Almost everyone who has had a panic attack says the same thing afterwards: I thought I was dying. That isn’t a figure of speech. It is the sensible conclusion to draw when your heart is hammering, you can’t get enough air, and the world goes strange all at once, with nothing in front of you to explain it.
This is here to explain what is going on. It isn’t a consultation and it isn’t a way to diagnose yourself: if you have had intense physical symptoms, the first step is a doctor ruling out other causes. With that done, the rest of this is useful.
What is happening in your body
A panic attack is a full alarm response, set off all at once and with nothing obvious setting it off. Your body does exactly what it would do if there were real danger in front of you: the heart pumps harder to get blood to the muscles, breathing speeds up to take in more oxygen, blood is redirected out towards your arms and legs.
All of that makes sense if you need to run. The problem is that there is nothing to run from, so the machinery is switched on with nowhere to put it. That is where the sensations come from:
- The racing heart and the pressure in your chest are a heart working hard, not a heart failing.
- Not being able to breathe is usually the opposite of what it looks like. You aren’t taking in too little air, you are taking in too much. Overbreathing lowers the CO₂ in your blood, and that is what produces the dizziness, the tingling in your hands and lips, and the feeling of suffocating.
- The unreality — watching yourself from somewhere outside, the room not quite being the room — is a well documented effect of intense arousal. It is the part that frightens people most and the part that matters least.
- The shaking and the sweating are the adrenaline arriving.
None of these sensations can harm you. They are unbearable and they are safe, both at the same time.
Why it frightens you so much
Because the fear is pointed at what is happening inside you, and you can’t walk away from that. Ordinary fear has something in front of it: a dog, a ledge, an exam. Here what frightens you is your own body, and your body comes with you everywhere.
There is a second trap. The fright feeds the response. You notice your heart racing, you think something is seriously wrong, and that thought sets the alarm off again, which pushes your heart higher still. That loop is what stretches out a spike that would otherwise have been brief.
How long it lasts
A panic attack climbs, peaks and comes down. The worst of it usually lasts a few minutes, though there is a hangover afterwards — tiredness, tension, the sense that it could start again — that can run on considerably longer.
This matters for a practical reason: the attack ends on its own. It doesn’t end because of something you did. When someone finds a trick that “works” — getting outside, drinking water, ringing a friend — it has almost always coincided with a descent that was coming anyway. That sounds like a small distinction and it isn’t. Once you believe you need the trick, you start avoiding anywhere you couldn’t use it.
What helps while it passes
There is no magic technique, and be suspicious of anyone selling you one. What does tend to help:
Make the out-breath longer. Not deep breaths, which usually make things worse. Let the air out slowly, taking longer to release it than you took to draw it in. That offsets the overbreathing and settles the dizziness and the tingling.
Don’t leave. If you can stay where you are, stay. Every time you get out of a place mid-attack, your brain records two things: that the place was dangerous, and that leaving saved you. Neither is true, and both stick.
Name it. “This is a panic attack, it’s horrible, and nothing is going to happen to me.” In the present tense, out loud if you can. It isn’t talking yourself round. It is handing yourself back information you already have, at the moment your body is busy hiding it.
Stop checking. Taking your pulse, testing whether you are breathing properly, scanning for symptoms — all of it holds your attention exactly where the loop feeds.
What doesn’t help, however much it looks like it does
Avoiding. It is the most natural thing in the world and it is what turns one bad episode into something that runs your life. It starts with not taking the metro, then not going anywhere on your own, then not crowded places, then nowhere that is difficult to leave. Every avoidance is a relief today and a slightly smaller life tomorrow.
Searching online at three in the morning doesn’t help either. I understand it completely and nearly everybody does it, but every search turns up one more illness to rule out, and that is what keeps the alarm switched on.
Doctor first, psychologist after
See a doctor first, always, if this is the first time or if something has changed. There are physical causes that produce similar symptoms and they are worth ruling out. Tests coming back clear doesn’t mean you are making it up: it means your heart is healthy and what you are feeling comes from somewhere else.
If you have recently moved here and haven’t yet worked out how to get seen, sort that out before anything else. It isn’t a detour from the problem — it is the first step in it.
See a psychologist once it starts making your decisions. When you have stopped doing things. When the day is organised around it not coming back. When you have spent weeks sleeping badly waiting for it. You don’t have to wait until it gets worse; there is more to work with while there is still room.
Medication is a doctor’s call. Some people work on anxiety in therapy alone, some combine the two. Neither is the right answer in the abstract.
If it is happening to someone you live with
The first thing is not to argue with the fear. “There’s nothing wrong, calm down” is true and useless: the person having it already knows they shouldn’t be having it, and hearing it adds the feeling of doing it badly on top.
What helps more is staying close, saying little, speaking slowly, and not taking charge. And what helps enormously is something almost nobody does: don’t reorganise the house around the fear. Going everywhere with them, running the errands for them, always picking the option that costs them least — it is all done out of love, and it all confirms to them that they couldn’t manage without it.
One sentence tends to land better than the rest: “I’m here, this passes, you don’t have to do anything.”
Worth holding on to
A panic attack is an alarm going off with no fire. The sensations are real, the danger isn’t. It ends by itself. And what keeps it going over months isn’t the attack — it is everything you start giving up so that it won’t come back.
That is where the work is, and it is work that responds well.
Talking to someone about it, in English
Fernando Ruiz Martínez is a psychologist and neuropsychologist in Granada (Col. M-39091), working in English or Spanish. There is no clinic to travel to: sessions are online, or at your home in Granada. Sessions are from 40 €.
The first conversation is free, by phone or video call. It is a chance to say what has been happening and to decide whether this way of working suits you, with no pressure either way.