The Essential Guide to Overcoming Panic Attacks: A Step by Step Resource
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The first panic attack I ever had came out of the blue in one of the most mundane of 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 exact 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 in different situations…
Previously normal places and situations, such as going to work, seeing friends or even getting in a car, 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 own 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 some generic article on CBT, nor is it positive thinking or some “secret technique” discovered in an obscure book somewhere.
It's a step by step template you can follow to see real results.
And you don't have to suffer for as long as I did, trying different strategies to overcome your panic.
It's simply what works based on my own experience suffering through constant panic attacks over the course of a decade – and it's the strategy I've used to help countless others.
To date, I haven't suffered from a panic attack in nearly 15 years.
So let's jump in with the very first step, which is 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'm not going to argue over semantics here – cleaning up this confusion can be helpful for many people.
To be clear and straight to the point:
“Panic Attack” is the term which 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 simply a general (mainstream) term that some people use instead of panic attack.
That's it.
Some people will try to separate the two terms and mention subtle differences between them.
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 choose to call it, but for this article we will simply be using the term panic attack to avoid any confusion.
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.
Panic attacks feel like having your anxiety turned up to 11
But what are panic attacks really?
The basic textbook definition of a panic attack is: “A sudden episode of intense fear or anxiety that includes 4 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.
The particular symptoms may differ slightly from person to person but 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 – the particular symptoms are not dangerous or fatal.
It's important to fully comprehend this point…
Panic attacks aren't dangerous
I will state this fact many times 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 our body's physiological response (rapid heartbeat, sweating, shaking, etc.) makes the situation seem much more precarious than it actually is.
Our fearful thoughts become amplified.
Our focus on our inner sensations becomes intensified.
Everything becomes blown out of proportion and exaggerated.
We misinterpret our experience and bodily sensations and work ourselves up with fear and worry.
In other words – we panic!
But no matter how scared you are or how 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 4 or more of the symptoms listed below.
For most people, one or two symptoms will often be the major “focal” point or object of fear with other symptoms occurring simultaneously.
When I would experience panic attacks, my major fear was the thought of losing control and subsequently going crazy.
I would also experience dizziness, sweating and derealization/depersonalization during a panic attack.
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
- Fear of “Losing Control”
- Fear of “Going Crazy”
- Fear of Passing Out or Fainting
- Derealization: feelings of unreality towards the external world (surroundings, objects or people may seem unreal)
- Depersonalization – feelings of unreality or detachment towards oneself (thoughts and feelings may seem unreal or not belonging to one's self)
- Fear of Dying
- Fear of Having a Heart Attack
- Intense Emotions or Disjointed Emotional State
What Really Happens During A Panic Attack?
Most of us are already well aware of the symptoms of panic attacks – often having experienced some of them first hand.
But what is really happening in the midst of 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 or 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:
Our SNS (Sympathetic Nervous System): which provides the 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…
Our Thoughts/Interpretations: our thoughts and interpretations about our sensations, feelings, experience, or even thoughts about our thoughts.
These 2 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.
We 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,” that may spark the flood of stress hormones, gearing us up to panic.
Or…
We may already have an activated SNS due to stress or other reasons and interpret our 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 go too in-depth here on the physiological changes associated with panic attacks and the fight-or-flight response, this guide is in-depth and extensive as it is.
Instead, I've provided a chart showing the changes that occur in the body during intense periods of anxiety and panic along with the purpose those changes serve (they do in fact serve a purpose), as well as possible symptoms and interpretations.
Physiological Change
accelerated heart rate and increased blood pressure
Purpose
increases blood flow and supplies extra energy
Possible Anxiety Symptom
pounding heart
Possible Interpretations
“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!”
(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”)
What Causes Panic Attacks?
Panic attacks are a many-faceted problem and the same holds true for the causes of panic attacks.
This means there isn't one single thing that we can point to as the underlying cause of panic attacks, unfortunately.
There are however certain factors that come together to form conditions that set us up to be more likely to experience panic attacks.
And not only if we just have a panic attack, but if we continue 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 simply means that the environmental, psychological and chemical/biological conditions in you and in your life create a state 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 a chaotic mess or is it fairly tame?
Do you use drugs, stimulants or other substances?
How are your relationships? -
COPING STRATEGIES (or lack thereof)
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 stimulus?
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 for 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 or "anal" 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 checkout our article “Psychological Causes of Anxiety,” for more on biology and anxiety check out “Biological Causes of Anxiety”).
It's important to understand this relationship between the environmental (your lifestyle, relationships, etc.), psychological (your beliefs, coping strategies, etc.) and the chemical/biological (your genetics, neurotransmitters, nervous system, etc.).
We don't experience panic attacks because of one area alone. It always a combination of these factors.
The panic attack itself is a chemical/biological response and it's very often our interpretation or fear (psychological) of this chemical response that takes us down the path of panic.
And… we don't live in isolation.
Our environment is the number one “trigger” for panic attacks.
Whether it's the environment of the location we are in, the environment of the people we are around, or the environment of our 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 which we interpret as something 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 strongest 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 can remember (which was also one of the worst) was during a normal shopping trip at the grocery store when I was 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 full breakdown and the police arriving to haul me off to the looney bin.
Everyone in the store, my family, my 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 came seemingly out of the blue and there was nothing exceptional about the experience that would otherwise have triggered the panic.
Despite the intensity of the experience and my deep fear of “losing control” and losing 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 about 10-15 minutes I was back to pretty much 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 I would end up having a panic attack before I ever even got 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 or a strong fear of hospitals, a conscious fear of death or disease, or those who have 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, we take these thoughts to be true.
And if the pain gets worse (which often happens if we intently focus on it with fear) it only further validates our premonition.
All of this being said – the truth is there are no “spontaneous” panic attacks.
There are proven observable physiological changes that occur before every panic attack.
Very often there are thoughts and fears just under the surface that we may not have been aware of at the time.
Being under extreme pressure for long periods of time or denying and suppressing emotions are two good examples of scenarios that can eventually lead to “spontaneous” panic attacks.
In the end there is no real 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 be “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 of us struggle with panic attacks much more than just once or twice in our 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 would occur in some of the most mundane situations, such as going to the mall or getting a hair cut.
Some times, just leaving the house would work me into a panic.
So what are some factors that can increase the likelihood of someone developing a panic disorder?
- Genetics: family history of panic attacks or other mental health issues
- Trauma: childhood trauma, physical abuse, sexual abuse, PTSD
- Major Stress or Life Changes: new financial difficulties, death of a loved one, a major illness, new or excessive responsibilities such as the birth of a child
- Chemical Imbalance: excessive or deficient availability of key 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 (we have in-depth guides for many proven techniques such as meditation, relaxation and EFT, right here on our website).
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.
In fact, I would say that if you truly understand the panic cycle and can truly break the cycle of fear and panic – you need do nothing else to free yourself from 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, the location, certain 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 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 the fear, you can actually overcome panic attacks for good.
Fear is the “linchpin.”
Remove the linchpin of fear and the whole system of panic 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 exactly what to do and what not to do to overcome panic attacks in your life.
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 been used to help many people around the world and I know it can help you too!
What You Can Do Right Now
Develop an Understanding of Panic Attacks
One of the single most powerful things you can do to free yourself from panic attacks is to first understand them.
By developing an understanding of 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.”
You will be able to reduce or eliminate your fear around the physical sensations that occur during a panic attack because you will know what is happening.
When you can eliminate the fear through better understanding you can short-circuit the fear response by not adding your own fearful thoughts on top of the experience.
Fear drives the panic.
We always fear what we don't understand.
Through understanding, you can greatly 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 our our in-depth guide HERE)
Eliminate Possible Diet & Lifestyle Triggers
What you put into your body has a direct effect on 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 we cut out these “triggers” and make positive changes in our lives we can greatly reduce the severity and frequency of panic attacks and even eliminate them entirely.
One of the greatest contributors to panic attacks in our diet is the excessive consumption of caffeine and other stimulants such as energy supplements
Reducing or eliminating your intake of caffeine and stimulants can greatly reduce the number and/or severity of panic attacks
In recent years there has developed a scientific link 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 – that can lead to feelings of anxiety and the potential for panic attacks.
Certain digestive and GI disorders can increase the likelihood of experiencing these negative 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 can give rise to extreme anxiety and panic.
The use of powerful drugs like amphetamines and cocaine can cause panic attacks.
The discontinuation of alcohol or stopping a daily dose of medication like an SSRI or Benzodiazepine (Xanax, Klonapin, etc.) can lead to panic attacks and overall increased anxiety
Just as important as dietary triggers, lifestyle triggers or stressors can wreak havoc on our mental and emotional health leading to anxiety and panic attacks
There is a seemingly infinite number of life stressors but all fall under 4 major areas of life: Career/Money, Love/Relationships, Leisure/Free Time and Deeper Meaning/Purpose
Having too much or not enough in any of these major 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, we can take action (even if it's the smallest action) to try to make the necessary changes in our lives.
Whenever and wherever possible, reducing negative stressors can help to greatly reduce our 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 was consuming 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 now and have done so for the past few years.
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 the caffeine.
In fact, caffeine and other stimulants are such a major instigator for panic attacks in many people, it's usually one of the first things I recommend changing in order 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 on a daily basis, I can almost guarantee that cutting back will reduce the intensity of the panic at the very least.
Start a Daily Practice
Starting a daily practice of some kind is a vitally important strategy that helps to develop 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 each day for deep relaxation or practicing 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 that we perform each day that allows us to turn our attention inward and moves us 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 greatly reducing our anxiety.
When we take an active role in our mental and emotional health, we become less pulled away by our uncontrollable fight-or-flight reactions.
We become less of the victim of our internal and external experiences.
As we continue to practice techniques such as conscious deep breathing we develop the internal resources to handle the inevitable storms of daily life.
Having a daily practice also greatly improves our ability to calm and relax and consciously activate the parasympathetic nervous system and calm the sympathetic stress response.
(For more on daily practices and techniques you can start right now check out our guides on Meditation, Relaxation or EFT)
What Not to Do Right Now
Avoid Situations That "Cause" Panic Attacks
It seems perfectly natural to want to avoid the things in life that cause us pain or discomfort.
And panic attacks rank up there as one of the most uncomfortable experiences most of us will have.
But the problem with avoidance is that by avoiding the situations that “cause” panic attacks (ie; going to the grocery store, making a speech, going to the doctor or dentist, facing a phobia, etc.), we reinforce the fear.
When we avoid situations and reinforce the fear, we make the fear stronger, make it more real and see the situation as a valid threat to our personal safety.
The more situations we associate with our panic attacks and the more we avoid these situations, the smaller our world becomes and the greater our overall fear and anxiety.
While there is no denying that panic attacks are uncomfortable (I have yet to meet anyone that 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 important to truly understand to free ourselves from panic attacks.
When we stop avoiding the situations and begin facing the discomfort fully we begin to loosen the fear and expand our lives.
What to Do Just Before & During an Attack
Breathe
The essential “technique” isn't complicated or some hidden secret…
As you begin to feel yourself moving into panic normalize your breathing.
Or
If the fear and panic occurs suddenly and you are already in the middle of a panic attack – move your attention to your breath and breathe normally.
In other words calmly at an even pace.
Not gasping, not hyperventilating, not super deep breaths or quick shallow breaths.
Normal, even breaths.
There are two reasons for this simple suggestion.
- We very often take shallow and/or rapid panic breaths when we are experiencing a panic attack. This often leads to feelings of hyperventilation, dizziness or light headedness, and an increased heart rate. It can also cause our thoughts to become more chaotic. If we can remember to normalize our breathing we can reduce these feelings and often “short circuit” the panic response or at least shorten it.
- 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 difficult to do much of anything when you're in the middle of a severe panic attack. So trying to do some technique you read online 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 point of our focus as we 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.
When you are in the midst of it, simply accept it, face it and breathe through 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 completely.
Ground Yourself
Panic attacks are instigated and made worse by our misinterpretations, imagination and fear-based beliefs – in other words, our 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 actually see happening with your own two eyes?
Instead of interpreting that pounding heart as a heart attack – just 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 grounded!
What To Do During a Panic Attack
Accept What You Are Feeling & Face the Fear/Discomfort
Whenever we resist or fight our feelings of panic (or anything for that matter) we inevitably make the situation worse and the feelings more intense.
This means we must accept our experience and face the fear and discomfort.
This means not running from it, not avoiding it, not changing it or distracting ourselves.
This also means not numbing ourselves to it 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 any kind to discomfort you will constantly find yourself running from situations that make you feel uncomfortable in any way.
We all seek safety.
We all seek comfort.
But 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.
Maybe you don't 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 looney bin or from beyond the grave – I'm going to guess you answered no to both of these 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 little while 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 is gone completely, you will be truly free from panic attacks for good.
What Not to Do During A Panic Attack
Try to Change or Get Rid of It
One of the biggest mistakes most of us make when we experience a panic attack is trying to change or get rid of it.
We resist it. We fight it. We try to ignore it. We run away from it.
We try some techniques we learned. Or we take medication to blunt the feelings.
It seems perfectly 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 our performance.
Wanting to get rid of the panic attack or at least calm ourselves down, makes complete sense.
However, by trying to force the panic away or resisting the feelings, we actually make the experience worse.
Anything we resist, persists and is often made more intense by our resistance.
When we try to force the feelings/experience away and it doesn't work, we try harder and harder and we inevitably increase the panic.
Which 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 we experience during a panic attack: rapid heart rate, sweating, shaking, etc., happen outside our conscious control.
When we are in the middle of a full-blown panic attack and adrenaline and other stress hormones are coursing through our bodies there isn't much we can do to stop the physical sensations – other than breathe and wait for it to pass.
One of the big mistakes we often make is adding our fear-based interpretations to the experience.
We add fear to the fear response.
We add anxiety to our feelings of anxiety.
We are responding to unconscious responses with conscious fear.
When we experience a panic attack it is important 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 we understand the bodily processes involved in panic attacks we 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 as well.
We experience our feelings as they arise without interpretation in the present moment.
When we get good at grounding ourselves we 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 already, without the attachment of fear to the sensations, the panic attacks will quickly dissipate.
What to Do After a Panic Attack
Assess and Record Your Experience
After a panic attack, it can be extremely helpful to write down exactly 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'm some kind of freak. This went on for 10 minutes or so and was extremely intense but then slowly went away. By the time Tim got here, it was completely gone 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 we can look back and see that no matter how bad we think things will be it never happens the way we 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 already this never works in the long 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 deeply 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 ok with the discomfort and learning to withdrawal 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 your suffering with 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 TO DO RIGHT NOW
1. Understand What Panic Attacks Are and How They Work
2. Eliminate Dietary/Lifestyle Triggers
3. Start A Daily Practice
WHAT TO DO JUST BEFORE & DURING A PANIC ATTACK
1. Breathe
2. Ground Yourself
WHAT TO DO DURING A PANIC ATTACK
1. Accept What You Are Experiencing
2. Face the Fear and Discomfort
WHAT TO DO AFTER A PANIC ATTACK
1. Assess and Record Your Experience
2. 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 truly disrupted my life.
If you're in a similar place as I was I know the strategies in this guide can help you to overcome panic attacks.
I have put many hours into writing this guide, having written it with the utmost sincerity – with the intent of helping you get back to normal, as I did.
This isn't just some fancy set of techniques or distractions.
This is how you develop permanent freedom from panic attacks.
I did it. I know that you can too.
If you have any questions regarding panic attacks please let a comment below.
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