A panic attack can feel as though the body is in acute danger. A racing heart, shortness of breath, dizziness or a feeling of a loss of control often set in very suddenly. The reactions are real and can be extremely distressing, even if no clear trigger is recognisable from the outside.

What is a panic attack?

A panic attack is a sudden onset period of intense fear or severe discomfort. It often reaches a high intensity within a short time. Some people experience them in a specific situation, others seemingly without a specific trigger.

Possible symptoms include palpitations or a racing heart, sweating, trembling, shortness of breath, a tightness in the chest, nausea, dizziness, tingling, and feeling hot or cold. These may be accompanied by a feeling of unreality, a fear of losing control, or the fear of being seriously ill or of dying.

What happens in the body during a panic attack?

Fear is, initially, an important protective response. The autonomic nervous system puts the body on high alert. Stress hormones are released, the heart rate and breathing quicken, the muscles tense up and attention is focused on potential dangers. This response prepares the body to act quickly.

During a panic attack, this alarm system is triggered even though there may be no immediately apparent external danger. The physical changes are perceived very clearly. Anyone who interprets a racing heart, dizziness or shortness of breath as signs of a catastrophe experiences additional anxiety. This can cause the physical response to intensify further.

Breathing and dizziness

When experiencing anxiety, some people breathe faster and often more shallowly without realising it. If this exhales more carbon dioxide than the body produces, its concentration in the blood can temporarily drop. Dizziness, tingling, feelings of pressure or a sense of unreality can be the result. These sensations can in turn be interpreted as a threat and intensify the panic.

However, the reference to a possible fear response must not prematurely rule out physical causes. New, unusual or severe symptoms should be medically investigated.

How does the cycle of anxiety develop?

During a panic attack, physical sensations, thoughts, emotions and behaviour all interplay. The sequence might look something like this, for example:

Many sufferers begin to observe their bodies intensively. Pulse, breathing and the smallest changes are checked repeatedly. So-called safety strategies can also develop, such as only leaving the house with a companion, always carrying a certain object, or only visiting places near an exit.

Such strategies are understandable. In the short term, they provide a sense of security. At the same time, however, one may miss out on the experience of realising that the situation can be managed even without this safety net. As a result, one’s personal freedom of action can sometimes become increasingly restricted.

Why do panic attacks seem to come out of nowhere?

Panic attacks do not always have a single, clear trigger. Often, several factors come together. These can include prolonged stress, stressful life events, physical exhaustion, lack of sleep, heightened awareness of bodily signals, or previous experiences of anxiety.

Substances and medication can also play a role. Caffeine, nicotine, alcohol, certain drugs or changes in medication can trigger or intensify physical reactions. Therefore, a careful medical history also includes asking about consumption, medication, physical health and current stressors.

Sometimes the initial trigger is not consciously perceived. The body can nevertheless react to inner images, memories, thoughts or physical sensations. The fact that an attack appears unexpected therefore does not mean that it is imagined.

When is a medical evaluation important?

Symptoms such as chest pain, shortness of breath, a racing heart, dizziness or a feeling of fainting can occur during panic, but can also have physical causes. Particularly a first-time attack, new or significantly changed symptoms as well as complaints after taking medication or substances should be evaluated by a doctor.

A medical assessment can also provide reassurance and establish a reliable basis for further psychotherapeutic evaluation.

What can help in dealing with panic?

During an acute panic reaction, the initial priority is to regain orientation. It can be helpful to feel both feet on the floor, consciously let your gaze wander around the room, and allow the out-breath to become slightly longer, calmly and without pressure. Forcibly deep breathing, on the other hand, can intensify symptoms.

Some people are helped by an inner phrase such as: „My body is in alarm mode right now. I am observing the reaction and letting it pass.“ This is not a guarantee that the anxiety will subside immediately. However, it can help to evaluate the sensations in a less catastrophic way.

Psychotherapeutic support

During psychotherapy, it can first be clarified together how the attacks develop, which triggers and appraisals play a role, and which situations are now being avoided. Cognitive behavioural therapy approaches, in particular, are well researched scientifically. These include psychoeducation, working on anxiety-intensifying appraisals and a carefully planned approach to feared situations or bodily sensations.

Depending on the individual’s personal history, additional stabilising techniques, work with the nervous system or processing of traumatic experiences may also be incorporated. EMDR may be considered if past experiences or inner images play a significant role in shaping the anxiety response. Whether a particular method is clinically appropriate can only be assessed following a detailed medical history.

Therefore, every therapy begins with the personal situation, potential physical and psychological comorbidities, resources, previous coping strategies and individual goals. In my private practice in Bad Schwalbach, I offer psychotherapeutic appointments in person or online.