anxiety.co.zaPeople call it anxiety
A panic attack is one of the most misunderstood mental health events you can have, mainly because it looks like a medical emergency and it feels like a medical emergency, and then you get told it is anxiety as if that word is meant to calm you down. The person having the panic is not being dramatic, not trying to get attention, and not choosing to react like this. Their nervous system has hit the panic button and the body follows through with the full siren package, racing heart, tight chest, short breath, shaking, sweating, dizziness, nausea, tingling, blurred vision, feeling unreal, and a fear that something terrible is about to happen right now. The problem is that panic is loud, physical, and sudden, so people around you often respond with judgement instead of help, and that judgement makes the fear worse the next time.
Panic gets dismissed because it does not always have a neat trigger, so others assume you are making it up or exaggerating, but panic does not need permission from logic. Your brain detects threat, sometimes correctly, often incorrectly, and when it does, it prioritises survival over explanation. That is why you can be standing in a queue, driving on the N1, sitting at your desk, or lying in bed, and then suddenly your body starts acting like you are being chased. In South Africa that experience gets wrapped in extra stigma, because many people still see mental health as weakness, and a panic attack in public is treated like you have lost control rather than like you have hit a health crisis that needs understanding and a plan.
What panic actually is
Panic is a threat response, not a character flaw. Your nervous system has two main gears, one for safety and connection, one for survival. When survival switches on, your body prepares you to fight, run, or freeze. Adrenaline and cortisol rise, breathing changes, muscles tighten, the heart pumps harder, and your senses sharpen. This is useful if you are about to be harmed, but it is brutal when it happens because your brain misreads a sensation, a situation, or a memory as danger.
A lot of people think panic is just strong fear, but panic is more like fear plus body hijack. You might be thinking, I am fine, this is silly, while your chest is tightening and your hands are shaking, and that mismatch is part of what makes it terrifying. You cannot talk your way out of it in the moment because the thinking part of the brain gets pushed aside by the survival part, and survival does not want a debate, it wants action. That is why people pace, bolt to the bathroom, want to escape the room, call someone, or beg for an ambulance, because the body is screaming, move now or die.
It is also why panic often comes with shame afterward. People replay what happened, they feel embarrassed, they apologise, they promise it will never happen again, and then they become anxious about becoming anxious, which is where the real trap begins.
Why people land in ER
If you have never had a panic attack, it is difficult to understand how convincingly physical it is. Chest tightness can feel like a heart attack. Light headedness can feel like you are about to faint. Tingling and numbness can feel like a stroke. Shortness of breath can feel like you are suffocating. When those symptoms hit fast, your brain does what it is designed to do, it assumes the worst, and you rush for medical help. That is not irrational, it is responsible, especially if it is your first time or if you have risk factors.
The problem is what happens after. Some people get checked, the ECG is fine, the bloods are fine, and they get sent home with a vague line about stress. Others get dismissed, spoken to like they are wasting time, or told to calm down as if calm is a switch. Then they go home with no plan, no explanation, and no support, just the fear that it will happen again. That gap between medical reassurance and practical guidance is where panic becomes chronic, because the person starts scanning their body for signs, avoiding places where panic happened, and building a life around preventing the next episode.
There is also another risk here, and it matters. Not every racing heart is anxiety, and not every chest pain is panic. The goal is not to label everything as psychological, it is to rule out medical causes when appropriate, then treat the anxiety properly instead of leaving someone in limbo. If you have new chest pain, fainting, severe shortness of breath, or symptoms with exertion, it is reasonable to get medical assessment. Once serious medical issues are ruled out, continuing to treat repeated panic like a mystery illness is what keeps the cycle alive.
What to do in the moment
When panic hits, the goal is not to stop the sensations instantly, because fighting panic usually makes it stronger. The goal is to communicate safety to the nervous system in a way that does not turn into a new ritual. People often get stuck because they try to control their breathing perfectly, control their heart rate, control their thoughts, and control the environment, and that level of control tells the brain the situation is dangerous. Instead, aim for steady, grounded actions that reduce escalation.
Start by naming it, not as a magical trick, but as a reality check. Say to yourself, this is panic, my body is in alarm, it will peak and come down. Then anchor your attention externally, because panic feeds on internal scanning. Look around and name five things you can see. Feel your feet on the floor. Notice the temperature of the air. If you can, slow your breathing slightly by extending the exhale, not by taking huge gulps of air. A long exhale helps signal safety, but the key is gentle, not forced. If you feel like you cannot breathe, remind yourself that panic cannot stop your breathing, it can only make it feel uncomfortable.
If you are in a place you want to flee, try not to sprint away if you can safely stay. Leaving can become avoidance, and avoidance teaches panic that the place is dangerous. Sometimes you have to step outside, sometimes you have to sit down, sometimes you need a quieter space, and that is fine, but do it with intention, not with a desperate escape. The message you want to send your brain is, I can be uncomfortable and still be safe. That is the exact opposite of what panic wants you to believe.
If you have repeated panic attacks, it also helps to reduce emergency style responses, like calling multiple people, checking your pulse every minute, or googling symptoms. Those actions feel helpful, but they become part of the loop. Calm support is good, panic rituals are not.
The real work starts when the panic ends
Most people focus on surviving the panic attack, but the bigger issue is what happens in the hours and days after. This is where people make fear stronger without realising it. They start planning their life around preventing panic. They cancel events. They avoid work situations. They stop driving. They stop exercising. They stop going to the shops. They start sleeping with the light on. They start carrying rescue items everywhere. All of that tells the nervous system, you were right, the world is dangerous.
A better approach is to treat the panic attack as a message, not a prophecy. It is a signal that your nervous system is overwhelmed, misfiring, or both. You look at sleep, caffeine, alcohol, cannabis, stress load, and emotional strain. You talk honestly about what you have been avoiding. You also start building skills that retrain the nervous system, because panic is treatable, and it responds well to structured therapy approaches like cognitive behavioural therapy and exposure based work, as well as body based approaches that improve regulation.
Exposure does not mean throwing someone into terror. It means gradually practicing being in situations that trigger fear while learning not to do safety behaviours that keep the fear alive. That is how the brain learns, this sensation is uncomfortable but not dangerous, this place is not a threat, I can handle the feelings without running. The first steps feel hard, but they are practical, and they change outcomes.
When to get professional help
If panic attacks are frequent, if they are leading to avoidance, if they are affecting work, parenting, relationships, or sleep, then it is time for professional help, not because you are weak, but because untreated panic tends to expand. If someone is having panic and also using substances to cope, that needs proper assessment. If panic comes with depression, hopelessness, or thoughts of self harm, it needs urgent support.
Medical assessment is sensible when symptoms are new, severe, or confusing, especially chest pain, fainting, irregular heartbeat, or severe breathing difficulty. The goal is to rule out medical conditions and then not get stuck in repeated medical checking when the pattern is clearly panic. Repeated reassurance without treatment is one of the main reasons panic becomes chronic.
