In short
During a panic attack, the most important thing is to remind yourself that this is an anxiety attack: it is not life-threatening and will pass on its own, usually within 10–20 minutes. Slow breathing with a longer exhale, grounding through the senses, and not fleeing the situation all help. A panic attack is a sudden surge of intense fear with a pounding heart, shortness of breath, trembling, dizziness, and a fear of dying or going crazy. If attacks keep coming back and you start to fear them and avoid places, this is panic disorder, and it responds well to psychotherapy and, when needed, medication.
Key points in one minute
- A panic attack is a sudden episode of intense fear with physical symptoms that peaks within a few minutes.
- An attack is unpleasant but not dangerous in itself: it does not cause a heart attack, fainting, or “going insane.”
- During an attack, slow breathing with a long exhale, grounding, and not running away all help.
- Repeated attacks and fear of having another one are signs of panic disorder, which needs treatment.
- A first episode with chest pain should be checked by a doctor to rule out heart disease.
What a Panic Attack Is and What It Feels Like
A panic attack is a sudden episode of intense fear or discomfort that reaches its peak within a few minutes. DSM-5 lists physical and psychological symptoms to describe it, and a full attack involves at least four of them. In ICD-10, recurrent unexpected attacks are classified as panic disorder (episodic paroxysmal anxiety, F41.0); in ICD-11, as panic disorder within the group of anxiety disorders.
The mechanism of an attack is the “fight or flight” response switching on without any real danger. The body releases adrenaline, the heart rate and breathing speed up, and the muscles tense. The person notices these sensations, becomes frightened by them, and the fear drives the physical reaction even harder. A vicious circle forms, and this is what makes an attack so distressing. Understanding this mechanism is already part of treatment.
- A pounding heart, a feeling that the heart is “jumping out of the chest”
- Shortness of breath, a choking sensation, or a lump in the throat
- Chest pain, tightness, or discomfort, and fear for the heart
- Trembling, sweating, hot flashes, or chills
- Dizziness, feeling faint, or unsteadiness
- Numbness or tingling in the hands or around the mouth
- A feeling that one’s surroundings or oneself are unreal
- Fear of dying, losing control, or going crazy
What to Do During a Panic Attack
The main task during an attack is not to fight the sensations or run away, but to ride out the wave while lowering your body’s arousal. Tell yourself: “This is a panic attack. I’m scared, but I’m safe. It will pass.” Trying to leave right away or taking a sedative or alcohol brings relief but reinforces the fear: the brain remembers that the situation was dangerous and that only escape helped.
Breathing is the most accessible tool. During panic, people often breathe quickly and shallowly, which causes dizziness and tingling. Slow belly breathing with an exhale longer than the inhale helps calm the nervous system. Detailed step-by-step instructions are given below. There is no need to breathe into a paper bag: this common advice is outdated and may be unsafe.
The 5-4-3-2-1 Grounding Technique
Shift your attention from internal sensations to the outside world: name five things you can see, four sounds you can hear, three things you can feel touching you (the chair, your clothes, the floor), two smells, and one taste. This helps the brain return to reality and reduces the sense that things are unreal.
How to Help Someone Having a Panic Attack
Speak calmly and briefly, and do not argue or shame them. Say that you are there and that it will pass. Offer to breathe together while slowly counting. Ask other people to step away, open a window, and suggest they sit down. Do not give them someone else’s medication or alcohol. If you are not sure it is panic, especially with an older person or when there is chest pain, call an ambulance.
| Feature | Panic attack | Possible heart attack |
|---|---|---|
| Onset | Sudden, often during anxiety or for no reason | Often during exertion, but can also occur at rest |
| Duration | Peaks within minutes, subsides within 10–30 minutes | Longer than 15–20 minutes; does not ease when calming down |
| Type of pain | Stabbing, vague, shifting | Pressing, burning, spreading to the arm, neck, or jaw |
| Accompanying sensations | Fear of death, a sense of unreality, tingling | Cold sweat, nausea, sudden weakness |
| Recurrence | Similar episodes have happened before, tests are normal | A first episode, or known heart disease |
How to Tell a Panic Attack From a Heart Attack and Other Conditions
Chest pain, shortness of breath, and a racing heart can occur both with panic and with serious illnesses: a heart attack, heart rhythm disorders, pulmonary embolism, an asthma attack, hypoglycemia, or thyrotoxicosis. That is why a first episode like this, especially in a person over 40 or with risk factors for heart disease, should not be put down to nerves; it should be checked by a doctor with an ECG, lab tests, and an examination.
Typical features of a panic attack are a rapid rise and fall of symptoms within 10–30 minutes, a link to anxiety and fear, repeated similar episodes, and normal test results. With a heart attack, the pain is more often pressing or burning, may spread to the arm, neck, or jaw, lasts longer, and does not go away when the person calms down. If in doubt, call 103: this is the right decision, not something to be ashamed of.
How to Cope With a Panic Attack on Your Own
- Name what is happeningTell yourself: “This is a panic attack. It’s unpleasant, but it isn’t dangerous, and it will pass in a few minutes.” This reduces the fear of the symptoms.
- Stop and find supportSit down or lean against a wall, and feel your feet on the floor. Do not run away from the situation if nothing is actually threatening you.
- Slow down your breathingBreathe in through your nose for a count of 4, pause briefly, and breathe out through your mouth for a count of 6–8. Repeat for a few minutes with one hand on your belly.
- Shift your attentionUse the 5-4-3-2-1 technique: name what you see, hear, and feel. You can also count objects of one color or describe the room.
- Do not fight the sensationsLet the pounding heart and the trembling be there, and watch them as you would a wave. Resisting and trying to stop everything immediately make the panic stronger.
- Avoid alcohol and other people’s pillsThey do not treat panic disorder and they reinforce the fear. Take only medications prescribed by your own doctor.
- Write down the episode and see a specialistAfter the attack, note where and when it happened. If attacks keep recurring, book an appointment with a psychiatrist or psychotherapist.
Why Panic Attacks Happen
There is no single cause. Predisposition is linked to heredity and features of the nervous system, including heightened sensitivity to bodily sensations. Attacks are triggered by chronic stress, lack of sleep, overwork, and difficult life events. The first attack often happens after a period of prolonged strain or illness, and sometimes seemingly out of the blue, which frightens the person all the more.
Substances deserve a special mention. Caffeine and energy drinks, nicotine, stimulants, and cannabis can provoke panic attacks. Alcohol withdrawal and hangovers are a frequent trigger: on the day after drinking, anxiety rises sharply. Many people begin relieving panic-related anxiety with alcohol or sedatives, and this gradually leads to addiction and even more frequent attacks.
- Chronic stress, overwork, and lack of sleep
- Hangovers and alcohol withdrawal, or abruptly stopping sleeping pills and tranquilizers
- Too much caffeine and energy drinks, and nicotine, especially on an empty stomach
- Use of stimulants and cannabis
- Past traumatic events and long-standing anxiety
- Co-occurring anxiety disorders and depression
What Panic Disorder and Agoraphobia Are
A single panic attack can happen to anyone and is not a diagnosis in itself. Panic disorder is diagnosed when attacks recur unexpectedly and are followed for at least a month by constant worry about new attacks and changes in behavior: the person avoids physical exertion, trips, and crowded places, or does not leave home without medication or someone to accompany them.
Panic disorder is often accompanied by agoraphobia: a fear of being in a situation that is hard to get out of or where no one will come to help, such as public transportation, stores, lines, bridges, or open spaces. The range of places the person can go gradually shrinks, and life becomes more and more restricted. Without treatment, agoraphobia can become entrenched for years, but with treatment it usually responds well.
How Panic Disorder Is Treated
The method with the strongest evidence base is cognitive behavioral therapy. It explains the mechanism of panic, teaches a different attitude toward bodily sensations, gradually brings the person back into the situations they avoid (exposure), and helps them drop safety behaviors. A course usually takes several months of regular sessions, and many people complete it online.
When symptoms are severe, a psychiatrist may prescribe medication. Long-term treatment is based on antidepressants from certain groups: they reduce the frequency and intensity of attacks, and the effect develops over several weeks. Tranquilizers from the benzodiazepine group bring quick relief but can be habit-forming, so doctors use them briefly and with caution, especially in people with a history of alcohol misuse. Treatment should be selected and stopped only with a doctor.
How Narcology 24 Can Help
If panic attacks are combined with the use of alcohol or sedatives, or with hangover anxiety, at Narcology 24 a psychiatrist and an addiction specialist assess both sides of the problem and draw up a shared plan. The initial consultation and a course of psychotherapy can be done online, and in an acute condition the doctor comes to the home.
When to see a doctor
- You have had a panic attack for the first time, especially with chest pain or if you are over 40
- Attacks keep recurring, and you constantly fear the next one and monitor your body
- You have started avoiding public transportation, stores, trips, or leaving home alone
- You use alcohol, sleeping pills, or tranquilizers without a prescription to relieve anxiety
- The attacks are combined with low mood, insomnia, or loss of interest in life
- The attacks began during withdrawal from alcohol, drugs, or medications
When urgent help is needed
Call 103 or 112 if chest pain is pressing and lasts longer than 15–20 minutes, if there is loss of consciousness, sudden weakness in an arm or leg, slurred speech, or severe shortness of breath at rest, and also if the attack happens to a person with heart disease. Suicidal thoughts alongside anxiety are also an emergency; the helpline 150 is available for children and young people.
How Narcology 24 can help
Round-the-clock home visits, inpatient care and detox, coding, rehab and online consultations with an addiction doctor or psychiatrist. Confidential, with no registry entry.
- Panic attack treatmentfrom 12 000 ₸ · Online 24/7
- Anxiety disorder treatmentfrom 12 000 ₸ · Online 24/7
- Online psychiatrist consultationfrom 15 000 ₸ · Online 24/7
Questions and answers
How long does a panic attack last?
The peak usually comes within 10 minutes, and the whole attack lasts from a few minutes to half an hour. Sometimes weakness, exhaustion, and anxiety linger for a while afterward. If it feels like an attack lasts for hours, it is more often a series of waves or background anxiety, and that is a reason to discuss your condition with a doctor.
Can you die from a panic attack?
No, a panic attack itself is not life-threatening: it does not cause cardiac arrest, suffocation, or loss of your mind, even though it feels exactly like that. However, similar symptoms occur with heart and lung diseases, so a first episode, especially with chest pain, should be checked by a doctor and an ECG should be done.
Why do panic attacks happen at night?
Nocturnal attacks happen when a person wakes up suddenly with fear, a pounding heart, and shortness of breath. They are linked to generally heightened anxiety and stress, and sometimes to sleep apnea or alcohol withdrawal. Night-time attacks are a common part of panic disorder and are treated with the same methods. Physical causes should also be ruled out.
Does alcohol help with panic attacks?
Alcohol reduces anxiety for a short time, but the next day it makes anxiety worse, disrupts sleep, and itself provokes attacks during a hangover. Gradually the person drinks more and more often, and addiction develops. At Narcology 24, when panic attacks are combined with drinking, a psychiatrist and an addiction specialist help together.
Which doctor treats panic attacks?
A psychiatrist handles diagnosis and medication, while psychotherapy is provided by a psychotherapist or clinical psychologist trained in cognitive behavioral therapy. A general practitioner or cardiologist helps rule out physical causes. A neurologist may also suspect panic disorder and refer you to a psychiatrist.
Can panic disorder be cured for good?
For most people, with the right treatment, attacks become rare or stop completely, and the avoidance goes away. Cognitive behavioral therapy provides skills that lower the risk of a return even after the course has ended. During periods of severe stress, symptoms may briefly come back, but by then the person knows how to cope with them.
What should I do if I have a panic attack while driving?
Turn on your hazard lights, slow down smoothly, and, if possible, stop in a safe place. Use slow breathing with a long exhale and grounding: feel the steering wheel and the seat, and name the objects around you. If attacks while driving keep happening, discuss this with a doctor and limit your driving for a while until treatment begins.
Sources and methodology
- ICD-10, category F41.0 “Panic disorder,” WHO
- ICD-11, Chapter 6, section “Anxiety or fear-related disorders,” WHO
- DSM-5, American Psychiatric Association
- NICE guideline CG113 “Generalised anxiety disorder and panic disorder in adults: management”
- APA Practice Guideline for the Treatment of Patients With Panic Disorder
- Clinical protocols for diagnosis and treatment, Ministry of Health of the Republic of Kazakhstan
This article was prepared by the Narcology 24 medical editorial team and reviewed by a doctor. It is for reference only and does not replace a specialist consultation. Editorial policy
Medically reviewed by
Zhanar Tulegenova, MDPsychiatrist and psychotherapist · experience 18 yearsDepression, anxiety and panic attacks, PTSD, OCD and insomnia; addiction psychotherapy and relapse prevention.
