On a crowded train at the end of the day, Mark’s heart suddenly began to pound on its own. At first he thought it was the heat. Then it beat faster and faster until he could not catch his breath, his hands and feet went numb, sweat broke out, and one thought surged up: “am I having a heart attack? Is something happening to me?” The more he thought it, the worse the symptoms became. The world around him blurred.

He pushed his way through the crowd and off at the next station with his legs shaking, and stood on the platform gasping for several minutes before it gradually eased.

Since that day Mark has avoided the train when it is busy, and every time his heart beats even slightly faster, his whole body tenses for fear it will happen again. What he fears most now is not the train. It is the feeling of panic itself.

A panic attack is a wave of intense fear or discomfort that arises abruptly and peaks within minutes. It usually arrives with physical symptoms such as palpitations, breathlessness, chest pain, dizziness, numb hands, sweating, a sense that the surroundings are not real, and the fear of dying or of losing control.

It is worth understanding first that having a single panic attack does not mean panic disorder. But if it happens repeatedly and unexpectedly, followed by fear of it recurring or avoidance of those situations to the point of affecting life, that warrants assessment.

And where an assessment has established that what you experienced was a panic attack, this needs emphasizing: a panic attack does not itself cause death, however severe and frightening the sensation at the time. Symptoms of the same kind can, however, arise from physical conditions, which is why seeing a doctor to rule out physical causes matters.

What a panic attack is, and how it differs from panic disorder

A panic attack is the body’s threat-response system — the fight-or-flight system — surging rapidly and intensely. Mechanically, panic is a wave of arousal that sometimes occurs without any clearly identifiable danger in front of us, and sometimes occurs on meeting a situation or cue the brain associates with threat. The body releases stress hormones to prepare us to fight or run, so the heart beats faster, breathing quickens, and the senses come fully alert.

As the body enters this braced state, heart, breathing, muscles, and perception all change rapidly. If the brain interprets those changes as evidence that a catastrophe is underway, fear rises further and drives the physical symptoms harder still — producing the panic cycle that feels so frightening.

The distinction worth drawing clearly: having an occasional panic attack is more common than many people assume, and happens to ordinary people during periods of heavy stress. Panic disorder is a condition in which panic attacks recur unexpectedly, together with continuous worry about their recurrence, or with behavior changed in order to avoid them, to the point of affecting life. Some people begin avoiding situations they fear would be hard to leave if an attack came — being afraid of a crowded train, for instance — and where that avoidance widens until it starts to restrict the space of a life, it sometimes relates to a condition called agoraphobia. Having one panic attack therefore does not always mean you have panic disorder. Diagnosis requires a professional to assess the whole picture.

Why the more we fear it, the more we panic

What allows a panic attack to spiral is what is called fear of fear.

It starts with some signal arising in the body — a heart beating faster from climbing stairs, from coffee, or simply from the heat. But at a moment when the system is already aroused, the brain may misread this ordinary signal as a sign of catastrophe: a fast heartbeat from some other cause read as an oncoming heart attack, or mere dizziness read as fainting or dying. Once it is interpreted that way, fear surges — and fear itself instructs the body to release more stress hormones, so the physical symptoms intensify, which then confirms the thought that something terrible is happening. The result is a spiral tightening in a matter of minutes.

Breathing may also play a part in this loop. In some people, breathing faster or more than the body requires — hyperventilation — may contribute to symptoms such as numb hands, dizziness, or lightheadedness. And when those symptoms are interpreted as signs of danger, they feed the panic cycle further. That said, excessive rapid breathing does not occur in everyone, and these symptoms may involve a number of components. Having been through the experience, many people then begin monitoring their own bodily signals constantly, while avoiding the places or situations where an attack occurred. It is that monitoring and that avoidance which leave the system more sensitive still to the smallest signal.

A panic attack is like a warning light on the dashboard being misread

Picture a warning light blinking on a car’s dashboard. The truth is that the light is not faulty — our heart genuinely is beating faster. The problem lies in reading its meaning. In panic, the brain reads the blinking light as “the engine is about to explode,” when in fact the light may only be reporting that we have just driven hard up a hill. And the more alarmed we are by the blinking, the harder we stamp on the brake, until everything is more chaotic than before.

Sometimes, though, a warning light does report a genuine problem. So the thing to do first, always, is take the car to a mechanic — that is, see a doctor to rule out physical causes and be sure. And once the engine has been checked and found to be sound, the remaining work is learning, gradually, not to read every light as catastrophe, so that we no longer have to slam on the brake in alarm each time one blinks.

When to see a doctor, and when panic needs serious care

This part matters a great deal and is worth reading in full. Many people wonder how panic differs from heart disease, and the reality is that a number of panic symptoms — chest pain, palpitations, breathlessness — also occur in serious physical conditions: problems involving the heart or thyroid, effects of substances or medication, and other conditions with similar presentations. So particularly if it is the first time, or the symptoms are severe, different from before, or accompanied by other concerning signs, seeing a doctor to be sure there is no physical cause is what should come first. Do not conclude on your own that it is only panic. And if there is severe chest pain or tightness, fainting, weakness in the limbs, slurred speech, serious difficulty breathing, symptoms arising during exertion, or new symptoms that have never been examined, seek medical help immediately.

Once examination has found no physical cause, and panic attacks begin recurring or leaving you avoiding things in your life, appropriate care can help the symptoms gradually improve. The good news is that panic is something that can genuinely be eased, and you do not have to face it alone.

What part hypnotherapy plays with panic

At NBRH we use hypnotherapy as our principal approach with the people we work with, without regarding it as a substitute for diagnosis or for medical care where that is needed. From experience in practice, work with panic in the therapy room tends to focus on helping a person practice reaching and holding a calmer state without interpreting every change in the body as danger; on gradually adjusting the relationship with bodily signals, from seeing a faster heartbeat or altered breathing as a sign of danger toward being able to notice it without alarm; and on reducing the monitoring of bodily signals, while adjusting the automatic pattern that hurries a person into avoidance the moment discomfort begins. These are things we encounter often in real work, and they align with the goals of care that a number of studies describe.

At NBRH we work on the principle of Neuro-Behavioral Repatterning & Hypnotherapy: adjusting the nervous system’s patterns of response, and behavior, systematically. Because lasting care for panic does not come from trying to control the body into having no symptoms at all. It comes from gradually changing the way bodily signals are perceived and responded to, so that the system can distinguish more accurately between a natural change and something that genuinely needs attention. When an ordinary signal is no longer read as catastrophe every time, the fear cycle that used to feed itself has the opportunity to weaken.

If your worry does not attach only to physical symptoms but floats across many things in your life, “Generalized Anxiety Disorder” may be worth reading. And to understand how the brain comes to read an ordinary signal as a threat, “What the Predictive Brain Is” connects that part of the picture.

What a Panic Attack Is: Why Fear of Fear Makes It Worse, and How to Care for It