Understanding Panic Attacks: Causes, Symptoms & Treatment in RI
Understanding Panic Attacks: What They Are, Why They Happen, and How to Get Help in Rhode Island
Have you ever felt your heart suddenly racing for no reason, convinced something terrible was about to happen? Maybe you were sitting in traffic on I-95, standing in line at the grocery store, or lying in bed at night when your body went into full alarm mode. A panic attack is a sudden episode of intense fear that causes a rapid heartbeat and shortness of breath, often accompanied by difficulty breathing and chest pain—and if you’ve experienced one, you know how terrifying it feels. Panic attacks can come on suddenly and make you feel as if you are in immediate danger, even when there is no real threat.
For people in Providence, Cranston, Edgewood, and throughout Rhode Island, panic attacks are more common than you might think. Understanding what’s actually happening in your body can be the first step toward managing them.
What Does a Panic Attack Feel Like?
Panic attacks involve abrupt waves of intense fear that often come unexpectedly. You might be calmly going through your day when suddenly your body responds as if you’re in serious danger, even though there’s no actual threat around.
The experience typically includes physical sensations:
Your heart feels like it’s going to burst - Racing or pounding that makes you think something’s wrong
Difficulty breathing or a choking sensation - Shortness of breath or a choking sensation
Chest pain or tightness - Often feels similar to a heart attack
Your body rebels - Sweating, trembling, dizziness, or nausea
Strange sensations - Numbness or tingling in your hands, feet, or face
Beyond the physical symptoms, panic attacks create psychological distress:
Overwhelming fear of dying
Terror that you’re losing control or “going crazy”
A sense of impending doom that feels completely real
Feeling detached from reality or watching yourself from outside
Confusion about what’s happening
Here’s what most people don’t realize: these symptoms are not dangerous and do not mean you are having a heart attack. Your body is having a false alarm—your nervous system is responding to a threat that doesn’t exist. While these symptoms occur suddenly and can feel severe, panic attacks do not cause physical harm.
Panic attacks typically happen unexpectedly and suddenly, reaching their worst intensity within minutes—usually peaking within 10 minutes. Panic attacks can last from a few minutes to an hour, though the most intense symptoms often subside within 20-30 minutes. In fact, most panic attacks resolve on their own within this time frame. Some people experience panic attacks several times a day, while others have them a few times a year. They can happen at any time, even waking you from sleep.
Early in our work with panic disorder, we thought the main challenge was helping people stop panic attacks from happening. Now we understand something more helpful: the goal isn’t to prevent every panic attack—it’s to change your relationship with them. When clients in Providence, Cumberland, and Cranston come to us terrified of their symptoms, we help them see that the fear of panic attacks is often worse than the attacks themselves. Once you stop being afraid of the fear, panic loses its power over your life.
What Causes Panic Attacks?
This is the question most people ask after their first panic attack: "Why did this happen to me?" Panic attacks can occur as a result of multiple factors working together—there's rarely one single cause.
Your Brain's Alarm System Gone Haywire
Think of your brain as having a sophisticated alarm system designed to keep you safe. When you face real danger, this system floods your body with adrenaline. Your heart rate increases to pump blood to your muscles. You breathe faster to get more oxygen. This is your fear response, and it's meant to save your life.
In people who experience panic attacks, this alarm system gets triggered without any actual threat. Research suggests this happens because of how certain brain circuits process fear and anxiety. Some people have a more sensitive alarm system—their brain interprets normal bodily sensations as dangerous when they're not.
Genetics and Biology
Having a family history of anxiety disorders increases your likelihood of developing panic attacks. If your parent or sibling has panic disorder, you're more likely to experience it yourself. Women are two times more likely to have panic disorder than men, and panic attacks often begin during late puberty or early adulthood.
Brain chemistry plays a role too. Individuals with a naturally anxious disposition are more likely to experience panic attacks. Your nervous system's sensitivity level can make you more vulnerable.
Life Circumstances and Stress
Stressful life events frequently precede panic attacks:
Major losses or changes - Death of a loved one, divorce, job loss, or moving
Ongoing stress - Financial worries, relationship problems, work pressure
Transitions - For adolescents, changes in schools or classes can trigger panic attacks
Past trauma - Previous frightening experiences can prime your nervous system
Chronic stress and exhaustion can lower your threshold for panic attacks. When you're already running on empty, it takes less to trigger your body's alarm system.
From a neuroscience perspective, we see panic attacks as your amygdala—the fear center of your brain—overreacting to perceived threats. Think of it like a smoke detector that goes off when you burn toast. The alarm isn't broken; it's just too sensitive. In our Rhode Island practice, we help people understand that panic attacks aren't a sign of weakness or mental instability. They're a sign of a sensitive nervous system that needs recalibration. That understanding alone reduces shame and opens the door to real healing.
Substances That Can Trigger Panic Attacks
Caffeine consumption is known to exacerbate anxiety and can trigger panic attacks. That morning coffee or afternoon energy drink might be contributing to your symptoms.
Other substances that can induce panic attacks:
Cannabis and nicotine - Psychoactive substances that affect your nervous system
Alcohol - Both intoxication and withdrawal can trigger attacks; panic disorder is commonly associated with alcohol misuse
Certain medications - Stimulants or medications that affect your heart rate
When Physical Health Plays a Role
Sometimes panic-like symptoms stem from actual medical conditions. Conditions affecting your heart, thyroid, or respiratory system can produce symptoms similar to panic attacks. A physical exam can help rule out conditions like low blood pressure or other medical issues. This is why it's important to see a doctor if you're experiencing these symptoms—not because panic attacks are dangerous, but to ensure there isn't an underlying health issue.
The Cycle That Keeps Panic Attacks Coming
Once you've had one panic attack, fear of having another can actually trigger more panic attacks. This is called anticipatory anxiety. You start avoiding places or situations where attacks happened. You become hyperaware of your body, interpreting normal sensations—a faster heartbeat from climbing stairs, dizziness from standing up quickly—as signs of an impending panic attack.
Hyperventilation can contribute to feelings of panic and trigger panic attacks, creating a self-reinforcing cycle where the physical symptoms themselves become triggers.
Types of Panic Disorders
Panic disorder is a specific type of anxiety disorder recognized by the Diagnostic and Statistical Manual (DSM-5)—the standard guide used by mental health professionals to diagnose mental health conditions. While many people experience one panic attack in their lifetime, panic disorder gets diagnosed when someone has recurrent, unexpected panic attacks and lives with ongoing worry about having more attacks—or changes their behavior to avoid them. Think of it as your brain's alarm system getting stuck on high alert, even when there's no real danger in sight.
There are a few ways panic disorders can present themselves in the wild:
Panic Disorder Without Agoraphobia: This is the classic form—where a person experiences repeated, unexpected panic attacks and persistent anxiety about future attacks, but doesn't necessarily avoid places or situations out of fear. It's like having a psychological tug-of-war with your own nervous system.
Panic Disorder With Agoraphobia: In this type, panic attacks come accompanied by agoraphobia—an intense fear of being in situations where escape might be difficult or help unavailable if a panic attack strikes. People may avoid public places, crowds, or even leaving home. Picture feeling like you're walking a tightrope every time you step outside your safe zone.
Panic Attacks as a Feature of Other Anxiety Disorders: Sometimes, panic attacks show up in the context of other anxiety disorders—such as social anxiety disorder or generalized anxiety disorder. In these cases, the panic attacks are typically triggered by specific situations related to the underlying anxiety disorder, rather than being truly unexpected. It's less about random alarm bells and more about predictable stress responses.
The DSM-5 emphasizes that for a diagnosis of panic disorder, the panic attacks must be unexpected—not directly caused by a specific external threat or situation. This unpredictability is what often makes panic disorder so distressing and disruptive to daily life. When your brain's threat-detection system starts firing off false alarms, it can feel like you're living with a smoke detector that goes off every time you make toast.
Understanding the type of panic disorder you—or a loved one—may be experiencing is crucial for developing an effective treatment plan. A mental health professional can help clarify the diagnosis and recommend the best approach to managing symptoms, whether through therapy, medication, or a combination of both. If you're struggling with frequent panic attacks or ongoing anxiety, reaching out for support is the first step toward relief—and toward getting your internal alarm system back to functioning properly.
How are Anxiety Attacks and a Panic Attacks Different?
People often use these terms interchangeably, but understanding the distinction can help you recognize what you’re experiencing and seek appropriate help.
Panic attacks come on suddenly and intensely. They’re like a wave that crashes over you without warning. You go from feeling fine to feeling like you’re dying in a matter of seconds. The symptoms are predominantly physical—your body is screaming danger even when your mind knows logically that you’re safe.
An anxiety attack, by contrast, is often triggered by specific stressors and develops gradually, unlike the sudden onset of a panic attack. Anxiety attacks are more like a slow rising tide of worry and tension. The experience is more cognitive—racing thoughts, excessive worrying, feeling overwhelmed. While anxiety attacks can include physical symptoms, they’re usually less intense but may last longer than panic attacks.
Here are the key differences:
Panic attacks:
Sudden, unexpected onset
Peak within 10 minutes
Intense physical symptoms dominate
Often feel like a medical emergency
Can happen during sleep
Anxiety attacks:
Gradual buildup
Connected to a specific worry or stressor
More mental than physical
Less likely to feel like an emergency
Don’t typically wake you from sleep
According to the Diagnostic and Statistical Manual of Mental Disorders, unexpected panic attacks are a defining feature of panic disorder. These attacks seem to come “out of the blue” without an obvious trigger.
Not everyone who experiences a panic attack will develop panic disorder. Factors such as the frequency of attacks, fear of recurrence, and whether the attacks lead to changes in behavior or avoidance can influence whether someone develops panic disorder. Up to 11% of people in the United States experience a panic attack each year. In Europe, approximately 3% of the population has a panic attack in a given year. However, only approximately 2% to 3% of people in the U.S. have panic disorder—meaning they experience recurrent panic attacks and develop ongoing fear about having more attacks. Frequent attacks can significantly diminish quality of life and may indicate an underlying anxiety disorder or conditions such as agoraphobia.
Understanding When Panic Attacks Develop into Panic Disorder
Having a panic attack doesn’t mean you have panic disorder. Panic disorder is an anxiety disorder that involves multiple unexpected panic attacks along with persistent worry about having more attacks. Panic disorder is diagnosed by a mental health professional who looks for recurring, unexpected panic attacks and significant behavioral changes or persistent worry that lasts at least one month.
To be diagnosed with panic disorder, you must experience recurrent, unexpected panic attacks and spend at least one month worrying about having more attacks. But the diagnosis isn’t just about frequency—it’s about how panic attacks change your life.
Panic disorder is commonly associated with other mental health conditions. People with panic disorder often develop:
Persistent fear between attacks - Constant anxiety about when the next panic attack will strike; can occur as frequently as several times a day or as rarely as a few times a year
Safety behaviors - Carrying medication, always knowing where exits are, avoiding being alone
Avoidance patterns - Staying away from places where panic attacks occurred
Agoraphobia - Panic disorder frequently presents with agoraphobia, also called agoraphobia, an intense fear of situations where escape may be difficult
The progression often looks like this: You have a panic attack at a crowded mall. You start avoiding that mall. Then you avoid all malls. Then you avoid any crowded place. Eventually, your world shrinks as you try to prevent panic attacks by controlling your environment. Not everyone who experiences panic attacks will develop panic disorder; some people may never develop panic disorder, while others do, depending on factors like the frequency of attacks and the fear of recurrence.
The most common mistake we see is people trying to eliminate all possibility of panic attacks by avoiding anything that might trigger them. What starts as “I’ll just skip this one event” becomes a lifestyle of avoidance. The tragedy is that avoidance doesn’t actually prevent panic attacks—it just makes your world smaller. Real recovery means gradually expanding what you’re willing to do, even with some discomfort.
Panic disorder can significantly change a person’s life. Work becomes difficult. Social relationships suffer. Simple errands feel impossible. Some people with panic disorder develop other mental health conditions or turn to alcohol and substance misuse to cope. The presence of multiple disorders can complicate treatment.
Panic disorder often begins in late teens or early adulthood, and panic attacks often begin during late puberty or early adulthood. Panic disorder is one of several psychiatric disorders that can develop during this period of life transition.
How to Calm Down a Panic Attack
When you’re in the middle of a panic attack, knowing what to do can help you get through it. Breathing exercises can reduce symptoms in patients with anxiety disorders. Your breathing pattern is one of the few things you can directly control during a panic attack, and changing it can signal your nervous system to calm down. Grounding and breathing techniques can help manage the symptoms of a panic attack as they occur, such as rapid heartbeat, shortness of breath, or dizziness. While these strategies can help you cope with the symptoms of a panic attack in the moment, they do not treat panic attacks in the long term.
Try this simple breathing technique called box breathing:
Breathe in through your nose for 4 counts
Hold for 4 counts
Breathe out through your mouth for 4 counts
Pause for 4 counts
Repeat
The goal isn’t to stop the panic attack immediately—that’s usually impossible. The goal is to prevent it from getting worse by breaking the hyperventilation cycle.
Grounding techniques can be useful for managing panic attacks. When you feel disconnected from reality, grounding brings you back to the present moment. Try the 5-4-3-2-1 method:
Name 5 things you can see
Name 4 things you can touch
Name 3 things you can hear
Name 2 things you can smell
Name 1 thing you can taste
The most important thing to remember: panic attacks are not life-threatening. Even though it feels like you’re dying, you’re not. Your body is having a false alarm. The symptoms will pass.
Tell yourself: “This is a panic attack. It feels terrible, but it’s not dangerous. It will end soon.”
What Makes Panic Attacks Worse
Certain responses to panic attacks actually intensify them:
Fighting against the sensations or trying to force them to stop
Fleeing the situation immediately (this reinforces the idea that the place was dangerous)
Consuming caffeine or other substances that can exacerbate anxiety and panic symptoms
Catastrophizing ("This will never end," "Something's seriously wrong with me")
How Are Panic Attacks and Panic Disorder Treated?
The encouraging news: most people get better with treatment. There are several effective ways to treat panic attacks, including therapy, medication, and self-help strategies. People with panic disorder can manage their symptoms with the right treatment and support. Treating panic attacks involves addressing both the physical symptoms and the psychological triggers to achieve lasting relief.
Therapy Approaches
Cognitive behavioral therapy (CBT) is commonly used to treat panic disorder and represents the most effective talk therapy for panic attacks. CBT teaches individuals different ways of thinking and reacting to feelings of anxiety during panic attacks and panic disorder.
In CBT, you work on three levels:
Understanding your panic - Learning what's actually happening in your body and why
Challenging catastrophic thoughts - Questioning beliefs like "I'm having a heart attack" or "I'm going crazy"
Exposure exercises - Gradually facing situations and sensations you've been avoiding
Exposure therapy is a common method within CBT that focuses on confronting fears. Exposure therapy involves confrontation with feared situations to help manage anxiety. This might mean deliberately triggering mild panic symptoms in a safe environment—like spinning in a chair to create dizziness—and learning that the sensations aren't dangerous.
Psychotherapy, particularly mindfulness-based therapies, can be effective for treating panic disorder. Relaxation techniques can help reduce the intensity of panic symptoms. Mindfulness teaches you to observe your sensations without judging them as dangerous, which reduces the fear that fuels panic attacks.
Medication Options
Medication options for panic disorder include antidepressants and anti-anxiety medications. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications recognized by the American Psychiatric Association. These medications help regulate brain chemistry and reduce the frequency and intensity of panic attacks. They're also used to treat depression and other anxiety disorders.
Benzodiazepines are effective at rapidly decreasing panic attack symptoms but may lead to tolerance and dependence, which is why they're not recommended for long-term use. They work quickly for acute symptoms but aren't a solution for managing panic disorder over time.
Effective management of panic disorder may include both medication and psychological therapies. A mental health professional can develop a treatment plan tailored to your specific needs. Psychotherapy, medication, or both are typically used to treat panic disorder. For some individuals with treatment-resistant symptoms, innovative treatment options for anxiety include ketamine infusion therapy, which may offer quicker relief.
Lifestyle Factors That Matter
Lifestyle changes can help alleviate symptoms of panic disorder, although they cannot replace treatment. Maintaining a healthy lifestyle, which includes getting enough sleep and exercise, can combat anxiety.
What helps:
Regular aerobic exercise - Exercise, especially aerobic, has been found to decrease symptoms of anxiety and panic. Physical activity is inversely related to anxiety symptoms
Consistent sleep schedule - Getting enough sleep is essential for managing stress and reduce symptoms
Stable nutrition - A healthy diet that maintains stable blood sugar supports mental health
Stress management practices - Finding healthy ways to manage stress reduces overall anxiety
Limiting substances - Avoidance of caffeine and other substances can help reduce anxiety and panic symptoms
Learning about panic attacks through psychoeducation can help you feel less afraid and more in control. When you understand what's happening and why, the symptoms become less frightening.
Finding Help in Rhode Island
If you've experienced frequent panic attacks or find yourself constantly worrying about having another one, reaching out for professional help is important. Early intervention can prevent panic attacks from developing into panic disorder.
Support groups can help individuals connect with others facing similar challenges related to panic disorder. Connecting with others who understand can reduce feelings of shame and provide practical coping strategies. Support from friends, family, or support groups can help you feel less isolated when dealing with panic attacks and panic disorder.
Whether you're in Providence, Cranston, Cumberland, Edgewood, or anywhere in Rhode Island, professional help is available. Several resources throughout the state specialize in treating anxiety and panic attacks.
If you're looking for support with panic attacks in Rhode Island, the therapists at Providence Therapy Group are here to help. Schedule an appointment to get started.
For urgent emotional support, you can call or text 988 for crisis support. The 988 Suicide & Crisis Lifeline provides immediate support and connects you to local resources.
Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding a medical or mental health condition. If you are in crisis or experiencing thoughts of self-harm, please call 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room.