Panic attacks typically involve common patterns.

Cognitive-behavioral therapy is the first-line treatment for panic attacks.

Identifying thought and behavioral patterns is the first step toward reducing the frequency of panic attacks.

If you have ever had a panic attack, you know it is not fun. It might build slowly or hit you suddenly. But either way, once the process starts, anxious thoughts and symptoms multiply and intensify until, Pop! — you are in the midst of a full-blown panic attack and are engulfed by racing thoughts, a rapid heartbeat, difficulty breathing, and sweaty palms. And during these episodes, you can’t dismiss the fear that you are going to have a heart attack, suffocate, or somehow go crazy.

It may help to know that there are common characteristics of panic experienced by those who deal with this type of anxiety.1 Understanding these common characteristics is critical to reducing or eliminating panic from your life.

4 Common Characteristics of Panic Attacks

1. Specific situations trigger panic symptoms. Although some panic attacks happen suddenly and without warning, many individuals are triggered by certain situations or experiences. For example, they might be triggered by enclosed spaces (e.g., an elevator, crowded spaces), feeling hot, or certain social situations. Once people who experience panic symptoms identify what triggers their panic, they will quickly learn to avoid such situations.

What situations trigger your panic symptoms?

What situations trigger your panic symptoms?

2. Panic leads someone to become hypervigilant about physiological symptoms. In addition to avoiding situations that trigger panic symptoms, people begin to fear the physical sensations of panic. As a result, they are constantly focused on their physical state and become overly focused on any potential unexplained physical symptoms as they move through their day.

What are your most feared physiological symptoms? Which symptoms do you look out for because you worry that they indicate a panic attack is on the horizon?

What are your most feared physiological symptoms? Which symptoms do you look out for because you worry that they indicate a panic attack is on the horizon?

3. Catastrophizing is the key ingredient of a panic attack. People who suffer from panic believe that panic attacks or panic symptoms signal a potential catastrophe. They often fear they are dying from a heart attack, suffocation, or something else. They might fear they will “lose control,” “go crazy,” or humiliate themselves. Or they might fear that their panic attacks will become more frequent, unmanageable, and uncontrollable. Ultimately, the core issue that needs to be addressed in panic attacks is helping one learn how to not catastrophize about the symptoms. In other words, because people believe that their panic attacks are potentially dangerous when, in fact, they are not, it is critical to modify this thinking in treatment.

When you experience panic attacks, what is the worst possible outcome you think could happen? What catastrophe do you envision happening? Dying? Humiliating yourself? Going insane?

When you experience panic attacks, what is the worst possible outcome you think could happen? What catastrophe do you envision happening? Dying? Humiliating yourself? Going insane?

4. The things one does to prevent panic attacks take over life and make the fear of panic worse. Of course, because the experience of panic can be so uncomfortable and scary, people start to engage in avoidance or certain safety-seeking behaviors to stave off the panic symptoms. For example, they might escape or avoid the situations that bring the feared symptoms, such as elevators, planes, heights, bridges, driving, social situations, or crowded spaces. Although the avoidance or escape might reduce anxiety in the short term, it ultimately makes the anxiety worse. As a result, the person’s involvement in the world grows smaller and more limited. They might go out less and less, avoid traveling, or avoid social events.

What do you do (or what do you avoid) to reduce the chances of having a panic attack?

What do you do (or what do you avoid) to reduce the chances of having a panic attack?

Improving Panic Attacks in Treatment

You might be saying to yourself, "OK, this all makes sense to me, but now what?'

When I am working with a client with panic (whether panicky symptoms or full-blown panic attacks), we start by collaboratively gathering data on their “panic profile.” This allows us to figure out the thoughts and behaviors that need to be targeted in treatment.

Once we identify the problematic thoughts and behaviors, we can address them through cognitive restructuring, behavioral experiments, and exposure tasks.

Common tasks in treatment include:

Tracking thoughts and behaviors to build awareness of one's patterns (the things they think and do that are making the fear of panic attacks worse over time)

De-catastrophizing panic symptoms to reduce fear of them—identifying specific thoughts and beliefs about the panic symptoms and then reshaping them and reducing the tendency to exaggerate the threat (e.g., "I will have a heart attack," "I will suffocate," "I will go crazy")

Engaging in behavioral experiments to "test out" one's predictions that symptoms are harmful or dangerous (e.g., predicting that if they don't have their phone with them 24/7, they will die from panic-induced suffocation because they weren't able to get emergency care)

Engaging in interoceptive exposure tasks in which one exposes themselves to the feared sensations in a systematic, controlled way to slowly reduce fear of them (e.g., breathing into a straw or running up stairs to induce breathlessness, spinning around in a chair to give the sensation of dizziness)

Engaging in situational exposure tasks in which one faces the feared scenarios that bring on feared symptoms (e.g., crowded spaces, driving, elevators) to learn how to re-engage in their environment and systematically reduce fear of these situations

If you experience panic attacks, please know it is treatable. Exposure-based cognitive-behavioral therapy is the first-line treatment for panic attacks.2 Once you see these bodily sensations more realistically and learn, through experience, that they are not dangerous, the panic attacks happen less and less often. I've seen many clients make remarkable improvement in a short period of time.

To find a therapist, visit the Psychology Today Therapy Directory.

1. Clark DA, Beck AT. Anxiety and Worry Workbook. Guilford Publications; 2023.‌

2. Papola D, Ostuzzi G, Tedeschi F, et al. Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials. The British Journal of Psychiatry. 2021;221(3):1–13. https://doi.org/10.1192/bjp.2021.148‌

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