Your top questions about panic attacks, answered

At best, panic attacks are uncomfortable. At worst, they’re terrifying. Symptoms can include a rapid heartbeat, sweating, shaking and shortness of breath. You might feel chest pain or nausea. You may even worry that you’ll lose control or die.

Panic attacks “are like a sudden wave of intense fear,” says Julie Groveman. She’s a licensed psychologist in New York City. “Your body can feel like you’re in extreme danger when in reality you’re safe.”

To make matters worse, panic attacks often have no obvious cause, says Groveman. That can add to the fear that the next one is just around the corner. But rest assured, there are ways to control the situation — and conquer the fear.

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To understand how panic attacks work (and how to potentially prevent them), read on.

What is a panic attack?

If you’ve watched the television show Schitt’s Creek, you might remember when the character David Rose had a panic attack. In the scene, he tells his doctor, “I think there’s a lack of oxygen getting to my heart, because I’m feeling very suffocated.”

Rose thought he was having a heart attack, which is a common mistake. The symptoms of a panic attack are often similar, according to Johns Hopkins Medicine.

“It’s a sudden, intense fear or anxiety that may make you short of breath,” explains Reena B. Patel. She’s a licensed educational psychologist, board-certified behavior analyst and an author. “You may feel out of control or that you don’t have enough air to breathe.” You might also feel dizzy, and you could black out.

(Here’s how to tell the difference between anxiety and angina, or chest pain caused by a lack of blood to the heart.)

Other common symptoms of panic attacks include:

• Chest tightness
• Sweating
• Trembling
• Shaking
• Chills
• Hot flashes
• Nausea
• Abdominal pain
• Headache
• Numbness

In severe cases, people can even feel as if they’re losing their minds or dying.

The length of these attacks varies. “Most usually last from 5 to 20 minutes,” says Patel. “But they can last even longer.” In some cases, up to a few hours.

Why do panic attacks happen?

There isn’t a specific cause of panic attacks. But in general, they’re connected to anxiety, says Amber Petrozziello. She’s a clinical supervisor at Empower Your Mind Therapy in New York City.

“And anxiety is often rooted in fear,” she explains. You may be afraid of people or new places. You may fear that you’re not capable, or you may have a general fear of the unknown.

People with anxiety often try to stay away from their triggers. But when they can’t, they may have the physical response known as a panic attack.

How can you stop a panic attack from happening?

You start by addressing your anxiety, says Petrozziello. If you’re anxious often, you may need to seek treatment for an anxiety disorder. This condition occurs when “anxiety becomes so overwhelming that it interferes with daily functioning,” says Petrozziello.

In this case, anxiety may affect you even when nothing unusual is happening. “Feeling nervous for a big work presentation doesn’t mean you have an anxiety disorder,” says Petrozziello. But getting sweaty at the thought of routine work interactions is another story. That could be a sign of trouble.

According to the University of Michigan, heavy drug use (including alcohol, nicotine and caffeine) and long-term stress can also cause panic attacks. In addition to addressing your anxiety, think about avoiding these as best you can.

What should you do when you feel a panic attack coming on?

Trying to stop a panic attack in motion can backfire, says Groveman. “What you resist persists,” she says. “It’s more helpful to surrender to the experience and trust that it will eventually pass on its own.”

Groveman recommends breathing deeply and listening to your body. “Bring mindful awareness to notice what’s happening without judging your experience,” she says. “Remember that no matter how uncomfortable you feel, anxiety symptoms will not harm you.”

Here are other strategies that can help during an attack:

The 5-4-3-2-1 mindfulness tool

“This involves focusing on the present moment by engaging all of your senses,” says Groveman. To do this, breathe deeply while identifying the following:

• 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

Self-talk

Talk to yourself as a friend would. You might say, “This moment is very upsetting, but it will pass,” says Patel. Or you can tell yourself, “I can breathe, and I will get through this.”

Saying it out loud brings it into the real world. That can be more effective than simply thinking it.

Body scan

This is another mindfulness strategy. To do it, focus on each part of your body, one at a time, starting at your feet. Then move to your ankles, your calves, and keep moving up toward your neck. “Isolate each part of your body by squeezing the muscles 3 times as you work your way from toe to shoulders,” says Patel.

Can you treat panic attacks with medication?

Medications don’t treat panic attacks directly, but they can treat anxiety disorder, says Patel. “These medications relax the central nervous system, which can lower the intensity of panic attacks,” she says.

(Here we’ve answered your top questions about treatment for anxiety disorder.)

Some medications for anxiety include:

• Selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro®) or fluoxetine (Prozac®)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta®)
• Benzodiazepines, such as diazepam (Valium®) or alprazolam (Xanax®)
• Other anti-anxiety medications, such as buspirone (Buspar®)

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Panic attacks can be scary, but if you address the underlying cause, they won’t loom over your everyday life. Then you’ll be free from the constant fear.