6 causes of panic attacks — and expert tools for how to cope

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If you suffer from panic attacks, read our expert advice to help you figure out why, and see what you can do to get them under control

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Quick facts

  • Underlying anxiety and a history of trauma may be one of the reasons for panic attacks
  • Cognitive Behavioural Therapy (CBT) can be used to treat panic disorder – it can also provide tools that help you manage a panic attack
  • Low blood sugar can trigger a panic attack — eating regular meals emphasising wholegrains and proteins may help

If you’ve ever experienced a panic attack, you already know how distressing they can be. ‘A panic attack is a sudden episode of intense fear that triggers a range of unpleasant sensations,’ says Dag Härdfeldt, Licensed Psychologist at Livi. ‘Typical symptoms may include a dry mouth, shortness of breath, a racing heartbeat, feeling faint, dizzy, chest pains, trembling, shaky limbs, nausea, sweating and tingling in your fingers. There may also be feelings of impending doom, terror and being out of control. You may even fear that you are having a heart attack. A panic attack can occur at any time and typically lasts for 5-20 minutes.’

What’s going on in your body during a panic attack?

‘The physiological reactions that occur during a panic attack come from the body’s “fight or flight” response,’ says Härdfeldt. This is an automatic ‘somatic’ response — meaning it occurs in the body — but is activated by the sympathetic nervous system, whenever you feel you’re in danger.

This stress response begins in the brain where the amygdala, the area to do with emotional processing, sends a signal to the hypothalamus, the area that communicates with the rest of the body. The hypothalamus activates the sympathetic nervous system, which signals to the adrenal glands to produce more adrenaline. As a result, your heart beats faster, breathing is quicker and more blood and oxygen go to your muscles, preparing your body to fight or run away. This can make you feel shaky, sweaty, dizzy or sick.

‘The fight or flight response is an important survival mechanism that we all have,’ Härdfeldt points out. ‘It becomes a problem if this response is repeatedly triggered when there is no actual danger, as it does during a panic attack, because your brain can’t distinguish between a real or perceived threat.’

Panic disorder is when you regularly have feelings of anxiety and fear that lead to panic attacks, often for no apparent reason. ‘Sometimes, people who have had a panic attack become so worried about it happening again that they misinterpret certain bodily signs,’ says Härdfeldt.

‘For example, if they get up quickly and feel dizzy, they worry that they’re about to have a panic attack. This fear triggers a fight or flight response that causes a panic attack. This makes them even more scared. It’s a vicious circle.’

Reasons for panic attacks

‘The causes of panic disorder are not yet fully understood — but research has shown a link between the disorder and factors such as genetic composition, major life transitions, overwhelming stress, and a history of trauma.’

1. Psychological triggers

‘One of the most common reasons for panic attacks is if you’ve experienced an event that triggered an intense fight or flight reaction,’ says Härdfeldt. ‘For example, if you had an accident as a child, that experience is stored in your emotional memory. Then, when you undergo extreme stress in later life, you might be susceptible to a panic attack.’

People who have been through trauma have an increased risk of panic attacks. ‘The brain has a tendency to favour emotionally-charged memories. If you experience something during strong emotional distress, that memory can come to play a big role in the anticipation of future events. So, if you’ve experienced immense emotional danger and fear before, your brain will be more inclined to interpret stressful events as dangerous in the future. Another way of putting it is that your fight or flight system has become hypersensitive.’

2. Caffeine

Caffeine in coffee, energy drinks and certain medications may be a reason for panic attacks in people susceptible to anxiety. ‘Caffeine increases heart rate and can make you nervous and jittery,’ says Härdfeldt. ‘In people who are sensitive to caffeine’s effects, these physiological reactions can exacerbate anxiety and trigger a panic attack.’ Conversely, caffeine may be used in controlled doses as a treatment — see below.

3. Medications

‘Antihistamines and benzodiazepines almost always have great anxiety-reducing effects in the moment, but can make the anxiety worse in the long run, because you’re conditioning your brain to believe that panic attacks are something so dangerous, they need to be medicated away,’ says Härdfeldt.

‘In contrast, caffeine almost makes the anxiety worse immediately, but in some treatments you actually increase the caffeine amount in order to “expose” the patient to its effect,’ he explains.

A recent study showed that some antidepressants can increase anxiety in the first few weeks of use. If you’re concerned about any medications you’re taking, always talk to your doctor.

4. Carbohydrates and sugar

Eating too many refined carbohydrates and sugary foods and drinks can worsen symptoms of panic attacks. A recent study reported that dietary carbohydrates may be significantly related to emotional and cognitive symptoms such as anxiety and difficulty in concentrating.

5. Low blood sugar

Low blood sugar (hypoglycaemia) is when your blood sugar drops too low, causing symptoms such as dizziness and, in some cases, shaking and sweating — similar to the symptoms of a panic attack. Eating a healthy diet of whole, unprocessed food with the emphasis on wholegrains and good quality proteins can help keep your blood sugar stable between meals. Eating regular meals can also help to keep blood sugar levels balanced. Sugary foods and drinks can also increase anxiety levels, so try to avoid them.

6. Alcohol

Alcohol lowers chemicals in the brain such as serotonin, which help to regulate and balance mood. Drinking too much alcohol can contribute to feelings of depression and anxiety, and can be a cause of panic attacks.

Can anything help to prevent panic attacks?

The best approach to panic attacks is to try to prevent them from happening. The time to act is when you start to feel anxious. By dealing with the anxiety and fear that triggers the fight or flight response, you’ll lessen the likelihood of a panic attack occurring.

Relaxation practices

‘Relaxation techniques can help to reduce stress and anxiety and manage the symptoms of panic attacks,’ says Härdfeldt. ‘Deep breathing exercises, visualisation, progressive muscle relaxation, meditation and yoga help to lower the heart rate, slow breathing, reduce muscle tension and calm the mind.’

To be of benefit, you need to practice these skills regularly, even when you’re not feeling anxious. Aim to practise a relaxation technique for at least 5 to 10 minutes every day. This will make it easier to put the method into practice whenever you feel panicked and anxious.

Regular physical exercise

This will help reduce stress and tension. Walking, running, yoga, tennis, cycling and dancing can all help you to relax and help the body to process excess stress hormones, such as adrenalin and cortisol, in a healthy way. Additionally, ‘What happens in our bodies during intense physical training isn’t that different from what happens during a panic anxiety attack. Regular physical exercise can therefore help your brain to get used to the somatic symptoms,’ says Härdfeldt.

Breathing techniques

Learn a couple of breathing techniques to help ease symptoms when they occur (see below). ‘One of the most effective ways to manage anxiety and panic attacks is through breathing,’ says Härdfeldt. ‘Slowing down your breathing can help reduce symptoms.’

Coping with panic attacks when they happen — a toolkit

These techniques will help you cope when a panic attack strikes. Choose the ones that resonate with you.

Get into the moment — and wait 20 minutes

Don’t fight a panic attack. Breathe slowly and deeply, reminding yourself that the attack will pass.

‘The fight or flight response cannot last forever,’ Härdfeldt points out. ‘It will eventually run out of gas. It usually peaks within 10 minutes then starts to wind down.

‘So, the best thing you can do is to remind yourself that, no matter how difficult it becomes, it will be over in about 20-30 minutes. And, the peak usually only lasts a couple of seconds. Focus on keeping your body relaxed and your breathing steady. It’s important not to act like you’re in danger. Sit still, don’t run around. Don’t walk between rooms. Try to ride the panic like a wave. This is where mindfulness techniques can be helpful.’

Deep-breathing exercises

Research shows that deep breathing (diaphragmatic breathing) can help to reduce anxiety and promote relaxation. The following can be done anywhere for a quick way to feel calmer:

  • Stand up, or sit on a chair or the floor, or lie down on a bed or a mat
  • If sitting or standing, place feet flat on the ground, hip-width apart
  • Inhale through your nose, deep into your tummy
  • Gently exhale through your mouth
  • Count 1 to 5 as you breathe in, and 1 to 5 as you breathe out
  • Continue for 3 to 5 minutes

How can your GP help?

‘If you experience panic attacks, consult a healthcare professional as soon as possible,’ says Härdfeldt. ‘Your doctor can refer you to a specialist. It’s usually possible to treat panic attacks in about 2 to 3 months.’ A GP may also carry out tests to rule out any underlying medical conditions that could be causing panic attacks.

Talking and psychological therapies, such as CBT, are the main treatment for panic disorder. These can help you change your behaviour so that you find it easier to remain calm during an attack. In some cases, it might be helpful to prescribe medication.

This article has been reviewed by Dag Härdfeldt, Licensed Psychologist at Livi

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