.  Smith A. How can you stop a panic attack? Medical News Today site. Updated 29 Sep 2020. Accessed 15 Apr 2021.

11.   Kubo KY, Iinuma M, Chen H. Mastication as a stress-coping behavior. Biomed Res Int. 2015;2015:876409.

12.  Jungmann M, Vencatachellum S, Van Ryckeghem D, Vögele C. Effects of cold stimulation on cardiac-vagal activation in healthy participants: randomized controlled trial. JMIR Form Res. 2018;2(2):e10257.

13.  Jerath R, Crawford MW, Barnes VA, Harden K. Self-regulation of breathing as a primary treatment for anxiety. Appl Psychophysiol Biofeedback. 2015;40:107–115.

14.  McAdam E.  Turn off anxiety in your nervous system: four ways to turn on the parasympathetic response. [Video] 19 NOV 2020. Accessed 4 Apr 2021.

15.  Chevalier G. The effect of grounding the human body on mood. Psychol Rep. 2015;116(2):534-42. Epub 2015 Mar 6.

16.  The Doctors TV site. Three ways to stop a panic attack in its tracks. 24 DEC 2018. Accessed 4 Apr 2021.

17.  Cutler N. Bodywork can help panic disorder. 11 Sep 2006.
Accessed 4 Apr 2021.

18.  WebMD site. What are the treatments for panic attacks? Updated 20 Jun 2020. Accessed 4 Apr 2021.    

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