During a panic attack, it can feel as though your body is in immediate danger. Your heart races, your chest feels heavy, you can’t breathe, and your body is sending you signals that something terrible is about to happen. When this happens consistently, and when you become fearful of when the next attack will start, a panic disorder is taking hold.
Panic attacks are overwhelming and deeply distressing. For many people, the only way to cope with the anxiety of when the next attack will happen is alcohol or other substances. However, this relief is temporary. Over time, substance use can intensify anxiety symptoms and increase the frequency or severity of panic attacks, reinforcing a difficult cycle. At All In Solutions, we take a serious approach toward treating those suffering from panic disorders.
What Is Panic Disorder?
Panic disorder is one of several anxiety disorders and is defined by recurrent, unexpected panic attacks with sudden surges of intense fear or emotional distress and the onset of physical symptoms, including shortness of breath, heart palpitations, chest tightness, dizziness, sweating, and a sense of impending doom.[1]
While anybody can have a panic attack, the difference between an isolated attack and a panic disorder is what happens afterward. With a panic disorder, the person suffering will experience persistent worry and anxiety about when the next attack will happen, significantly change their behavior to avoid another attack, or both.[2] This anticipatory anxiety and avoidance can both hinder daily functioning and can be just as disabling as the panic attacks themselves.
Agoraphobia is common among a significant number of people diagnosed with panic disorder and is characterized by an intense fear of places in which it may be difficult to escape or get help if needed.[3] This leads to avoidance of crowds and places, sometimes to the point where the person suffering is housebound due to their anxiety, making this condition very debilitating.The DSM-5 classifies panic disorder as one of the various types of anxiety disorders and also recognizes it as one of the most treatable types of mental illness when appropriate, evidence-based treatment is implemented.[4]
How Long Do Panic Attacks Last?
Panic attacks typically peak in intensity within the first ten minutes of the event. Symptoms usually subside within about twenty to thirty minutes, however, some symptoms can remain longer, especially if multiple short attacks occur consecutively.[5] Physical symptoms like elevated heart rate, shortness of breath, chest pain, and trembling can last well after the attack peaks, and people may find themselves emotionally exhausted afterward.[6]
Clinically, the short duration of panic attacks is an important consideration. Because there is significant overlap between panic symptoms and those associated with cardiac or medical emergencies, many people experiencing their first panic attack seek emergency room treatment. The overwhelming feeling of terror and the uncertainty as to when the next attack will occur is the underlying motivation for the behavioral changes and avoidance that characterize panic disorder.
Symptoms of Panic Disorder
During a panic attack, symptoms include:
- Pounding or racing heart rate
- Shortness of breath or feeling smothered
- Chest pain or discomfort
- Dizziness, lightheadedness, or faintness
- Tingling or numbness in the hands or face
- Sweating, trembling, or shaking
- Nausea or stomach distress
- Chills or hot flashes
- A sense of unreality or detachment from surroundings (derealization or depersonalization)
- Intense fear of losing control, going crazy, or dying
The between-attack period in panic disorder involves:
- Persistent worry about when the next panic attack will occur
- Preoccupation with the physical symptoms of panic and what they mean
- Significant changes in behavior in order to avoid triggers
- Avoidance of places or situations associated with past attacks
- Reduced engagement in daily life, work, relationships, and activities
Alcohol and Panic Disorder: A Dangerous Combination
There is a well-documented, bidirectional relationship between alcohol and panic disorder. Many people with panic disorder find alcohol to be a reliable means of reducing the physiological arousal and anticipatory anxiety of panic attacks, and drinking becomes a means of self-medication.[7] Unfortunately, this self-medication is an easy path from panic disorder to alcohol use disorder.
The relief alcohol provides is only temporary, and it has long-term, opposite effects on anxiety. After drinking, alcohol can disrupt the ability to sleep normally and cause rebound anxiety as it is metabolized — this “next-day” anxiety is the result of the effects alcohol has on the GABA and glutamate systems.[8] Over time, ongoing alcohol use worsens baseline anxiety, tolerance to its calming effects develops, and withdrawal produces intense anxiety and panic, which often end up triggering another attack.
Over time, the two disorders become mutually reinforcing. Treating alcohol use without addressing panic leaves the anxiety driving the drinking in place. Conversely, treating panic while alcohol use continues makes treatment approaches for panic disorder less effective. Integrated dual diagnosis treatment is the only way to address both.[9]
Non-Prescription Methods of Stopping Panic Attacks
Stopping or reducing panic attacks without relying on addictive prescription medications — particularly benzodiazepines — is the primary focus of treating panic disorder, especially for people with co-occurring substance use. Research-supported, non-pharmacological approaches include:
- Diaphragmatic Breathing — Breathing slowly and deeply through your diaphragm activates your parasympathetic nervous system and counters hyperventilation, which causes many of the symptoms of panic attacks.[10] Controlled breathing at 4-6 breaths per minute reduces the severity of panic symptoms.
- Cognitive Restructuring — The physical sensation of panic is partly due to thinking the worst about these sensations. Learning that a racing heart does not necessarily indicate a heart attack and that rapid breathing will not cause suffocation reduces the fear that creates the cycle of panic.
- Interoceptive Exposure — Deliberate, controlled, therapeutic exposure to panic-like sensations (by spinning, exercising, or hyperventilating) allows you to develop a higher tolerance to the physical sensations that trigger panic attacks.
- Mindfulness — Practicing non-judgmental awareness of your panic symptoms without adding to them through your thoughts will significantly decrease the secondary fear response that contributes to panic attacks.
- Situational Exposure — Facing situations you have been avoiding reduces agoraphobic avoidance and creates a new, non-threatening association to those situations.
For clients in dual diagnosis treatment, these skills are not only effective for panic, but they are also directly transferable to managing cravings, tolerating distress, and navigating the anxiety that early recovery generates.
Evidence-Based Treatment for Panic Disorder
Cognitive Behavioral Therapy (CBT)
CBT is the gold-standard evidence-based treatment for panic disorder, with decades of research supporting its effectiveness.[11] CBT for panic disorder addresses the three elements sustaining the panic cycle: catastrophic misinterpretation of physical sensations, avoidance of situations that prevent the extinction of fear, and physiological hyperarousal that exacerbates symptoms. Treatment combines cognitive restructuring, interoceptive exposure, and situational exposure in a structured, graduated program.
Research repeatedly shows that CBT for panic disorder produces lasting outcomes that are maintained well after treatment ends — unlike benzodiazepines, which only yield symptomatic relief during the period in which they are used and present an inherent risk for people with a history of substance use.[12]
Exposure Therapy
Exposure therapy, both interoceptive (directed toward feared body sensations) and in vivo (directed toward avoidance situations), is the active mechanism of change. Systematic, incremental exposure to feared stimuli without the catastrophic consequences anxiety anticipates allows the brain’s fear response to extinguish, reducing both the frequency and intensity of panic attacks and the avoidance behavior that limits daily life.
Medication Management
SSRIs and SNRIs are the first-line pharmacological treatments for panic disorder and are safe and effective for clients who don’t have a history of substance use. For clients in dual diagnosis treatment, medication selection will be closely managed to avoid benzodiazepines and any medication with abuse potential. Psychiatric oversight will ensure the use of medications that facilitate recovery without creating additional risk.
