A panic attack is one of the most frightening physical experiences a person can have. Your heart pounds. You cannot get a full breath. Your chest tightens. Your hands go numb. You feel like you might be dying, or losing your mind, or both at once. And then, as suddenly as it started, it passes.
That experience is terrifying. And then something else happens, which is often worse than the panic attack itself: you start waiting for the next one. That anticipatory anxiety, the fear of fear, is often what brings people into anxiety and stress therapy at Rubin Therapy more than the attacks themselves.
What Is Actually Happening During a Panic Attack
A panic attack is the nervous system’s threat-response system activating in the absence of an actual threat. The brain perceives danger, the body responds exactly as it would to a real emergency: adrenaline surges, heart rate accelerates, breathing shifts, blood moves to the muscles. The entire system prepares to fight or flee from something that is not there.
This is why panic attacks feel like medical emergencies. The physical sensations are real and intense. But they are produced by the nervous system, not by a physical danger, and understanding this is one of the first genuinely useful things to know about them.
What often makes them worse is the response to the sensations themselves. When someone in the middle of a panic attack notices their heart pounding and thinks “I am having a heart attack,” that thought increases fear, which increases the physical response, which increases the fear further. The spiral is real, and it is driven by the interpretation of the sensations, not just the sensations themselves.
Why Some People Get Panic Attacks and Others Do Not
Panic attacks are more common than most people realize. According to the National Institute of Mental Health, panic attacks affect a significant portion of the population at some point in their lives, and panic disorder, characterized by recurrent attacks and persistent fear of future episodes, affects roughly 2-3% of adults in the United States.
People who are more prone to panic attacks often have a nervous system that is generally more reactive, are going through a period of high stress, have a history of anxiety or trauma, or have a tendency toward the kind of body-focused awareness that makes physical sensations easier to notice and harder to dismiss. Genetics plays a role. So does environment and history.
Importantly, a panic attack is not a sign of weakness or mental fragility. It is a physiological response that some people are more prone to than others, and it is treatable.
The Problem of Avoidance
The most common response to panic attacks is avoidance: staying away from situations where you have panicked before, avoiding physical sensations that feel similar to panic (like exercise-induced heart rate increase), and narrowing your world to feel safer. This makes intuitive sense. If something caused a terrifying experience, avoiding it feels logical.
But avoidance reinforces the panic. It confirms to the nervous system that the situation was genuinely dangerous and worth avoiding. Over time, the avoided situations multiply and the world gets smaller. What started as one frightening experience in a specific place can expand into significant restrictions on movement, activity, and life.
Effective treatment for panic addresses the avoidance directly, not by forcing exposure before someone is ready, but by building understanding and gradually demonstrating to the nervous system that the sensations are not dangerous. Anxiety therapy at Rubin Therapy approaches this work at a pace that is sustainable and supported.
When Panic Has Roots in Trauma
For some people, panic attacks are connected to trauma. The body has learned to activate in response to triggers that are associated with past threatening experiences, sometimes consciously recognized and sometimes not. In these cases, addressing the trauma is an important part of addressing the panic. Trauma-informed therapy at Rubin Therapy works with the nervous system in ways that reach this level of the experience.
Panic Attacks Are Treatable. You Do Not Have to Just Manage Them.
The most important thing to understand about panic attacks is that you do not have to simply learn to live with them. They are highly responsive to therapy. Most people who work with a skilled therapist see significant reduction in both the frequency of attacks and the anticipatory anxiety between them.
Individual therapy at Rubin Therapy can help you understand what is driving the panic, shift your relationship to the physical sensations, and build real steadiness rather than just strategies for white-knuckling through the next attack. We work with adults in New York and New Jersey, in-person and virtually.
Book a free consultation. It is a simple place to begin.
Frequently Asked Questions
What is a panic attack?
A panic attack is a sudden episode of intense fear and physical symptoms caused by the nervous system’s threat-response activating without an actual external threat. Common symptoms include a racing or pounding heart, chest tightness, difficulty breathing, dizziness, numbness or tingling in the hands, and an overwhelming sense of dread or fear of losing control. Attacks typically peak within ten minutes and pass within twenty to thirty minutes. They are terrifying but not physically dangerous. Anxiety therapy at Rubin Therapy can help you understand and treat them.
Are panic attacks dangerous?
Panic attacks feel dangerous because the physical sensations can be intense and alarming. But a panic attack itself is not physically harmful. The symptoms are produced by the nervous system’s stress response and will pass without causing physical damage. That said, if you are experiencing chest pain, shortness of breath, or other physical symptoms for the first time, it is appropriate to rule out a medical cause before attributing them to panic. Once medical causes have been excluded, working with a therapist is an effective next step.
What triggers a panic attack?
Triggers vary significantly between people. Some panic attacks seem to come out of nowhere, without an obvious trigger. Others are linked to specific situations, places, physical sensations, or memories. Stress, fatigue, caffeine, and sleep deprivation can all lower the threshold for panic. For people with a trauma history, triggers may be connected to past experiences in ways that are not immediately obvious. Identifying your specific triggers is part of the work in anxiety and panic therapy.
How is a panic attack different from a heart attack?
This is a common and understandable fear. Panic attacks can produce chest pain, shortness of breath, and a pounding heart, all of which overlap with heart attack symptoms. Key differences include the sudden onset and rapid peak of panic attacks, the absence of other cardiac symptoms like pain radiating to the arm or jaw, and the fact that panic attacks typically resolve within thirty minutes. If you are ever unsure, it is always appropriate to seek medical evaluation. Once a cardiac cause has been ruled out, therapy is an effective treatment for the panic.
Can therapy stop panic attacks?
Yes. Panic attacks are among the most successfully treated mental health experiences. Effective therapy helps you understand the mechanism driving the attacks, shift your relationship to the physical sensations, address the avoidance behavior that maintains the problem, and build a calmer baseline in your nervous system. Most people who engage seriously with therapy for panic see meaningful reduction in frequency and severity. Book a free consultation at Rubin Therapy to learn more about how this work happens.