Panic Attacks and Anxiety Attacks: What They Are, Why They Happen, and How to Get Through Them

Few experiences are as frightening as a panic attack. People often describe it as feeling like they are about to die, lose control, or lose their mind. Many end up in emergency rooms convinced they are having a heart attack, stroke, or medical emergency—only to be told later that what they experienced was “just anxiety.” That phrase alone can feel invalidating.

Panic attacks are not imaginary, not exaggerated, and not a sign of weakness. They are intense nervous-system events that can feel overwhelming, disorienting, and terrifying.

Panic Attack vs. Anxiety Attack: Are They the Same?

The terms panic attack and anxiety attack are often used interchangeably, but clinically, they are different.

Panic Attacks (Clinical Term)

Panic attacks are defined in the DSM-5-TR. They are sudden, intense surges of fear or discomfort that peak quickly and involve strong physical symptoms.

Panic attacks:

• Come on abruptly

• Peak within minutes

• Can feel catastrophic

• Often include intense physical sensations

• May occur “out of the blue”

Anxiety Attacks (Informal Term)

“Anxiety attack” is not a formal diagnosis, but people use it to describe a period of escalating anxiety.

Anxiety attacks:

• Build gradually

• Are often tied to a specific stressor

• Feel distressing but less explosive

• May last longer than panic attacks

Both experiences are real and distressing—but panic attacks are more sudden, intense, and physically overwhelming.

What Is a Panic Attack?

A panic attack is a brief but intense episode of fear or discomfort accompanied by powerful physical and psychological symptoms. The body’s threat system activates as if there is immediate danger—even when there is none.

This response is driven by the autonomic nervous system, not by conscious choice.

DSM-5-TR Criteria for a Panic Attack (Explained With Examples)

A panic attack involves an abrupt surge of intense fear or discomfort that reaches a peak within minutes and includes four or more of the following symptoms.

1. Palpitations or Accelerated Heart Rate

Explanation: The heart begins beating rapidly or irregularly as adrenaline surges.

Example: Feeling like your heart is “pounding out of your chest” or skipping beats.

2. Sweating

Explanation: The body prepares to respond to perceived danger.

Example: Sudden sweating even in a cool environment.

3. Trembling or Shaking

Explanation: Muscle tension and adrenaline cause involuntary shaking.

Example: Hands or legs trembling uncontrollably.

4. Shortness of Breath or Smothering Sensation

Explanation: Breathing becomes rapid or shallow.

Example: Feeling like you can’t get enough air despite breathing.

5. Feeling of Choking

Explanation: Throat muscles tighten during stress.

Example: Sensation of something stuck in the throat.

6. Chest Pain or Discomfort

Explanation: Muscle tension and hyperventilation mimic cardiac symptoms.

Example: Sharp or tight chest pain that triggers fear of a heart attack.

7. Nausea or Abdominal Distress

Explanation: Blood flow shifts away from digestion.

Example: Stomach pain, nausea, or urge to use the bathroom.

8. Dizziness, Lightheadedness, or Faintness

Explanation: Changes in breathing and blood flow affect balance.

Example: Feeling like you might pass out.

9. Chills or Heat Sensations

Explanation: Stress disrupts temperature regulation.

Example: Sudden waves of heat or cold.

10. Paresthesias (Numbness or Tingling)

Explanation: Hyperventilation alters carbon dioxide levels.

Example: Tingling in hands, feet, or face.

11. Derealization or Depersonalization

Explanation: The brain creates distance from overwhelming sensation.

Example: Feeling unreal or detached from your body.

12. Fear of Losing Control or “Going Crazy”

Explanation: Cognitive panic escalates fear.

Example: “I’m going to lose my mind.”

13. Fear of Dying

Explanation: Intense bodily sensations feel life-threatening.

Example: Certainty that death is imminent.

What Is Panic Disorder?

Panic Disorder is diagnosed when:

• A person has recurrent, unexpected panic attacks

• At least one attack is followed by persistent worry about future attacks or behavioral changes (avoidance)

• Symptoms are not due to substances or medical conditions

Avoidance can become more disabling than the panic attacks themselves.

How Common Are Panic Attacks?

Lifetime Prevalence

• About 22–28% of adults experience at least one panic attack

• 2–3% meet criteria for Panic Disorder

Prevalence by Age

• Most common onset: late adolescence to early adulthood

• Panic attacks are common in young adults navigating life transitions

• Panic disorder can occur at any age

Prevalence by Gender

• Panic disorder is diagnosed twice as often in women

• Men often underreport symptoms or present with medical complaints

• Hormonal changes may influence vulnerability in women

Risk Factors for Panic Attacks and Panic Disorder

Panic attacks often develop from a combination of factors:

• Genetic predisposition

• High baseline anxiety or neuroticism

• Chronic stress

• Trauma or adverse childhood experiences

• Substance use (especially caffeine or stimulants)

• Major life transitions

• Health anxiety

• Perfectionism

• Sensitivity to bodily sensations

Panic attacks are not random—they are learned nervous-system responses that can be unlearned.

20 Coping Skills for Panic Attacks (CBT + DBT Based)

These skills help interrupt the panic cycle and retrain the nervous system.

CBT-Focused Skills (Changing Thoughts & Responses)

1. Name the Panic – Remind yourself this is panic, not danger.

2. Reality Testing – Ask: “What evidence supports this fear?”

3. Time Limiting – Panic peaks and falls, usually within minutes.

4. Symptom Reframing – “This is uncomfortable, not dangerous.”

5. Interoceptive Exposure (with guidance) – Gradually reduce fear of sensations.

6. Reduce Safety Behaviors – Avoid reinforcing fear through avoidance.

7. Thought Labeling – “This is a panic thought, not a fact.”

8. Psychoeducation – Understanding panic reduces fear.

9. Behavioral Experiments – Testing feared predictions safely.

10. Self-Talk Scripts – Pre-planned calming statements.

DBT-Focused Skills (Regulating the Nervous System)

11. Cold Water or Ice – Activates the dive reflex.

12. Paced Breathing – Slow, extended exhales calm the body.

13. 5-4-3-2-1 Grounding – Anchor attention to the present.

14. Muscle Relaxation – Release physical tension.

15. Temperature Change – Warm or cool sensations ground the body.

16. Movement – Gentle walking or stretching.

17. Self-Soothing – Engage the senses intentionally.

18. Opposite Action – Stay present instead of escaping.

19. Containment Imagery – Visualize storing panic safely.

20. Radical Acceptance – Allow panic to pass without fighting it.

How Counseling Helps With Panic Attacks

Counseling helps clients:

• Understand panic without fear

• Reduce avoidance behaviors

• Retrain the nervous system

• Build confidence in bodily sensations

• Restore daily functioning

• Address underlying anxiety or trauma

Therapy is not about eliminating fear—it’s about reducing fear of fear.

Best-Practice Therapies for Panic Disorder

Cognitive Behavioral Therapy (CBT)

Gold-standard treatment for panic disorder.

Exposure-Based Therapy

Reduces avoidance and fear conditioning.

Acceptance and Commitment Therapy (ACT)

Builds flexibility around anxiety.

Dialectical Behavior Therapy (DBT)

Strengthens emotion regulation and distress tolerance.

Trauma-Informed Therapy

Addresses panic linked to trauma responses.

A Final Thought

Panic attacks are terrifying—but they are treatable. With the right support, people learn not only to manage panic, but to trust their bodies again.

Counseling offers tools, understanding, and relief—without judgment.

If panic attacks or anxiety are interfering with your life, help is available, and recovery is possible.