Panic Attacks | Symptoms, Causes and Evidence-Based Treatment
A panic attack is a sudden rush of intense fear along with strong physical symptoms, often arriving with no obvious trigger. Most last between 5 and 20 minutes. They are frightening, and they are not dangerous. When panic attacks keep happening and you start to fear the next one, that pattern is treatable.
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What is a panic attack?
A panic attack is your body's threat response firing when there is no threat. Adrenaline floods your system, your heart speeds up, your breathing changes, and everything that would be useful if you needed to run from danger happens while you are standing in a supermarket queue.
Attacks usually build very quickly, peak within a few minutes, and then subside. The NHS describes most as lasting between 5 and 20 minutes, though some have been reported to last up to an hour, usually where one attack has followed straight after another.
What makes them so frightening is how physical they are. Many people having a first panic attack believe they are having a heart attack, or that they are about to collapse or die. That belief is not irrational given what the body is doing. It is simply not what is happening.
What does a panic attack feel like?
The experience varies, but common symptoms include:
a pounding, racing or irregular heartbeat
shortness of breath, or a feeling that you cannot get a full breath
chest tightness or chest pain
sweating, trembling or shaking
feeling hot or suddenly cold
nausea, or an urgent need for the toilet
dizziness, light-headedness or feeling faint
tingling in the fingers or lips
a sense of unreality, or of being disconnected from yourself or your surroundings
a powerful urge to escape
fear that you are dying, losing control or going mad
Hyperventilating is part of why the symptoms escalate. Breathing too fast changes the balance of gases in your blood, producing dizziness and tingling that can feel like more evidence that something is seriously wrong.
Most panic attacks last 5 to 20 minutes, with the peak coming in the first few minutes. Some have been reported to last up to an hour, though this usually means one attack followed another, or high anxiety continued after the first one ended. You may feel drained for some hours afterwards.
How long do panic attacks last?
Panic attacks at night
Waking suddenly in a panic is common and particularly disorientating, because there is no situation to point to as a cause. Nocturnal panic attacks are still panic attacks. They tend to be maintained by the same cycle, with the added difficulty that people start to dread going to sleep.
Panic attack or anxiety attack: what is the difference?
People use "anxiety attack" a great deal, and it is worth knowing that it is not a clinical term. There is no diagnosis called an anxiety attack.
What people usually mean by it is a period of building, intense anxiety, often with an identifiable cause, that can last a long time and gradually ease. A panic attack, by contrast, tends to arrive abruptly, peaks fast, is extremely physical, and passes relatively quickly.
The distinction matters less than it might seem. If what you are experiencing is distressing and it is affecting your life, the name it goes by will not change what helps.
What causes panic attacks?
The exact cause is not fully understood, and for many people the first attack arrives without a clear explanation.
Contributing factors typically include a period of significant stress or a stressful life event such as bereavement, a family history of anxiety problems, and sometimes a physical trigger such as illness, exhaustion, caffeine, or the effects of alcohol.
What is much better understood is what keeps panic going. After an attack, most people start watching for the next one. That means monitoring your body, noticing every skipped heartbeat or moment of dizziness, and reading those sensations as warnings. Attention to bodily sensations makes them more noticeable, which raises anxiety, which produces more sensations.
Alongside that, avoidance sets in. You stop going to the place where it happened, or you only go with someone else, or you carry water or medication. Each of these lowers anxiety in the moment and teaches you that you got away with it, which strengthens the belief that the situation was genuinely dangerous.
When panic attacks become panic disorder
Having a panic attack does not mean you have panic disorder. Occasional attacks, particularly during a stressful period, are common.
Panic disorder may be diagnosed when you have regular and unexpected panic attacks followed by at least a month of ongoing worry about having more of them. The defining feature is not the attacks themselves. It is the fear of the fear, and the way life narrows around it.
It is also worth noting that panic triggered reliably by one specific thing, such as flying or needles, is usually a phobia rather than panic disorder. And panic attacks that happen when you are away from home or in crowds may point towards agoraphobia. All of these are treatable, but they are treated slightly differently, which is why proper assessment matters.
Contact our team via email to book, or learn more about our comprehensive assessments for a range of mental health conditions.
Treatment for panic attacks and panic disorder
Treatment in the UK follows NICE guideline CG113, Generalised anxiety disorder and panic disorder in adults: management.
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Psychological therapy is the intervention with evidence for the longest-lasting effect. NICE specifies that Cognitive Behavioural Therapy (CBT) should be offered in an optimal range of 7 to 14 hours in total.
CBT for panic works on the cycle rather than on the symptoms directly. That usually means understanding exactly how an attack builds for you, testing what actually happens when you stop using safety behaviours, deliberately bringing on some of the physical sensations in session so they become less alarming, and dropping the avoidance that has built up around them. The goal is not to prevent every sensation. It is for a racing heart to stop meaning catastrophe.
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NICE recommends that bibliotherapy based on CBT principles is offered as part of stepped care, with support from a healthcare professional. For panic that is recent or relatively mild, structured self-help can be enough.
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NICE states that antidepressants should be the only medication used in the longer-term management of panic disorder. As of the guideline's 2020 amendment, escitalopram, sertraline, citalopram, paroxetine and venlafaxine are licensed for panic disorder in the UK. If an SSRI is unsuitable or brings no improvement, imipramine or clomipramine may be considered.
Medication is prescribed by a GP or psychiatrist rather than a psychologist. NICE advises review two weeks after starting a new medication, then at 4, 6 and 12 weeks, with a decision at 12 weeks about whether to continue.
How to help someone having a panic attack
If you are with someone during an attack, the useful things are simple.
Stay with them, and say so. Keep your voice calm and your sentences short. Remind them that this will pass and that panic attacks are not dangerous. Encourage slow, steady breathing, particularly slow out-breaths, and breathe with them if that helps.
Try not to rush them away from where they are unless they need to move. Leaving immediately can feel like the only option and tends to reinforce the fear of the place. Afterwards, they may be exhausted, and they may be embarrassed. Neither needs commenting on.
Support for panic attacks at Regal Private Therapy Practice
Our Clinical Psychologists provide CBT for panic and panic disorder to adults, working in line with NICE guidance.
In practice that means starting with a clear map of your own panic cycle, which is often the first point at which the whole thing stops feeling random. From there the work is gradual and collaborative: reducing the checking and the safety behaviours, testing predictions rather than arguing with them, and rebuilding the parts of life that panic has narrowed.
Nobody is pushed into situations before they are ready, and pace is something you set together.
Read more about therapy for adults and about cognitive behavioural therapy. If you are seeking help for a child or teenager, see therapy for children and adolescents.
If you need urgent support
If you are struggling to cope or worried about your safety, help is available now. Call 111 and select the mental health option, or contact your GP. Samaritans are available 24 hours a day on 116 123. In an emergency, call 999 or go to your nearest A&E.
If you have chest pain that is new, severe, or spreading to your arm, jaw or back, treat it as a medical emergency and call 999. Do not assume it is panic.
Frequently asked questions about panic attacks
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No. Panic attacks are frightening but they do not cause physical harm. The NHS is clear on this point. The symptoms are produced by your body's normal threat response firing at the wrong moment, and they subside on their own, usually within 5 to 20 minutes.
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You often cannot tell in the moment, and you should not try to. If chest pain is new, severe, or spreading to your arm, jaw or back, call 999. Getting checked is always the right call. A GP can then rule out physical causes, which is a standard part of assessing panic.
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Yes. Unexpected attacks with no identifiable trigger are typical of panic disorder, and they are one of the things that makes it so unsettling. There is usually a pattern underneath, involving how bodily sensations are being interpreted, but it is rarely obvious without looking for it.
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Not necessarily. Occasional panic attacks are common, particularly during stressful periods. Panic disorder involves regular unexpected attacks followed by at least a month of continuing worry about having more. If attacks are recurring and you are changing your life around them, it is worth getting assessed.
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Not individually, and trying to prevent every one tends to make things worse, because prevention behaviours reinforce the fear. What treatment can do is break the cycle that keeps producing them, so attacks become less frequent and much less frightening when they do happen.
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References
NICE (2011, last updated 2020). Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline CG113. https://www.nice.org.uk/guidance/cg113
NHS. Panic disorder. https://www.nhs.uk/mental-health/conditions/panic-disorder/
NHS. Get help with anxiety, fear or panic. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/anxiety-fear-panic/
Oxford Health NHS Foundation Trust (OHSPIC). Panic disorder.