Panic attacks aren't necessarily a reason to panic: they are your body's way of responding to stress

Panic attacks typically occur when a person is under stress. The stress can be physical, like being run down, or emotional, like a significant life change.

Panic attacks are a relatively common experience with as many as one in seven people experiencing them at least once. A little more than half of those people will have repeated panic attacks.

Our understanding of panic attacks has changed over time, but we’ve now come to a good understanding of what panic attacks are and how we can help those who experience them.

It’s important to understand that panic attacks are a physiological expression of anxiety, and not intrinsically dangerous. The symptoms are the body’s natural way of coping with perceived threats.

Read more: Explainer: what are panic attacks and what's happening when we have them?

A build-up of stress

Panic attacks are typically experienced as time-limited episodes of intense anxiety.

The effects of stress can accumulate slowly, and a person is unlikely to be aware of the extent of their stress until a panic attack occurs.

Panic attacks often appear to arise for no apparent reason. They can occur anywhere and at any time, including at night, when the person has been asleep.

Panic attacks often have a very abrupt onset and usually resolve over the course of minutes rather than hours.

They are often, but not always, experienced as physical symptoms, such as rapid or skipped heartbeat, difficulty breathing and tightness in the chest, dizziness, muscular tension and sweating.

When someone experiences a panic attack there is also an emotional response which is driven by perceptions of threat or danger. If the person doesn’t know why a panic attack is happening, or perceives it as something more sinister, they are likely to feel more anxious.

Are panic attacks dangerous?

Panic attacks are not dangerous in and of themselves. They are simply intense anxiety, and the symptoms are real expressions of the sympathetic and parasympathetic nervous system activating and regulating.

An increase in heart rate occurs to improve the delivery of oxygen to our muscles to prepare for action like fight or flight. More oxygen is therefore needed and so breathing rate is increased, resulting in a sense of breathlessness and tightness in the chest.

As oxygen is directed to the core and muscles, supply can proportionately decrease to the head, leading to symptoms of dizziness.

The expression of these symptoms will self-regulate, so all panic attacks will cease. However, the residual effects of the body’s chemical messengers, adrenaline and noradrenaline, take some time to “wash out”. So it’s likely that after a panic attack the person will still feel some anxiety.

Again, this serves the function of having the body be prepared to reactivate for any other perceived or real threat. It’s also understandable that after this experience the person will feel tired and drained.

So if you have a panic attack, while unpleasant, it isn’t necessarily a sign that you need to seek help. It may be that through reflection you can use the panic attack as a signal to examine what is happening to lead to the physical or emotional stress in your life, and perhaps make some changes.

When should you seek help?

A small portion of people (1.7%) who experience panic attacks may go on to develop a panic disorder.

Panic attacks may become frequent and lead a person to avoid situations they perceive as high risk.

Read more: Australians understand depression, so why don't we ‘get’ anxiety?

In this case the panic attacks become a panic disorder, and it would be useful to seek expert help from a registered mental health professional, such as a psychologist or psychiatrist.

The most effective treatment for panic disorder is psychological therapy (cognitive behaviour therapy) with or without antidepressants.

What can I do to help a friend?

If you see someone having a panic attack, try not to “feed the fear” by responding with anxiety or fear. Remember and calmly remind the person that while the experience is unpleasant, it is not dangerous and will pass.

Perhaps the most useful thing to do for someone having a panic attack will be to help to re-focus their mind, away from the thoughts that are causing stress.

But you can also give them a sense of control over the physical effects of the attack. This can be done by helping to slow and pace the person’s breathing. There are many variations of this process, but one example is to calmly ask the person to breathe in for four seconds, hold their breath for two seconds, and then breathe out slowly over six seconds.

You can quietly count the seconds with the person and repeat the procedure for a minute or so, or as needed.

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