It may hit you suddenly, out of nowhere, or you may sense the build-up over several hours or even days.
It’s the intense fear or distress that peaks within minutes.
It’s the pounding heart, the sweating, the chest pains, the lightheadedness, the numbness or tingling, the sensation that things don’t quite seem real. Even the fear of losing control or of dying.
Afterwards worrying may in. What if it happens again? What if you can’t cope? What if there’s no one around when it happens? What if it happens and you can’t escape?
You may then start to avoid places you’re unfamiliar with, or where you’ve previously felt anxious. You may turn to carrying medication ‘just in case’ you need it, or only going places when a familiar person is with you.
Over time you may find:
- You feel safe in fewer and fewer situations to the point where you’re very limited in where you will venture and what things you will take on
- You develop a series of subtle avoidances (e.g. rather than escape altogether you may have ‘safety figures’ or use a bit of Dutch courage if it is socially permissible.
- Your mood suffers because of how much the fear affects your life.
Given how distressing panic attacks can be, the impact on an individual’s life can be devastating. They can also lead to repeated presentations with medical practitioners for the distressing physical symptoms.
ABOUT PANIC ATTACKS
Panic attacks are thought to affect about 30% of individuals at some point in their lives. 
When panic attacks are recurrent and severe and come out of the blue, significantly restrict your life, are accompanied by worrying about the consequences of having a panic attack, and lead to avoidance of situations in which you may have panic attacks, then we are likely looking at a picture of Panic Disorder.
Panic attacks are also sometimes seen together with Agoraphobia, which refers to a pattern of avoidance in response to intense fear when entering situations from which escape seems difficult. Such situations may include using public transport, being in enclosed spaces (e.g. shopping centres), being in open spaces (e.g. parks, bridges), even standing in line or being in a crowd.
Panic attacks may also occur in specific situations, for example if someone experiences social anxiety then his/her anxiety may be so intense when engaging in a social situation that a panic attack is triggered, or panic attacks may occur in individuals with a fear of flying when they have to travel somewhere by air.
WHAT CONTRIBUTES TO PANIC ATTACKS?
Three broad factors come to mind when we think about panic attacks:
1. Family history. Twin and family studies of Panic Disorder revealed that genes make a significant contribution to the emergence of panic disorder. 
2. Our health. Some medical conditions may yield symptoms that mimic panic symptoms, including thyroid diseases, cardiac diseases, and respiratory disorders. 
3. The degree of stress placed on our system. This may be due to our thoughts ‘ramping up’ our anxiety, or through physical sources of stress such as the use of stimulants including caffeine and nicotine.
WHAT CAN BE DONE TO HELP WITH PANIC ATTACKS?
When it comes to helping with your panic attacks let's approach it from two levels. While we can look at what to do with the immediate symptoms so that you're better able to cope with the distress, we strongly encourage that you also seek assistance to address the anxiety in the longer term. We've outlined these two approaches and put together a printable summary below.
WHAT TO DO WHEN YOU'RE IN THE MIDST OF IT
1. Slow down your breathing as this will help to decrease your anxiety. Start by holding your breath while counting to ten, then breathe in over four seconds and out over another four seconds. Breathe from your diaphragm rather than your chest, and continue for 5 to 10 minutes, repeating if necessary.
2. Check your thoughts in case they’re escalating your panic symptoms. Catastrophising about the worst case scenario can increase your panic symptoms. Instead, look to test if the thoughts are true (e.g. Is it the case that no one will help if I do have a panic attack in public? Have I ever heard of someone passing out from a panic attack?). Alternatively, you can try to take a mindfulness approach by letting the thoughts come and go without getting caught up in them.
3. Keep in mind that the panic attack will eventually subside. It may not feel pleasant in the meantime, but it will pass. Think of it as ‘surfing’ the wave of anxiety.
WHAT TO DO A LITTLE BIT LATER
After the panic attack it’s helpful to take some action to help in the longer term. Steps that you can take include:
1. Consulting with your health professional to rule out any underlying medical conditions (e.g. respiratory conditions, cardiac diseases, thyroid diseases) that may contribute to panic symptoms.
2. Seeking assistance from a mental health professional such as a psychologist to learn skills to help you cope with anxiety. Psychological treatment options shown to be effective include:
a. Cognitive Behaviour Therapy which includes exposure therapy in the forms of graded exposure and also interoceptive exposure (which is exposure to those uncomfortable panic symptoms).
b. Acceptance and Commitment Therapy.
c. Mindfulness (either on its own, or as part of Mindfulness-based Cognitive Therapy or ACT).
3. Making lifestyle changes to keep your overall stress levels down, including:
a. Decreasing strain on your body by limiting the use of stimulants that may produce panic-like symptoms (e.g. excessive caffeine consumption may lead to heart palpitations).
b. Engaging in aerobic exercise on a regular basis.
c. Looking at improving on manageable sources of stress by developing skills including stress management, time management, and developing efficient processes to streamline your life and decrease your daily hassles.
Thanks for reading. We hope that the tips on managing panic attacks are helpful.
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 Lam-Po-Tang, J. (2011). Panic disorder and agoraphobia. Australian Doctor, 28 October 2011, 29-36.
 Hettema, J.M., Neale, M.C., & Kendler, K.S. (2001). A review and meta-analysis of the genetic epidemiology of anxiety disorders. American Journal of Psychiatry, 158, 1568-1578.