Introduction
You’re not dying. It just feels exactly like it.
Most people remember their first panic attack the way they’d remember a car accident: where they were, what they were holding, the exact second the floor tilted. The queue at Woolies in Cavendish. The M5 at five o’clock, boxed in on every side. An ordinary Tuesday meeting, when your heart suddenly tried to climb out through your throat.
Then comes the part nobody warns you about. Your chest is tight, your hands are tingling, you can’t get a full breath, so your mind goes looking for an explanation. It finds the worst one available. Heart attack. Stroke. Going mad. Losing control in front of everyone.
Here’s what I want you to know before anything else. A panic attack is frightening, but it isn’t dangerous. It peaks, then it passes. There are things you can do in the moment to help it pass sooner, and some of them (ice, a lemon, the way you breathe out) are so simple they sound like a joke. They work anyway.
This post covers what’s happening in your body, what to do during a panic attack, the one catch nobody mentions, and what actually stops them coming back.
What a Panic Attack Actually Is
A panic attack is your body’s alarm going off with no fire in the building.
The fight-or-flight response is ancient, fast and very good at its job. When it fires, adrenaline floods in. Your heart speeds up to push blood to your muscles; your breathing quickens; your digestion shuts down; your vision narrows. If a taxi were coming straight at you, every one of those changes would help. Sitting in a meeting, they feel like the end of the world.
The symptoms build quickly, usually peaking within about ten minutes. The common ones:
- a pounding or racing heart
- tightness or pain in the chest
- shortness of breath, or a feeling of choking
- dizziness, and tingling or numbness in the hands and face
- hot flushes or chills, sweating, trembling, nausea
- a sense of unreality, as if you’re watching yourself from outside
- a sudden certainty that you’re about to die, faint or lose your mind
They can strike in the middle of something completely calm. They can even wake you from sleep.
You’re far from alone. A study that surveyed nearly 143,000 adults in 25 countries (with UCT’s Professor Dan Stein among its authors) found that 13.2% of adults have had at least one panic attack. Only a small share of them ever develop panic disorder. So a panic attack isn’t a diagnosis; it’s an event. What happens after it is what counts.
First, Rule Out Your Heart
This matters, so I’ll say it plainly. If it’s your first attack, if the chest pain spreads into your arm, jaw or back, or if you have a heart condition, get checked. Call 10177 for an ambulance (112 from a cellphone), or have someone drive you to the nearest emergency unit.
Nobody in casualty will think you’re wasting their time. Doctors would far rather rule out a heart attack in someone who turns out to be panicking than miss one.
Once you’ve been checked and cleared, you’ve got something valuable for next time: proof that your heart is fine, even when it doesn’t feel it.
What to Do During a Panic Attack
None of what follows will switch a panic attack off like a light. The aim is smaller, and more realistic: to take the edge off, to give your mind something else to hold on to, to get you to the other side a little sooner. Try a few. Keep the ones that work for you.
Say what it is
Name it, out loud if you can. “This is a panic attack. It’s horrible, and it will pass.”
It sounds too simple to matter. It isn’t. It moves you from “I’m dying” to “I know what this is”, and panic feeds on the unknown. Naming it takes some of its food away.
Breathe out for longer than you breathe in
When you panic, you gulp air. That over-breathing causes a lot of the tingling and dizziness, which then frightens you more. So forget big, deep breaths. Focus on the out-breath.
One version is called cyclic sighing. Breathe in through your nose; then, without breathing out, take a second, shorter sip of air on top; then let it all go slowly through your mouth, taking about twice as long to breathe out as you did to breathe in. Repeat.
In a Stanford study published in 2023, people who practised this for five minutes a day for a month reported better moods and slower breathing than a group who meditated for the same time. It was a small study, and it wasn’t done during panic attacks. But the principle holds: a long exhale nudges your heart rate down. Practise it on a calm day, so it’s there on a bad one.
Use cold
This is the one people raise an eyebrow at.
Hold an ice cube in your hand. Press a cold pack (or a bag of frozen peas) against your forehead and eyes for 15 to 30 seconds. Or fill a basin with cold water, hold your breath, then put your face in.
Cold on the face sets off what’s called the dive reflex, a survival response we share with seals and whales, which slows the heart. It’s a formal skill in dialectical behaviour therapy (DBT). And a small study found that 30 seconds of cold water on the face reduced both the physical and the mental symptoms of panic in people with panic disorder.
Two cautions. For some people, sudden cold does the opposite: it triggers a cold shock that pushes the heart rate up, not down. So try it on a calm day first, and see how your body responds. And if you have a heart condition or blood pressure concerns, are pregnant or tend to faint, speak to your doctor before trying the face-in-the-basin version.
Bite into something sour
A wedge of lemon. A sour sweet from the garage shop. Something sharp enough to make your eyes water.
I’ll be honest with you: there’s no proper research on this one yet. The evidence is people’s own experience (there’s a great deal of it). Still, the reasoning makes sense. Panic narrows your attention onto the frightening sensations in your body. A fierce taste drags it somewhere else, into your mouth and into the present, and it’s very hard to catastrophise while your whole face is puckering.
Keep a few sour sweets in your handbag, your desk drawer or the cubbyhole of the car.
Come back through your senses
No ice, no lemon? Your senses are still there. Press your feet into the floor and notice the pressure. Then find five things you can see, four you can hear, three you can touch, two you can smell and one you can taste.
It’s called the 5-4-3-2-1 technique, and it runs on the same principle as the lemon. It pulls your attention out of the alarm and back into the room.
Let it crest
This one runs against instinct. Fighting a panic attack tends to feed it, because fighting tells your brain the threat is real. Instead, let it rise, the way you’d let a wave roll over you at Muizenberg. Notice the sensations. Tell yourself they’re uncomfortable, not dangerous. Let them peak.
They will come down. Afterwards you’ll probably feel wrung out, shaky, even a bit embarrassed. That’s normal. Go easy on yourself, the way you would with a friend.
The Catch Nobody Tells You
Here’s where I part ways with the internet a little.
Every trick above is useful. But there’s a trap in them. If you come to believe that the only reason you survived your last panic attack was the lemon in your bag, you’ll soon be unable to leave home without it. The lemon becomes a lucky charm, and your brain files the lesson as “I was rescued” instead of “I was never in danger”.
Therapists call these safety behaviours: things we do to feel safe that, over time, keep the fear alive. Always sitting near the exit. Never driving on the N1. Carrying water everywhere. Checking your pulse, again and again.
So use the ice, the breath and the sour sweets. They’re there to get you through. The longer-term goal is quieter: learning, in your body and not only in your head, that a panic attack on its own can’t hurt you.
That’s where therapy comes in.
Why Panic Attacks Keep Coming Back
Most people who have one panic attack go on to have more. In that same 25-country study, two-thirds of people who’d ever had a panic attack had had repeated ones.
Often it isn’t the attack itself that keeps the cycle going. It’s the fear of the next one. You start scanning your body for danger, so you notice every flutter. You avoid the shopping centre where it happened, then the highway, then anywhere crowded. Your world gets smaller, one quiet “no” at a time.
That shrinking, more than the attacks themselves, is what brings many people to my door.
Panic also rarely arrives from nowhere, even when it feels that way. It tends to turn up after months of long, grinding stress (a hard job, a difficult relationship, a parent who needs you every day), after trauma, or on top of anxiety that’s been humming away for years. The attack is the smoke alarm. It’s worth finding out what’s smouldering.
If Someone Near You Is Having a Panic Attack
Stay calm, and stay close. Speak slowly and simply. Don’t tell them to calm down; nobody has ever calmed down because they were told to. Instead:
- ask what they need, and believe the answer
- breathe slowly and visibly alongside them, so they can match you
- offer a glass of cold water
- remind them it’s a panic attack, and that it will pass
- stay until it has
If it’s your teenager, the same rules apply. Teens often feel panic as shame as much as fear, so keep your voice low and your face kind, and leave the questions for later.
If you’re at all unsure whether it’s panic or something medical, call for help.
How Therapy Helps with Panic Attacks
Panic attacks respond well to treatment. That’s the good news.
Cognitive behavioural therapy (CBT) is the best-studied approach to panic, and a lot of it is practical. We’ll look at what happens in your body during an attack, so it becomes predictable rather than terrifying. We’ll look at the thoughts that pour fuel on it (“I’m going to faint”, “everyone will see”). Gently, and only at your pace, we might practise bringing on some of the sensations on purpose (a racing heart after running on the spot, say, or light-headedness after spinning in a chair) so your brain learns, again and again, that they pass.
We’ll also look at what’s underneath. The stress, the old hurts, the life that’s been asking too much of you for too long. That’s often where the real work is.
If medication might be part of the picture, that’s a conversation for your GP, and I’m happy to work alongside them. And if you need someone to talk to between sessions, SADAG offers free telephonic counselling on 0800 20 50 26, from 8am to 8pm every day.
Conclusion
A panic attack will tell you, very convincingly, that you’re in danger. It’s lying. Your body is doing exactly what it was built to do, just at the wrong moment.
In the moment, you have more tools than you think: a longer out-breath, cold on your face, something sour on your tongue, your feet on the floor. Beyond the moment, you have the chance to understand why the alarm keeps going off, then to turn it down.
If panic has started to shrink your world, you don’t have to wait until it’s one room wide. I see clients in Claremont, a short drive from Rondebosch, Newlands and Kenilworth, and online across South Africa.
The wave always breaks.
About Me
I’m Paula Marais, a registered specialist wellness counsellor based in Claremont, Cape Town. I hold an Honours in Psychology (Unisa) and a Master’s in Creative Writing (UCT), and I’m registered with the Association for Supportive Counsellors and Holistic Practitioners (ASCHP).
I offer individual and couples counselling, in person in Claremont and online across South Africa. Online sessions are equally as effective as in-person sessions.
There’s no pressure and no judgment. You can reach me at info@paulamaraistherapy.com or on WhatsApp at 072 633 7661.
#PanicAttacks #PanicAttackHelp #AnxietySupport #AnxietyRelief #GroundingTechniques #MentalHealthMatters #MentalHealthSA #AnxietyTherapy #CapeTownTherapist #ClaremontCounselling #CounsellingCapeTown #OnlineTherapySA #PaulaMaraisTherapy
FACEBOOK POST
You’re not dying. It just feels exactly like it.
If you’ve had a panic attack, you’ll know the racing heart, the tight chest, the certainty that something is terribly wrong. It’s frightening. It isn’t dangerous.
In my latest blog, I explore:
💓 What’s actually happening in your body during a panic attack
🧊 Why ice, or cold water on your face, can slow a racing heart
🍋 The lemon trick, and what the research does (and doesn’t) say
🌬️ A way of breathing that helps more than “just take a deep breath”
🔄 The catch in calming tricks, and why panic attacks keep coming back
🤝 How to help someone who’s having one
Panic attacks respond well to support. You don’t have to keep white-knuckling through them.
Read the full post here: [BLOG URL]
info@paulamaraistherapy.com | WhatsApp 072 633 7661
#PanicAttacks #AnxietySupport #GroundingTechniques #MentalHealthSA #CapeTownTherapist #ClaremontCounselling #PaulaMaraisTherapy