David D. Burns recommends breathing exercises for those suffering from anxiety. One such breathing exercise is a 5-2-5 count. Using the stomach (or diaphragm)—and not the chest—inhale (feel the stomach come out, as opposed to the chest expanding) for 5 seconds. As the maximal point at inhalation is reached, hold the breath for 2 seconds. Then slowly exhale, over 5 seconds. Repeat this cycle twice and then breathe 'normally' for 5 cycles (1 cycle = 1 inhale + 1 exhale). The point is to focus on the breathing and relax the heart rate. Regular diaphragmatic breathing may be achieved by extending the outbreath by counting or humming.
People who have repeated, persistent attacks or feel severe anxiety about having another attack are said to have panic disorder. Panic disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked.[18] However, panic attacks experienced by those with panic disorder may also be linked to or heightened by certain places or situations, making daily life difficult.[19]
Although how long a panic attack lasts can vary greatly, its duration is typically more than 10 minutes. A panic is one of the most distressing conditions that a person can endure, and its symptoms can closely mimic those of a heart attack. Typically, most people who have one panic attack will have others, and when someone has repeated attacks with no other apparent physical or emotional cause and it negatively changes their behavior due to the attacks or feels severe anxiety about having another attack, he or she is said to have panic disorder. A number of other emotional problems can have panic attacks as a symptom. Some of these illnesses include posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, schizophrenia, and intoxication or withdrawal from alcohol and certain other drugs of abuse.
Generally, panic attacks are treated with reassurance and relaxation techniques. By definition, panic attacks last less than an hour, so many times a person already feels much better by the time he or she makes it to the doctor's office. Nevertheless, because the diagnosis is made by excluding more dangerous causes, people may be given medications during their attack.
Behaving in an apprehensive manner produces the physiological, psychological, and emotional state of anxiety. When we behave apprehensively (worried, fretful, concerned, afraid), the body activates the stress response, which secretes stress hormones into the bloodstream where they travel to targeted spots in the body to bring about specific changes that enhance the body’s ability to deal with danger. The stress response is often referred to as the fight or flight response because of how it equips the body to either fight with or flee from danger.
The typical course of panic disorder begins in adolescence and peaks in early to mid-twenties, with symptoms rarely present in children under the age of 14 or in older adults over the age of 64 (Kessler et al., 2012). Caregivers can look for symptoms of panic attacks in adolescents, followed by notable changes in their behavior (e.g., avoiding experiencing strong physical sensations), to help potentially identify the onset of panic disorder. Panic disorder is most likely to develop between the ages of 20-24 years and although females are more likely to have panic disorder, there are no significant sex differences in how the disorder presents (McLean et al., 2011).
Over time, many who suffer panic attacks develop an on-going fear of having another attack. This fear can severely hamper daily activities and overall quality of life. Some people refuse to leave their houses or to put themselves in situations that remind them of their previous attacks. Agoraphobia (a fear of being outside of known and safe surroundings) or other mental problems may follow.
Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.
Says Clyman: "You might start to consider your emotions as changing experiences that are always fluctuating. When we feel distressed, it can seem like the distress is going to go on and on forever until we emotionally combust. But instead, emotions act more like a wave, at times increasing and becoming more intense. But inevitably they'll reach a plateau, subsiding and finally passing."
Over time, many who suffer panic attacks develop an on-going fear of having another attack. This fear can severely hamper daily activities and overall quality of life. Some people refuse to leave their houses or to put themselves in situations that remind them of their previous attacks. Agoraphobia (a fear of being outside of known and safe surroundings) or other mental problems may follow.
You do not need to be officially diagnosed with panic disorder to have an attack. Some people have only one or two panic attacks in their life and don't have panic disorder. Panic attacks are actually much more common than panic disorder. According to one Harvard Medical School survey, about 23 percent of people interviewed experienced at least one panic attack in their lifetime, while only about 3 percent of people experienced panic disorder in their lifetime. (1)
Without treatment, panic attacks tend to occur repeatedly for months or years. While they typically begin in young adulthood, the symptoms may arise earlier or later in life in some people. Complications, which are symptoms that can develop as a result of continued panic attacks and develop into other mental illnesses, may include specific irrational fears (phobias), especially of leaving home (agoraphobia) and avoidance of social situations. Other possible complications can include depression, work or school problems, suicidal thoughts or actions, financial problems, and alcohol or other substance abuse. For children and adolescents, panic disorder can even interfere with normal development. Panic disorder and other anxiety disorders also predispose sufferers to developing heart or gastrointestinal diseases, high blood pressure or diabetes, having more severe symptoms if they have a respiratory disease, and of dying prematurely.
Dialectical Behavior Therapy (DBT) is form of Cognitive therapy that emphasizes individual psychotherapy as well as group skills training to help people learns new skills and strategies—including mindfulness and distress tolerance– to manage their anxiety and panic.  According to the American Psychological Association therapists who practicing DBT aim to strike a balance between validation and change by clearly communicating acceptance of who the client is and the challenges the client faces, while at the same time helping the client to learn new skills to improve emotion regulation, interpersonal communication skills and how to participate in life and cope with problems without defaulting to impulsive behavior.

We all tend to avoid certain things or situations that make us uncomfortable or even fearful. But for someone with a phobia, certain places, events or objects create powerful reactions of strong, irrational fear. Most people with specific phobias have several things that can trigger those reactions; to avoid panic, they will work hard to avoid their triggers. Depending on the type and number of triggers, attempts to control fear can take over a person’s life.


David D. Burns recommends breathing exercises for those suffering from anxiety. One such breathing exercise is a 5-2-5 count. Using the stomach (or diaphragm)—and not the chest—inhale (feel the stomach come out, as opposed to the chest expanding) for 5 seconds. As the maximal point at inhalation is reached, hold the breath for 2 seconds. Then slowly exhale, over 5 seconds. Repeat this cycle twice and then breathe 'normally' for 5 cycles (1 cycle = 1 inhale + 1 exhale). The point is to focus on the breathing and relax the heart rate. Regular diaphragmatic breathing may be achieved by extending the outbreath by counting or humming.

There has been recent interest in using psychoactive substances in conjunction with psychotherapy; the two that have received increased attention have been cannabis (marijuana) and methylenedioxymethamfetamine (MDMA, known as ecstasy or molly). These drugs are somewhat controversial, given that they also have psychoactive, i.e. "feeling high" effects. However, with increasing legalization of marijuana it is important to address whether these substances could be used to alleviate clinical symptoms of anxiety. While there have been only a few randomized clinical trials for these drugs, certain forms of cannabis have demonstrated positive effects on anxiety. Specifically, cannabidiol, a component of cannabis has been effective for Social Anxiety Disoder, and tetrahydrocannabinol (THC) has helped PTSD patients. However, the plant form of cannabis has not shown great efficacy and has potential to worsen symptoms, so should be used with caution and only under supervision of a provider. MDMA has shown some positive effects for PTSD, but should only be used as an adjunct to psychotherapy, again under clinical care.
In addition to the emotional turmoil and the physical manifestations that Caroline and Kirstie describe panic attacks can cause palpitations, pounding heart or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, light-headed or faint; chills or overheating; numbness or tingling; feelings of unreality (derealization) or being detached from oneself (depersonalization); fear of losing control or “going crazy”; and fear of dying.

Fortunately, panic disorder is one of the most treatable of the anxiety disorders. Psychotherapy (sometimes called talk therapy), cognitive, or biofeedback therapy can all help alter a person's response to stimuli. Medications, such as antidepressants and beta-blockers, are another option. And certain lifestyle changes, such as limiting caffeine and sticking to a daily exercise plan, can decrease symptoms as well.
When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased bloodflow in the amygdala.[87][88] In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.
Almost everyone experiencing symptoms of a panic attack needs evaluation. Unless the person has a history of having panic attacks, is otherwise healthy, and is experiencing a typical attack, they must be evaluated promptly by a doctor. The level of evaluation depends on many factors. Err on the side of safety when deciding whether to go to a hospital's emergency department.
Many medical conditions can cause anxiety. This includes conditions that affect the ability to breathe, like COPD and asthma, and the difficulty in breathing that often occurs near death.[63][64][65] Conditions that cause abdominal pain or chest pain can cause anxiety and may in some cases be a somatization of anxiety;[66][67] the same is true for some sexual dysfunctions.[68][69] Conditions that affect the face or the skin can cause social anxiety especially among adolescents,[70] and developmental disabilities often lead to social anxiety for children as well.[71] Life-threatening conditions like cancer also cause anxiety.[72]
Everyone experiences anxiety from time to time. Perhaps the person has watched a scary move, or seen something upsetting on TV. Or, more ominous, perhaps the person has experienced or witnessed a crime. Anyone might get anxious in these situations, but the person with an anxiety disorder has persistent or recurrent anxiety that prevents him or her from full participation in life. Anxiety can range from relatively mild (occasional “butterflies,” jitteriness, accompanied by a sense of unease) to severe (frequent, disabling panic attacks). Severe anxiety disorders can lead the person to alter his lifestyle to accommodate the anxiety, for example not leaving home. More
Acceptance Affection Anger Angst Anguish Annoyance Anticipation Anxiety Apathy Arousal Awe Boredom Confidence Contempt Contentment Courage Curiosity Depression Desire Despair Disappointment Disgust Distrust Ecstasy Embarrassment Empathy Enthusiasm Envy Euphoria Fear Frustration Gratitude Grief Guilt Happiness Hatred Hope Horror Hostility Humiliation Interest Jealousy Joy Loneliness Love Lust Outrage Panic Passion Pity Pleasure Pride Rage Regret Social connection Rejection Remorse Resentment Sadness Saudade Schadenfreude Self-confidence Shame Shock Shyness Sorrow Suffering Surprise Trust Wonder Worry
Now as you feel slightly calmer, you need to identify and face the roots of the anxiety attack. The truth is – there’s always a trigger for it. Even if it’s not obvious, it’s always there. Panic attacks can happen as a response to a stressful or traumatic issue that happened months ago.  Try digging into your mind and thinking of the exact cue that might have caused it.  Remember, an anxiety attack is just a host of physical reactions. No matter how real it feels, the danger is usually non-existent.
Cognitive-behavioral therapy, or CBT, teaches patients to see the links between the their thoughts, beliefs, and actions. By changing distorted thought patterns that maintain the anxiety and by exposing the person to anxiety-provoking symptoms or situations in a gradual manner, CBT can help create mastery over the anxiety and panic symptoms. Therapy may help those with panic disorder to
A person with separation anxiety disorder is excessively fearful or anxious about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six months in adults) and causes problems functioning. A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation. Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood.
Adoration Aesthetic emotions Affection Agitation Agony Amusement Anger Anguish Annoyance Anxiety Apathy Arousal Attraction Awe Boredom Calmness Compassion Contempt Contentment Defeat Depression Desire Disappointment Disgust Ecstasy Embarrassment Vicarious Empathy Enthrallment Enthusiasm Envy Euphoria Excitement Fear Flow (psychology) Frustration Gratitude Grief Guilt Happiness Hatred Hiraeth Homesickness Hope Horror Hostility Humiliation Hygge Hysteria Infatuation Insecurity Insult Interest Irritation Isolation Jealousy Joy Limerence Loneliness Longing Love Lust Melancholy Mono no aware Neglect Nostalgia Panic Passion Pity Pleasure Pride hubris Rage Regret Rejection Remorse Resentment Sadness Saudade Schadenfreude Sehnsucht Sentimentality Shame Shock Shyness Sorrow Spite Stress Suffering Surprise Sympathy Tenseness Wonder Worry
For more information, please visit Mental Health Medications Health Topic webpage. Please note that any information on this website regarding medications is provided for educational purposes only and may be outdated. Diagnosis and treatment decisions should be made in consultation with your doctor. Information about medications changes frequently. Please visit the U.S. Food and Drug Administration website for the latest information on warnings, patient medication guides, or newly approved medications.
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