You sit peacefully in bed and watch TV. Suddenly you feel you can’t breathe, your heart is pounding in your chest, your vision blurs and you fall to the floor unable to cry for help.

This whole ordeal lasts for a couple of minutes (you’re not sure how long because it felt like an eternity anyway) and then you get up as if nothing had happened.

You’re scared you might have a serious illness and head to the doctor. You are examined by several specialists and they conclude that there is nothing wrong with you.

Well, what then?

What is it then?

You completely lost it and you just thought you had something, or you do actually have something?

If it sounds familiar, then you need to find out that what you felt was a panic attack.

Panic attacks are a terrifying experience.

Especially the first time it happens.

Panic attacks are horrible all the time. But the first time is somehow worse.

Because the first time you don’t even know what’s happening.

What are panic attacks?

A panic attack is an episode of intense terror that often comes out of nowhere and for seemingly no reason.

Between panic episodes, you feel worried that a new episode will occur and you may develop additional disorders such as depression or alcohol or drug abuse.

Sometimes you may start to avoid situations where a panic attack is more likely to occur and, in extreme cases, you may even end up not leaving the house.

Early intervention prevents these symptoms from worsening.

How common are panic attacks?

According to the NHS, panic attacks affect around 1-2% of the population and are twice as common in women. There is no particular age group at higher risk – panic attacks occur in young people as well as in adults and the elderly.

The DSM-V diagnostic manual describes two types of panic attacks: anticipated or announced and unexpected. The announced ones occur when you are triggered by certain situations or stimuli.

For example, if you have a fear of heights, you may have a panic attack when you go out on the balcony of a very tall building.

Unexpected panic attacks happen for no apparent reason. These are also the symptoms most commonly associated with a diagnosis of panic disorder.

Symptoms and manifestations of panic attacks

The first panic attack usually comes out of nowhere and can scare you so much that you will do anything to protect yourself from a future attack.

You may start to avoid the place where the first attack happened, you may not leave the house until after you’ve made sure you have your phone or other items that make you feel safe. You can try to put it out of your mind, anything to take the fear away.

With all the precautions you take, you continue to have panic attacks in different situations.

Some you expect, like getting stuck in an elevator or in a crowd. But some continue to surprise you.

For example, a panic attack during the night, which wakes you from a deep sleep and won’t let you fall asleep, could be an even more traumatizing experience than the first attack and leave you feeling like you have nowhere to hide from panic attacks.

Every panic attack ends without killing you, without you going crazy, without any of the dangers you feared at the time of the attack, but the fact that you’ve survived another attack is usually not enough to reassure you.

You might think you’ve escaped scot-free just because you left a busy place, pulled your car over or called a friend.

This is precisely what maintains the panic disorder, the fact that you credit your survival to something as trivial as talking to someone close to you.

As long as you think that’s all that saved you, you’ll call someone whenever you have another attack.

And what happens when they don’t answer the phone?

That’s why an important part of recovery is learning to stop relying on such help.

The symptoms are acute and can be very frightening for the person experiencing them, especially if it’s the first time they’ve experienced them. Symptoms last from 5-10 minutes up to several hours in extreme cases (however, in most cases, the plateau occurs after 20 minutes).

The frequency of panic attacks varies from person to person: some experience 1-2 attacks per month, while others may experience several attacks per day.

The place or situation in which the attack is triggered varies just as much, but it also gives clues as to the cause of the panic attack: the attack can be triggered while shopping, driving, walking down the street, relaxing at home, watching TV and even while sleeping.

As well as the overwhelming feeling of fear, panic attacks can also include the following symptoms (usually not all at the same time):

• shortness of breath or a feeling of suffocation (shortness of breath – a lump in the throat)
• dizziness or fainting
• hot or cold flushes (chills)
• profuse sweating
• shivering
• chest pains, extrasystoles and heart palpitations (often mistaking a panic attack for a heart attack)
• fear of dying – the feeling of losing control of your body
• fear of losing your mind
• sweaty palms
• facial flushing
• numbness or tingling in your limbs
• nausea
• dry mouth
• frequent urination or diarrhea
• muscle spasms
• ringing in the ears
• depersonalization: feeling separated from your own body

It’s important to say that a panic attack can look different from person to person and is experienced differently by everyone.

The symptoms above are the most common, but you may not necessarily feel all of them.

Chest pain and panic attacks

Chest pain is usually a very worrying symptom because we usually associate it with a heart problem, especially angina pectoris or a myocardial infarction (heart attack).

Although chest pain can be related to these conditions, it can also be caused by panic attacks.

The chest pain that occurs in a panic attack is caused by the severe muscle contraction that occurs at the onset of the attack. The chest may hurt for hours or even days after a panic attack.

Chest pain is the symptom that can most often bring you to the hospital or doctor.

A doctor will easily distinguish between a panic attack and a heart problem.

An electrocardiogram will show tachycardia but, if you’re having panic attacks without any physical damage, it won’t show the specific changes that are commonly present in someone who has had a heart attack.

That is, it will show clearly on the EKG whether or not you’ve had a heart attack.

Consequences of panic attacks

Because of the intensity of panic attacks and the association with morbid thoughts, you feel that you can’t relax even after the attack stops.

The constant worry that another attack will occur throws you into a vicious cycle of living in a perpetual ‘fear of being afraid’, which further reinforces the panic and anxiety.

The effects of this anticipatory anxiety are devastating to your self-esteem and self-confidence and can seriously affect your normal, everyday functioning.

If panic attacks are left untreated, what is called phobic avoidance develops, which is the avoidance of those situations or places that increase the risk of having a panic attack. If this behavior is not stopped, agoraphobia (fear of open spaces) will develop.

Agoraphobia is a common complication of panic attacks and the NHS estimates that 1 in 3 people who suffer from panic attacks will develop this disorder.

If you’re agoraphobic, you’ll be afraid to leave your home and avoid risky situations, especially the following:

• going places where a panic attack might make you uncomfortable: you will avoid going out with friends, going to work or visiting relatives
• leaving the house without the company of someone you trust (usually your partner or a close relative)
• consuming any substance that could precipitate an episode: coffee, alcohol, foods high in sugar
• physical exhaustion: if you are sedentary, you will become even more sedentary, to the point where any form of physical exertion will make you overly tired
• driving a car or using public transport from which you can’t easily escape (especially the underground)

The intensity of agoraphobia can vary, for example, some people can leave the house alone without problems, but only if they go somewhere they know and perceive as safe (e.g. to the shop in front of the block).

Hypochondria is another possible consequence of repeated panic attacks. Because you feel the physical effects, your tendency is to pay more and more attention to the manifestations of your own body. This increased focus will cause you to constantly find new reasons to worry that you might be suffering from a serious illness.

This leads to endless trips to the doctor or hospital and numerous, often unnecessary, medical investigations. The underlying question is: “what if I do have something?”.

All these health worries can affect your performance at school or work, lead to substance or alcohol abuse, cause money problems (because you either stop going to work or waste money on all sorts of unnecessary and expensive medical investigations), depression and even suicidal thoughts.

Another serious consequence is a damaged relationship with people close to you. Usually, when you have panic attacks, you become dependent on others to do even simple things and others, at some point, begin to feel overwhelmed by your increasingly irrational demands. This constant nagging can cause them to distance themselves from you, which will amplify your symptoms.

Panic attacks in children

Panic attacks are less common in children but, because they often involve desperate screams and cries of pain, they are a cause of extreme concern for everyone who witnesses them, especially parents.

When severe, they can affect a child’s development, especially if they prevent them from leaving the house to go to school or disrupt their interactions with other people.

Panic attacks at night while sleeping

Although it may sound strange, you can have a panic attack at night while asleep.

These nocturnal attacks are similar to those during the day, with the difference that the symptoms occur during sleep and wake you up with their intensity. Because you are asleep, you are totally unprepared to deal with this attack, even more unprepared than during the day.

Other common symptoms of nocturnal attacks are feelings of depersonalization, feeling like you are dreaming or watching yourself from a distance.

The consequences of panic attacks during the night are that you will feel tired during the next day, which will increase your anxiety and further disturb your sleep pattern.

Causes of panic attacks – why panic attacks occur

The scientific world has not agreed on the definite causes of panic attacks.

What is known for sure is that most often panic attacks are related to major stress caused by traumatic experiences or major changes in a person’s life.

There are other theories as to what causes these episodes, such as imbalances in the structure of neurotransmitters in the brain or increased sensitivity to carbon monoxide in the air we breathe.

While I can’t dispute the validity of these theories, in my practice I have not seen any cases that do not respond to therapy, so I have some doubts about these ideas. Even though they may be aggravating factors, the fact that the patient responds to therapy to me is a signal that the nature of the condition is not physiological.

I have also heard the misconception that only a person with a mental disorder experiences panic attacks.

This is false.

While it is true that a person with a disorder can also have a panic attack, in reality anyone can have panic attacks, with or without a diagnosis of a mental disorder.

In fact, according to some statistics, 13% of the total population is prone to panic attacks.

Factors that aggravate panic attacks

In addition to stressful events in one’s life, panic attacks can also be triggered by a poor physical state, either due to illness or physical exhaustion: if someone does not sleep well, does not eat properly and does not drink enough water, the risk of having a panic attack is considerably higher.

As I said above, in my experience panic attacks have different causes from physical ones.

But in order to reach this conclusion, possible medical causes have to be ruled out first.

If you have symptoms but you’re not absolutely sure it’s a panic attack, see a doctor!

The fact that it may be a panic attack should not be used as an excuse not to take the situation seriously.

In addition, one of the important cognitive-behavioral interventions for panic attacks is to remind yourself that, although frightening, the panic attack is not physically dangerous and that you will most likely not die in those moments, even if you feel that you will.

Think of it this way: how could you be repeating this idea to yourself if you haven’t eliminated the medical cause?

There are a number of medical conditions that can cause panic attack-like symptoms but they are real, physical medical conditions that require medical treatment. They are:

• hyperthyroidism: over-activity of the thyroid gland
• hypo-glycemia: low blood sugar
• drug withdrawal
• use of neuro-stimulants: coffee, alcohol, amphetamines, cocaine
• Prolapsed mitral valve: a minor heart condition that means one of the heart’s valves does not close completely

My personal experience with panic attacks

Related to the last point on the previous list, I want to tell you about my personal experience with panic attacks.

Specifically, the first panic attack I experienced was caused by a “small mitral valve prolapse” when I was 6 years old. Simply put, a valve in the heart had not closed properly at birth (they normally close at birth and then the baby starts crying) and this caused a systolic murmur, meaning the heart was beating strangely (I’m simplifying the explanation a lot).

It wasn’t serious what I had, I was cured without medication, just a change of lifestyle and regular medical checkups, but at 6 years old I had no way of knowing that.

Then I had another series of mild anxiety attacks 1 year before I left the corporation. When I decided I was going to leave, they disappeared completely.

They didn’t disappear when I left, they disappeared when I decided to leave. Reread that last sentence carefully, because it’s one of the keys to getting rid of panic attacks.

Why am I telling you this?

First of all, so you know that I’ve experienced the effects of panic attacks first hand, and I’m not just speaking from books.

Secondly, and much more importantly, as a request, especially if you haven’t personally experienced it: don’t trivialize panic attacks because it is an absolutely terrifying experience.

I often hear ideas from people around those affected by panic attacks that the person is “just showing off”, “needs attention” or even “acting crazy”.

It’s not like that at all and, going back to what I told you about myself, I’ll add one more thing: even though it happened almost 30 years ago, I remember everything that happened then perfectly: the clawing in my chest, the choking (I was gasping for air and it felt like it wasn’t going into my lungs), the conviction that I was going to die in the next few minutes, the blurring of my vision and the feeling of fainting which I interpreted at the time as the belief that that was it, end of story, that was that.

You can imagine how traumatizing it was for the child at the time if I haven’t forgotten any of the details (I remember many other details I don’t want to bore you with, including what I was wearing for example).

And now consider that we’re only talking about one episode.

How do you think someone who goes through this a few times a day is feeling?

What do you do when you have panic attacks?

Before you get to more complex solutions, you need to know how to act immediately in the event of a panic attack. Here’s what you can do immediately.

If you can, sit down or even lie down. The best position is the fetal position (like a baby in its mother’s womb): on your side, with your back curved and your knees pulled in towards your chest (not too tightly, because you want to avoid compressing your lungs). This position can be applied in much the same way when sitting in a chair, for example.

If you are wearing tight or tight-fitting clothes and this is possible, undress them or undo as many buttons as possible. If you wear a tie, loosen the knot.

Concentrate on your breathing: breathe steadily and belly deep, don’t try to inhale a large amount of air (which is counter-intuitive, as you’ll be tempted to do this if you feel you’re suffocating).

Get someone to sit with you: often the mere presence of someone close to you will help you relax, without the need for them to do anything other than simply sit with you.

As soon as your symptoms disappear, I encourage you to make an appointment with your GP.

The next steps are to see a specialist (cardiology, neurology, etc.) and then (if there are no medical conditions), to come to talk to me.

Treatment for panic attacks – herbal remedies and medication

Apart from psychotherapy, there are a number of other possible interventions.

From my experience I can tell you that they are not as effective. These are:

Medications: mainly antidepressants (Zoloft), anxiolytics (Anxiar) and benzodiazepines. The best known drugs in this class are Diazepam and Xanax.

As these drugs have serious side-effects and are addictive, my recommendation is to use them only as a last resort (if the situation is serious and you do not respond to psychotherapy) and only after consulting a psychiatrist.

Don’t start taking them on your own because we are not talking about Aspirin, we are talking about psychotropic drugs that are extremely powerful and dangerous if taken by ear.

The widespread use of drugs to treat panic attacks is questionable to say the least.

Homeopathic remedies: in general, any homeopathic remedy relies on the placebo effect. In other words, it doesn’t actually work on a biological level, just the idea that you are taking something to change your condition. From this point of view, these remedies are much easier to recommend than drugs.

Herbal remedies: some herbal extracts can have a calming effect (especially valerian – a powerful natural sedative), but don’t rely on them to solve the problem, they are an option to control the symptom and that’s all. They have roughly the same counter-indications and risks as drugs (just because they’re herbal doesn’t mean they’re not dangerous – even mugwort is an herb, and it’s a poisonous herb that can kill you).

Acupuncture, yoga, massage therapy and meditation: less intrusive, these therapeutic methods have fewer contraindications and can help control symptoms through the relaxation they induce. They don’t solve the underlying problem, but they can help.

How you can help someone having a panic attack

Educate yourself about panic attacks: read this article, send it to a friend who might need it, share it on social networks, search the internet for other resources.

Stay calm: the best way to help someone having a panic attack is to speak calmly and reassure them that the attack will pass.

Reassure the person that everything is okay: a panic attack can make you think you are having a heart attack and will die. That’s why it’s important to reassure the person that this won’t happen, that it’s just a panic attack and they are not in danger. Panic attacks usually peak within 10 minutes of onset.

Encourage the person to breathe slowly and steadily. It helps if you make hand gestures: up for inhaling, down for exhaling.

Don’t patronize the person. Lines like “get over it” or “think of something else” don’t help. Neither do commands like “relax” or “cool it”.

Don’t try to distract them, because unless they’re a 3-year-old, it won’t work.

Assure the person that the panic attack will eventually pass.

Stick around: sometimes someone having a panic attack may want to leave the place they are in and be alone. But most of the time, this only makes their symptoms worse. It helps more if you stay with them and apply the previous points in this list.

Psychotherapy for panic attacks

When it comes to panic attacks, the tendency for many people is to automatically turn to cognitive behavioral therapy (CBT).

In my opinion, CBT doesn’t solve the underlying problem, it only addresses and relieves the symptoms, similar to medication but without the side effects associated with it.

There is nothing wrong with this approach if the goal is just to feel better now.

In the long term, however, the underlying problem is not solved and, as such, the symptoms may either reappear or turn into something else (e.g. depression).

The alternative I suggest is psychodynamic therapy (such as my own Adlerian therapy, analytic therapy or psychoanalysis).

The psychodynamic approach directly addresses the underlying problem and considers the panic attack to be a symptom of the problem, not the problem itself.

There are studies that show the effectiveness of the psychodynamic approach in treating panic attacks: see Milrod and Shear 1991 as well as the authors Renik, Stern and Kessler. On the other hand, there are also studies demonstrating the effectiveness of the cognitive-behavioral approach. Therefore, I’m not claiming that CBT doesn’t work, I’m just saying that it’s not the holy grail for behavioral disorders.

The idea underpinning psychodynamic intervention is that panic attacks have a cause and a purpose.

Most often, it reveals the presence of an inner conflict.

For example, as the song goes, “you’ve got an idiot boss at the office”. So far so good and you could simply resign.

But for there to be conflict, there has to be at least as strong a reason for choosing not to.

So as well as having an idiot boss, you’re also getting paid very well. Here’s the conflict: what do you do, leave and miss out on the big paycheck or stay and suffer because of the way you’re treated?

If you stay hanging in the balance for too long, you may have panic attacks to convince yourself (or give yourself a good reason) to make a decision.

The panic attack will disappear when its cause disappears and that cause is conflict.

Internal conflict is not the only possible cause of a panic attack.

In general, however, the causes have one thing in common: they are situations that are hurting you and from which, for one reason or another, you are unable or unwilling to escape.

That’s where the psychodynamic approach comes in, to help you clarify the situation, the options you have and the decision you will take.

The ultimate goal is to understand what caused the panic attack and prevent it from recurring in the future.

Panic attacks are curable

No matter how long you’ve been suffering from panic attacks, it’s important to know that panic attacks are a problem that can be solved.

Panic attacks can be cured and you don’t have to let them mess up your life. Help is available, you just need to seek it and ask for it.