Anxiety and panic attacks: understanding what is happening

Anxiety is a normal response to threat. It becomes a disorder when it is persistent, out of proportion to the situation, and starts limiting what you do.

What a panic attack feels like

A sudden surge of fear with physical symptoms: pounding heart, chest tightness, shortness of breath, dizziness, sweating, trembling, tingling in the hands or face, nausea, and a sense of unreality or losing control. It usually peaks within minutes and then subsides, though it can leave you exhausted.

Important: chest pain and breathlessness can also indicate a heart or lung problem. If this is new, severe, or you have risk factors, get it assessed urgently rather than assuming panic. Once a cardiac cause has been excluded, the diagnosis of panic becomes safer to work with.

In the moment

• Remind yourself what it is: unpleasant and frightening, but not dangerous, and it will pass.
• Slow your breathing out. Breathe in for about four counts and out for six, which calms the nervous system more than deep breaths in.
• Ground yourself: name five things you can see, four you can touch, three you can hear, two you can smell, one you can taste.
• Keep your feet on the floor and loosen tight clothing.
• Do not rush away from the situation if you can stay safely, since escaping teaches the brain the place was dangerous.

Reducing anxiety over time

• Regular sleep, activity and meals, which stabilise the baseline
• Reducing caffeine, which can mimic and worsen anxiety symptoms
• Gradual, planned exposure to avoided situations rather than sudden confrontation
• Limiting reassurance-seeking and symptom-checking online, which maintains the cycle
• Talking therapies, particularly cognitive behavioural approaches, which have strong evidence
• Medication where appropriate, discussed with a clinician

What makes anxiety worse without you noticing

Alcohol and some recreational substances raise anxiety in the following days. Certain medicines and conditions, including thyroid problems, can produce similar symptoms, which is why a physical check is part of a proper assessment.

Seek help promptly if

Anxiety stops you working, studying, travelling or socialising; panic attacks are frequent; you avoid more and more situations; you use alcohol or substances to cope; or you have thoughts of harming yourself. Treatment works, and earlier is easier.