Verke Editorial

Panic attacks: what they are and what to do

Verke Editorial · May 5, 2025

A panic attack is a sudden surge of intense fear that peaks within minutes. Your heart races, chest tightens, you feel like you're dying or losing control. It's terrifying — and it's not dangerous.

If you're having one right now, start with the next section. If you want to understand panic attacks and have fewer of them, keep reading past it.

No one has ever died from a panic attack. The symptoms are adrenaline, and adrenaline is temporary.

A panic attack is your fight-or-flight system firing without an actual threat. Your amygdala — the brain's alarm center — sends a false alarm, and your body responds as if you were in real danger. Adrenaline floods your bloodstream. Heart rate spikes. Breathing accelerates. Muscles tense. Every one of these symptoms has a biological explanation, and none of them are dangerous.

About 28% of people experience at least one panic attack in their lifetime — nearly one in three. Around 4.7% develop panic disorder, where attacks recur and the fear of the next attack starts shaping daily life.

Why your body does what it does

The panic cycle (Clark, 1986)

Psychologist David Clark identified the engine that turns a single uncomfortable sensation into full-blown panic: catastrophic misinterpretation. Your heart beats faster — normal, maybe from caffeine or standing up quickly. But your brain interprets "fast heartbeat" as "heart attack." That interpretation spikes your anxiety. The anxiety makes your heart beat even faster. Which looks like even more evidence. Within minutes, a harmless sensation has escalated into terror.

The misinterpretation is the engine. "My heart is racing" is a sensation. "I'm having a heart attack" is the catastrophic leap that turns sensation into panic. Understanding this distinction is itself therapeutic — Clark's research showed that psychoeducation alone reduces panic frequency, because once you know what's happening, the misinterpretation loses its grip. For more on how catastrophic misinterpretation drives anxiety, see the health anxiety article, which shares this same mechanism.

A panic attack is a clinical term with specific diagnostic criteria in the DSM-5: sudden onset, peaks within minutes, and includes at least four symptoms like racing heart, chest pain, dizziness, or derealization. An "anxiety attack" is a colloquial term for a period of elevated anxiety — it tends to build gradually, last longer, and reach a lower peak intensity.

Both are real experiences. The distinction matters because the treatment approaches differ. If your anxiety builds slowly over hours, the techniques for calming anxiety in the moment may be a better fit. If it hits suddenly and peaks in minutes, the protocol at the top of this page is designed for you.

Understanding the mechanism (what you just read)

Psychoeducation is treatment, not just background reading. When you know that chest tightness is muscle tension from adrenaline — not a heart attack — the catastrophic misinterpretation that fuels the cycle weakens. Clark (1986) showed that understanding the mechanism alone reduces panic frequency. The symptom table above is a tool: read it during a calm moment, let it sink in, and your brain will have an alternative explanation available the next time a sensation spikes.

The post-panic debrief

After each attack, write down five things while the memory is fresh:

1. What was happening before the attack?
2. What was the first sensation you noticed?
3. What was the catastrophic thought? ("I'm dying," "I'm going crazy," "I'm losing control.")
4. What actually happened? (The attack peaked and passed.)
5. What does this tell you about the next one? (It will also peak and pass.)

Over time, this builds an evidence file your brain can access during the next attack: "I've been here before. I survived every time." The debrief turns each attack from a traumatic event into data that weakens the next one.

Interoceptive exposure (advanced — with guidance)

Interoceptive exposure means deliberately inducing mild panic-like sensations in a safe context: breathing through a straw (to produce breathlessness), spinning in a chair (dizziness), or jogging in place (elevated heart rate). The purpose is to break the association between sensation and catastrophe. When your heart races from exercise and nothing bad happens, "racing heart equals heart attack" weakens.

This is an advanced technique from Barlow and Craske's (2007) panic treatment protocol, and roughly 80% of people who complete CBT for panic disorder are panic-free at the end of treatment. Amanda can guide you through it step by step, or work with a clinician for severe presentations.

For a broader toolkit of evidence-based anxiety exercises — including thought challenging, exposure ladders, and progressive muscle relaxation — see the full practical guide.

If panic attacks happen weekly or more, if you're changing your life to avoid them — skipping exercise, not traveling, staying home from events — or if you live with a persistent fear of the next attack between episodes, this is panic disorder. It responds extremely well to CBT: about 80% of people who complete treatment are panic-free afterward. See a clinician. Tools like Verke complement professional treatment but do not replace it for clinical panic disorder.

Amanda specializes in anxiety, stress, and the patterns that keep them running. She can walk you through the post-panic debrief after an attack, guide interoceptive exposure at your own pace, and help you build a track record of getting through panic attacks that your brain can reference the next time one hits. She remembers your history across sessions, so each conversation builds on the last. For more on her approach, see CBT for anxiety.

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