Panic Attacks: Symptoms, Causes and Treatment Options
A panic attack is a sudden surge of intense fear that peaks within minutes and brings strong physical symptoms: a pounding heart, breathlessness, dizziness, chest tightness and a sense of losing control or dying. Panic attacks are frightening but not dangerous in themselves. They're the body's alarm system firing when there's no real threat, and they respond well to psychological treatment, particularly CBT.
If you're having chest pain or symptoms for the first time, see a doctor or call 000 to rule out a medical cause. Once that's been done, the information below can help you understand what's happening.
Common symptoms of a panic attack
Symptoms usually build rapidly and peak within about ten minutes. They can include:
racing or pounding heart
shortness of breath or a smothering feeling
chest pain or tightness
dizziness, light-headedness or feeling faint
trembling or shaking
sweating, chills or hot flushes
nausea or stomach discomfort
tingling or numbness, often in the hands or face
feeling detached from yourself or your surroundings
fear of losing control, going crazy or dying
Many people's first panic attack ends in an emergency department, convinced they're having a heart attack. That's an understandable response to frightening symptoms, and getting checked is the right call. When tests come back clear, the experience can still leave you shaken and watchful.
Why panic attacks happen: fight or flight
Your body has a built-in threat response designed to help you survive danger. When your brain detects a threat, it releases adrenaline, which:
speeds up your heart to pump blood to your muscles
speeds up breathing to take in more oxygen
tenses muscles in preparation to fight or run
diverts blood away from digestion (hence nausea)
sharpens attention on the threat
In a panic attack, this system activates without a real external danger. Common contributors include prolonged stress, poor sleep, caffeine, stimulants, hormonal changes, a period of illness, or a history of anxiety. Sometimes there's no obvious trigger at all, which is part of what makes panic attacks so unsettling.
The panic cycle
A single panic attack doesn't mean you have panic disorder. Panic disorder develops when people start fearing the attacks themselves. The cycle looks like this:
Trigger: a physical sensation such as a skipped heartbeat, feeling hot or light-headed.
Catastrophic interpretation: "Something's wrong with my heart" or "I'm going to faint."
Anxiety rises, releasing more adrenaline.
Symptoms intensify, which seems to confirm the fear.
Panic peaks, then subsides.
Fear of the next attack leads to scanning your body for signs and avoiding situations where attacks have happened.
Over time, people may avoid exercise (because a raised heart rate feels like panic), coffee, driving, shopping centres or being far from home. When avoidance becomes widespread, this is sometimes called agoraphobia.
Grounding techniques for the moment
These won't cure panic disorder, but they can help you ride out an attack.
Slow the breath, emphasise the out-breath. Breathe in gently through your nose for about four counts and out for about six. Longer exhales help activate the parasympathetic "rest and digest" system. Avoid gulping big breaths, which can worsen light-headedness.
5-4-3-2-1 grounding. Name five things you can see, four you can feel, three you can hear, two you can smell and one you can taste. This pulls attention out of internal alarm and into the present.
Name what's happening. Saying to yourself "This is a panic attack. It's adrenaline. It will pass" can interrupt the catastrophic interpretation.
Let it peak rather than fighting it. This sounds counterintuitive, but trying to force panic away often intensifies it. Allowing the wave to rise and fall usually shortens it.
Stay where you are if you can. Leaving teaches your brain the situation was dangerous. If you can stay until the panic settles, you learn that it passes on its own.
Treatment for panic attacks and panic disorder
Cognitive behavioural therapy
CBT has strong evidence for panic disorder. It typically includes:
Education about the fight-or-flight response, so the symptoms become less mysterious
Cognitive work to examine catastrophic interpretations of body sensations
Interoceptive exposure: deliberately bringing on harmless panic-like sensations (for example, spinning in a chair to feel dizzy or running on the spot to raise your heart rate) in a controlled way, so they lose their power to trigger fear
Situational exposure: gradually returning to places and activities you've been avoiding
Dropping safety behaviours like always carrying water, sitting near exits or needing someone with you
ACT and mindfulness
ACT helps people make room for uncomfortable sensations rather than fighting them, which directly counters the struggle that fuels panic. Mindfulness practice builds the ability to observe sensations without reacting to them as emergencies.
Medication
Some people benefit from medication prescribed by their GP or psychiatrist, particularly when panic is severe. Therapy has the advantage of teaching skills that last after treatment ends.
How long does it take to improve?
Many people notice a meaningful reduction in panic attacks within a course of 6 to 12 CBT sessions, especially if they practise between sessions. Longer-standing avoidance may take more time to unwind.
When to get help
See a psychologist if you've had more than one panic attack, are worrying about having another, or have started avoiding places or activities. Panic disorder tends to become more entrenched the longer avoidance continues, so starting early helps.
Support with Satya Psychology
We offer CBT and ACT-based treatment for panic, via telehealth across Australia, in person in Nobby Beach, or through Walk and Talk sessions on the Gold Coast. Gentle walking can be a useful setting for people who've started avoiding exercise because a raised heart rate feels like panic. Book a session, or read our anxiety treatment guide for more on how treatment and Medicare rebates work.
This article is general information. If you have new or unexplained chest pain or breathing difficulty, call 000. For crisis support, call Lifeline on 13 11 14.