A Beginner’s Guide to Managing Panic Attacks

Heart racing, breath getting short, dizziness, an overwhelming sense of dread. Panic attacks hit hard, fast, and sometimes completely unexpectedly. If you struggle with them often, they can also get in the way of work, school, relationships, and day-to-day tasks. 

As a therapist who’s been in the mental health field for years, I know how debilitating panic attacks can be. Getting them under control can be one of the most relieving things you can learn to do. In this article, I break down the following: 

• What is a panic attack? Understanding the symptoms
• Why panic attacks happen (and why they’re not dangerous)
• What to do during a panic attack: step-by-step strategies
• Long-term ways to reduce panic attacks
• When to seek therapy for panic attacks

By the end of the article, you’ll have a better understanding of your panic attacks, know what you can do to help yourself immediately and in the long-term, and figure out if therapy might be the right option for you.

What Is a Panic Attack? Understanding the Symptoms

A panic attack is a sudden burst of intense fear that leads to strong physical reactions including the following:

• A racing or pounding heartbeat
• Sweating
• Shaking
• Feeling of being unable to catch your breath
• Chest pain or discomfort
• Feeling like you’re choking
• Nausea or stomach pain
• Dizziness or feeling faint
• Chills or hot flashes
• Tingling or numbness in the hands, feet, or face
• Feeling detached from yourself or your surroundings
• Fear of losing control, “going crazy,” or dying

These symptoms usually peak at 10 minutes, and continue for another 20 to 30 minutes, although it can range from person to person. People who experience regular panic attacks may even become triggered by a fear of panic attacks themselves, pushing them into a vicious cycle where the anticipation of panic triggers the attack. Panic attacks can lead to avoidance of things that trigger panic like public speaking, crowded areas, driving, or high pressure settings. They can also lead to avoidance of places where you’ve had a panic attack before, places you cannot escape easily, and places where help is not available.

Many people have one or two panic attacks in their lifetime, but if you experience them often, and spend time worrying about having another one or changing your behaviour to avoid them, you may have panic disorder. About 4% of Canadians experience panic disorder in their lifetime.

An important note: Although panic attacks themselves are not at all dangerous, the symptoms can be very similar to those of serious medical conditions.

Seek emergency medical care immediately if you have:

• New or severe chest pain, especially if it spreads to your arm, jaw, neck, or back
• Difficulty breathing that doesn’t ease up
• Fainting or complete loss of consciousness
• Sudden weakness, confusion, or trouble speaking
• Symptoms that are different from your usual panic attacks

Why Panic Attacks Happen (And Why They’re Not Dangerous)

Panic attacks aren’t dangerous, but they can feel completely overwhelming and frightening. 

Panic attacks are, at their core, your body’s fight-or-flight response setting off internal alarms when there isn’t actually a physical threat. It’s your nervous system doing exactly what it was designed to do; preparing you to survive danger. The issue is that it’s mistaken a safe situation for a threatening one.

When this system goes off, your brain begins to release stress hormones like adrenaline and cortisol. Your breathing speeds up so you can get more oxygen into your body. Your heart rate increases so you can get more blood to your muscles. You begin to tense your muscles to prepare to run away. Your senses become more alert. Everything in you is prepping you to escape a real threat, but when you’re sitting in a meeting, driving, or relaxing at home, they can feel confusing and terrifying.

The problem isn’t that these sensations are dangerous, it’s how we interpret them. It’s common for people to think, “I’m losing control.” Those thoughts are totally understandable, but they create even more fear, which tells the nervous system there’s even more danger, making the panic attack even more intense.

What to Do During a Panic Attack: Step-by-Step Strategies

When you’re in the middle of a panic attack it can be difficult to figure out what you’re supposed to do. Having a strategy to remind your body that it’s safe ahead of time can be really helpful and effective. 

1. Remind yourself what’s happening

As aforementioned, although panic attacks feel life-threatening, they’re not. One of the most effective ways to reduce panic is naming the experience. It sounds simple, but it can reduce its intensity.

Try saying to yourself:

“This is a panic attack. It feels scary, but it isn’t dangerous. My body is having a false alarm, and this will pass.”

Even if you don’t fully believe it at the moment, repeating this message helps interrupt the spiral of worst-case scenario thinking. 

2. Make Your Exhale Twice as Long

Panic leads to shortness of breath, shortness of breath leads to dizziness and tingling, and dizziness and tingling can lead to more panic.

A good rule of thumb to aim for is to try to get your exhale to be twice as long as your inhale. You don’t have to get it on the first breath if you feel very activated, but aim towards that.

For example:

Inhale through your nose for four seconds.

Exhale slowly through your mouth for eight seconds.

Repeat for a few minutes.

When we slow everything down we’re forcing our nervous system to reconsider whether there’s a threat. If we’re not taking in a lot of oxygen, it signals that we may not be in danger after all.

3. Play the categories game

Panic pulls your attention toward frightening thoughts and sensations. Bringing your attention into the present moment can help interrupt that cycle.

The categories game is simple; choose a category and name everything in your immediate surroundings that falls under that category.

For example: 

Name everything you see that’s blue. 

Name everything you see that’s made of glass.

Name everything you see that’s round.

This helps deactivate the part of your brain that’s in threat mode, and bring your back into the present moment.

4. Resist the urge to escape

As long as it’s actually safe to do so, try to stay where you are instead of escaping.

Escaping might bring your some immediate relief, but in the long run, it teaches your brain that a non-dangerous situation is dangerous. Although it’s tough, staying in the discomfort (even just for a few minutes) until it eases helps teach your body that you’re actually okay.

5. Let the wave pass

This strategy comes from a therapy approach called DBT. Panic attacks rise, peak, and eventually dissipate. Although it might feel like it, they do not stay at their highest peak forever.

Instead of fighting the sensations associated with the panic attack, see if you can allow them to come and go like a wave. Tell yourself,

“This is what I feel right now. This will pass.”

Oftentimes, the more we struggle against panic, the stronger it becomes. Learning to ride it out, like a wave is tough at first, but it is one of the most powerful ways to lower panic attacks over time.

Long-Term Ways to Reduce Panic Attacks

Again, a lot of folks will experience panic one or two times in their life, especially in moments of high stress or anxiety. However, if panic attacks are happening on a regular basis, managing them in the moment is only part of the solution. Long-term recovery requires addressing your overall anxiety. 

This can look like:

• Learning to identify the thoughts or situations that come before the panic and addressing them in new ways.
• Sitting with your discomfort rather than leaving the situation that caused panic.
• Regularly practicing grounding, breathing, and mindfulness exercises even when you’re not panicking.
• Getting regular sleep and exercise, and having balanced nutrition.
• Reducing caffeine or other stimulant intake.
• Attending therapy for panic attacks.

Remember that panic attacks are often just a symptom of other anxiety. Addressing the root causes helps the attacks often become less frequent and less intense, or disappear altogether.

When to Seek Therapy for Panic Attacks in Toronto

If panic is starting to affect your quality of life, going to therapy can be a big support.

You might benefit from therapy if:

• You’re avoiding places or situations because you’re afraid of having a panic attack.
• You spend a lot of time worrying about when the next attack will happen.
• Panic attacks are interfering with work, school, relationships, or daily activities.
• You’ve tried coping on your own, but the panic keeps coming back.

Therapy can help you:

• Understand why your panic attacks are happening
• Reduce your fear of the symptoms
• Build the confidence to return to the activities you’ve been avoiding

If you’re looking for therapy for panic attacks in Toronto, I’d be happy to help. Together, we can understand what’s driving your anxiety, develop practical tools to manage panic, and work toward helping you feel calmer, more confident, and back in control of your life. Book a free call or shoot me an email and we can discuss what next steps look like.