It comes out of nowhere, or it seems to.
You're on the journey home, or mid-argument with your partner, or doing absolutely nothing at all… And then something shifts fast, without warning: your heart starts hammering, you feel a wave of heat or cold through your entire body, you can't seem to get a full breath even though you're clearly breathing, your hands tingle, the room feels slightly off, like something about it isn't quite real, and underneath all of it is a thought that arrives with absolute certainty: something is very wrong.
That is a panic attack. And if you've had one, you'll know that describing it afterwards just doesn't capture how frightening it is while it's happening, regardless of when it strikes.
What Is a Panic Attack?
A panic attack is a sudden, intense wave of fear or physical discomfort that peaks rapidly, usually within minutes, and then gradually subsides. Contrary to what we think in the moment, it isn't a sign that we're going mad, or that our body is failing, even though it can feel exactly like that.
What's happening underneath is a nervous system response: the same fight-or-flight activation we explored in the article on emotions, firing at full blast, without a real immediate external threat to justify it. The amygdala has read the situation as dangerous, triggered the alarm, and flooded the body with adrenaline. Every physical sensation that follows is the body doing exactly what it's designed to do in a moment of genuine danger. It's just doing it at the wrong moment, in response to something that isn't actually there.
What Does a Panic Attack Feel Like?
Panic attacks vary between people, but if you've had one, you probably recognise at least several of these:
Heart pounding, racing, or beating irregularly, sometimes so loudly you can hear it
Chest tightness or pain that makes you certain something is wrong with your heart
Shortness of breath, hyperventilating, or that uncomfortable feeling of not being able to get a full breath in
Dizziness, lightheadedness, or the sensation that you might faint
Tingling or numbness, often in the hands, fingers, feet or face or all of them at the same time
Sweating, chills, or sudden hot flushes
Nausea, or a stomach that drops as though you've just stepped off a kerb
Trembling or shaking, sometimes visible, sometimes internal
A strange sense that things around you aren't quite real, or that you're watching yourself from a distance, like you're observing yourself from above or aside
An overwhelming, hard-to-shake certainty that something terrible is about to happen, that you're about to lose control, or that you might be dying
The last one is important. That feeling of "this is it, this is serious" is part of the panic attack itself, not evidence that something is actually wrong.
"Am I Having a Panic Attack or a Heart Attack?"
If you've had a panic attack, there's a good chance you've also googled this at some point… not necessarily in the moment because you just couldn't do both… more likely afterwards or at 2am, phone under the duvet, convincing yourself you're about to die. And you are not alone in that.
The physical overlap is real: racing heart, chest pain, breathlessness, a sense of impending doom. And it is always reasonable to get checked if you're not sure, especially if it's a first episode or if you have any cardiac history. There's no shame in going to A&E and being told your heart is fine. Many people have done exactly that, and being told there's nothing wrong with your heart is, in itself, genuinely useful information.
If you've been to the GP or A&E multiple times with these symptoms and been given the all-clear each time, you may have been told it could be panic attacks. This doesn't take away the impact they have, or that what you feel is any less real or valid.
Panic Attack vs Anxiety Attack: What Is the Difference?
You'll hear these terms used as though they mean the same thing — not quite, though the distinction isn't always obvious.
A panic attack is sudden and typically unpredictable. One moment things are fine; the next, full alarm. It can happen in situations that feel completely safe, even during sleep. The physical intensity is extreme, and it peaks fast.
An "anxiety attack" — which isn't actually a clinical term (you won't find it in any diagnostic manual) — is what people often use to describe something different: a slow build of overwhelming anxiety, usually tied to something specific. Think of the kind of dread that accumulates across a whole day before a difficult conversation, or the escalating spiral of "what ifs" before a big presentation, until you're shaking and struggling to think straight. Less sudden, less explosive but potentially just as exhausting.
The distinction matters because the two can feel similar in the moment but come from slightly different places, and the most helpful response to each is slightly different.
Why Do Panic Attacks Happen?
Panic attacks can happen to anyone, even people with no history of anxiety. But they're more likely when the nervous system is already stretched: from sustained stress, from running on empty for too long, from a period of significant change or uncertainty.
Sometimes there's a thread you can trace. The Tube because of a bad experience years ago. Crowded spaces because of a time you felt trapped. A particular kind of silence that reminds your body of a memory it hasn't finished processing. Sometimes there's no obvious thread at all — and that unpredictability is part of what makes panic attacks so scary. The body fires, and you don't know why, and then you start watching for it.
That watching is where things can begin to snowball. Because the fear of having another panic attack is itself a source of anxiety and that anxiety keeps the nervous system primed. You start reading your body differently, alert to the slightest change in heart rate, the first hint of dizziness. You begin avoiding the Tube, or the shopping centre, or the situation where it last happened, just in case. Gradually, bit by bit, your world gets smaller and smaller.
What Helps in the Moment
The single most useful thing to know during a panic attack, even if you can't hold onto much else, is this: it will pass. The body cannot sustain that level of activation indefinitely. Even when it doesn't feel like it, the wave will peak and begin to ease.
Slow your exhale. If you can only do one thing, do this. Breathe in for four counts, breathe out for six or eight. Don't worry about doing it perfectly. The extended exhale, longer out than in, sends a signal to the nervous system that you're safe, and begins to bring the alarm down. It won't stop the panic immediately, but it gives the body something to follow. (If you have asthma, be aware that focused breathwork can sometimes trigger symptoms — the grounding exercise below is a good alternative starting point.)
Don't fight it. The instinct is to resist: to clench, to try to control what's happening, to tell yourself to stop. That effort tends to add fuel rather than douse it and you end up struggling against the panic on top of experiencing it, which makes everything more intense. Letting the wave come, without trying to block it, sounds counterintuitive but it usually shortens it, as ridiculous as it may sound, because who would willingly let this happen...
Come back to what's real. Look around you. Name five things you can see: the colour of the wall, the pattern on a fabric, the light in a window. Four things you can hear: the rain outside, the cars driving past. Three things you can physically feel: the weight of your feet on the floor, your back against a seat, the temperature of the air. This isn't a distraction technique; it's a way of bringing the nervous system back to the present moment, so it realises the threat isn't actually there.
Afterwards: panic attacks are exhausting. Give yourself time to settle. Don't immediately push yourself back into whatever you were doing as if nothing happened. The body has just been through something intense. Grab a fluffy blanket, make yourself a cup of tea and stay on the sofa for as long as you need to recover.
What Helps Longer Term
If panic attacks are recurring, or if the fear of having one is starting to shape your choices, what you do, where you go, what you quietly start avoiding, that's worth bringing to a conversation with a therapist.
Panic attacks are manageable. What tends to keep them going isn't the panic itself but the patterns that build around it: the hypervigilance, the avoidance, the way the nervous system learns to stay on alert, and the fear of having more panic attacks, that can be a trigger in itself. Working through those patterns, understanding what the body is responding to, and slowly building a different relationship with the fear, that's where lasting change tends to come from. Not managing symptoms indefinitely, but actually shifting what's underneath.
If panic attacks have been taking up more space in your life than you'd like, you don't have to work it out alone. You're welcome to get in touch for a free 20-minute videocall — or simply to ask me a question first.
I offer sessions in person in West Hampstead and Paddington, and online across the UK.
