Panic attacks and PTSD – what are they are how can you prevent them?

Gaining an understanding of what panic attacks are can be helpful in finding ways to prevent them from happening. As well as helping you to develop coping mechanisms to manage the effects of panic attacks as they happen.

First, it’s important to appreciate that the human body is ‘hard-wired’ with protective systems. Natural instincts and processes there are designed to signal danger and to get your body ready to respond quickly and decisively.

These are important defence mechanisms. However, when you have PTSD or C-PTSD, you can have an altered perception of ‘danger’ or an oversensitivity to it. In fact, some people are constantly in ‘alarm mode’ and hypervigilant about things that make them fearful.

Logically, this affects your natural responses to situations and experiences, in a way that can be seen and felt very noticeably. Including triggering panic attacks.

What is a panic attack?

We know that with PTSD and C-PTSD there is a biological impact of trauma, and these physical changes to your brain can alter your body’s natural protective systems.

Central to that – and to panic attacks – is a part of the brain called the amygdala. This is your biological warning mechanism, that signals your nervous system that it needs to be ready to defend you. This response includes the release of adrenalin to increase your heart rate and blood pressure. This in turn pumps more oxygen to your muscles, to help you to fight or run (you may have heard about the fight, flight or freeze reactions).

The additional oxygen also helps your brain to become fully alert, ready to formulate its response to the perceived danger.

Now, imagine if all this happened in an exaggerated way, beyond the level necessary to deal with a situation.

Your heart is pumping faster, and your blood pressure is up. It can feel like your heart is racing or painfully ‘beating out of your chest’. You start to breathe rapidly – possibly hyperventilating – to grasp the extra oxygen needed. The rush of oxygen to your brain can make you feel lightheaded and ill.

You may also get numb hands and feet, sweat profusely or feel cold, due to all this instinctive biological activity and rerouted oxygen.

The normal course of a panic attack is that within 10 minutes of perceived danger, your body is in a highly active state of ‘emergency’ and you reach a peak of feeling seriously unwell. Then, it would start to subside if you gain control.

What do panic attacks feel like?

Authors, scientists and almost everyone who has experience them has tried to explain panic attacks for hundreds of years. Especially as they can feel like a heart attack or stroke, and understandably cause concern to people who witness them, as well as the person experiencing them. Here are some great examples of what they do feel like (although it can be different for everyone):

• “The worst part for me is the sinking, dizzy feeling that makes me feel like I’m about to pass out and lose control over my body. It’s horrible.”
• “Getting a panic attack for no reason is such scary experience. Sometimes I would sit down and play on my PC until I feel a sudden rush on my heart out of nowhere and began having intrusive thoughts of death, heart attack, etc. When I first have it, the attack lasted almost two hours and I began having anxiety about my body. Don’t worry guys, panic attack is just the mind playing tricks.”
• “One time I had a panic attack while driving. My one hand went completely numb that I couldn’t even grip the steering wheel, I was so scared. You are not alone, we all got this.”
• “Panic attacks physically feel like the moment you tipped too far back in your chair and about to fall, except it can last hours.”
• “I used to have them so often, they were so scary, I hated having them in front of people because they kept talking to me but their voices were muffled so I couldn’t understand what they were saying; my legs went numb, I was nauseous, heart went crazy, couldn’t breathe…”
• “It legitimately feels like you’re dying when in the throes of an attack.”
• “With my attacks I feel like I can’t breath and everything is closing in on my body so I am unable to move. My breathing gets raspy and that only seems to make it worse. My thoughts are jumbled and the only ideas that make it through the noise in my head is the need to quickly escape from where I standing.”
• “I describe a Panic attacks as “you’re watching a car about to crash and you see it about to hit but it never does and you caught in a repeat of that moment over and over”

How do panic attacks subside naturally?

Under normal circumstances, when your amygdala has activated this intense alarm mode, a different part of your brain then analyses the situation. This is called the prefrontal cortex, and it deals with sorting logic and emotion. To deactivate the ‘panic’ response, it releases acetylcholine – which is like the opposite of adrenalin.

This hormone slows your heart back down and calms the biological processes that created a panic attack.

Are panic attacks inevitable then?

The scientific explanation of what a panic attack is can be concerning for someone with PTSD or C-PTSD. You have heightened perceptions of danger and can re-experience trauma due to unwanted thoughts, nightmares, and triggers such as sights, sounds and smells.

As your systems are so sensitive to threats and dangers, it would be easy to assume this make panic attacks inevitable.

One of the worst things about the link between PTSD and panic attacks is that they can ‘feed each other’. Your mental health issues can make you anxious and lacking in confidence to engage in normal, everyday activities. If you then suffer panic attacks in public, this sort of scare and any residual embarrassment can make you even more anxious about going out and being with other people.

Also, you can inadvertently trigger panic attacks due to your fear that you will have one!

This makes it vital to appreciate that there are things you can do to prevent panic attacks, and it is possible to gradually stop them from happening.

Ways to prevent and manage panic attacks

Cognitive Behavioural Therapy (CBT) can address PTSD symptoms, including panic attacks.

Ultimately, CBT and self-managing panic attacks both rely on you considering the sort of things that trigger you, and the best ways to address those triggers in a decisively way.

For example, if you know that certain situations make you deeply anxious, and could therefore lead to a panic attack, you could try breathing exercises and grounding techniques before and during that situation. The goal would be to create a feeling of being calm, and safe, to offset the physical aspects of panic.

CBT could help you to restructure your perceptions of danger too, and change your learnt responses and connections. From this, you can start to reduce the number of panic attacks over time.

What do I do if I feel a panic attack coming?

As soon as you feel the first signs of a panic attack – such as a higher-than-normal heartbeat – try to de-escalate it by breathing deeply, and thinking of calming things. Ask family and friends to help you to deal with these initial stages, by distracting and soothing you too.

Here are some other examples of things people to do help panic attacks from occurring, or to help defuse them once they begin:

• “My solution to a panic attack may be unconventional. I have had several in my life and my cure is to accept and acknowledge that I am having a panic attack. I will tell myself “Oh, this is a panic attack, just let it in and get it over with”. My panic attacks last a couple seconds this way with no aftermath. I hope this helps someone!”
• “Trust yourself, forgive yourself, be kind to yourself, give yourself the time and space you need. You will get better, trust me.
• “For me it felt like I wasn’t getting any oxygen no matter how much I breathed. I was completely convinced I was suffocating to death and I was about to die. Once I realised it was strange I hadn’t passed out, I realised that I HAD to have been receiving oxygen. Suddenly the feeling went away in minutes. Maybe this line of reasoning could help somebody else out too”
• “When you have a panic attack, I feel like the best way to calm it is to have someone who hugs you strongly in his arms until it’s gone. You desperately need the reassurance that everything is alright and that there’s nothing to be scared of.”
• “I’ve suffered of panic attacks for almost my entire childhood and part of my adolescence, they haven’t stopped but they have decreased to the point of having one just once a year. I felt like I was going to die, that thing you feel in your stomach when you go down in a roller coaster, but in every part of my body. I was scared I might throw up or stop breathing and couldn’t realise I was hurting my hands with my nails. One thing that started to help was to think that I’m like a tree, through the roots I absorbed peace and “good energy” as I breathed, and as I exhaled I used to force myself to think that all the anxiety was leaving my body (even if I didn’t feel a thing changing the first times, it was basically just having faith it would be different when I stopped doing the exercises). After a couple of times it made me feel better, and the next panic attacks lasted less and less.”
• “The thing that worked for me was learning not to fight the panic. Instead i accepted it and took a step back and let it wash over me. I managed to prevent an attack like this one time. Its different for everyone but maybe this helps someone.”
• “it’s kinda hard to explain this but whenever I have a panic attack or feel one coming on I tell myself “bring it” or “just get it over with” and it literally shortens the attack to maybe a minute and then it’s over. I still get feelings or fear of passing out and losing control but they don’t last as long. CBT is extremely effective, please look into this and speak to a professional to see what type of treatment you should get. But the most important advice I got was that I wasn’t alone & guess what? neither are you! You’re extremely strong and your panic attacks are a way for your mind and body to handle stress. Once I understood that I knew most of it wasn’t my fault so it makes it easier to live with.”

What should you do, if you see someone having a panic attack?

Remind the person they are safe, using a calm, soothing voice, and gently encourage them to breathe slowly and deeply. Suggest they sit down, and stay with them, reminding them of your presence and support.

Tell them you’re here, and won’t leave them until they’re ok. If they ask you to leave, “as long as they’re not in immediate danger, take a few steps back and give them some space. Stay nearby so you can still keep an eye on things, and let them know that should they change their mind, you’ll come right back.”

“A soothing, familiar voice helps some people, but try to avoid repeatedly saying things like “don’t worry” or asking them if they’re alright over and over.

Of course you mean well, but your words may not have much benefit in the moment. They can also make the situation more stressful, since your loved one may believe they’re doing something wrong by not being alright.

They may want a hug, or they may want no physical contact at all – so don’t presume either way.

“Help them feel grounded. To help someone ground themselves, you can try:

“During an attack, it’s okay to calmly ask what you can do to support them. Just prepare for the possibility of a short or curt response.

The fight-or-flight stress response can affect the ability to think and behave logically. Try to remain neutral, and don’t take their response personally.”

Remember, if you show alarm – or panic – you are likely to cause even more anxiety in someone trying to control a panic attack, so stay as calm as possible. 

Coping with the aftermath and getting help

“It’s common to feel completely wiped out as your body and its processes return to normal after an extreme fear response. Someone who’s just had a panic attack might not feel up to anything beyond quiet relaxation.” Relax if you can, and be kind to yourself. 

Panic attacks can be one of the first signs you have PTSD or C-PTSD. So, if you start to experience them, it is wise to seek professional help – you may not have PTSD, but there are a number of conditions which can cause panic attacks, and they will be able to help you.

It can take time for someone with PTSD to learn relaxation techniques that work for them. Meanwhile keep reminding yourself these unpleasant experiences are temporary, and can’t cause lasting damage.

NICE guidance updated in 2018 recommends the use of trauma focused psychological treatments for Post Traumatic Stress Disorder in adults, specifically the use of Eye Movement Desensitisation Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (CBT).

Please remember, these aren’t meant to be medical recommendations, but they’re tactics that have worked for others and might work for you, too. Be sure to work with a professional to find the best methods for you.