Panic attacks: the signs and how to get through one

It can come out of nowhere: in a packed Luas carriage, in the queue at Tesco, or lying in bed. Your heart pounds, your breathing goes shallow, and you feel something terrible is about to happen. A panic attack is frightening, but understanding what's going on in your body can take some of its power away. Here's how to recognise one and what to do when it hits.

What is a panic attack?

A panic attack is a sudden wave of intense fear or discomfort that peaks within a few minutes. It's your body's alarm system at work, the same "fight or flight" system that kept our ancestors safe. During a panic attack, though, the alarm goes off when there's no real danger.

Sometimes a panic attack follows a long stretch of stress, sometimes it happens in a particular situation (a crowded shop, a meeting, a bus), and sometimes it comes with no obvious cause, even when you're sitting quietly. Some people have one panic attack in their life; others have them regularly.

For instance, someone might have their first panic attack on a crowded train home from a match at Croke Park and start avoiding public transport afterwards. Learning slow breathing (in for four, out for six), naming five things you can see, and gradually getting back on the train for short trips can help rebuild confidence.

How to recognise a panic attack

Symptoms vary from person to person, but the most common include:

• a pounding or racing heart;
• shortness of breath, or feeling you can't get enough air;
• tightness or discomfort in the chest;
• sweating, shaking, or hot or cold flushes;
• dizziness, or feeling you're about to faint;
• pins and needles in your hands or around your mouth;
• an upset stomach;
• a sense that things aren't real, or that you're losing control.

This table isn't a diagnostic tool. If you're in any doubt, call 112 or 999. It's always better to get checked.

What to do during a panic attack

1. Tell yourself what's happening. "This is a panic attack. It's uncomfortable, but it will pass." This eases the fear of the fear itself.
2. Slow your breathing. Breathe in gently through your nose for four seconds and out slowly through your mouth for six. Keep going for a few minutes. Long out-breaths help your body settle.
3. Ground yourself in your senses. Name five things you can see, four you can feel, three you can hear, two you can smell and one you can taste.
4. Don't fight it. Trying to push the attack away often makes it worse. Think of it as a wave: it rises, peaks and falls again.
5. Keep your feet on the ground. Press your feet into the floor or hold something cold, and notice how it feels.
6. Stay where you are, if you can. If you leave every time, your brain learns the place is dangerous. If you wait until the attack eases, it learns the opposite.

Most panic attacks last between five and twenty minutes. Time feels slower during an attack, so it can help to look at a clock and remind yourself it will end.

How to have fewer panic attacks

• Practise breathing when you're calm. Two minutes of the four-six breath each day makes it feel more natural when an attack begins.
• Cut back on caffeine and alcohol. Both can put your body on alert and trigger attacks.
• Sleep and movement. Regular sleep and physical activity lower the background stress that feeds panic.
• Don't avoid everything. If you've started avoiding places or situations for fear of another attack, go back to them gradually, in small steps.
• Write it down. Note when attacks happen. A pattern often shows up, such as after a bad night or a very busy day.

If your mind races at night too, our guide to sleep problems may help.

When to look for help

It's worth talking to your GP:

• if you've had a first attack and haven't been checked;
• if you keep having attacks;
• if you're avoiding places or activities for fear of another attack;
• if you feel low, anxious most of the time, or hopeless.

Your GP can check for physical causes and refer you to HSE mental health services. Panic attacks and panic disorder respond well to treatment, particularly CBT (cognitive behavioural therapy). A conversation with Psychologist AI can help you settle after an attack, but it isn't a replacement for professional care.

Frequently asked questions

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