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The Essential Guide to Overcoming Panic Attacks: A Step-by-Step Resource
This is the complete Step-By-Step guide to overcoming panic attacks. Learn what panic attacks are, what causes them, and how to overcome them in this essential resource.
The first panic attack I ever had came out of the blue in one of the most mundane situations – shopping at the grocery store.
It shook me to the core and left an impression of deep fear.
I became consumed by the worry, "Would it happen again?"
Which, of course, it did – spurred on by that fear of it happening again.
But it wasn't just grocery shopping that became an issue – I began having panic attacks in different locations and situations…
Ordinary places and situations, such as driving, shopping, and hanging out with friends, became filled with fear and a strong urge to avoid the situation entirely.
I began having panic attacks nearly every week…
And then I began having panic attacks nearly every day…
When my anxiety and panic were at their worst, I barely left the house unless I absolutely had to.
Until….
I learned how to overcome my panic attacks for good using what I will present in this guide.
This is the guide to overcoming panic attacks – based on my experience through hell and back.
This is the most complete guide out there for understanding panic attacks.
It combines proven strategies and actionable steps you can take right now to overcome your panic attacks, no matter how severe.
This isn't a generic article on CBT, positive thinking, or some "secret technique" discovered in an obscure book.
It's a step-by-step template you can follow to see actual results.
And you don't have to suffer for as long as I did, trying different strategies to overcome your panic.
It simply works based on my own experience suffering through constant panic attacks over a decade – and it's the strategy I've used to help countless others.
And the results are often permanent.
I haven't suffered from a panic attack in nearly 15 years.
So let's jump in with the first step- an essential part of this entire strategy – understanding what panic attacks are and how they work…
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Panic Attack vs Anxiety Attack
A Quick Note on Terminology
You'll often hear the terms "panic attack" or "anxiety attack" used to describe experiences of intense anxiety, fear, scary uncomfortable physical sensations, or other distress.
Quite often, these terms are used interchangeably.
While I won't argue over semantics here – cleaning up this confusion can be helpful.
"Panic Attack" is the term that means the sudden and intense onset of extreme anxiety and fear.
As we will be discussing in this article.
Panic Attack is the correct terminology recognized by the DSM 5 and the medical community.
So what is an "anxiety attack? "
It's a general (mainstream) term that some people use instead of panic attack.
Some people will try to separate the two terms and mention subtle differences.
In reality, "anxiety attack" is not a proper medical term, nor does it define a process entirely different from "panic attack."
Panic attack is the proper term.
Honestly, it doesn't matter what you call it, but to avoid confusion, this article will use the term panic attack.
So, What are Panic Attacks Really?
Panic attacks can be a lot of things.
Scary. Frightening. Uncomfortable. Unexpected.
If you've experienced a panic attack in the past (if you're reading this guide, I'm guessing you have), you may have had any number of intense sensations or thoughts.
You may have felt your heart rapidly pounding…
You might have begun sweating or shaking…
Maybe you felt dizzy or worried you would pass out…
Or you may have panicked at the thought that if it didn't stop, you would lose control and "go crazy."
You may have even believed you were going to die…
If you've had a panic attack, it's probably easy for you to describe the thoughts and sensations you experienced.
If you've had a panic attack, it's probably easy for you to describe the thoughts and sensations you experienced.
Panic attacks feel like having your anxiety turned up to 11
But what are panic attacks really?
The textbook definition of a panic attack is: "A sudden episode of intense fear or anxiety that includes four or more physical symptoms."
Panic attacks typically reach their peak within 10 minutes and subside within 15-20 minutes, but it can feel like a nightmare that lasts much longer.
Although the particular symptoms may differ slightly from person to person, there is a general cluster of symptoms (which we will discuss below) that nearly everyone experiences during a panic attack.
While the experience may feel uncomfortable, scary, or downright dreadful – panic attacks are not dangerous or fatal
Panic attacks aren't dangerous.
I will repeatedly state this fact in this article – and for good reason.
It's an essential part of our step-by-step guide to overcoming panic attacks.
It's also important to understand that these wild, scary thoughts we have during a panic attack (such as "I'm going to have a heart attack") simply aren't true.
The surge of adrenaline and other stress hormones, along with your body's physiological response (rapid heartbeat, sweating, shaking, etc.), make the situation seem much more precarious than it actually is.
Your fearful thoughts become amplified.
Your focus on your inner sensations becomes intensified.
Everything becomes blown out of proportion and exaggerated.
You misinterpret your experience and bodily sensations and work yourself up with fear and worry.
In other words – you panic!
But no matter how scared or bad you feel – it will always pass.
Always.
Common Symptoms of Panic Attacks
The DSM-5 (the diagnostic manual published by the American Psychiatric Association) describes a panic attack as consisting of four or more of the symptoms listed below.
For most people, one or two symptoms will often be the central "focal" point or object of fear, with other symptoms coinciding.
When I would experience panic attacks, my primary fear was the thought of losing control and subsequently going crazy.
During a panic attack, I would also experience dizziness, sweating, and derealization/depersonalization.
For someone else, it could be the fear of a heart attack associated with the physical sensations of a pounding heart and chest pain.
With the fear of a heart attack, there is almost always a deeper underlying fear of dying.
For you, it could be something completely different.
(Please note: while the standard definition of panic attacks only states specific "common" symptoms, there could easily be more unique symptoms that do not strictly align with the DSM-5)
Physical Symptoms
- Pounding Heart or Palpitations
- Shortness of Breath or Feelings of "Smothering"
- Shaking
- Sweating
- Nausea and/or Stomach Pain
- Chest Pain
- Feeling Dizzy or Lightheaded
- Feelings of Choking or a "Lump in the Throat"
- Tingling or Numbness in Various Parts of the Body
Mental/Emotional Symptoms
- "I should be perfect" or "I should be perfect at ____"
- "I'll never get ____"
- "I must have ____ to be happy"
- "I should be more ____"
- "I should do this all on my own" or "I don't need any help"
- "I should stop doing ____"
- "I don't think I can handle ____"
What Really Happens During a Panic Attack?
Most people are already well aware of the symptoms of panic attacks – often having experienced some of them firsthand.
But what is really happening during a panic attack?
When your heart is pounding, your head is spinning, or you feel like you might die?
Where does that smothering feeling come from, that tickle in your throat or that nausea?
What's behind the intense feelings and fearful thoughts?
It all boils down to two major factors:
Your SNS (Sympathetic Nervous System): your SNS provides your body with the strength and energy to fight or flee, otherwise known as the fight-or-flight response, which sets up a cascade of physiological and chemical changes in the body.
And…
Your Thoughts/Interpretations: your thoughts and interpretations about your sensations, feelings, experiences, or even beliefs about your thoughts.
These two factors feed directly into each other and are responsible for the panic cycle (see below for more on the panic cycle).
Either one of these factors can begin the panic process.
You may have a seemingly innocuous thought, such as, "This room is a little too crowded. What if more people come in and there isn't enough air."
These thoughts may spark a flood of stress hormones, gearing you up to panic.
Or…
You may already have an activated SNS due to stress or other reasons and interpret your physical sensations, such as a pounding heart, as something terrible, such as a heart attack.
With just two examples, it's easy to see how these two factors play off each other and how they are at the core of panic.
I'm not going to discuss the physiological changes associated with panic attacks and the fight-or-flight response in great detail here; this guide covers them extensively later on.
Instead, I've provided a chart showing the bodily changes that occur during intense periods of anxiety and panic, the purpose of those changes (they do, in fact, serve a purpose), and possible symptoms and interpretations.
(If you would like to learn more about the processes behind anxiety, panic, and the fight-or-flight response, check out our article "The Guide to How Anxiety Works.”)
Physiological Change
Purpose
Possible Anxiety Symptom
Possible Interpretation
accelerated heart rate and increased blood pressure
increases blood flow and supplies extra energy
pounding heart
"I'm having a heart attack!"
blood flow is diverted away from the digestive system
blood is rerouted to the limbs and muscles
stomach pains/knots or nausea
"I might get sick or throw up!"
more oxygen is taken into the lungs
allows for more oxygen exchange for energy
panic breaths/ lightheadedness
"I can't breathe!" or "I might pass out!"
pupils dilate
allows more light to enter the eye for focused/far vision
tunnel vision
"I'm going crazy!" or "Something is wrong with me!"
the liver produces extra glucose
supplies additional energy
headache/blurred vision/trouble thinking clearly
"I might lose control" or "I might go crazy!"
accelerated heart rate and increased blood pressure
increases blood flow and supplies extra energy
pounding heart
"I'm having a heart attack!"
What Causes Panic Attacks?
Panic attacks, as a whole, are a multi-faceted problem, and the same holds true for the underlying causes of panic attacks.
Unfortunately, this means there isn't one thing we can point to as the underlying cause of panic attacks.
However, certain factors come together to form conditions that make it much more likely to experience panic attacks.
These conditions apply not only to having a panic attack but also if a person continues having panic attacks.
It should be made very clear that having panic attacks doesn't mean you are weak or that you have mental/emotional problems.
It means that your life's environmental, psychological, and chemical/biological conditions create a state in which you are more likely to experience the sudden onset of fear and panic.
Underlying Factors That Can Lead to Panic Attacks
Stress:
- How bad is the stress in your life?
- Are you under a lot of pressure?
- Do you have a lot of responsibilities?
Lifestyle:
- Is your life chaotic, or is it reasonably organized?
- Do you use drugs, stimulants, or other substances?
- How are your relationships?
Coping Strategies:
- How do you deal with the challenges of daily life?
- How do you handle failures or unmet needs?
- How do you cope with panic attacks?
- Are your coping strategies healthy, or are you making it worse for yourself?
Emotional or Mental Sensitivities:
- Would you consider yourself a "sensitive person?"
- Are you easily bothered by loud noises or other external stimuli?
- Do you become flustered by unexpected situations or experiences?
Beliefs:
- What you believe about yourself and the world around you has a huge impact not only on panic and anxiety but on your life in general
Biological Makeup:
- Is there a history of anxiety and/or panic attacks in your family?
- Are you "high-strung," "tightly wound," or constantly "activated?"
- Have you had to deal with mental or physical illnesses?
Personality Traits:
- Would you consider yourself a perfectionist?
- Are you obsessive about things being right or going a certain way?
- Do you tend to focus on the negative or find problems in every situation?
(Further reading: for more on beliefs and their underlying role in anxiety, check out our article "Psychological Causes of Anxiety," and for more on biology and anxiety, check out "Biological Causes of Anxiety").
It's important to understand this relationship between environmental factors (your lifestyle, relationships, etc.), psychological factors (your beliefs, coping strategies, etc.), and chemical/biological factors (your genetics, neurotransmitters, nervous system, etc.).
You don't experience panic attacks because of one area alone. It is always a combination of these factors.
The panic attack itself is a chemical/biological response, and it's very often your interpretation or fear (psychological) of this chemical response that takes you down the path of panic.
And… you don't live in isolation.
Your environment is the number one "trigger" for panic attacks.
Whether it's the environment of your location, the environment of the people you are around, or the environment of your own body.
If you believe (psychological) the street you are walking down (environmental) is dangerous, your body will respond (chemical/biological) to prepare you to defend yourself or flee.
You may interpret (psychological) the physiological changes in your body (chemical/biological) as scary and panic.
Or another example…
If you interpret (psychological) the pounding (chemical/biological) in your chest (environmental) as a heart attack, you may panic.
Situational vs Spontaneous Panic Attacks
Panic attacks are often associated with specific situational triggers (e.g., going to the mall alone) or internal cues that you interpret as dangerous or scary (e.g., chest pain).
For many people, experiencing one of these personal triggers can set up a seemingly automatic response of fear and worry that can lead to a panic attack.
You feel a pain in your chest – you think, "maybe it's a heart attack" – you're off to the races.
One of the most potent situational triggers for many people is where they were when they experienced a panic attack.
There is often a deep fear of it happening again whenever they are in the same location or situation.
The first major panic attack I remember (which was also one of the worst) was during a typical shopping trip at the grocery store as a teenager.
Several minutes after arriving, I went from having mild anxiety to a full-blown panic attack.
My mind was spinning; I was sweating heavily and experienced the situation (the people, the store, the cans on the shelves, my body) as unreal.
I became fixated on the terrifying thought of losing control and going crazy in the middle of the store.
I imagined having a complete breakdown and the police arriving to haul me off to the looney bin.
Everyone in the store, my family and friends, would all talk about how crazy I was, and I would remain in an asylum for the rest of my life.
Good times…
This is an example of what is often referred to as a "spontaneous " panic attack.
It seemed to come out of nowhere, and nothing exceptional about the experience would have triggered the panic
Despite the intensity of the experience and my deep fear of "losing control" and my mind, what actually happened during my shopping trip was much less dramatic.
The intensity of the fear and the sensations eventually mellowed out.
After 10-15 minutes, I was back to normal functioning.
No trip to the looney bin. No "crazy" outbursts.
Nothing other than some heavy sweating, fearful thoughts, and overall discomfort.
Regardless of the reality of the situation (10-15 mins of temporary discomfort), shopping at grocery stores by myself became a situational trigger for me.
For months afterward, I would avoid going to a grocery store alone, or if I did go, I would constantly worry about having another panic attack.
Quite often, I would work myself up and scare myself so badly that I would panic before getting to the store.
This is a prime example of an external situational trigger for panic attacks.
I developed an intense fear of having a panic attack in a specific situation (the grocery store) based on my experience of having one in that situation in the past.
Internal cues can trigger panic attacks just as easily as external cues, if not more so.
Those with health anxiety, a deep-seated fear of death or disease, or a stronger sensitivity to changes in their own body can easily be thrown into a panic by otherwise harmless bodily sensations.
Chest pain turns into "I'm having a heart attack."
Headaches turn into "I have a brain tumor."
In the heat of the moment, they take these thoughts to be true.
And if the sensations intensify (which often happens if you intently focus on sensations with fear), it only further validates the premonition.
All of this being said – the truth is there are no "spontaneous" panic attacks.
The truth is there are no "spontaneous" panic attacks - there are proven observable physiological changes that occur before every panic attack.
Very often, thoughts and fears lurk just under the surface that you may not have been aware of at the time.
Being under extreme pressure for long periods or denying and suppressing emotions are two good examples of scenarios that can eventually lead to "spontaneous" panic attacks.
Ultimately, there is no natural way to run from ourselves – everything catches up to us eventually.
But that is a discussion for another article…
Whether a panic attack seems to come out of the blue or you believe it is "caused" by some trigger, the process for overcoming the panic is the same.
Risk Factors for Panic Attacks & Panic Disorder
It's estimated that somewhere between 40%-50% of the population will experience at least one panic attack in their life.
Constant stress and the pressures of modern living, medical conditions, the excessive use/abuse of stimulants, and other common factors can play a role in whether or not someone experiences a panic attack.
That being said, some people will struggle with panic attacks much more than just once or twice in their lives.
You may be someone who has panic attacks several times per month, several times per week, or even daily.
Panic disorder is a term used to classify those who frequently experience panic attacks.
When my anxiety was at its worst, I would experience panic attacks nearly every day.
Often, these panic attacks occurred in the most mundane situations, such as going to the mall or getting a haircut.
Sometimes, just leaving the house would put me in a panic.
So, what are some factors that can increase the likelihood of developing a panic disorder?
- Genetics: family history of panic attacks or other mental health issues
- Trauma: childhood trauma, physical abuse, sexual abuse, PTSD
- Significant Stress or Life Changes: new financial difficulties, death of a loved one, a major illness, new or extensive responsibilities such as the birth of a child
- Chemical Imbalance: excessive or deficient availability of critical neurotransmitters in the brain (often caused by trauma, stress, illness, drug/medication use, or genetics) has been linked to panic attacks
These risk factors do not mean you are doomed to anxiety or panic attacks. They are simply markers that may increase your susceptibility to panic attacks.
If you have dealt with one or more of the above, you may have to take extra steps to ensure your mental and emotional health.
This can include talking with a therapist, eating healthy, or developing a daily practice.
(Our website has in-depth guides for proven techniques, such as meditation, relaxation, and EFT)
The Panic Cycle
One of the most important concepts (if not the most important) for understanding and overcoming panic attacks is the concept of the Panic Cycle.
If you truly understand the panic cycle and can truly break the cycle of fear and panic – you will free yourself from the grip of panic attacks.
That is why I have provided its own section here. It's that important.
So, what is the panic cycle?
It is a 3 step process that feeds itself:
You experience a panic attack
You develop fear around the experience of the panic attack (the sensations, location, related thoughts, etc.)
You work yourself into a panic attack through your fear of the panic attack occurring again
It is a vicious circle run by fear.
You experience a panic attack, which jars and frightens you.
The experience can be so intense, scary, embarrassing, or uncomfortable that you worry about it happening again.
You may avoid the situation, avoid where it occurred, or feel extreme anxiety when you are in the same situation again.
You might fear a specific aspect of the panic attack, such as a pounding heart, and you work yourself into a panic when you think about it.
Or you panic from worrying about panicking.
In this way, you create a panic cycle.
Your fear of having a panic attack actually causes a panic attack, which reinforces the fear and on and on…
As I mentioned, by truly understanding how the panic cycle works and breaking free from fear, you can overcome panic attacks for good.
Fear is the "linchpin."
Remove the linchpin of fear, and the whole panic system falls apart.
Step-by-Step Plan for Overcoming Panic Attacks
Now, it's time to lay out the step-by-step plan.
The plan outlined below is what to do and what not to do to overcome panic attacks.
These strategies weren't just pulled out of thin air – these are the exact strategies I used to end my panic attacks permanently in less than a few weeks.
The individual strategies can be found in different forms of therapy, but the overall plan is one I have established after years of suffering from panic attacks combined with years of trial and error.
This plan has helped many people worldwide, and I know it can help you too!
Lesson 1: What You Can Do Right Now
Develop an Understanding of Panic Attacks
One of the most powerful things you can do to free yourself from panic attacks is first understanding them.
By understanding panic attacks, you can significantly reduce the fear surrounding them and eliminate the fearful thoughts you add to the experience.
These fear-based thoughts always make the experience so much worse.
Instead of thinking, "I'm having a heart attack," you will know, "It's just fear; my body is releasing adrenaline, and my heart is beating harder than usual."
Knowing what happens during a panic attack can help reduce or eliminate your fear of the physical sensations.
When you can eliminate the fear through better understanding, you can short-circuit the fear response by not adding your fearful thoughts to the experience.
Fear drives the panic.
We always fear what we don't understand.
Through understanding, you can significantly reduce the fear and rein in the panic response.
Knowledge is power!
(For more on understanding how anxiety works and the processes behind anxiety in general, check out our in-depth guide HERE.)
Eliminate Possible Dietary & Lifestyle Triggers
What you put into your body directly affects your brain and nervous system.
The intense physical and mental effects of a panic attack can be instigated or made worse by certain dietary and lifestyle factors.
When you cut out these "triggers" and make positive changes in your life, you can greatly reduce the severity and frequency of panic attacks and even eliminate them entirely.
One of the most significant contributors to panic attacks in a diet is the excessive consumption of caffeine and other stimulants such as energy supplements.
Reducing or eliminating your intake of caffeine and stimulants can reduce the number and/or severity of panic attacks.
In recent years, a scientific link has been developed between gut health and brain/emotional health.
Food allergens such as gluten can cause an autoimmune response in the body that can cause an imbalance in brain chemicals as well as chronic inflammation – which can lead to feelings of anxiety and the potential for panic attacks.
Certain digestive and GI disorders can increase the likelihood of experiencing these adverse effects.
Legal and illegal drugs that affect the brain and nervous system can contribute to panic attacks – either through their excessive use or the result of discontinuation.
Marijuana, for example, has been known to reduce anxiety in some people, but for others, it can give rise to extreme anxiety and panic.
The use of powerful drugs like amphetamines and cocaine can cause panic attacks. As well as the withdrawals that come with stopping the use of drugs such as alcohol and opiates.
The discontinuation of a daily medication like an SSRI (Zoloft, Prozac, Lexapro, etc.) or a Benzodiazepine med (Xanax, Klonopin, etc.) can lead to panic attacks and overall increased anxiety.
Just as important as dietary triggers, lifestyle triggers or stressors can wreak havoc on a person's mental and emotional health, leading to anxiety and panic attacks.
There are seemingly infinite life stressors, but nearly all fall under 4 major areas of life: Career/Money, Love/Relationships, Leisure/Free Time, and Deeper Meaning/Purpose.
Having too much stress and/or not enough time to dedicate to or low-quality experiences in any of these significant areas tends to lead to anxiety and suffering for most people.
While it's easy to put lip service to making "life changes," it can be much more complicated than that.
In many instances, such as quitting a stressful job you hate or getting out of an abusive relationship – having a plan or seeking the help of others is often necessary and may involve many different factors.
Regardless, you can take action (even if it's the smallest) to make the necessary changes in your life.
Whenever and wherever possible, reducing negative stressors can help significantly reduce anxiety and feelings of panic.
Eliminating caffeine was the very first step I took to overcome my panic attacks in my late teen years.
I consumed several cups of coffee in the morning and then multiple Mountain Dews throughout the day.
By eliminating caffeine, I greatly reduced the number of panic attacks I experienced.
But I love coffee… I drink a cup nearly every morning and have done so for the past few years; however, I keep it in moderation.
By shoring up other areas of my diet and lifestyle and practicing the strategies I mention in this article, panic attacks haven't been an issue for me for well over a decade – even with a daily dose of caffeine.
It should be noted, however, that many people are extremely sensitive to caffeine, and even a small amount can cause feelings of anxiety.
In fact, caffeine and other stimulants are such significant instigators of panic attacks in many people it's usually one of the first things I recommend changing to reduce the number and severity of panic attacks.
While reducing or eliminating caffeine and other stimulants may not "cure" your panic attacks completely, if you consume a lot daily, I can almost guarantee that cutting back will reduce the intensity of the panic.
Start a Daily Practice
Starting a daily practice is a vitally important strategy for developing the ability to face the storm without being carried away by it.
A daily practice could be a meditation or mindfulness practice.
You could take time daily for deep relaxation or practice techniques such as Qi-Gong, Tai-Chi, or EFT.
Or you could practice something like deep breathing throughout the day.
An effective daily practice is any practice you perform each day that allows you to turn your attention inward and moves you toward achieving conscious relaxation, greater awareness, and/or letting go of mental and emotional patterns
Having a daily practice is an essential step to overcoming panic attacks and reducing anxiety.
When you take an active role in your mental and emotional health, you become less pulled away by your uncontrollable fight-or-flight reactions.
You become less of a victim of your internal and external experiences.
As you continue to practice techniques such as conscious deep breathing, you develop the internal resources to handle the inevitable storms of daily life.
Having a daily practice also improves your ability to calm down, relax, and consciously activate the parasympathetic nervous system while calming the sympathetic stress response.
(For more on daily practices and techniques, you can start right now by checking out our guides on Meditation, Relaxation, or EFT.)
Lesson 2: What Not to Do in Your Daily Life
Avoid Situations That Cause Panic Attacks
It seems natural to want to avoid the things that cause pain or discomfort.
Panic attacks rank as some of the most uncomfortable experiences many people will have.
But the problem with avoidance is that you reinforce the fear by avoiding the situations that "cause" panic attacks (i.e., going to the grocery store, making a speech, going to the doctor or dentist, facing a phobia, etc.).
When you avoid situations and reinforce the fear, you make the fear stronger, make it more real, and see the situation as a valid threat to your personal safety.
The more situations you associate with your panic attacks and the more you avoid these situations, the smaller your world becomes and the greater your overall fear and anxiety.
While there is no denying that panic attacks are uncomfortable (I have yet to meet anyone who finds panic attacks enjoyable), they are essentially harmless.
This concept of panic attacks being harmless is something I will repeat many times in this article – it's crucial to understand to free yourself from panic attacks.
When you stop avoiding the situations and fully face the discomfort, you loosen the fear and expand your life.
Lesson 3: What to Do at the Onset of a Panic Attack
Breathe
As you begin to feel yourself moving into panic, normalize your breathing.
Or
If the fear and panic occur suddenly and you are already in the middle of a panic attack, move your attention to your breathing and slow your breathing.
In other words, breathe calmly at an even pace.
Not gasping, hyperventilating, super deep breaths, or quick shallow breaths.
Normal, even breaths.
There are two reasons for this simple suggestion.
- 1. Most people take shallow and/or rapid panic breaths when they are experiencing a panic attack. This often leads to feelings of hyperventilation, dizziness or lightheadedness, and an increased heart rate. It can also cause thoughts to become more chaotic. If you can remember to normalize your breathing, you can reduce these feelings and often "short circuit" the panic response or at least shorten it.
- 2. It's a simple focal point. Trying to perform some complex sequence of techniques to "get rid of" a panic attack rarely works (see below). It's also challenging to do much of anything when you're in the middle of a severe panic attack. So trying to do some fancy technique while your mind is filled with fear and your heart racing is not only difficult but can be counter-productive. The breath is always there, making it the perfect focus point as you breathe through the discomfort.
Breathing is simple, straightforward, and natural.
When you are approaching panic, notice the breath and keep your breathing calm and even.
Accept, face, and breathe through it when you are in the midst of it.
If you can keep your breathing smooth, calm, and evenly paced before you go into a full-blown panic attack, you can often avoid it altogether.
Ground Yourself
Panic attacks are instigated and made worse by your misinterpretations, imagination, and fear-based beliefs – in other words, your thinking.
Rather than going down the rabbit hole of fearful thoughts and catastrophic imaginings – leave your thoughts alone.
Instead, ground yourself…
Bring your awareness to what you're actually experiencing instead of your interpretations of what is happening
Instead of imagining what will happen – what do you see happening with your own two eyes?
Instead of interpreting that pounding heart as a heart attack – feel what it actually feels like as it is happening.
Use your senses to bring yourself out of your fearful thoughts and into the present moment.
What do you see?
What can you hear?
What do you smell?
What do you feel?
You can use the breath mentioned above to help you with grounding.
I personally found the grounding technique to be a game-changer.
As someone whose primary panic-induced fear was the fear of going crazy, grounding techniques helped to pull me out of the spiral of fearful thoughts and the disconnect from reality I had created.
Breathing and grounding can help immensely with overcoming panic attacks as you are pulled less and less into the eye of the storm.
Remain centered, remain calm, and remain grounded!
Lesson 4: What to Do During a Panic Attack
Accept What You Are Feeling and Face the Fear & Discomfort
Whenever you resist or fight your feelings of panic (or anything for that matter), you inevitably make the situation worse and the feelings more intense.
This means you must accept your experience and face the fear and discomfort.
This means not running, avoiding, changing, or distracting yourself.
This also means not numbing through the use of "crutches" such as alcohol, drugs, certain medications (such as Xanax), or anything else that may reduce the feelings of fear and/or discomfort.
As many therapists are known to say – "become comfortable with the discomfort. "
If you have a strong aversion or fear of discomfort, you will probably find yourself running from situations that make you feel uncomfortable.
We all seek safety.
We all seek comfort.
To truly overcome panic attacks for good, you have to face the intense feelings and come out the other side – no longer afraid.
You have to see that although panic attacks can be extremely intense and uncomfortable, they are only temporary discomfort.
You won't die. You won't go crazy.
You may not believe me.
Ask yourself this:
Have you actually gone crazy from a panic attack?
Have you actually died from a panic attack?
Unless you're reading this from the loony bin or beyond the grave, you answered no to both questions.
So trust me… the worst that we imagine in the grips of panic almost never actually occurs, and as bad as it feels, panic attacks always end.
You may feel rattled for a bit afterward or sleepy or a little anxious – but you will be fine.
Once the fear of panic attacks and the internal and external fears that surround them are gone, you will be genuinely free from panic attacks for good.
Lesson 5: What Not to Do During a Panic Attack
Try to Change or Get Rid of It
One of the biggest mistakes most people make when they experience a panic attack is trying to change or get rid of it.
They resist it. They fight it. They try to ignore it. They run away from it.
They try some techniques they learned to reduce the sensations.
Or they take medication to blunt the feelings.
It seems logical to want to get rid of a panic attack.
For example, experiencing a panic attack right before a presentation is not only frightening and uncomfortable but can (understandably) interfere with your performance.
Wanting to get rid of the panic attack or at least calm yourself down makes complete sense.
However, by trying to force the panic away or resisting the feelings, you actually make the experience worse.
Anything you resist persists and is often made more intense by your resistance.
When you try to force the feelings/experience away, and it doesn't work, you try harder and harder, inevitably increasing the panic.
This leads to our next "don't…"
Add Anything to the Experience
The fight-or-flight response underlying the panic response happens mostly unconsciously.
This means the bodily sensations you experience during a panic attack: rapid heart rate, sweating, shaking, etc., happen outside your conscious control.
When you are in the middle of a full-blown panic attack and adrenaline and other stress hormones are coursing through your body, there isn't much you can do to stop the physical sensations – other than breathe and wait for it to pass.
One of the big mistakes people often make is adding fear-based interpretations to the experience
You add fear to the fear response.
You add anxiety to your feelings of anxiety.
You are responding to unconscious responses with conscious fear.
When you experience a panic attack, it is essential not to add anything to the experience.
Let the heavy beating of the heart be what it is instead of interpreting it as a heart attack.
This is where understanding panic attacks (mentioned above) comes into play and is extremely important.
When you understand the bodily processes involved in panic attacks, you can begin to experience the intense feelings and sensations without irrational interpretations.
This also includes not trying to rationally understand what is happening or trying to force the experience to change or end.
Without your fearful interpretations, you may find that the panic attack comes and goes much more quickly with less suffering involved as you aren't prolonging the experience with your added fears or resistances.
This is also where the technique of grounding (discussed above) comes into play.
You experience your feelings as they arise in the present moment - without interpretation.
When you get good at grounding yourself, you can experience the intensity of the panic attack without the fear and suffering, almost like riding a wave.
The feelings and sensations arise and fall away.
As mentioned several times, without the attachment of fear to the sensations, the panic attacks will quickly dissipate.
Lesson 6: What to Do After a Panic Attack
Assess and Record Your Experience
After a panic attack, it can be beneficial to write down precisely what you experienced.
This can be done in a notebook or journal where you can keep a written log.
Something like:
"I felt extremely nervous and shaky before Tim came to pick me up for our first date. Suddenly, I felt nauseous, and the room started to spin. I worried I would throw up and pass out before he got here, and he would find me on the floor, thinking I was some freak. This went on for 10 minutes or so and was extremely intense, but then slowly went away. It was completely gone by the time Tim got here, although I still felt anxious. I never passed out or threw up."
Very often, our idea of a panic attack or our irrational added fears makes it seem much worse than it really is or will be.
By accurately accessing what happened and writing it down, you can look back and see that no matter how bad you think things will be, it never happens the way you fear.
I had panic attacks nearly every day in my late teens and early twenties, with the constant reoccurring panic that I would "go crazy."
I've had that particular fear dozens and dozens of times in the middle of extreme panic.
The number of times my fear came true, and I went crazy?
Zero.
But I kept having the thought during panic attacks.
It wasn't until I began to keep a log of my panic attacks that I began to see how ridiculous the fear was and how, no matter how many times I "knew" this was the time it would happen – it never did.
Give Yourself Compassion and Respect For Facing Your Fears
Facing your fears and panic attacks head-on is hard and takes a certain degree of courage and self-control.
The average/comfortable response is to run away – to avoid the situations that cause panic in the first place and to live "safe" lives.
But as I've mentioned, this only works in the short run.
Eventually, you will need to face your experience.
The alternative is your world becoming smaller and smaller, controlled by fear.
You should give yourself compassion and respect for taking the steps to face your fears and overcome panic attacks. It's not always easy. It's not always comfortable. And it can be frightening.
Reward yourself for taking action.
Pat yourself on the back.
Raise your chest in pride and confidence.
Soothe and comfort yourself.
As someone who struggled with severe panic attacks, I know how hard it can be, and I have tremendous respect for you for taking the necessary steps and facing the discomfort.
You should hold the same respect for yourself for doing what it takes.
You are one step closer to freedom.
What if the Panic Attacks Are Just Too Much?
For some, the experience of panic attacks may be too intense, especially if they occur frequently (such as several times per week).
I sincerely encourage you to face the discomfort and the fear with the knowledge that there is nothing life-threatening about having a panic attack – no matter how intense or scary it feels or what your fearful thoughts tell you.
Being okay with the discomfort and learning to withdraw the fear surrounding panic attacks is key to becoming free from them forever…
That being said, sometimes it is just too much for some people.
If you're too frazzled by fear to function or suffer from panic attacks daily, other causes may be to blame – such as a chemical imbalance or other underlying health issues.
If this is your experience, it may be best to speak with your doctor about ruling out any potential biological causes of your panic attacks (such as getting your thyroid checked).
Medications (such as SSRIs and Beta-Blockers) are valid and potentially helpful options to help manage panic attacks until you can better practice the step-by-step plan outlined above.
There's no shame in taking medication for panic attacks.
Although some people look down on medications such as antidepressants, if you are experiencing crippling panic attacks that have taken over your ability to live your life, these types of meds may be able to help.
(For a deep dive into medications for panic attacks and anxiety, including medications to avoid, you can check out our article here…)
Ultimately, there will come a time when you will have to feel the discomfort fully and face the fear without a "crutch" of any kind to truly overcome panic attacks.
Facing your panic without numbing or distracting yourself is the only way to truly become free of panic attacks for good.
Step-by-Step Outline for Overcoming Panic Attacks
What You Can Do Right Now
- Understand What Panic Attacks Are and How They Work
- Eliminate Dietary/Lifestyle Triggers
- Start A Daily Practice
What Not to Do in Your Daily Life
- Avoid Situations that Cause You to Have Panic Attacks
What to Do at the Onset of a Panic Attack
- Breathe
- Ground Yourself
What to Do During a Panic Attack
- Face the Fear and Discomfort
- Accept What Your Are Experiencing Without Adding Your Interpretations to It
What to Do After a Panic Attack
- Assess and Record Your Experience
- Give Yourself Compassion and Respect For Facing Your Fear
Final Thoughts
When my panic attacks were at their absolute worst, I believed I would never get back to normal.
As bad as my anxiety was at the time, having panic attacks on an almost daily basis on top of it genuinely disrupted my life.
If you're in a similar place as I was, I know the strategies in this guide can help you overcome panic attacks.
I have written and presented this guide with the utmost sincerity – with the intent of helping you get back to normal, as I did.
This is how you develop permanent freedom from panic attacks.
I did it.
I know that you can, too.
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