Panic attacks are frightening, but they are not dangerous, and both anxiety and panic attacks respond well to treatment. If panic is rising right now, stay where you are safe, breathe slowly and remind yourself that the surge will pass. If you have severe or unfamiliar chest pain, collapse or real difficulty breathing, call 112 or 999.
How anxiety, panic attacks and panic disorder differ
Anxiety is the body's response to stress or a threat it thinks is there. It tends to build slowly, as worry about a deadline, a relationship or your health, and it can stay long after the situation that set it off has passed. A panic attack is different. It is a sudden surge of intense fear that usually peaks within minutes. People often call it an "anxiety attack", but that isn't a clinical term, and most of the time they mean a panic attack.
Panic disorder is when panic attacks keep coming without warning, and the fear of the next one starts to shape your life. The US National Institute of Mental Health describes it as recurring, unexpected attacks along with at least a month of worry about further attacks, or changes in behaviour to avoid them. One panic attack, or even a few, doesn't mean you have panic disorder.
| Anxiety | Panic attack | Panic disorder | |
|---|---|---|---|
| Onset | Gradual | Sudden | Sudden attacks, often unexpected |
| Trigger | Usually a worry or stress you can name | A trigger, or none at all | Often no obvious trigger |
| Intensity | Mild to severe | Intense, peaks within minutes | Intense attacks plus ongoing fear of them |
| Duration | Hours, days or longer | Usually 5 to 30 minutes | A pattern lasting a month or more |
| Pattern | Comes and goes with stress | Can be a one-off | Repeated attacks, with avoidance or constant worry |
What panic feels like and why it happens without danger
The physical symptoms of panic can be overwhelming: a racing or pounding heart, tightness in your chest, breathlessness, sweating, shaking, dizziness, nausea, tingling in your hands or lips, and hot flushes or chills. Alongside them come the thoughts. You might feel you are losing control, going mad or about to die. Some people feel detached from themselves, or feel the room around them has become strange and unreal.
According to the HSE, most panic attacks last between 5 and 30 minutes. The NHS notes that some have been reported to last up to an hour. Not every attack follows the same pattern, and you can feel shaken or tired for a while afterwards.
All of this is your fight, flight or freeze response firing when there is nothing to fight or run from. Your body releases adrenaline and gets ready for an emergency, and the sensations it produces then feel like proof that something is wrong. The exact cause of panic disorder isn't fully understood. The NHS links it to very stressful or traumatic experiences such as bereavement, to family history and to brain chemistry. Ongoing stress, big life changes, poor sleep, caffeine, alcohol, drugs and some health conditions can all add to it. Sometimes, though, there is no trigger at all. If you felt panicked out of nowhere, while relaxing on the sofa or waking in the night, that doesn't mean something is badly wrong with you. Panic can happen that way.
What to do in the moment when panic hits
If you suddenly feel panicked, these steps can help the wave pass more quickly:
- Stay where you are if it is safe. If you are driving, pull over when you can, and move away from roads, water or heights.
- Tell yourself what is happening: "This is panic. It is not dangerous and it will pass."
- Loosen anything tight, such as a collar, tie or belt.
- Breathe slowly and comfortably. The HSE suggests breathing in through your nose and out through your mouth while counting slowly to five. Let the out-breath be a little longer than the in-breath, and don't force big, deep gulps of air.
- Ground yourself. Press both feet into the floor, hold a familiar object, or name five things you can see, four you can touch and three you can hear.
Some things tend to make panic worse. Trying to fight the sensations usually feeds them, so let them rise and fall. Checking your pulse again and again keeps your attention locked on your body. Reaching for alcohol or drugs that weren't prescribed for you may take the edge off briefly, but over time it makes anxiety harder to manage. If your symptoms are severe, don't drive until they have settled.
When to see a GP or get urgent help
We would encourage you to see your GP if panic attacks keep coming back, if you are living in fear of the next one, if you have started avoiding places or situations, or if anxiety is affecting your sleep, work or relationships. The same goes if you have been trying to manage it on your own and it isn't helping. You don't need to wait until things are unbearable.
Your GP will ask about your symptoms: when attacks happen, what might set them off, how long they last, how they are affecting your daily life and whether you worry about the next one. They may also check for physical causes or related problems, such as thyroid issues, medication side effects, substance use, depression, trauma or another anxiety condition. For many people this check is a relief in itself, because it rules out the things they were most afraid of.
Call 112 or 999 for chest pain that is severe or unlike anything you've had before, collapse, serious difficulty breathing, signs of a stroke (a drooping face, a weak arm or slurred speech), or if you or someone else is in immediate danger. If you are in crisis, you can go to your nearest emergency department, call Samaritans free on 116 123, or see the HSE's urgent and emergency care and urgent mental health help pages.
How therapy helps with panic attacks
Talking therapy is one of the main treatments for panic disorder, and the NHS names cognitive behavioural therapy (CBT) as the main talking therapy for it. In CBT you learn how panic builds: a sensation, a frightening thought about it, more adrenaline, a stronger sensation. Then you learn to break that loop. Part of the work is gradual, supported exposure, meaning you face the feelings or situations you have been avoiding, at a pace you agree with your therapist. The aim is to reduce both the attacks and the fear of the next one.
Panic doesn't always come out of nowhere. For some people it sits on top of years of anxiety, stress at work, an old trauma or a loss that hasn't been grieved. In those cases, we think counselling and psychotherapy that looks at the wider picture matters as much as learning techniques, because it gets to what keeps the anxiety going. Which approach suits you depends on your history and what you need, and our therapists will talk this through with you at the start. Our guide to what therapy is best for anxiety compares the options in more detail.
A GP or psychiatrist may also discuss medication, most often a type of antidepressant. That is a decision to make with your doctor, and you should never start or stop medication without their guidance. Recovery looks different for everyone, but the NIMH is clear that with the right treatment and support, people with panic disorder can manage their symptoms and improve their quality of life. You can read more about how we work with panic attacks and anxiety.
Managing anxiety and panic day to day
Steady routines give your nervous system less to react to. The HSE recommends eating regularly, exercising and learning relaxation techniques, and cutting back on caffeine, alcohol and nicotine. Regular sleep matters too, and if you use recreational drugs, notice whether they make your anxiety worse. A short daily breathing or relaxation practice helps more when you do it on calm days, so the skill is there when you need it.
It can help to note when attacks happen and what was going on beforehand, but try not to turn this into constant body-checking. Over time, gently going back to the places you have been avoiding shows your brain they are safe. A therapist can help you do this step by step.
If someone close to you is having a panic attack, stay calm and stay with them. Tell them you know it feels awful and that it will pass, rather than telling them to calm down. Offer to breathe slowly with them, and ask what would help. Some people want to talk, others just want company.
None of this guarantees you will never have another attack, and if one comes, it doesn't mean you have failed. What these habits can do is make attacks less frequent and less frightening. Be as kind to yourself through this as you would be to a friend.
FAQs
How can I tell a panic attack from a heart attack?
You can't always tell for sure, which is why new, severe or unfamiliar chest pain always needs a 112 or 999 call. Panic attacks often come with fear, tingling and fast breathing, and they ease within minutes. Heart attack pain may spread to the arm, jaw or back and doesn't ease. If you aren't sure, get checked, and once your doctor has ruled out a heart problem, you can work on the panic with more confidence.
Are panic attacks physically dangerous?
No. The NHS puts it simply; although panic attacks are frightening, they're not dangerous, and an attack will not cause you any physical harm. Knowing this won't stop the fear in the moment, but reminding yourself of it during an attack can take some of its power away.
What should I expect from counselling for anxiety and panic attacks?
Your first session with us is a chance to talk about what has been happening and what you would like to change. There is no pressure to tell everything at once. Together with your therapist, you will agree an approach and a pace that feel right. Our guide to your first therapy session explains more.
How much does anxiety therapy cost in Ireland, and can I have it online?
Our current fees are on our prices page, and we keep a low-cost counselling option for people who would otherwise go without. Your health insurance or workplace assistance programme may cover some sessions, so it is worth asking. We see clients in Dublin and Galway, and we also offer online therapy anywhere in Ireland, which many people find easier to fit around work and home. If you are weighing up the two, our article on online and in-person therapy may help.
Talking to someone about panic and anxiety
If panic or anxiety is shaping your days, you don't have to work it out alone, and you don't need to wait for a crisis before asking for help. Our therapists in Dublin, Galway and online work with anxiety and panic, and whenever you feel ready, you can get in touch with us to find the right therapist for you. If your symptoms are urgent, please call 112 or 999 rather than sending an enquiry.