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Aug. 10, 2021

What Causes Panic Attacks to Feel Like You're Dying

What Causes Panic Attacks to Feel Like You're Dying

Panic attacks can make you feel like your having a stroke, heart attack or other serious symptoms. According to recent research, most emergency room visits are anxiety related. Learn the physical response to panic attacks in this episode. Get tips on how to prevent them.

Are you wondering what causes panic attacks to feel like your dying? Have you noticed that panic can sometimes feel like it came out of nowhere? I have noticed some similarities and sure they all experienced this racing heart, this sweating, trembling in place.

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Some of them experienced this depersonalization in other words, they feel like they're detached from their body, but I've noticed that their panic attacks seem to happen in three specific places. Now, before I mentioned them, let me just say this, a panic attack can happen anywhere. It can feel like it's falling out of the sky for no reason, but here's where I've noticed that it happens a lot for people.

Show Highlights

  • What are common causes of panic attacks
  • Why anxiety can feel like you’re dying
  • How CBT helps treat panic and worry
  • Natural ways to calm nerves
  • Word from this episode's sponsor - BetterHelp


Panic Attacks Can Happen Anywhere

Number one is at the grocery store, yes, it can happen for people at the grocery store that are in line they feel stuck they feel like something might happen in the store and they're in danger and they go into this fight or flight mode. They're in panic. The second place is on an airplane. lots and lots of people struggle with panic attacks when they go to get on an airplane. The third place is large venues or at a place where there is going to be a lot of people. Now, again, panic attacks can happen anywhere, but in my experience, this is where I've seen them happen most of the time for people. 

So I got really curious about this and I started to do some research and I went over to And I'll leave a link in the episode notes so that you can read this yourself. But according to their research, 93%, I mean, it's amazing. 93% of people who went to the ER room had some sort of anxiety-related issue. And I guess these people would show up at the hospital, they'd go to the ER room and they think to themselves, they're having a cardiac arrest or a stroke or some kind of other physical issue going on inside their body. All right just a fast disclaimer this show isn't meant to replace mental health counselling or medical help. And I'm not your personal therapist.

Panic Attack Symptoms Can Feel Like Dying

Panic. Yeah. For a lot of people, it can feel like they're dying. And one of the first questions I'll get from a new patient is why does it feel like I'm about to die when I have a panic attack? Well, here's the short answer I'd like to use an example of Star Trek because I'm a big fan of that series. If you can imagine that in your brain is the bridge, which is basically the amygdala and inside the amygdala or the bridge, it sends out a warning to the rest of the body. This red alert whenever it perceived it's in danger. So the amygdala communicates with the adrenal glands, which starts to pump out this adrenaline. And as a result, all these symptoms start to happen. The first is there is this change to vision. The person's vision starts to become more acute, but they might develop this tight kind of tunnel vision where they don't see anything else except for what's in front of them.

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Next is a dry mouth. If you've ever talked with someone or experienced a panic attack, you know that the mouth can get dry, it needs water, it's thirsty all of a sudden. Next is the heart starts to beat quick. And overall across all the patients, I've worked with panic attacks, they described this rapid heartbeat. It's going to pump out of their chest for some of them. The next thing is this nausea or this feeling like there are butterflies in the stomach. After that, a person might experience a hot flash or maybe they might get chills all over. 

And I should say that this doesn't happen all in a row. It's not linear. This can all actually happen very quickly and at the same time. Next is blood is starting to get pumped into the large muscles and these muscles start to get tense. It can feel really tight inside of like the leg muscles or in the chest where you have some of the larger muscles going on. After that, the breathing starts to become very quick and shallow, and everyone knows what that's like when they feel like they're out of breath and they're breathing really quickly. That's what it's like for someone with a panic attack. And then finally a person might experience these sweaty palms because they're in this fight or flight, they perceive that they're in danger. 

All right. So you understand some of the physical symptoms. So here's what happens when I sit down with someone for the first time in therapy and they're describing their panic attacks. One of the first thing I want to know is about their medical background. And the reason I want to know is maybe there's somewhere in their hyperthyroidism or there's sleep apnea or even restless leg syndrome. Now all of these are other ones can affect the way a person experiences, stress, and how they experience panic. Once we're able to kind of rule out any medical issues and maybe they've went to their doctor for a check-up next, I like to ask a series of questions. And this again is before we actually get into the therapy. 

Related Article: Why Acceptance Helps Anxiety Symptoms 

Work Related Panic

Now, the first question I want to know about is how much are they working? And especially are they bringing their work home? Do they have any boundaries between what they're doing at their job and their home life? Because a lot of people out there will continue to answer the phone or be plugged in and respond to emails all throughout the night. The next question I ask about is their eating and hydration. In other words, are they eating well? And are they keeping hydrated? This has so much to do with a person's overall wellness in all kinds of areas. 

Panic Because of Alcohol

The next question I ask is about alcohol consumption. Now alcohol isn't always the bad thing, sometimes it can be. One person can have a beer and it doesn't affect them at all. While for another person, just one beer makes them lightheaded, they might get a headache, they might get tired. So again, it's different for everyone. Then we move on to the next category, which is sleep. And I'm very curious if the person is getting six to seven hours of good deep sleep each night. Is it uninterrupted? Are they sleeping well? Sleep can absolutely affect how a person experiences, panic, and anxiety for sure.

Exercise Helps Anxiety

Next, is, is the person exercising? Do they have time to exercise? Is there any room in their schedule where they could build in some kind of exercise routine? And finally, the final question I'll ask about is caffeine intake, how much coffee is to person drinking? And just like alcohol, it’s not that caffeine is a bad thing, but some people are very sensitive to it. You want to reduce anxiety naturally if possible. 

Caffeine Increases Panic Attacks

In fact, I've worked with people who struggle with some kind of anxiety disorder or even bipolar disorder. And when they have a lot of coffee their symptoms start to really flare-up. So it's really important to pay attention to all of these factors before we address the issue of a panic attack. I want you to imagine for a second, this slope and at the top of the slope is this person and at the bottom of the slope is a panic attack. At the top of the slope, maybe the person isn't getting enough sleep. Maybe they're not exercising. Maybe they're bringing all their work home with them and they're working to all hours of the night. So they've got all this stuff going on. Maybe they're drinking a lot of coffee on top of it. Well, this sets them up with the perfect storm to experience a more intense and maybe more frequent panic attack. So that's why I asked these questions. 

Panic Disorder DSM 5

All right. So after I get through these series of questions, we start to talk about the symptoms. Now a panic disorder is what's described in the DSM five or the diagnostic statistical manual for mental disorders. And I'm not a big fan of that term disorder. And that's because when people hear it, you can see the reaction. They feel like they did something bad or something's wrong with them. And that's simply not the case. Now a panic disorder lives inside of the same family as OCD or social anxiety disorder or generalized anxiety disorder, except with all of these, they have their own criteria, which must be met.

I also want to say it's really important for people to talk with a professional and have a correct diagnosis. Now here's why somebody with major depression disorder or bipolar disorder or borderline personality disorder, all of these people can totally experience the symptoms of panic, but they're not having the root of the problem, that base of what the problem is addressed. It's just the symptoms. So again, there is no shame in talking to a professional and answering some questions to help you get down to the root of what the real issue is. Sometimes it might just be the panic disorder. Okay, so a panic attack is very treatable. A person can be treated with either medication or therapy or a combination of both. Now here's the thing. Medications can be very effective at treating the symptoms, the rapid heartbeat, the sweating, they may be feeling like you're having this out-of-body experience, it can help with that, but it isn't going to teach you the skills you need to be able to manage and cope with that panic attack, therapy can do that.

CBT for Anxiety Episodes

Now, if you listened to this podcast, you know that I practice cognitive-behavioral therapy. And with CBT here is how it works essentially. First, you have the thought second is the emotion. And then third is the behavior. Let me give you an example. Let's say that you've got someone who's going to the grocery store and they're inside of the store, they're in line. And they suddenly feel like they're going to die. They think that something terrible is going to happen in the store. They're going to get trapped. They really catastrophize the roof is going to fall and that's going to be the end. So that's the thought. Second starts the emotion. They become very, very fearful. They're very scared for their life in that moment. As a result of this emotion of fear, they start to get this rapid heart rate they're trembling in place. They might even get to a point where they feel light-headed.  Next is the behavior. The behavior is they run out of the store and in the future, maybe they don't ever come back again. So that's the essence of this thought emotion and behavior that we talk about in CBT. 

I also want to mention here that from a cognitive behavioral therapy standpoint, anxiety or emotions are very, very subjective. Let me give you an example. Let's do a thought experiment. Let's say for a moment, you've got a flight, and this flight is going from Chicago, Illinois, to Houston Texas, you've got two people that are going to get on this same exact flight, Jack and Jill. Jack arrived at the airport he gets on the plane and he suddenly starts to get these thoughts that the plane is going to go down, or that something's bad is going to happen to him. And that he's going to die. As a result, his heart starts racing. He gets lightheaded. He starts to get these hot flashes all over and he feels trapped. And in that moment, he is very fearful for his life.

Anxiety is Subjective to the Mind

On that same flight is a Jill. Jill gets on the plane. She sits down in her seat. She puts her head against the headrest, and she actually can't wait to fall asleep so that she can show up at her destination. So here it is, you've got the same flight or the same event, which is experienced differently by two different people. So that's what I mean by subjective. So, you might be wondering right now, well, what does a person do if they have a panic attack, how do they respond to it? Well, there are lots of different strategies out there. And in fact, depending on the therapist you talk to, they might have a different strategy. For example, a psychodynamic person-centered therapy, reality therapy. These are all different modalities. 

Now I work from that CBT framework. And in this framework, I want the person to focus as much as they can on the here and now, because if you think about it for our minds, a lot of us, it operates Somewhere in the future or in the past. It's very seldom that it's in the very moment at this very second. So that's what I'm aiming to do. One of the most popular strategies out there is deep breathing, and it is very useful. In fact, it's probably one of the most useful things that a person can do when they're struggling from anxiety or some sort of panic attack. But when I'm working with a person, I ask them to make sure they're focusing and concentrating on the actual act of breathing. So as they're breathing in through their nose and breathing out through their mouth, they allow themselves to feel that air going through the nostrils, filling up the lungs, and going out. Now, this is because this requires the person to be in this very second in time, right here and right now. 

Appeal to the 5 Senses

One of the most popular strategies that I've seen for people to cope with a panic attack is to appeal to one of their five senses. That sense of sight, hearing, smell, touch, or taste. And, recently movement's been added to it in the therapy world. But let me give you an example. Let's say you've got someone at home, and they go into a panic attack they're anxious. Well, that person might go into the kitchen, turn on the cold water and splash it all over their face, this appeals to their sense of touch. And in that moment, that person has sort of snapped out of the thoughts that they're having those anxious, toxic thoughts. And they're snapped back into the present moment and they're able to get out of fight or flight. 

Here's another way someone might appeal to their senses. The next one might be sound, let's say the person is on a train and they're anxious. They're not able to get up and go get some cold water. So instead, they put on their headphones, and they listen to some of their favorite music or relaxing music. And the person focuses on the instruments they're hearing or the voices from the singer they might be listening to. And in that second, in that very moment of time, there are 100% focused on what they're hearing. And again, this can help them to get out of that awfulizing or catastrophic thinking. 

Here's just one more, one more example that I can give, let's say we want to appeal to the person's sense of smell well for this person, we might have them carry around with them a small bottle of lavender oil, those essential oils. And in the moment when they're having a panic attack, they open the bottle, and they smell it. And that smell stimulates all their whole body with this sort of calm feeling. And they're focusing and concentrating on the scent they're intaking. And because of that, they're focused on the present moment and they're no longer in fight or flight, or at least they start to come out of it. These are popular strategies people use to combat a panic attack. 

I probably should've mentioned more about movement like yoga or even guided meditation. And if you're interested in that, you can go back to episode 13, because that seems to help with a lot of people, at least with stress. 

Now therapy is a little bit different with CBT what we're trying to do two is change that initial thought so that there isn't the emotion and there isn't the behavior. Example might be instead of thinking, oh my goodness, the plane is going to go down, I'm going to die. The person stops for a minute because they've trained their mind enough to be able to think, wait, is there any evidence that this plane is going to go down? Isn't it true that most planes make it to their destination with no problem at all? In fact, isn't flying the safest way of traveling. So again, we're trying to change that basic thought process.

Well, that's all I've got for today. Folks. I want to say thank you to everyone who's been tuning in and listening to the podcast. If you're wondering, you can reach me by going to From there You can follow us on social media. You can leave a voicemail, or you can drop me a line. Again, I also wanted to say, thank you so much to everyone. Who's been leaving feedback and reviews. It means so much to me. You know, between my life working as a clinical therapist and as a father, and then doing CrossFit four or five times a week, it gets a little crazy and it can sometimes be difficult to make these episodes.

I try to make the time to do this so that's why it means so much when I get the feedback. Thank you for listening to the Anxiety Therapist Podcast.