Panic attacks can be frightening to anyone who suffers from them: it can seem as if the world careens out of control. The heart pounds, breathing feels difficult, and a person can shake or tremble. These feelings are sudden and intense, cresting within ten minutes or so before subsiding. A person can have several panic attacks in a row, making the attacks seem endless.

It’s easy to feel helpless in the face of a panic attack, but there are things you can do to control them. It helps to know what a panic attack is, what it isn’t, what symptoms are typically involved, and how to lessen those symptoms.

Panic Attack Symptoms

A panic attack is a sudden and intense surge of fear or extreme discomfort. When we think about or encounter stressful events, we can become anxious, activating a section of the brain called the amygdala. The amygdala is the center of the fight or flight response. It helps prepare the body to either fight or flee: getting needed oxygen to the muscles, increasing muscle tension and elevating heart rate and breathing. When a person does not engage in actual fight or flee, the brain recognizes the fight or flight response itself as anxiety-provoking. The result becomes a cycle of anxiety, escalating into panic attacks.

Panic attacks need to be diagnosed by a licensed clinician. Clinically, the Diagnostic Statistical Manual V (DSM-5) defines a panic attack as a sudden surge of intense fear or discomfort that peaks in minutes and contains four or more of the following symptoms:

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded or faint
• Fear of losing control or “going crazy”
• Feelings of unreality or being detached from yourself
• Fear of dying
• Paresthesia (numbness or tingling sensation)
• Chills or hot flushes

Not everyone will experience all of these symptoms, but even four of these symptoms are enough to make a person feel highly uncomfortable.

Panic Attacks vs. Anxiety Attacks

Though people use these terms interchangeably, they are two different things. Panic attacks come on suddenly, usually without a trigger, and are intense. They are classified on their own as a panic disorder in the DSM-5. In contrast, anxiety attacks are less intense, usually follow a period of heightened worry or anxiety, and can be a part of several different anxiety disorders.

Anxiety attack symptoms are similar to those experienced in panic attacks and can include:

• Startling easily
• Fear, worry or distress
• Chest pain or rapid heart rate
• Fatigue, dizziness or lack of concentration
• Irritability
• Pain or numbness
• Hyperventilation
• Sleep disturbances

Anxiety attack symptoms can persist for days or weeks.

Helpful Tips for Stopping Panic Attacks

There are tools you can use to help control panic attacks. You may try several to determine which techniques work best for you. Practice them regularly to initiate a calming response as soon as the technique is engaged.

Deep breathing

Evidence shows that deep breathing greatly reduces anxiety. As the breathing calms, so does the fear. Breathing techniques and preferences vary among people: through their nose, through their mouth, or a combination of inhaling through the nose and exhaling through the mouth. Singers and yoga practitioners often use diaphragmatic breathing or “belly breathing”: the belly releases in the inhalation, and the diaphragm descends, allowing air into the lower part of the lungs.

Meditation

Because so many feel a sense of unreality or a sense of being detached from themselves during a panic attack, meditation can help ground a person into the present moment. Using an anchor such as the breath pulls a person from their fear back into their body. Regular practice cues a calming response.

Grounding techniques

Grounding techniques are a great way to interrupt the fight or flight response and bring a person back to their surroundings. The 5-4-3-2-1 technique is a great way to start. As you sit quietly, observe the area around you. See the space you are in.

• Name five items you can see around you.
• Name four things you can touch around you.
• Name three things you can hear, preferably outside your body.
• Name two things you can smell — you may need to take around your environment to do this.
• Name one thing you can taste — notice and taste the inside of your mouth.

Holding an object and focusing on it can also help ground a person into the present moment. Noting an object’s structure, color and feel in the hand can all refocus attention away from anxiety-provoking thoughts.

Mantras

Mantras are repeated syllables or phrases that calm the body and mind. Born out of mindfulness meditation, mantras are another anchor to the present moment. A mantra may be repeated silently internally or spoken or chanted aloud.

Studies show that chanting for ten minutes improves mood and social cohesion. The syllable “om” contains a hum and has long been used as a mantra to calm the body and mind. Ten minutes of humming also releases nitrous oxide (laughing gas), which helps blood flow and muscle relaxation.

Muscle Relaxation Techniques

High levels of anxiety often come with high levels of muscle tension. Applied relaxation techniques such a progressive muscle relaxation have been shown to help reduce the anxiety that may trigger a panic attack. Progressive muscle relaxation interrupts the fight or flight response and elicits a calming effect, lowering heart rate and muscle tension.

To begin, sit comfortably and calm your breath. Begin at the feet and work up the body, tensing and releasing muscles one by one. Noticing how much more relaxed muscles are after releasing them. Work slowly and methodically, breathing through each cycle of tension and release.

Light Exercise

Adrenaline levels are exceptionally high during a panic attack. One way to interrupt the attack is to divert that adrenaline into another activity: exercise. By mimicking a person’s physical actions in fight or flight, the body moves through the adrenaline, calming the body and ending the panic attack. Go for a run, a brisk walk, do some aerobics or dance to a favorite tune. Once the adrenaline surge has stopped, the mind can refocus.

Mindfulness

A mindfulness practice can help you change your relationship with your anxious thoughts and feelings, enabling you to feel anxiety relief and curb panic attacks. A mindfulness meditation practice can help a person gain awareness of their thoughts and feelings as they pass without letting those thoughts or feelings overwhelm or control them. Thoughts are transient and can pass like leaves on flowing water. There are many mindfulness meditation apps available on a variety of platforms, including the Nobu mental wellness app.

Seeking Treatment for Panic Attacks and Panic Disorder

For many, additional help is needed to help curb panic attacks. Therapists, psychiatrists and medical doctors are all able to help in their own way.

Talk With a Therapist

Talking with a therapist who’s a good fit for you can help you find coping solutions that work for you. They’ll work with you on the patterns of behavior you use to deal with anxious thoughts and feelings.

Therapists vary in their approach to therapy. Many clients respond well to therapists using cognitive-behavioral approaches, including some of the techniques already discussed. Working in this way can often empower a client who has been feeling controlled and held back by their panic attacks.

EMDR

Eye Movement Desensitization and Reprocessing (EMDR) is a proven tool in treating a broad spectrum of anxiety issues. Developed in the 1980s, it involves rapid eye movement back and forth and from side to side while holding a traumatic thought or memory in the mind’s eye. This allows the brain to reprocess the thought or memory, making it less traumatic. This work needs to be done with a licensed clinician who has been specially trained.

Medications

There are times when medication can help reduce the symptoms associated with panic attacks. Medications are usually effective in the short term and in combination with other treatments and tools, like therapy. Any medication must be prescribed and monitored by a medical doctor or a psychiatrist.

There are three classes of medications that are effective in treating panic attacks and panic disorder:

• Selective Serotonin Reuptake Inhibitors (SSRIs): This class of antidepressants includes fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): Another class of antidepressants, including venlafaxine (Effexor XR).
• Benzodiazepines: These sedatives calm the central nervous system. This class of medications includes alprazolam (Xanax) and clonazepam (Klonopin). They are addictive and cannot be used long-term. It can be dangerous to use alcohol or other drugs in combination with this class of medications.

Dealing with panic attacks can seem overwhelming, but it is possible. Developing a working plan to address panic attacks can help curb them in the long term. Moreover, developing good coping skills and mechanisms reduces the toll that anxiety can take in your daily life, helping you feel empowered and in control again.

Taking the Next Step

Do not be afraid to reach out for help. The Nobu mental wellness app offers free tools and resources to practice meditation, deep breathing and mindfulness techniques. You can also access online sessions with licensed therapists for an additional cost, some or all of which can be covered by your health insurance. Download the Nobu app on the App Store or Google Play store and take steps towards your mental wellness goals.