Anxiety Attacks: A Complete Guide

Have you ever had an unexpected choking sensation? Was it hard to breathe? Did it make you intensely afraid of losing control, going crazy, or even dying? Anxiety attacks are quite common in the general population. This guide will help you understand them and how to control them.

anxiety attacks
anxiety attacks

What are anxiety attacks?

Anxiety attacks are defined as a sudden, isolated intense fear or distress. They begin abruptly and reach their peak ten minutes later. Their total duration is estimated to be between 15 and 30 minutes.

The nervous system, during these anxiety attacks, sends danger signals at inappropriate times. What does this mean? That anxiety and panic are felt in situations where there are no real reasons to feel them. Anxiety attacks differ from panic attacks in that the latter is much more intense.

Anxiety attacks are one of the most frequent anxiety disorders: between 10% and 20% of the population has suffered anxiety attacks at some point in their lives. Anyone is likely to experience an anxiety attack, especially in situations of stress or psychological vulnerability.

Anxiety attacks- Symptoms

The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) considers an anxiety attack when at least four of the following symptoms are met:

  • A choking sensation or fainting
  • Palpitations, increased heart rate
  • Chest tightness
  • Muscle tension
  • Shaking
  • Sweating
  • Hot flashes or chills.
  • Nausea
  • Dizziness
  • Fear of losing control, going crazy, or even dying.
  • Derealization (alteration of the perception by which the outside world feels strange or unreal).
  • Depersonalization (alteration of the perception by which the individual feels detached from their mind and/or body as if they were a mere observer).
  • Paraesthesia (tingling or numbness sensations)

How do anxiety attacks affect us?

Having relatively frequent anxiety attacks often leads to unwanted changes. The person often stops doing their routine activities and tasks for fear of suffering these attacks again, especially in situations associated with fear. This affects the emotional state of the person, sometimes leading to depression which can cause a strong feeling of losing control.

People with anxiety attacks often feel “beaten up”. They feel as if the anguish has paralyzed them, leaving them unprotected and helpless.

Continued exposure to anxiety attacks can lead to absentmindedness, mild memory loss, concentration problems, digestive problems, appetite disturbances, sleep disturbances such as insomnia, etc.

Why do they happen?

Stressful events

These attacks usually follow a very stressful event that has not been well managed or periods of stress. They may not take place at the same time you are feeling anxious but rather when you are already calm.

Examples: job-stress, interpersonal conflicts, superstitious attribution (unfounded beliefs that something bad is going to happen), etc.

High levels of general anxiety

High anxiety mixed with poor strategies to fight it can lead to anxiety attacks.

Personal Characteristics

Some people are more susceptible than others. If they read about a disease or see it in someone close to them, they may worry and think that they, too, may be sick. They may even attribute the anxiety symptoms to another illness and believe that something very worse is happening to them.

Catastrophic thinking generates interpretations of situations that are not as dangerous as dangerous ones. The previous fears are a plus since they can generate new fears that form the perfect breeding ground for anxiety attacks.

Of course, the fear of fear takes on great importance. If you fear panic attacks, the fear is even greater when they appear.

Genetic predisposition

Genetics can influence, but it is not determinant. This means that we are not going to suffer anxiety attacks if there is a family history, but perhaps we will find ourselves more anxious.

Parenting Styles

Overprotective education makes a person fearful and vulnerable, with less problem-solving ability. They often react with frustration and anxiety in the face of difficulties, which in turn gives them a greater inability to resolve obstacles. On the other hand, worrying excessively may be transmitted to children.

Anxiety attacks vs time

There are different factors that make this problem persist.

Catastrophic Interpretations

The physiological activation, fight or flight response, that causes anxiety generates alert symptoms. The sufferer often interprets (consciously or unconsciously) that there is a danger to their health and life (“I can’t breathe, I’m drowning”, “I’m dying”). This leads to more anxiety and panic, and symptoms persist and increase.

Escape behaviors

People suffering from panic attacks want to defend themselves from symptoms in order to prevent the supposed dangers. That’s why they engage in behaviors to get relief, but they don’t let you know if the threat is real or not (“am I drowning, fainting, or dying?”), nor do they let you face the symptom and lose your fear.

Escape from the situation, seeking medication, stopping everything to focus on the symptom, avoiding places that are associated with the symptoms (for example, public transport), not leaving home alone, etc. are common.

Reaction to the symptom

The presence of the symptom itself, without coming to its interpretation, may be enough to cause fear. This is because it has suffered so many times that it has already associated bodily sensation with fear.

Treatment for anxiety attacks

Once the doctor verifies that it is anxiety and discards the physical causes, it is best to see a mental health professional for appropriate treatment.

It is thought that people who suffer anxiety attacks do not consult a specialist until after an average of seven years. It is important not to let it pass so long since it can chronicle or lead to other more severe disorders (such as social phobia).

Cognitive-behavioral therapy

It has been shown that individualized cognitive-behavioral therapy achieves therapeutic success in 81-90% of cases, being the most effective treatment. In addition, it has the lowest relapse rate and the highest cost-benefit ratio.

What techniques are used in this type of therapy?

  • Psychoeducation. The patient is informed about panic and anxiety: what are their mechanisms, how they work, what are their symptoms, the relationship between catastrophic thoughts and emotions, etc.
  • Identifying and neutralizing certain behaviors. It usually refers to those behaviors that the person carries out thinking it helps them, but in reality, what they do is maintain the anxiety.
  • Activation control techniques. Breathing techniques are useful to regulate and stop certain anxiety-related symptoms (such as hyperventilation). Relaxation techniques focus on decreasing the tension that accompanies anxiety.
  • Cognitive techniques. Cognitive restructuring in terms of distorted and catastrophic beliefs and thoughts, automatic thoughts, self-fulfilling prophecies, etc.
  • Interceptive exposure. The person with anxiety attacks is exposed to the feared bodily symptoms, encouraging them to become familiar with the symptoms. This will help them to prove that they are not dangerous and to lose the fear of being afraid.
  • Live exposure. Progressively, the affected person is exposed to the real and daily situations they fear and, therefore, avoids. The habituation will help them face and diminish anxiety.
  • Assertiveness training. Working with emotional skills allows you to improve the expression and acceptance of your own emotions.
  • In addition, you can seek a therapist, who can provide or recommend certain self-help materials for working at home.

Little by little, skills and tools will be obtained so that the person is able to expose themselves to the situation they fear.


They have an estimated success of 50-55%. Due to the high risk of dependence, they should only be consumed if they have been prescribed by a doctor. Also, the withdrawal of treatment should be progressive so as not to suffer unwanted side effects.

How to act when having anxiety attacks

Don’t fight it

When we are going through an anxiety attack, it will last between 15 and 30 minutes, whether we fight it or not. Fighting won’t end it sooner. Trying to relax won’t do any good at the most intense point either, which will scare us even more.

The most effective thing is to recognize that we are facing a crisis, that we must go through it and that it will disappear in a short time.

Avoid hyperventilation

Try to not have an accelerated, intense and superficial breathing (hyperventilation), because it accentuates the symptoms, especially the choking sensation. It also causes an excessive increase in blood oxygen levels. Breathing into a paper bag will help restore balance.

Abdominal breathing is more appropriate. It consists of breathing in calmly for several seconds and then breathing out slowly. Instead of swelling the chest, we should try to inflate the abdomen. This type of breathing counteracts the effects of stress.

Look for a quiet space

We must find a place that allows us to feel as relaxed as possible. For example, a park or a less crowded room if we are at a party. Stop any activity you are doing and look for a calm space. Once found, it is very useful to focus attention on something else and not on the symptoms themselves. If we are able to evoke positive emotions and situations, the good feeling effect will be even greater.

Don’t run away

It’s important that we don’t run away from where we are. Running away means not facing the symptoms or the reality that something terrible is not happening to us. If we do not stand up to them, they will always succeed in defeating us, because our fear will always be stronger.

This, in turn, facilitates the development of other disorders such as social phobia, agoraphobia, etc.

Do not perform “rituals”

Anxiety attacks decrease on their own. Attributing this descent to “magical” acts or rituals only leads one to think that these are the ones that have helped when they have not. By believing this, we risk depending on strange and meaningless rituals and, in more serious and chronic cases, can become an Obsessive-Compulsive Disorder (OCD).

How can we prevent anxiety attacks?

Anxiety attacks may appear without warning, but they can also be anticipated with the first symptoms. In any case, we can actively act to prevent them.

  • Avoid stimulants. Tobacco, coffee and stimulant drinks are bad for anxiety prevention. The same happens with alcohol, even if its true effect is to depress the nervous system.
  • Take care of your sleep habits. Try to sleep between 7 and 9 hours, in a suitable environment in terms of lighting, temperature, etc.
  • Exercise. Sport generates endorphins, hormones that benefit enormously in cases of anxiety. Try at least twenty minutes a day for three days a week.
  • Practice relaxation activities. Yoga, taichi, and meditation are examples that promote relaxation and increase the feeling of well-being.

How can we help someone who is having anxiety attacks?

If someone else is having an anxiety attack, we often don’t know what to do. Here are a few basic guidelines on how to act:

  • Have a conversation. Distracting the person won’t be easy, but getting them to be able to follow an active conversation will keep them from paying attention to their symptoms.
  • Active listening. Be understanding. Validate their feelings, emotions, and thoughts of the person suffering from the anxiety.
  • Don’t magnify the symptoms. Although they may scare you at first, understand and help them understand that the symptoms won’t hurt them. Remind them that it will be over in a few minutes.
  • Avoid crowds. Several people around them may want to help, but a ton of people will only make the anxiety worse. Prevent them from feeling overwhelmed.
  • Normalize what is happening. Those who suffer from this tend to underestimate their resources and overestimate the danger. We must not feed their exaggerated fears or overprotect them, but must try to encourage them to face what they are feeling.
  • Help them to seek help. Help them get in contact with a therapist and encourage them to stay in therapy long enough to start feeling better.

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