“All You Have to Fear Is Fear Itself”: How to Respond to Panic Attacks

“He was overcome by a sudden, uncontrollable fear.” (Kafka, Metamorphosis).

A panic attack - acute severe anxiety - often arrives without warning. It is to be overtaken by a surge of fear and terror. Physical symptoms may include dizziness, breathlessness, chest pain, sweating, shaking, and tingling.

Alongside these symptoms can come frightening thoughts: I’m going crazy… I’m having a heart attack… I’m going to collapse… I’ve lost control… I need to escape… I’m going to die.

Photo by Anastasia Stoeckmann on Unsplash

The following literary lines capture the intensity of what many experience:

My heart beat thick, my head grew hot; a sound filled my ears, which seemed the rushing of wings  (Charlotte Brontë, Jane Eyre).

I was trembling all over; I felt I should fall to the ground (Fyodor Dostoevsky, Notes from Underground).

I could only clutch the door, my heart thudding so that I thought it would burst (Henry James, The Turn of the Screw).

These sensations are the result of extreme fear. A panic attack is the body going into a fight-or-flight physiological state -preparing to respond to danger. 

• Clinically: The term “panic attack” tends to be reserved for high fear even through an external threat is absent. Our bodies are responding as if there is a severe danger, even though there isn't one. 

• Experientially / somatically: The body can produce panic-level activation in response to real or perceived danger.

When there is no actual external danger, during a panic attack, all you have to fear is fear itself. P

Because panic is driven by fear, self-interventions work best when they help your body and brain register that you are safe.

What can you do during a panic attack?

Clients often find the following techniques helpful. Not every technique suits everyone, so experiment and find what works for you.

Mindful breathing

Slow, deliberate breathing can cue your nervous system that the threat has passed.

Grounding techniques

Using your senses - touch, temperature, sound - helps anchor you in the present moment rather than in the spiral of fear.

Interoceptive mindfulness

Gently noticing internal sensations without judgement (“My heart is pounding… my hands are tingling… and that’s okay”) reduces the urge to fight or flee from them.

Why these techniques help

1. They reduce fear of the sensations
Panic escalates when physical symptoms are interpreted as dangerous. Observing rather than resisting them weakens the “fear of fear” that fuels the cycle.

2. They shift you into mindful awareness
Mindfulness interrupts the adrenaline-driven narrative of Something is wrong… this is getting worse, allowing space and clarity.

3. They break the avoidance cycle
Trying to escape sensations often intensifies them. Accepting them (“uncomfortable but not dangerous”) allows them to peak and settle.

4. They activate the parasympathetic nervous system
Acceptance lowers the brain’s threat response, helping the body gradually return to a calmer state.

How therapy can help

Therapy can help you understand what fuels your panic attacks - whether stress, past experiences, or unhelpful beliefs - and support you in developing calmer, more confident ways of responding.

 See also my two articles on anxiety and overthinking.  

If you are looking for therapy and would like to have free chat/ consultation, please feel free to get in touch. 

Photo by Anastasia Stoeckmann on Unsplash