I Think I Just Had a Panic Attack: What Do I Do Next?

Source: Yehsong Kim, used with permission

This guest post was contributed by Yehsong Kim, a graduate student in the USC Psychology Department's Clinical Science Program.

Your first question may be: Is what just happened to me really a panic attack?

A panic attack features a sudden and intense fear or discomfort that usually lasts a few minutes. This fear or discomfort can be accompanied by bodily symptoms, like a pounding heart, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, chills, and a fear of losing control or dying. Panic attacks are different from ongoing anxiety because of how quickly they come on (within a few minutes) and how intense they feel.

Rest assured, you’re going to be okay. You’re not going crazy, and you are not going to die. Your body has gone into survival mode for a few minutes, and that’s OK.

Panic attacks are surprisingly common: about 15 percent of the U.S. population has had a panic attack in their lifetime. For many people, the occasional panic attack isn’t too disruptive to their lives. For others, panic attacks might escalate into panic disorder. I know, I know, now you’re thinking: Wait, what is a panic disorder, and do I have that?

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To meet the criteria for panic disorder, you have to have had multiple panic attacks and then developed a consistent worry about having more panic attacks in the future or changes in your behavior due to the panic attacks. For example, you had a panic attack in the past while on a run, and now you avoid exercising to avoid having another panic attack—this is a behavioral change that’s happened because of a panic attack.

I’m sure some of you are now relieved and are excited not to have to read the rest of the post. But for some of you, I’ve only worsened your concerns. Don't worry—there's only good news from here.

Is panic disorder treatable?

Yes, it absolutely is. There are therapies to treat panic disorder with lots of evidence behind them (though, fair warning, there may be some “treatments” with no evidence out there, too).

The most common evidence-based treatment for panic disorder is cognitive-behavioral therapy or CBT. The goal of this therapy is to change your thinking about bodily sensations related to panic attacks. Up to 70-80 percent of those receiving cognitive-behavioral therapy for panic disorder reported having no more panic attacks, and most people report much improvement.

What is cognitive-behavioral treatment like?

Great question. CBT can be as short as 12 sessions, during which you gain tools to stop having panic attacks. The treatment begins with education around what causes panic and anxiety, and how feedback loops among your physical sensations, thoughts, and subsequent actions work to keep your panic and anxiety high. Ultimately, you’ll be working to break those feedback loops.

Therapists then seek to identify patterns around the situations in which panic attacks are likely to happen—things like negative thoughts, scary imagery, and physical sensations. For “homework,” you’ll monitor yourself for panic attacks, anxiety, and your mood.

Because panic attacks are frightening, and anxiety can warp thinking, this monitoring helps you become more accurate in your observations of what’s really happening in your body and mind. Next, you learn a few other important skills, including breathing re-training—learning to take deep breaths from your diaphragm, a skill meant to help you cope with anxiety-provoking situations—and cognitive restructuring, just a fancy term for changing your thinking.

Therapists help you examine potential errors in your thinking (e.g., “I’m afraid I’m going to die during a panic attack”) to understand that these thoughts may be unfounded (e.g., “Does the feeling that you will die mean that you really will die?”).

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With these important skills under your belt, therapists then move onto exposing you to those sensations or situations that you have avoided since you started having panic attacks. Why? Why would they do something so scary?

Well, the idea is that those scary situations are actually not so harmful, and learning to cope with those situations will eventually help rid you of your panic attacks. Therapists won’t throw you into the deep end—you develop an exposure hierarchy to start from a situation that only provokes a little bit of anxiety and build up to those things you really fear.

You are encouraged to use your newfound breathing and cognitive restructuring skills to cope with the fear and anxiety that may come up during exposure. Eventually, with enough exposure, you’ll get so used to those once scary sensations and situations that they won’t trigger panic attacks in you anymore.

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How do I find help?

Finding a therapist can feel like a daunting task. The first question to ask yourself is how you’ll be paying for it. If you can afford therapy out of pocket (usually between $50-$150 a session), you can type in your city or zip code on the Psychology Today page to find a therapist near you. You can look at each therapist’s profile for the types of issues they treat (panic disorder) and their treatment approach (Cognitive Behavioral or CBT). Sometimes therapists have long lists of their treatment approaches, and it may be worth giving them a call to see if they’ve been trained in treating panic disorder with CBT.

If you’ve got health insurance that will cover behavioral treatment, you can search within your health care website for providers that are covered under your health insurance. Be sure to check your deductible to see how much you will need to pay out of pocket before insurance kicks in and your co-pay to see how much of the session you’ll have to pay thereafter.

What if I can’t afford it?

Therapy can be expensive, and some health care plans may not cover therapy. A more affordable option might be group therapy, which you can often find in community mental health centers, though you’ll want to find one specific to panic disorder.

Another option is to find a university near you with an accredited clinical psychology program with an in-house clinic. They often offer low-cost, evidence-based treatments as clinicians will be trainees. In some cases, medications can be helpful, which you can talk more to your doctor about.

What if I’m not sure I need therapy and want to try some strategies on my own?

The first thing you can do is recognize that anxious bodily sensations will not hurt you and are part of your body’s normal, adaptive stress response. Panic can be a vicious cycle—the more you focus on and worry about your anxiety sensations, the worse they can get. Soon you may be white-knuckling your way through situations wondering when the next panic attack will come on, which puts your body into a revved-up state that ironically makes you more vulnerable to anxiety.

Notice the sensations rather than catastrophizing, and recognize that they do eventually go away. Practice staying in the situation and building tolerance, even if your impulse is to escape. In those situations, you can try deep breathing, breathing from the diaphragm and taking longer on the exhale, to help your body relax.

If you’re up to it, you can create your own exposure hierarchy. If you panic in enclosed spaces, see if you can build up the number of minutes you stay in the closet or try traveling just a few floors in an elevator. You can gradually work yourself up.