Signs of a Panic Attack and Why They Happen

Do you know the signs of a panic attack? Having a panic attack can be a terrifying experience. If you’ve had an intense rush of anxiety or fear that comes out of the blue, you may have had a panic attack. Read on to learn more about common signs of a panic attack and how CBT can help.

Am I having a panic attack?

Panic attacks are short-term, intense bursts of anxiety that may come out of nowhere or be triggered by thinking about something that’s making you anxious. These rushes of anxiety often make you feel as though your heart is beating out of your chest, like you can’t take a deep breath, or like you’re having a medical emergency. 

Other signs of a panic attack might include:

  • intense apprehension
  • a feeling of impending doom
  • feeling hot
  • sensations of being smothered
  • dizziness
  • loss of balance or faintness
  • choking sensations
  • palpitations or accelerated heart rate
  • shakiness
  • sweating
  • nausea or other form of abdominal distress
  • depersonalization or derealization (feeling detached from your body or mind)
  • paresthesias (a “pins and needles” feeling)
  • chest discomfort or pain
  • fear of dying and fear of not being in control of oneself or “going crazy”

To meet the diagnosis for a panic attack, four or more of these symptoms must be experienced simultaneously. If you only have one or two of these symptoms at a time, you’re likely experiencing anxiety but not a panic attack. For most people, panic attacks reach their most severe point after about ten minutes and then start to calm down. 

If you’ve had an experience like this, you may start to worry about having another attack or about feeling any anxiety at all. You may start to avoid certain situations to prevent anxiety or uncomfortable situations. You might avoid driving, flying, waiting in lines, sitting in the middle of a theater, or situations that cause you to feel hot. It’s possible that you avoid being alone or doing things alone because you worry you might have symptoms and not be able to get help. You might also avoid any situations that make  you feel trapped or like it would be hard to escape if you started to feel panicky. This avoidance is called agoraphobia.

Why am I having panic attacks?

Knowing the signs of a panic attack can be helpful in understanding the experience. Although really unpleasant, panic attacks are totally normal. Over 30% of the population has had a panic attack in the last  year. Panic attacks are most likely the result of an interaction between biological factors, psychological factors, and environmental factors. 

Biological factors, like your genetics, may be involved. There is some evidence that anxiety and panic run in families. What is inherited is a vulnerability to have panic attacks in stressful situations. This means that you may have a brain that is more sensitive than other people’s brains to potential threat or danger. Panic attacks are responses to perceptions of danger (more on this below) so if you have a brain that is already sensitive, it may take less stress to trigger a panic attack.  

Differences in thinking styles are also likely involved in panic attacks. Many people who have panic attacks interpret their symptoms as dangerous. They might believe that a fast beating heart is a sign that something is really wrong or that shortness of breath means that they’re suffocating. Naturally, these thoughts increase anxiety, which only makes these physical sensations more intense, leading to even more catastrophic thoughts about the sensations. This escalation often intensifies to the point of a full blown attack. 

The context of life is probably also at play in causing panic attacks. Stress in particular seems to make attacks more likely. Many people report that their first attack happened at a stressful time in their life. You can think about the biological vulnerability and the environmental stress interacting together. The biological vulnerability is like having a cup that’s more full than other people’s, just at baseline. Stress adds to your cup and at some point it’s going to be too much and overflow. Because your cup is already full, it might take less stress to result in a panic attack. 

Why is it hard to breathe during a panic attack?

One of the scariest parts of a panic attack is feeling like you can’t breathe. It might be helpful to know, however, that the symptoms you’re experiencing during a panic attack are probably actually due to OVER breathing rather than from not getting enough oxygen. 

We all know that humans need oxygen to survive. The balance between oxygen and carbon dioxide in the blood is also important. After using oxygen, cells release carbon dioxide, which we then breathe out. We breathe in again to obtain more oxygen.We get balance by changing our breathing to match the needs of our cells. For example, when we exercise, breathing increases to increase the amount of oxygen we take in for our muscles to use.

When we are in a fight or flight situation, our breathing increases so that we have more oxygen to use to deal with the threat. Maybe you are going for a hike on a nice day when a bear appears out of the woods in your path. In that case, the extra oxygen goes to your muscles so you can quickly run away. 

When you have a panic attack, your breathing also increases. But since there is no threat and you’re not quickly running away, the oxygen isn’t used up. This is overbreathing. When you over breathe, the balance of oxygen and carbon dioxide in your blood gets out of balance.

The body tries to get this balance back in place by temporarily limiting the amount of blood and oxygen it releases to the body. When this happens, we have uncomfortable, but not dangerous, sensations. In our heads, we may feel confused, light headed, or have blurry vision or feelings of unreality. Our hearts beat harder and faster, we may have numbness or tingling in our hands and feet, or feel cold or clammy hands. Because over breathing is hard work, we might also experience soreness or discomfort in our chests.

The key take away from this explanation is that although panic attacks feel really scary, these symptoms are not dangerous. They actually are signs that the body is working to regulate itself and get balance back.

Practice reminding yourself that discomfort does not mean danger the next time you have these sensations. 

Does therapy for panic disorder work? 

We have a lot of research on CBT for panic disorder. A research paper written back in 1995 reviewed 43 studies, which included more than four thousand patients. The authors examined the treatment effects of both medication and therapy. 

This is what they found: 

  • Sixteen studies (including 2,708 patients) showed that medications overall had a medium-low effect on symptoms (effect size of 0.47, p<0.0001). 
  • Nineteen studies (including 832 patients) of  CBT showed an overall medium-high effect on symptoms (effect size of 0.63 (p<0.0001). 
  • The overall effect size of CBT (0.63) was significantly higher than that of medication treatments using placebo control groups (0.47, p=0.05).
  • Drop out rates were higher among patients receiving a medication intervention (20%) than those receiving CBT (6%).

Based on these data, we know that CBT for panic disorder is effective. 

How long will I need therapy for panic disorder?

This is a difficult question to answer. There are a lot of factors involved in the number of therapy sessions needed to reach therapy goals.  We typically write our initial treatment plans for about 12  to 16 weeks (or 12 to 16 sessions). Sometimes people reach their treatment goals before that time and others take a little longer. 

For panic disorder, we often ask our clients to get the Mastery of Your Anxiety and Panic by Barlow and Craske workbook, which goes along with the treatment plans we create. 

You can find that workbook online locally at Left Bank Books here or on Amazon.

If you’re in St. Louis or the state of Missouri, any of our therapists can work with you. Several therapists are also able to see clients who live in certain states via telehealth. You can find a list of those states here.

For any questions about therapy for panic disorder or agoraphobia, please don’t hesitate to call our care coordinator at 314-462-2965 or send a message through the website.