Panic attacks and agoraphobia
A racing heart, the feeling of suffocating, the fear of dying or going mad, then the fear that it will happen again — and life narrowing down to the places judged safe. This guide explains what a panic attack is, why it feeds itself, and how to get out of it: correcting catastrophic interpretations, deliberately exposing yourself to the sensations you dread, giving up safety behaviours, and winning back the places you avoid.
In short
This guide is for adults who have panic attacks, who live in dread of the next one, or who avoid places and situations — transport, shops, crowds, going out alone, going far from home. It describes precisely what happens in the body, the circle that turns a false alarm into a lasting disorder, and the method with the strongest evidence behind it: cognitive behavioural therapy with exposure to sensations and to situations. It gives concrete exercises, week by week, and says when a medical consultation must come first.
- Topic
- Anxiety
- Who it's for
- For yourself
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The programme
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Frequently asked questions
Can a panic attack kill me? No. It is a normal alarm reaction, triggered without real danger. It is very unpleasant and not life-threatening. The usual caution still applies: have a first attack checked by a doctor, especially if there is chest pain.
How long does an attack last? The peak is reached within a few minutes and then comes back down. What can last longer is the state of tension that follows, and the fear that a new attack will occur.
Why does it happen to me for no reason, sometimes at rest? Because the trigger is often an unremarkable bodily sensation — the heart speeding up after a movement, dizziness from tiredness — which attention picks up and interprets as dangerous. Rest does not prevent these variations: it even makes them more visible.
Should I breathe into a paper bag? No. This old recommendation is not without risk and is no longer advised. Slowing the out-breath slightly is enough when hyperventilation is obvious, provided you do not turn it into a ritual designed to prevent a catastrophe.
Do I have to give up coffee? Cutting down helps many people, especially at the start of a programme. Later, having a coffee even becomes a useful exposure: it reproduces the sensations you are learning no longer to fear.
The exercises that bring on the sensations — is that not dangerous? They are safe for most people, and they are the most effective ingredient of the treatment. Ask your doctor's advice if you have a heart or lung condition, epilepsy, or if you are pregnant.
I have a tablet in my pocket that I never take. Does that count? Yes, very much so. A medicine that is never taken but is always there works like a charm: it maintains the idea that, without it, something serious would happen. Giving it up gradually is part of the programme.
Does it come back? Isolated attacks can reappear in periods of tiredness or stress. What counts is not to reintroduce the avoidances: a few exposures are generally enough to close the episode.
Why am I having attacks when my life is going well at the moment? This is very common. Attacks often appear after a difficult period rather than during it: as long as you have to hold on, the body holds on; it is when you let go that the alarm goes out of order. Besides, once the fear of fear has taken hold, it no longer needs external stress to keep itself going.
Is it hereditary? There is a degree of family vulnerability, as with most anxiety disorders: it increases the risk, it decides nothing. What turns a vulnerability into a lasting disorder is the interpretations and the avoidances — and both of those can be changed.
I have attacks in the car, should I stop driving? No, unless a doctor advises otherwise. A panic attack does not make you lose control of the vehicle. Stopping driving, on the other hand, installs a very costly avoidance that is hard to undo. Start again with short journeys, without a reassuring passenger, and lengthen them gradually.
Should I go to A and E during an attack? The first time, or if the picture is new, yes: a medical cause must be ruled out. After that, no. Repeated trips to A and E bring relief for a few hours and lastingly reinforce the idea that the situation was dangerous.
My smart watch is flagging up high heart rates: should I be worried? Talk to your doctor about it once, with the data, and then stop looking. These devices often get it wrong, and even an accurate measurement says nothing about danger. Consulting them constantly is a form of checking, and checking keeps the fear going.
How long before I feel better? Structured programmes often last between eight and fifteen sessions, with clear improvements from the first weeks of regular exposure. The speed depends above all on how often you do the exercises, not on how severe things were at the start.