Panic! an attack out of the blue:

Panic attacks can seem to come out of nowhere.  You’re in a shopping mall or out driving in the car and suddenly you experience extreme anxiety with physical symptoms such as a racing heart and trembling.  There is nothing going on that would warrant such a reaction but all you can think of is escape and going home.  The defining feature of a panic attack is a discrete period of intense fear or discomfort that is accompanied by a range of physical symptoms and fearful thoughts.  The attack has a sudden onset and builds to a peak rapidly, usually in 10 minutes or less, and is often accompanied by a sense of imminent danger or impending doom and an urge to escape.  Symptoms can include palpitations, sweating, trembling or shaking, shortness of breath or feeling like you are smothering or choking, chest pain or discomfort, nausea or abdominal distress, lightheadedness, fear of dying, losing control or ‘going crazy’.  Some panic attacks occur in the context of a trigger, such as having to give a speech, while others occur very unpredictably.  People who have had panic attacks can also develop a fear of having a panic attack.

What’s really happening is more emotional than physical-though the symptoms are very physical.   When it happens for the first time-many people go to an emergency room, fearing they are having a heart attack.  It is a necessary first step to rule out a serious medical problem prior to psychological treatment.  Also, a few medical problems seem to be associated with panic attacks such as mitral valve prolapse or other autonomic dysfunctions.  With repeated panic attacks, it becomes more evident that the problem is psychological.  This is a condition best treated by a combination of medication and psychotherapy.

What you can do:
• Have a thorough medical evaluation to rule out a physical cause of these reactions.
• Remind yourself that the physical sensations are simply a “fight or flight” reaction and are not dangerous.
• Learn and think positive, coping thoughts rather than fear-promoting thoughts:  “This is just a panic attack and will soon be over,” “I’ve handled this before and can handle it again,”  Avoid thoughts like:  “I’m having a heart attack,” “I can’t stand this,” “I’m going crazy.”). 
• Learn controlled breathing techniques: for example-count slowly, steadily, from 1 to 5 on each breath, and breathe from  your abdomen (so your stomach moves, not your chest) to avoid inhaling too much oxygen too quickly.
• Move around and distract yourself: go for a walk, get a drink of water, watch a funny video or TV program.
• Talk to a supportive person or imagine that person’s presence.
• Learn to be assertive (not aggressive) and set boundaries.
• Therapy can help.