What a Panic Attack Actually Is, and What Helps

Have you ever had your heart start pounding out of nowhere and wondered, for a few genuinely frightening minutes, whether something was wrong with your body? Maybe it happened in the car, or standing in line at the store, or lying in bed at the end of an ordinary day. Maybe it passed as fast as it arrived, and what stayed with you afterward was the quiet worry that it might happen again.

I'm Charles Scribner, a psychiatric nurse practitioner in Brea, and this is one of the more common reasons adults reach out to me. Here is what is actually happening in your body during a panic attack, what helps while you are in the middle of one, and what the evidence says about treating panic over time.

What is a panic attack?

A panic attack is a sudden surge of intense fear or discomfort that arrives with strong physical symptoms and usually reaches its peak within about ten minutes [1]. It is an event, and an event is not a diagnosis.

The symptoms people describe most often are a pounding or racing heart, chest pain or tightness, shortness of breath or a feeling of being smothered, trembling, sweating, dizziness, numbness or tingling in the hands or face, nausea, chills or hot flushes, and a strange sense that things around you are not quite real or that you are losing control [1][2].

Most attacks ease within twenty to thirty minutes, though the tiredness afterward can last much longer.

Why does it feel like something is physically wrong with me?

Because physically, something real is happening. A panic attack sets off the same fight-or-flight response your body would use if you were in actual danger, and that response floods your system with adrenaline [2]. Your heart speeds up to move blood to your muscles. Your breathing quickens. Blood moves away from your hands and your face, which is where the tingling comes from.

Every one of those symptoms makes sense if you are about to run from something. The difficult part is that the response has switched on when there is nothing to run from, so all that preparation has nowhere to go and you are left feeling it.

Your body is not malfunctioning. It is doing something it is very good at, at a moment when it is not needed.

Could this be a heart attack?

This is the question that sends people to the emergency department, and I want to be careful here rather than reassuring.

Some patterns are more typical of one than the other:

Please read that as background, not as a way to talk yourself out of being seen. The honest position is the one most emergency clinicians take: if you are not sure, treat it as a heart emergency and get evaluated [5]. A first episode with chest pain is worth having checked, and so is any episode with severe or crushing chest pain, pain spreading to your arm or jaw, fainting, or an irregular heartbeat. Call 911 for those.

Being evaluated and reassured costs you an afternoon. The other mistake costs more than that.

Does one panic attack mean I have panic disorder?

No, and this is worth saying clearly because a lot of people assume otherwise.

Panic attacks are far more common than panic disorder. Panic disorder is a specific diagnosis, and it requires repeated unexpected attacks together with ongoing worry about having another one, or changes to how you live in order to avoid one [2]. An estimated 2.7% of U.S. adults had panic disorder in a given year, and about 4.7% experience it at some point in their lives [3].

A single attack during a stressful stretch is a fairly ordinary thing for a nervous system to do. What tends to turn attacks into a disorder is not the attacks themselves so much as the fear of the next one, and the way life quietly narrows around avoiding it.

That fear is worth pausing on. The attack itself usually arrives with no storyline you can even name, which is why so many people tell me theirs came out of nowhere. The dread of the next one is different. It lives entirely up ahead, in a future that has not arrived, and it is the part of this that most resembles ordinary anxiety. That is where the disorder takes hold, and it is also where treatment gets its foothold.

What helps while it is happening?

Slowing your breathing down helps, and there is reasonable evidence behind it. Breathing at roughly five or six breaths a minute, with the out-breath longer than the in-breath, lowers physical arousal, and a meta-analysis of randomized trials found breathwork associated with lower self-reported anxiety than control conditions [6]. It will not stop an attack the way a switch stops a light, and it is not supposed to.

The second thing that helps is naming what is happening. Telling yourself that this is a panic attack, that it will peak and pass, and that you have felt this before, takes some of the fuel out of it. Fighting the sensations tends to make them louder.

There is one honest caution worth adding here. If slow breathing becomes the thing you must do or something terrible will happen, it has stopped being a tool and started being what clinicians call a safety behavior. Safety behaviors quietly keep panic alive by never letting you learn that the feared outcome does not arrive, which is the same mechanism that keeps a compulsion going in obsessive-compulsive disorder [7]. That is one of the things good treatment works on directly.

What actually treats panic over time?

Panic is one of the more treatable things I see. For most people the plan has two parts, therapy and sometimes medication, and they tend to work best together.

Therapy is the foundation

I want to be plain about this. Therapy is not the optional half of the plan. It is the part that teaches your nervous system something new and lasting, and it holds up well after treatment ends.

Cognitive behavioral therapy is the first-line treatment for adults with panic disorder, and it has held that position across a large body of research [4]. The component of it that the evidence supports most strongly is interoceptive exposure, which sounds clinical but is fairly plain in practice. You deliberately bring on the physical sensations you are afraid of, in small and controlled ways, so your nervous system gets repeated evidence that a racing heart or a light head is uncomfortable rather than dangerous. A component analysis of CBT for panic found interoceptive exposure and face-to-face delivery associated with better outcomes [4].

When trauma is part of the picture, EMDR is often the better fit, and national treatment guidelines list it among the recommended therapies for post-traumatic stress disorder in adults [8]. Alongside either one sit the skills you can carry with you, which are slow paced breathing, self-awareness, and the practice of returning to the present.

Where medication fits

Medication can be a valuable part of the plan, especially when attacks are frequent, when panic sits alongside depression or another anxiety condition, or when someone is too overwhelmed to do the therapy work until the volume comes down a little.

The usual starting point is an SSRI, the class that includes sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac). SSRIs and the related SNRIs are both considered first-line medication treatment for panic disorder [9]. They work gradually over a few weeks and act on the underlying anxiety rather than on any single attack. Which one, and whether medication makes sense for you at all, is a conversation with a prescriber who knows your history. If you have tried medication before and had a rough time with it, that history is useful information rather than a dead end, and it is one of the reasons I sometimes look at how your body processes psychiatric medication.

A closer look at propranolol

One medication I like to talk about is propranolol, because it works in a way that surprises people.

Propranolol is a beta blocker. In the strictest sense it is a heart medication, and what it does is block the effect of adrenaline on the body [10]. Adrenaline, as the earlier part of this article describes, is exactly what drives the physical side of panic, including the pounding heart, the fast breathing, the sweating and the tension. Propranolol turns down the volume on all of that before it can build.

Why that matters is the loop. In an anxious moment you feel your heart speed up, you read that racing heart as a sign that something is wrong, and the fear of the sensation feeds more of it. You become anxious because you are feeling anxious, and it spirals. By quieting the physical response, propranolol keeps that ramp from getting started. That is why its most familiar use is performance or situational anxiety, meaning giving a speech, walking into a presentation, or doing the specific thing that reliably sets your body off [10]. Taken beforehand, it lets you feel more like yourself when it counts.

A few honest caveats, and they matter. Propranolol works on the body and not on the storyline, so it does little for the worrying thoughts themselves, which is part of why it usually sits alongside therapy rather than replacing it. It is not approved by the FDA for anxiety, so this is an off-label use [10]. It is not right for everyone: a naturally low heart rate, low blood pressure, asthma or other breathing conditions, and several other factors all matter, and propranolol in particular is non-selective, which is why a prescriber checks these before you start [10]. On the other side, it is not sedating and not habit-forming, which for many people is a real advantage.

I mention propranolol partly because it helps, and partly because it illustrates something about this work. The most useful medication is not always the one filed under anxiety. Matching the right approach to the right person is most of the job, and that is a longer conversation, and a good one to have in person.

A note on trauma

For some people the body's alarm was set by something that genuinely happened. When there is a history of trauma, the sentence "you are safe now" is truer than it feels but much harder to settle into, and panic can be tangled up with it. That does not change the direction of the work, but it usually means the work needs its own careful, unhurried approach. It is worth naming early rather than working around.

How do I get help for panic in Brea, or anywhere in California?

I see adults at my office in Brea and by telehealth across California. A first visit for panic is mostly conversation. We go through what your attacks look like, when they started, what you have already tried, and what your life has quietly reorganized around, and then we decide together what a reasonable plan looks like.

Questions I hear a lot

Can a panic attack actually hurt me? The attack itself is not physically dangerous, though it certainly does not feel that way while it is happening. That said, symptoms that look like panic can occasionally have other medical causes, which is part of why a proper evaluation matters.

How long do they last? The peak usually comes within about ten minutes and most attacks settle within half an hour. Feeling wrung out for the rest of the day afterward is normal.

Is worry the same as a panic attack? No, though they are different shapes of the same underlying thing. Worry tends to be the slow, running version. A panic attack is the acute, all-at-once version. Both respond to treatment.

Will I need medication forever? Not necessarily, and for many adults medication is not the whole plan or even the main part of it. Therapy has good durability after treatment ends.

Can this be treated over video? Yes, for most people. Panic responds well to structured work that translates to telehealth, and I see patients across California that way.

This article is education rather than medical advice, and it is not a recommendation for any specific treatment or medication. Please talk with your healthcare provider about your own situation. If you are in crisis, call or text 988 to reach the Suicide and Crisis Lifeline.

One small step

You do not have to decide about therapy or medication today. If you have had an attack and have been bracing for the next one ever since, the doable next step is putting words to it with someone who works with this regularly. Reach out through the contact form and we will talk through what has been happening.

References

1. Cleveland Clinic. Panic Attacks and Panic Disorder. https://my.clevelandclinic.org/health/diseases/4451-panic-attack-panic-disorder

2. National Institute of Mental Health. Panic Disorder: When Fear Overwhelms. https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms

3. National Institute of Mental Health. Panic Disorder statistics (National Comorbidity Survey Replication). https://www.nimh.nih.gov/health/statistics/panic-disorder

4. Pompoli A, et al. Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychological Medicine, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137372/

5. Cedars-Sinai. Heart Attack or Panic Attack: How to Tell the Difference. https://www.cedars-sinai.org/stories-and-insights/expert-advice/is-it-a-heart-attack-or-a-panic-attack

6. Fincham GW, Strauss C, Montero-Marin J, Cavanagh K. Effect of breathwork on stress and mental health: a meta-analysis of randomised-controlled trials. Scientific Reports, 2023. https://pubmed.ncbi.nlm.nih.gov/36624160/

7. National Institute of Mental Health. Obsessive-Compulsive Disorder (OCD). https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd

8. American Psychological Association. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. 2017. https://www.apa.org/ptsd-guideline/ptsd.pdf

9. Garakani A, et al. Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in Psychiatry, 2020. https://pmc.ncbi.nlm.nih.gov/articles/PMC7786299/

10. Farzam K, Jan A. Beta Blockers. StatPearls, StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532906/