The first panic attack is almost always the worst, because the person does not know what is happening. Many first-attack sufferers go to the emergency room convinced they are having a heart attack or stroke. Panic attacks are not heart attacks. They are not dangerous. They feel catastrophic. Here is what panic actually feels like in the body, why it happens, and what to do when it does.
A panic attack is a sudden surge of intense fear accompanied by physical sensations. The attack peaks within about 10 minutes and resolves on its own, though the after-effects can linger for hours. The physical symptoms are the fight-or-flight response firing in a context where there is no actual threat. The body thinks it is in danger. The mind cannot find the danger. The mismatch is part of what makes panic so frightening.
Not every attack includes every symptom. Some people experience predominantly cardiac symptoms. Some predominantly respiratory. Some predominantly dissociative.
The sympathetic nervous system has activated. Adrenaline floods the system. Heart rate and breathing accelerate. Blood flow shifts to large muscle groups. Pupils dilate. Digestion slows. This is the body preparing to fight or flee, exactly the response that would save your life if a bear walked into the room. In a panic attack, there is no bear. The response activates anyway, often in response to a thought, a body sensation, or even nothing identifiable.
The instinct in a panic attack is to fight the panic. The work that actually helps is the opposite: accept what is happening, let it peak, and let it pass. The attack will peak within about 10 minutes regardless of what you do. Fighting it usually extends it.
Specific things that help:
Breathing into a paper bag is not recommended in modern panic protocols. It does not address hyperventilation in the way once thought. Caffeine and alcohol make panic worse over time. Avoiding situations where panic has happened strengthens the fear of panic, which strengthens the cycle.
A panic attack is an isolated episode. Panic disorder is the recurrent experience of panic attacks combined with significant fear of having more attacks. The fear of panic becomes its own driver. Avoidance starts. The world shrinks. This is when treatment becomes important.
Panic disorder is one of the most treatable conditions in mental health. The evidence-based treatment is a specific form of CBT that includes interoceptive exposure (deliberately producing the physical sensations of panic in controlled doses to reduce the fear of them), cognitive work on the catastrophic interpretations, and gradual reduction of avoidance.
Most clients see substantial improvement in 10 to 16 sessions.
If panic has happened more than once or twice, and especially if you have started avoiding places or situations because of it, treatment is worth pursuing now. The longer the avoidance patterns build, the more work it takes to undo them.
Curio Counselling Calgary has clinicians trained in evidence-based panic treatment. Free 20-minute consultations let you describe what has been happening and decide on the right approach. Curio Counselling Calgary is at 1414 8 St SW Suite 200, Calgary, AB T2R 1J6, in the Beltline. Phone 403-243-0303. In-person and virtual sessions across Alberta.
