Panic Attack Symptoms and Causes: What’s Really Happening in Your Body

Written By Courtney Thurston
Busy city street representing anxiety triggers and panic attacks – virtual therapy for panic attacks and anxiety in Jackson, MI

Out of nowhere, your heart starts racing. Your chest hurts. You feel a wave of panic. Am I having a heart attack?

Maybe you’ve already been to the ER or your doctor. They ran tests. Everything came back normal. They told you it’s anxiety. Maybe even called it a panic attack. Panic attacks feel scary. The symptoms can look and feel a lot like heart problems—especially chest pain, fast heartbeat, and shortness of breath. It makes sense that people go to the hospital—panic attacks feel that intense.

When panic attacks happen, it’s easy to start avoiding the places or situations that triggered them. That’s not weakness—it’s your nervous system doing its best to protect you. In this post, we’ll break down what’s really happening during a panic attack, why your chest hurts, and how to cope.

What Is a Panic Attack, Anyway?

A panic attack can happen out of nowhere—or be triggered by a specific situation or thought. It involves a sudden, intense wave of fear or stress that leads to physical symptoms, often without warning.

Common physical symptoms of a panic attack include:

Person clutching chest experiencing panic attack symptoms – virtual counseling for panic attacks and anxiety in Jackson, MI

  • Dizziness

  • Sudden increase in body temperature or hot flashes

  • Chest pain or tightness

  • Trouble breathing or feeling like you can’t get enough air

  • Sweating

  • Nausea or stomach discomfort

During a panic attack, it’s common to feel like you’re dying or having a heart attack. These sensations are very real and incredibly scary—but they’re usually a result of the body’s fight-or-flight response, not a medical emergency.

Some people experience panic attacks occasionally. Others may develop Panic Disorder, which involves recurring panic attacks and ongoing fear about having another one. People with Panic Disorder often avoid certain places, situations, or activities to try to prevent future episodes.

Diagnostic Criteria for Panic Disorder

To be diagnosed with Panic Disorder, a person must experience:

Recurrent, unexpected panic attacks, with 4 or more of the following symptoms:

  • Rapid or increased heart rate

  • Sweating

  • Trembling or shaking

  • Shortness of breath or feeling like you can’t breathe

  • Feeling like you’re choking

  • Chest pain or discomfort

  • Nausea or stomach distress

  • Feeling dizzy, lightheaded, or faint

  • Chills or sudden heat sensations

  • Numbness or tingling (also called paresthesia)

  • Feeling detached from yourself (depersonalization) or from reality (derealization)

  • Fear of losing control or “going crazy”

  • Fear of dying

These symptoms often come on suddenly and can feel overwhelming—many people describe panic attacks as feeling like a heart attack or medical emergency.

At least one of the attacks is followed by one month or more of one (or both) of the following:

  • Persistent worry about having more panic attacks or their consequences (e.g., fear of losing control, having a heart attack, or "going crazy")

  • A noticeable change in behavior related to the attacks—such as avoiding places, situations, or activities where a panic attack occurred or might occur

What’s Actually Happening in Your Body During a Panic Attack

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Experts still aren’t completely sure why some people experience panic attacks while others don’t.

Many believe that panic attacks are triggered by the brain and body’s fight-or-flight response. For some reason, your brain detects a “threat”—this could be something in your environment or even just a sensation in your body. In that moment, your brain misinterprets the signal and believes you’re in danger, even if you’re not.

That fear response kicks in fast. One part of your brain might recognize that everything is fine and try to move on. But another part isn’t convinced—and it starts sending intense physical symptoms to grab your attention. This can include chest pain, shortness of breath, dizziness, or a racing heart—all common panic attack symptoms.

It’s like your brain is sounding the alarm, even when there’s no real emergency.

When to Get Medical Help

People often wonder: Should I go to the ER? How do I know if it’s a panic attack or something more serious? These are valid questions—and it’s always okay to seek medical help when you’re unsure.

Here are a few signs that you should consider going to the emergency room or seeing your doctor:

Medical instruments in ER representing panic and anxiety symptoms – online counseling for panic and anxiety in Jackson, MI

  • You’ve never experienced these symptoms before

  • Your symptoms feel different than usual

  • The episode is lasting longer than 20 minutes (most panic attacks peak within 10–15 minutes and improve shortly after)

  • Your symptoms aren’t improving over time—panic attacks typically start strong and then ease up

Because panic attack symptoms can closely mimic those of a heart attack, it’s better to play it safe. If you’re unsure, seek medical care. Doctors can run tests to rule out heart issues or other physical conditions. It’s not overreacting—chest pain, shortness of breath, dizziness, and other intense symptoms deserve to be taken seriously.

Once physical issues are ruled out, and if panic attacks keep happening, working with a therapist—especially one who offers anxiety therapy—can help you understand your symptoms and regain a sense of control.

How to Cope During a Panic Attack

Coping during a panic attack involves two key steps: first, sending reassuring messages to your brain like, “I am safe, I am not in danger.” Second, it’s important to regulate your nervous system to reduce physical symptoms and calm your body.

Brown grass blowing in the wind symbolizing anxiety and panic – telehealth counseling for anxiety and panic in Jackson, MI

Sending Safety Messages to Your Brain to Calm Panic Symptoms

Develop calming statements to use during a panic attack—phrases that acknowledge what your brain, body, and nervous system are experiencing. For example, you might say, “I see that I’m stressed, but I am safe and I am not dying.” These statements help retrain your brain and reduce the misfiring signals that make you feel like you’re in danger.

Coping Skills for Regulating your Nervous System

How to Regulate Your Breathing During a Panic Attack

Diaphragmatic Breathing. Breathing into your diaphragm—rather than your chest—can help activate the body’s relaxation response. Most of us naturally take shallow breaths into our chest, especially when we’re anxious. Diaphragmatic breathing encourages slower, deeper breaths that signal to your nervous system that you’re safe.

4-Square Breathing technique diagram for anxiety relief – telehealth counseling for anxiety and panic in Jackson, MI

4-square breathing. Also known as box breathing, 4-square breathing is a simple, structured technique that helps regulate your breath and calm your mind. It gives you something to focus on during a panic attack, which can interrupt the spiraling thoughts and physical symptoms.

I created this helpful image to guide you through 4-square breathing [ Click here to Download the Guide ]—you can download it to your phone for easy access outside of therapy sessions.

Change Your Sensory Input to Calm Panic and Anxiety

Sometimes, it helps to give your body a different sensation to focus on—especially during a panic attack or wave of anxiety. For example, you might hold a cold bottle of water, run your hands or wrists under cool water, or place an ice pack on your neck or chest. This can redirect your brain and body to focus on a new, non-threatening physical sensation.

These are called sensory grounding techniques, and they’re great for reducing panic symptoms and helping you feel more present. Some people also use strong flavors or smells—like sucking on sour candy, chewing mint gum, or smelling essential oils—to help their brain shift focus and calm the nervous system.

Experiment with different sensory tools to see what works best for you. They're simple but powerful ways to feel more in control during moments of high anxiety or overwhelm.

Mental Strategies to Interrupt Panic and Anxiety Spirals

Grounding techniques can help redirect your brain back to the present moment—reminding your body that you're safe and not in danger. These tools are especially useful during panic attacks or moments of intense anxiety.

ROY G BIV grounding strategy color guide for anxiety and panic relief – virtual therapy in Jackson, M

One of my favorite strategies is the ROY G BIV grounding technique, which uses colors to guide your focus. (Check out this image that walks you through the steps.)

Another widely used option is the 5 Senses Grounding Technique. This method helps you reconnect with your surroundings using what you can see, hear, feel, smell, and taste. Click here for an article and video that explain how to use the 5 Senses technique during high-stress moments.

What to Do After the Panic Passes

It’s completely normal to want to overanalyze why a panic attack happened and what you could have done to prevent it. A little reflection can be helpful—but try to be kind to yourself in the process.

Panic attack recovery isn’t just physical—it’s emotional, too. Guilt, shame, frustration, or fear of it happening again are all common. Instead of judging those feelings, work on normalizing your emotional response and giving yourself the same compassion you’d offer a friend.

How Therapy Can Help

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Therapy can be a powerful space to collaborate on strategies to face panic—together.
Panic attacks happen to more people than you might think. It’s one of the body’s ways of trying to protect you, even if the response is a little misguided.

In therapy, we’ll work together to clarify your goals around anxiety and panic attack symptoms. You’ll learn and practice coping strategies tailored to your needs. I often help clients identify and reframe the thoughts that fuel panic, while also building skills to manage the physical symptoms that come with it.

I also support clients through exposure-based strategies (also called exposure therapy)—a proven approach that helps your brain and body learn that you are safe, even in situations that typically trigger high anxiety.

With the right tools, support, and guidance, it’s absolutely possible to reduce your symptoms, understand your triggers, and feel safe in your body again.

I offer online individual therapy for anxiety and panic attacks in Jackson, MI, and across the state of Michigan. Therapy can help you feel more grounded, build lasting coping skills, and regain a sense of control.

Click here to schedule a free 10-minute consultation call.


Resources

Courtney Thurston
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Effective Ways to Monitor Your Mental Health Symptoms Between Therapy Sessions