Last updated: January 13th, 2021
What Are Panic Attacks?
People having a panic attack describe them by saying things like, “I’m freaking out.” “I’m having anxiety.” “I feel panicky.” A panic attack is a sudden period of intense fear or discomfort that reaches a peak within a few minutes and then subsides. Some common symptoms that can occur during a panic attack, include the following:
- Increased heart rate or palpitations
- Trembling or shaking
- Feeling short of breath or smothering
- Feeling of choking
- Chest pain or tightness
- Nausea or abdominal discomfort
- Feeling dizzy or lightheaded
- Cold or hot flashes
- Numbness or tingling
- Feeling that things are not real (derealization) or feeling detached from oneself (depersonalization)
- Fear of losing control or “going crazy”
- Fear of dying
How Common Are Panic Attacks?
Panic attacks are more common than you might think. About 11% of adults in the United States experience one in any given year. Attacks can start at moments when you’re already feeling anxious, but can also occur when you’re feeling calm. Some are predictable, and happen in response to a noticeable trigger, while others occur “out of the blue.”
What Conditions Cause Panic Attacks?
Panic attacks can be associated with a variety of psychiatric diagnoses, including generalized anxiety disorder, social anxiety disorder, phobias, depression, posttraumatic stress disorder, and substance use disorders. Panic disorder is a mental health condition which involves recurrent unexpected panic attacks as well as either persistent worry about having additional attacks, or avoidance behavior (avoiding exercising, enclosed spaces, unfamiliar situations, etc.). So, while individuals with panic disorder certainly experience panic attacks, not everyone who has a panic attack has panic disorder.
Panic attacks are frightening. In fact, many individuals suffering a panic attack mistakenly believe they are experiencing a serious medical problem (such as a heart attack) and visit the emergency room. However, panic attacks are not actually dangerous. In fact, having a panic attack is only possible because of helpful reactions our bodies have developed to respond to threats.
Role of the Fight-or-Flight System
When we are faced with danger, our “fight-or-flight” system is activated. This system has evolved to help us survive when facing threats in the environment. This response leads to a number of physiological changes in the body. While these changes are helpful for escaping a threat, they can also produce the uncomfortable sensations described above. Take a look at the chart below:
|Physiological Change||Benefit for Escaping Threat||Associated Panic Symptoms|
|Faster breathing||Take in more oxygen to meet energy demands||Feeling dizzy or lightheaded; |
shortness of breath;
chest pain or tightness
|Increase heart rate||Increase blood flow to muscles for energy||Palpitations or pounding heart|
|Increase muscle tension||Provide body with extra speed and strength||Trembling or shaking|
|Dilate blood vessels to muscles|
Constrict other blood vessels
|Maximize blood flow to muscles and core organs||Numbness and tingling|
Cold or hot flashes
|Slow digestion||Conserve energy/direct blood flow toward muscles||Nausea or abdominal discomfort|
|Hyperfocus/tunnel vision||Assess and track threat/danger||Derealization or depersonalization|
As you can see from the above chart, the same physiological processes that are helpful for survival when faced with a threat are also responsible for panic attacks. Think of a panic attack as a helpful reaction occurring in response to the wrong triggers. These triggers can be stressful or shocking thoughts or emotions (as in the case of predictable panic attacks), or even small physiological changes outside conscious awareness that activate the fight-or-flight response.
CBT for Panic Disorder and Other Options
Thankfully, there are effective treatments for panic symptoms and the suffering they can cause. Cognitive-behavioral therapy (CBT) has been proven highly effective in the treatment of panic attacks and panic disorder. CBT for panic entails learning and practicing various skills that impart long-lasting benefit and symptom relief. These skills may involve any or all of the following:
- changing your thought processes
- helping you become less reactive to triggering bodily sensations
- learning about exactly what happens in your body during an attack
- changing habits that might be inadvertently worsening the attacks
Medications, such as benzodiazepines (e.g., Klonopin, Xanax), are often prescribed to help manage panic attacks. However, unlike psychological treatment, the benefits of these medications are lost when the medication is discontinued. Consider consulting with a CBT therapist if panic attacks are interfering with your wellbeing and overall functioning.
Please contact us if we can help you in your efforts to find therapy for panic attacks here in New York. Our CBT therapists are doctoral-level psychologists. We also have student therapists who offer reduced-fee services. Our offices are in midtown Manhattan, but we offer teletherapy services to people elsewhere in New York State, New Jersey, and Florida. If you’re looking for CBT therapy in another part of the country or world, please contact us — we are happy to help!