Panic Attacks: What They Feel Like and What to Do

A panic attack is one of the most frightening experiences a person can have — not because it's dangerous (it isn't), but because it genuinely feels like something catastrophic is happening to your body. Many people experiencing their first panic attack end up in the emergency room convinced they're having a heart attack or dying.

Understanding what a panic attack actually is — and what to do when one happens — takes away much of its power.

What a Panic Attack Feels Like

Panic attacks are sudden surges of intense fear or discomfort that peak within minutes. Symptoms can include:

• Racing or pounding heart — often the most alarming symptom
• Chest pain or tightness — can feel exactly like cardiac chest pain
• Shortness of breath — feeling like you can't get enough air, or like something is sitting on your chest
• Dizziness or lightheadedness — the room may spin
• Tingling or numbness — particularly in the hands, feet, or face
• Sweating — sometimes profuse
• Trembling or shaking
• Nausea or stomach distress
• Feeling detached from yourself (depersonalization) or like the world isn't real (derealization)
• A sense of impending doom — a visceral conviction that something terrible is about to happen
• Fear of losing control or "going crazy"
• Fear of dying

Most panic attacks last 10-30 minutes, though they can feel much longer. The peak intensity usually occurs within the first 10 minutes.

What's Actually Happening in Your Body

A panic attack is essentially your fight-or-flight response firing at full intensity — in the absence of actual danger. Here's the cascade:

Your amygdala (the brain's threat-detection center) sends an alarm signal. Your sympathetic nervous system floods your body with adrenaline. Heart rate increases, breathing accelerates, blood is redirected to large muscles, digestion pauses, and your senses sharpen.

This is a survival response designed to help you fight a predator or flee from danger. It's incredibly effective for that purpose. The problem is that it's activating without a real threat — and the physical sensations themselves become the thing you fear.

The chest pain is from rapid breathing and muscle tension. The tingling is from hyperventilation (too much oxygen, too little CO2). The dizziness is from the breathing pattern change. The feeling of doom is your brain interpreting its own alarm signals as confirmation of danger.

None of it is dangerous. Your heart is not failing. You are not dying. You are not going crazy. Your body is doing exactly what it's designed to do in an emergency — it's just misfiring.

What to Do During a Panic Attack

Recognize what's happening

The single most helpful thing is being able to say to yourself: "This is a panic attack. I've been through this before. It's not dangerous and it will pass." This interrupts the fear-of-fear cycle that escalates panic.

Slow your breathing

Hyperventilation drives many of the symptoms. Deliberately slow your breathing:

• Breathe in through your nose for 4 counts
• Hold for 2 counts
• Breathe out through your mouth for 6 counts
• The extended exhale activates your parasympathetic nervous system

Ground yourself

Engage your senses to anchor yourself in the present moment:

• Name 5 things you can see
• 4 things you can touch
• 3 things you can hear
• 2 things you can smell
• 1 thing you can taste

This redirects your brain from internal alarm signals to external reality.

Don't fight it

Paradoxically, trying to suppress or fight a panic attack often intensifies it. The approach that works better: acknowledge what's happening, remind yourself it's not dangerous, and let it pass through you. Resistance adds a layer of struggle on top of the panic itself.

Stay where you are (if safe)

The instinct is to flee — leave the store, pull over, go home. While this provides temporary relief, it reinforces the association between the location and danger. If you can, stay put and ride it out. Over time, this teaches your brain that the situation isn't actually threatening.

When Panic Attacks Become Panic Disorder

Isolated panic attacks are common — roughly 11% of adults experience at least one per year. Panic disorder is diagnosed when:

• You have recurrent, unexpected panic attacks
• At least one attack is followed by a month or more of persistent worry about having another attack, or significant behavior change because of the attacks (avoiding places, situations, or activities)

The avoidance piece is what makes panic disorder disabling. People begin avoiding situations where they've had attacks — or where they fear having one. This can progressively narrow their world: avoiding driving, grocery stores, crowds, exercise (because the elevated heart rate mimics panic), and eventually leaving home.

Treatment That Works

Cognitive-behavioral therapy (CBT)

CBT is the most effective treatment for panic disorder. It involves:

• Education about what panic is and why it occurs
• Cognitive restructuring — challenging catastrophic interpretations of symptoms
• Interoceptive exposure — deliberately inducing mild physical sensations (like spinning in a chair or breathing through a straw) to desensitize yourself to the feared body sensations
• In vivo exposure — gradually returning to avoided situations

CBT for panic has among the highest success rates of any psychotherapy for any condition.

Medication

SSRIs (sertraline, paroxetine, escitalopram) are first-line medications for panic disorder. They reduce the frequency and intensity of attacks. They take 2-4 weeks to reach full effect.

Benzodiazepines (like alprazolam or clonazepam) provide rapid relief but carry risks of dependence and can interfere with the learning that makes CBT work. They're best used sparingly, not as a daily maintenance treatment.

The combination

For moderate to severe panic disorder, CBT plus an SSRI often produces the best outcomes.

When to See a Doctor

If you're having recurrent panic attacks, if you're avoiding situations because of fear of panic, or if panic is affecting your daily functioning — treatment can help significantly. Most people with panic disorder respond well to treatment, and many achieve complete remission.

And if you're not sure whether your symptoms are panic attacks or something cardiac — it's always appropriate to get checked out. A normal cardiac workup is reassuring, not a waste of time.

Ready to talk to a real doctor? Get started with Coral Health today.