Panic attacks: what they are, what to do mid-attack, and when they need help

A panic attack can feel like you’re dying. That’s not an exaggeration. Many people who have a first panic attack go to A&E convinced they’re having a heart attack — and the tests come back clean, which is confusing until you know what a panic attack actually is.

Here’s what they are, what helps in the moment, and when they become something worth treating.

What a panic attack actually is

A panic attack is a sudden surge of intense fear or physical discomfort that peaks within about 10 minutes. Common symptoms include:

• Racing or pounding heartbeat.
• Shortness of breath or a sensation of choking.
• Chest tightness or pain.
• Dizziness, lightheadedness, or feeling faint.
• Tingling or numbness in the hands, feet, or face.
• Trembling or shaking.
• Sweating or hot flashes.
• Nausea or stomach upset.
• A sense of unreality or detachment (“derealisation” / “depersonalisation”).
• A strong fear of dying, losing control, or “going crazy”.

The physiology is your body’s fight-or-flight system firing without an actual threat. Adrenaline surges, heart rate jumps, breathing speeds up, blood moves to large muscles — everything the body would do if you were running from a lion. The problem is that you aren’t running from a lion. You’re sitting in traffic, or in a meeting, or in bed at 3 am.

Panic attacks are terrifying. They are not dangerous. They cannot cause a heart attack, a stroke, or death. Medical A&E staff in Pakistan see them often — and the correct response (once they’ve ruled out cardiac issues) is reassurance plus referral.

What to do mid-attack

A technique that works for most people, practised enough that you can reach for it automatically:

1. Name it, out loud or internally. “This is a panic attack. It peaks in 10 minutes. I am not dying.” Recognition alone takes some of the edge off.
2. Slow your breath. The breathing during panic is usually too fast and too shallow, which worsens the dizziness and tingling. Try4-7-8: inhale through the nose for 4 counts, hold for 7, exhale slowly through the mouth for 8. Repeat six times. The exhale is the part that calms the nervous system — make it longer than the inhale.
3. Ground through your senses. Name out loud: 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, 1 you can taste. This pulls your brain out of catastrophic thinking and into the present.
4. Don’t run from it. The instinct is to escape the situation. Running reinforces the panic — next time, the same situation will trigger the same response, worse. Where safe, stay put and let the attack peak and pass.
5. Wait it out. Ten to twenty minutes. Every panic attack ends. Yours will too.

After an attack, most people feel drained, slightly shaky, and tired for a few hours. Hydrate. Eat something gentle. Don’t immediately try to “prove you’re fine” by going hard at your day — rest.

When panic attacks become panic disorder

A single panic attack, in isolation, doesn’t mean you have a disorder. Many people have one in their lifetime and never have another. It becomes panic disorder when:

• Attacks are recurrent (more than a few over months).
• At least some of them come out of nowhere, without an obvious trigger.
• You’re worrying about when the next one will come or about “what it means”.
• You’re starting to change your behaviour to avoid them— avoiding specific places, crowded spaces, driving, being alone.

This is a diagnosable, highly treatable condition. The gold standard for panic disorder is cognitive-behavioural therapy (CBT) — typically 8 to 12 weekly sessions. Most people see significant reduction in frequency and intensity by the end. For severe cases, a psychiatrist may add medication (usually an SSRI like sertraline or escitalopram).

What therapy for panic actually looks like

CBT for panic has a specific structure. Rough week-by-week shape:

• Weeks 1–2: Understanding what a panic attack actually is (the physiology, why it isn’t dangerous), tracking yours, naming triggers.
• Weeks 3–5: Breathing retraining, cognitive restructuring (changing catastrophic thoughts like “I’m going to die” into accurate ones), and reducing safety behaviours that accidentally keep the panic alive.
• Weeks 6–10: Interoceptive exposure — gently and deliberately triggering the physical sensations of panic in a controlled way (quick breathing, standing up fast) so your brain learns they’re not dangerous. This is the part that does most of the work.
• Weeks 11–12: Relapse prevention and consolidation.

The interoceptive exposure piece is counterintuitive but critical. Trying to avoid panic symptoms makes them more powerful. Teaching your brain that a racing heart or dizziness is just physiology, not a threat, takes the fuel out of future attacks.

When to go to A&E

If you’ve never had a panic attack before and are experiencing sudden chest pain, especially with pain radiating to the left arm or jaw, one-sided weakness, confusion, or if your symptoms don’t subside within about 30 minutes, go to the nearest emergency department. A real cardiac event shares some symptoms with panic — the safe move is to rule it out with an ECG.

Once a cardiac cause has been cleared, and especially if this has happened multiple times, the next step is a psychologist or psychiatrist, not more emergency visits.

Getting help in Pakistan

CBT for panic is within the training of any registered clinical psychologist in Pakistan. Safe Healing’s intake asks about anxiety-specific symptoms and can match you with a therapist trained in panic work. Start the intake.

If you’re currently in a mental-health crisis, contact Umang Pakistan at 0311-7786264 or visit your nearest emergency department.