As a patient of mine described it, «experiencing a panic attack can be an overwhelming and terrifying experience. It’s like suddenly being engulfed in a whirlwind of intense emotions and physical sensations, without any warning or control over what’s happening to me. The onset is often rapid, and it feels like my heart is pounding out of my chest, almost as if it might explode.

My breath becomes shallow and rapid, and I struggle to catch my breath, making me feel like I’m suffocating. It’s like my body is on high alert, and I’m convinced that something terrible is about to happen, even though I can’t pinpoint exactly what that something is. My mind races with anxious thoughts, and I find it nearly impossible to focus on anything else. It’s as if my thoughts are running wild, and I’m trapped inside this chaotic mental state.

Everything around me seems to blur, and I might feel detached from reality, almost like I’m living in a dream. At the same time, my senses become hypersensitive, making even the smallest sounds or movements feel overwhelming. The world becomes a frightening place, and I just want to escape from it all.

Physically, my body might tremble uncontrollably, and I might break out in a cold sweat. Nausea can also set in, adding to the discomfort and distress. It’s like a vicious cycle – the more my body reacts to the panic, the more terrified I become, which only fuels the symptoms even further.


The whole experience is utterly exhausting, both mentally and physically. After the panic attack subsides, I’m left feeling drained, as if I’ve just run a marathon. I might also feel embarrassed or ashamed, especially if the panic attack occurred in public, and I worry about others judging me for not being able to handle my emotions.

Overall, having a panic attack is an indescribable rollercoaster of fear, confusion, and desperation. It’s like being trapped in a storm of emotions and sensations, desperately seeking calm and safety amidst the chaos.»

What is a Panic Attack or Panic Episode?

Panic attacks are often unexpected episodes of intense fear with feelings of lack of control, discomfort, or terror, frequently associated with a sensation of dying. These episodes can appear for no reason or after a stressful situation, and usually evolve rapidly in a matter of 10 minutes or even less time. While the peak of intensity can be fairly quick to arrive, the average duration of a panic episode is between 5 and 20 minutes, sometimes lasting longer, even hours.

Although not all people experience it in the same way, the most common symptoms are palpitations (tachycardia), sweating, hand trembling, leg weakness, nausea, abdominal discomfort, dizziness, headache, chest tightness, choking sensation and suffocation. In more extreme cases, vomiting, fainting, or states of great confusion and depersonalization may occur. As in many cases it tends to occur unexpectedly, people have difficulty recognizing it as a symptom of anxiety and may think that they are suffering from a heart attack or other serious medical problem.

At a biological level, a panic attack is a «normal» response of our organism, but in an inconvenient situation. Let me explain, in an emergency situation or serious danger, our body launches the «Flight, Fight or Freeze Response». This means that, faced with a dangerous situation, our brain sets in motion a survival mechanism that involves the release of certain substances (mainly adrenaline and cortisol), which first activate our heart, causing it to beat faster (palpitations/tachycardia). This causes more oxygen to reach the muscles, which would allow us to run away or defend ourselves. At the same time, to supply the increased need for oxygen, our breathing becomes faster and/or deeper (hyperventilation). This mechanism also allows us to reinforce or protect some vital organs and respond better to the situation.


The problem with panic attacks is that the brain triggers this «fight, flight or block response» in situations where it is not really necessary, which deeply disconcerts us and causes us to feel as if we are going crazy or losing control.

What can I do if I suffer from Panic Episodes?

Many patients who suffer a panic attack for the first time usually call an ambulance, but it is usually not necessary to go to the hospital. Although extremely distressing and unpleasant, panic attacks are usually not dangerous and do not require hospital treatment. To manage panic episodes without pharmacological help, different guidelines can be followed, some at a cognitive level and others at a behavioral level.

First of all, when you start to feel the first symptoms of a panic attack (palpitations, muscle tension, pressure in the chest, sweating), it is very important to do a calming mental exercise. In other words, when the episode is triggered, it is very normal to think things like «I am going crazy», or «I am having a heart attack», or «I am going to lose control», which make the symptoms worse. It is very important to tell ourselves more positive messages such as, «it is just an anxiety episode, «it will pass soon», or «I am not going to die, far from it».

It is also important to give ourselves time and space to allow the anxiety (excess adrenaline and cortisol) to dissipate. To do this, certain behavioral guidelines can be performed, such as:

  • Stop what you are doing for the moment.
  • Find a quiet space or go for a leisurely walk. Being in a quiet environment can help reduce the intensity of the panic attack.
  • Do a breathing exercise, trying to breathe in slowly through your nose, holding your breath for a few seconds and then breathing out slowly through your mouth. This will help regulate your breathing and bring a sense of calm.
  • Keep the attention on the breathing, rather than on the symptoms or negative thoughts, and focus on pausing the breathing as much as possible. In this way, we will be able to lower the heart palpitations.
  • Use positive and reassuring affirmations, such as "This will pass", "It's just a panic episode", or "Of course I can handle this!
  • Give yourself plenty of time to regain your composure, rather than rushing off.
  • Seek support from someone you know and trust, and tell them what is happening to you. Sometimes, sharing your feelings can help. If you are alone, calling or texting someone you trust can also help. But remember that the important thing is to manage the panic yourself.

A panic attack is like a «brain earthquake» so if it happens once, it can happen again. It is very likely that the panic episode itself is a symptom that we are going through a period of increased stress, which has our system hyperactivated. Therefore, it is highly recommended, on the one hand, to stop and think about what is going on in our lives and how we can reduce our stress level (self-care).

On the other hand, it is highly advisable to seek psychological and even psychiatric help, because if we do nothing and the stress level remains or worsens, the probability of further episodes rises. And if you are experiencing panic attacks frequently or they significantly affect your daily life, definitely see a mental health professional as soon as possible. Therapies such as Cognitive Behavioral Therapy (CBT) can be very effective in learning to manage panic attacks and anxiety.

About the author

Guillermo Gabarain Beristain is a Psychologist and Coach at SINEWS MTI with more than 15 years of experience, licensed in both Spain and the USA to practice as a psychologist, bilingual and with international experience. Trained in scientifically validated methodologies, such as Cognitive Behavioral Therapy, Solution Focused Therapy, Gottman Method of Couples Therapy, Crisis Prevention and Intervention, as well as in Humanistic and Systemic approaches. His main activity is focused on working with adults and couples, and he is specialized in the treatment of depression and anxiety disorders, complex grief, adjustment problems due to migration, substance use disorders and addictions, and couple problems.

Guillermo Gabarain
Division of Psychology, Psychotherapy and Coaching
Guillermo Gabarain
Adults and couples
Languages: English and Spanish
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