A panic attack is an episode of intense fear that appears suddenly, peaks within a few minutes, and is accompanied by very strong physical symptoms. Those who experience it for the first time almost always think they are having a heart problem: this is understandable, because the body really does react as if the danger were real and immediate.
The Main Symptoms
- Sudden tachycardia, heartbeat perceived as irregular
- Feeling of choking or shortness of breath
- Dizziness, feeling faint, weak legs
- Sweating, trembling, chills or hot flashes
- Feeling of unreality or detachment from oneself
- Fear of dying, going crazy, or losing control
The episode, however terrifying, resolves on its own: the peak lasts a few minutes, then the activation subsides. No one has ever died from a panic attack.
Panic attack: the immediate remedy
There is no pill that stops it on the spot, and anyone who promises you that is misleading you. There are, however, a few things that really work in the minutes while the episode is happening, and here they are.
Name it. Telling yourself “this is a panic attack, it will pass” reduces the secondary alarm — the fear of the symptoms themselves — which is what fuels the escalation.
Lengthen the exhale. There's no need to breathe deeply — that risks worsening hyperventilation. What matters is exhaling longer than you inhale: breathe in counting to four, breathe out counting to six or eight. It's the long exhale that activates the parasympathetic system.
Ground yourself in the present (grounding). Plant your feet firmly on the ground and mentally name five things you see, four things you feel by touch, three things you hear. This brings your attention out of your body and out of the chain of thoughts.
Stay where you are, if you can. This is the hardest and most useful part: fleeing gives immediate relief but teaches your brain that the place really was dangerous.
What not to do: breathing very fast and deep, seeking obsessive reassurance, constantly checking your pulse. These are behaviors that calm you in the short term and reinforce the problem in the long term.
Can you die from a panic attack?
No. It's the question almost everyone who has had one asks, and it's understandable: the symptoms resemble those of a cardiac problem and the fear is real. But a panic attack is not life-threatening. The body is activating an alarm response designed to protect you, not to harm you, and that response resolves on its own.
This doesn't mean ignoring the body. With the first episodes it's right to see your doctor to rule out organic causes: once ruled out, knowing for certain that it's not your heart is itself part of the treatment, because it takes fuel away from the fear.
Nocturnal panic attacks
A significant portion of episodes happen during sleep: you wake up already in full activation, with no context to attach the fear to. They are more disorienting than daytime ones and disrupt rest, feeding the cycle. I discuss this in the article dedicated to nocturnal panic attacks.
Why they happen
The causes are more than one and intertwine on three levels: what predisposes, what triggers, and what maintains the problem over time. I explore them in more depth in the article on why panic attacks happen.
Rarely is there a single cause. Contributing factors include prolonged periods of stress, unrecognized anxiety, major life changes, and sometimes unresolved past experiences. They can also appear in moments of apparent calm, which makes them even more disorienting.
With the first episodes, it makes sense to talk to your doctor to rule out organic causes. Once that's done, the work is psychological.
Difference between a panic attack and anxiety
They are constantly confused, but they are two different things.
Theanxiety is a state: it rises gradually, can last hours or days, has variable intensity, and remains compatible with carrying out activities. It is future-oriented — it anticipates something that might happen.
Thepanic attack is an event: it comes on suddenly, peaks within a few minutes, has extreme intensity, and stops you in your tracks. And it's all in the present — the feeling is that disaster is happening right now.
A simple way to remember it: anxiety is the background noise, a panic attack is the fire alarm. You can have anxiety without ever having a panic attack, and you can have a panic attack without generally suffering from anxiety — although in most cases the two coexist.
The real problem isn't the attack
It's what comes after: the fear that it will happen again. This anticipatory anxiety leads to progressively avoiding places and situations associated with the episode — the subway, the supermarket, the highway. Avoidance reduces anxiety in the moment, which is why it becomes entrenched, but it narrows your life and confirms the idea of danger. It's this cycle that therapy addresses.
How therapy works
On three levels: managing acute symptoms, gradually reducing avoidance, and understanding what that anxiety is signaling. I use cognitive-behavioral techniques and physiological regulation methods such as Autogenic Training, within a Gestalt approach to awareness; when there are traumatic experiences at the root, I considerEMDR.
A journey in Florence or online
I receive clients at my office in Florence, at Via Tommaso Campanella 5, in the Campo di Marte – Coverciano area, and online. You can learn more on the page about panic attacks in Florence or contact me for an initial consultation.
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