How to Work Through a Panic Attack

Morgan is at home, typing an email for work, when all of a sudden she starts to shake. She feels heat rising up through her body, and before she knows it, her heart is racing, she feels pain in her chest, and she breaks into a sweat. “Am I dying?,” she asks herself as she starts panicking and debates going to the emergency room.

Many of us can relate to Morgan’s experience, as we know firsthand how scary panic attacks can be. And panic attacks are harder to deal with when you aren’t sure if you are experiencing a panic attack, especially since many of the symptoms mirror scary conditions such as heart attacks or strokes.

When you don’t know what is happening to your body, it can lead you to fear that you are dying, experiencing something life-threatening, or going crazy. And this can make you feel even more powerless and anxious, which often increases the panic. In one clinical study, researchers found 77% of individuals who experienced a panic attack that year went to the emergency room because of their physical symptoms (Foldes-Busque et al., 2019).

But there is hope in knowing that panic attacks are treatable, and that you are more capable of coping with panic attacks than you are likely given yourself credit for. Before we can learn how to work through panic attacks in the moment, we must first be able to recognize what panic attacks look like.

Know the symptoms

A panic attack is characterized by the abrupt onset of intense fear or discomfort that reaches its peak within minutes and includes the following symptoms:

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
• Fear of losing control or “going crazy”
• Fear of dying
• Paresthesias (numbness or tingling sensation)
• Chills or hot flushes

Although panic attacks vary in intensity and duration, most panic attacks reach their peak within 10 minutes and slowly start to subside. Typically, to be diagnosed with a panic attack at least four of these symptoms need to be experienced, but someone may have similar experiences to a full-blown panic attack yet have fewer than four symptoms.

Many people will also meet criteria for panic disorder if they experience recurrent, unexpected panic attacks and have consistent worry and fear about the possibility of experiencing future panic attacks. Panic disorder is extremely common with some data indicating that 4.7% of all U.S. adults will meet criteria for panic disorder in their lifetime, a staggering 14 million Americans (Harvard Medical School, 2007).

Familiarizing yourself with the general symptoms of a panic attack is a powerful step in working through them, because identifying them as “panic attacks” in the moment can help take some of the fear and mystery away.

How to work through a panic attack

Tip #1: Don't fight the panic, accept it

Ironically, many of the ways we are biologically wired to respond to panic attacks actually prolong and intensify the panic attack. As humans, we are programmed to want to avoid discomfort, and since panic attacks are uncomfortable (to say the least!), our natural instinct is to try and fight the panic with the hope of getting rid of it. This can look like actively trying to escape it, fight it, or will it away.

But, the more you fight and resist the panic, the longer and stronger it lingers. Your body has gone into flight/fight mode, because it thinks it is protecting you from a possible threat. So, trying to fight our nervous systems when they are doing what they are programmed to do is fruitless and leaves you feeling exhausted, frustrated, and likely even more anxious.

The first step to work through a panic attack is to work with your panic, not against. So, start with accepting that panic is present. Let it be. Don’t fight or try to run from what’s happening. Notice that it is here with you. Acknowledge its presence by saying something to yourself like “Panic is here, and it is okay. It can just be here.”

Tip #2: Remind yourself that discomfort does not equal danger

When our nervous systems get activated, we understandably associate discomfort and fear with danger. This makes evolutionary sense! When we were cave people and a saber tooth tiger was looming nearby, we wouldn’t have been surprised if we started to shake, feel lightheaded, or began to sweat. And that’s because we were in danger, and we needed our nervous systems to help us either fight, flee, or freeze in response to threat. So, panic attacks themselves aren’t dangerous. They are just extremely unpleasant and uncomfortable. It may be helpful to use this coping statement, or one like it, in response to a panic attack: “This is uncomfortable, but it isn't dangerous. And this will pass.”

Tip #3: Try not to get caught up in "fear of the fear"

One thing that makes panic attacks harder to cope with is when we experience fear about the fear. Your mind might start sending you questions such as, “What if this is a heart attack?” “What if I am dying?” “Am I going crazy”? “What if this is actually the time something is wrong, and I miss the chance to take action?”

It can be helpful to try your best to notice these “what ifs” and try to not engage in them. You can try to say something to yourself like, “I’m noticing I am having the thought that this could be something dangerous.” Or try to visualize the fears as thoughts and mentally put them on a cloud and watch them float away.

This will be easier said than done, because you will be going against what feels natural (to take the fears seriously) vs. just letting them be. And that is okay! It’s a practice, and it will take time.

Tip #4: Relax your body 

During a panic attack, there is so much happening in your body, so it can be worth it to try and find ways to relax your body as you wait for the panic to subside. Remember: you are making yourself comfortable, but you are not actively trying to get rid of the panic!

Review the below suggestions and see what you are willing to try in moments of heightened anxiety. Make sure to practice them and don’t be afraid to tweak them to better suit your needs:

• Take long, slow, deep breaths: Breathe in for four seconds and exhale for eight. Repeat five to 10 times.
• 5-4-3-2-1: From where you are standing or sitting, name five things you see, four things you feel, three things you hear, two things you smell, and one thing you can taste.
• Visualize your panic as a wave. See yourself riding the wave and watch as it rises and falls. Breathe, be with the panic, and trust that this wave will pass soon.

Tip #5: Redirect your attention to the present  

Panic attacks take us out of the present moment, so refocusing on whatever task we were doing prior to the panic attack can help ground us as we wait for the panic to pass. Put your mental focus on the task, connect to your senses, and continue to remind yourself that you are capable of working through discomfort. If you get to step 5 and panic remains, go back to step 1 and repeat the steps as needed.

Closing thoughts

Although panic attacks are scary, they are treatable. The more we familiarize ourselves with what panic attacks look like, practice accepting vs. resisting them, and support our bodies, the more confidence we can feel in our ability to ride the waves of panic. Rest easy knowing you have everything you need right now to work with panic.