Panic Attacks: What They Really Feel Like, and What Actually Helps in the Moment

The first time someone has a panic attack, they almost always think they're having a heart attack. Heart pounding, breathing fast, chest tight, hands tingling, an unshakeable sense that something is catastrophically wrong. People show up at hospital emergency rooms — and emergency-room records in India suggest a meaningful proportion of "cardiac" admissions in adults under 35 turn out to be panic, not heart events.

This article won't replace clinical care, but if you've had one and don't know what hit you, this should help.

What a panic attack actually is

A panic attack is your body's alarm system firing without an actual threat. The fight-or-flight response — adrenaline, cortisol, accelerated heart rate, rapid breathing, narrowed vision — is exactly what you'd want if a tiger walked into the room. The problem is when it fires while you're sitting in a meeting, on a metro, or trying to fall asleep.

The DSM-5 (the diagnostic manual psychiatrists use) defines a panic attack by an abrupt surge of intense fear or discomfort that peaks within minutes, accompanied by at least four of the following:

• Pounding or accelerated heartbeat
• Sweating
• Trembling or shaking
• Sensations of shortness of breath
• Choking sensation
• Chest pain or discomfort
• Nausea or stomach distress
• Dizziness or feeling faint
• Chills or hot flashes
• Numbness or tingling
• Feelings of unreality (derealisation) or detachment from yourself (depersonalisation)
• Fear of losing control or "going crazy"
• Fear of dying

Most episodes peak in 5–10 minutes and resolve within 30. They are, despite how they feel, medically harmless in almost every case — your body is built to tolerate exactly this kind of activation. (This statement comes with the caveat that genuinely cardiac symptoms in someone with cardiac risk factors should still be checked by a doctor. If in doubt, get the ECG. Rule it out.)

Panic attack vs anxiety attack — quick clarification

People use these interchangeably, but clinically:

• Panic attack is the abrupt surge described above. Out of nowhere, peaks fast, resolves in under an hour
• Anxiety attack isn't a formal clinical term. People usually use it to describe a slower-onset, longer-lasting wave of acute anxiety. Less intense per moment, but can last hours

If what you're describing peaks in 5–10 minutes and feels physically dramatic, that's panic. If it's a slow build and stays for hours, that's more like an anxiety wave.

What helps in the moment

This is the section you came for if you're having one right now. Bookmark this for when you need it.

1. Name what's happening, out loud or in your head. "This is a panic attack. It is uncomfortable. It is not dangerous. It will pass in less than 30 minutes." Saying this is not woo. Naming it engages your prefrontal cortex, which competes for cognitive resources with the threat response.

2. Slow your exhale, not your inhale. The instinct in panic is to gulp air. That hyperventilation actually worsens the symptoms — light-headedness, tingling, chest tightness all get worse. The fix isn't deep breathing in; it's long, slow exhale out. Inhale for a count of 4, exhale for a count of 6 or 7. Six rounds. This activates the parasympathetic nervous system and slows the heart.

3. Ground in your senses (5–4–3–2–1). Name 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, 1 you can taste. This pulls attention out of catastrophic thoughts into the present-moment environment. Boring is the point — the brain can't catastrophise and inventory simultaneously.

4. Move, but slowly. Walking, even pacing in a small room, helps the body metabolise the adrenaline. Fast intense movement can sometimes worsen things — slow walking is better.

5. Don't run from where you are (if it's safe). The instinct in a panic attack at, say, a meeting is to flee. If you can stay (excusing yourself to the washroom for 10 minutes is fine), the brain learns that the situation isn't actually dangerous. Always running away makes the next attack more likely in similar contexts.

6. Cold water on your face. The mammalian dive reflex — splashing cold water on your face — slows heart rate within seconds. It's a real physiological response, not a vibe. Useful if you're somewhere with access to a tap.

What to not do

• Don't drink alcohol to calm down. It works for 90 minutes, then makes the next 24 hours worse
• Don't take someone else's anti-anxiety medication. Benzodiazepines (Alprax, Restyl, etc.) are prescribed for a reason and have real risks
• Don't decide, mid-attack, that you're going to give up on whatever you were about to do (a meeting, a flight, a presentation). Decisions made during panic are usually wrong

Preventing the next one

A single panic attack can be a one-off, particularly during high stress (an exam, a wedding, a relationship crisis). If you have one and never have another, you don't have a panic disorder.

Repeated attacks (4+ in a year, with worry about the next one between them) is what we call panic disorder, and it's very treatable. CBT specifically for panic — sometimes called CBT-P — has high success rates: studies show 70–90% of people who complete a 12-session course see substantial reduction in attacks. Often without medication.

Things that help reduce attack frequency:

• Reducing caffeine. Many young Indians drink 4–6 cups of coffee a day. Two is plenty
• Improving sleep. Sleep deprivation is one of the strongest panic triggers
• Treating underlying anxiety. Most panic disorder sits on top of generalised anxiety
• Stopping the avoidance loop. Avoiding situations where you've had attacks makes the disorder worse, not better

When to see a clinician

If you're having recurring panic attacks (more than 2–3 in a few months), or you're starting to avoid situations because of fear of an attack, or you're worried about your heart — see someone. A clinical psychologist can teach you the techniques above in depth and run you through CBT-P. A psychiatrist can prescribe medication if needed (usually SSRIs for prevention, occasionally short-term benzodiazepines for the worst phase).

Take a wellness check to see whether what you're experiencing fits a clinical pattern, or get matched with someone who works specifically with panic.

In the moment of an attack, if you're alone and afraid, you can call Tele MANAS at 14416 (24×7, free). They will talk you through it.

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Dr. Ananya Iyer is a Clinical Psychologist (RCI-licensed) in Mumbai. She works with anxiety disorders including panic, OCD, and generalised anxiety using CBT and mindfulness-based approaches.