Panic Attacks: what they are, why they occur, how to help yourself and others

Imagine that suddenly, for no apparent reason, you are overcome with incredibly strong fear.

Your heart is pounding, you’re breathing hard, it seems like something terrible is about to happen – maybe you’re even afraid of dying or going crazy. It could be a panic attack. Such conditions are not uncommon, and it is important to know what they are and how to act.

What is a panic attack?

A panic attack is a sudden and very intense attack of fear or anxiety that reaches its peak in a few minutes. It’s like a wave that covers your head. In this case, a person feels not only fear, but also very real unpleasant symptoms in the body.

If such attacks occur unexpectedly and repeatedly, and a person begins to constantly fear a new attack or changes their behavior to avoid them, we can talk about panic disorder.

Here are the main signs of a panic attack (four or more of them are enough to suspect an attack):

• The heart beats very fast, strongly, or irregularly.
• Heavy sweating.
• Trembling or shaking.
• Feeling that there is not enough air or it is difficult to breathe.
• A feeling of tightness in the throat.
• Pain or discomfort in the chest.
• Nausea or discomfort in the abdomen.
• Dizziness, a feeling that you are going to faint.
• Chills or, conversely, a feeling of heat.
• Tingling or numbness in the arms or legs.
• The feeling that everything around you is unreal, or that you are looking at yourself from the outside.
• Fear of losing control or going crazy.
• Fear of dying.

Why do panic attacks occur?

The symptoms and duration of a panic attack can also vary from person to person and situation to situation, although symptoms usually peak within a few minutes. Most panic attacks last between 5 and 20 minutes and can subside as quickly as they start. It is possible to experience more than one panic attack in a row. Panic attacks can be triggered by everyday events, such as leaving the house or being in a noisy or crowded place. However, not all panic attacks have a trigger and often occur unexpectedly.

After a panic attack, a person may feel exhausted and drained. The physical and emotional effects of a panic attack can last for several hours

Some studies point to possible combinations of several factors as the cause of panic disorders:

• Heredity: If your family members have had panic attacks, you may be at a slightly higher risk of experiencing them. This does not mean that you will necessarily have them, but this predisposition can be passed on.
• Brain function: Our brains have special chemicals (neurotransmitters) that help transmit signals between cells. If the balance of these substances is disturbed (e.g., serotonin, norepinephrine, or GABA), it can contribute to anxiety and panic. The functioning of certain parts of the brain that are responsible for the fear response is also important.
• Hypersensitivity to body signals: Some people are very sensitive to normal changes in the body (for example, heart palpitations after coffee) and start thinking that this is a sign of something dangerous. This can trigger a “chain reaction” of fear. Modern research suggests that sometimes the brain misreads the body’s signals, which leads to panic. Severe or prolonged stress, difficult events in life (loss of loved ones, problems at work, war), and traumatic experiences can become a trigger for panic attacks. A Mayo Clinic study emphasizes that panic attacks often occur in people who have anxiety disorders or have had traumatic experiences.
• Our thoughts and beliefs: The tendency to “wind yourself up,” expect the worst, and perceive any unusual sensations as a catastrophe can fuel panic.

What does a person feel besides the attack itself?

Often people with panic attacks are also worried:

• Constant anxiety, fear that the attack could happen again at any time.
• Avoidance of certain places or situations: For example, a person may be afraid to ride the subway, go shopping, or visit a place where an attack has occurred before. Sometimes this can develop into agoraphobia – a fear of open spaces or places where it is difficult to leave quickly.
• Other problems: Panic attacks are often “friends” with depression, other types of anxiety, or sleep problems.

How to help yourself during a panic attack and in life?

Although a panic attack is very unpleasant, there are ways to alleviate your condition.

During the attack:

1. It is important to “switch”, to direct the flow of thoughts in a different direction. Remind yourself: “This is a panic attack, it’s safe, and it will pass.” It is not a heart attack or insanity, although the feelings may be very strong.
2. Do not fight panic. Trying to suppress it can only make it worse. Allow these feelings to pass through you.
3. Focus on your breathing. Breathe slowly and deeply – slowly inhale through the nose for 4 counts, a short delay (1-2 seconds) and a long, smooth exhale through the mouth for 6 counts.
4. “Ground yourself.”
   • The 5-4-3-2-1 technique, pay attention to your surroundings:
   • name 5 things you see;
   • 4 things you can touch;
   • 3 sounds you hear;
   • 2 flavors;
   • 1 flavor (or just name one of your good traits).
   • Feel your feet on the floor, the texture of your clothes.
5. Change the environment (if possible) – go out into the fresh air or move to another room.

These techniques are not universal, but it is important to be aware of them and choose the ones that work for you. Sometimes it’s hard to control your breathing or focus on objects, but changing your environment, for example, will take away the triggers for a panic reaction.

General tips for life:

• Learn more about panic attacks – understanding what’s happening to you already reduces fear.
• Learn relaxation techniques – in addition to breathing exercises, it can be meditation or just doing your favorite quiet activity.
• Be physically active – regular exercise (walking, running, swimming) has a good effect on mood and reduces anxiety.
• Limit coffee, strong tea, alcohol, and nicotine, as these substances can provoke or exacerbate panic.
• Try to get enough sleep.

When should you see a specialist and how are panic attacks treated?

If your panic attacks are recurrent, interfere with your life, or you are constantly afraid of a new attack, you should seek help from a psychotherapist or psychiatrist. This is not a shame, but rather a step towards improving your life.

The main methods of treatment that have proven to be effective:

1. Cognitive behavioral therapy (CBT): This is one of the most effective methods. In simple terms, it is a talking therapy where you are together with a specialist:
   • Learn all about the mechanisms of panic.
   • Learn to recognize and change negative thoughts that provoke fear (for example, the thought “my heart is beating fast – it’s a heart attack” to “it’s just an anxiety reaction, it’s safe”).
   • Gradually “meet” your fears and bodily sensations in a safe environment to make sure they are not dangerous (for example, special exercises to cause a slight increase in heart rate and get used to this sensation).
   • Learn how to gradually return to the places and situations that you have started to avoid. Recent research shows that CBT is effective even in the form of online counseling or short intensive programs.
2. Medications: Sometimes your doctor may prescribe medications:
   • Antidepressants (most often SSRIs or SSRIs): These are the main medications for treating panic disorder. They help restore the balance of chemicals in the brain. Their effect does not occur immediately, usually after a few weeks.
   • Benzodiazepines (tranquilizers): These medications work quickly and can relieve an acute seizure. However, they are prescribed with caution and usually for a short time because they can be addictive. The decision to prescribe medications and their choice is always made by the doctor individually for each person. Often, the best results are obtained by combining psychotherapy and medications.

How to help another person during a panic attack

• If you think someone is having a panic attack, first ask if the person knows what is happening and if something similar has happened before. Introduce yourself if you don’t know each other. Reassure the person that they are safe. If the person is unable to communicate or does not respond to questions, ask yes or no questions and encourage non-verbal responses, such as a thumbs up or a nod.
• Stay calm. Your calmness will help the person feel safer. If the person is in danger because of a potential threat, encourage them to move to a safe place. Do not stop the person from doing what they are doing if it does not endanger them or other people. If the person is driving during a panic attack, ask them to pull over as soon as it is safe to do so.

– Stay close to the person (if he or she is comfortable with it). If the person feels like they are “going crazy,” reassure them that they are not. If they express feelings of shame, let them know that there is nothing to be ashamed of. Ask what you can do to help, if there was something similar before that helped.

• Speak in a calm, quiet voice. Avoid phrases such as “calm down!” or “it’s nothing.” Speak confidently, in short phrases – “I can see that you are feeling bad. I am here with you. It will pass soon. You are safe.”
• Help them find a quiet place, if there is noise around, and remove anything that causes them distress.
• Remind them that this is a panic attack, and it will end.
• Ask them to breathe slowly with you.
• Don’t force people to talk if they don’t want to.
• Help her focus on something real: ask her to describe what she sees or squeeze your hand.
• After the attack, support and advise them to see a specialist if the attacks recur.

Panic attacks are a serious challenge, but with the right knowledge and support, you can learn to control them. It is important to disseminate information about self-help techniques and support those who face these difficulties, especially in times of war. Remember that seeking professional help is a sign of strength, not weakness.