I'm having panic attacks

Having a panic attack can feel like the world is suddenly crashing down on you. You might feel numb, hot, dizzy, nauseous, have difficulty breathing and feel your heart start to race. It might also feel like your whole body is being overwhelmed by a crushing sense of fear or dread. Some people even think they are about to pass out or have a heart attack.

Overcoming panic attacks is possible. This section can help you find out more about panic attacks and why they happen, find the right support services in Leeds and find different ways you can help yourself.

What is the threat or 'flight or fight' response?

Everyone feels anxious and has a sense of panic from time to time. It's part of an automatic response called 'flight or fight' which is designed to help us respond to sudden dangers or stressful situations. We've all had that moment of panic when we can't answer a question in an exam, or a car doesn't stop when we're crossing the road, for example.

The response evolved millions of years ago when early humans often met sudden or life-threatening dangers. Faced with a saber-toothed tiger, being able to run away or fight was then vital to our survival.

The response is triggered automatically as soon as the brain becomes aware of a threat. The body goes through a number of changes to get ready to either run away or fight. Our breathing and thoughts speed up and heart starts to race. Hormones called adrenaline and cortisol are released into the bloodstream. This increases our blood pressure to help us react more quickly and makes our breathing faster so that we take in more energy for running away or leaping to safety.

Download the Flight or fight response sheet to find out what happens to the body during the response and what physical symptoms you may experience.

Flight or fight response PDF

We don't often encounter life-threatening situations these days, but the same threat response is still part of our bodily make-up. You will have experienced the response during situations that cause you fear, worry or stress - a job interview or exam, for example, or if you're running late for an important appointment.

The 'freeze' response

The threat response is sometimes now known as 'flight, fight or freeze'. If a sudden threat is detected and we don't think we can either fight off or run away from the danger - another response can be triggered to help increase our chances of survival. Responding to danger by freezing may have helped early humans to hide from a predator or fake their death so that the opponent lost interest in its prey. The freeze response may also have protected them from feeling physical pain and distress when being attacked. You can see this response in action when a mouse's body goes limp when caught by a cat. It's still not uncommon, nowadays, for people to freeze in certain situations that cause them fear or to freeze during a panic attack.

What is a panic attack?

A panic attack is a sudden rush of intense fear and physical symptoms.

The signs and symptoms of a panic attack develop quickly, without much warning and usually reach their peak within 10 minutes. Panic attacks rarely last more than an hour, with most ending within 20 to 30 minutes.

Some people may have panic attacks once in a while; while other people may have them every day. It's also possible to have one panic attack during a very stressful situation and not experience any more.

In a panic attack the 'flight or fight' response, which is very sensitive to possible danger, is triggered when someone feels frightened or under attack. This can happen even though there may not be an immediate danger in reality. Panic attacks are often described as a 'fire alarm sounding when there's no smoke or fire.'

The physical symptoms of the 'flight or fight' response are felt much more intensely than usual and can build up very quickly. They may include:

  • Breathing much faster.
  • Fast-beating heart (palpitations).
  • Shaking or wobbly limbs.
  • Chest pain.
  • Upset stomach - feeling sick or having to rush to the toilet.
  • Sweating and hot flushes.
  • Feeling faint or dizzy.
  • Dry mouth.
  • Stiff muscles.
  • Difficulty concentrating.
  • Feeling numb or frozen and unable to feel emotion.

Some people also report feeling detached from their body like they are watching themselves from a distance (known as Depersonalisation) or feeling things or people around them are unreal or unfamiliar, known (known as Derealisation).

During an attack there is an overwhelming feeling of fear that something terrible is happening. We might think we're having a heart attack, about to faint or pass out, stop breathing, vomit, lose control of our bladder or embarrass ourselves in public, for example. People who have experienced panic attacks say that they felt like the symptoms were taking over their whole body. This was so frightening they couldn't think logically and had a strong urge to escape the situation and find safety.

In reality, the panic attack itself is not dangerous. Once the feeling of intense anxiety starts to ease your heart rate will start to slow down, your breathing will become more regular and your body can quite quickly get back to normal.

It can feel that panic attacks 'come out of nowhere'. What's likely, however, is that you were feeling anxious in the time building up to an attack. And when you feel anxious you can start to breathe faster and take in too much oxygen which disrupts the balance of oxygen and carbon dioxide in the body. A lower level of carbon dioxide reduces blood flow to the brain which can trigger the physical symptoms of anxiety. Taking a breath out and then slowly breathing in can help your body to relax. We will explore more ways of managing panic attacks later in in this section.

What can keep panic attacks going?

Panic attacks are common - around one in 10 people will experience at least one attack in their lifetime. And it's quite possible to experience one panic attack in a particular situation that caused you a high level of stress and not experience any more.

It's not surprising, however, that once someone has experienced a panic attack they can start to fear having another one, especially in situations that are similar to when the first attack happened. They can also become very aware of the normal symptoms of anxiety, that we all have from time-to-time and worry that these are the signs of another panic attack starting. This worry can then make them feel even more anxious and this can help to keep panic attacks going.

It will help to look at our case study which shows this in action.

Panic attacks - case study

As we can see in the case study, a Vicious cycle can develop in which the fear of having a panic attack can make panicking more likely. You can use the blank Vicious cycle of panic sheet to look at a panic attack you've had recently and think about how your thoughts and feelings could be helping to keep your panic attacks going. You can refer to the example cycle (based on our case study) to help you complete the blank version.

Vicious cycle of panic (blank)

Vicious cycle of panic (with example)

For us to understand what can help to keep panic attacks happening it's also important to consider what professionals call 'catastrophic misinterpretation', 'safety behaviours' and 'avoidance'.

Catastrophic misinterpretation

When someone starts to panic they can mistake the strong physical signs of anxiety as evidence that something terrible REALLY IS happening. This is known as catastrophic misinterpretation.

It's common to think that a fast-beating heart is the sign of a heart attack starting, for example. Some people can also fear that they are going to be sick, lose control or might do something 'crazy' and embarrass themselves in public. Download this sheet to explore common examples of Catastrophic misinterpretations.

Common examples of catastrophic misinterpretations

Not surprisingly, someone who thinks that something terrible is happening is going to get even more anxious and scared. This can trigger another threat response making the physical sensations they're experiencing even worse. And this helps to provide further 'proof' that something bad really is happening! Some people even seek emergency assistance thinking their physical health is in danger.

The sheet below shows how Suzanne, in our case study, mistakes the symptoms of anxiety (feeling dizzy, hot, wobbly and light-headed) as signs that she might be about to faint, making her even more anxious.

Vicious cycle of panic (catastrophic misinterpretation) - with example

You can use this blank Vicious cycle to look at a panic attack you've experienced and explore how catastrophic misinterpretation could be keeping your attacks happening.

Vicious cycle of panic (catastrophic misinterpretation) - blank

Safety behaviours

Many people who start to have panic attacks dread having another one. It's only natural to want to do something to stop this from happening again. Safety behaviours are things you might do to feel safer and reduce your anxiety, in order to try and stop another panic attack from happening.

Common examples of safety behaviours include:

  • Carrying medication with you at all times.
  • Standing next to a wall to lean on in case you feel faint.
  • Listening to music on public transport to distract you from what's going on.
  • Only travelling with a friend.
  • Sitting near the exit or bathroom.
  • Going to the supermarket late at night.
  • Asking for reassurance from others that everything is OK.

The Vicious cycle of panic - safety behaviours sheet shows how Suzanne has started using safety behaviours to help her cope with her fear of having another panic attack. You can use the blank version to look at what safety behaviours you might be using.

Vicious cycle of panic - safety behaviours (blank)

Vicious cycle of panic - safety behaviours (with example)

While safety behaviours may reduce the discomfort you might be feeling, right now, you can become dependent on them and start to believe that you can't do certain things without them.

What's more, relying on safety behaviours can make you believe even more strongly that certain situations are putting you in actual danger. This can stop you from testing out just how dangerous situations really are, making it more likely that you will continue to have more panic attacks.

Avoidance

It's also common for people who are experiencing panic attacks to start escaping from or avoiding situations where they've panicked before. This is known as avoidance. They may also start to avoid places where they feel more vulnerable, at risk, unable to escape, or under increased pressure, such as:

  • A busy supermarket, a crowded train station or a packed shopping centre.
  • In a cinema, theatre, sports arena, restaurant, train, airplane or in a lift.
  • Being alone in the house (particularly at night) or driving a car.
  • Speaking in front of a group of people.
  • An environment where lots of decisions and actions are needed quickly - like being in a high-pressure workplace or in an exam, for example.
  • Places that are noisy with bright lights and lots of distractions.

These are situations where we may feel less in control of what's happening and experience certain thoughts, ideas or fears which may trigger an attack.

People can also start to avoid situations where they might experience panic-like symptoms such as exercising, having sex, drinking coffee or situations where they might need to express strong emotions.

Unfortunately, avoiding situations that you fear will mean that the next time you need to try and face the same situation the anxiety continues…

The Vicious cycle of panic - avoidance sheet can help you to identify situations and places that you may be avoiding.

Vicious cycle of panic - avoidance (blank)

Vicious cycle of panic - avoidance (with example)

Go to the MindWell self-help section for panic attacks to find ways of breaking through the Vicious cycle and help with overcoming avoidance and safety behaviours.

Why am I having panic attacks?

If you're experiencing panic attacks it's likely to have started with one particular situation one day which made you feel panicky, anxious or frightened. You may have been giving an important work presentation, trapped on a crowded bus or stuck in a lift, for example.

It's not surprising that you may have started to avoid similar situations for fear that they might trigger another attack. Unfortunately, as we have just explored, avoidance - and safety behaviours (things you might do to keep yourself safe) - can actually increase your sense of fear and help to keep attacks happening.

Our case study shows how panic attacks can develop in this way.

Panic attacks - case study

While this could happen to anyone at any time, it's also the case that some stressors or factors can reduce someone's resilience and make them more vulnerable to experiencing panic attacks. These can include:

  • Stressful life events - such as bereavement, a relationship break-down, unemployment, ill health or debt.
  • A period of stress or change - experiencing lots of difficult or challenging events or issues can start to add up and reduce your ability to cope. This could include uncertainty at work, changing jobs, health worries, money issues, arguments at home, moving house, having a baby or leaving home to go to college.
  • A stressful lifestyle - working or living in a pressurised environment or in hostile or dangerous places.
  • Difficult or traumatic life experiences - when someone experiences a frightening danger like being in a fire, a car crash, domestic abuse or a violent attack, or, has a distressing experience like harassment, hate crime or witnessing an upsetting event. This can include a single one-off event or experiences which happened over time. Panic attacks can also be sometimes related to experiences that took place in your childhood or teenage years such as experiencing neglect, physical, sexual or emotional abuse or bullying.

So while experiencing a panic attack can seem like a 'false alarm' as there may not be any immediate danger, right now - they can be linked to very real emotional problems or difficult events (including experiences that have happened in the past).

While emotional factors are more common - it is also possible for some physical health issues to cause panic-type symptoms as well, including:

  • Asthma.
  • Drinking too much caffeine or alcohol, medication issues or using certain illegal drugs.
  • Poor sleep.
  • Heart problems.
  • Hormonal or thyroid problems.
  • Low blood sugar.

Speak to your GP if you are concerned that some physical factors may be behind your panic attacks.

What is panic disorder?

When someone has panic attacks at random times and places, they can start to fear when the next one will happen. They might then avoid going out or being in certain situations where they can't leave easily if they panic. They might also become extremely sensitive to any tension or anxiety in their body and assume it's a panic attack starting.

If fears continue and these issues start to affect everyday life, it's sometimes known as Panic disorder.

Some people are affected so much that they develop a fear of being in any place where escape may be difficult. When this fear is severe it is called Agoraphobia.

If you feel that your everyday life is being affected by panic or fear of panic attacks, talking to your GP or a referral to IAPT could help.

Is it helpful to take medication?

If you're experiencing panic attacks your GP may prescribe you with some medication to help you feel less anxious. If you're taking medication it's still important to confront feared situations that you may be avoiding by self-referring to IAPT or by using this self-help guide. Medication can sometimes become a kind of 'safety behaviour' that stops you from testing out your fears and finding out that you can overcome your panic attacks. If you have any concerns or questions about your medication, or you're experiencing any side effects, talk to your GP before making any changes.

How can I help someone having panic attacks?

If someone you care about has panic attacks, it might be helpful if you know what to do when one starts. Download this sheet for help and information.

How can I help someone having panic attacks?

How could IAPT help me?

Panic attacks are treatable.

Leeds Improving Access to Psychological Therapies (IAPT) is run by Leeds Community Healthcare NHS Trust, Community Links, Touchstone and Northpoint Wellbeing. They provide a range of treatments that can help to improve symptoms of panic attacks. One option you can access without an assessment is a 6 week stress control class which has a session focused on improving these symptoms. You can book this course directly through the Leeds IAPT website.

You can read more about IAPT and how to self-refer to have an assessment to look at your needs. A number of questions will pop-up - these are to make sure you are being directed to the right service. You don't need to see your GP to access this service although your GP will be updated about your treatment.

When do I need to talk to my GP?

Many people have feelings of anxiety from time to time, and sometimes experience panic attacks during stressful times, particularly when experiencing a life change or big event.

Anyone who is worried about their panic attacks should speak to their GP. Your GP can check whether there might be a physical cause and can also help you if panic attacks are starting to have an impact on your day-to-day life.

Find support

Leeds IAPT is run by Leeds Community Healthcare NHS Trust, Community Links, Touchstone and Northpoint Wellbeing and provides assessments and a range of talking treatments.

You can self-refer to the service through an online form. A number of questions will pop-up - these are to make sure you are being directed to the right service. You don't need to see your GP to access this service although your GP will be updated about your treatment.

Local peer support group - Anxiety Leeds

Leeds Mind Peer support - offer range of support groups, workshops and courses.

Anxiety UK - a national charity which supports people with agoraphobia and other anxiety disorders and phobias.

No Panic - a national charity which helps people who suffer from panic attacks.

Find a counsellor - whilst Cognitive Behavioural Therapy (CBT) is the recommended approach for helping with panic, if you feel there are issues such as bereavement, or other life events you have struggled to adjust to, which underlie your panic it may also be helpful to seek counselling.

Online platforms - Elefriends, Big White Wall

Tools and apps

NHS Choices Moodzone - an online resource with useful information, interactive tools, and videos to support you on your way to feeling better.

Silver Cloud - a safe and secure online space offering personalised programmes to help people experiencing a range of mental health problems (available via self-referral to Improving Access to Psychological Therapies (IAPT).

Anxiety management apps in the NHS apps library

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