What's Happening During a Panic Attack and Steps to Get Through One

A panic attack is a sudden surge of intense fear and physical symptoms that peaks within about 10 minutes and typically passes in 5 to 20. The body's alarm system — driven by the locus coeruleus and amygdala — fires as if a threat were present, releasing norepinephrine and triggering a racing heart, shortness of breath, and a sense of losing control. Grounding, slow breathing, and naming the attack for what it is can shorten the wave and lower its intensity, and if attacks are recurring, evidence-based anxiety counselling can reduce how often they happen.

Last updated: August 2026 · Written by Christopher Hein, Co-Founder, Trillium Counselling

What's actually happening in your body during a panic attack

Panic attacks are your body's threat-response system firing at full volume when there is no real danger to escape from. The brain regions involved include the locus coeruleus (a small brainstem nucleus that releases norepinephrine throughout the nervous system), the amygdala (which detects threat), and the periaqueductal gray (which drives fight-or-flight behaviour). When these regions activate, your heart rate climbs, your breathing quickens, blood shunts away from your gut and skin, and your senses sharpen. It feels catastrophic — but it is a survival response running in the wrong context, not a medical emergency.

CAMH describes the peak as intense fear or discomfort that hits within minutes, alongside physical symptoms like a pounding heart, sweating, shortness of breath, dizziness, tingling, or a sense of unreality. Cognitive symptoms — thoughts like "I'm having a heart attack" or "I'm losing control" — are part of the attack, not evidence that something dangerous is happening. Understanding this is the first step in taking the intensity down. When panic attacks become a pattern, this is where clients typically reach out for help. At Trillium, our anxiety therapists build on the same grounding-breath-reframe foundation using techniques like interoceptive exposure and cognitive reframing.

How to recognize the signs early

Panic attacks tend to build over seconds, not minutes. Common early signs include:

• A sudden feeling of dread or "something is wrong" without a clear trigger
• Heart racing or pounding
• Shortness of breath or a sense of not being able to get a full breath
• Tightness or pressure in the chest
• Dizziness, lightheadedness, or feeling detached from your body
• Tingling in your hands, feet, or face
• A hot flush or cold chills
• Nausea or a sudden urge to leave the room

Symptoms usually peak within about 10 minutes and resolve within 5 to 20. Recognizing the pattern early — before the fear compounds — gives you the widest window to intervene.

Step 1 — Ground yourself in your senses

Grounding pulls attention out of the internal alarm loop and back into the room around you. It signals to your nervous system that the environment is stable, which lets the fear response begin to settle. The 5-4-3-2-1 method is the most widely used because it engages multiple senses in sequence:

1. Name 5 things you can see — a picture, a light switch, a colour, the pattern of the floor
2. Name 4 things you can touch — your feet on the ground, the chair under you, fabric, a cold surface
3. Name 3 things you can hear — traffic, a fan, your own breath
4. Name 2 things you can smell — coffee, soap, fresh air
5. Name 1 thing you can taste — water, mint, your last meal

Do this slowly — the pace itself is calming. If 5-4-3-2-1 feels like too much, cold water on your wrists or the back of your neck also works: it activates the mammalian dive reflex, which slows your heart rate.

Step 2 — Slow your breathing

Fast, shallow breathing feeds the panic response — it lowers CO₂, which triggers tingling, dizziness, and more fear. Slower breathing, especially a longer exhale than inhale, activates the parasympathetic nervous system and starts turning the alarm off.

A simple pattern that works during an attack:

• Inhale slowly through your nose for a count of 4
• Hold gently for a count of 2
• Exhale slowly through pursed lips for a count of 6
• Repeat for 6 to 8 cycles

The exhale being longer than the inhale is the important piece — it's what shifts the nervous system toward calm. If counting is too hard mid-attack, just focus on making each exhale a little longer than the one before.

Step 3 — Name the attack and reframe the thought

Once your body starts to settle, the cognitive step is to tell yourself, plainly, what is happening. Something like: "This is a panic attack. It will peak in about 10 minutes and pass. I'm not in danger — my body is responding to a false alarm."

This is not "positive thinking." It's a specific cognitive-behavioural technique: labelling the physical sensations as a panic response (rather than as a heart attack or losing your mind) breaks the feedback loop between fear and physical symptoms. In therapy, this is refined with interoceptive exposure — gradually and safely re-experiencing panic-adjacent sensations so your brain stops interpreting them as dangerous. Anxiety therapy at Trillium can use this approach as part of standard CBT for panic.

When it's time to consider professional support

One panic attack is not a mental health disorder. Panic disorder is diagnosed when attacks are recurrent and unexpected, and when there's at least a month of ongoing worry about future attacks or behaviour changes to avoid them (like avoiding driving, crowds, or exercise). About 1.6% of Canadians meet criteria for panic disorder in any given year, with a lifetime prevalence of 3.7% — and women are about twice as likely to develop it as men. Panic attacks themselves are much more common: Canadian clinical practice guidelines estimate a lifetime prevalence of around 28% for at least one panic attack.

Both NIMH and CAMH describe cognitive behavioural therapy as the most effective psychotherapy for panic disorder — often shorter than people expect, typically 8 to 15 sessions. Support usually makes sense when attacks are happening often, when the fear of future attacks is shaping your day, or when avoidance is limiting your work, relationships, or freedom of movement.

Panic attacks are frightening, but they are treatable — and understanding what's happening takes some of the fear out of the experience itself. If you'd like to talk to someone about what's been going on for you, our matching consult is free, private, and low-pressure. No commitment, just a conversation about what might help.

Learn more about anxiety counselling at Trillium

Crisis Resources

If you or someone you know needs support right now, help is available:

• 988 Suicide Crisis Helpline (Canada-wide): call or text 9-8-8 — free, confidential, 24/7.
• Here 24/7 (Waterloo–Wellington crisis & mental health line): 1-844-437-3247.
• If someone is in immediate physical danger, call 911.