Panic attack symptoms, triggers and how to calm down

CIf you've ever had a panic attack you'll know how scary it can be. If you haven't, it helps to be aware of panic attack symptoms and how manage them.

Every year in England, 1 in 4 of us will suffer from a mental health problem. Conditions can range from stress or depression, to debilitating phobias, to panic and anxiety. In fact, according to mental health charity Mind, every week 6 in 100 people are diagnosed with generalised anxiety disorder (GAD) and around 1 in 100 with a panic disorder.

A panic attack can be incredibly frightening. Ironically, though, it's a sign that your body is acting as it should – at first, anyway. “A panic attack happens when your body triggers the ‘fight-or-flight’ response, where you experience symptoms that are essentially trying to ‘pump up’ your body into action," explains psychological wellbeing practitioner Holly Thurston. "This is a normal response to a fearful situation. However, sometimes this response is triggered when there’s no real threat.”

There is a wide range of panic attack symptoms, some of which can be very alarming. It's not uncommon, for example, for people to believe they are having a heart attack or that they are dying. What's more, just the thought of having one can trigger one, so it can be a difficult cycle to break.

"Panic attacks can be maintained by worrying about what symptoms mean," continues Holly. "If we worry about the dangers of our symptoms this will make us feel anxious, and when we feel more anxious these symptoms appear or become stronger. We are hyperaware of these symptoms and so we think that there must be something really wrong with us. In turn, we worry more," she explains.

The good news is that if you recognise panic attack symptoms, you can avoid known triggers or – if one occurs – use tried-and-tested ways to calm down. Not only is educating yourself an act of self-care, you’ll be able to help other sufferers.

What is a panic attack?

A panic attack is an extreme response to either a real or imagined fear. Symptoms can affect us physically, mentally or emotionally.

"Panic attacks are a rush of intense psychological, behavioural and physical symptoms – an exaggeration of the body’s normal ‘fight or flight’ reaction," reiterates Dave Smithson, operations director at Anxiety UK. "This is often a sudden period of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something bad is going to happen."

Panic attacks can feel impossible to escape from, but there are ways to minimise them. They rarely last long and are not dangerous – although it can be hard to believe this when you're in the midst of one. "Panic attacks usually last between 5-20 minutes," says Mind's head of content Kerry McLeod. "Some people have one then don't ever experience another, whilst others will experience them regularly, or have several in a short space of time."

Panic attack symptoms

These are some common symptoms of a panic attack. Whether mental or physical, these symptoms can have a negative effect on our emotional wellbeing.

Physical: 

• Breathlessness and/or rapid breathing
• Chest and/or stomach pain
• Faster heart rate/palpitations
• Feeling faint or dizzy
• Feeling very hot or cold
• Ringing in the ears
• Nausea
• Numbness
• Shaking
• Sweating

Mental: 

• A feeling that something bad will happen
• Having a desperate need to escape
• Intense fear
• Losing sense of reality
• Thinking you might die
• Worrying you're having a heart attack

Panic attack symptoms vs heart attack symptoms

It's not unusual to think that the symptoms of a panic attack are, in fact, the same as having a heart attack. There are similarities, such as chest pain, rapid heartbeat and sweating, but there are also marked differences.

"One difference between a panic attack and a heart attack is that heart attacks frequently begin during physical exertion, such as walking up stairs or running," says Holly, who works for livelife, a UK social enterprise providing affordable, NHS-quality online therapy. "However, panic attacks can occur when we're resting or not doing anything."

The length of time of the attack also matters. "Panic attacks get better and are usually over within 20 minutes," she explains. "Whereas a heart attack would last longer and get worse over time."

It's also rare to faint during a panic attack, while a loss of consciousness is common with heart attacks, she adds. "And seek medical attention if you experience intense chest pain that lasts longer than a couple of minutes, or chest pain that spreads to the jaw or shoulders," she says.

If you are unsure always call 111 for urgent medical advice, or 999 for an ambulance.

How do you calm a panic attack?

In the lead-up to, or during a panic attack, you may struggle to believe that there are ways to calm yourself down. However, there are some excellent techniques for managing panic attack symptoms and for shortening an attack, as well as ways to prevent attacks.

Ways to manage a panic attack

• Breathe deeply and slowly. Breathing exercises can be a very effective way of reducing stress and anxiety. "It's good to find a breathing technique that you like, such as ‘box breathing’," says Holly. "This involves closing your eyes, breathing in through your nose and using stomach breathing (your stomach should rise instead of your chest) while counting slowly to four, holding your breath while counting slowly to four, then slowly exhaling for four seconds. Repeat these steps around three times." For more advice on how to breath to manage your emotions, read Stuart Sandeman's book Breathe In, Breathe Out (HQ, £16.99 from Waterstones).
• Stamp on the spot. As well as being a distraction, "some people find this helps control their breathing," says Kerry.
• Focus on something structured and repetitive. Counting out loud is useful. Or repeat a mantra over and over, such as 'I am okay, I am safe, I can get through this moment.'
• Imagine a peaceful setting. Picturing your happy place – a beach or meadow, for instance – or remembering a moment when you felt safe, such as hugging your mum, can boost feelings of wellbeing.
• Focus on your senses. Kerry recommends sucking a sweet or chewing gum, or cuddling something soft. You could also try aromatherapy. For instance, applying Tisserand's Total De-Stress Pulse Point Roller Ball (£6.41, Amazon) to your pulse points and inhaling the scent can reduce anxiety.
• Try not to fight it. This may seem counterintuitive, but knowing that a panic attack can't harm you and that it will be over soon can help you gain control of the situation. "Acknowledge and accept that you are having a panic attack. Remember that it will pass," says Kerry 

Ways to prevent a panic attack

• Practise mindfulness and meditation. If you are less stressed in your day-to-day life you are in a stronger position to cope with anxiety-inducing moments or situations. Mindfulness and meditation are natural ways to relieve stress that can ground you and help you face your fears. A 2020 study found that daily mindfulness training can actually make it easier for us to forget our fears. "These are a great way to remain calm and present, and not to be controlled by fears and worries," says Dave.
• Start talking. Therapy can help you recognise and manage the feelings that lead to panic, as well as help you understand any unhelpful thoughts that perpetuate your anxiety. You could try counselling, cognitive behavioural therapy or psychotherapy. Speak to your doctor for a referral or visit a mental health charity website for information. "Anxiety UK has a national team of talking therapy practitioners that offer therapies such as counselling , CBT, CFT, and clinical hypnotherapy," advises Dave.
• Keep a diary. Kerry suggests noting down difficult thoughts or feelings. "This might help get them out of your head and make them feel less overwhelming. You can then reflect on them when you feel calmer," she says.
• Avoid stimulants. Alcohol, caffeine, smoking and street drugs can all raise our heart rate and trigger a panic attack. If you're prone to panic, or are more stressed that unusual, avoid these.
• Take regular exercise. It's well-documented that exercising releases endorphins and reduces stress. One study found that regular exercise reduced anxiety by 20%. Even a daily 20 minute walk or a quick run can make a difference to mood.
• Try exposure therapy. While it's important to use techniques such as breathing to manage anxiety, in the long-term it's possible to become too reliant on these 'safety behaviours' and hide behind them, rather than treating the cause of the panic. To get to the root of the issue, Holly suggests exposure therapy. "It's helpful to expose ourselves to situations that make us feel anxious, and to remain in those situations without escaping them or using safety behaviours. Over time, the anxious feelings will naturally start to decline," she says. To do this, start small and work your way up. "For example, if you experience panic in shopping centres, then your first goal might be to go to a shopping centre at a quieter time of day, with a friend or family member for support, and stay in the situation until the anxiety subsides. Then, slowly increase your exposure," she suggests.
• Consider medication. If your feelings of panic are particularly severe, your doctor may suggest medication such as anti-depressants or betablockers. Because of the addictive nature of tranquilisers, these are increasingly only offered in extreme cases, and only for a short period.

It also helps to treat yourself kindly afterwards. “Following a panic attack, it’s important to pay attention to what your body needs," says Kerry. "For example, consider practising self-care such as finding somewhere quiet to rest, or eat or drink something."

You can also benefit from telling someone close to you what happened, what your symptoms were, and what helped, so they can support you in the event of another attack, says Kerry.

What can trigger a panic attack?

The most commonly known panic attack trigger is stress – such as a job interview or bereavement – or a threat to our wellbeing, such as experiencing a traumatic event. There are physiological reasons too, such as a lack of sleep, having a genetic predispostion, or the menopause.

Common panic attack triggers:

• Stress. This can be caused by a job interview, job loss, exams, a relationship break-up, bereavment, or moving house.
• Shock. This could be because you were in – or witnessed – an accident. Or you were the victim of a crime, experienced trauma, or received bad news.
• Menopause. Hormonal fluctuations – and in particular low oestrogen – can trigger anxiousness and panic. Indeed,  a 2020 study found that 58% of women aged 44-55 years suffered from anxiety. Hormone replacement therapy (HRT) can keep anxiety at bay, as well as manage the 'embarrassing' symptoms that can trigger panic. "Women may start to panic when experiencing hot flushes in social situations, due to distressing physical sensations," says Holly.
• A lack of sleep. Research indicates that sleep therapy can benefit people who suffer from anxiety or panic attacks.
• A genetic predisposition to anxiety disorders. There can be a biological cause for people's anxiety, which may be treated with medication and/or therapy.
• Sometimes there is no obvious trigger or reason for a panic attack. If this is the case, managing symptoms is the best course of action.

Panic attack vs anxiety attack

Panic attack vs anxiety attack are two interchangeable terms. Often, people will use them to mean the same thing, although some health practictioners believe that there are differences.

"Panic attacks and anxiety attacks share similarities, but they are two different things," says Holly. "The main difference is that an anxiety attack is triggered by a current stressor or event, such as an exam or presentation, whereas panic attacks can be unpredictable and often appear to come out of the blue with the particular stressor unknown," she explains.

"Whereas anxiety is an emotion often described as a general sense of dread or fear, a panic attack is usually characterised as an episode of sharp, intense anxiety where extreme physiological and psychological symptoms are experienced," adds Dave. "It's also often described as a sudden rush or spike of intense anxiety."

When to see a doctor about panic attack symptoms

Sometimes, a panic attack is an isolated incident, but as panic attack symptoms can be frightening seeing a doctor can be very reassuring. A health professional can check that you don't have any underlying health conditions, then offer advice and support on how to manage any future panic attacks.

"In general, if you're having frequent panic attacks then it's important to see your doctor," says Holly. You may have a panic disorder, which requires treatment. "You should especially contact your doctor when your panic starts to interfere with your daily life," she says. "For example, if you change your behaviour to try to prevent a panic attack. Examples include not going out alone or taking time to plan your escape route. Or, if you start to avoid certain situations due to worrying about having a panic attack there."

A doctor or therapist is usually your best option, but some people feel uncomfortable talking about their mental health. If this sounds like you, Mind's article on seeking help for a mental health problem is really useful. You can also contact Anxiety UK or call their helpline (03444 775 774) for advice.

For more advice, visit:

• Mind's useful contacts for anxiety and panic
• Mental Health Org
• Anxiety Care UK