Panic Attacks: What Is Happening in the Body and How Counselling Helps

It usually arrives without warning. Your heart begins to pound on a packed MRT, your chest tightens in the middle of a meeting, or you wake at night with your hands tingling and a conviction that something is terribly wrong. Within minutes the sensations can feel overwhelming, and many people leave the experience certain that they came close to collapsing, losing control or dying.

This article explains what a panic attack is, what is happening in the body, how to tell panic from a medical problem, and how counselling helps. It is general psychoeducation, not a diagnosis, and it cannot replace an assessment by a doctor.

What Is a Panic Attack?

A panic attack is a sudden surge of intense fear or discomfort, accompanied by strong physical sensations and alarming thoughts. It typically builds quickly, peaks within minutes and then eases, although people are often left shaky and drained for hours afterwards.

The experience varies from person to person, but commonly includes:

• A pounding or racing heart

• Breathlessness or a feeling of being unable to get enough air

• Chest tightness or discomfort

• Dizziness or light-headedness

• Tingling or numbness in the hands, feet or face

• Sweating, trembling or hot and cold flushes

• Nausea or abdominal distress

• A sense of unreality or of being detached from yourself

• Fear of losing control, going mad or dying

A single panic attack does not mean that you have a disorder, and many people experience one or two during particularly stressful periods. "Anxiety attack" is a popular phrase, not a formal diagnostic term, and people use it to describe everything from a rising wave of worry to a full panic attack.

What Is Happening in the Body?

During a panic attack, the body's threat-detection system sounds an alarm when no real danger is present. Stress hormones such as adrenaline are released, the heart beats faster, breathing quickens and blood is redirected towards the large muscles, which is the body preparing to fight or flee. These changes are protective in a genuine emergency, and in panic they are simply misfiring.

Many of the frightening sensations follow directly from this response. Faster breathing can bring dizziness and tingling, a pounding heart can feel like chest pain, and tense muscles can feel like trembling or weakness. In a person whose medical investigations are clear, these sensations reflect an alarm response and not an ongoing medical event.

Researchers have proposed a range of explanations for why the alarm fires, including neurochemical, genetic and respiratory accounts alongside psychological ones. A recent narrative review concluded that the origins of panic disorder are complex and multifactorial, which means that no single cause explains every case (Kyriakoulis & Kyrios, 2023).

Could It Be Something Else? Ruling Out Medical Causes

Panic symptoms can closely resemble physical illness, and that is the reason a medical check matters. A narrative review of six common panic symptoms (non-cardiac chest pain, palpitations, breathlessness, dizziness, abdominal distress and tingling) found that these symptoms can mimic, or occur alongside, somatic illness, with long COVID named as one example. The authors argue that distinguishing the two takes a combined psychological and medical view, partly to spare people costly investigations and prolonged suffering (Tunnell et al., 2024).

A doctor can check for conditions that produce similar symptoms and can review medications, caffeine and other stimulants that may contribute. This is especially important if the attacks are new, if you have risk factors for heart or lung disease, or if the symptoms differ from your usual pattern.

Seek emergency care straight away if you have chest pain with pressure or spreading discomfort, breathlessness that does not ease, fainting, or any symptoms that feel different from what you have experienced before. In Singapore, call 995 for an ambulance. The emergency resources page lists further support options.

Panic Attack, Panic Disorder or Anxiety?

Panic attacks, panic disorder and generalised anxiety overlap, and only a qualified professional can diagnose them. As a general guide, panic disorder involves repeated, unexpected panic attacks together with persistent worry about further attacks, or with changes in behaviour made to avoid it.

The distinction matters because the pattern around the attacks is often a bigger problem than the attacks themselves. Someone who has had a handful of attacks and continues life as normal faces a very different situation from someone who has stopped taking the MRT, avoids lifts or crowded places, and spends the day scanning their body for warning signs.

The broader picture of anxiety is covered in the guide to anxiety counselling in Singapore, and the panic attacks page describes how the concern is approached in sessions. If your worry centres on illness and bodily symptoms more generally, the material on health-related anxiety may be closer to your experience.

Why Panic Keeps Going: The Fear of Fear Cycle

The cognitive account of panic holds that people with panic disorder tend to interpret ordinary bodily sensations in a catastrophic way. A racing heart becomes "I am having a heart attack", dizziness becomes "I am about to faint", and the fear that follows produces more sensations, which seem to confirm the original alarm. Behavioural and cognitive models of panic have gained support partly because cognitive behavioural therapy works for the condition (Kyriakoulis & Kyrios, 2023).

Avoidance and safety behaviours keep this cycle going. Common examples include:

• Avoiding places where an attack occurred, such as trains, lifts or meetings

• Carrying water, medication or a phone at all times "just in case"

• Checking your pulse or breathing repeatedly

• Always sitting near an exit or insisting on company

Each of these brings short-term relief and teaches the brain that the situation really was dangerous. Over time, life narrows around the fear. In a city of crowded transport, open-plan offices and demanding schedules, that narrowing can happen quickly and quietly, and it often overlaps with the pressures described in the articles on how chronic stress affects the body and mind and stress and burnout in Singapore.

What Helps in the Moment?

In the middle of an attack, the aim is not to force the feelings away, because fighting the sensations often intensifies them. Some approaches that people find useful are:

• Remind yourself that this is panic, that it has happened before and that it will pass

• Let your breathing slow gently, with a longer out-breath, without forcing deep breaths

• Stay where you are if it is safe, instead of fleeing, so the brain can learn the situation was survivable

• Anchor attention in the present by naming things you can see, hear and touch

• Let the sensations be there without arguing with them

You can find the slow-exhalation and grounding techniques explained in the anxiety counselling guide. These tools can ease an attack, but they are not a treatment for recurring panic, and relying on them as an escape can become a safety behaviour in its own right.

How Does Counselling Help?

Counselling for panic usually draws on cognitive behavioural approaches, which are described on the page about cognitive behavioural therapy. The work typically includes understanding the body's alarm response, examining the catastrophic interpretations that follow, and gradually returning to avoided situations. Many programmes also include deliberately and safely bringing on the feared sensations, such as breathlessness or dizziness, so that the person learns they are tolerable.

The evidence supports this approach, with some honest limits. A network meta-analysis of psychological therapies for panic disorder included 60 studies, 54 of them (with 3,021 patients) in the quantitative analysis. It found that cognitive behavioural therapy had the best-replicated evidence and was often superior to other therapies, although effect sizes were small and precision often insufficient. The authors also stated that there is no high-quality, unequivocal evidence to support one psychological therapy over the others (Pompoli et al., 2016).

A separate meta-analysis of randomised placebo-controlled trials across anxiety-related conditions found a moderate overall benefit of cognitive behavioural therapy. For panic disorder specifically, the effect was small to moderate, based on a small number of trials (Carpenter et al., 2018). In practice, this means that therapy helps many people but does not work identically for everyone, and the relationship with the counsellor and the fit of the approach still matter.

Mindfulness-based work, which teaches people to observe sensations without reacting to them, is described on the page about mindfulness-based therapy. Individual sessions are available through private individual counselling, in person or through online counselling.

What About Medication?

Medication decisions belong with a doctor or psychiatrist, and a counsellor can help you think through the questions to ask. A recent review notes that combination treatments have outperformed single approaches in some cases, which supports an integrated view of care (Kyriakoulis & Kyrios, 2023). Counselling and medication are not rivals, and many people benefit from both, while others manage well with counselling alone.

Supporting Someone Who Is Having a Panic Attack

If someone near you is having a panic attack, a calm presence is the most useful thing you can offer. These steps can help:

1. Check for warning signs. Call 995 straight away if they have chest pain, fainting or breathlessness that does not ease, or if you are unsure whether it is panic.

2. Speak in a steady voice and ask what helps. Avoid telling them to calm down, which tends to add pressure.

3. Offer a quieter space if one is close. Let the person choose whether to move.

4. Ask before touching them. Some people find physical contact overwhelming during an attack.

5. Keep your words short and simple. Breathe slowly alongside them instead of instructing them to breathe.

6. Stay with them until it passes. Your steady presence matters more than finding the right words.

7. Let them rest afterwards. Avoid analysing what went wrong, ask what would help next, and suggest seeing a doctor if the symptoms are new or severe.

For longer-term guidance, see how to support someone struggling with their mental health in Singapore.

When Should You Seek Help?

It is worth speaking to a professional if attacks are recurring, if you are avoiding places or activities because of them, or if the fear of the next attack is shaping your days. You do not need to wait for a formal diagnosis, and a counsellor can work with you while a doctor rules out physical causes.

For a sense of what to expect, what to expect at the start of counselling explains the process, and the counselling fees page sets out the costs. If you would like to talk it through, you can book a counselling session. If you are in distress and need support sooner, the urgent counselling sessions page explains the options, and the emergency resources page lists crisis support.

Frequently Asked Questions