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Panic Attack: Why Does It Happen and What to Do Immediately?
A panic attack is a sudden wave of fear that comes with the feeling 'I am going to die' or 'I am going mad', and the shared question of everyone who experiences it is the same: is this dangerous? The short answer: no. The long answer is hidden in understanding how a panic attack works.
A panic attack is an intense wave of fear and bodily alarm that is triggered without real danger and peaks within minutes. It is not dangerous and passes on its own. The most effective thing you can do immediately is, instead of fighting the symptoms, to remember that they are temporary and harmless and to slow your breathing. The lasting solution is CBT, which targets the cognitive mechanism of panic disorder.
What is a panic attack?
A panic attack is a sudden and intense wave of fear or discomfort that peaks within a few minutes. Typical symptoms: palpitations, sweating, trembling, shortness of breath, a feeling of choking, chest pain, nausea, dizziness, a sense of unreality (derealisation), fear of losing control or 'going mad', fear of dying, numbness and tingling. It usually peaks within 10 minutes and is largely over within 20-30 minutes.
Having a single panic attack is common and is not in itself a disorder. Panic disorder is defined by the person starting to fear new attacks and restricting their life out of that fear. So the real problem is not the attack itself, but the fear of 'what if it happens again?'.
The mechanism: the false-alarm cycle
The cognitive model of the panic attack (David Clark) is today the best-supported explanation and works like this: the body produces a harmless sensation (palpitations from coffee, dizziness on standing up, faster breathing in the heat) → the person interprets this as a catastrophe ('a heart attack!', 'I am going to faint!') → this interpretation creates terror → the terror releases adrenaline → the symptoms intensify → the interpretation appears confirmed. This cycle, which spins around within seconds, turns a small spark into a fire.
The key point: what starts a panic attack is not the danger, but the interpretation of the bodily sensation as danger. That is why the same palpitations create pride in a runner and terror in someone with panic disorder. Treatment targets precisely this interpretation.
Heart attack or panic attack?
This fear is universal and reasonable; the symptoms really do overlap. Absolute principle: chest pain that occurs for the first time or has not been medically assessed before must be checked urgently; a diagnosis of panic is not made without ruling out a heart problem. Once a cardiac assessment has been carried out and comes back clear, the distinguishing clues are: the symptoms of a panic attack typically peak within minutes and then decrease, ease when attention is distracted, the fear of 'going mad or losing control' is dominant, and there have usually been similar attacks before. Even so, assessing recurrent symptoms with your huisarts is part of the process, both for safety and for the reassurance that 'this is not coming from my heart'.
What to do during an attack?
Do not fight it, allow it. Fighting panic ('stop, go away, do not happen') feeds it; because fighting keeps the perception of threat alive. The most effective attitude is paradoxical: saying 'this is a panic attack, uncomfortable but harmless, it will pass on its own' and allowing the wave to pass.
Slow your breathing. During panic, hyperventilation (over-breathing) increases the symptoms. Slow down with belly breathing, keeping the exhalation longer than the inhalation (e.g. breathe in for 4 seconds, out for 6). The aim is not a 'deep' breath, but a slow breath. Anchor in the present (grounding): see 5 things, hear 4 things, touch 3 things; drawing attention away from the catastrophe scenario toward the senses breaks the cycle. Do not flee. Fleeing from the place where you are when the attack comes relieves it for a moment, but builds the belief 'I was saved because I fled from there'; the next time, that place becomes dangerous. If possible, meeting the attack where you are and waiting for it to pass prevents the map of avoidance from expanding.
The lasting solution: how is panic treated?
Panic disorder is one of the most successfully treated conditions in mental health; with CBT most people experience a clear improvement. The core components of treatment: Psycho-education: understanding the false-alarm cycle weakens the fear from the very start. Cognitive restructuring: replacing catastrophic interpretations ('I am going to faint') with realistic ones. Interoceptive exposure: deliberately producing the feared bodily sensations (dizziness by spinning on the spot, palpitations by breathing fast) and experiencing that they are harmless; this is the most powerful but most skipped part of the treatment. Undoing avoidance: a gradual return to places and activities given up because of the panic.
Medication (especially SSRIs) is an effective option for moderate to severe conditions and can be combined with CBT; for mild to moderate panic, however, CBT alone is usually sufficient and more lasting.
Scientific basis: the cognitive model of panic disorder (Clark, 1986 and later); meta-analyses on interoceptive exposure and CBT for panic. For chest pain that occurs for the first time or has not been assessed, a medical check is needed first; this article does not replace medical advice.
Frequently asked questions
Is a panic attack dangerous, will it harm me?
No; a panic attack is extremely uncomfortable but physically harmless and passes on its own. Even so, chest pain that occurs for the first time should first be medically assessed.
How long does a panic attack last?
It usually peaks within 10 minutes and is largely over within 20-30 minutes. The body's alarm response cannot stay high continuously; the effect of adrenaline naturally dies down.
Will I faint?
Fainting during a panic attack is very rare; because panic raises blood pressure, whereas fainting lowers it. The feeling 'I am going to faint' is different from the real risk of fainting: the feeling is strong, but the outcome does not come.
Can a panic attack be treated?
Yes; panic disorder is one of the most successfully treated conditions. With CBT, especially interoceptive exposure, most people experience a clear and lasting improvement.
Does online therapy work for panic attacks?
Yes; CBT-based panic treatment can be applied effectively in an online format. Most of the exercises are already done in the person's own living environment anyway.
Clinical boundaries and emergencies
This article is intended solely for general psycho-education and does not replace a diagnosis or personal treatment advice. In the event of an acute crisis, a risk of self-harm or a threat to safety, contact 112 in the Netherlands, your huisarts (general practitioner) or the huisartsenpost (out-of-hours GP service). To talk, the 113 Zelfmoordpreventie helpline (0800-0113) is available day and night.
If you would like support
If the themes in this article noticeably affect your life, you can request an appointment for online Turkish-language therapy or read the frequently asked questions.