During panic attacks people experience intense, unpredictable, and uncontrollable physiological arousal. This can include rapid heart beat, rapid irregular breathing, sweaty palms, tightness in the chest, shaking and trembling, vomiting, nausea, and diarrhoea. 

The body has essentially gone in to extreme danger mode and the need for immediate action such as escape and avoidance occur. Having these reactions when there is a real and clear threat makes sense. However, often we might believe that we are losing control, going to die, or going crazy.

Symptoms of fear, panic, and hyper-arousal can severely restrict the quality and range of a person’s life. People tend to retract from life, growth, and opportunity in order to feel safe. 

There are many factors that can influence the onset of panic attacks or panic disorder. Panic can sometimes be triggered in relation to a specific thing such as spiders or heights. If we have a terrifying experience we are likely to pair this object to fear. This form of panic is known as a phobia. 

Sometimes panic might occur in relation to travel, work, packed spaces or some other event. Often a person might report being in a crowded space, elevator, driving, or at supermarket or shopping centre when they first experience a panic attack. 

During periods of intense stress or change panic attacks and disorder can be triggered. In some instances the the body itself sets off a panic reaction (e.g. if we have too much caffeine or other stimulation). Here we become hyper-attuned to the body and attempt to constrict and control the bodies response. Caffeine, stimulants, alcohol withdrawal, and other medication can also activate panic/anxiety responses.

Furthermore, panic reactions can develop if we have experienced violence or abuse at some point. Often when there have been incidents of developmental trauma we don’t develop a sense of safety and security. The bodies alarm system switches to threat mode readily. 

Panic symptoms can manifest as physical, cognitive, emotional, and behavioural patterns. The physiological arousal and bodily reaction is often the most pronounced set of symptoms Often these symptoms are intertwined and contribute to each other.

1. Increased heart rate
2. rapid, irregular, or shallow breathing
3. trembling or shaking
4.  nausea, dizziness or feeling faint
5. Fear of dying or losing control, catastrophizing,
6. butterflies in your stomach
7. numbness or tingling, 
8.  muscle tightness or tension.
9. Intense fear.
10. Anticipatory worry and anxiety.
11.  Difficulty concentrating, cognitive narrowing
12. mind going blank or patterns of derealization or depersonalitation
13. Escape and avoidance from situation related to the panic.
14. Drug and alcohol use

The main treatment for panic disorder is Cognitive-behavioural therapy. This is where we learn to down-regulate overall panic and anxiety, coupled with gradually confronting feared scenarios. Overall, we are trying to teach the bodies nervous system how to feel safe and that there is no immediate danger. 

With all anxiety treatments we aim to cultivate a stance from reluctance, resistance, and avoidance to approach, curiosity, and openness. Furthermore, by changing our thought patterns and beliefs we can shift away from worst-case thinking.

Psychodynamic and trauma-informed therapies can also be useful to unpack internal experiences that contribute to panic symptoms.