If you live in Islamabad or Rawalpindi, or you are seeking help online from elsewhere in Pakistan, a panic attack can be one of the most frightening experiences of your life. Your heart may race, your chest may feel tight, and you may feel convinced that something terrible is about to happen, even when you are in a safe place. If this has happened to you, you are not losing your mind, and you are not alone.
A panic attack is intense, but it is also understandable once you know what the body is doing. This article explains what happens during panic, why it feels so dangerous, what research says about therapy, and what you can do in the moment and over time. It is general information only and is not a substitute for medical assessment.
What a panic attack can feel like
A panic attack usually arrives suddenly and peaks within minutes. You may notice a racing or pounding heart, shaking, sweating, shortness of breath, dizziness, nausea, tingling, or a feeling of unreality. Some people feel hot or cold, have chest discomfort, or fear they are having a heart attack, fainting, or losing control.
Because the sensations are so physical, it is natural to worry about your health. That worry can make the attack feel worse. The body becomes more alert, breathing becomes faster, and attention narrows to every heartbeat and breath. A cycle can build quickly: a sensation causes alarm, alarm increases the sensation, and the sensation increases alarm.
Afterwards, you may feel exhausted, shaky or embarrassed, especially if the attack happened in public, at work, in a market in Islamabad, or on the road to Rawalpindi. Many people then start avoiding places where they fear another attack, which can gradually shrink their lives.
What is happening in your body?
Research explains panic as a misinterpreted fight-or-flight response. This is the body’s alarm system, designed to prepare you to face danger or run from it. Adrenaline and related stress hormones increase heart rate, send blood to muscles, quicken breathing and heighten alertness. In a real emergency, that response is helpful.
In panic, the alarm can switch on when there is no immediate physical danger, or it can overreact to normal body sensations. A slightly faster heartbeat after climbing stairs, a moment of breathlessness, or a wave of tiredness may be read by the brain as a sign of catastrophe. The body then responds as if danger is real, which creates more of the very sensations that caused alarm.
This does not mean panic is “all in your head”. The sensations are real, and the alarm system is doing a real job, just at the wrong time or with too much force. Understanding this can reduce some of the fear, because the attack becomes less mysterious, even though it remains unpleasant.
What the research says
CBT with interoceptive exposure is supported by meta-analyses, including work by Pompoli and colleagues, for panic disorder. Interoceptive exposure means gently and gradually practising the body sensations that frighten you, such as breathing a little faster or spinning slowly in a chair, in a safe and controlled way. The aim is not to suffer, but to learn that these sensations are uncomfortable, not dangerous, and that they pass.
Guidelines such as those from NICE, the National Institute for Health and Care Excellence, recommend CBT as a first-line psychological treatment for panic disorder. CBT for panic usually combines understanding the panic cycle, learning to respond differently to feared sensations and thoughts, and gradually returning to avoided situations.
Research findings describe general patterns, not guarantees. Some people improve quickly, others need more time, and some also need medical review or other support. What matters is a careful assessment and a plan that fits your experience, rather than a single technique applied without context.
What happens in therapy for panic?
Early sessions at Therapy with Anjum focus on understanding your panic pattern: when attacks happen, what sensations and thoughts appear first, what you do to cope, and what you have started to avoid. Your therapist will also ask about your medical history and whether you have had a medical check, because some physical conditions need to be ruled out.
Together, you build a shared explanation of panic and practise new responses. This may include slower, steadier breathing, noticing catastrophic thoughts without treating them as facts, and small, planned steps back into situations you have avoided. Progress is usually gradual, and setbacks are treated as information, not failure.
You can attend in person in Islamabad or online, which can help if you live in Rawalpindi or elsewhere in Pakistan. To learn more, visit the panic attack therapy page on this website.
Practical steps you can try during panic
- Remind yourself that panic is distressing but usually passes, and that the sensations are part of an alarm response.
- Plant your feet and notice five things you can see, four you can touch, three you can hear, two you can smell and one you can taste.
- Breathe out slowly, rather than forcing deep breaths in. A longer out-breath can help the body settle.
- Loosen tight clothing, sit down if you feel dizzy, and avoid rushing to leave if it is safe to stay.
- Resist the urge to constantly check your pulse or seek reassurance, as checking can keep attention fixed on alarm.
- After the attack, rest, drink water, and note what happened without judging yourself harshly.
- Between attacks, practise small exposures with support, such as walking a short distance you have avoided.
These steps are supports, not a replacement for professional care. If they do not help, or panic keeps returning, that is a sign to seek further help, not a personal failure.
When to seek professional help
Seek professional help if panic attacks keep happening, if you worry often about the next attack, or if fear is changing your work, studies, travel, sleep or relationships. Help is also important if you have started avoiding many places, or if low mood, anxiety or sleep problems are growing alongside panic.
Seek urgent medical help straight away for chest pain, severe breathlessness, fainting, or any new or unexplained physical symptoms, especially the first time they happen. A medical professional should assess these symptoms, because panic can feel very similar to other health problems. Do not assume every episode is panic.
Seek urgent help immediately if you feel unsafe or at risk of harming yourself. Contact local emergency services or go to your nearest hospital, and ask a trusted person to stay with you while you get help.
Regaining confidence, step by step
Recovery from panic is rarely about never feeling anxious again. It is about changing your relationship with anxiety, so that a racing heart no longer means danger, and a feared place no longer controls your choices. With understanding, practice and support, many people find attacks become less frequent, less intense and less frightening.
If panic has been limiting your life, you deserve calm, respectful support. To take a first step, book an appointment with Therapy with Anjum, in person in Islamabad or online.
Therapy with Anjum — by Anjum Mehmood Siddiqui, Consultant Clinical Psychologist, Personality Analyst and Psychotherapist. Therapy in Islamabad, Rawalpindi and online. To begin, book an appointment.
Disclaimer: This article is general information only. It is not a diagnosis and is not a substitute for professional care. If you are in immediate danger, please seek emergency help straight away.