🕷️ Crawler Inspector

URL Lookup

Direct Parameter Lookup

Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 121 (from laksa192)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa121.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.helpguide.org/mental-health/anxiety/panic-attacks-and-panic-disorders\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.helpguide.org/mental-health/anxiety/panic-attacks-and-panic-disorders\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.helpguide.org\/mental-health\/anxiety\/panic-attacks-and-panic-disorders","crawl_time":1775900289,"first_indexed_time":1719833686,"http_code":200,"src_unparsed":"org,helpguide!www,\/mental-health\/anxiety\/panic-attacks-and-panic-disorders s443","src_root_hash":"10679577116146527521","history_drop_reason":null,"meta_title":"Panic Attacks and Panic Disorder - HelpGuide.org","meta_descriptions":["Have you had a panic attack? Recognize panic attack symptoms and how you can help yourself overcome panic disorder."],"attrs_boilerpipe_text":"What is a panic attack?\nA panic attack is an intense wave of fear characterized by its unexpectedness and debilitating, immobilizing intensity. Your heart pounds, you can’t breathe, and you may feel like you’re dying or going crazy. Panic attacks often strike out of the blue, without any warning, and sometimes with no clear trigger. They may even occur when you’re relaxed or asleep.\nA panic attack may be a one-time occurrence, although many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape, triggering the body’s fight-or-flight response.\nYou may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder,\nsocial phobia\n, or\ndepression\n. Regardless of the cause, panic attacks are treatable. There are strategies you can use to reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life.\nPaula's story\nPaula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.\nPaula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has a panic attack.\nPanic attack signs and symptoms\nThe signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home.\nPanic attack symptoms include:\nShortness of breath or hyperventilation.\nHeart palpitations or racing heart.\nChest pain or discomfort.\nTrembling or shaking.\nChoking feeling.\nFeeling unreal or detached from your surroundings.\nSweating.\nNausea or upset stomach.\nFeeling dizzy, light-headed, or faint.\nNumbness or tingling sensations.\nHot or cold flashes.\nFear of dying, losing control, or going crazy.\nIs it a heart attack or a panic attack?\nMost of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think you’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around.\nPanic attack vs. anxiety attack\nPeople often use “anxiety attack” and “panic attack” interchangeably. However, the terms can mean very different things. One key difference is that the Diagnostic and Statistical Manual of Mental Disorders (DSM) doesn’t list anxiety attacks as a condition. There’s no formal definition or diagnosis criteria for an anxiety attack.\nAnxiety attacks may refer to distress that has built up over time due to consistent stressors or fears of the future. Imagine that you’ve been stressed about your workplace responsibilities all week, and now your feelings have reached a boiling point. During an anxiety attack, life can feel overwhelming. You might experience tension, irritability, restlessness, or lack of focus.\nPanic attacks, on the other hand, are always sudden and often come with symptoms like derealization or a feeling of approaching doom. Panic attacks typically pass within 30 minutes, while an anxiety attack—although less intense—may last minutes or hours. \nSpeak to a Licensed Therapist\nBetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.\nTake Assessment\nHelpGuide is user supported. We earn a commission if you sign up for BetterHelp’s services after clicking through from this site.\nLearn more\nSigns and symptoms of panic disorder\nWhile many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.\nYou may be suffering from panic disorder if you:\nExperience frequent, unexpected panic attacks that aren’t tied to a specific situation.\nWorry a lot about having another panic attack.\nAre behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked.\nWhile a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:\nAnticipatory anxiety\n– Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.\nPhobic avoidance\n– You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.\nNocturnal panic attacks\nDuring a nocturnal panic attack, you wake up while experiencing a sudden episode of fear and distress. These attacks occur while you’re in\nstage 2 or stage 3 of non-REM sleep\n, and generally only last between two and eight minutes. However, the unpleasantness of the experience can make it difficult for you to go back to sleep or even lead you to try to avoid sleep.\nNocturnal panic attacks are common in people with panic disorder, affecting more than half of all patients. Some experts theorize that these types of panic attacks are caused by a fear of uncertainty or vulnerability. In other words, you feel anxious about your inability to react to threats while asleep.\nNocturnal panic attacks vs. nightmares and night terrors\nAlthough nocturnal panic attacks may seem similar to nightmares or sleep terrors, they are distinct issues and occur at different stages of sleep.\nNight terrors\ninvolve episodes of screaming and flailing while asleep. When you have a night terror, you likely won’t remember the experience when you wake up later. On the other hand, if you have a nocturnal panic attack, you’ll wake up during the experience.\nNightmares are bad dreams that occur during\nrapid eye movement (REM) sleep\n. You can likely recall a few nightmares you’ve had in your life. Nocturnal panic attacks don’t involve a dreaming experience.\nPanic disorder with agoraphobia\nAgoraphobia\nwas traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks.\nIf you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations.\nFor example, you may begin to avoid:\nCrowded places such as shopping malls or sports arenas.\nCars, airplanes, subways, and other forms of travel.\nSocial gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack.\nPhysical exercise in case it triggers panic.\nCertain food or drinks that could provoke panic, such as alcohol,\ncaffeine\n, sugar, or specific medications.\nGoing anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home.\nCauses of panic attacks and panic disorder\nAlthough the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby.\nSevere stress\n, such as the death of a loved one, divorce, or job loss can also trigger panic attacks.\nPanic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities:\nMitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn’t close correctly.\nHyperthyroidism (overactive thyroid gland).\nHypoglycemia (low blood sugar).\nStimulant use (amphetamines, cocaine, caffeine).\nMedication withdrawal.\nSelf-help tips for panic attacks\nNo matter how powerless or out of control you may feel about your panic attacks, it’s important to know that there are many things you can do to help yourself. The following self-help techniques can make a big difference to helping you overcome panic:\nTip 1: Learn about panic and anxiety\nSimply knowing more about panic can go a long way towards relieving your distress. Read up on \nanxiety\n, panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy.\nBecome familiar with the sensations. Panic is often driven by discomfort with physical sensations. For example, you might worry that your chest tightness is actually a heart attack. That kind of catastrophizing—jumping to the worst possible conclusion—can propel you into a panic attack.\nLearning more about normal physical sensations, including heart palpitations, tight throat, nausea, tremors, and headaches, can help maintain a more grounded perception. It’s also important to recognize that the mental sensations, such as fear of losing control and derealization, are temporary states.\nTip 2: Experiment with relaxation techniques\nWhen practiced regularly, activities such as yoga,\nmeditation\n, and\nprogressive muscle relaxation\nstrengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity.\nLearn how to control your breathing.\nHyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack.\nDeep breathing\n, on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you can calm yourself down when you begin to feel anxious. And if you know how to control your breathing, you’re also less likely to create the very sensations that you’re afraid of.\nSome breathing exercises to try\nPaced breathing\n. Slowly inhale through your nose for two to four seconds, expanding your chest and belly as you pull in the air. Exhale through your mouth. Aim to make your exhale about twice as long as your inhale. Repeat this several times.\nCyclic sighing\n. Inhale deeply through your nose. Take a second, shorter inhale, further filling your lungs. Exhale slowly through your mouth. Repeat this exercise for five minutes.\nTip 3: Reframe your relationship to panic\nIn the book “\nDARE: The New Way to End Anxiety\n,” Barry McDonagh offers a four-step process for handling anxiety and panic. The process, DARE, isn’t about reaching a state of calm but rather adopting a new mindset toward your symptoms.\nDefus\ne. Often, panic is escalated by negative “what if” statements, such as “What if I’m having a heart attack?” So, when you feel panic attack sensations beginning, say, “So what? This is harmless.” Or rely on a more personalized coping statement, such as, “The last panic attack I had didn’t kill me.”\nAllow\n. Practice accepting the symptoms, even though they’re unpleasant. The shaking, the rapid heartbeat, the sense of detachment—know that it’s all the result of a temporary flood of adrenaline.\nRun towards it\n. Dare the symptoms to intensify. Tell yourself that the adrenaline is exciting rather than threatening. Think of this as a form of exposure therapy. You’re intentionally inviting in the sensations that alarm you so you can discover how harmless they actually are.\nEngage\n. Once the adrenaline begins to subside, ground yourself in another activity. Whether it’s a conversation with your friend or a walk around the neighborhood, try to focus entirely on your current experience. This keeps you from dwelling on the panic and pulls you back into the present moment. You might still feel a little shaky from the experience, but acknowledge the shaking as a natural reaction.\nTip 4: Make time for self-care\nCertain self-care habits can help reduce your overall anxiety levels. This could, in turn, reduce the severity of panic attacks or help you better cope with them.\nExercise regularly.\nExercise is a\nnatural anxiety reliever\nso try to get moving for at least 30 minutes on most days (three 10-minute sessions is just as good). Rhythmic aerobic exercise that requires moving both your arms and legs—like walking, running, swimming, or dancing—can be especially effective.\nGet enough restful sleep.\nInsufficient or poor quality sleep can make anxiety worse, so try to get seven to nine hours of restful sleep a night. If sleeping well is a problem for you,\nthese tips to getting a good night’s sleep\ncan help.\nAvoid smoking, alcohol, and caffeine.\nThese can all provoke panic attacks in people who are susceptible. If you need help to kick the cigarette habit, see\nHow to Quit Smoking\n. Also, be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications.\nTip 5: Find the right support\nConnect face-to-face with family and friends.\nSymptoms of anxiety can become worse when you feel isolated, so reach out to people who care about you on a regular basis. If you feel that you don’t have anyone to turn to, explore ways to meet new people and\nbuild supportive friendships\n.\nJoin a support group\n. Friends and family members can offer comfort but, unless they also struggle with panic disorder, they might not fully understand what you’re going through. Consider joining a\nsupport group\n, either in-person or online, for people with anxiety disorders, panic disorder, or panic attacks. Not only can the members relate to your experiences, but they may also share coping techniques and strategies that work for them.\nTreatment for panic attacks and panic disorder\nThe most effective form of professional treatment for tackling panic attacks, panic disorder, and agoraphobia is\ntherapy\n. Even a short course of treatment can help.\nCognitive behavioral therapy\nfocuses on the thinking patterns and behaviors that are sustaining or triggering your panic attacks and helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.\nExposure therapy for panic disorder\nallows you to experience the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.\nExposure therapy for panic disorder with agoraphobia\nincludes exposure to the situations you fear and avoid is also included in treatment. As in\nexposure therapy\nfor specific phobias, you\nface the feared situation\nuntil the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions.\nMedication for panic attacks and panic disorder\nMedication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn’t treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.\nMedications used may include:\nAntidepressants.\nIt takes several weeks before\nantidepressants\nbegin to work, so you have to take them continuously, not just during a panic attack.\nBenzodiazepines.\nThese are\nanti-anxiety drugs\nthat act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack can provide rapid relief of symptoms.\nXanax for panic attacks\nAlprazolam\n—often sold under the brand name Xanax—is the most commonly prescribed benzodiazepine. During a panic attack, your nervous system is in a state of hyperactivity. By slowing down your nervous system, Xanax may quickly help put you into a more relaxed state.\nHowever, like other benzodiazepines, Xanax for panics attacks can be addictive and is only intended for short-term use. If you take it too often, a physical dependence can develop, meaning you’ll experience withdrawal when you attempt to stop taking it. In addition, overdose can lead to serious issues like confusion, coma, or even death.\nHow to help someone having a panic attack\nSeeing a friend or loved one suffering a panic attack can be frightening. Their breathing may become abnormally fast and shallow, they could become dizzy or light-headed, tremble, sweat, feel nauseous, or think they’re having a heart attack. No matter how irrational you think their panicked response to a situation is, it’s important to remember that the danger seems very real to your loved one. Simply telling them to calm down or minimizing their fear won’t help. But by helping your loved one ride out a panic attack, you can help them feel less fearful of any future attacks.\nStay calm yourself.\nBeing calm, understanding, and non-judgmental will help your loved one’s panic subside quicker.\nFocus your loved one on their breathing.\nFind a quiet place for your friend to sit and then guide them to take slow, deep breaths for a few minutes.\nDo something physical.\nTogether, raise and lower your arms or stamp your feet. It can help to burn off some of your loved one’s stress.\nGet your friend out of their own head\nby asking them to name five things around them or talking soothingly about a shared interest.\nEncourage your loved one to seek help.\nOnce the panic attack is over, your loved one may feel embarrassed about having an attack in front of you. Reassure them and encourage them to seek help for their anxiety.\nHotlines and support\nNAMI Helpline\n – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness)\nFind a Therapist\n – Search for anxiety disorder treatment providers in the U.S. (Anxiety Disorders Association of America)\nSupport Groups\n – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America)\nAnxiety UK\n – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK)\nAnxiety Canada\n – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada)\nSANE Help Centre\n – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia).\nHelpline (India) \n– Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330. (Vandrevala Foundation)\nMore Information\nTaylor, C. B. (2006). Panic disorder. BMJ: British Medical Journal, 332(7547), 951–955.\nLink\nKunas, S. L., Hilbert, K., Yang, Y., Richter, J., Hamm, A., Wittmann, A., Ströhle, A., Pfleiderer, B., Herrmann, M. J., Lang, T., Lotze, M., Deckert, J., Arolt, V., Wittchen, H.-U., Straube, B., Kircher, T., Gerlach, A. L., & Lueken, U. (2020). The modulating impact of cigarette smoking on brain structure in panic disorder: A voxel-based morphometry study. Social Cognitive and Affective Neuroscience, 15(8), 849–859.\nLink\nOtte, C. (2011). Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues in Clinical Neuroscience, 13(4), 413–421.\nLink\nTolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review. Clinical Psychology Review, 30(6), 710–720.\nLink\nRoberge, P., Marchand, A., Reinharz, D., & Savard, P. (2008). Cognitive-Behavioral Treatment for Panic Disorder With Agoraphobia: A Randomized, Controlled Trial and Cost-Effectiveness Analysis. Behavior Modification, 32(3), 333–351.\nLink\nOugrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: Systematic review and meta-analysis. BMC Psychiatry, 11(1), 200.\nLink\nReinecke, A., Thilo, K. V., Croft, A., & Harmer, C. J. (2018). Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety. Translational Psychiatry, 8(1), 1–9.\nLink\nCraske, M. G., & Stein, M. B. (2016). Anxiety. Lancet (London, England), 388(10063), 3048–3059.\nLink\nAylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18(1), 559.\nLink\nKandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018). Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Current Psychiatry Reports, 20(8), 63.\nLink\nAnxiety Disorders. (2013). In\nDiagnostic and Statistical Manual of Mental Disorders\n. American Psychiatric Association.\nLink\nAit-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal.\nJournal of Addiction Medicine\n,\n12\n(1), 4–10.\nLink\nAlprazolam: MedlinePlus Drug Information\n. (n.d.). Retrieved November 30, 2023, from\nLink\nBalban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal.\nCell Reports Medicine\n,\n4\n(1), 100895.\nLink\nKircanski, K., Craske, M. G., Epstein, A. M., & Wittchen, H.-U. (2011). Subtypes of Panic Attacks: A Critical Review of the Empirical Literature.\nFOCUS\n,\n9\n(3), 389–398.\nLink\nMcDonagh, B. (2015).\nDare: The New Way to End Anxiety and Stop Panic Attacks.\nBMD Publishing.\nLink\nMeuret, A. E., Wolitzky-Taylor, K. B., Twohig, M. P., & Craske, M. G. (2012). Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions.\nBehavior Therapy\n,\n43\n(2), 271–284.\nLink\nNight terrors and nightmares—NHS\n. (n.d.). Retrieved November 30, 2023, from\nLink\nSmith, N. S., Albanese, B. J., Schmidt, N. B., & Capron, D. W. (2019). Intolerance of uncertainty and responsibility for harm predict nocturnal panic attacks.\nPsychiatry Research\n,\n273\n, 82–88.\nLink\nStaner, L. (2003). Sleep and anxiety disorders.\nDialogues in Clinical Neuroscience\n,\n5\n(3), 249–258.\nLink\nThe Medical Minute: Anxiety attack or panic attack? Actually, it can be both—Penn State Health News\n. (n.d.). Retrieved November 30, 2023, from\nLink","attrs_markdown":"[![HelpGuide.org](https:\/\/www.helpguide.org\/wp-content\/uploads\/Group-13075.svg)](https:\/\/www.helpguide.org\/)\n\n- [Español](https:\/\/www.helpguide.org\/es\/ansiedad\/ataques-de-panico-y-trastorno-de-panico)\n\n- [About Us](https:\/\/www.helpguide.org\/about-us)\n  - [About Us](https:\/\/www.helpguide.org\/about-us)\n  - [Meet Our Team](https:\/\/www.helpguide.org\/about-us\/meet-our-team)\n  - [Our Story](https:\/\/www.helpguide.org\/about-us\/our-story)\n  - [Jeanne Segal, Ph.D.](https:\/\/www.helpguide.org\/about-us\/jeanne-segal)\n  - [Advisory Council](https:\/\/www.helpguide.org\/professional-advisory-council)\n  - [Contact Us](https:\/\/www.helpguide.org\/contact-us)\n- [Resources](https:\/\/www.helpguide.org\/mental-health\/anxiety\/panic-attacks-and-panic-disorders)\n  - [Harvard Health Partnership](https:\/\/www.helpguide.org\/harvard)\n  - [Audio Meditations](https:\/\/www.helpguide.org\/mental-health\/meditation)\n  - [Newsletter](https:\/\/www.helpguide.org\/newsletter)\n  - [Helplines](https:\/\/www.helpguide.org\/find-help)\n\n[Donate](https:\/\/give.helpguide.org\/give\/581002\/#!\/donation\/checkout)\n\n[![HelpGuide.org](https:\/\/www.helpguide.org\/wp-content\/uploads\/Logo-3.svg)](https:\/\/www.helpguide.org\/)\n\n[Donate](https:\/\/give.helpguide.org\/give\/581002\/#!\/donation\/checkout)\n\n- [Exposure Therapy: What is it and How Does it Help?](https:\/\/www.helpguide.org\/mental-health\/treatment\/exposure-therapy)\n- [Phobias and Irrational Fears](https:\/\/www.helpguide.org\/mental-health\/anxiety\/phobias-and-irrational-fears)\n- [Therapy for Anxiety Disorders](https:\/\/www.helpguide.org\/mental-health\/treatment\/therapy-for-anxiety-disorders)\n- [Can Anxiety Cause Chest Pains?](https:\/\/www.helpguide.org\/mental-health\/anxiety\/anxiety-cause-chest-pain)\n- [Anxiety Attack vs Panic Attack: What’s the 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[Newsletter](https:\/\/www.helpguide.org\/newsletter)\n- [Helplines](https:\/\/www.helpguide.org\/find-help)\n\nWhat is a panic attack?\n\n- What is a panic attack?\n- Panic attack signs and symptoms\n- Signs and symptoms of panic disorder\n- Nocturnal panic attacks\n- Panic disorder with agoraphobia\n- Causes of panic attacks and panic disorder\n- Self-help tips for panic attacks\n- Tip 1: Learn about panic and anxiety\n- Tip 2: Experiment with relaxation techniques\n- Tip 3: Reframe your relationship to panic\n- Tip 4: Make time for self-care\n- Tip 5: Find the right support\n- Treatment for panic attacks and panic disorder\n- Medication for panic attacks and panic disorder\n- How to help someone having a panic attack\n\n[Home](https:\/\/www.helpguide.org\/) [Choose a Therapist](https:\/\/www.helpguide.org\/)\n\n### Choose a Therapist\nThis therapist directory is offered in partnership with BetterHelp. If you sign up for therapy after clicking through from this site, HelpGuide will earn a commission. This helps us continue our nonprofit mission and continue to be there as a free mental health resource for everyone.\n\nNeed to talk to someone now? [Find a crisis helpline](https:\/\/www.helpguide.org\/find-help)\n\nIf you're a BetterHelp therapist with questions about your directory listing, please contact [therapists@betterhelp.com](mailto:therapists@betterhelp.com)\n\nNeed to talk to someone now? [Find a crisis helpline](https:\/\/www.helpguide.org\/find-help)\n\n[Are You Feeling Suicidal? How to Cope with Thoughts of Suicide](https:\/\/www.helpguide.org\/mental-health\/suicide-self-harm\/are-you-feeling-suicidal)\n\n[![depression-helpline](https:\/\/www.helpguide.org\/wp-content\/plugins\/helpguide-core-functionality\/assets\/images\/svg\/depression-helpline.svg) Coping with depression Tips for overcoming depression one step at a time](https:\/\/www.helpguide.org\/mental-health\/depression\/coping-with-depression)\n\n[![generalized-helpline](https:\/\/www.helpguide.org\/wp-content\/plugins\/helpguide-core-functionality\/assets\/images\/svg\/generalized-helpline.svg) Generalized Anxiety Disorder Symptoms, treatment, and self-help for chronic anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety\/generalized-anxiety-disorder-gad)\n\n[Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety)\n\n# Panic Attacks and Panic Disorder\nLast updated on February 27, 2026\n\nEver experienced a sudden surge of overwhelming anxiety and fear? Explore this guide to panic attacks, including symptoms, treatment, and self-help tips.\n\n![Looking up through the dark, bare branches of several tall pine trees against a stark white sky, representing panic attacks.](https:\/\/www.helpguide.org\/wp-content\/uploads\/2023\/02\/Panic-Attacks.jpeg)\n\nBy  [Lawrence Robinson](https:\/\/www.helpguide.org\/bio\/lawrence-robinson), [Jeanne Segal, Ph.D.](https:\/\/www.helpguide.org\/bio\/jeanne-segal-phd) and [Sheldon Reid](https:\/\/www.helpguide.org\/bio\/sheldon-reid)\n\n- What is a panic attack?\n- Panic attack signs and symptoms\n- Signs and symptoms of panic disorder\n- Nocturnal panic attacks\n- Panic disorder with agoraphobia\n- Causes of panic attacks and panic disorder\n- Self-help tips for panic attacks\n- Tip 1: Learn about panic and anxiety\n- Tip 2: Experiment with relaxation techniques\n- Tip 3: Reframe your relationship to panic\n- Tip 4: Make time for self-care\n- Tip 5: Find the right support\n- Treatment for panic attacks and panic disorder\n- Medication for panic attacks and panic disorder\n- How to help someone having a panic attack\n\n## What is a panic attack?\nA panic attack is an intense wave of fear characterized by its unexpectedness and debilitating, immobilizing intensity. Your heart pounds, you can’t breathe, and you may feel like you’re dying or going crazy. Panic attacks often strike out of the blue, without any warning, and sometimes with no clear trigger. They may even occur when you’re relaxed or asleep.\n\nA panic attack may be a one-time occurrence, although many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape, triggering the body’s fight-or-flight response.\n\nYou may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, [social phobia](https:\/\/www.helpguide.org\/mental-health\/anxiety\/social-anxiety-disorder), or [depression](https:\/\/www.helpguide.org\/mental-health\/depression\/depression-symptoms-and-warning-signs). Regardless of the cause, panic attacks are treatable. There are strategies you can use to reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life.\n\n#### Paula's story\nPaula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.\n\nPaula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has a panic attack.\n## Panic attack signs and symptoms\nThe signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home.\n\nPanic attack symptoms include:\n\n- Shortness of breath or hyperventilation.\n- Heart palpitations or racing heart.\n- Chest pain or discomfort.\n- Trembling or shaking.\n- Choking feeling.\n- Feeling unreal or detached from your surroundings.\n- Sweating.\n- Nausea or upset stomach.\n- Feeling dizzy, light-headed, or faint.\n- Numbness or tingling sensations.\n- Hot or cold flashes.\n- Fear of dying, losing control, or going crazy.\n### Is it a heart attack or a panic attack?\nMost of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think you’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around.\n\n### Panic attack vs. anxiety attack\nPeople often use “anxiety attack” and “panic attack” interchangeably. However, the terms can mean very different things. One key difference is that the Diagnostic and Statistical Manual of Mental Disorders (DSM) doesn’t list anxiety attacks as a condition. There’s no formal definition or diagnosis criteria for an anxiety attack.\n\nAnxiety attacks may refer to distress that has built up over time due to consistent stressors or fears of the future. Imagine that you’ve been stressed about your workplace responsibilities all week, and now your feelings have reached a boiling point. During an anxiety attack, life can feel overwhelming. You might experience tension, irritability, restlessness, or lack of focus.\n\nPanic attacks, on the other hand, are always sudden and often come with symptoms like derealization or a feeling of approaching doom. Panic attacks typically pass within 30 minutes, while an anxiety attack—although less intense—may last minutes or hours.\n\n#### Speak to a Licensed Therapist\nBetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.\n\n[Take Assessment](https:\/\/hasofferstracking.betterhelp.com\/aff_c?offer_id=2&aff_id=2729&source=helpguide)\n\nHelpGuide is user supported. We earn a commission if you sign up for BetterHelp’s services after clicking through from this site.  [Learn more](https:\/\/www.helpguide.org\/affiliate-disclosure)\n## Signs and symptoms of panic disorder\nWhile many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.\n\nYou may be suffering from panic disorder if you:\n\n- Experience frequent, unexpected panic attacks that aren’t tied to a specific situation.\n- Worry a lot about having another panic attack.\n- Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked.\n\nWhile a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:\n\n**Anticipatory anxiety** – Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.\n\n**Phobic avoidance** – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.\n\n## Nocturnal panic attacks\nDuring a nocturnal panic attack, you wake up while experiencing a sudden episode of fear and distress. These attacks occur while you’re in [stage 2 or stage 3 of non-REM sleep](https:\/\/www.helpguide.org\/wellness\/sleep\/stages-of-sleep#three-stages), and generally only last between two and eight minutes. However, the unpleasantness of the experience can make it difficult for you to go back to sleep or even lead you to try to avoid sleep.\n\nNocturnal panic attacks are common in people with panic disorder, affecting more than half of all patients. Some experts theorize that these types of panic attacks are caused by a fear of uncertainty or vulnerability. In other words, you feel anxious about your inability to react to threats while asleep.\n\n### Nocturnal panic attacks vs. nightmares and night terrors\nAlthough nocturnal panic attacks may seem similar to nightmares or sleep terrors, they are distinct issues and occur at different stages of sleep.\n\n[Night terrors](https:\/\/www.helpguide.org\/wellness\/sleep\/childhood-insomnia-and-sleep-problems#night-terrors) involve episodes of screaming and flailing while asleep. When you have a night terror, you likely won’t remember the experience when you wake up later. On the other hand, if you have a nocturnal panic attack, you’ll wake up during the experience.\n\nNightmares are bad dreams that occur during [rapid eye movement (REM) sleep](https:\/\/www.helpguide.org\/wellness\/sleep\/stages-of-sleep#dreaming). You can likely recall a few nightmares you’ve had in your life. Nocturnal panic attacks don’t involve a dreaming experience.\n\n## Panic disorder with agoraphobia\n[Agoraphobia](https:\/\/www.helpguide.org\/mental-health\/anxiety\/agoraphobia) was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks.\n\nIf you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations.\n\nFor example, you may begin to avoid:\n\n- Crowded places such as shopping malls or sports arenas.\n- Cars, airplanes, subways, and other forms of travel.\n- Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack.\n- Physical exercise in case it triggers panic.\n- Certain food or drinks that could provoke panic, such as alcohol, [caffeine](https:\/\/www.helpguide.org\/mental-health\/wellbeing\/how-much-caffeine), sugar, or specific medications.\n- Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home.\n## Causes of panic attacks and panic disorder\nAlthough the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. [Severe stress](https:\/\/www.helpguide.org\/mental-health\/stress\/stress-symptoms-signs-and-causes), such as the death of a loved one, divorce, or job loss can also trigger panic attacks.\n\nPanic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities:\n\n1. Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn’t close correctly.\n2. Hyperthyroidism (overactive thyroid gland).\n3. Hypoglycemia (low blood sugar).\n4. Stimulant use (amphetamines, cocaine, caffeine).\n5. Medication withdrawal.\n## Self-help tips for panic attacks\nNo matter how powerless or out of control you may feel about your panic attacks, it’s important to know that there are many things you can do to help yourself. The following self-help techniques can make a big difference to helping you overcome panic:\n\n## Tip 1: Learn about panic and anxiety\nSimply knowing more about panic can go a long way towards relieving your distress. Read up on [anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety), panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy.\n\nBecome familiar with the sensations. Panic is often driven by discomfort with physical sensations. For example, you might worry that your chest tightness is actually a heart attack. That kind of catastrophizing—jumping to the worst possible conclusion—can propel you into a panic attack.\n\nLearning more about normal physical sensations, including heart palpitations, tight throat, nausea, tremors, and headaches, can help maintain a more grounded perception. It’s also important to recognize that the mental sensations, such as fear of losing control and derealization, are temporary states.\n\n## Tip 2: Experiment with relaxation techniques\nWhen practiced regularly, activities such as yoga, [meditation](https:\/\/www.helpguide.org\/mental-health\/meditation), and [progressive muscle relaxation](https:\/\/www.helpguide.org\/mental-health\/meditation\/progressive-muscle-relaxation-meditation) strengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity.\n\n**Learn how to control your breathing.** Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. [Deep breathing](https:\/\/www.helpguide.org\/mental-health\/meditation\/deep-breathing-meditation), on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you can calm yourself down when you begin to feel anxious. And if you know how to control your breathing, you’re also less likely to create the very sensations that you’re afraid of.\n\n### Some breathing exercises to try\n**Paced breathing**. Slowly inhale through your nose for two to four seconds, expanding your chest and belly as you pull in the air. Exhale through your mouth. Aim to make your exhale about twice as long as your inhale. Repeat this several times.\n\n**Cyclic sighing**. Inhale deeply through your nose. Take a second, shorter inhale, further filling your lungs. Exhale slowly through your mouth. Repeat this exercise for five minutes.\n\n## Tip 3: Reframe your relationship to panic\nIn the book “[DARE: The New Way to End Anxiety](https:\/\/www.amazon.com\/Dare-Anxiety-Stop-Panic-Attacks\/dp\/0956596258),” Barry McDonagh offers a four-step process for handling anxiety and panic. The process, DARE, isn’t about reaching a state of calm but rather adopting a new mindset toward your symptoms.\n\n**Defus**e. Often, panic is escalated by negative “what if” statements, such as “What if I’m having a heart attack?” So, when you feel panic attack sensations beginning, say, “So what? This is harmless.” Or rely on a more personalized coping statement, such as, “The last panic attack I had didn’t kill me.”\n\n**Allow**. Practice accepting the symptoms, even though they’re unpleasant. The shaking, the rapid heartbeat, the sense of detachment—know that it’s all the result of a temporary flood of adrenaline.\n\n**Run towards it**. Dare the symptoms to intensify. Tell yourself that the adrenaline is exciting rather than threatening. Think of this as a form of exposure therapy. You’re intentionally inviting in the sensations that alarm you so you can discover how harmless they actually are.\n\n**Engage**. Once the adrenaline begins to subside, ground yourself in another activity. Whether it’s a conversation with your friend or a walk around the neighborhood, try to focus entirely on your current experience. This keeps you from dwelling on the panic and pulls you back into the present moment. You might still feel a little shaky from the experience, but acknowledge the shaking as a natural reaction.\n\n## Tip 4: Make time for self-care\nCertain self-care habits can help reduce your overall anxiety levels. This could, in turn, reduce the severity of panic attacks or help you better cope with them.\n\n**Exercise regularly.** Exercise is a [natural anxiety reliever](https:\/\/www.helpguide.org\/wellness\/fitness\/the-mental-health-benefits-of-exercise) so try to get moving for at least 30 minutes on most days (three 10-minute sessions is just as good). Rhythmic aerobic exercise that requires moving both your arms and legs—like walking, running, swimming, or dancing—can be especially effective.\n\n**Get enough restful sleep.** Insufficient or poor quality sleep can make anxiety worse, so try to get seven to nine hours of restful sleep a night. If sleeping well is a problem for you, [these tips to getting a good night’s sleep](https:\/\/www.helpguide.org\/wellness\/sleep\/getting-better-sleep) can help.\n\n**Avoid smoking, alcohol, and caffeine.** These can all provoke panic attacks in people who are susceptible. If you need help to kick the cigarette habit, see [How to Quit Smoking](https:\/\/www.helpguide.org\/mental-health\/addiction\/how-to-quit-smoking). Also, be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications.\n\n## Tip 5: Find the right support\n**Connect face-to-face with family and friends.** Symptoms of anxiety can become worse when you feel isolated, so reach out to people who care about you on a regular basis. If you feel that you don’t have anyone to turn to, explore ways to meet new people and [build supportive friendships](https:\/\/www.helpguide.org\/relationships\/social-connection\/making-good-friends).\n\n**Join a support group**. Friends and family members can offer comfort but, unless they also struggle with panic disorder, they might not fully understand what you’re going through. Consider joining a [support group](https:\/\/www.helpguide.org\/mental-health\/treatment\/support-groups), either in-person or online, for people with anxiety disorders, panic disorder, or panic attacks. Not only can the members relate to your experiences, but they may also share coping techniques and strategies that work for them.\n\n## Treatment for panic attacks and panic disorder\nThe most effective form of professional treatment for tackling panic attacks, panic disorder, and agoraphobia is [therapy](https:\/\/www.helpguide.org\/mental-health\/treatment\/therapy-for-anxiety-disorders). Even a short course of treatment can help.\n\n**Cognitive behavioral therapy** focuses on the thinking patterns and behaviors that are sustaining or triggering your panic attacks and helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.\n\n**Exposure therapy for panic disorder** allows you to experience the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.\n\n**Exposure therapy for panic disorder with agoraphobia** includes exposure to the situations you fear and avoid is also included in treatment. As in [exposure therapy](https:\/\/www.helpguide.org\/mental-health\/treatment\/exposure-therapy) for specific phobias, you [face the feared situation](https:\/\/www.helpguide.org\/mental-health\/anxiety\/phobias-and-irrational-fears#face-fears) until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions.\n\n## Medication for panic attacks and panic disorder\nMedication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn’t treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.\n\nMedications used may include:\n\n**Antidepressants.** It takes several weeks before [antidepressants](https:\/\/www.helpguide.org\/mental-health\/depression\/antidepressant-medication) begin to work, so you have to take them continuously, not just during a panic attack.\n\n**Benzodiazepines.** These are [anti-anxiety drugs](https:\/\/www.helpguide.org\/mental-health\/anxiety\/anxiety-medication) that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack can provide rapid relief of symptoms.\n\n#### Xanax for panic attacks\n[Alprazolam](https:\/\/medlineplus.gov\/druginfo\/meds\/a684001.html)—often sold under the brand name Xanax—is the most commonly prescribed benzodiazepine. During a panic attack, your nervous system is in a state of hyperactivity. By slowing down your nervous system, Xanax may quickly help put you into a more relaxed state.\n\nHowever, like other benzodiazepines, Xanax for panics attacks can be addictive and is only intended for short-term use. If you take it too often, a physical dependence can develop, meaning you’ll experience withdrawal when you attempt to stop taking it. In addition, overdose can lead to serious issues like confusion, coma, or even death.\n## How to help someone having a panic attack\nSeeing a friend or loved one suffering a panic attack can be frightening. Their breathing may become abnormally fast and shallow, they could become dizzy or light-headed, tremble, sweat, feel nauseous, or think they’re having a heart attack. No matter how irrational you think their panicked response to a situation is, it’s important to remember that the danger seems very real to your loved one. Simply telling them to calm down or minimizing their fear won’t help. But by helping your loved one ride out a panic attack, you can help them feel less fearful of any future attacks.\n\n**Stay calm yourself.** Being calm, understanding, and non-judgmental will help your loved one’s panic subside quicker.\n\n**Focus your loved one on their breathing.** Find a quiet place for your friend to sit and then guide them to take slow, deep breaths for a few minutes.\n\n**Do something physical.** Together, raise and lower your arms or stamp your feet. It can help to burn off some of your loved one’s stress.\n\n**Get your friend out of their own head** by asking them to name five things around them or talking soothingly about a shared interest.\n\n**Encourage your loved one to seek help.** Once the panic attack is over, your loved one may feel embarrassed about having an attack in front of you. Reassure them and encourage them to seek help for their anxiety.\n\n#### Hotlines and support\n[NAMI Helpline](http:\/\/www.nami.org\/Find-Support\/NAMI-HelpLine) – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness)\n\n[Find a Therapist](https:\/\/findyourtherapist.adaa.org\/?gad_source=1&gad_campaignid=21784584429&gbraid=0AAAAADOzZllsIkkYd2B1CzWOBkUt96kkV&gclid=CjwKCAiAnoXNBhAZEiwAnItcG7qf5gHZ2SkBwk650m8mhvG-Tq77XmH5UU8aBdgy7QNwe_CKgP2ZFBoCiwAQAvD_BwE) – Search for anxiety disorder treatment providers in the U.S. (Anxiety Disorders Association of America)\n\n[Support Groups](https:\/\/adaa.org\/find-help\/support) – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America)\n\n[Anxiety UK](http:\/\/www.anxietyuk.org.uk\/) – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK)\n\n[Anxiety Canada](https:\/\/www.anxietycanada.com\/articles\/recommended-links\/) – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada)\n\n[SANE Help Centre](https:\/\/www.sane.org\/get-support) – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia).\n\n[Helpline (India)](https:\/\/www.vandrevalafoundation.com\/) – Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330. (Vandrevala Foundation)\n\n## More Information\nReferences\n\n1. Taylor, C. B. (2006). Panic disorder. BMJ: British Medical Journal, 332(7547), 951–955.\n   [Link](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1444835\/)\n2. Kunas, S. L., Hilbert, K., Yang, Y., Richter, J., Hamm, A., Wittmann, A., Ströhle, A., Pfleiderer, B., Herrmann, M. J., Lang, T., Lotze, M., Deckert, J., Arolt, V., Wittchen, H.-U., Straube, B., Kircher, T., Gerlach, A. L., & Lueken, U. (2020). The modulating impact of cigarette smoking on brain structure in panic disorder: A voxel-based morphometry study. Social Cognitive and Affective Neuroscience, 15(8), 849–859.\n   [Link](https:\/\/doi.org\/10.1093\/scan\/nsaa103)\n3. Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues in Clinical Neuroscience, 13(4), 413–421.\n   [Link](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3263389\/)\n4. Tolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review. Clinical Psychology Review, 30(6), 710–720.\n   [Link](https:\/\/doi.org\/10.1016\/j.cpr.2010.05.003)\n5. Roberge, P., Marchand, A., Reinharz, D., & Savard, P. (2008). Cognitive-Behavioral Treatment for Panic Disorder With Agoraphobia: A Randomized, Controlled Trial and Cost-Effectiveness Analysis. Behavior Modification, 32(3), 333–351.\n   [Link](https:\/\/doi.org\/10.1177\/0145445507309025)\n6. Ougrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: Systematic review and meta-analysis. BMC Psychiatry, 11(1), 200.\n   [Link](https:\/\/doi.org\/10.1186\/1471-244X-11-200)\n7. Reinecke, A., Thilo, K. V., Croft, A., & Harmer, C. J. (2018). Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety. Translational Psychiatry, 8(1), 1–9.\n   [Link](https:\/\/doi.org\/10.1038\/s41398-018-0277-5)\n8. Craske, M. G., & Stein, M. B. (2016). Anxiety. Lancet (London, England), 388(10063), 3048–3059.\n   [Link](https:\/\/doi.org\/10.1016\/S0140-6736\\(16\\)30381-6)\n9. Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18(1), 559.\n   [Link](https:\/\/doi.org\/10.1186\/s12913-018-3313-5)\n10. Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018). Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Current Psychiatry Reports, 20(8), 63.\n    [Link](https:\/\/doi.org\/10.1007\/s11920-018-0923-x)\n11. Anxiety Disorders. (2013). In *Diagnostic and Statistical Manual of Mental Disorders*. American Psychiatric Association.\n    [Link](https:\/\/doi.org\/10.1176\/appi.books.9780890425787.x05_Anxiety_Disorders)\n12. Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal. *Journal of Addiction Medicine*, *12*(1), 4–10.\n    [Link](https:\/\/doi.org\/10.1097\/ADM.0000000000000350)\n13. *Alprazolam: MedlinePlus Drug Information*. (n.d.). Retrieved November 30, 2023, from\n    [Link](https:\/\/medlineplus.gov\/druginfo\/meds\/a684001.html)\n14. Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. *Cell Reports Medicine*, *4*(1), 100895.\n    [Link](https:\/\/doi.org\/10.1016\/j.xcrm.2022.100895)\n15. Kircanski, K., Craske, M. G., Epstein, A. M., & Wittchen, H.-U. (2011). Subtypes of Panic Attacks: A Critical Review of the Empirical Literature. *FOCUS*, *9*(3), 389–398.\n    [Link](https:\/\/doi.org\/10.1176\/foc.9.3.foc389)\n16. McDonagh, B. (2015). *Dare: The New Way to End Anxiety and Stop Panic Attacks.* BMD Publishing.\n    [Link](https:\/\/www.amazon.com\/Dare-Anxiety-Stop-Panic-Attacks\/dp\/0956596258)\n17. Meuret, A. E., Wolitzky-Taylor, K. B., Twohig, M. P., & Craske, M. G. (2012). Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions. *Behavior Therapy*, *43*(2), 271–284.\n    [Link](https:\/\/doi.org\/10.1016\/j.beth.2011.08.002)\n18. *Night terrors and nightmares—NHS*. (n.d.). Retrieved November 30, 2023, from\n    [Link](https:\/\/www.nhs.uk\/conditions\/night-terrors\/)\n19. Smith, N. S., Albanese, B. J., Schmidt, N. B., & Capron, D. W. (2019). Intolerance of uncertainty and responsibility for harm predict nocturnal panic attacks. *Psychiatry Research*, *273*, 82–88.\n    [Link](https:\/\/doi.org\/10.1016\/j.psychres.2019.01.025)\n20. Staner, L. (2003). Sleep and anxiety disorders. *Dialogues in Clinical Neuroscience*, *5*(3), 249–258.\n    [Link](https:\/\/pubmed.ncbi.nlm.nih.gov\/22033804\/)\n21. *The Medical Minute: Anxiety attack or panic attack? Actually, it can be both—Penn State Health News*. (n.d.). Retrieved November 30, 2023, from\n    [Link](https:\/\/pennstatehealthnews.org\/2023\/03\/the-medical-minute-anxiety-attack-or-panic-attack-actually-it-can-be-both\/)\n\n[Copy Link](https:\/\/www.helpguide.org\/mental-health\/anxiety\/panic-attacks-and-panic-disorders)\n\nLink copied\\!\n\nShare\n\nPrint\n\nDownload PDF\n\n## More in Anxiety\n[Treatment](https:\/\/www.helpguide.org\/mental-health\/treatment)\n\n### [Exposure Therapy](https:\/\/www.helpguide.org\/mental-health\/treatment\/exposure-therapy)\nBenefits, types, getting the most from treatment\n\n[![A woman's feet about to hit water, evoking a sense of playfulness.](https:\/\/www.helpguide.org\/wp-content\/uploads\/2024\/08\/Exposure-Therapy-Definition-Benefits-and-Techniques-384x256.jpg)](https:\/\/www.helpguide.org\/mental-health\/treatment\/exposure-therapy)\n\n[Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety)\n\n### [Phobias and Irrational Fears](https:\/\/www.helpguide.org\/mental-health\/anxiety\/phobias-and-irrational-fears)\nTips for recognizing, confronting, and breaking free of phobias\n\n[![A red and white circular \"No Entry\" sign stands against a backdrop of sharp, angular metal slats, representing phobias and irrational fears.](https:\/\/www.helpguide.org\/wp-content\/uploads\/2023\/02\/Phobias-and-Fears-384x256.jpeg)](https:\/\/www.helpguide.org\/mental-health\/anxiety\/phobias-and-irrational-fears)\n\n[Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety)\n\n### [Therapy for Anxiety Disorders](https:\/\/www.helpguide.org\/mental-health\/treatment\/therapy-for-anxiety-disorders)\nCognitive behavioral therapy, exposure therapy, and other options\n\n[![A person in a charcoal knit sweater sits on a dark sofa, writing in a spiral notebook, representing therapy for anxiety disorders.](https:\/\/www.helpguide.org\/wp-content\/uploads\/2023\/02\/Therapy-for-Anxiety-Disorders-384x256.jpeg)](https:\/\/www.helpguide.org\/mental-health\/treatment\/therapy-for-anxiety-disorders)\n\n[Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety)\n\n### [Can anxiety cause chest pain](https:\/\/www.helpguide.org\/mental-health\/anxiety\/anxiety-cause-chest-pain)\nWondering if your chest pain is due to anxiety? Learn how to identify anxiety-related chest discomfort and when to seek emergency help.\n\n[Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety)\n\n### [Anxiety Attack vs Panic Attack](https:\/\/www.helpguide.org\/mental-health\/anxiety\/anxiety-attack-vs-panic-attack)\nWhile anxiety attacks and panic attacks can share some symptoms, there are key differences. Learn how to tell them apart and what to do if you’re experiencing anxiety or panic attacks.\n\n[![A young woman in a pink coat sits on a subway platform, covering her face with her hands in distress.](https:\/\/www.helpguide.org\/wp-content\/uploads\/2025\/12\/anxiety-attacks-vs-panic-attacks-384x256.jpg)](https:\/\/www.helpguide.org\/mental-health\/anxiety\/anxiety-attack-vs-panic-attack)\n\n[Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety)\n\n### [High-Functioning Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety\/high-functioning-anxiety)\nSigns and how to cope\n\n[![A woman with short hair and large earrings leans against an office wall with eyes closed and hands clasped to her forehead in a moment of stress or deep focus.](https:\/\/www.helpguide.org\/wp-content\/uploads\/2025\/11\/High-Functioning-Anxiety-384x256.jpg)](https:\/\/www.helpguide.org\/mental-health\/anxiety\/high-functioning-anxiety)\n\n[Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety)\n\n### [Cognitive Dissonance](https:\/\/www.helpguide.org\/mental-health\/anxiety\/cognitive-dissonance)\nWhen your beliefs and actions conflict\n\n[![A woman gazes thoughtfully through window blinds, with a softly blurred background enhancing the sense of cognitive dissonance](https:\/\/www.helpguide.org\/wp-content\/uploads\/2024\/11\/Cognitive-Dissonance-Definition-Examples-How-to-Reduce-It-384x256.jpg)](https:\/\/www.helpguide.org\/mental-health\/anxiety\/cognitive-dissonance)\n\n[Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety)\n\n### [Cognitive Distortions](https:\/\/www.helpguide.org\/mental-health\/anxiety\/cognitive-distortions-put-an-end-to-distorted-thinking)\nPut an end to negative thinking\n\n[![A woman's face is half obscured by out-of-focus glass](https:\/\/www.helpguide.org\/wp-content\/uploads\/2024\/04\/CatastrophisingAndOtherCognitiveDistortions-384x257.jpg)](https:\/\/www.helpguide.org\/mental-health\/anxiety\/cognitive-distortions-put-an-end-to-distorted-thinking)\n\nShare\n\nDownload PDF\n\n### More in Anxiety\n[Treatment](https:\/\/www.helpguide.org\/mental-health\/treatment)\n\n### [Exposure Therapy](https:\/\/www.helpguide.org\/mental-health\/treatment\/exposure-therapy)\nBenefits, types, getting the most from treatment\n\n[Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety)\n\n### [Phobias and Irrational Fears](https:\/\/www.helpguide.org\/mental-health\/anxiety\/phobias-and-irrational-fears)\nTips for recognizing, confronting, and breaking free of phobias\n\n[Anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety)\n\n### [Therapy for Anxiety Disorders](https:\/\/www.helpguide.org\/mental-health\/treatment\/therapy-for-anxiety-disorders)\nCognitive behavioral therapy, exposure therapy, and other options\n\n![](https:\/\/www.helpguide.org\/wp-content\/uploads\/2024\/02\/therapy-sidebar-384x229.jpg)\n\n#### Professional therapy, done online\nBetterHelp makes starting therapy easy. 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Find helplines and other resources around the world.\n\n[Get Help](https:\/\/www.helpguide.org\/find-help)\n\n©1999-2026 HelpGuide.org   \n All rights reserved. HELPGUIDE.ORG INTERNATIONAL is a tax-exempt 501(c)3 organization (ID \\#45-4510670). Our content does not constitute a medical or psychological consultation. See a certified medical or mental health professional for diagnosis. [Learn more](https:\/\/www.helpguide.org\/terms-of-use).\n\n- [Terms of Use](https:\/\/www.helpguide.org\/terms-of-use)\n- [Privacy Policy](https:\/\/www.helpguide.org\/privacy-policy)\n- [Cookies Policy](https:\/\/www.helpguide.org\/cookie-policy)\n- [Affiliate Policy](https:\/\/www.helpguide.org\/affiliate-disclosure)","attrs_readable_markdown":"## What is a panic attack?\nA panic attack is an intense wave of fear characterized by its unexpectedness and debilitating, immobilizing intensity. Your heart pounds, you can’t breathe, and you may feel like you’re dying or going crazy. Panic attacks often strike out of the blue, without any warning, and sometimes with no clear trigger. They may even occur when you’re relaxed or asleep.\n\nA panic attack may be a one-time occurrence, although many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape, triggering the body’s fight-or-flight response.\n\nYou may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, [social phobia](https:\/\/www.helpguide.org\/mental-health\/anxiety\/social-anxiety-disorder), or [depression](https:\/\/www.helpguide.org\/mental-health\/depression\/depression-symptoms-and-warning-signs). Regardless of the cause, panic attacks are treatable. There are strategies you can use to reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life.\n\n#### Paula's story\nPaula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.\n\nPaula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has a panic attack.\n## Panic attack signs and symptoms\nThe signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home.\n\nPanic attack symptoms include:\n\n- Shortness of breath or hyperventilation.\n- Heart palpitations or racing heart.\n- Chest pain or discomfort.\n- Trembling or shaking.\n- Choking feeling.\n- Feeling unreal or detached from your surroundings.\n- Sweating.\n- Nausea or upset stomach.\n- Feeling dizzy, light-headed, or faint.\n- Numbness or tingling sensations.\n- Hot or cold flashes.\n- Fear of dying, losing control, or going crazy.\n### Is it a heart attack or a panic attack?\nMost of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think you’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around.\n\n### Panic attack vs. anxiety attack\nPeople often use “anxiety attack” and “panic attack” interchangeably. However, the terms can mean very different things. One key difference is that the Diagnostic and Statistical Manual of Mental Disorders (DSM) doesn’t list anxiety attacks as a condition. There’s no formal definition or diagnosis criteria for an anxiety attack.\n\nAnxiety attacks may refer to distress that has built up over time due to consistent stressors or fears of the future. Imagine that you’ve been stressed about your workplace responsibilities all week, and now your feelings have reached a boiling point. During an anxiety attack, life can feel overwhelming. You might experience tension, irritability, restlessness, or lack of focus.\n\nPanic attacks, on the other hand, are always sudden and often come with symptoms like derealization or a feeling of approaching doom. Panic attacks typically pass within 30 minutes, while an anxiety attack—although less intense—may last minutes or hours.\n\n#### Speak to a Licensed Therapist\nBetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.\n\n[Take Assessment](https:\/\/hasofferstracking.betterhelp.com\/aff_c?offer_id=2&aff_id=2729&source=helpguide) HelpGuide is user supported. We earn a commission if you sign up for BetterHelp’s services after clicking through from this site.  [Learn more](https:\/\/www.helpguide.org\/affiliate-disclosure)\n## Signs and symptoms of panic disorder\nWhile many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.\n\nYou may be suffering from panic disorder if you:\n\n- Experience frequent, unexpected panic attacks that aren’t tied to a specific situation.\n- Worry a lot about having another panic attack.\n- Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked.\n\nWhile a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:\n\n**Anticipatory anxiety** – Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.\n\n**Phobic avoidance** – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.\n\n## Nocturnal panic attacks\nDuring a nocturnal panic attack, you wake up while experiencing a sudden episode of fear and distress. These attacks occur while you’re in [stage 2 or stage 3 of non-REM sleep](https:\/\/www.helpguide.org\/wellness\/sleep\/stages-of-sleep#three-stages), and generally only last between two and eight minutes. However, the unpleasantness of the experience can make it difficult for you to go back to sleep or even lead you to try to avoid sleep.\n\nNocturnal panic attacks are common in people with panic disorder, affecting more than half of all patients. Some experts theorize that these types of panic attacks are caused by a fear of uncertainty or vulnerability. In other words, you feel anxious about your inability to react to threats while asleep.\n\n### Nocturnal panic attacks vs. nightmares and night terrors\nAlthough nocturnal panic attacks may seem similar to nightmares or sleep terrors, they are distinct issues and occur at different stages of sleep.\n\n[Night terrors](https:\/\/www.helpguide.org\/wellness\/sleep\/childhood-insomnia-and-sleep-problems#night-terrors) involve episodes of screaming and flailing while asleep. When you have a night terror, you likely won’t remember the experience when you wake up later. On the other hand, if you have a nocturnal panic attack, you’ll wake up during the experience.\n\nNightmares are bad dreams that occur during [rapid eye movement (REM) sleep](https:\/\/www.helpguide.org\/wellness\/sleep\/stages-of-sleep#dreaming). You can likely recall a few nightmares you’ve had in your life. Nocturnal panic attacks don’t involve a dreaming experience.\n\n## Panic disorder with agoraphobia\n[Agoraphobia](https:\/\/www.helpguide.org\/mental-health\/anxiety\/agoraphobia) was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks.\n\nIf you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations.\n\nFor example, you may begin to avoid:\n\n- Crowded places such as shopping malls or sports arenas.\n- Cars, airplanes, subways, and other forms of travel.\n- Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack.\n- Physical exercise in case it triggers panic.\n- Certain food or drinks that could provoke panic, such as alcohol, [caffeine](https:\/\/www.helpguide.org\/mental-health\/wellbeing\/how-much-caffeine), sugar, or specific medications.\n- Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home.\n## Causes of panic attacks and panic disorder\nAlthough the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. [Severe stress](https:\/\/www.helpguide.org\/mental-health\/stress\/stress-symptoms-signs-and-causes), such as the death of a loved one, divorce, or job loss can also trigger panic attacks.\n\nPanic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities:\n\n1. Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn’t close correctly.\n2. Hyperthyroidism (overactive thyroid gland).\n3. Hypoglycemia (low blood sugar).\n4. Stimulant use (amphetamines, cocaine, caffeine).\n5. Medication withdrawal.\n## Self-help tips for panic attacks\nNo matter how powerless or out of control you may feel about your panic attacks, it’s important to know that there are many things you can do to help yourself. The following self-help techniques can make a big difference to helping you overcome panic:\n\n## Tip 1: Learn about panic and anxiety\nSimply knowing more about panic can go a long way towards relieving your distress. Read up on [anxiety](https:\/\/www.helpguide.org\/mental-health\/anxiety), panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy.\n\nBecome familiar with the sensations. Panic is often driven by discomfort with physical sensations. For example, you might worry that your chest tightness is actually a heart attack. That kind of catastrophizing—jumping to the worst possible conclusion—can propel you into a panic attack.\n\nLearning more about normal physical sensations, including heart palpitations, tight throat, nausea, tremors, and headaches, can help maintain a more grounded perception. It’s also important to recognize that the mental sensations, such as fear of losing control and derealization, are temporary states.\n\n## Tip 2: Experiment with relaxation techniques\nWhen practiced regularly, activities such as yoga, [meditation](https:\/\/www.helpguide.org\/mental-health\/meditation), and [progressive muscle relaxation](https:\/\/www.helpguide.org\/mental-health\/meditation\/progressive-muscle-relaxation-meditation) strengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity.\n\n**Learn how to control your breathing.** Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. [Deep breathing](https:\/\/www.helpguide.org\/mental-health\/meditation\/deep-breathing-meditation), on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you can calm yourself down when you begin to feel anxious. And if you know how to control your breathing, you’re also less likely to create the very sensations that you’re afraid of.\n\n### Some breathing exercises to try\n**Paced breathing**. Slowly inhale through your nose for two to four seconds, expanding your chest and belly as you pull in the air. Exhale through your mouth. Aim to make your exhale about twice as long as your inhale. Repeat this several times.\n\n**Cyclic sighing**. Inhale deeply through your nose. Take a second, shorter inhale, further filling your lungs. Exhale slowly through your mouth. Repeat this exercise for five minutes.\n\n## Tip 3: Reframe your relationship to panic\nIn the book “[DARE: The New Way to End Anxiety](https:\/\/www.amazon.com\/Dare-Anxiety-Stop-Panic-Attacks\/dp\/0956596258),” Barry McDonagh offers a four-step process for handling anxiety and panic. The process, DARE, isn’t about reaching a state of calm but rather adopting a new mindset toward your symptoms.\n\n**Defus**e. Often, panic is escalated by negative “what if” statements, such as “What if I’m having a heart attack?” So, when you feel panic attack sensations beginning, say, “So what? This is harmless.” Or rely on a more personalized coping statement, such as, “The last panic attack I had didn’t kill me.”\n\n**Allow**. Practice accepting the symptoms, even though they’re unpleasant. The shaking, the rapid heartbeat, the sense of detachment—know that it’s all the result of a temporary flood of adrenaline.\n\n**Run towards it**. Dare the symptoms to intensify. Tell yourself that the adrenaline is exciting rather than threatening. Think of this as a form of exposure therapy. You’re intentionally inviting in the sensations that alarm you so you can discover how harmless they actually are.\n\n**Engage**. Once the adrenaline begins to subside, ground yourself in another activity. Whether it’s a conversation with your friend or a walk around the neighborhood, try to focus entirely on your current experience. This keeps you from dwelling on the panic and pulls you back into the present moment. You might still feel a little shaky from the experience, but acknowledge the shaking as a natural reaction.\n\n## Tip 4: Make time for self-care\nCertain self-care habits can help reduce your overall anxiety levels. This could, in turn, reduce the severity of panic attacks or help you better cope with them.\n\n**Exercise regularly.** Exercise is a [natural anxiety reliever](https:\/\/www.helpguide.org\/wellness\/fitness\/the-mental-health-benefits-of-exercise) so try to get moving for at least 30 minutes on most days (three 10-minute sessions is just as good). Rhythmic aerobic exercise that requires moving both your arms and legs—like walking, running, swimming, or dancing—can be especially effective.\n\n**Get enough restful sleep.** Insufficient or poor quality sleep can make anxiety worse, so try to get seven to nine hours of restful sleep a night. If sleeping well is a problem for you, [these tips to getting a good night’s sleep](https:\/\/www.helpguide.org\/wellness\/sleep\/getting-better-sleep) can help.\n\n**Avoid smoking, alcohol, and caffeine.** These can all provoke panic attacks in people who are susceptible. If you need help to kick the cigarette habit, see [How to Quit Smoking](https:\/\/www.helpguide.org\/mental-health\/addiction\/how-to-quit-smoking). Also, be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications.\n\n## Tip 5: Find the right support\n**Connect face-to-face with family and friends.** Symptoms of anxiety can become worse when you feel isolated, so reach out to people who care about you on a regular basis. If you feel that you don’t have anyone to turn to, explore ways to meet new people and [build supportive friendships](https:\/\/www.helpguide.org\/relationships\/social-connection\/making-good-friends).\n\n**Join a support group**. Friends and family members can offer comfort but, unless they also struggle with panic disorder, they might not fully understand what you’re going through. Consider joining a [support group](https:\/\/www.helpguide.org\/mental-health\/treatment\/support-groups), either in-person or online, for people with anxiety disorders, panic disorder, or panic attacks. Not only can the members relate to your experiences, but they may also share coping techniques and strategies that work for them.\n\n## Treatment for panic attacks and panic disorder\nThe most effective form of professional treatment for tackling panic attacks, panic disorder, and agoraphobia is [therapy](https:\/\/www.helpguide.org\/mental-health\/treatment\/therapy-for-anxiety-disorders). Even a short course of treatment can help.\n\n**Cognitive behavioral therapy** focuses on the thinking patterns and behaviors that are sustaining or triggering your panic attacks and helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.\n\n**Exposure therapy for panic disorder** allows you to experience the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.\n\n**Exposure therapy for panic disorder with agoraphobia** includes exposure to the situations you fear and avoid is also included in treatment. As in [exposure therapy](https:\/\/www.helpguide.org\/mental-health\/treatment\/exposure-therapy) for specific phobias, you [face the feared situation](https:\/\/www.helpguide.org\/mental-health\/anxiety\/phobias-and-irrational-fears#face-fears) until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions.\n\n## Medication for panic attacks and panic disorder\nMedication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn’t treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.\n\nMedications used may include:\n\n**Antidepressants.** It takes several weeks before [antidepressants](https:\/\/www.helpguide.org\/mental-health\/depression\/antidepressant-medication) begin to work, so you have to take them continuously, not just during a panic attack.\n\n**Benzodiazepines.** These are [anti-anxiety drugs](https:\/\/www.helpguide.org\/mental-health\/anxiety\/anxiety-medication) that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack can provide rapid relief of symptoms.\n\n#### Xanax for panic attacks\n[Alprazolam](https:\/\/medlineplus.gov\/druginfo\/meds\/a684001.html)—often sold under the brand name Xanax—is the most commonly prescribed benzodiazepine. During a panic attack, your nervous system is in a state of hyperactivity. By slowing down your nervous system, Xanax may quickly help put you into a more relaxed state.\n\nHowever, like other benzodiazepines, Xanax for panics attacks can be addictive and is only intended for short-term use. If you take it too often, a physical dependence can develop, meaning you’ll experience withdrawal when you attempt to stop taking it. In addition, overdose can lead to serious issues like confusion, coma, or even death.\n## How to help someone having a panic attack\nSeeing a friend or loved one suffering a panic attack can be frightening. Their breathing may become abnormally fast and shallow, they could become dizzy or light-headed, tremble, sweat, feel nauseous, or think they’re having a heart attack. No matter how irrational you think their panicked response to a situation is, it’s important to remember that the danger seems very real to your loved one. Simply telling them to calm down or minimizing their fear won’t help. But by helping your loved one ride out a panic attack, you can help them feel less fearful of any future attacks.\n\n**Stay calm yourself.** Being calm, understanding, and non-judgmental will help your loved one’s panic subside quicker.\n\n**Focus your loved one on their breathing.** Find a quiet place for your friend to sit and then guide them to take slow, deep breaths for a few minutes.\n\n**Do something physical.** Together, raise and lower your arms or stamp your feet. It can help to burn off some of your loved one’s stress.\n\n**Get your friend out of their own head** by asking them to name five things around them or talking soothingly about a shared interest.\n\n**Encourage your loved one to seek help.** Once the panic attack is over, your loved one may feel embarrassed about having an attack in front of you. Reassure them and encourage them to seek help for their anxiety.\n\n#### Hotlines and support\n[NAMI Helpline](http:\/\/www.nami.org\/Find-Support\/NAMI-HelpLine) – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness)\n\n[Find a Therapist](https:\/\/findyourtherapist.adaa.org\/?gad_source=1&gad_campaignid=21784584429&gbraid=0AAAAADOzZllsIkkYd2B1CzWOBkUt96kkV&gclid=CjwKCAiAnoXNBhAZEiwAnItcG7qf5gHZ2SkBwk650m8mhvG-Tq77XmH5UU8aBdgy7QNwe_CKgP2ZFBoCiwAQAvD_BwE) – Search for anxiety disorder treatment providers in the U.S. (Anxiety Disorders Association of America)\n\n[Support Groups](https:\/\/adaa.org\/find-help\/support) – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America)\n\n[Anxiety UK](http:\/\/www.anxietyuk.org.uk\/) – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK)\n\n[Anxiety Canada](https:\/\/www.anxietycanada.com\/articles\/recommended-links\/) – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada)\n\n[SANE Help Centre](https:\/\/www.sane.org\/get-support) – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia).\n\n[Helpline (India)](https:\/\/www.vandrevalafoundation.com\/) – Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330. (Vandrevala Foundation)\n\n## More Information\n1. Taylor, C. B. (2006). Panic disorder. BMJ: British Medical Journal, 332(7547), 951–955.\n   [Link](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1444835\/)\n2. Kunas, S. L., Hilbert, K., Yang, Y., Richter, J., Hamm, A., Wittmann, A., Ströhle, A., Pfleiderer, B., Herrmann, M. J., Lang, T., Lotze, M., Deckert, J., Arolt, V., Wittchen, H.-U., Straube, B., Kircher, T., Gerlach, A. L., & Lueken, U. (2020). The modulating impact of cigarette smoking on brain structure in panic disorder: A voxel-based morphometry study. Social Cognitive and Affective Neuroscience, 15(8), 849–859.\n   [Link](https:\/\/doi.org\/10.1093\/scan\/nsaa103)\n3. Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues in Clinical Neuroscience, 13(4), 413–421.\n   [Link](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3263389\/)\n4. Tolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review. Clinical Psychology Review, 30(6), 710–720.\n   [Link](https:\/\/doi.org\/10.1016\/j.cpr.2010.05.003)\n5. Roberge, P., Marchand, A., Reinharz, D., & Savard, P. (2008). Cognitive-Behavioral Treatment for Panic Disorder With Agoraphobia: A Randomized, Controlled Trial and Cost-Effectiveness Analysis. Behavior Modification, 32(3), 333–351.\n   [Link](https:\/\/doi.org\/10.1177\/0145445507309025)\n6. Ougrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: Systematic review and meta-analysis. BMC Psychiatry, 11(1), 200.\n   [Link](https:\/\/doi.org\/10.1186\/1471-244X-11-200)\n7. Reinecke, A., Thilo, K. V., Croft, A., & Harmer, C. J. (2018). Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety. Translational Psychiatry, 8(1), 1–9.\n   [Link](https:\/\/doi.org\/10.1038\/s41398-018-0277-5)\n8. Craske, M. G., & Stein, M. B. (2016). Anxiety. Lancet (London, England), 388(10063), 3048–3059.\n   [Link](https:\/\/doi.org\/10.1016\/S0140-6736\\(16\\)30381-6)\n9. Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18(1), 559.\n   [Link](https:\/\/doi.org\/10.1186\/s12913-018-3313-5)\n10. Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018). Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Current Psychiatry Reports, 20(8), 63.\n    [Link](https:\/\/doi.org\/10.1007\/s11920-018-0923-x)\n11. Anxiety Disorders. (2013). In *Diagnostic and Statistical Manual of Mental Disorders*. American Psychiatric Association.\n    [Link](https:\/\/doi.org\/10.1176\/appi.books.9780890425787.x05_Anxiety_Disorders)\n12. Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal. *Journal of Addiction Medicine*, *12*(1), 4–10.\n    [Link](https:\/\/doi.org\/10.1097\/ADM.0000000000000350)\n13. *Alprazolam: MedlinePlus Drug Information*. (n.d.). Retrieved November 30, 2023, from\n    [Link](https:\/\/medlineplus.gov\/druginfo\/meds\/a684001.html)\n14. Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. *Cell Reports Medicine*, *4*(1), 100895.\n    [Link](https:\/\/doi.org\/10.1016\/j.xcrm.2022.100895)\n15. Kircanski, K., Craske, M. G., Epstein, A. M., & Wittchen, H.-U. (2011). Subtypes of Panic Attacks: A Critical Review of the Empirical Literature. *FOCUS*, *9*(3), 389–398.\n    [Link](https:\/\/doi.org\/10.1176\/foc.9.3.foc389)\n16. McDonagh, B. (2015). *Dare: The New Way to End Anxiety and Stop Panic Attacks.* BMD Publishing.\n    [Link](https:\/\/www.amazon.com\/Dare-Anxiety-Stop-Panic-Attacks\/dp\/0956596258)\n17. Meuret, A. E., Wolitzky-Taylor, K. B., Twohig, M. P., & Craske, M. G. (2012). Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions. *Behavior Therapy*, *43*(2), 271–284.\n    [Link](https:\/\/doi.org\/10.1016\/j.beth.2011.08.002)\n18. *Night terrors and nightmares—NHS*. (n.d.). Retrieved November 30, 2023, from\n    [Link](https:\/\/www.nhs.uk\/conditions\/night-terrors\/)\n19. Smith, N. S., Albanese, B. J., Schmidt, N. B., & Capron, D. W. (2019). Intolerance of uncertainty and responsibility for harm predict nocturnal panic attacks. *Psychiatry Research*, *273*, 82–88.\n    [Link](https:\/\/doi.org\/10.1016\/j.psychres.2019.01.025)\n20. Staner, L. (2003). Sleep and anxiety disorders. *Dialogues in Clinical Neuroscience*, *5*(3), 249–258.\n    [Link](https:\/\/pubmed.ncbi.nlm.nih.gov\/22033804\/)\n21. *The Medical Minute: Anxiety attack or panic attack? Actually, it can be both—Penn State Health News*. (n.d.). Retrieved November 30, 2023, from\n    [Link](https:\/\/pennstatehealthnews.org\/2023\/03\/the-medical-minute-anxiety-attack-or-panic-attack-actually-it-can-be-both\/)","meta_canonical":null}

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Boilerpipe Text	What is a panic attack? A panic attack is an intense wave of fear characterized by its unexpectedness and debilitating, immobilizing intensity. Your heart pounds, you can’t breathe, and you may feel like you’re dying or going crazy. Panic attacks often strike out of the blue, without any warning, and sometimes with no clear trigger. They may even occur when you’re relaxed or asleep. A panic attack may be a one-time occurrence, although many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape, triggering the body’s fight-or-flight response. You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, social phobia , or depression . Regardless of the cause, panic attacks are treatable. There are strategies you can use to reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life. Paula's story Paula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken. Paula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has a panic attack. Panic attack signs and symptoms The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home. Panic attack symptoms include: Shortness of breath or hyperventilation. Heart palpitations or racing heart. Chest pain or discomfort. Trembling or shaking. Choking feeling. Feeling unreal or detached from your surroundings. Sweating. Nausea or upset stomach. Feeling dizzy, light-headed, or faint. Numbness or tingling sensations. Hot or cold flashes. Fear of dying, losing control, or going crazy. Is it a heart attack or a panic attack? Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think you’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around. Panic attack vs. anxiety attack People often use “anxiety attack” and “panic attack” interchangeably. However, the terms can mean very different things. One key difference is that the Diagnostic and Statistical Manual of Mental Disorders (DSM) doesn’t list anxiety attacks as a condition. There’s no formal definition or diagnosis criteria for an anxiety attack. Anxiety attacks may refer to distress that has built up over time due to consistent stressors or fears of the future. Imagine that you’ve been stressed about your workplace responsibilities all week, and now your feelings have reached a boiling point. During an anxiety attack, life can feel overwhelming. You might experience tension, irritability, restlessness, or lack of focus. Panic attacks, on the other hand, are always sudden and often come with symptoms like derealization or a feeling of approaching doom. Panic attacks typically pass within 30 minutes, while an anxiety attack—although less intense—may last minutes or hours. Speak to a Licensed Therapist BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours. Take Assessment HelpGuide is user supported. We earn a commission if you sign up for BetterHelp’s services after clicking through from this site. Learn more Signs and symptoms of panic disorder While many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks. You may be suffering from panic disorder if you: Experience frequent, unexpected panic attacks that aren’t tied to a specific situation. Worry a lot about having another panic attack. Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked. While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms: Anticipatory anxiety – Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling. Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia. Nocturnal panic attacks During a nocturnal panic attack, you wake up while experiencing a sudden episode of fear and distress. These attacks occur while you’re in stage 2 or stage 3 of non-REM sleep , and generally only last between two and eight minutes. However, the unpleasantness of the experience can make it difficult for you to go back to sleep or even lead you to try to avoid sleep. Nocturnal panic attacks are common in people with panic disorder, affecting more than half of all patients. Some experts theorize that these types of panic attacks are caused by a fear of uncertainty or vulnerability. In other words, you feel anxious about your inability to react to threats while asleep. Nocturnal panic attacks vs. nightmares and night terrors Although nocturnal panic attacks may seem similar to nightmares or sleep terrors, they are distinct issues and occur at different stages of sleep. Night terrors involve episodes of screaming and flailing while asleep. When you have a night terror, you likely won’t remember the experience when you wake up later. On the other hand, if you have a nocturnal panic attack, you’ll wake up during the experience. Nightmares are bad dreams that occur during rapid eye movement (REM) sleep . You can likely recall a few nightmares you’ve had in your life. Nocturnal panic attacks don’t involve a dreaming experience. Panic disorder with agoraphobia Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks. If you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations. For example, you may begin to avoid: Crowded places such as shopping malls or sports arenas. Cars, airplanes, subways, and other forms of travel. Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack. Physical exercise in case it triggers panic. Certain food or drinks that could provoke panic, such as alcohol, caffeine , sugar, or specific medications. Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home. Causes of panic attacks and panic disorder Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. Severe stress , such as the death of a loved one, divorce, or job loss can also trigger panic attacks. Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities: Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn’t close correctly. Hyperthyroidism (overactive thyroid gland). Hypoglycemia (low blood sugar). Stimulant use (amphetamines, cocaine, caffeine). Medication withdrawal. Self-help tips for panic attacks No matter how powerless or out of control you may feel about your panic attacks, it’s important to know that there are many things you can do to help yourself. The following self-help techniques can make a big difference to helping you overcome panic: Tip 1: Learn about panic and anxiety Simply knowing more about panic can go a long way towards relieving your distress. Read up on anxiety , panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy. Become familiar with the sensations. Panic is often driven by discomfort with physical sensations. For example, you might worry that your chest tightness is actually a heart attack. That kind of catastrophizing—jumping to the worst possible conclusion—can propel you into a panic attack. Learning more about normal physical sensations, including heart palpitations, tight throat, nausea, tremors, and headaches, can help maintain a more grounded perception. It’s also important to recognize that the mental sensations, such as fear of losing control and derealization, are temporary states. Tip 2: Experiment with relaxation techniques When practiced regularly, activities such as yoga, meditation , and progressive muscle relaxation strengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity. Learn how to control your breathing. Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. Deep breathing , on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you can calm yourself down when you begin to feel anxious. And if you know how to control your breathing, you’re also less likely to create the very sensations that you’re afraid of. Some breathing exercises to try Paced breathing . Slowly inhale through your nose for two to four seconds, expanding your chest and belly as you pull in the air. Exhale through your mouth. Aim to make your exhale about twice as long as your inhale. Repeat this several times. Cyclic sighing . Inhale deeply through your nose. Take a second, shorter inhale, further filling your lungs. Exhale slowly through your mouth. Repeat this exercise for five minutes. Tip 3: Reframe your relationship to panic In the book “ DARE: The New Way to End Anxiety ,” Barry McDonagh offers a four-step process for handling anxiety and panic. The process, DARE, isn’t about reaching a state of calm but rather adopting a new mindset toward your symptoms. Defus e. Often, panic is escalated by negative “what if” statements, such as “What if I’m having a heart attack?” So, when you feel panic attack sensations beginning, say, “So what? This is harmless.” Or rely on a more personalized coping statement, such as, “The last panic attack I had didn’t kill me.” Allow . Practice accepting the symptoms, even though they’re unpleasant. The shaking, the rapid heartbeat, the sense of detachment—know that it’s all the result of a temporary flood of adrenaline. Run towards it . Dare the symptoms to intensify. Tell yourself that the adrenaline is exciting rather than threatening. Think of this as a form of exposure therapy. You’re intentionally inviting in the sensations that alarm you so you can discover how harmless they actually are. Engage . Once the adrenaline begins to subside, ground yourself in another activity. Whether it’s a conversation with your friend or a walk around the neighborhood, try to focus entirely on your current experience. This keeps you from dwelling on the panic and pulls you back into the present moment. You might still feel a little shaky from the experience, but acknowledge the shaking as a natural reaction. Tip 4: Make time for self-care Certain self-care habits can help reduce your overall anxiety levels. This could, in turn, reduce the severity of panic attacks or help you better cope with them. Exercise regularly. Exercise is a natural anxiety reliever so try to get moving for at least 30 minutes on most days (three 10-minute sessions is just as good). Rhythmic aerobic exercise that requires moving both your arms and legs—like walking, running, swimming, or dancing—can be especially effective. Get enough restful sleep. Insufficient or poor quality sleep can make anxiety worse, so try to get seven to nine hours of restful sleep a night. If sleeping well is a problem for you, these tips to getting a good night’s sleep can help. Avoid smoking, alcohol, and caffeine. These can all provoke panic attacks in people who are susceptible. If you need help to kick the cigarette habit, see How to Quit Smoking . Also, be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications. Tip 5: Find the right support Connect face-to-face with family and friends. Symptoms of anxiety can become worse when you feel isolated, so reach out to people who care about you on a regular basis. If you feel that you don’t have anyone to turn to, explore ways to meet new people and build supportive friendships . Join a support group . Friends and family members can offer comfort but, unless they also struggle with panic disorder, they might not fully understand what you’re going through. Consider joining a support group , either in-person or online, for people with anxiety disorders, panic disorder, or panic attacks. Not only can the members relate to your experiences, but they may also share coping techniques and strategies that work for them. Treatment for panic attacks and panic disorder The most effective form of professional treatment for tackling panic attacks, panic disorder, and agoraphobia is therapy . Even a short course of treatment can help. Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering your panic attacks and helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying. Exposure therapy for panic disorder allows you to experience the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic. Exposure therapy for panic disorder with agoraphobia includes exposure to the situations you fear and avoid is also included in treatment. As in exposure therapy for specific phobias, you face the feared situation until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions. Medication for panic attacks and panic disorder Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn’t treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder. Medications used may include: Antidepressants. It takes several weeks before antidepressants begin to work, so you have to take them continuously, not just during a panic attack. Benzodiazepines. These are anti-anxiety drugs that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack can provide rapid relief of symptoms. Xanax for panic attacks Alprazolam —often sold under the brand name Xanax—is the most commonly prescribed benzodiazepine. During a panic attack, your nervous system is in a state of hyperactivity. By slowing down your nervous system, Xanax may quickly help put you into a more relaxed state. However, like other benzodiazepines, Xanax for panics attacks can be addictive and is only intended for short-term use. If you take it too often, a physical dependence can develop, meaning you’ll experience withdrawal when you attempt to stop taking it. In addition, overdose can lead to serious issues like confusion, coma, or even death. How to help someone having a panic attack Seeing a friend or loved one suffering a panic attack can be frightening. Their breathing may become abnormally fast and shallow, they could become dizzy or light-headed, tremble, sweat, feel nauseous, or think they’re having a heart attack. No matter how irrational you think their panicked response to a situation is, it’s important to remember that the danger seems very real to your loved one. Simply telling them to calm down or minimizing their fear won’t help. But by helping your loved one ride out a panic attack, you can help them feel less fearful of any future attacks. Stay calm yourself. Being calm, understanding, and non-judgmental will help your loved one’s panic subside quicker. Focus your loved one on their breathing. Find a quiet place for your friend to sit and then guide them to take slow, deep breaths for a few minutes. Do something physical. Together, raise and lower your arms or stamp your feet. It can help to burn off some of your loved one’s stress. Get your friend out of their own head by asking them to name five things around them or talking soothingly about a shared interest. Encourage your loved one to seek help. Once the panic attack is over, your loved one may feel embarrassed about having an attack in front of you. Reassure them and encourage them to seek help for their anxiety. Hotlines and support NAMI Helpline – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness) Find a Therapist – Search for anxiety disorder treatment providers in the U.S. (Anxiety Disorders Association of America) Support Groups – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America) Anxiety UK – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK) Anxiety Canada – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada) SANE Help Centre – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia). Helpline (India) – Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330. (Vandrevala Foundation) More Information Taylor, C. B. (2006). Panic disorder. BMJ: British Medical Journal, 332(7547), 951–955. Link Kunas, S. L., Hilbert, K., Yang, Y., Richter, J., Hamm, A., Wittmann, A., Ströhle, A., Pfleiderer, B., Herrmann, M. J., Lang, T., Lotze, M., Deckert, J., Arolt, V., Wittchen, H.-U., Straube, B., Kircher, T., Gerlach, A. L., & Lueken, U. (2020). The modulating impact of cigarette smoking on brain structure in panic disorder: A voxel-based morphometry study. Social Cognitive and Affective Neuroscience, 15(8), 849–859. Link Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues in Clinical Neuroscience, 13(4), 413–421. Link Tolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review. Clinical Psychology Review, 30(6), 710–720. Link Roberge, P., Marchand, A., Reinharz, D., & Savard, P. (2008). Cognitive-Behavioral Treatment for Panic Disorder With Agoraphobia: A Randomized, Controlled Trial and Cost-Effectiveness Analysis. Behavior Modification, 32(3), 333–351. Link Ougrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: Systematic review and meta-analysis. BMC Psychiatry, 11(1), 200. Link Reinecke, A., Thilo, K. V., Croft, A., & Harmer, C. J. (2018). Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety. Translational Psychiatry, 8(1), 1–9. Link Craske, M. G., & Stein, M. B. (2016). Anxiety. Lancet (London, England), 388(10063), 3048–3059. Link Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18(1), 559. Link Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018). Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Current Psychiatry Reports, 20(8), 63. Link Anxiety Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. Link Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal. Journal of Addiction Medicine , 12 (1), 4–10. Link Alprazolam: MedlinePlus Drug Information . (n.d.). Retrieved November 30, 2023, from Link Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine , 4 (1), 100895. Link Kircanski, K., Craske, M. G., Epstein, A. M., & Wittchen, H.-U. (2011). Subtypes of Panic Attacks: A Critical Review of the Empirical Literature. FOCUS , 9 (3), 389–398. Link McDonagh, B. (2015). Dare: The New Way to End Anxiety and Stop Panic Attacks. BMD Publishing. Link Meuret, A. E., Wolitzky-Taylor, K. B., Twohig, M. P., & Craske, M. G. (2012). Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions. Behavior Therapy , 43 (2), 271–284. Link Night terrors and nightmares—NHS . (n.d.). Retrieved November 30, 2023, from Link Smith, N. S., Albanese, B. J., Schmidt, N. B., & Capron, D. W. (2019). Intolerance of uncertainty and responsibility for harm predict nocturnal panic attacks. Psychiatry Research , 273 , 82–88. Link Staner, L. (2003). Sleep and anxiety disorders. Dialogues in Clinical Neuroscience , 5 (3), 249–258. Link The Medical Minute: Anxiety attack or panic attack? Actually, it can be both—Penn State Health News . (n.d.). Retrieved November 30, 2023, from Link
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Explore this guide to panic attacks, including symptoms, treatment, and self-help tips. ![Looking up through the dark, bare branches of several tall pine trees against a stark white sky, representing panic attacks.](https://www.helpguide.org/wp-content/uploads/2023/02/Panic-Attacks.jpeg) By [Lawrence Robinson](https://www.helpguide.org/bio/lawrence-robinson), [Jeanne Segal, Ph.D.](https://www.helpguide.org/bio/jeanne-segal-phd) and [Sheldon Reid](https://www.helpguide.org/bio/sheldon-reid) - What is a panic attack? - Panic attack signs and symptoms - Signs and symptoms of panic disorder - Nocturnal panic attacks - Panic disorder with agoraphobia - Causes of panic attacks and panic disorder - Self-help tips for panic attacks - Tip 1: Learn about panic and anxiety - Tip 2: Experiment with relaxation techniques - Tip 3: Reframe your relationship to panic - Tip 4: Make time for self-care - Tip 5: Find the right support - Treatment for panic attacks and panic disorder - Medication for panic attacks and panic disorder - How to help someone having a panic attack ## What is a panic attack? A panic attack is an intense wave of fear characterized by its unexpectedness and debilitating, immobilizing intensity. Your heart pounds, you can’t breathe, and you may feel like you’re dying or going crazy. Panic attacks often strike out of the blue, without any warning, and sometimes with no clear trigger. They may even occur when you’re relaxed or asleep. A panic attack may be a one-time occurrence, although many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape, triggering the body’s fight-or-flight response. You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, [social phobia](https://www.helpguide.org/mental-health/anxiety/social-anxiety-disorder), or [depression](https://www.helpguide.org/mental-health/depression/depression-symptoms-and-warning-signs). Regardless of the cause, panic attacks are treatable. There are strategies you can use to reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life. #### Paula's story Paula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken. Paula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has a panic attack. ## Panic attack signs and symptoms The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home. Panic attack symptoms include: - Shortness of breath or hyperventilation. - Heart palpitations or racing heart. - Chest pain or discomfort. - Trembling or shaking. - Choking feeling. - Feeling unreal or detached from your surroundings. - Sweating. - Nausea or upset stomach. - Feeling dizzy, light-headed, or faint. - Numbness or tingling sensations. - Hot or cold flashes. - Fear of dying, losing control, or going crazy. ### Is it a heart attack or a panic attack? Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think you’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around. ### Panic attack vs. anxiety attack People often use “anxiety attack” and “panic attack” interchangeably. However, the terms can mean very different things. One key difference is that the Diagnostic and Statistical Manual of Mental Disorders (DSM) doesn’t list anxiety attacks as a condition. There’s no formal definition or diagnosis criteria for an anxiety attack. Anxiety attacks may refer to distress that has built up over time due to consistent stressors or fears of the future. Imagine that you’ve been stressed about your workplace responsibilities all week, and now your feelings have reached a boiling point. During an anxiety attack, life can feel overwhelming. You might experience tension, irritability, restlessness, or lack of focus. Panic attacks, on the other hand, are always sudden and often come with symptoms like derealization or a feeling of approaching doom. Panic attacks typically pass within 30 minutes, while an anxiety attack—although less intense—may last minutes or hours. #### Speak to a Licensed Therapist BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours. [Take Assessment](https://hasofferstracking.betterhelp.com/aff_c?offer_id=2&aff_id=2729&source=helpguide) HelpGuide is user supported. We earn a commission if you sign up for BetterHelp’s services after clicking through from this site. [Learn more](https://www.helpguide.org/affiliate-disclosure) ## Signs and symptoms of panic disorder While many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks. You may be suffering from panic disorder if you: - Experience frequent, unexpected panic attacks that aren’t tied to a specific situation. - Worry a lot about having another panic attack. - Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked. While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms: Anticipatory anxiety – Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling. Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia. ## Nocturnal panic attacks During a nocturnal panic attack, you wake up while experiencing a sudden episode of fear and distress. These attacks occur while you’re in [stage 2 or stage 3 of non-REM sleep](https://www.helpguide.org/wellness/sleep/stages-of-sleep#three-stages), and generally only last between two and eight minutes. However, the unpleasantness of the experience can make it difficult for you to go back to sleep or even lead you to try to avoid sleep. Nocturnal panic attacks are common in people with panic disorder, affecting more than half of all patients. Some experts theorize that these types of panic attacks are caused by a fear of uncertainty or vulnerability. In other words, you feel anxious about your inability to react to threats while asleep. ### Nocturnal panic attacks vs. nightmares and night terrors Although nocturnal panic attacks may seem similar to nightmares or sleep terrors, they are distinct issues and occur at different stages of sleep. [Night terrors](https://www.helpguide.org/wellness/sleep/childhood-insomnia-and-sleep-problems#night-terrors) involve episodes of screaming and flailing while asleep. When you have a night terror, you likely won’t remember the experience when you wake up later. On the other hand, if you have a nocturnal panic attack, you’ll wake up during the experience. Nightmares are bad dreams that occur during [rapid eye movement (REM) sleep](https://www.helpguide.org/wellness/sleep/stages-of-sleep#dreaming). You can likely recall a few nightmares you’ve had in your life. Nocturnal panic attacks don’t involve a dreaming experience. ## Panic disorder with agoraphobia [Agoraphobia](https://www.helpguide.org/mental-health/anxiety/agoraphobia) was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks. If you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations. For example, you may begin to avoid: - Crowded places such as shopping malls or sports arenas. - Cars, airplanes, subways, and other forms of travel. - Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack. - Physical exercise in case it triggers panic. - Certain food or drinks that could provoke panic, such as alcohol, [caffeine](https://www.helpguide.org/mental-health/wellbeing/how-much-caffeine), sugar, or specific medications. - Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home. ## Causes of panic attacks and panic disorder Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. [Severe stress](https://www.helpguide.org/mental-health/stress/stress-symptoms-signs-and-causes), such as the death of a loved one, divorce, or job loss can also trigger panic attacks. Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities: 1. Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn’t close correctly. 2. Hyperthyroidism (overactive thyroid gland). 3. Hypoglycemia (low blood sugar). 4. Stimulant use (amphetamines, cocaine, caffeine). 5. Medication withdrawal. ## Self-help tips for panic attacks No matter how powerless or out of control you may feel about your panic attacks, it’s important to know that there are many things you can do to help yourself. The following self-help techniques can make a big difference to helping you overcome panic: ## Tip 1: Learn about panic and anxiety Simply knowing more about panic can go a long way towards relieving your distress. Read up on [anxiety](https://www.helpguide.org/mental-health/anxiety), panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy. Become familiar with the sensations. Panic is often driven by discomfort with physical sensations. For example, you might worry that your chest tightness is actually a heart attack. That kind of catastrophizing—jumping to the worst possible conclusion—can propel you into a panic attack. Learning more about normal physical sensations, including heart palpitations, tight throat, nausea, tremors, and headaches, can help maintain a more grounded perception. It’s also important to recognize that the mental sensations, such as fear of losing control and derealization, are temporary states. ## Tip 2: Experiment with relaxation techniques When practiced regularly, activities such as yoga, [meditation](https://www.helpguide.org/mental-health/meditation), and [progressive muscle relaxation](https://www.helpguide.org/mental-health/meditation/progressive-muscle-relaxation-meditation) strengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity. Learn how to control your breathing. Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. [Deep breathing](https://www.helpguide.org/mental-health/meditation/deep-breathing-meditation), on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you can calm yourself down when you begin to feel anxious. And if you know how to control your breathing, you’re also less likely to create the very sensations that you’re afraid of. ### Some breathing exercises to try Paced breathing. Slowly inhale through your nose for two to four seconds, expanding your chest and belly as you pull in the air. Exhale through your mouth. Aim to make your exhale about twice as long as your inhale. Repeat this several times. Cyclic sighing. Inhale deeply through your nose. Take a second, shorter inhale, further filling your lungs. Exhale slowly through your mouth. Repeat this exercise for five minutes. ## Tip 3: Reframe your relationship to panic In the book “[DARE: The New Way to End Anxiety](https://www.amazon.com/Dare-Anxiety-Stop-Panic-Attacks/dp/0956596258),” Barry McDonagh offers a four-step process for handling anxiety and panic. The process, DARE, isn’t about reaching a state of calm but rather adopting a new mindset toward your symptoms. Defuse. Often, panic is escalated by negative “what if” statements, such as “What if I’m having a heart attack?” So, when you feel panic attack sensations beginning, say, “So what? This is harmless.” Or rely on a more personalized coping statement, such as, “The last panic attack I had didn’t kill me.” Allow. Practice accepting the symptoms, even though they’re unpleasant. The shaking, the rapid heartbeat, the sense of detachment—know that it’s all the result of a temporary flood of adrenaline. Run towards it. Dare the symptoms to intensify. Tell yourself that the adrenaline is exciting rather than threatening. Think of this as a form of exposure therapy. You’re intentionally inviting in the sensations that alarm you so you can discover how harmless they actually are. Engage. Once the adrenaline begins to subside, ground yourself in another activity. Whether it’s a conversation with your friend or a walk around the neighborhood, try to focus entirely on your current experience. This keeps you from dwelling on the panic and pulls you back into the present moment. You might still feel a little shaky from the experience, but acknowledge the shaking as a natural reaction. ## Tip 4: Make time for self-care Certain self-care habits can help reduce your overall anxiety levels. This could, in turn, reduce the severity of panic attacks or help you better cope with them. Exercise regularly. Exercise is a [natural anxiety reliever](https://www.helpguide.org/wellness/fitness/the-mental-health-benefits-of-exercise) so try to get moving for at least 30 minutes on most days (three 10-minute sessions is just as good). Rhythmic aerobic exercise that requires moving both your arms and legs—like walking, running, swimming, or dancing—can be especially effective. Get enough restful sleep. Insufficient or poor quality sleep can make anxiety worse, so try to get seven to nine hours of restful sleep a night. If sleeping well is a problem for you, [these tips to getting a good night’s sleep](https://www.helpguide.org/wellness/sleep/getting-better-sleep) can help. Avoid smoking, alcohol, and caffeine. These can all provoke panic attacks in people who are susceptible. If you need help to kick the cigarette habit, see [How to Quit Smoking](https://www.helpguide.org/mental-health/addiction/how-to-quit-smoking). Also, be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications. ## Tip 5: Find the right support Connect face-to-face with family and friends. Symptoms of anxiety can become worse when you feel isolated, so reach out to people who care about you on a regular basis. If you feel that you don’t have anyone to turn to, explore ways to meet new people and [build supportive friendships](https://www.helpguide.org/relationships/social-connection/making-good-friends). Join a support group. Friends and family members can offer comfort but, unless they also struggle with panic disorder, they might not fully understand what you’re going through. Consider joining a [support group](https://www.helpguide.org/mental-health/treatment/support-groups), either in-person or online, for people with anxiety disorders, panic disorder, or panic attacks. Not only can the members relate to your experiences, but they may also share coping techniques and strategies that work for them. ## Treatment for panic attacks and panic disorder The most effective form of professional treatment for tackling panic attacks, panic disorder, and agoraphobia is [therapy](https://www.helpguide.org/mental-health/treatment/therapy-for-anxiety-disorders). Even a short course of treatment can help. Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering your panic attacks and helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying. Exposure therapy for panic disorder allows you to experience the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic. Exposure therapy for panic disorder with agoraphobia includes exposure to the situations you fear and avoid is also included in treatment. As in [exposure therapy](https://www.helpguide.org/mental-health/treatment/exposure-therapy) for specific phobias, you [face the feared situation](https://www.helpguide.org/mental-health/anxiety/phobias-and-irrational-fears#face-fears) until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions. ## Medication for panic attacks and panic disorder Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn’t treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder. Medications used may include: Antidepressants. It takes several weeks before [antidepressants](https://www.helpguide.org/mental-health/depression/antidepressant-medication) begin to work, so you have to take them continuously, not just during a panic attack. Benzodiazepines. These are [anti-anxiety drugs](https://www.helpguide.org/mental-health/anxiety/anxiety-medication) that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack can provide rapid relief of symptoms. #### Xanax for panic attacks [Alprazolam](https://medlineplus.gov/druginfo/meds/a684001.html)—often sold under the brand name Xanax—is the most commonly prescribed benzodiazepine. During a panic attack, your nervous system is in a state of hyperactivity. By slowing down your nervous system, Xanax may quickly help put you into a more relaxed state. However, like other benzodiazepines, Xanax for panics attacks can be addictive and is only intended for short-term use. If you take it too often, a physical dependence can develop, meaning you’ll experience withdrawal when you attempt to stop taking it. In addition, overdose can lead to serious issues like confusion, coma, or even death. ## How to help someone having a panic attack Seeing a friend or loved one suffering a panic attack can be frightening. Their breathing may become abnormally fast and shallow, they could become dizzy or light-headed, tremble, sweat, feel nauseous, or think they’re having a heart attack. No matter how irrational you think their panicked response to a situation is, it’s important to remember that the danger seems very real to your loved one. Simply telling them to calm down or minimizing their fear won’t help. But by helping your loved one ride out a panic attack, you can help them feel less fearful of any future attacks. Stay calm yourself. Being calm, understanding, and non-judgmental will help your loved one’s panic subside quicker. Focus your loved one on their breathing. Find a quiet place for your friend to sit and then guide them to take slow, deep breaths for a few minutes. Do something physical. Together, raise and lower your arms or stamp your feet. It can help to burn off some of your loved one’s stress. Get your friend out of their own head by asking them to name five things around them or talking soothingly about a shared interest. Encourage your loved one to seek help. Once the panic attack is over, your loved one may feel embarrassed about having an attack in front of you. Reassure them and encourage them to seek help for their anxiety. #### Hotlines and support [NAMI Helpline](http://www.nami.org/Find-Support/NAMI-HelpLine) – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness) [Find a Therapist](https://findyourtherapist.adaa.org/?gad_source=1&gad_campaignid=21784584429&gbraid=0AAAAADOzZllsIkkYd2B1CzWOBkUt96kkV&gclid=CjwKCAiAnoXNBhAZEiwAnItcG7qf5gHZ2SkBwk650m8mhvG-Tq77XmH5UU8aBdgy7QNwe_CKgP2ZFBoCiwAQAvD_BwE) – Search for anxiety disorder treatment providers in the U.S. (Anxiety Disorders Association of America) [Support Groups](https://adaa.org/find-help/support) – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America) [Anxiety UK](http://www.anxietyuk.org.uk/) – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK) [Anxiety Canada](https://www.anxietycanada.com/articles/recommended-links/) – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada) [SANE Help Centre](https://www.sane.org/get-support) – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia). [Helpline (India)](https://www.vandrevalafoundation.com/) – Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330. (Vandrevala Foundation) ## More Information References 1. Taylor, C. B. (2006). Panic disorder. BMJ: British Medical Journal, 332(7547), 951–955. [Link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1444835/) 2. Kunas, S. L., Hilbert, K., Yang, Y., Richter, J., Hamm, A., Wittmann, A., Ströhle, A., Pfleiderer, B., Herrmann, M. J., Lang, T., Lotze, M., Deckert, J., Arolt, V., Wittchen, H.-U., Straube, B., Kircher, T., Gerlach, A. L., & Lueken, U. (2020). The modulating impact of cigarette smoking on brain structure in panic disorder: A voxel-based morphometry study. Social Cognitive and Affective Neuroscience, 15(8), 849–859. [Link](https://doi.org/10.1093/scan/nsaa103) 3. Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues in Clinical Neuroscience, 13(4), 413–421. [Link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/) 4. Tolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review. Clinical Psychology Review, 30(6), 710–720. [Link](https://doi.org/10.1016/j.cpr.2010.05.003) 5. Roberge, P., Marchand, A., Reinharz, D., & Savard, P. (2008). Cognitive-Behavioral Treatment for Panic Disorder With Agoraphobia: A Randomized, Controlled Trial and Cost-Effectiveness Analysis. Behavior Modification, 32(3), 333–351. [Link](https://doi.org/10.1177/0145445507309025) 6. Ougrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: Systematic review and meta-analysis. BMC Psychiatry, 11(1), 200. [Link](https://doi.org/10.1186/1471-244X-11-200) 7. Reinecke, A., Thilo, K. V., Croft, A., & Harmer, C. J. (2018). Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety. Translational Psychiatry, 8(1), 1–9. [Link](https://doi.org/10.1038/s41398-018-0277-5) 8. Craske, M. G., & Stein, M. B. (2016). Anxiety. Lancet (London, England), 388(10063), 3048–3059. [Link](https://doi.org/10.1016/S0140-6736\(16\)30381-6) 9. Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18(1), 559. [Link](https://doi.org/10.1186/s12913-018-3313-5) 10. Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018). Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Current Psychiatry Reports, 20(8), 63. [Link](https://doi.org/10.1007/s11920-018-0923-x) 11. Anxiety Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. [Link](https://doi.org/10.1176/appi.books.9780890425787.x05_Anxiety_Disorders) 12. Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal. Journal of Addiction Medicine, 12(1), 4–10. [Link](https://doi.org/10.1097/ADM.0000000000000350) 13. Alprazolam: MedlinePlus Drug Information. (n.d.). Retrieved November 30, 2023, from [Link](https://medlineplus.gov/druginfo/meds/a684001.html) 14. Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. [Link](https://doi.org/10.1016/j.xcrm.2022.100895) 15. Kircanski, K., Craske, M. G., Epstein, A. M., & Wittchen, H.-U. (2011). Subtypes of Panic Attacks: A Critical Review of the Empirical Literature. FOCUS, 9(3), 389–398. [Link](https://doi.org/10.1176/foc.9.3.foc389) 16. McDonagh, B. (2015). Dare: The New Way to End Anxiety and Stop Panic Attacks. BMD Publishing. [Link](https://www.amazon.com/Dare-Anxiety-Stop-Panic-Attacks/dp/0956596258) 17. Meuret, A. E., Wolitzky-Taylor, K. B., Twohig, M. P., & Craske, M. G. (2012). Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions. Behavior Therapy, 43(2), 271–284. [Link](https://doi.org/10.1016/j.beth.2011.08.002) 18. Night terrors and nightmares—NHS. (n.d.). Retrieved November 30, 2023, from [Link](https://www.nhs.uk/conditions/night-terrors/) 19. Smith, N. S., Albanese, B. J., Schmidt, N. B., & Capron, D. W. (2019). Intolerance of uncertainty and responsibility for harm predict nocturnal panic attacks. Psychiatry Research, 273, 82–88. [Link](https://doi.org/10.1016/j.psychres.2019.01.025) 20. Staner, L. (2003). Sleep and anxiety disorders. Dialogues in Clinical Neuroscience, 5(3), 249–258. [Link](https://pubmed.ncbi.nlm.nih.gov/22033804/) 21. The Medical Minute: Anxiety attack or panic attack? Actually, it can be both—Penn State Health News. (n.d.). Retrieved November 30, 2023, from [Link](https://pennstatehealthnews.org/2023/03/the-medical-minute-anxiety-attack-or-panic-attack-actually-it-can-be-both/) [Copy Link](https://www.helpguide.org/mental-health/anxiety/panic-attacks-and-panic-disorders) Link copied\! Share Print Download PDF ## More in Anxiety [Treatment](https://www.helpguide.org/mental-health/treatment) ### [Exposure Therapy](https://www.helpguide.org/mental-health/treatment/exposure-therapy) Benefits, types, getting the most from treatment [![A woman's feet about to hit water, evoking a sense of playfulness.](https://www.helpguide.org/wp-content/uploads/2024/08/Exposure-Therapy-Definition-Benefits-and-Techniques-384x256.jpg)](https://www.helpguide.org/mental-health/treatment/exposure-therapy) [Anxiety](https://www.helpguide.org/mental-health/anxiety) ### [Phobias and Irrational Fears](https://www.helpguide.org/mental-health/anxiety/phobias-and-irrational-fears) Tips for recognizing, confronting, and breaking free of phobias [![A red and white circular "No Entry" sign stands against a backdrop of sharp, angular metal slats, representing phobias and irrational fears.](https://www.helpguide.org/wp-content/uploads/2023/02/Phobias-and-Fears-384x256.jpeg)](https://www.helpguide.org/mental-health/anxiety/phobias-and-irrational-fears) [Anxiety](https://www.helpguide.org/mental-health/anxiety) ### [Therapy for Anxiety Disorders](https://www.helpguide.org/mental-health/treatment/therapy-for-anxiety-disorders) Cognitive behavioral therapy, exposure therapy, and other options [![A person in a charcoal knit sweater sits on a dark sofa, writing in a spiral notebook, representing therapy for anxiety disorders.](https://www.helpguide.org/wp-content/uploads/2023/02/Therapy-for-Anxiety-Disorders-384x256.jpeg)](https://www.helpguide.org/mental-health/treatment/therapy-for-anxiety-disorders) [Anxiety](https://www.helpguide.org/mental-health/anxiety) ### [Can anxiety cause chest pain](https://www.helpguide.org/mental-health/anxiety/anxiety-cause-chest-pain) Wondering if your chest pain is due to anxiety? Learn how to identify anxiety-related chest discomfort and when to seek emergency help. [Anxiety](https://www.helpguide.org/mental-health/anxiety) ### [Anxiety Attack vs Panic Attack](https://www.helpguide.org/mental-health/anxiety/anxiety-attack-vs-panic-attack) While anxiety attacks and panic attacks can share some symptoms, there are key differences. Learn how to tell them apart and what to do if you’re experiencing anxiety or panic attacks. [![A young woman in a pink coat sits on a subway platform, covering her face with her hands in distress.](https://www.helpguide.org/wp-content/uploads/2025/12/anxiety-attacks-vs-panic-attacks-384x256.jpg)](https://www.helpguide.org/mental-health/anxiety/anxiety-attack-vs-panic-attack) [Anxiety](https://www.helpguide.org/mental-health/anxiety) ### [High-Functioning Anxiety](https://www.helpguide.org/mental-health/anxiety/high-functioning-anxiety) Signs and how to cope [![A woman with short hair and large earrings leans against an office wall with eyes closed and hands clasped to her forehead in a moment of stress or deep focus.](https://www.helpguide.org/wp-content/uploads/2025/11/High-Functioning-Anxiety-384x256.jpg)](https://www.helpguide.org/mental-health/anxiety/high-functioning-anxiety) [Anxiety](https://www.helpguide.org/mental-health/anxiety) ### [Cognitive Dissonance](https://www.helpguide.org/mental-health/anxiety/cognitive-dissonance) When your beliefs and actions conflict [![A woman gazes thoughtfully through window blinds, with a softly blurred background enhancing the sense of cognitive dissonance](https://www.helpguide.org/wp-content/uploads/2024/11/Cognitive-Dissonance-Definition-Examples-How-to-Reduce-It-384x256.jpg)](https://www.helpguide.org/mental-health/anxiety/cognitive-dissonance) [Anxiety](https://www.helpguide.org/mental-health/anxiety) ### [Cognitive Distortions](https://www.helpguide.org/mental-health/anxiety/cognitive-distortions-put-an-end-to-distorted-thinking) Put an end to negative thinking [![A woman's face is half obscured by out-of-focus glass](https://www.helpguide.org/wp-content/uploads/2024/04/CatastrophisingAndOtherCognitiveDistortions-384x257.jpg)](https://www.helpguide.org/mental-health/anxiety/cognitive-distortions-put-an-end-to-distorted-thinking) Share Download PDF ### More in Anxiety [Treatment](https://www.helpguide.org/mental-health/treatment) ### [Exposure Therapy](https://www.helpguide.org/mental-health/treatment/exposure-therapy) Benefits, types, getting the most from treatment [Anxiety](https://www.helpguide.org/mental-health/anxiety) ### [Phobias and Irrational Fears](https://www.helpguide.org/mental-health/anxiety/phobias-and-irrational-fears) Tips for recognizing, confronting, and breaking free of phobias [Anxiety](https://www.helpguide.org/mental-health/anxiety) ### [Therapy for Anxiety Disorders](https://www.helpguide.org/mental-health/treatment/therapy-for-anxiety-disorders) Cognitive behavioral therapy, exposure therapy, and other options ![](https://www.helpguide.org/wp-content/uploads/2024/02/therapy-sidebar-384x229.jpg) #### Professional therapy, done online BetterHelp makes starting therapy easy. 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Readable Markdown	## What is a panic attack? A panic attack is an intense wave of fear characterized by its unexpectedness and debilitating, immobilizing intensity. Your heart pounds, you can’t breathe, and you may feel like you’re dying or going crazy. Panic attacks often strike out of the blue, without any warning, and sometimes with no clear trigger. They may even occur when you’re relaxed or asleep. A panic attack may be a one-time occurrence, although many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape, triggering the body’s fight-or-flight response. You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, [social phobia](https://www.helpguide.org/mental-health/anxiety/social-anxiety-disorder), or [depression](https://www.helpguide.org/mental-health/depression/depression-symptoms-and-warning-signs). Regardless of the cause, panic attacks are treatable. There are strategies you can use to reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life. #### Paula's story Paula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken. Paula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has a panic attack. ## Panic attack signs and symptoms The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or even sitting on the couch at home. Panic attack symptoms include: - Shortness of breath or hyperventilation. - Heart palpitations or racing heart. - Chest pain or discomfort. - Trembling or shaking. - Choking feeling. - Feeling unreal or detached from your surroundings. - Sweating. - Nausea or upset stomach. - Feeling dizzy, light-headed, or faint. - Numbness or tingling sensations. - Hot or cold flashes. - Fear of dying, losing control, or going crazy. ### Is it a heart attack or a panic attack? Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that you may think you’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, elevated heart rate, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around. ### Panic attack vs. anxiety attack People often use “anxiety attack” and “panic attack” interchangeably. However, the terms can mean very different things. One key difference is that the Diagnostic and Statistical Manual of Mental Disorders (DSM) doesn’t list anxiety attacks as a condition. There’s no formal definition or diagnosis criteria for an anxiety attack. Anxiety attacks may refer to distress that has built up over time due to consistent stressors or fears of the future. Imagine that you’ve been stressed about your workplace responsibilities all week, and now your feelings have reached a boiling point. During an anxiety attack, life can feel overwhelming. You might experience tension, irritability, restlessness, or lack of focus. Panic attacks, on the other hand, are always sudden and often come with symptoms like derealization or a feeling of approaching doom. Panic attacks typically pass within 30 minutes, while an anxiety attack—although less intense—may last minutes or hours. #### Speak to a Licensed Therapist BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours. [Take Assessment](https://hasofferstracking.betterhelp.com/aff_c?offer_id=2&aff_id=2729&source=helpguide) HelpGuide is user supported. We earn a commission if you sign up for BetterHelp’s services after clicking through from this site. [Learn more](https://www.helpguide.org/affiliate-disclosure) ## Signs and symptoms of panic disorder While many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks. You may be suffering from panic disorder if you: - Experience frequent, unexpected panic attacks that aren’t tied to a specific situation. - Worry a lot about having another panic attack. - Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked. While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms: Anticipatory anxiety – Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling. Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia. ## Nocturnal panic attacks During a nocturnal panic attack, you wake up while experiencing a sudden episode of fear and distress. These attacks occur while you’re in [stage 2 or stage 3 of non-REM sleep](https://www.helpguide.org/wellness/sleep/stages-of-sleep#three-stages), and generally only last between two and eight minutes. However, the unpleasantness of the experience can make it difficult for you to go back to sleep or even lead you to try to avoid sleep. Nocturnal panic attacks are common in people with panic disorder, affecting more than half of all patients. Some experts theorize that these types of panic attacks are caused by a fear of uncertainty or vulnerability. In other words, you feel anxious about your inability to react to threats while asleep. ### Nocturnal panic attacks vs. nightmares and night terrors Although nocturnal panic attacks may seem similar to nightmares or sleep terrors, they are distinct issues and occur at different stages of sleep. [Night terrors](https://www.helpguide.org/wellness/sleep/childhood-insomnia-and-sleep-problems#night-terrors) involve episodes of screaming and flailing while asleep. When you have a night terror, you likely won’t remember the experience when you wake up later. On the other hand, if you have a nocturnal panic attack, you’ll wake up during the experience. Nightmares are bad dreams that occur during [rapid eye movement (REM) sleep](https://www.helpguide.org/wellness/sleep/stages-of-sleep#dreaming). You can likely recall a few nightmares you’ve had in your life. Nocturnal panic attacks don’t involve a dreaming experience. ## Panic disorder with agoraphobia [Agoraphobia](https://www.helpguide.org/mental-health/anxiety/agoraphobia) was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks. If you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations. For example, you may begin to avoid: - Crowded places such as shopping malls or sports arenas. - Cars, airplanes, subways, and other forms of travel. - Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack. - Physical exercise in case it triggers panic. - Certain food or drinks that could provoke panic, such as alcohol, [caffeine](https://www.helpguide.org/mental-health/wellbeing/how-much-caffeine), sugar, or specific medications. - Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home. ## Causes of panic attacks and panic disorder Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, or having a baby. [Severe stress](https://www.helpguide.org/mental-health/stress/stress-symptoms-signs-and-causes), such as the death of a loved one, divorce, or job loss can also trigger panic attacks. Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilities: 1. Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn’t close correctly. 2. Hyperthyroidism (overactive thyroid gland). 3. Hypoglycemia (low blood sugar). 4. Stimulant use (amphetamines, cocaine, caffeine). 5. Medication withdrawal. ## Self-help tips for panic attacks No matter how powerless or out of control you may feel about your panic attacks, it’s important to know that there are many things you can do to help yourself. The following self-help techniques can make a big difference to helping you overcome panic: ## Tip 1: Learn about panic and anxiety Simply knowing more about panic can go a long way towards relieving your distress. Read up on [anxiety](https://www.helpguide.org/mental-health/anxiety), panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy. Become familiar with the sensations. Panic is often driven by discomfort with physical sensations. For example, you might worry that your chest tightness is actually a heart attack. That kind of catastrophizing—jumping to the worst possible conclusion—can propel you into a panic attack. Learning more about normal physical sensations, including heart palpitations, tight throat, nausea, tremors, and headaches, can help maintain a more grounded perception. It’s also important to recognize that the mental sensations, such as fear of losing control and derealization, are temporary states. ## Tip 2: Experiment with relaxation techniques When practiced regularly, activities such as yoga, [meditation](https://www.helpguide.org/mental-health/meditation), and [progressive muscle relaxation](https://www.helpguide.org/mental-health/meditation/progressive-muscle-relaxation-meditation) strengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity. Learn how to control your breathing. Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. [Deep breathing](https://www.helpguide.org/mental-health/meditation/deep-breathing-meditation), on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you can calm yourself down when you begin to feel anxious. And if you know how to control your breathing, you’re also less likely to create the very sensations that you’re afraid of. ### Some breathing exercises to try Paced breathing. Slowly inhale through your nose for two to four seconds, expanding your chest and belly as you pull in the air. Exhale through your mouth. Aim to make your exhale about twice as long as your inhale. Repeat this several times. Cyclic sighing. Inhale deeply through your nose. Take a second, shorter inhale, further filling your lungs. Exhale slowly through your mouth. Repeat this exercise for five minutes. ## Tip 3: Reframe your relationship to panic In the book “[DARE: The New Way to End Anxiety](https://www.amazon.com/Dare-Anxiety-Stop-Panic-Attacks/dp/0956596258),” Barry McDonagh offers a four-step process for handling anxiety and panic. The process, DARE, isn’t about reaching a state of calm but rather adopting a new mindset toward your symptoms. Defuse. Often, panic is escalated by negative “what if” statements, such as “What if I’m having a heart attack?” So, when you feel panic attack sensations beginning, say, “So what? This is harmless.” Or rely on a more personalized coping statement, such as, “The last panic attack I had didn’t kill me.” Allow. Practice accepting the symptoms, even though they’re unpleasant. The shaking, the rapid heartbeat, the sense of detachment—know that it’s all the result of a temporary flood of adrenaline. Run towards it. Dare the symptoms to intensify. Tell yourself that the adrenaline is exciting rather than threatening. Think of this as a form of exposure therapy. You’re intentionally inviting in the sensations that alarm you so you can discover how harmless they actually are. Engage. Once the adrenaline begins to subside, ground yourself in another activity. Whether it’s a conversation with your friend or a walk around the neighborhood, try to focus entirely on your current experience. This keeps you from dwelling on the panic and pulls you back into the present moment. You might still feel a little shaky from the experience, but acknowledge the shaking as a natural reaction. ## Tip 4: Make time for self-care Certain self-care habits can help reduce your overall anxiety levels. This could, in turn, reduce the severity of panic attacks or help you better cope with them. Exercise regularly. Exercise is a [natural anxiety reliever](https://www.helpguide.org/wellness/fitness/the-mental-health-benefits-of-exercise) so try to get moving for at least 30 minutes on most days (three 10-minute sessions is just as good). Rhythmic aerobic exercise that requires moving both your arms and legs—like walking, running, swimming, or dancing—can be especially effective. Get enough restful sleep. Insufficient or poor quality sleep can make anxiety worse, so try to get seven to nine hours of restful sleep a night. If sleeping well is a problem for you, [these tips to getting a good night’s sleep](https://www.helpguide.org/wellness/sleep/getting-better-sleep) can help. Avoid smoking, alcohol, and caffeine. These can all provoke panic attacks in people who are susceptible. If you need help to kick the cigarette habit, see [How to Quit Smoking](https://www.helpguide.org/mental-health/addiction/how-to-quit-smoking). Also, be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications. ## Tip 5: Find the right support Connect face-to-face with family and friends. Symptoms of anxiety can become worse when you feel isolated, so reach out to people who care about you on a regular basis. If you feel that you don’t have anyone to turn to, explore ways to meet new people and [build supportive friendships](https://www.helpguide.org/relationships/social-connection/making-good-friends). Join a support group. Friends and family members can offer comfort but, unless they also struggle with panic disorder, they might not fully understand what you’re going through. Consider joining a [support group](https://www.helpguide.org/mental-health/treatment/support-groups), either in-person or online, for people with anxiety disorders, panic disorder, or panic attacks. Not only can the members relate to your experiences, but they may also share coping techniques and strategies that work for them. ## Treatment for panic attacks and panic disorder The most effective form of professional treatment for tackling panic attacks, panic disorder, and agoraphobia is [therapy](https://www.helpguide.org/mental-health/treatment/therapy-for-anxiety-disorders). Even a short course of treatment can help. Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering your panic attacks and helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying. Exposure therapy for panic disorder allows you to experience the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic. Exposure therapy for panic disorder with agoraphobia includes exposure to the situations you fear and avoid is also included in treatment. As in [exposure therapy](https://www.helpguide.org/mental-health/treatment/exposure-therapy) for specific phobias, you [face the feared situation](https://www.helpguide.org/mental-health/anxiety/phobias-and-irrational-fears#face-fears) until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions. ## Medication for panic attacks and panic disorder Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn’t treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder. Medications used may include: Antidepressants. It takes several weeks before [antidepressants](https://www.helpguide.org/mental-health/depression/antidepressant-medication) begin to work, so you have to take them continuously, not just during a panic attack. Benzodiazepines. These are [anti-anxiety drugs](https://www.helpguide.org/mental-health/anxiety/anxiety-medication) that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack can provide rapid relief of symptoms. #### Xanax for panic attacks [Alprazolam](https://medlineplus.gov/druginfo/meds/a684001.html)—often sold under the brand name Xanax—is the most commonly prescribed benzodiazepine. During a panic attack, your nervous system is in a state of hyperactivity. By slowing down your nervous system, Xanax may quickly help put you into a more relaxed state. However, like other benzodiazepines, Xanax for panics attacks can be addictive and is only intended for short-term use. If you take it too often, a physical dependence can develop, meaning you’ll experience withdrawal when you attempt to stop taking it. In addition, overdose can lead to serious issues like confusion, coma, or even death. ## How to help someone having a panic attack Seeing a friend or loved one suffering a panic attack can be frightening. Their breathing may become abnormally fast and shallow, they could become dizzy or light-headed, tremble, sweat, feel nauseous, or think they’re having a heart attack. No matter how irrational you think their panicked response to a situation is, it’s important to remember that the danger seems very real to your loved one. Simply telling them to calm down or minimizing their fear won’t help. But by helping your loved one ride out a panic attack, you can help them feel less fearful of any future attacks. Stay calm yourself. Being calm, understanding, and non-judgmental will help your loved one’s panic subside quicker. Focus your loved one on their breathing. Find a quiet place for your friend to sit and then guide them to take slow, deep breaths for a few minutes. Do something physical. Together, raise and lower your arms or stamp your feet. It can help to burn off some of your loved one’s stress. Get your friend out of their own head by asking them to name five things around them or talking soothingly about a shared interest. Encourage your loved one to seek help. Once the panic attack is over, your loved one may feel embarrassed about having an attack in front of you. Reassure them and encourage them to seek help for their anxiety. #### Hotlines and support [NAMI Helpline](http://www.nami.org/Find-Support/NAMI-HelpLine) – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness) [Find a Therapist](https://findyourtherapist.adaa.org/?gad_source=1&gad_campaignid=21784584429&gbraid=0AAAAADOzZllsIkkYd2B1CzWOBkUt96kkV&gclid=CjwKCAiAnoXNBhAZEiwAnItcG7qf5gHZ2SkBwk650m8mhvG-Tq77XmH5UU8aBdgy7QNwe_CKgP2ZFBoCiwAQAvD_BwE) – Search for anxiety disorder treatment providers in the U.S. (Anxiety Disorders Association of America) [Support Groups](https://adaa.org/find-help/support) – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America) [Anxiety UK](http://www.anxietyuk.org.uk/) – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK) [Anxiety Canada](https://www.anxietycanada.com/articles/recommended-links/) – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada) [SANE Help Centre](https://www.sane.org/get-support) – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia). [Helpline (India)](https://www.vandrevalafoundation.com/) – Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330. (Vandrevala Foundation) ## More Information 1. Taylor, C. B. (2006). Panic disorder. BMJ: British Medical Journal, 332(7547), 951–955. [Link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1444835/) 2. Kunas, S. L., Hilbert, K., Yang, Y., Richter, J., Hamm, A., Wittmann, A., Ströhle, A., Pfleiderer, B., Herrmann, M. J., Lang, T., Lotze, M., Deckert, J., Arolt, V., Wittchen, H.-U., Straube, B., Kircher, T., Gerlach, A. L., & Lueken, U. (2020). The modulating impact of cigarette smoking on brain structure in panic disorder: A voxel-based morphometry study. Social Cognitive and Affective Neuroscience, 15(8), 849–859. [Link](https://doi.org/10.1093/scan/nsaa103) 3. Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues in Clinical Neuroscience, 13(4), 413–421. [Link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/) 4. Tolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review. Clinical Psychology Review, 30(6), 710–720. [Link](https://doi.org/10.1016/j.cpr.2010.05.003) 5. Roberge, P., Marchand, A., Reinharz, D., & Savard, P. (2008). Cognitive-Behavioral Treatment for Panic Disorder With Agoraphobia: A Randomized, Controlled Trial and Cost-Effectiveness Analysis. Behavior Modification, 32(3), 333–351. [Link](https://doi.org/10.1177/0145445507309025) 6. Ougrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: Systematic review and meta-analysis. BMC Psychiatry, 11(1), 200. [Link](https://doi.org/10.1186/1471-244X-11-200) 7. Reinecke, A., Thilo, K. V., Croft, A., & Harmer, C. J. (2018). Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety. Translational Psychiatry, 8(1), 1–9. [Link](https://doi.org/10.1038/s41398-018-0277-5) 8. Craske, M. G., & Stein, M. B. (2016). Anxiety. Lancet (London, England), 388(10063), 3048–3059. [Link](https://doi.org/10.1016/S0140-6736\(16\)30381-6) 9. Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18(1), 559. [Link](https://doi.org/10.1186/s12913-018-3313-5) 10. Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018). Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Current Psychiatry Reports, 20(8), 63. [Link](https://doi.org/10.1007/s11920-018-0923-x) 11. Anxiety Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. [Link](https://doi.org/10.1176/appi.books.9780890425787.x05_Anxiety_Disorders) 12. Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal. Journal of Addiction Medicine, 12(1), 4–10. [Link](https://doi.org/10.1097/ADM.0000000000000350) 13. Alprazolam: MedlinePlus Drug Information. (n.d.). Retrieved November 30, 2023, from [Link](https://medlineplus.gov/druginfo/meds/a684001.html) 14. Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. [Link](https://doi.org/10.1016/j.xcrm.2022.100895) 15. Kircanski, K., Craske, M. G., Epstein, A. M., & Wittchen, H.-U. (2011). Subtypes of Panic Attacks: A Critical Review of the Empirical Literature. FOCUS, 9(3), 389–398. [Link](https://doi.org/10.1176/foc.9.3.foc389) 16. McDonagh, B. (2015). Dare: The New Way to End Anxiety and Stop Panic Attacks. BMD Publishing. [Link](https://www.amazon.com/Dare-Anxiety-Stop-Panic-Attacks/dp/0956596258) 17. Meuret, A. E., Wolitzky-Taylor, K. B., Twohig, M. P., & Craske, M. G. (2012). Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions. Behavior Therapy, 43(2), 271–284. [Link](https://doi.org/10.1016/j.beth.2011.08.002) 18. Night terrors and nightmares—NHS. (n.d.). Retrieved November 30, 2023, from [Link](https://www.nhs.uk/conditions/night-terrors/) 19. Smith, N. S., Albanese, B. J., Schmidt, N. B., & Capron, D. W. (2019). Intolerance of uncertainty and responsibility for harm predict nocturnal panic attacks. Psychiatry Research, 273, 82–88. [Link](https://doi.org/10.1016/j.psychres.2019.01.025) 20. Staner, L. (2003). Sleep and anxiety disorders. Dialogues in Clinical Neuroscience, 5(3), 249–258. [Link](https://pubmed.ncbi.nlm.nih.gov/22033804/) 21. The Medical Minute: Anxiety attack or panic attack? Actually, it can be both—Penn State Health News. (n.d.). Retrieved November 30, 2023, from [Link](https://pennstatehealthnews.org/2023/03/the-medical-minute-anxiety-attack-or-panic-attack-actually-it-can-be-both/)
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