What Are Panic Attacks?

If you have ever experienced a panic attack, chances are that you are probably well aware of what a panic attack is and what it feels like. There really is no mistaking a panic attack. A panic attack is much more than just strong anxiety or fear. Panic attacks are basically your body’s fight-­or-­flight system going off unexpectedly. It is a “false alarm” (Bouton, Mineka, and Barlow 2001). During a panic attack, your body is essentially telling you that you are in some kind of immediate danger, even if a threat really isn’t present. We’ll talk more a little later in this chapter about why this may happen. Someone who experiences a panic attack has very strong feelings of fear, terror, or discomfort that arise quickly and intensely (APA 2000). A panic attack can be expected or unexpected. Panic attacks that are unexpected or occur without warning are also sometimes described as “out of the blue, ” spontaneous, or uncued. Many of the first panic attacks that people ever experience occur without warning.

Left alone, a panic attack will be relatively short lived, lasting just a few minutes (even though it may feel as if it lasts longer). However, how you respond to a panic attack can determine whether the panic attack persists for a longer period of time. You see, when a panic attack occurs, unfortunately there isn’t too much that you can do about it except to let it run its course. You essentially have to wait for that false alarm to turn off. Now, if you try to avoid the symptoms of a panic attack or push them away, that alarm can persist or sometimes even get stronger.

Don’t get us wrong; it makes sense that someone would want to try to get away from a panic attack as quickly as possible, as it is a really scary and unpleasant experience. In the end, though, trying to fight or escape a panic attack just fuels it and makes it stronger. Therefore, as scary as a panic attack can be, the best bet is to simply ride it out until it passes. Later we will walk you through some DBT skills that may make it easier to sit with the discomfort of a panic attack.

During a panic attack, people may feel a variety of sensations in their bodies, including increased heart rate, sweating, shortness of breath, and dizziness. In addition, people often have certain fearful thoughts during a panic attack, such as I’m going crazy or I’m going to die. In fact, because the physical sensations and fear that accompany a panic attack are so intense, it is very common for people who experience panic attacks to think that they are having a heart attack, prompting a visit to the emergency room, a place where many people with panic attacks first try to get help (Swinson et al. 1992).

Listed next are some common sensations that people experience when they are having a panic attack. The most common symptoms are increased heart rate, dizziness, trembling, and fear of losing control (Barlow 2002c). To qualify as a panic attack, at least four of the symptoms described next must be experienced. If you have fewer than four of these symptoms, you may be experiencing what is called a limited-­symptom panic attack. Limited-­symptom panic attacks are less common than standard panic attacks and generally less intense. However, they may still have some of the same negative consequences that accompany full-­symptom panic attacks (ibid.; Rapee, Craske, and Barlow 1990). Regardless of whether you tend to experience full-­symptom or limited-­symptom panic attacks, it is important for you to be aware of the symptoms you generally experience when you have a panic attack. This information will allow you to tailor to these particular symptoms the DBT skills we describe next.

Exercise 8.1 Identify Your Panic Attack Symptoms