Understanding Panic Attacks: Causes and Coping Strategies

Panic attacks are sudden episodes of overwhelming fear accompanied by intense physical symptoms like rapid heartbeat, shortness of breath, and dizziness, but licensed therapists use evidence-based techniques including cognitive behavioral therapy to help individuals effectively manage and reduce these distressing experiences.

Ever felt like you're dying when your heart suddenly pounds out of nowhere? Panic attacks create that terrifying experience for millions of Americans, but understanding what's happening in your body and mind can help you regain control and find relief.

Content warning: This article discusses panic attacks and anxiety-related topics that some readers may find distressing. If you are currently in crisis or need immediate support, please contact emergency services or a crisis helpline in your area.

Panic attacks represent one of the most frightening experiences a person can have—a sudden surge of overwhelming fear accompanied by intense physical sensations that can make you feel like you’re losing control or even dying. Yet despite how isolating these episodes feel, the underlying mechanisms are remarkably consistent across individuals.

Whether you’ve experienced panic attacks yourself or want to better understand what a loved one goes through, learning about the mental and physical dimensions of these episodes can help you respond more effectively when they occur.

This article examines the neurobiological foundations and psychological factors behind panic attacks, along with practical strategies for managing them.

Understanding the biology and psychology of panic attacks

Panic attacks are sudden episodes characterized by intense fear and distress that seem to come out of nowhere. They trigger a cascade of physiological responses—including rapid heartbeat, shortness of breath, and an overwhelming sense of impending catastrophe—all hallmarks of the body’s fight-or-flight response. But what actually causes these frightening episodes?

While panic attacks are commonly linked with anxiety disorders, they can happen to anyone, regardless of whether they have a diagnosed mental health condition. A stressful life event, a traumatic experience, or even no identifiable trigger at all can precipitate a panic attack.

The roots of most panic attacks likely lie in the central nervous system, which can be activated by perceived threats, sudden stress, or neurochemical imbalances. According to research published in 2023 examining biological theories regarding panic attacks, “A neurochemical imbalance of neurotransmitters in the brain, such as serotonin, norepinephrine, dopamine, and gamma-aminobutyric acid (GABA), is thought to cause PD symptoms. This biological theory is evidenced by the symptom reduction effects of antidepressant or anxiolytic medication in many PD suffers.”

In simpler terms, when the brain’s chemical messengers—particularly serotonin and related neurotransmitters—fall out of balance, panic disorder symptoms may emerge. The effectiveness of certain medications in treating these symptoms supports this neurochemical explanation.

However, research increasingly points to multiple contributing factors, both genetic and environmental. People with close family members who have panic disorder face elevated risk themselves. Neurobiological studies have identified specific brain regions involved in panic responses, including the prefrontal cortex and brain stem, as well as disruptions in the neural pathways that process fear.

Sometimes panic attacks occur without any obvious trigger. However, several mental health conditions, physical factors, and life circumstances are associated with increased panic attack risk:

Anxiety disorders

Generalized anxiety disorder and other anxiety conditions can lead to panic attacks. While not everyone with anxiety experiences panic attacks, the chronic stress and worry associated with anxiety disorders can culminate in these acute episodes. When someone develops intense fear specifically about having panic attacks, they may receive a diagnosis of panic disorder.

Autism spectrum disorder

Autism spectrum disorder is a neurodevelopmental condition—a form of neurodivergence rather than a mental illness. Autistic individuals may experience heightened anxiety and panic attacks, partly due to challenges with sensory processing. Certain sounds, textures, lights, or smells can become overwhelming, potentially triggering panic responses. Research indicates that approximately 40% of individuals with ASD or other forms of neurodivergence also live with an anxiety disorder.

Phobias

Phobias are intense, irrational fears centered on specific objects, situations, or concepts. While traumatic experiences can sometimes cause phobias, many people develop them without any direct negative encounter with their feared stimulus. When someone with a phobia faces—or even anticipates facing—the object of their fear, they may experience a panic attack.

For instance, someone with social phobia may become trapped in a self-reinforcing cycle: fear of social situations triggers panic attacks, which then seem to validate the original fear, making future social encounters even more anxiety-provoking. This process, known as fear conditioning, can intensify both the phobia and the frequency of panic attacks over time.

Stress and life circumstances

Panic attacks aren’t limited to people with diagnosed mental health conditions. Anyone experiencing significant stress can have a panic attack. Highly stressful situations—witnessing or surviving violence, experiencing a serious accident, facing workplace burnout, or dealing with sensory overload—can all trigger panic episodes.

The misconception that panic attacks only affect people with mental illness may explain why some individuals mistake their symptoms for heart attacks or other medical emergencies. Understanding common panic attack symptoms can help you recognize them in yourself or others. Because the symptoms are predominantly physical, they often don’t feel like what we typically associate with anxiety or fear.

The psychological experience of panic attacks

During a panic attack, your mental state can change dramatically. You might feel lightheaded, confused, or unable to think clearly. Many people experience overwhelming fear and dread. Some become convinced they’re dying from a heart attack or other medical crisis.

While panic attacks create an intense sense of mortal danger, this perceived threat doesn’t reflect actual risk. Despite feeling like you might die, panic attacks themselves are not fatal. That said, if you’re genuinely concerned about a medical emergency, seeking professional evaluation is always appropriate. Panic attack symptoms typically resolve within 30 minutes to an hour, though they can occasionally persist longer.

In the midst of a panic attack, remembering that you’re safe and that the episode will pass feels nearly impossible. However, grounding yourself in this reality and using specific techniques can help you regain control over your body and prevent symptoms from escalating.

Physical responses during panic attacks

While the psychological triggers for panic attacks vary considerably between individuals, the body’s response follows a consistent pattern. Some stimulus—whether an external event or internal thought—convinces your brain that you’re in danger. This perception activates what researchers call the “stress response,” commonly known as the “fight-flight-freeze” response.

This physiological process is an evolutionary inheritance. For our ancestors, this response system helped them survive genuine threats—predators, hostile encounters, natural disasters. When danger appeared, their bodies needed to prepare instantly for intense physical action: fighting, fleeing, or freezing to avoid detection.

Modern life rarely demands these physical responses. We don’t need to outrun our financial problems or physically fight our work deadlines. Yet our nervous systems haven’t evolved to distinguish between ancient physical threats and contemporary psychological stressors. When your brain perceives danger—even social or abstract danger—it can still trigger the full stress response. Below are the physical manifestations you might experience during a panic attack:

Cardiovascular changes

When your muscles prepare for intense activity, they require more oxygen delivered through your bloodstream. Your body accomplishes this through several mechanisms.

Your heart rate increases and each beat becomes more forceful, both of which dramatically increase blood flow. While these sensations feel normal during exercise, they can be alarming when you’re sitting still or engaged in everyday activities. This explains why many people experiencing panic attacks fear they’re having a heart attack.

Your body also redirects blood away from internal organs toward your muscles. This redistribution can cause flushed or pale skin, feeling suddenly hot or cold, nausea, and lightheadedness—all common panic attack symptoms.

Respiratory changes

In another attempt to increase oxygen intake, your brain signals your lungs to breathe faster and more deeply. This hyperventilation can feel extremely uncomfortable and alters the balance of gases in your blood, potentially causing lightheadedness or, in severe cases, fainting.

Unlike your heart rate, which operates largely outside conscious control, breathing is something you can learn to regulate. Controlling your breath is often the most effective tool for managing a panic attack in progress.

Strategies for managing panic attacks

Certain aspects of panic attacks lie beyond your immediate control. However, once you recognize that a panic attack is occurring, you can take specific steps to reduce its intensity and duration. Working with a licensed clinical social worker can help you develop personalized management strategies. Consider trying the following approaches:

Recognize what’s happening

Panic attacks are intensely uncomfortable and frightening, but they aren’t medically dangerous. Recognizing that you’re experiencing a panic attack—rather than a heart attack or other medical emergency—is typically the first step toward managing your symptoms. Resist the urge to seek repeated reassurance or research your symptoms online during the episode, as this can actually intensify anxiety.

Communicate with others

Mental health challenges, including panic attacks, still carry unfortunate stigma. However, if you realize you’re having a panic attack, telling someone nearby can be tremendously helpful. When others don’t know what’s happening, they may mistake your symptoms for a heart attack or allergic reaction and call emergency services unnecessarily.

Letting someone know you’re having a panic attack also allows them to provide comfort, assistance, or simply stay with you until the episode passes. If you experience panic attacks regularly, identify what helps you most during these episodes and communicate this to people close to you ahead of time, since clear communication becomes difficult during an attack.

If you’re alone when a panic attack begins, consider calling someone you trust. Having another person on the line, even if they can’t stop the attack, often provides meaningful comfort until it subsides.

Control your breathing

Although your breathing may feel completely out of control during a panic attack, you actually have more influence over it than you might think. Bodily functions fall into two categories: autonomic (automatic processes like heartbeat and digestion) and somatic (conscious actions like walking or throwing a ball).

During a panic attack, your autonomic nervous system takes over your breathing. However, you can override this by consciously taking long, slow, deep breaths. Because your nervous system and breathing communicate bidirectionally, deliberately slowing your breath sends signals to your brain that you’re safe. If you find deep breathing difficult during panic, consider downloading a breathing guidance app that can walk you through each breath with calming audio or visual cues.

Recovery and next steps after panic attacks

Typically, panic attack symptoms resolve completely once the episode ends, with no lasting physical consequences. The person gradually returns to their baseline state. However, while individual panic attacks don’t cause long-term health problems, chronic stress has been linked to cardiovascular complications and other health issues. If stress triggered your panic attack, consider consulting a mental health professional.

If the thought of traditional in-person therapy creates anxiety or presents logistical challenges, telehealth counseling through a platform like ReachLink offers an accessible alternative. Meeting with a licensed clinical social worker via secure video sessions allows you to receive professional support on your schedule, from a location where you feel comfortable. You can connect with your therapist through video calls, phone sessions, or messaging, depending on what works best for you.

Research demonstrates that telehealth therapy can effectively help people experiencing recurrent panic attacks. A 2012 study showed that online, therapist-guided treatment significantly improved symptoms both immediately after treatment and at 12-month follow-up.

For comprehensive evaluation and diagnosis of panic disorder or related conditions, you may also wish to consult with a psychologist or psychiatrist who can assess your symptoms based on clinical practice guidelines and provide additional treatment recommendations.

Moving forward

Panic attacks create intense psychological and physical distress that can interfere significantly with daily life. However, with proper understanding and support, you can learn to manage these episodes more effectively and reduce their frequency. Licensed clinical social workers specializing in anxiety and panic can teach you evidence-based techniques—including cognitive behavioral therapy approaches—that address both the thought patterns and physical responses involved in panic attacks.

Remember that experiencing panic attacks doesn’t reflect personal weakness or failure. These episodes result from complex interactions between neurochemistry, learned fear responses, and stress—factors that respond well to therapeutic intervention. Reaching out for professional support is a sign of strength and self-awareness, not inadequacy.

The information in this article is intended for educational purposes and should not replace professional medical advice, diagnosis, or treatment. If you’re experiencing panic attacks or other mental health concerns, please consult with a qualified mental health professional. ReachLink’s licensed clinical social workers can provide therapeutic support for anxiety and panic-related concerns, though psychiatric medication management requires consultation with a physician or psychiatrist.

FAQ

• What are the most common triggers for panic attacks?

  Common panic attack triggers include stressful life events, caffeine consumption, physical sensations like rapid heartbeat, crowded spaces, and specific phobias. Triggers can also be internal thoughts or memories related to past traumatic experiences. Understanding your personal triggers is an important first step in developing effective coping strategies through therapy.

• How can therapy help someone manage panic attacks?

  Therapy helps by teaching coping techniques, identifying triggers, and changing thought patterns that contribute to panic. Cognitive Behavioral Therapy (CBT) is particularly effective, helping people recognize and challenge catastrophic thoughts during panic episodes. Therapists also teach breathing exercises, grounding techniques, and gradual exposure methods to reduce the frequency and intensity of attacks.

• What therapeutic techniques are most effective for panic disorder?

  The most effective therapeutic approaches include Cognitive Behavioral Therapy (CBT), which addresses negative thought patterns, and Dialectical Behavior Therapy (DBT), which teaches distress tolerance skills. Exposure therapy helps people gradually face their fears in a controlled way. Mindfulness-based techniques and relaxation training are also highly effective for managing panic symptoms and preventing future episodes.

• How long does it typically take to see improvement with therapy for panic attacks?

  Many people begin noticing improvements within 6-12 weeks of consistent therapy sessions. However, the timeline varies based on individual factors like the severity of symptoms, frequency of panic attacks, and personal commitment to practicing therapeutic techniques. Some people may see initial relief in just a few sessions, while others may need several months to develop strong coping skills and see significant reduction in panic episodes.

• Can panic attacks be prevented through therapeutic strategies?

  Yes, therapeutic strategies can significantly reduce the frequency and severity of panic attacks, and in many cases prevent them entirely. Regular practice of breathing exercises, progressive muscle relaxation, and mindfulness techniques helps build resilience. Learning to identify early warning signs and applying coping skills immediately can stop a panic attack from escalating. Ongoing therapy provides the tools and support needed for long-term prevention.